Table of Contents

2. Table of Contents

3. Overview The National Fire Fighter Near-Miss Reporting System is a voluntary, confidential, non-punitive and secure reporting system with the goal of improving firefighter safety. By collecting and analyzing information on near-miss events, improvements canbe made in command, education, operations and training.

4. Definition of a Near Miss A near miss is an unintentional, unsafe occurrence that could have resulted in an injury, fatality or property damage. Only a fortunate break in the chain of events prevented an injury, fatality or property damage.

5. Program Goals • Provide an opportunity for firefighters to share experiences which can help prevent injuries and protect the lives of other firefighters. • Collect information which can assist in formulating strategies to reducethe number of firefighter injuriesand fatalities. • Foster a safety-focused culture that recognizes errors as aninherent part of human behavior.

6. Firefighter Fatality and Injury Statistics • There have been an average of 100 fatalities and 100,000 injuries per year since 1977. • The fatality and injury statistics are, essentially, increasing over the last 15 years when compared to a decreasing number of structure fires. • Improvements in PPE, equipment and training have caused a “Catch-22” for firefighters. Better protection, aggressive tactics, lighter weight construction and improved handling capabilities of heavy apparatus are putting firefighters at greater risk. • Non-fatal firefighter injuries and prevention efforts cost anywhere from $2.8 billion to $7.8 billion per year.(NIST Report on Consequences of Fire Fighter Injuries - 2005)

7. Crew Resource Management • Crew Resource Management (CRM) is a tool created to optimize human performance by reducing the effect of human error through the use of all resources. • CRM promotes improved human performance and interaction by concentrating on 5 critical areas: • Communication • Decision-Making • Task Allocation • Teamwork • Situational Awareness

8. Crew Resource Management (continued) • Aviation industry presented CRM and near-miss reporting at the Wildland Fire Conference. (1999) • Similarities exist between the aviation industry andthe fire service: • Work unit structure(3-5 people per team) • Discipline • Hierarchy • Team Assembly

9. Crew Resource Management (continued) • A task force was formed to explore CRM and near-miss reporting as it applies to the fire service. (2000) • Crew Resource Managementwas published and is available to download or to order on www.iafc.org. (2001) • Task force recommended investigating near-miss reporting for the fires service based on successful aviation near-miss reporting. (2001)

10. The Near-Miss Connection 1 Serious Accident 15 Major Accidents 300 Near Misses 15,000 Observed Worker Errors

11. Near-Miss Reporting System This project is funded by grants from the Department of Homeland Security’s Assistance to Firefighters Grant Program and Fireman’s Fund Insurance Company. The project is supported by FirefighterCloseCalls.com in mutual dedication for firefighter safety and survival.

12. Near-Miss Reporting System (continued) The project is administered by the International Association of Fire Chiefs (IAFC) in consultation with the National Fire Fighter Near-Miss Reporting System Task Force. The project is endorsed by IAFC, International Association of Fire Fighters and the Volunteer & Combination Officers Section of the IAFC.

13. Why Share Near-Miss Experiences? • To share lessons learned with firefighters on a national scale. • To prevent another firefighterfrom getting injured or killed. • To identify trends ininjury-producing behaviors. • Aviation industry found that sharing near-misses improved overall safety.

14. What will be done with the collected information? • Members of the fire service community can learn from other firefighters. • Officers can use the reports in training drills. • Fire service community will receive bulletins, program reports and alerts depending on the urgency of the information collected. • Training academics can incorporate near-miss reports in building curriculum. • Fire service associations can use the reports as part of an improved emphasis on safety to their members. • Manufacturers will be notified when reports are received regarding performance issueswith equipment.

