National Fire Fighter Near-Miss Reporting System

Last updated
Fire Fighter Near Miss Reporting System
FoundedAugust 12, 2005 (2005-08-12)
FocusThe Firefighter Near Miss Reporting System’s mission is to assist responders with managing risk by gathering lessons learned from real world experiences and sharing them globally.
Location
Area served
Worldwide
Website www.firefighternearmiss.com

The Fire Fighter Near Miss Reporting System was launched on August 12, 2005 by the International Association of Fire Chiefs. It was announced at a press conference in Denver, Colorado, after having completed a pilot program involving 38 fire departments across the country. The Near Miss Reporting System aims to prevent injuries and save lives of other firefighters by collecting, sharing and analyzing near-miss experiences. The near-miss experiences are collected by firefighters who voluntarily submit them; the reports are confidential, non-punitive, and secure. After the reports are compiled, they are posted to the website where firefighters can access them and learn from each other's real-life experiences. Overall these reports help to formulate strategies, reduce firefighter injuries and fatalities, and enhance the safety culture of the fire service. The program is based on the Aviation Safety Reporting System (ASRS), which has been gathering reports of close calls from pilots, flight attendants, air traffic controllers since 1976. The reporting system is funded by the International Association of Fire Chiefs. [1]

Contents

Near-miss event

A near-miss event is defined as an opportunity to improve health and safety practices based on a condition or an incident with potential for more serious consequence.". [2]

Near-miss report

A near-miss report consists of five sections: [3]

Section 1: Reporter InformationThis section is designed to provide basic knowledge about the report submitter. (title, years of fire service experience, department type, etc.)
Section 2: Event InformationThis section provides information about the near-miss event. (type, cause, etc.)
Section 3: Event DescriptionThis section contains a detailed narrative. It is the key to successful data collection and trend analysis.
Section 4: Lessons LearnedThe key to any near miss report is the lesson learned. In this section reporters are asked to describe what they learned to prevent the near-miss from happening again. They can share these lessons with the fire service community at large to prevent the event from occurring again.
Section 5: Contact Information (Optional)The information is kept confidential. If a reviewer has questions they will make contact with the reporter one time to have the questions answered. Then the contact information is deleted and is not kept in association with the report in any way.

Report of the Week

Every Wednesday there is a new Report of the Week. These reports are available online and can be emailed for free with a Report of the Week subscription. [4] They are ideal tools used for training and for informational purposes.

The reports chosen are recent and contain discussion questions for further thought. They are also matched with 5 similar reports from previous years. These reports give readers insight to what is currently going on, and how people are dealing with their near-misses. The discussion questions help readers understand what actions need to be taken in order to prevent further near-misses. Many subscribers use the reports for informal training drills, forward the reports to other fire departments, or use them for their own informational needs.

Resources

The Fire Fighter Near-Miss Reporting System website offers many different resources to its users. As mentioned above, there is a Report of the Week, which offers a training tool for departments all over the country. In addition to the Report of the Week, there are illustrated case studies, videos, grouped reports, and photos. [5]

Videos and Photos: [6] You can find many different visuals here that can help you understand the reports.
Near-Miss Calendar: [7] The Near-Miss calendar contains case studies and other information about the program.

Human Factors Analysis and Classification System (HFACS)

The U.S. Navy's Human Factors Analysis and Classification System (HFACS) was selected as the first tool for analyzing firefighter near-miss reports. HFACS takes four levels of individual and institutional performance into consideration. [8]

The Human Factors Analysis and Classification System (HFACS) identifies the human causes of an accident and offers tools for analysis as a way to plan preventative training. It was developed by Dr Scott Shappell of the Civil Aviation Medical Institute and Dr Doug Wiegmann of the University of Illinois at Urbana-Campaign in response to a trend that showed some form of human error was a primary causal factor in 80% of all flight accidents in the Navy and Marine Corps.

  1. Unsafe acts
  2. Preconditions to unsafe acts
  3. Unsafe supervision
  4. Organizational influences

HFACS level 1 - Unsafe acts

The "unsafe acts" level contains two categories: errors and violations. The determination that an unsafe act has occurred is not an indictment of an individual firefighter or firefighters. So far, statistics have shown that 80% of reported near misses have occurred when firefighters were following established procedures. Errors are classified as resulting from lack of skill, education or training, poor decision making, or misperception. Each in turn can be broken down into omissions, failure to prioritize, poor technique, misinterpretation of conditions, wrong response to conditions, and decision errors.

