Summary of Recommendations from the Fire Fighter Fatality Investigation and Prevention Program from 2006—2014

Posted on by Suzanne Marsh, MPA; Sydney Webb, PhD; and Karis Kline, MS

Since 1998, NIOSH has conducted independent investigations of firefighter line-of-duty deaths and recommended ways to prevent deaths and injuries through the Fire Fighter Fatality Investigation and Prevention Program (FFFIPP). A recent article, “Summary of recommendations from the National Institute for Occupational Safety and Health Fire Fighter Fatality Investigation and Prevention Program, 2006–2014” provides information on recent FFFIPP recommendations. The article also examines whether recommendations have changed over time by comparing data from this analysis to that from a prior analysis of FFFIPP investigations and recommendations from 1998-2005.

From 2006–2014, there were 742 firefighter line-of-duty deaths (NFPA, 2017). NIOSH’s FFFIPP initiated 282 firefighter investigations during this period capturing 306 (41%) of the 742 fatalities reported by the National Fire Protection Association (NFPA):

  • Only select traumatic injury and medical line-of-duty deaths are investigated through the FFFIPP.
  • Investigations were conducted in 43 different states and seven states had 10 or more investigations –Texas, New York, Pennsylvania, California, Illinois, North Carolina, and Ohio.
  • Of the fatalities investigated, 138 fatalities had a medical cause of death and in 125 cases, the cause of death was from trauma.
  • The investigations were divided between volunteer fire departments (38%) and career fire departments (44%). Another 41 (16%) occurred in combination departments (which include both career and volunteer) and 5 (2%) were classified as “other” (fire academy, inmate, paid on-call, federal wildland, or full/part-time).

There were 1,067 total recommendations made in the 282 published firefighter investigative reports covering both medical and trauma-related firefighter fatalities for the period 2006–2014.

Most Common Traumatic Injury Fatality Recommendations

The most common traumatic fatality events investigated were motor vehicles (23%), which included vehicle collision/rollover (13%) and struck by a vehicle (10%). The second leading cause of death was caught/trapped (16%), followed by structure collapse (13%), and lost/disoriented (10%).

Since traumatic injury fatalities have multiple causes, recommendations are dispersed among several different areas related to the nature and cause of the injury. For the 1998–2005 analysis, training was grouped together with Standard Operating Procedures (SOPs) as a recommendation element. In 2009, NIOSH separated training to ensure that fatalities resulting from a lack of or inadequate training are captured. The top three leading recommendations from traumatic FFFIPP reports for 2006–2014 were: 1. Training, 2. SOPs/SOGs, and 3. Incident command. For 1998–2005 the leading recommendation was SOPs (which included training), followed by communication and incident command recommendations.

Most Common Medical Fatality Recommendations

For medical fatality investigations, 89% were cardiovascular related.

The leading recommendations from the NIOSH FFFIPP medical investigations between 2006 and 2014 were: 1. Medical screening, 2. Fitness and wellness, and 3. Medical clearance for duty. These were the same leading recommendations made between 1998 and 2005, except for medical clearance for duty, which was added later.


NIOSH only investigated 41% of firefighter fatalities for 2006–2014, which means the types of incidents investigated may not be representative of all firefighter line-of-duty-deaths during this time period, especially since investigations focused more on cardiovascular events, structure fires, and motor vehicle deaths during this time period.

The FFFIPP aims to have fire departments and firefighters apply recommendations identified through its investigations to prevent firefighter deaths. It will take continued vigilance in addressing hazards facing firefighters to decrease fatalities in this workforce.

Our FFFIPP fatality reports are available online and are searchable by state, incident year, and trauma or medical related.

We want to hear from you!

Tell us how our reports and recommendations have helped to support you and your department in the comments below.


Suzanne Marsh, MPA, is a Statistician in the NIOSH Division of Safety Research.

Sydney Webb, PhD, is a Health Communication Specialist in the NIOSH Division of Safety Research.

Karis Kline, MS, Safety Management, is a Safety and Occupational Health Specialist and Fire Fighter Fatality Investigator in the NIOSH Division of Safety Research.

Posted on by Suzanne Marsh, MPA; Sydney Webb, PhD; and Karis Kline, MS

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Page last reviewed: April 13, 2020
Page last updated: April 13, 2020