15. Firefighternearmiss.com: Development • 38 fire departments participated in pilot testing from April-July 2005. • National launch of firefighternearmiss.com occurred in August 2005. • Arvada Fire Protection District (CO) • Atlanta Fire Rescue Department (GA) • Austin Fire Department (TX) • Baltimore County Fire Department (MD) • Bernalillo County Fire & Rescue (NM) • Charlotte Fire Department (NC) • Clark County Fire Department (NV) • Cy-Fair Volunteer Fire Department (TX) • Downey Fire Department (CA) • Fairfax County Fire & Rescue Department (VA) • Fort Wayne Fire Department (IN) • Freeport Fire Department (NY) • Fulton County Fire Department (GA) • Greensboro Fire Department (NC) • Henderson Fire Department (NV) • Hobbs Fire Department (NM) • Houston Fire Department (TX) • Indianapolis Fire Department (IN) • Long Beach Fire Department (CA) • Los Angeles County Fire Department (CA) • Loveland-Symmes Fire Department (OH) • Magnolia Volunteer Fire Department (TX) • Manchester Fire-Rescue-EMS (CT) • Marietta Fire & Emergency Services (GA) • Midwest City Fire Department (OK) • Montgomery County Fire & Rescue Services (MD) • Mountain View Fire Protection District (CO) • Oklahoma City Fire Department (OK) • Prince William County Department of Fire & Rescue (VA) • Rocky Hill Volunteer Fire Department (CT) • South Farmingdale Fire Department (NY) • South Windsor Fire Department (CT) • Stillwater Fire Department (OK) • Toledo Department of Fire & Rescue Operations (OH) • Virginia Beach Fire Department (VA) • Wallingford Department of Fire Services (CT) • Washington Fire Department (MO) • Western Taney County Fire Protection District (MO)

16. Who can submit a report and does it need to be a recent experience? Any member of the fire service community is encouraged tosubmit a report when he/she is involved in, witnesses, or is toldof a near-miss event. Regardlessof when the near-miss experience occurred, all reports contain valuable information.

17. Two ways to submit a report • Electronically submit a report on firefighternearmiss.com. • Print a form from the website and submit it via mail or fax.

18. Home Page Screen

19. Demographics Questions Seven questions about the reporter(title, years of fire service experience, department type, etc.)

20. Event Questions Eight questions about the event (type, cause, etc.)

21. Event Description Describe the event in your own words.

22. Lessons Learned Describe the lessons learned.

23. Optional Contact Information Providing your name and contact information is optional.Reports can be submitted anonymously without contact information.

24. Post Submission Screen Once a report is submitted, the reporter can view a list of reports similar to his/her report.

25. Search Reports Screen View reports submitted from other firefighters.

26. How long does it take to submit a report? It takes about 3-5 minutes to enter the demographic and event questions. You decide how much time you want to spend on the event description and the lessons learned.

27. What happens to a report once it is filed? The report is reviewed by active duty, experienced fire service professionals who remove or generalize names, departments and other information as needed in order to protect the identity of the reporter. Reviewers are trained to identify any safety hazards requiring immediate action. Reviewers also code the reports into a database in order to analyze trends. Once the report is de-identified, reviewed and coded, the report is posted on firefighternearmiss.com for other firefighters to use as a learning tool.

28. Report Trail • 1st Reviewer • Opens report • (within 72 hours of submission) • Reads • De-identifies • Forwards to 2nd Reviewer Firefighter submits report • 2nd Reviewer • Ensures report is de-identified • Returns to 1st Reviewer 1st Reviewer Codes report Report is Posted for Viewing Alerts & bulletins issued as needed

29. Sample Report Event Description I was on an engine crew performing a search for hidden fire in knee walls on a second story house. Our truck crew was on the roof performing vertical ventilation procedures. I heard the truck crew above us using a chain saw. The ceiling of the room that we were in was pitched and the ceiling was approximately 1 to 2 feet above our heads. While I was removing the wall exposing the hidden fire, I felt a quick jerk to my helmet. I immediately dropped to my knees. When I looked up,I noticed that the chain saw blade was through the ceiling. My officer and another crewmate grabbed me because they thought I had fallen through a hole in the floor. We exited the structure and I noticed that I had a mark on my helmet, but it was still intact. 

30. Sample Report (continued) Lessons learned • Always ensure that your proper PPE is worn. • Chin straps do keep helmets on heads. • Both crews involved were doing the allocated task assigned to them and doing it correctly. However, we need to be aware of the type of structure that we are in and where crews could possibly be located both in and out. • Be aware of what the crew members you are with are doing because you never know when something might happen and you will need to react quickly in their assistance.

