The National Center for Injury Prevention and Control of the Centers for Disease Control and Prevention and the leaders of the Department of Homeland Security's Assistance to Firefighters Grant program are committed to identifying the best global prevention practices for residential fire safety that might be applied to the U.S. fire problem.

The TriData Division of System Planning Corp. was asked to assist in a three-year program to examine best practices in countries that generally have fire-death rates lower than those in the United States; are considered by their international peers to have strong prevention programs; and have been involved in similar research in the past. Two of these countries are Sweden and Norway.

The quality and effectiveness of prevention and safety programs require dedicated fire department staff with specific training. Sweden and Norway are developing highly educated fire engineers to form the cadre for risk management and resource planning. Swedish fire-recruit training lasts two years, with 25% of the time spent on prevention and risk management. The proportion of fire department staff dedicated to prevention is much higher than in the United States. Oslo, Norway, a city of 540,000, has 40 fire prevention personnel on duty, along with just 50 firefighters in stations on a typical weekday. Norway requires a minimum of one full-time prevention employee for every 10,000 residents. There are no required fire prevention staff levels in the United States, and typically about 3% to 5% of a fire department budget goes for prevention personnel.

To devote more staff resources to prevention, response time goals are more lenient compared with the United States. Sweden and Norway require the first-responding units to arrive in 10 minutes, versus the National Fire Protection Association standard goal of six minutes for a U.S. city. Scandinavian countries gives more weight to prevention and early extinguishment of fires by residents and less to rapid response. The additional prevention activity results in fewer calls per capita. Even with higher response times, Scandinavian authorities have found the net result to be favorable.

Wide-scale home safety visits are an important component of Scandinavian prevention activities. The protocol for determining the frequency of home inspections is set by the fire service. In the United States, some homes are visited by the fire service to maintain or install smoke alarms, but the scale of doing this is much lower than in the best practices of Scandinavia and the United Kingdom, among others. In Sweden and Norway, homes with chimneys must be inspected regularly. Depending on the fuel used for heating and the frequency of use, inspections may occur from four times a year to once every four years. These inspections are conducted by licensed chimney sweeps, but that name is misleading — they are essentially specialized fire inspectors. They do inspect chimneys and clean them if necessary, but they also check heating systems and do broader home safety inspections.

Apart from chimney sweeps, the Oslo fire brigade annually visits most of its old, high-risk apartment buildings to discuss fire safety with the occupants. Posters put up in the buildings advertise when the fire service is coming. Condominium associations are given self-inspection checklists to pass on to unit owners. The department works with insurance companies on this campaign. Insurance premiums vary for these buildings depending on the number and types of safety measures taken, so it is to the occupants' advantage to make the buildings safer.

In Umea, Sweden, a city of 135,000, the fire brigade has been doing home safety inspections in addition to chimney sweep visits. The visits are announced in advance in local media, so that people won't be surprised when firefighters appear at their door. To maximize the probability of finding someone home, inspections are done typically from 6 p.m. to 8 p.m. The inspections often are done in the cold weeks prior to Christmas, when people are more likely to be home, and in conjunction with national and local campaigns associated with Advent. The local fire officials decide which homes to approach. Eight or nine firefighters make the visits. Although the home inspections are voluntary, virtually everyone agrees to participate.

During a visit, the firefighters test smoke alarms, check extinguishers and talk about fire risks with the household. If no smoke alarms are present, the firefighters give the household a written notification to get one to comply with the national law. To affirm compliance, the household sends back to the fire brigade part of the written notification form. There are legal penalties possible for non-compliance, but they are usually not given unless the lack of compliance leads to a casualty or major incident. Last year, Umea officials asked firefighters from each fire station to visit 300 homes. Local firefighters believe the home visits make a memorable impression on the households.

To reduce cooking fires in Norway, manufacturers are building stoves with shut-off timers or, less expensively, homeowners are plugging their stoves into heavy-duty timers. The timers shut the stoves off if the person cooking doesn't do so. The fire department advocates these timers, especially for households with elderly people. It also recommends that other electrical equipment that doesn't need to operate all night long be plugged into power strips that are turned off at night and promotes the use of safety candles. The wicks in the candles do not burn down to the bottom, so that the candles self-extinguish before reaching a flammable surface.

