1 nfirs 5 - fire service casualty module used to report injuries, deaths or exposures to fire...
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NFIRS 5 - Fire Service Casualty
Module
Used to report injuries, deaths or exposures to fire service personnel.
A - 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
B - Injured Person
Identifies personal information name gender (sex)
Department type volunteer (include paid-on-call) career
,Acres burned (outside fires)
Not Residential
Number of buildings involved
Estimated number of residential living units in building of origin whether 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
C - Casualty Number
Each fire service casualty is assigned a number begin with 1
,Acres burned (outside fires)
Not Residential
Number of buildings involved
Estimated number of residential living units in building of origin whether 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
D - Age or Date of Birth
Identifies the age or date of birth of the fire service casualty
,Acres burned (outside fires)
Not Residential
Number of buildings involved
Estimated number of residential living units in building of origin whether or not all units became involved
B2
B3
Buildings not involved
Less than one acre
None
Property Details
B1
B
1
2
In years OR
Date of Birth
Age or Date of BirthD
Day Month Year
Age
E - Date and Time
Identifies the date and time of injury midnight is 0000
Time of Injury Date of Injury
Date & Time of InjuryEMidnight is 0000.
Month Day Year Hour Minutes
F - Responses
Identifies the number of responses that the firefighter made during the previous 24 hours
,Acres burned (outside fires)
Not Residential
Number of buildings involved
Estimated number of residential living units in building of origin whether or not all units became involved
B2
B3
Buildings not involved
Less than one acre
None
Property Details
B1
B
1
2
ResponsesF
Number of prior responses during past 24 hours
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
Intentional Unintentional Failure of equipment or heat source Act of nature Cause under investigation Cause undetermined after investigation
E1Cause of Ignition
Check box if this is an exposure report.
12345U
Skip to Section G
x
G1Usual Assignment
Suppression EMS Prevention Training Maintenance Communications Administration Fire investigation Other
123456780
G2 - Physical Condition
Identifies the condition of the firefighter prior to the injury
D
Area of fire origin
Heat source
Item first ignited
Type of material first ignited
D1
D2
D3
D4
Ignition
Check box if fire spread was confined to object of origin
Required only if item first ignited code is 00 or < 70
1
2 1 BedroomG2
Physical Condition Just Prior To Injury
RestedFatiguedIll or injuredOther
1230
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
,Acres burned (outside fires)
Not Residential
Number of buildings involved
Estimated number of residential living units in building of origin whether 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 only
Treated by physician (no lost time) Moderate (lost time) Severe (lost time) Life threatening (lost time)
Death
SeverityG31234567
G4 - 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
Check box if this is an exposure report.
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
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
Intentional Unintentional Failure of equipment or heat source Act of nature Cause under investigation Cause undetermined after investigation
E1Cause of Ignition
Check box if this is an exposure report.
12345U
Skip to Section G
x
Activity at Time of InjuryG5
Activity at time of injury
H1 - Primary Apparent 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
Check box if this is an exposure report.
12345U
Skip to Section G
x
H1
Primary apparent symptom
Primary Apparent Symptom
H2 - Area of Body Injured
Identifies the part of the body which sustained the most serious injury
Primary injured body part or area
H2Primary Area of Body Injured
I1 - Cause of Injury
Identifies the cause of the firefighter injury codes can be found in the
Handbook or QRG
Cause of Firefighter Injury
Cause of injury
I1
I2 - Contributing Factors
Identifies the most significant factor contributing to the injury
Contributing factor
Factor Contributing to InjuryI2
I3 - Object Involved in Injury
Is used to clarify what object contributed to the injuryNone
Equipment Involved In Ignition
Equipment Involved
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 5Object involved in injury
Object Involved in InjuryI3
None
J1 - Where Injury Occurred
Describes the location of the fire service casualty at the time of injury
None
Equipment Involved In Ignition
Equipment Involved
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
J2 - Story Where Injury Occurred
Identifies the story above or below grade where the injury occurred Complete only for structures
None
Equipment Involved In Ignition
Equipment Involved
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
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
None
Equipment Involved In Ignition
Equipment Involved
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 Complete as
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
J4 - 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
Complete ONLY if Specific Location code is >60
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
Did protective equipment fail and contribute to the injury?
Please complete the remainder of this form ONLY if you answered YES.
K1 Yes
No
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)
,Acres burned (outside fires)
Not Residential
Number of buildings involved
Estimated number of residential living units in building of origin whether 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
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.
None
Equipment Involved In Ignition
Equipment Involved
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
K3 - Protective Equipment Problem
None
Equipment Involved In Ignition
Equipment Involved
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)
K4 - 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
Serial Number
.
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
1.Firefighter injured (or killed) during training exercise
2.Firefighter injured (or killed) playing basketball while on duty
Scenarios