Editor's note: A trend to require more fire safety equipment in residences and nursing homes will reduce deaths and injuries, both among firefighters and the general public, says E. Metts Hardy, vice president/Fire Investigations for EFI Global (www.efiglobal.com), a Kingwood, Texas-based provider of engineering, fire investigation, environmental, accident reconstruction, and laboratory testing services. Hardy discussed recent developments in fire safety in a May 9, 2005, conversation with Occupational Health & Safety's editor. Excerpts from the conversation follow.

A report issued in March 2005 for the National Institute of Standards and Technology, "The Economic Consequences of Firefighter Injuries and Their Prevention," said injuries fell in the fire service by 20 percent from 1992 to 2002. The factors they mentioned are fewer fires being fought, better safety practices and protective gear, and safety features on fire vehicles. My question is, why hadn't the injury rate fallen even more? Twenty percent is not a huge gain, given all of those factors.

E. Metts Hardy: Twenty percent is quite a bit. There are dangers commonly associated with the job that even the input of new equipment and new technology just can't change. A lot of firefighters are killed in accidents responding to alarms, so the technology is not going to have an impact on that.

In 2003, there were 111 firefighters killed. So, if you think about fire personnel responding to 1.6 million calls--or a fire call about every 20 seconds--that's not that bad. That's a pretty good statistic.

There have been quite a few developments in their protective clothing, in the breathing apparatus they're using now, and also with the infrared technology. Firefighters can see either where the fire is, or if in there for search and rescue, they can see where the victim is located. It makes for a quicker in, quicker out, which also has a bearing on the amount of injuries. Injury is related to exposure: The longer that they're exposed to the fire conditions or the events going on within a burning structure, then the more opportunity there is for injury.

Are there equivalent gains being made in terms of firefighters' fitness or in work practices that the fire service is using?

Hardy: Of course, fire departments do have regulations and they do promote physical training. That helps with the amount of physical exertion that's involved. I think, too, another one of the factors is so many cities and municipalities now have EMS respond with the fire service calls. If a firefighter does have an episode with exertion or injury, he or she can be treated on the scene. I think that is a big factor that is changing the severity of injuries.

That might be a worsening factor for firefighters, responding to EMS calls. They are going on a lot more calls--fewer fire calls, but more calls overall.

Hardy: That's possible. It goes back to exposure again.

So there is some capability they take with them to help a firefighter should he go down from a heart attack, but is the net effect negative because of so many more calls being answered?

Hardy: The industry is moving toward firefighters' safety. They are responding to a lot more emergencies, but they've got the opportunity to have help on the scene in a much shorter time than perhaps having to wait for an ambulance to come from a remote location.

There's no difference in the priority given or the speed of response of a fire call as opposed to a medical call, is there?

Hardy: No.

The NIST report about firefighter injuries said only about 5,000 of the 2002 injuries were burns, but about 28,000 of the total 80,800 injuries that year caused firefighters to lose time off the job. Basically, a third of all injuries caused them to lose time. Does that strike you as high?

Hardy: Not really, because of the inherent danger of the job. Most of the time, these firefighters that are injured in fires receive broken bones from something falling, sprained or torn muscles, or cuts and burns, and they can't take the chance on the inability to perform at 100 percent.

It's a lot worse than the percentage of lost-time injuries, say, in private industry.

Hardy: The [firefighting] job in itself is very dangerous.

As I understand it, heart attacks and vehicle crashes are the leading causes of death among firefighters. Is that still correct?

Hardy: In my experience and understanding, I agree, they are.

Those are not among the leading causes of injuries for firefighters: Heart attacks and vehicle crashes aren't among the top factors. So there's a dichotomy between what's causing the injuries, lost time and otherwise, and what's causing the deaths. Does that seem odd to you?

Hardy: No, it's not really odd at all. I think it is related to the type of job they're doing.

Is it related at all to the age of the average firefighter today? I don't know whether people are working older or working longer.

Hardy: That's difficult to answer. I don't know what the national average age of the firefighter is nowadays.

The most provocative thing in this report, to me, was the suggestion that protective ensembles worn by firefighters may have become too effective, causing them to stay longer and penetrate deeper into fires than they would've before. I'm not used to seeing protective equipment called too good.

Hardy: I spent 13 years in the fire service. When I was in the fire service, they'd just come out with Nomex hoods. . . . When you put on the Nomex hood and had a breathing apparatus on, you were so encapsulated that you really couldn't feel the heat. You just concentrated on what you were trying to do. Couple that with bad vision because of the smoke and people are finding themselves in situations that under other circumstances they perhaps would avoid.

But, as you know, firefighters are totally dedicated to preserving life and property. Only in the fire service and law enforcement do you find people running into situations that everybody else is running out of.

Do you sense this is becoming an important issue for the fire service--that people are encouraged by what they're wearing and what they perceive to stay longer in dangerous situations than they should?

Hardy: I don't really see that as a problem. I see it as a positive in the advancement of the technology for their gear. Training, being seasoned, and knowing your limitations and capabilities, I think that's all part of it. These men and women, when they respond they're ready to put their lives on the line at the ring of a bell. When you're trying to get in and get somebody out, your priority and your focus is on doing just that.

We also should talk about the Government Accountability Office's "Nursing Home Fire Safety" report and the rule from the federal Centers for Medicare & Medicaid Services requiring nursing homes to install battery-operated smoke detectors in resident rooms and public areas if they do not have sprinkler systems. Were you aware of that? How important do you think that is?