The fire service in Norway uses one safety device that seems worthy of special mention. The Oslo fire brigade equips all fire units with large, rapidly inflatable cushions for use in rescuing people trapped up to the fourth floor. These cushions can be deployed much faster than ladders. Trapped victims can jump onto a cushion if a ladder is not available and they can't escape otherwise. The cushions aided in 13 people being saved in their first year of use.

As in many other nations, the Scandinavian elderly are a growing high-risk population that accounts for a large percentage of fire deaths. In Norway, seniors account for over half of all fire deaths. Because people are living longer, the elderly now are divided conceptually into two groups, 65 to 80 years old and over 80 years old, with special emphasis on the latter.

A relatively new social policy removes elderly people from institutional homes and establishes them in their own homes or apartments. The Scandinavian fire service believes that this policy has increased the fire risk of the elderly, so the service works more closely with the social services and health agencies whose care providers visit the elderly at home. The fire service trains care providers either at the fire department or at the agencies themselves to look for fire risks when they are in homes performing their primary duties. The fire service my conduct this training regularly because of staff turnover in social and health agencies.

Care providers or the fire service can install smoke alarms or change batteries when they visit homes of the elderly, but that might not be going far enough. The elderly may be too infirm, groggy or mentally impaired to escape when smoke alarms go off. For this reason, the Swedish Fire Protection Association encourages home fire-safety inspectors and social services to check on elderly residents' mobility and escape paths and to give advice on how to improve the escape plan. For example, inspectors give instructions to the wheelchair-bound on how to get out of the home, how to take refuge or how to arrange with someone nearby to help with an escape.

Disabled or secluded elderly people unable to escape when a smoke alarm goes off are candidates for a portable-mist sprinkler system provided by the community. These units cost about $2,700, but they can be reused. Additionally, elderly smokers may receive fire-resistant aprons that catch embers and prevents clothing from igniting.

School children represent both a high-risk group and a means of reaching parents. Several Swedish cities annually give fire-safety training to children in schools and then designate the children as the “fire marshals” for their homes, with specific responsibilities. The school children receive fire-safety calendars that designates two days per month for specific household safety actions, such as testing smoke alarms, checking fire extinguishers and practicing escape plans.

Children also participate in safety events scheduled during Advent and other winter activities. Because the numbers of fires and fire deaths in Scandinavia are relatively low, fire brigades often package fire-safety messages in the broader context of accidental injury prevention, such as vehicle and bicycle safety.

Scandinavian countries target the general population through prevention campaigns. The SFPA president believes that most people can't learn about fires from personal experience because they may have only one serious fire in the home in a lifetime. Therefore, people have only one chance to get it right, and the fire service needs to educate people in a way that will be remembered about what a fire looks like and what to do when one occurs.

The SFPA started a national campaign in 2007 that will run for the next four years. Each year it has a different emphasis. The SFPA has 23 regional fire protection associations in which 600 fire officers work on their days off (for pay). These regional associations help implement the national campaign. The campaign is trying to convince people and the media that there is an inherent fire risk in the home and to inform them about what to do in case of fire. SPFA believes that having a year-long campaign with one focus, not just a campaign during fire prevention week, increases message exposure and retention.

The SFPA message in 2007 was that smoke exposure can kill and that it is important to close doors to contain smoke and fire. The “close the door” theme was aimed especially at people in apartment buildings. When someone flees an apartment and leaves the door open, smoke and fire can spread to other apartments and block exit paths, such as stairways. The Swedish fire service recommends that people stay in their own apartment and not evacuate if the fire is elsewhere; the likelihood of getting injured is thought to be greater if they flee through a smoke-filled stairway than if they stay put.

A fire service campaign called Safe Home is aimed at builders. If they comply, builders can advertise that they build homes that are fire safe. Such an advertisement is attractive to the safety- and health-conscious Swedes.

Another fire-safety campaign is aimed at employees. Some fire brigades provide instruction to municipal and some private industry workers on fire safety at work and at home. In Nykoping, Sweden, city employees were trained over a four-year period on a variety of safety topics, including fire safety, accident prevention and first aid. The city employees included elder-care providers, daycare workers and school teachers. This voluntary program consisted of four to five classes of three hours each, with one hour devoted to fire safety. Employees who have taken the course are now encouraging new employees to take it.

