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US Fire Administration U.S. Fire Administration Firefighter Autopsy Protocol March 2008 U.S. Fire Administration Mission Statement As an entity of the Federal Emergency Management Agency (FEMA), the mission of the U.S. Fire Administration (USFA) is to reduce life and economic losses due to fi re and related emergencies, through leadership, advocacy, coordination, and support. We serve the Nation independently, in coordination with other Federal agencies, and in partnership with fi re protection and emergency service communities. With a commitment to excel lence, we provide public education, training, technology, and data initiatives. Firefighter Autopsy Protocol ■ ■ ■ Jeffrey O. Stull International Personnel Protection, Inc. Austin, Texas ■ ■ ■ March 2008 Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of the Department of Homeland Security or the U.S. Fire Administration. ■■Table of Contents OVERVIEW . .VI ACKNOWLEDGEMENT . VII I. BACKGROUND . 1 i .1 Scope of the Problem . 1 i .2 Rationale for the Protocol . 3 i .3 Description of the Protocol . 4 II. MEDICOLEGAL AUTOPSY PROCEDURES IN THE UNITED STATES . 9 ii .1 When Is an Autopsy Required? . 10 ii .2 Definition of Manner, Cause, and Mechanism of Death . 10 ii .3 Chain of Custody and Documentation . 11 ii .4 Retention of Autopsy Specimens and Paperwork . 12 III. OCCUpaTIONAL ASPECTS OF FIREFIGHTING OF SPECIFIC CONCERN TO AUTOPSY . 13 iii .1 Firefighter Death Classification . 13 iii .2 Trends in Line-of-Duty Deaths . 14 iii .3 Investigation of Line-of-Duty Deaths . 18 iii .4 Alcohol and Drugs . 19 iii .5 Fire Toxicology . 20 iii .6 Burns . 24 iii .7 Personal Protective Equipment . 26 iii .8 Non-Line-of-Duty Deaths . 28 iii .9 Firefighter Health . 29 IV. PUBLIC SAFETY OFFICER BENEFITS (PSOB) PROGRAM . 31 IV .1 Summary of the PSOB Law . 31 IV .2 Summary of the Heart/Stroke Amendment . 32 IV .3 Useful Web sites . 33 SELECTED BIBLIOGRAPHY . 34 Determination of Alcohol Levels During Autopsy . 34 Carbon Monoxide Determination During Autopsy . 44 ■ iv ■ ■ Firefighter Autopsy Protocol ■ v ■ Table of Contents ■ APPENDIX A: DEATH INVESTIGATION SYSTEMS IN THE UNITED STATES AND TERRITORIES . 55 APPENDIX B: NIOSH FIREFIGHTER FATALITY REPORts—AUTOPSY INFORMATION . 93 APPENDIX C: EXAMINATION OF PERSONAL PROTECTIVE EQUIPMENT . 160 Protective Helmets . 163 Protective Hoods . 163 Protective Garments (Coat and Pants) . 163 Protective Gloves . 164 Protective Footwear (Rubber) . 165 Protective Footwear (Leather) . 165 ■■Overview he Firefighter Autopsy Protocol has been extensively revised since its original 1994 edition . In this Tnew protocol, a number of additional areas of information have been provided to take into account emerging issues and new technologies as applied to the conduct of autopsies . As stated in the report, it is recommended that autopsies be performed for all firefighter fatalities where a line-of-duty death has occurred . It is further recommended that an autopsy be performed when a non-line-of-duty death may be linked to a line-of-duty exposure . Specific sections have been provided in this report as background and areas of information as related to the conducting of autopsies . General autopsy procedures must be supplemented with additional analyses and reviews in order to ascertain specific causes and mechanisms of death and to add to the body of knowledge for understanding firefighter fatalities which, in turn, helps to prevent future firefighter fatalities .The protocol gives specific attention to several areas, where current autopsy practice may be supplemented with additional evaluations and considerations . Examples of these supplemental factors include ■■evaluation of victim work history with specific attention to prior exposures; ■■examination of personal protective equipment (PPE) for relating effects of clothing and equipment on individual parts of the body, particularly in cases of trauma and burn injury; ■■details in the physical examination for identifying signs of smoke asphyxiation and burn injury as contributing causes of firefighter fatality; ■■implementation of appropriate carbon monoxide and cyanide evaluation protocols as part of the toxicological evaluation; and ■■detailed toxicological evaluations where hazardous atmospheres have been encountered . The utility of this specific firefighter autopsy protocol is intended to advance the analysis of the causes of firefighter deaths to aid in the development of improved firefighter health and safety equipment, procedures, and standards . It also is critical in helping to determine eligibility for death benefits under the Federal government’s Public Safety Officer Benefits (PSOB) Program, as well as State and local programs . Lastly, implementation of this protocol will