Hardy: Yes, I was aware of it, and I think it's important. Any time you can get advanced warning and notification, the situation usually can still be controlled. The opportunity for injury or death is going to be minimized.

The rule takes effect May 24, 2005, which is shortly after you and I are talking now. It's typical, I think, when such rules are being proposed that the community facing the regulation reacts by saying, "The retrofit costs are enormous. We can't bear it." What does the fire service think of that argument?

Hardy: Smoke detectors are generally affordable. The statistics show that 81 percent of fire fatalities occur in the home. The addition of smoke detectors is going to give occupants the opportunity for early notification. If you're notified, then you know to take action. So I think it's important, putting smoke detectors into facilities and residences like that. I think we'll definitely see a reduction in the amount of injuries and deaths because as the training and pre-planning of the fire department and training of the staff in the building [occur, and there are] regular inspections, it's going to remove a lot of the opportunity for events such as what prompted this rule and the report.

There were two 2003 multi-fatality nursing home fires, as you're aware, that obviously led to this one.

Hardy: You were talking earlier about the cost, and it being cost-prohibitive. Any loss of life is not the desired result. It's hard to put a dollar value on life, but there is a tremendous amount of cost associated with retrofitting buildings. Now, this cost has to be passed on to someone to pay.

The practical nature of it is, yes, it would be good and beneficial in practice to do so, but the other side of the coin is that some of these homes and businesses--that are not inherently dangerous, that do comply with all of the applicable codes, and that do have inspections routinely--the cost could perhaps cause these places to close.

They could also, of course, improve their insurance rates once they do install such safety equipment. Might they be able to recover some of the cost?

Hardy: I'm sure they would to some extent, but I don't think the cost would be offset.

Would it be sensible for jurisdictions to follow this model even for private homes?

Hardy: Actually, they are. There's a municipality outside the county in Tennessee where I live that has proposed an ordinance requiring new homes to have sprinklers. So it is approaching the residential area. And, as I said earlier, 81 percent of fire fatalities occur in the home.

Have you heard of other jurisdictions doing the same?

Hardy: I have not heard of anything out of the state of Tennessee. I do know that there are a number of advocates for placing sprinklers in residential settings.

The one I heard about was in New Jersey, but it involved fire extinguishers, not sprinklers. The acting governor of New Jersey, Richard Codey, signed legislation that requires fire extinguishers in every single- or double-occupancy home upon sale, lease, or transfer.

Hardy: I'm sure some feel that a little is better than nothing, but that also requires untrained people to expose themselves to danger. Fighting fire is better left to the professionals.

What was the home builders' response to the rule you're familiar with in Tennessee?

Hardy: Again, such as every other issue, they were concerned about the increased cost. There would be some offset with the insurance premiums that you spoke of earlier, but the bulk of the costs would be passed to the consumer.

I would like to see that taken up elsewhere. I don't know what it would do to the cost of a home. But sprinklers are beyond what I would have expected for private homes. I would think of smoke detectors and extinguishers, perhaps, being required.

Hardy: Right. They're actually moving in the direction of installing sprinklers . . . . On a personal note, I wouldn't mind having a sprinkler system in my home. Obviously, it would be a good investment.

We talked about the new Medicare rule for nursing homes, stemming from those Nashville and Hartford fires. Two other recent multi-fatality fires, the Chicago high-rise fire and the Rhode Island nightclub fire, raised attention to fire risks in such facilities nationwide. Did we learn anything about emergency evacuation from what happened in Chicago or in the fire at The Station nightclub?

Hardy: What happened in the nightclub fire is that it was overcrowded and, coupled with the soundproofing material mixed with pyrotechnics, was just a recipe for disaster once something did happen. The panic resulted in the exits being blocked and the loss of life there.

The Chicago high-rise fire in the Cook County office building--the victims were trapped in the stairwells . . . . The doors had locked on the stairwell side, and no one could reenter a floor from the stairwell. I think Chicago has changed their code requirements since to make sure these doors are unlocked under alarm conditions, so a person can exit out of the stairwell, back onto the floor, in order to have a better opportunity for survival.

That's one of the changes that have been prompted out of that fire. Of course, fire protection professionals are always looking at the fire spread rating of materials, as well as the smoke production, to minimize injuries and loss of life.

A lot of the debate after the Chicago fire was whether they should have evacuated at all. It wasn't a serious fire, and it was below the people who were caught in the stairwell and died of smoke inhalation.

Hardy: Right. Well, that's hard to say. It's similar to the people in the World Trade Center: When the disaster happened in the North Tower, people in the South Tower were initially told not to evacuate.

Do many jurisdictions look at fires like these and change their fire codes in response? Do the national codes change in response, as a rule?

Hardy: Yes. The national codes administration and the building congress that formulate building codes meet on a regular basis. And any time they can identify some improvement, they'll take that into consideration. And if it's warranted and approved by the membership, they will make the necessary changes. I think that's part of the reason you're seeing a decrease in fire incidences, as well as the injuries and loss of life.

You're talking about injuries and loss of life among firefighters themselves?

Hardy: I'm talking about firefighters as well as the general occupants of buildings. Catastrophic events often initiate changes in fire codes.

And that's the normal course of things. For instance, The Station fire. There have been many major fires in public gathering/nightclub settings over the years. Even then, sometimes you still have facilities that are either grandfathered or just don't stay up to code.

Hardy: Well, part of it is having inspectors get out and inspect these types of buildings. But any time you're remodeling or renovating at least 50 percent of a building, the building is required to be brought up to code at that point.