HFACS level 2 - Preconditions to unsafe acts

The "preconditions to unsafe acts" level focuses on the individuals involved. Was the individual focused or distracted? Was the individual hurried? Was the individual physically ill or otherwise unfit for duty? Was the individual somehow incompatible with the assigned task? The team is also analyzed. For example, are the team members familiar with, and do they practice crew resource management and personal readiness?

HFACS level 3 - Unsafe supervision

The "unsafe supervision" level mirrors the military's emphasis on the officer's role in all aspects of operations. Specifically it looks at factors like inadequate supervision, poor planning, failure to correct problems, and other supervisory problems.

HFACS level 4 - Organizational influences

The "organizational influences" level is the final level of evaluation. It acknowledges that a fire departments top management is ultimately responsible for organizational culture, and may have contributed to some degree to a firefighter's actions that led to a near-miss event.

Error management

Based on the first year of data, the various working groups of the National Fire Fighter Near-Miss Reporting System have offered the following recommendations for error-management and to improve firefighter performance and safety.

See also

Related Research Articles

Firefighter rescuer trained to extinguish hazardous fires

A firefighter is a rescuer extensively trained in firefighting, primarily to extinguish hazardous fires that threaten life, property and the environment as well as to rescue people and animals from dangerous situations.

Fire marshal Person who inspects buildings for fire safety

A Fire Marshal or fire commissioner, in the United States and Canada, is often a member of a state, provincial or territorial government, but may be part of a building department or a separate department altogether. Fire marshals' duties vary but usually include fire code enforcement or investigating fires for origin and cause. Fire marshals may be sworn law-enforcement officers and are often experienced firefighters. In larger cities with substantially developed fire departments the local fire departments are sometimes delegated some of the duties of the fire marshal.

Incident Command System

The Incident Command System (ICS) is a standardized approach to the command, control, and coordination of emergency response providing a common hierarchy within which responders from multiple agencies can be effective.

Crew resource management or cockpit resource management (CRM) is a set of training procedures for use in environments where human error can have devastating effects. Used primarily for improving aviation safety, CRM focuses on interpersonal communication, leadership, and decision making in the cockpit of an airliner. Its pioneer was David Beaty, a former Royal Air Force pilot and later a BOAC pilot who wrote his seminal book The Human Factor in Aircraft Accidents in the late 1950s. Despite the considerable development of electronic aids since then, many of principles he developed continue to prove effective today.

Firefighting jargon includes a diverse lexicon of both common and idiosyncratic terms. One problem that exists in trying to create a list such as this is that much of the terminology used by a particular department is specifically defined in their particular standing operating procedures, such that two departments may have completely different terms for the same thing. For example, depending on whom one asks, a safety team may be referred to as a standby, a RIT or RIG or RIC, or a FAST. Furthermore, a department may change a definition within its SOP, such that one year it may be RIT, and the next RIG or RIC.

Human reliability is related to the field of human factors and ergonomics, and refers to the reliability of humans in fields including manufacturing, medicine and nuclear power. Human performance can be affected by many factors such as age, state of mind, physical health, attitude, emotions, propensity for certain common mistakes, errors and cognitive biases, etc.

Pilot error decision, action or inaction by a pilot of an aircraft

Historically, the term pilot error has been used to describe an accident in which an action or decision made by the pilot was the cause or a contributing factor that led to the accident, but also includes the pilot’s failure to make a correct decision or take proper action. Errors are intentional actions that that fail to achieve their intended outcomes. Chicago Convention defines accident as "An occurrence associated with the operation of an aircraft [...] in which [...] a person is fatally or seriously injured [...] except when the injuries are [...] inflicted by other persons." Hence the definition of the "pilot error" does not include deliberate crash.

An incident is an event that could lead to loss of, or disruption to, an organization's operations, services or functions. Incident management (IcM) is a term describing the activities of an organization to identify, analyze, and correct hazards to prevent a future re-occurrence. These incidents within a structured organization are normally dealt with by either an incident response team (IRT), an incident management team (IMT), or Incident Command System (ICS). Without effective incident management, an incident can disrupt business operations, information security, IT systems, employees, customers, or other vital business functions.

