Trending Topics

Is it time to add a psychological section to our NIOSH reports?

Considering how to incorporate psychology into investigations to help prevent firefighter traumatic injury and death

Firefighter work at night.

We need psychology to help us understand our culture that contributes to firefighter traumatic fireground injury and death.

Kamonchai Mattakulphon/Getty Images/iStockphoto

Firefighter fatalities have been studied at a national level for over two decades. Significant advances in firefighter PPE, training and performance standards have helped reduce firefighter injury and death. Despite these efforts, the morbidity and mortality of firefighters remains at unacceptable levels.

More and more, the underlying culture of the fire service is emerging as the root cause of these tragedies. This is not a technical problem but rather an adaptive issue. As such, I contend that we must incorporate psychology in the research, assessment and intervention of firefighter traumatic fireground injuries and fatalities to better understand the impact of individual, group, team and organizational-level dysfunctional culture and adaptive challenges.

In order to understand this future opportunity, we must consider our current process.

Tracking firefighter injuries and fatalities

In 1998, Congress recognized the need to address the national problem of work-related firefighter deaths, and funded NIOSH to implement a firefighter safety initiative. The resulting Fire Fighter Fatality Investigation and Prevention Program makes recommendations on ways to prevent firefighter deaths and injuries. It does not enforce compliance with state or federal job safety and health standards or determine fault or place blame on fire departments or individual firefighters.

Since that time, safety standards have improved significantly, but the number of firefighter injuries and fatalities has not declined in a proportional manner. As detailed by the National Fallen Firefighters Foundation (NFFF): “Nationwide, the firefighter’s personal protective ensemble, apparatus and equipment technology, available training and safety resources, and safety standards are at the highest, safest levels ever experienced in fire service history. However, United States Fire Administration statistics reveal a ten-year plateau of more than 100 firefighter line-of-duty deaths and approximately 10,000 serious line-of-duty injuries each year. To worsen matters, firefighters are being injured and killed on incidents at rates close to those of 20 years ago. Case analyses show that most of these line-of-duty deaths and injuries are preventable.”

Something had to change.

The role of culture in firefighter injury and death

In 2004, the NFFF held a summit at which the 16 Firefighter Life Safety Initiatives were created. Life Safety Initiative 1 – Culture Change – serves as a foundation for fire service progress.

Define and advocate the need for cultural change within the fire service related to safety, incorporating leadership, management, supervision, accountability, and personal responsibility.

Cultural change is not easy. In 2008, visionary fire chief Alan Brunacini illustrated one of the central cultural challenges facing the fire service – a controversial topic few were willing to acknowledge out loud:

When the fire kills us, our department typically conducts a huge ritualistic funeral ceremony, engraves our name on the honor wall and makes us an eternal hero. Every LODD gets the same terminal ritual regardless if the firefighter was taking an appropriate risk to protect a savable life or was recreationally freelancing in a clearly defensive place. A Fire Chief would commit instant occupational suicide by saying that the reason everyone is here today in their dress blues is because the dearly departed failed to follow the department safety plan. Genuine bravery and terminal stupidity both get the same eulogy. Our young firefighters are motivated and inspired to attack even harder by the ceremonialization of our battleground deaths.

While I agree with Bruno’s general sentiment, stupidity is not the word I would use here. Human behavior is complex and driven, in part, by psychology. Our behavior will ultimately be judged by its perceived “rightness” or “wrongness” in the context of our culture – another highly complex aspect of the industry to full understand, and change.

In 2011, doctors Kumar Kunadharaju, Todd Smith and David DeJoy, all from the College of Public Health at the University of Georgia, published the paper “Line of Duty Deaths among U.S. Firefighters: An Analysis of Fatality Investigations” that also illustrated the cultural challenge the fire service faces related to firefighter occupational injury and fatalities. They studied 189 NIOSH reports that included 213 LODDs from 2004 to 2009. The NIOSH reports made a total of 1,167 recommendations to reduce firefighter injury and death. The researchers categorized the recommendations into five factors: Incident Command, Personnel, Equipment, Operations/Tactics and External. The researchers applied root cause analysis techniques to the data set to determine the basic or higher-order causes that they classified as: under resourced, inadequate preparation for/ anticipation of adverse events, incomplete adoption of incident command procedures, and sub-optimal personnel readiness. An important point they make is that these higher-order causes “... do not provide any definitive insights as to their origin,” but “... may actually be tapping the basic culture of firefighting.” The researchers go on to make the following observation about the core culture of firefighting:

Operating with too few resources, compromising certain roles and functions, skipping, or short-changing operational steps and safeguards and relying on extreme individual efforts and heroics may reflect the cultural paradigm of firefighting. This should not be construed to be a culture of negligence or incompetence, but rather a culture of longstanding acceptance and tradition. Within many fire service organizations, these operational tenets may be accepted as “the way we do things.” Moreover, this tolerance of risk may be reinforced both externally and internally through the positive public image of firefighters and firefighting and internally through the fire service’s own traditions and member socialization.

