Improving the Health & Safety of all Emergency Responders


                  From the National Institute for Occupational Safety and Health

Preventing Deaths and Injuries of Fire Fighters during Training Exercises

Summary: Fire fighters are at risk of death or injury during training incidents.  Death or major injury during training is preventable.  The NIOSH Fire Fighter Fatality Investigation and Prevention Program (FFFIPP) recommends training in accordance with established standards to prevent life threatening consequences.

Description of Problem

During the period from 2001 to 2013, the United States Fire Administration reported that approximately 11% (141 out of 1,305) of the line-of-duty deaths were training-related.  The leading cause of training-related deaths was heart attacks (50%) followed by traumatic injury (31%).  The remaining 19% were other types of cardiovascular disease and other diverse circumstances.

Physical fitness activities, apparatus/equipment drills, and live-burn exercises were the three leading types of training-related activities associated with the fatalities [USFA 2013].

The role of the fire department has evolved over the years to encompass more than traditional fire suppression.  Fire fighters respond to hazardous material incidents, combustible-metal fires, large-scale disasters, and terrorist threats. They perform trench, high incline, confined space rescues, and provide emergency medical service calls.  Even fire suppression has become multifaceted with changes in technology and the fireground environment.  The expanded role of the fire fighter has made training a necessity for carrying out the mission of the fire service as safely as possible.

Given the inherent dangers of fire fighting, the importance of improving skill sets and proficiency cannot be overstated.  Training is beneficial in a number of ways including the following: (1) enabling fire fighters to become familiar with the strategies and tactics of fire fighting, (2) improving their responsiveness in performing essential tasks, (3) ensuring proficiency in the use of personal protective equipment and fire fighting equipment, and (4) fostering teamwork.

Inadequate training without the necessary safeguards can have a legal repercussions and effect public image on the fire department and be life threatening to the fire fighter.  National consensus standards for training programs have been established for decades; however, some fire departments are not conducting training in accordance with established standards.   The reasons can include budgetary constraints, time constraints, and/or a lack of understanding the standards and the benefits of complying with them.


During 2001 to 2013, 77 training-related fatalities were investigated by NIOSH through the Fire Fighter Fatality Investigation and Prevention Program.  Of these fatalities, 62 (80%) were cardiac-related and 11 (14%) were trauma-related.  These investigations included 38 deaths due to physical fitness activities, 23 deaths due to apparatus/equipment drills, 10 deaths due to live-burn exercises, and 5 deaths due to other training associated circumstances.

Case Studies

Case 1

On December 8, 2008, a 42-year-old lieutenant in a volunteer fire department died after completing live-fire training drills that were part of a certified Fire Fighter II training course (see Figure 1).

The live-fire training involved two separate drills: (1) extinguishing a simulated natural gas fire and (2) discharging a foam line.  The lieutenant complained of cold symptoms during the training and became short of breath during the last training evolution.  Upon completion of the last drill, as other students cleaned up the hoselines, the lieutenant indicated that he was going to his fire department vehicle to rest.  Approximately 10 minutes after leaving the training area, the lieutenant was found between the training site and his FD vehicle.  Cardiopulmonary resuscitation was initiated by fire fighters followed by advanced life support by the arriving ambulance personnel.  Despite these efforts the lieutenant died.  The autopsy report listed the cause of death as “cardiac arrhythmia following strenuous physical activity (firefighter training) in individual with hypertensive and atherosclerotic cardiovascular disease.”  NIOSH investigators concluded that the physical exertion associated with the training drills performed in full personal protective equipment triggered the lieutenant’s sudden cardiac death.

The fire department did require a pre-employment medical evaluation for new members but had no annual requirement for continuing members.  The fire department had no formal wellness/fitness program or standard operating guidelines. [NIOSH 2009a].

Case 2

On January 25, 2009, two male career fire fighters, age 28 and age 45, died after falling from an elevated aerial platform during a training exercise in Texas. The entire duty shift reported to a college dormitory for hands-on training to familiarize fire fighters with the operation of the new 95-foot midmount aerial platform truck (see Figure 2).

A group of four fire fighters were standing in the aerial platform, which was raised to the roof of an eight-story dormitory building at a local college. The platform became stuck on the concrete parapet wall at the top of the building. During attempts to free the platform, the top edge of the parapet wall gave way and the aerial ladder sprang back from the top of the building, and began whipping violently back and forth. Two of the four fire fighters standing in the platform were ejected.  The fire fighters fell approximately 83 feet to the ground and died from their injuries. None of the four fire fighters were wearing safety harnesses.

The fire department in this incident was in the process of writing a new standard operating procedure (SOP) for the ladder truck.  This SOP would have required the presence of a designated safety officer at the training exercise, which may have positively influenced the use of fall protection while on the platform. [NIOSH 2009b].