Interagency hotshot crew

In the United States, an interagency hotshot crew (IHC), or simply hotshot crew, is a hand crew consisting of 20-22 wildland firefighters, with specific qualifications to take on leadership roles while providing extended attack on large fires across the nation. They meet and exceed the requirements of Type 1 firefighters in terms of their extensive training, high physical fitness standards, and ability to undertake difficult, dangerous, and stressful assignments. They often respond to large, high-priority fires and are trained and equipped to work in remote areas for extended periods of time with little logistical support.

A near miss, "near hit", "close call", or "nearly a collision" is an unplanned event that has the potential to cause, but does not actually result in human injury, environmental or equipment damage, or an interruption to normal operation.

As firefighting has a rich history throughout the world, traditions in this profession vary widely from country to country.

Calgary Fire Department

The Calgary Fire Department (CFD) provides fire services for the city of Calgary, Alberta.

Swiss cheese model

The Swiss cheese model of accident causation is a model used in risk analysis and risk management, including aviation safety, engineering, healthcare, emergency service organizations, and as the principle behind layered security, as used in computer security and defense in depth. It likens human systems to multiple slices of swiss cheese, stacked side by side, in which the risk of a threat becoming a reality is mitigated by the differing layers and types of defenses which are "layered" behind each other. Therefore, in theory, lapses and weaknesses in one defense do not allow a risk to materialize, since other defenses also exist, to prevent a single point of failure. The model was originally formally propounded by Dante Orlandella and James T. Reason of the University of Manchester, and has since gained widespread acceptance. It is sometimes called the "cumulative act effect".

The Fire Fighter Fatality Investigation and Prevention Program (FFFIPP) is administered by the National Institute for Occupational Safety and Health (NIOSH), part of the Center for Disease Control and Prevention (CDC). It performs independent investigations of firefighter fatalities in the United States, also referred to as line of duty deaths (LODD).

Maintenance resource management (MRM) training is an aircraft maintenance variant on crew resource management (CRM). Although the term MRM was used for several years following CRM's introduction, the first governmental guidance for standardized MRM training and its team-based safety approach, appeared when the FAA (U.S.) issued Advisory Circular 120-72, Maintenance Resource Management Training in September, 2000.

Human factors are the physical or cognitive properties of individuals, or social behavior which is specific to humans, and influence functioning of technological systems as well as human-environment equilibria. The safety of underwater diving operations can be improved by reducing the frequency of human error and the consequences when it does occur. Human error can be defined as an individual's deviation from acceptable or desirable practice which culminates in undesirable or unexpected results.

Dive safety is primarily a function of four factors: the environment, equipment, individual diver performance and dive team performance. The water is a harsh and alien environment which can impose severe physical and psychological stress on a diver. The remaining factors must be controlled and coordinated so the diver can overcome the stresses imposed by the underwater environment and work safely. Diving equipment is crucial because it provides life support to the diver, but the majority of dive accidents are caused by individual diver panic and an associated degradation of the individual diver's performance. - M.A. Blumenberg, 1996

Maritime Resource Management (MRM) is a human factors training programme aimed at the maritime industry. The MRM training programme was launched in 1993 - at that time under the name Bridge Resource Management - and aims at preventing accidents at sea caused by human error.

Academy of Technical Training

The Academy of Technical Training is a privately owned institution which provides training programs in aviation security and safety, air traffic control, and management of aircraft accidents. The curriculum and courses are accredited and certified by the General Civil Aviation Authority.

Aviation accident analysis is performed to determine the cause of errors once an accident has happened. In the modern aviation industry, it is also used to analyze a database of past accidents in order to prevent an accident from happening. Many models have been used not only for the accident investigation but also for educational purpose.

References

  1. ↑ Archived May 5, 2010, at the Wayback Machine
  2. ↑ Archived May 5, 2010, at the Wayback Machine
  3. ↑ Archived May 5, 2010, at the Wayback Machine
  4. ↑ "Archived copy". Archived from the original on 2010-05-05. Retrieved 2010-06-29.CS1 maint: archived copy as title (link)
  5. ↑ "Index of /resources". Firefighternearmiss.com. Archived from the original on 2012-03-08. Retrieved 2012-05-22.
  6. ↑ "Archived copy". Archived from the original on 2010-04-26. Retrieved 2010-07-06.CS1 maint: archived copy as title (link)
  7. ↑ "Archived copy". Archived from the original on 2010-04-26. Retrieved 2010-07-06.CS1 maint: archived copy as title (link)
  8. ↑ [ dead link ]
 https://web.archive.org/web/20131203021531/http://www.firefighternearmiss.com/index.php/home
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.