31. Does it work? I read a report about an airbag which had not deployed after a vehicle crash and that night I responded to a similar situation. I recognized the danger and warned my crew, the police department and ambulance personnel. As a result of reading the near-miss report, I was able to pass along information about a potential hazard. - Commander Kip Stanger Marietta Fire Department (GA)

32. Does it work? (continued) One of my firefighters compared the website to a large ready room filled with hundreds of firefighters telling their stories and having the chance to learn from each other. It doesn’t matter if your department is large or small, paid or volunteer, rural, urban or suburban. -Deputy Chief Steven Mormino South Farmingdale Volunteer Fire Department (NY)

33. Does it work? (continued) Feedback from the field has reflected positively that the National Fire Fighter Near-Miss Reporting System provides the medium for the potential development of measures to reduce the number of fatalities and injuries. - Captain Mike Lewis Los Angeles County Fire Department (CA)

34. Does it work? (continued) The National Fire Fighter Near-Miss Reporting System is indicative of the changing attitudes that departments across the nation are having toward safety. This program helps link departments across the nation and helps us to identify common and unique situations that can cause a safety concern. Having a resource like this can help keep us all aware and focused on potentially hazardous situations. - Firefighter Will Schwisow Hobbs Fire Department (NV)

35. How can I participate in this program? Visit www.firefighternearmiss.com to: • Submit a near-miss report so other firefighters can learn from your experiences. • Read, learn and share information from near-miss reports with members ofyour department. • Learn more about theNational Fire Fighter Near-Miss Reporting System.

36. Acknowledgements The National Fire Fighter Near-Miss Reporting Systemwould not be possible without the dedication, knowledge, professionalism and generous input of the following people: Near-Miss Reporting System Task Force: • Garry Briese, Executive Director, International Association of Fire Chiefs • Chief Alan Brunacini, Phoenix Fire Dept (AZ) • Chief I. David Daniels, Fulton County Fire Dept (GA) • Deputy Chief William Goldfeder, Loveland-Symmes Fire Dept (OH) • Chief Manuel Gomez, Hobbs Fire Dept (NM) • Pat Morrison, Health and Safety Director, International Association of Fire Fighters • Dennis Smith, Chairman, First Responders Foundation

37. Acknowledgements (continued) Near-Miss Reporting System Task Force: • Linda Connell, Director, Aviation Safety Reporting System • Commander Scott Ferguson, U.S. Coast Guard • John Gould, Fire and Aviation Safety Specialist, SAFENET • Gordon Graham, Graham Research Consultants • Christopher Hart,Federal Aviation Administration • Dr. Robert Helmreich, University of Texas-Austin • Tom Phillips, Airline Pilots Association

38. Acknowledgements (continued) Special thank you to the members of the following departments. • Arvada Fire Protection District (CO) • Atlanta Fire Rescue Department (GA) • Austin Fire Department (TX) • Baltimore County Fire Department (MD) • Bernalillo County Fire & Rescue (NM) • Charlotte Fire Department (NC) • Clark County Fire Department (NV) • Cy-Fair Volunteer Fire Department (TX) • Downey Fire Department (CA) • Fairfax County Fire & Rescue Department (VA) • Fort Wayne Fire Department (IN)

39. Acknowledgements (continued) • Freeport Fire Department (NY) • Fulton County Fire Department (GA) • Greensboro Fire Department (NC) • Henderson Fire Department (NV) • Hobbs Fire Department (NM) • Houston Fire Department (TX) • Indianapolis Fire Department (IN) • Long Beach Fire Department (CA) • Los Angeles County Fire Department (CA) • Loveland-Symmes Fire Department (OH) • Magnolia Volunteer Fire Department (TX) • Manchester Fire-Rescue-EMS (CT) • Marietta Fire & Emergency Services (GA)

40. Acknowledgements (continued) Fire Departments • Midwest City Fire Department (OK) • Montgomery County Fire & Rescue Services (MD) • Mountain View Fire Protection District (CO) • Oklahoma City Fire Department (OK) • Prince William County Department of Fire & Rescue (VA) • Rocky Hill Volunteer Fire Department (CT) • South Farmingdale Fire Department (NY) • South Windsor Fire Department (CT) • Stillwater Fire Department (OK) • Toledo Department of Fire & Rescue Operations (OH) • Virginia Beach Fire Department (VA) • Wallingford Department of Fire Services (CT) • Washington Fire Department (MO) • Western Taney County Fire Protection District (MO)

41. Near-Miss Contact Information Mailing Address:National Fire Fighter Near-Miss Reporting System4025 Fair Ridge Drive Fairfax, VA 22033 E-mail:nearmiss@iafc.orgPhone:703-273-0911 or 571-238-8287Fax:703-273-0920 Photography by Jason R. HenskeSlides: 2,3,4,5,9,13,16,17,29,31,32,33,34,35,38,39 Carlos Alfaro - Slide: 8 Bob Bartosz - Slide: 7