The National Institute for Occupational Safety and Health is recommending fire departments have more involved risk evaluation during fire attacks and a better enforced policy on SCBA procedure after a firefighter died while conducting vertical ventilation.
Lt. Todd Krodle, 41, a 17-year veteran of the Dallas Fire-Rescue was attempting to perform vertical ventilation during a fire an apartment complex, the report said.
When crossing over to the peak of the roof of the building to ventilate above the fire, he fell through the roof, into the attic. Although he was wearing his SCBA, he was not wearing his facepiece.
By the time fellow firefighters were able to get him to the hospital, he died.
An examination revealed he died from "asphyxiation from the products of combustion."
Investigators are recommending that the fire officer on the scene conduct an initial size-up on the attack, especially in terms of risk versus gain in high-risk and low-frequency incidents.
Incident commanders should follow risk assessment as outlined in NFPA 1500 and continually evaluate the fire attack to ensure that certain hazards aren't overlooked as the fire burns.
"The reason for the focus on low frequency/high risk incidents is that these incidents do not occur on a frequent basis, but when they occur, the outcome can be harmful or detrimental to fire fighters," the report said.
In Lt. Krodle's case, vertical ventilation in the involved apartment building was high-risk, because the structure was older and less stable.
NIOSH is also recommending that dispatchers be equipped with information pertaining to building code and structural integrity of buildings that crews are responding to.
Having this information on hand will allow firefighters to adequately prepare for any potential hazards and allows for pre-incident planning.
The apartment complex that Lt. Krodle was responding to had been previously damaged in other fires, although it is unclear if further inspections were conducted to reveal that the roof was not up to standard safety measures. Had responding crews been aware, they may have been able to avoid Lt. Krodle's incident.
Along with this, investigators say there should be stricter enforcement of building code and older buildings be brought up to current standards.
It is unclear why Lt. Krodle was not wearing his facepiece before the incident, but had he been on air, investigators say he would have had a much greater chance at survival. After falling through the roof, Lt. Krodle was unable to don his facepiece.
The report cites the International Fire Service Training Association, saying "firefighters should never get on a roof wearing anything less than full protective clothing, SCBA, and a PASS device…" in case of the toxic products of combustion.
NIOSH is also recommending that fire departments consider having a rapid intervention team to respond immediately to emergency rescue incidents and that incident commanders establish a command post.