Besides the usual television, radio and print media, Scandinavian fire services use some unique outlets to deliver education and safety messages. The Umea fire brigade assigns firefighters to show supermarket shoppers a short safety film, discuss safety issues and hand out safety literature. Movie theaters in Sweden showed a one-minute fire safety spot addressing winter safety hazards. Showing the safety film can be effective because there is a captive audience that is already focused on the movie screen.

Fire safety officials also use the Internet to communicate with younger people who are computer-literate and frequently online. In Umea, a university town, the fire brigade maintains an interactive Web site on which it posts safety information and engages in dialogue with students and others regarding fire-safety concerns and questions.

Another medium is the public walls in apartment houses. Posters are put in stairwells of apartment buildings to address the need to remove clutter in public spaces. People often store baby strollers or other bulky items in the public areas for convenience and to avoid using space inside their apartments. When there is heavy smoke, however, clutter can't be seen; it becomes a tripping hazard that will interfere with evacuation.

U.S. fire departments have been reluctant to encourage people to extinguish fires, emphasizing escape instead. Other nations take a different view and believe that residents can be trained to fight small fires in a reasonably safe manner. Home occupants are trained to extinguish small fires on the premise that the fire service can't arrive within the two to four minutes it takes for some fires to reach flashover.

Residents in Sweden learn to help fire victims and potential victims first (pull them away from the fire, warn others), to call the fire brigade, and then attempt to put the fire out if it is small. If more than one person is available, these tasks should be accomplished simultaneously. About 35% of Sweden's homes are equipped with fire extinguishers. Swedish authorities encourage homeowners to use extinguishers only while the fire is small. If the fire is large or not immediately extinguished, people are instructed to close the door and evacuate.

Norway goes a step further than just recommending use of fire extinguishers. Extinguishers now are required in every home, in addition to smoke alarms. A hoseline attached to a faucet can be substituted for an extinguisher, but that is rarely the choice. It is largely left to the homeowner to comply, similar to how those in the United States deal with required smoke alarms in the home, except when the home transfers title or must be inspected for renovation.

So far, Norway and Sweden officials have found that encouraging and training home occupants to use fire extinguishers is effective, and there is no evidence that injuries have increased as a result.

Norway and Sweden have made major changes in their approaches to fire service delivery in the past decade, devoting substantially more effort and a larger percentage of fire brigade staff hours to improving fire safety in the home, where most fire deaths occur. These changes in strategy are widely believed to have led to a substantial reduction in fire deaths.

A key practice in Scandinavia is visits by the fire brigade to high-risk households, on a scale similar to or even higher than what Tri-Data previously reported for the United Kingdom. These nations also have well-targeted, well-funded fire-safety campaigns at the national and local levels. They tailor safety programs to various age groups, especially school children and the elderly. They reach large percentages of students in schools with fire-safety programs, often in two or more grades. They rely on partnerships with other agencies, such as health and social services, to leverage fire-service resources, especially for delivering safety programs to the elderly with disabilities who live at home.

These practices have the potential for successful translation to the United States. Most are not radically different from practices that have been tried sporadically in individual U.S. communities. A more intensive prevention effort conducted on a wider scale is needed in the United States for obtaining the broader reductions already realized by other nations. More American fire chiefs and fire prevention specialists should consider adapting and applying these best practices in and across their own communities. Such approaches may well help reduce fire injury and death rates in U.S. homes.

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Philip Schaenman is the president of the TriData Division of System Planning Corp. Schaenman previously was the associate administrator of the U.S. Fire Administration in charge of the National Fire Data Center and the Fire Technology Program. He holds advanced engineering degrees from Stanford University and Columbia University.

Dr. Mick Ballesteros is a researcher and epidemiologist in the Division of Unintentional Injury Prevention of the Centers for Disease Control and Prevention. He is the scientific lead on all of CDC's residential fire-safety and prevention activities.

The full report can be downloaded at www.sysplan.com/TriData/Publications/International.