1. NFIRS 5 - Fire Service Casualty Module Used to report injuries, deaths or exposures to fire service personnel.

2. A - Header Header information is repeated on all modules . . . • In an automated system, this information is entered once and imported into all modules

3. Injured Person Male Career 1 1 B 2 Female 2 Volunteer Identification Number First Name MI Last Name Suffix 1 2 B - Injured Person • Identifies personal information • name • gender (sex) • Department type • volunteer (include paid-on-call) • career

4. Casualty Number C Casualty Number 1 2 C - Casualty Number  • Each fire service casualty is assigned a number • begin with 1

5. Age or Date of Birth D Age Date of Birth OR In years Month Day Year 1 2 D - Age or Date of Birth  Identifies the age or date of birth of the fire service casualty

6. Midnight is 0000. E Date & Time of Injury Date of Injury Time of Injury Month Day Year Hour Minutes E - Date and Time  • Identifies the date and time of injury • midnight is 0000

7. Responses F Number of prior responses during past 24 hours 1 2 F - Responses Identifies the number of responses that the firefighter made during the previous 24 hours

8. Usual Assignment G 1 x 1 Suppression 2 EMS 3 Prevention 4 Training 5 Maintenance 6 Communications 7 Administration 8 Fire investigation 0 Other G1 - Usual Assignment Identifies the usual assignment of the injured fire service personnel • this might not be the same as the individual’s activity at the time of injury

9. Physical Condition Just Prior To Injury G 2 1 Rested 2 Fatigued 3 Ill or injured 0 Other 2 1 Bedroom G2 - Physical Condition Identifies the condition of the firefighter prior to the injury

10. Severity G 3 1 Report only, including exposure 2 First aid only 3 Treated by physician (no lost time) 4 Moderate (lost time) 5 Severe (lost time) 6 Life threatening (lost time) 7 Death 1 2 G3 - Severity Identifies the severity of the injury • Used to report injuries, deaths or exposures to fire service personnel. • Exposure of fire service personnel to toxic substances or harmful physical agents may be reported

11. Taken To G 4 1 Hospital 4 Doctor’s office 5 Morgue/funeral home 6 Residence x 7 Station or quarters 0 Other N Not transported G4 - Taken To Identifies where the fire service casualty was taken after the injury occurred

12. Activity at Time of Injury G 5 Activity at time of injury x G5 - Activity at Time of Injury Identifies what the firefighter was doing at the time of injury • codes are found in the Handbook or QRG

13. Primary Apparent Symptom H 1 Primary apparent symptom x H1 - Primary Apparent Symptom • Block H1: Primary Apparent Symptom • describe most serious apparent injury • Coded field • codes are found in Handbook and QRG

14. Primary Area of Body Injured H 2 Primary injured body part or area H2 - Area of Body Injured Identifies the part of the body which sustained the most serious injury

15. Cause of Firefighter Injury I 1 Cause of injury I1 - Cause of Injury Identifies the cause of the firefighter injury • codes can be found in the Handbook or QRG

16. Factor Contributing to Injury I 2 Contributing factor I2 - Contributing Factors Identifies the most significant factor contributing to the injury

17. Object Involved in I 3 Injury None Object involved in injury 6 3 2 Hot Plate XRS 130 34-2345 1 9 8 5 I3 - Object Involved in Injury Is used to clarify what object contributed to the injury

18. Where Injury Occurred J 1 1 Enroute to FD location 2 At FD location 3 Enroute to incident scene 4 Enroute to medical facility 5 At scene in structure 6 At scene outside 6 3 2 Hot Plate 7 At medical facility 8 Returning from incident 9 Returning from med facility Other 0 XRS 130 34-2345 1 9 8 5 J1 - Where Injury Occurred Describes the location of the fire service casualty at the time of injury

19. Story Where Injury Occurred J 2 Complete for structures only. Story of injury Below grade 6 3 2 Hot Plate XRS 130 34-2345 1 9 8 5 J2 - Story Where Injury Occurred Identifies the story above or below grade where the injury occurred • Complete only for structures

20. Complete as Specific Location J 3 applicable 65 In aircraft 64 In boat or ship or barge 63 In rail vehicle 61 In motor vehicle 54 In sewer 53 In tunnel 49 In structure 45 In attic 36 In water 35 In well 34 In ravine 33 In quarry or mine 32 In ditch or trench 31 In open pit 28 On steep grade 27 On fire escape/outside stairs 26 On vertical surface or ledge 6 3 2 Hot Plate 25 On ground ladder 24 On aerial ladder or in basket 23 On roof XRS 130 22 Outside at grade 00 Other 34-2345 1 9 8 5 J3 - Specific Location • Provides additional details on the specific location of the casualty at the time of injury • Complete J4 if casualty was in a vehicle when injured

21. Vehicle Type J Complete ONLY if 4 Specific Location code is >60 1 Suppression vehicle 2 EMS vehicle 3 Other FD vehicle 4 Non-FD vehicle J4 - Vehicle Type Complete only if the fire service casualty was in a vehicle at the time of injury

22. K1 - Protective Equipment • If protective equipment failed and was a factor in this injury, complete Section K • If the answer to K1 is “yes” complete equipment sequence field, and the remainder of the Module

23. 1 2 K1 - Equipment Sequence A unique number assigned to each piece of equipment that failed and contributed to the injury • First piece of faulty equipment is always “001” (consecutively number additional pieces)

24. Protective Equipment Item K 2 Head or Face Protection 11 Helmet 12 Full face protector 13 Partial protector 14 Goggles/eye protection 15 Hood 16 Ear protector 17 Neck protector 10 Other 6 3 2 Hot Plate XRS 130 34-2345 1 9 8 5 K2 - Protective Equipment Item Identifies each piece of equipment that contributed to the injury of the firefighter • If more than one piece of protective equipment was a factor in the firefighter’s injury, use additional sheets.

25. 6 3 2 Hot Plate XRS 130 34-2345 1 9 8 5 K3 - Protective Equipment Problem Describes the most serious problem with the piece of equipment that failed and contributed to the injury (Partial list)

26. Equipment Manufacturer, Model & Serial K 4 Number . Manufacturer Model Serial Number K4 - Equipment Manufacturer, Model, & Serial Number Provide detailed information on the specific equipment that failed and contributed to the injury

27. Summary • The Fire Service Casualty Module (NFIRS 5) is used to report firefighter injuries or deaths related to an incident • Exposure of fire service personnel to toxic substances or harmful physical agents should be reported, even if no signs or symptoms are present • Fire service casualty information can be used by Health and Safety Officers to reduce risks at incidents

28. Scenarios Firefighter injured (or killed) during training exercise Firefighter injured (or killed) playing basketball while on duty