This study reinforces the notion that the behavior that results in firefighter injury and death is not negligence or incompetence, so again, “stupidity” is not an accurate assessment. Our fire service culture is the root cause. The external culture that the community is involved in relates to our heroic “ceremonialization of our battleground deaths.” Again, culture and psychology drive behavior.

NIOSH weighs in

On June 27, 2022, the NIOSH Fire Fighter Fatality Investigation and Prevention Program (FFFIPP) held a Fire Service Community Meeting to take recommendations about how the program could be improved. The invitation for comment was open to any organization or individual interested in the program or firefighter occupational injury and death. There were 40 suggestions and responses – and one was about culture and human factors:

Suggestion: Organizational culture and human factors need to be addressed in the investigation.

Comment [or issue]: Several comments reflected concern that the FFFIPP reports failed to address the cultural and leadership/management factors that might have played a role in events leading up to a fatality.

NIOSH Response: The FFFIPP understands the added value of assessing fire department cultures and leadership/management factors during an investigation. Acknowledging deficiencies, safety culture and leadership/management is difficult to describe in reports without finding fault or placing blame on fire departments or individual firefighters. One measure of the safety culture of a fire department is the development, use, and enforcement of standard operating policies and procedures. Currently, investigators routinely collect this information as part of their investigation. The FFFIPP will remain alert to possibilities to add insight in this area when we are able to do so without finding fault or placing blame on fire departments or individual firefighters. Not placing blame or finding fault is a key concept of the program. The most important aspect of an investigation is to identify recommendations to prevent similar incidents from happening.

The concern of finding fault and placing blame is a significant hurdle to uncovering the culture that contributes to the tragic injury and loss of firefighters. This is understandable in today’s litigious environment. Some may see not placing fault and blame as a way to prevent the “terminal stupidity” classification that Chief Brunacini mentioned. But difficult and uncomfortable discussions must be held, or the losses will continue.

Psychology can help

The fire service cannot continue to rely solely on training, equipment, PPE, codes and standards to get a different outcome. After 20 years, we need adaptive change because firefighter occupational injuries and deaths are not a technical problem. We need psychology to help us understand our culture that contributes to firefighter traumatic fireground injury and death.

Psychology can help individuals, groups, teams and organizations, including those in the fire service, to overcome the fear of finding fault or assigning blame when it comes to firefighter occupational injury and death. It can help understand the cultural norms both internal to the fire service and external in the large social, political, economic and technological environment that contributes to our unacceptable firefighter morbidity and mortality.

There are at least two psychology specialties that can help in this regard: industrial/organizational (I/O) psychology and social psychology. Both disciplines conduct research and counseling related workplace culture and safety.

I/O psychology addresses organizational and individual issues related to job performance, wellbeing, motivation, job satisfaction, and the health and safety of employees. Social psychology is the study of how thoughts, feelings and behaviors are influenced by the actual, imagined or implied presence of others. Social psychologists typically explain human behavior as a result of the relationship between mental states and social situations, studying the social conditions under which thoughts, feelings and behaviors occur, and how these variables influence social interactions.

Integrating the work of I/O and social psychology could help us better understand our individual, interpersonal, group and organizational behavior and the fire departments’ larger social interaction with the community. Using these lenses, we can get a clearer picture of our fireground injury and death. This will help us replace the notion of negligence, incompetence and stupidity with accountability as a discipline. A psychology supplement to our NIOSH program may help us all avoid the blame and fault-finding trap and instead work on our much-needed culture change.

The first step to psychological health and safety is to ask for help. The result can be physical health and safety for firefighters. We should have the courage to ask for help, if not for ourselves then for all the families to whom we gave a flag and put their loved one’s name on a wall. We can do better.

Dr. Burton A. Clark, EFO, has been in the fire service for 49 years. He serves on the Board of Advisors for the Fire Service Psychology Association and the Board of Governors for the John M. Moschella Fire Service Research Grant Trust. Dr. Clark is a technical expert reviewer for the NIOSH Fire Fighter Fatality Investigation and Prevention program and a dissertation advisor at various universities. He is the author of “I Can’t Save You And I Don’t Want To Die Trying: American Fire Culture.”