5-1

Fire Service Casualty Fire Service Casualty ModuleModuleFire Service Casualty Fire Service Casualty ModuleModule

5-2

ObjectivesObjectivesObjectivesObjectives

The participants will be able to:– describe when the Fire Service

Casualty Module is to be used.– demonstrate how to correctly

complete the Fire Service Casualty Module.

5-3

Fire Service Casualty Fire Service Casualty ModuleModuleFire Service Casualty Fire Service Casualty ModuleModule

­ Used to report injuries, deaths or exposures to fire service personnel.– Exposure of fire service personnel to

toxic substances or harmful physical agents should be reported, even if no signs or symptoms are present.

­ One module is completed for each fire service individual.

­ For any incident type or on-duty ­ injury.

5-4

A - HeaderA - HeaderA - HeaderA - Header

Header information is repeated on all modules . . .­ In an automated system, this

information is entered once and imported into all modules

Delete A Change

NFIRS - 5Fire Service

Casualty Station FDID Incident Date

MM DD YYYY

State Incident Number

5-5

B - Injured Person B - Injured Person B - Injured Person B - Injured Person

Identifies personal information– name– gender (sex)

Department type– volunteer (include paid-on-call)– career

,Acres­burned­(outside­fires)­

Not Residential

Number­of­buildings­involved­

Estimated­number­of­residential­living­units­in­building­of­origin­whether or not all units became involved

B2

B3

Buildings not involved

Less than one acre

None

Property Details

B1

B

1

2First Name Last Name Suffix

Injured PersonBIdentification Number

MI

Male Female

12

Career Volunteer

12

5-6

C - Casualty Number C - Casualty Number C - Casualty Number C - Casualty Number

Each fire service casualty is assigned a number.– begin with 001.– Separate from Civilian

Fire Casualties.

,Acres­burned­(outside­fires)­

Not Residential

Number­of­buildings­involved­

Estimated­number­of­residential­living­units­in­building­of­origin­whether or not all units became involved

B2

B3

Buildings not involved

Less than one acre

None

Property Details

B1

B

1

2

Casualty NumberC

Casualty Number

5-7

D - Age or Date of Birth D - Age or Date of Birth D - Age or Date of Birth D - Age or Date of Birth

Identifies the age or date of birth of the fire service casualty.

,Acres­burned­(outside­fires)­

Not Residential

Number­of­buildings­involved­

Estimated­number­of­residential­living­units­in­building­of­origin­whether or not all units became involved

B2

B3

Buildings not involved

Less than one acre

None

Property Details

B1

B

1

2

In­years­OR

Date of Birth

Age or Date of BirthD

Day­Month­ Year­

Age

5-8

E - Date and Time E - Date and Time E - Date and Time E - Date and Time

Identifies the date and time of injury.– midnight is 0000.

Time of Injury Date of Injury

Date & Time of InjuryEMidnight­is­0000.­

Month­ Day­ Year­ Hour Minutes

5-9

F - Responses F - Responses F - Responses F - Responses

Identifies the number of responses that the firefighter made during the previous 24 hours.

,Acres­burned­(outside­fires)­

Not Residential

Number­of­buildings­involved­

Estimated­number­of­residential­living­units­in­building­of­origin­whether or not all units became involved

B2

B3

Buildings not involved

Less than one acre

None

Property Details

B1

B

1

2

ResponsesF

Number­of­prior­responses­during­past­24­hours­

5-10

GG11 - Usual Assignment - Usual Assignment GG11 - Usual Assignment - 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.

Intentional Unintentional Failure of equipment or heat source Act of nature Cause under investigation Cause undetermined after investigation

E1Cause of Ignition

Check­box­if­this­is­an­exposure­report.­

12345U

Skip to Section G

x

G1Usual Assignment

Suppression EMS Prevention Training Maintenance Communications Administration Fire investigation Other

123456780

5-11

GG22 - Physical Condition - Physical Condition GG22 - Physical Condition - Physical Condition

Identifies the condition of the firefighter prior to the injury.

D

Area­of­fire­origin­

Heat­source­

Item­first­ignited­

Type­of­material­first­ignited­

D1

D2

D3

D4

Ignition

Check­box­if­fire­spread­was­confined­to­object­of­origin­

Required­only­if­item­first­ignited­code­is­00­or­<70­

1

2 1 BedroomG2Physical Condition Just Prior To Injury

RestedFatiguedIll or injuredOther

1230

5-12

GG33 - Severity - Severity GG33 - Severity - 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.

,Acres­burned­(outside­fires)­

Not Residential

Number­of­buildings­involved­

Estimated­number­of­residential­living­units­in­building­of­origin­whether or not all units became involved

B2

B3

Buildings not involved

Less than one acre

None

Property Details

B1

B

1

2

Report only, including exposure First aid onlyTreated by physician (no lost time) Moderate (lost time) Severe (lost time) Life threatening (lost time) Death

SeverityG31234567

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GG44 - Taken To - Taken To GG44 - Taken To - Taken To

Identifies where the fire service casualty was taken after the injury occurred.

Intentional Unintentional Failure of equipment or heat source Act of nature Cause under investigation Cause undetermined after investigation

E1Cause of Ignition

Check­box­if­this­is­an­exposure­report.­

12345U

Skip to Section G

x

G4Taken To

Hospital Doctor’s office Morgue/funeral home Residence Station or quarters Other Not transported

1 4 5 6 7 0 N

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GG55 - Activity at Time of - Activity at Time of Injury Injury

GG55 - Activity at Time of - Activity at Time of Injury Injury

Identifies what the firefighter was doing at the time of injury.– codes are found in the Handbook

or QRG.

Intentional Unintentional Failure of equipment or heat source Act of nature Cause under investigation Cause undetermined after investigation

E1Cause of Ignition

Check­box­if­this­is­an­exposure­report.­

12345U

Skip to Section G

x

Activity at Time of InjuryG5

Activity­at­time­of­injury­

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HH11 - Primary Apparent - Primary Apparent Symptom Symptom

HH11 - Primary Apparent - Primary Apparent Symptom Symptom

Block H1: Primary Apparent Symptom. – describe most serious apparent injury.

Coded Field.– codes are found in Handbook and QRG.

Intentional Unintentional Failure of equipment or heat source Act of nature Cause under investigation Cause undetermined after investigation

E1Cause of Ignition

Check­box­if­this­is­an­exposure­report.­

12345U

Skip to Section G

x

H1

Primary­apparent­symptom­

Primary Apparent Symptom

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HH2 2 - Area of Body Injured - Area of Body Injured HH2 2 - Area of Body Injured - Area of Body Injured

Identifies the part of the body which sustained the most serious injury.

Primary­injured­body­part­or­area­

H2Primary Area of Body Injured

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II11 - Cause of Injury - Cause of Injury II11 - Cause of Injury - Cause of Injury

Identifies the cause of the firefighter injury.– codes can be found in the

Handbook or QRG.

Cause of Firefighter Injury

Cause­of­injury­

I1

5-18

II22 - Contributing Factors - Contributing Factors II22 - Contributing Factors - Contributing Factors

Identifies the most significant factor contributing to the injury.

Contributing­factor­

Factor Contributing to InjuryI2

5-19

II33 - Object Involved in - Object Involved in Injury Injury

II33 - Object Involved in - Object Involved in Injury Injury

Is used to clarify what object contributed to the injury.

None

Equipment Involved In Ignition

Equipment­Involved­

Brand­

Year­

F1

Model­

Serial­#­

If equipment was not involved, skip to Section G

6 3 2 Hot Plate

XRS 130

34-2345

1 9 8 5Object­involved­in­injury­

Object Involved in InjuryI3

None

5-20

JJ11 - Where Injury Occurred - Where Injury Occurred

JJ11 - Where Injury Occurred - Where Injury Occurred

Describes the location of the fire service casualty at the time of injury.

