For the last 136 years, the Milwaukee Fire Department has viewed on-the-job injuries as a normal part of the occupation. When a member was injured, he or she went on leave and all other department members went back to business as usual.

Recently, a few firefighters sustained significant burn injuries that later were found to be avoidable. This prompted department officials to look for ways to fix the problem. They wanted to find out why injuries occurred and how to prevent them.

Although they don't get the attention that line-of-duty deaths receive, injuries are a serious problem. According to a 2007 study by the National Fire Protection Association, there was an annual average of 38,545 firefighter injuries in the United States between 2001 and 2004. This does not include those injured in the Sept. 11, terrorist attacks. Of those injuries, 9,755 were labeled moderate or severe. Strains and sprains accounted for more than 30% of those injuries, with thermal burns the cause of 9.5%. Pain was the source of the injury in 8% of the cases and exhaustion and fatigue were the culprit in 6% of the incidents.

This fall, Milwaukee implemented a program to change the way on-the-job injuries are viewed and handled. The idea behind its significant-injury plan sprung from a group that included the fire chief, the assistant fire chief, seven deputy chiefs and the 12 members of the health and safety committee. The plan was hatched in September 2007, test driven for four months, and made policy and put into full practice this September.

The plan entails looking at current protocols; recreating scenes; taking photos; and interviewing all the crew members, witnesses and the injured at the scene. The significant-injury investigations mirror how the Occupational Safety and Health Administration investigates line-of-duty deaths.

Milwaukee's initial investigations began to uncover some pertinent information about why these accidents were occurring. In some situations, firefighters were not following protocols, and in others, the equipment malfunctioned or firefighters merely were not paying attention and looking out for their own safety.

“There has been a cultural fault in the fire service that burn injuries and injuries of all sorts are OK,” says Chief Douglas Holton. Holton, who spent most of his career in Milwaukee before taking the chief's job in St. Paul, Minn., returned as Milwaukee's fire chief in early 2007. “However, injuries in the fire service are not OK. They are unacceptable, and in most cases, preventable. The MFD has to begin to change the cultural climate on how we view injuries, as well as learn from our mishaps.”

The plan calls for a set of procedures to be followed immediately after a department member is badly hurt. First, a deputy chief decides if an injury is significant or minor. Significant injuries include lacerations, smoke inhalation, thermal and chemical burns, or falls from a considerable distance. If the injury is identified as significant, dispatch is notified and an alert is sent to the command staff. The incident safety officer then collects any evidence related to the incident, and retrieves the injured firefighter's safety gear and equipment. The gear and equipment are photographed, as is the injury scene, including all sides of the building, the address, entryways to the building and the main point of entry. An interior picture of the building layout and damage also is painted, as well as the spot where the member was injured.

Depending on the person's injuries, either his or her protective gear (all department members have two sets) or equipment is sent back to the bureau from which it was received. At the bureau, the gear or equipment is inspected meticulously and either sent back to the manufacturer, repaired or replaced.

Everyone who was present at the scene of the injury — the deputy chief, battalion chief, incident safety officer, company officers and witnesses — must write a report about the incident.

After all the documentation, photos and the investigation are complete, a presentation is put together outlining the findings of the injury investigation. It is presented to all chief officers and the health and safety committee. That committee then develops best practices. All the information gathered from the onset of the injury then is made into a DVD. The DVD is sent to each fire station and bureau head with a sign-off sheet. Every MFD member must sign the sheet to confirm he or she has watched the DVD.

Aside from the labor costs, there are no other costs associated with the plan. It is difficult to determine how many hours the staff logs to expedite this injury-reduction program because the more serious injuries or more complex circumstances surrounding some injuries will require more investigative effort. However, there are between 10 and 15 staff members involved in a typical investigation.

The significant-injury plan was not created as a disciplinary action against the injured, but as a way to stop other department members from sustaining the same, or more significant, injuries. To that end, department officials sought and received buy in from the union before launching the program. They did this by emphasizing that it was a safety program designed to protect, not punish, firefighters. The program is still too new to know if injury investigation results would find their way into a workers' compensation claim.

In addition, the department is aware that occasionally unique situations arise causing someone to get hurt. For example, one firefighter was faced with rescuing a child from a burning home after losing one glove. The firefighter took the calculated risk to save the child. As a result, he sustained a serious burn on the hand missing a glove.

“The ultimate goal of creating the significant-injury plan is to keep our members safe on the job. Our people are our greatest asset,” Holton says. “Our department is aiming to be a world leader in firefighter safety and eventually wants to be known as eliminating on-the-job injuries.”

Since its inception, the department has only had three serious injuries and cannot assess whether or not the plan is working. In September 2009, officials will examine the number of injuries and the amount of injury-leave time to see if there is an appreciable decline. The goal, officials say, is zero.

Again, with the program still in its infancy there have not been many lessons learned. But officials are finding it challenging to shift the culture. Firefighters are very focused on the safety of the public, a department spokeswoman says. The challenge has come in getting them to apply the same focus on their own safety. “We all own our share in safety and we are trying to get that point conveyed to all our members.”

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Michael Jones is deputy chief of the Milwaukee Fire Department Bureau of Instruction and Training. Jones was a member of the hazmat team, and is now the chair of the health and safety committee, as well as the research and development committee. He has been with the department for 29 years and is an active member of the International Association of Fire Chiefs.

Fireground Injuries Nationwide

Year	Total	Strain, Sprain	Wound, Cut, Dislocation, Fracture	Respiratory	Burns, Smoke Inhalation	Fire or Chemical Burn	Heart Attack or Stroke	Thermal Stress
2001	41,395	16,410	10,355	3,925	1,190	3,255	310	2,315
2002	37,860	15,735	9,200	2,790	975	3,205	345	2,415
2003	38,045	16,830	9,195	2,890	980	2,765	235	2,145
2004	36,880	17,890	7,370	2,915	585	2,860	290	1,875
2005	41,950	18,620	8,570	3,390	750	2,930	315	2,480
2006	44,210	20,655	8,705	3,755	575	3,070	350	2,280

Source: National Fire Protection Association, Fire Analysis and Research Division.