increase interest in the study of deaths as related to occupational illnesses among firefighters, both active and retired . ■ vi ■ ■■Acknowledgement This project could not have been undertaken without the expertise of the following people who provided invaluable guidance and input throughout this project: Professor Vincent Brannigan, JD Ms .Valerie C . Neal* Dept . of Fire Protection Engineering PSOB (Senior Benefits Manager) University of Maryland 810 7th Street, NW College Park, MD 20742-3031 Washington, DC 20531 Dr . Merritt Birky Dr . Fredric Rieders National Transportation Safety Board National Medical Services 2419 Childs Lane 2300 Stratford Avenue Alexandria, VA 22308 Willow Grove, PA 19090 Richard Duffy Kevin Roche Int’l Association of Fire Fighters Phoenix Fire Department 1750 New York Avenue, NW 2625 South 19th Street Washington, DC 20006 Phoenix, AZ 85009 Ms . Rita Fahy Mary Ellis** National Fire Protection Association National Fallen Firefighters Foundation 1 Batterymarch Park 16825 South Seton Avenue, Building O Quincy, MA 02169-7471 P . O . Drawer 498 Emmitsburg, MD 21727 Captain Tom Hales, MD Center for Disease Control Jim Monahan 4676 Columbia Parkway Beebe Medical Center Cincinnati, OH 45226 424 Savannah Road Lewes, DE 19958 Dr . James Melius NY State Laborers 18 Corporate Woods Blvd . Albany, NY 12211 *No longer with PSOB at the time of publication . **No longer with the NFFF at the time of publication . ■ vii ■ ■■I. BACKGROUND he U .S . Fire Administration (USFA) is committed to improving the health and safety of firefighters . TThis mission has created an accompanying interest in learning about the causes of firefighter deaths and injuries . In the process of researching firefighter deaths, it was determined that forensic medicine had no standard protocol that would assist a coroner or medical examiner specifically in determining the cause of a firefighter death . Many purposes for firefighter autopsy are related to ensuring benefits in addition to providing an improved understanding of fireground hazards and the effectiveness of firefighting equipment . In 1993, the USFA initiated a project to develop a standard firefighter autopsy protocol . Experts in forensic pathology, toxicology, epidemiology, and medicolegal aspects of autopsy, as well as representatives of several national fire service organizations, were selected to serve as aT echnical Advisory Committee, to provide expertise and guidance for development of the new autopsy protocol .The first firefighter autopsy protocol was finalized in 1994 and disseminated in 1995 .This protocol effectively served the forensic professional and provided a basis for examining firefighter deaths more consistently . In 2004, a revision of the firefighter autopsy protocol was undertaken to further refine and update autopsy procedures to account for new types of analyses and concerns that have arisen with respect to the conducting of firefighter autopsies . A second Technical Advisory Committee, with membership similar to the first, was formed to help guide and review the modifications .The new changes and improvements in the autopsy protocol are represented in this publication . The consensus of the Technical Advisory Committee is reflected in the new protocol .This protocol is intended to provide guidance to medical examiners, coroners, and pathologists on uniform recommended procedures for investigating the causes and contributing factors related to firefighter deaths .The protocol recognizes and addresses those attributes of firefighter casualties which distinguish them from casualties in the general population, as well as from civilian fire casualties .These differences include the use of protective clothing and equipment, prolonged exposures to the hazardous environment, and specialized training and duties . The accompanying documentation is intended to describe the need for a revised autopsy protocol, the situations that led to its development, and the major issues that are related to it . I.1 Scope of the Problem Firefighting has been described as one of the Nation’s most hazardous occupations .The USFA estimated that the number of firefighters in 2005 was 1,136,650, comprising 313,300 career and 823,350 ■ 1 ■ ■ Firefighter Autopsy Protocol ■ 2 ■ I: Background ■ volunteer firefighters .1This figure included only those career firefighters working for public municipalities rather than for private fire brigades or for State or Federal government . The NFPA defines on-duty fatalities as follows (Fahy, 2007): On-duty fatalities include any injury sustained in the line of duty that proves fatal, any illness that was incurred as a result of actions while on duty that proves fatal, and fatal mishaps involving non-emergency occupational
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