None

Equipment Involved In Ignition

Equipment­Involved­

Brand­

Year­

F1

Model­

Serial­#­

If equipment was not involved, skip to Section G

6 3 2 Hot Plate

XRS 130

34-2345

1 9 8 5

Where Injury Occurred J1

Enroute to FD location At FD location Enroute to incident scene Enroute to medical facility At scene in structure At scene outside At medical facility Returning from incident Returning from med facility Other

1234567890

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JJ22 - Story Where Injury - Story Where Injury Occurred Occurred

JJ22 - Story Where Injury - Story Where Injury Occurred Occurred

Identifies the story above or below grade where the injury occurred. – Complete only for structures.

None

Equipment Involved In Ignition

Equipment­Involved­

Brand­

Year­

F1

Model­

Serial­#­

If equipment was not involved, skip to Section G

6 3 2 Hot Plate

XRS 130

34-2345

1 9 8 5

J2Story Where Injury Occurred Complete for structures only.

Below grade

Story of injury

5-22

JJ33 - Specific Location - Specific Location JJ33 - Specific Location - 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.

None

Equipment Involved In Ignition

Equipment­Involved­

Brand­

Year­

F1

Model­

Serial­#­

If equipment was not involved, skip to Section G

6 3 2 Hot Plate

XRS 130

34-2345

1 9 8 5

J3Specific Location Complete­as­

applicable­

656463615453494536353433323128272625242322 00

In aircraft In boat or ship or barge

In rail vehicle In motor vehicle In sewer In tunnel In structure In attic In water In well In ravine In quarry or mine In ditch or trench In open pit On steep grade On fire escape/outside stairs On vertical surface or ledge On ground ladder On aerial ladder or in basket

On roof Outside at grade

Other

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JJ44 - Vehicle Type - Vehicle TypeJJ44 - Vehicle Type - Vehicle Type

Complete only if the fire service casualty was in a vehicle at the time of injury.

Suppression vehicle EMS vehicle Other FD vehicle Non-FD vehicle

Vehicle TypeJ4

1234

Complete­ONLY­if­Specific­Location­code­is­>60­

5-24

KK11 - Protective Equipment - Protective Equipment

KK11 - Protective Equipment - 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.

Did protective equipment fail and contribute to the injury?

Please complete the remainder of this form ONLY if you answered YES.

K1 Yes

No

5-25

KK11 - Equipment Sequence - Equipment SequenceKK11 - Equipment Sequence - 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).

,Acres­burned­(outside­fires)­

Not Residential

Number­of­buildings­involved­

Estimated­number­of­residential­living­units­in­building­of­origin­whether or not all units became involved

B2

B3

Buildings not involved

Less than one acre

None

Property Details

B1

B

1

2

Equipment Sequence Number

5-26

KK22 - Protective Equipment - Protective Equipment ItemItemKK22 - Protective Equipment - Protective Equipment ItemItem

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.

None

Equipment Involved In Ignition

Equipment­Involved­

Brand­

Year­

F1

Model­

Serial­#­

If equipment was not involved, skip to Section G

6 3 2 Hot Plate

XRS 130

34-2345

1 9 8 5

K2Protective Equipment Item

1112131415161710

Head or Face Protection

Helmet Full face protector Partial protector Goggles/eye protection Hood Ear protector Neck protector Other

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KK33 - Protective Equipment - Protective Equipment ProblemProblemKK33 - Protective Equipment - Protective Equipment ProblemProblem

None

Equipment Involved In Ignition

Equipment­Involved­

Brand­

Year­

F1

Model­

Serial­#­

If equipment was not involved, skip to Section G

6 3 2 Hot Plate

XRS 130

34-2345

1 9 8 5

Describes the most serious problem with the piece of equipment that failed and contributed to the injury.

(Partial list)

5-28

KK44 - - Equipment Manufacturer, Model, & Serial Number

KK44 - - Equipment Manufacturer, Model, & Serial Number

Provide detailed information on the specific equipment that failed and contributed to the injury.

K4Equipment Manufacturer, Model & Serial Number

Manufacturer­

Model­

Serial­Number­

.

5-29

SummarySummarySummarySummary

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.

5-30

Questions?Questions?Questions?Questions?