 Fire fighting is a dangerous occupation primarily because the environment is typically one that is immediately dangerous to life or health (IDLH).  The fire fighter’s job is to gain control of a hazardous situation, which may require an extended period of time in an IDLH environment.  Fire fighter training activities, however, can be conducted in a semi-controlled environment, while still providing fire fighters with the needed hands-on experience.  Fire departments should be aware of the potential hazards during training so they can plan, coordinate, and monitor activities to ensure the safety of all participants, including instructors and trainees.  Standard operating procedures are a vital component to operating safely and effectively.  Developing, implementing, and enforcing SOPs can significantly reduce the risk of injuries and deaths to fire fighters during training exercises.  All persons involved in training exercises must maintain strict personal discipline and follow established safety, health, and operating guidelines just as in an actual event.

To minimize risk when conducting training exercises, NIOSH recommends that fire departments and training participants take the following precautions:

Prior to training

Fire Departments should:

  • Establish easy-to-understand, written standard operating procedures (SOPs) for all training activities and ensure they are implemented and enforced.
  • Conduct a hazard analysis on each training exercise.
  • Ensure that a sufficient number of qualified instructors are available to conduct the specific training and maintain optimal student-to-instructor ratios, as per NFPA 1403, Standard on Live Fire Training Evolutions and NFPA 1670, Standard on Operations and Training for Technical Search and Rescue Incidents.
  • Establish a mandatory wellness/fitness program.
  • Medically evaluate fire fighter trainees to ensure compliance with the requirements of NFPA 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments.
  • Ensure training participants have all course prerequisites.
  • Ensure that participants are screened to determine physical capacity and fitness to participate in the training.
  • Medically clear fire fighters for respirator use and full-duty fire suppression by a physician knowledgeable about the physical demands of fire fighting.
  • Designate a qualified individual to act as safety officer for all training activities.
  • Ensure that all new training curricula undergo comprehensive safety review by management personnel prior to implementation.
  • Ensure that the training environment and facilities are safe.
  • Ensure that adequate time is allotted to safely carry out the training exercise.
  • Ensure that all equipment, including personal protective equipment (PPE), is approved and in good working order.
  • Ensure that a 360 degree size-up is conducted for all training activity as would be done in an actual event.

During training

  • Establish and follow a pre-training checklist.
  • Provide pre-training safety briefings, including a facility walk-through, for all participants.
  • Ensure that sufficient numbers of fire suppression apparatus and equipment are readily available for live-burn training evolutions.
  • Ensure that the proper types and adequate amounts of extinguishing agents are available for live-burn training evolutions.
  • Ensure adequate space is provided for proper placement of all necessary apparatus.
  • Ensure that all established standards and procedures are followed.
  • Monitor participants’ physical stress and watch for signs of overexertion.
  • Ensure training participants wear the appropriate personal protective equipment at all times.
  • Ensure that appropriate personnel and equipment (e.g., rapid intervention team) are available for assistance, rescue, emergency treatment, and transport.
  • Ensure that a staffed and fully equipped ambulance is on scene and ready to respond in case of an emergency.
  • Provide adequate supervision and monitoring of activities.
  • Maintain strict on-scene training discipline, adhering to program and safety protocols.
  • Follow the training checklist.

Training participants should:

Prior to training

  • Recognize the signs and symptoms of personal medical emergencies and know the appropriate course of action.
  • Participate in a mandatory wellness/fitness program.
  • Know the potential hazards of training exercises such as toxins, explosive materials, and indicators of structural collapse, flashover, and backdraft.
  • Be aware of emergency exit routes and alternative emergency escape plans.
  • Understand your role in the exercise.
  • Complete all course prerequisites for the specific training.

During training

  • Conduct the training exercise according to established operating procedures.
  • Maintain personal discipline and accountability for actions during training exercises.



 Principal contributors to this Workplace Solution document were Matt Bowyer, Virginia Miles, Tommy Baldwin, and Thomas Hales, NIOSH FFFIPP; Linda Frederick, NIOSH Office of the Director; Stephen Berardinelli, Bureau of Prisons; and John S. Jackson, Department of the Navy. Rita Fahy, National Fire Protection Association, provided the NFPA data.


[USFA 2013]. U.S. Fire Administration, Firefighter Fatalities in the United States in 2013, Date last accessed: August 25, 2015

NIOSH [2009a].  Lieutenant suffers a fatal cardiac event after completing live-fire training—Wisconsin.  Morgantown, WV: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Fatality Assessment and Control Evaluation (FACE) Report F2009-16.

NIOSH [2009b].  Two career fire fighters die after falling from elevated aerial platform—Texas.  Morgantown, WV: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Fatality Assessment and Control Evaluation (FACE) Report F2009-06.

For More Information

The National Fire Protection Association (NFPA) develops voluntary consensus standards for the fire service.  A number of these standards describe the performance requirements for fire fighter trainees and fire service instructors.  Available training and brief descriptions of NFPA standards for  training and fitness can be viewed at:

The US Fire Administration (USFA) maintains a website with related training and education courses offered by the National Fire Academy:

The National Volunteer Fire Council (NVFC) maintains a website on training offered through the NVFC Academy: