The National Institute for Occupational Safety and Health (NIOSH) Fire Fighter Fatality Investigation and Prevention Program (FFFIPP) recently released updated investigation prioritization guidelines to better define what types of serious injury incidents FFFIPP may investigate. The FFFIPP reviews all trauma, medical and PPE-related requests using these guidelines to determine selection of investigations. The updates can help inform fire departments and other requestors’ decisions to request an investigation.
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As background, in 1998, NIOSH created the FFFIPP with the goal of learning from firefighter line-of-duty deaths (LODDs) and serious injuries to prevent similar incidents. The program reports on characteristics and contributing factors to these incidents and provides educational materials that include prevention actions for the nation’s fire service.[2] Investigation participation is voluntary and results in prevention-focused, non-punitive, research-based reports. Fire departments and fire academies use these reports to inform training, standards development, and updated standard operating procedures or guidelines.[3]
Updated selection criteria
In 2022, FFFIPP updated their prioritization guidelines based on feedback from the fire service community. Fire departments asked FFFIPP to develop a public-facing investigation matrix that showed how investigations were selected based on priority. This was requested to inform fire department decisions on submitting investigation requests.[4] These guidelines articulated selection criteria based on traumatic and medical incident details. Only LODD incidents were covered by these guidelines. With an increase in requests received in 2024, the program updated the guidelines to define what incidents may qualify as serious injuries that the FFFIPP could investigate.
The most recent updated prioritization guidelines were published in March 2026.[5] The new guidelines provide a clearer approach for prioritizing investigation requests. This includes a separate column listing criteria for serious injury incidents, such as if the firefighter was hospitalized, received medical care with time off from work, and/or if multiple firefighters sustained injuries at the same incident. The guidelines also provide a definition for unique and emerging issues. The updates reflect FFFIPP’s ability to address the evolving challenges facing U.S. firefighters and provide corresponding prevention actions.
Investigating serious injuries
The number of firefighter deaths in the U.S. decreased from 157 in 1977 to less than 100 per year since 2009.[6] While firefighter injuries have also declined, over 63,000 injuries were reported in 2023, including an estimated 19,200 vehicle collisions that involved fire department emergency vehicles.[7] Although only some of these qualify as serious injuries, investigating serious injury incidents can provide valuable lessons and help save subsequent lives. Reflecting on these tragedies and the lessons learned from the incident may help fire departments across the nation improve workplace safety and health.[8]
Since 1998, the FFFIPP has completed more than 750 investigations.[2] While the majority of these have been for LODDs, more than 20 have focused on traumatic serious injury incidents. The International Association of Fire Fighters (IAFF) requested FFFIPP’s first serious injury investigation in 1998. The report, “Injury in the line of duty,” involved two career firefighters injured while trying to escape the path of a collapsing porch roof at a vacant dwelling fire.[9] Since this report, the FFFIPP has published additional reports examining traumatic serious injuries related to:
- Oxygen regulator flash fires
- Lithium-ion battery explosions
- Rapid fire progression
- Structural collapse
- Training emergencies
- Explosions
- Aerial ladder collapses
- Air management issues
- Falls from a ladder
Commitment to a safer and healthier fire service
Consistent with current proclamations, FFFIPP is committed to conducting high-quality investigations and sharing findings in a manner that helps fire departments prevent future tragedies. While the investigation processes and procedures have evolved over the years, the program continues to look for ways to improve to help prevent the next tragedy.[3] This includes adapting investigation selection criteria to meet the evolving challenges facing the nation’s firefighters.
More information
FFFIPP receives requests for LODD and serious injury investigations through NIOSH’s website. Firefighters and other interested parties can see what investigations FFFIPP is currently working on by visiting the ongoing reports webpage.
Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention.
Serious injury reports
Below is a list of all published FFFIPP serious injury reports:
- F1998-18 VA: Vacant dwelling fire injures two fire fighters – Virginia
- F1998-23 FL: Oxygen regulator flash severely burns one fire fighter – Florida
- F1998-24 SC: Emergency medical technician receives serious burns from an oxygen regulator flash fire – South Carolina
- F1999-07 NV: Aluminum regulator fire injures one fire fighter – Nevada
- F1999-39 FL: Two fire fighters injured when an automated external defibrillator battery exploded or ruptured during testing – Florida
- F2000-43 DE: A volunteer assistant chief was seriously injured and two volunteer fire fighters were injured while fighting a townhouse fire – Delaware
- F2001-03 AR: Roof collapse injures four career fire fighters at a church fire – Arkansas
- F2003-41 ME: Live-fire exercise in mobile flashover training simulator injures five career fire fighters – Maine
- F2007-11 OH: Two career fire fighters seriously injured during swiftwater rescue training at a low-head dam – Ohio
- F2007-35 DC: Four career fire fighters injured while providing interior exposure protection at a row house fire – District of Columbia
- F2008-03 CO: Nine fire fighters from a combination department injured in an explosion at a restaurant fire – Colorado
- F2009-13 MD: Eight fire fighters from a combination department injured in a natural gas explosion at a strip mall – Maryland
- F2009-21 CA: Career fire fighter seriously injured from collapse of bowstring truss roof – California
- F2010-30 CA: Seven career fire fighters injured at a metal recycling facility fire – California
- F2012-04 PA: Career captain injured in aerial ladder collapse – Pennsylvania
- F2024-03 OR: Career firefighter seriously injured during search operations in a residential structure fire – Oregon
- F2025-01 TX: Senior captain and two firefighters of ladder company burned during primary search in garden apartment fire – Texas
- F2025-08 TX: Nine career firefighters injured at residential structure fire – Texas
- F2025-10 TX: Career firefighter sustains serious burns and another injured in carport collapse at residential structure fire – Texas
- F2026-01 KS: Four career firefighters injured from a floor collapse in an abandoned residential structure fire – Kansas
- F2026-02 PA: Career firefighter injured after falling from ladder while self-extricating from boarding house fire – Pennsylvania
- F2026-05 VA: Career firefighter sustains serious burns at residential structure fire with hoarding conditions – Virginia
REFERENCES
[1] U.S. Senate [1997]. Departments of Labor, Health and Human Services, and Education and related agencies appropriation bill, 1998, 105 congress, 1st Session. Washington, DC: U.S. Senate. U.S. Government Printing Office, Report 105-58.
[2] NIOSH [2026]. About the FFFIPP. Morgantown, WV: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health.
[3] Attwood WR, Wilkinson A, and Tarley JL [2026]. Learning from line-of-duty deaths and serious injuries in 2025. Firefighter Strong, June 30.
[4] NIOSH [2022]. Meeting summary: Fire service suggestions and NIOSH responses. Morgantown, WV: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health.
[5] NIOSH [2026]. How FFFIPP prioritizes investigations: Selection criteria. Morgantown, WV: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health.
[6] Campbell R and Petrillo JT [2025]. Fatal firefighter injuries in the United States. Quincy, MA: National Fire Protection Association.
[7] Campbell R, Hall S, Petrillo JT [2025]. United States firefighter injuries. Quincy MA: National Fire Protection Association.
[8] Attwood WR, Robinson T, Eisenberg J, and Tarley JL [2026]. Assessing outcomes: Learning from line-of-duty deaths and injuries. Fire Engineering, June 1.
[9] NIOSH [1998]. Vacant dwelling fire injures two fire fighters – Virginia. By Baldwin T and Washenitz FC. Morgantown, WV: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, F1998-18.
ABOUT THE AUTHOR
Wesley R. Attwood, DrCJ, is the Senior Investigator with the NIOSH Fire Fighter Fatality Investigation and Prevention Program’s Trauma team.
