NFIRS 4 - Civilian Fire Casualty

Module

Captures data regarding civilian casualties resulting from a fire

Civilian Fire Casualty Module

Captures data regarding civilian and/or non-fire service casualties

The injury must be the result of a fire

A - Header

Header information is repeated on all modules . . .

In an automated system, this information is entered once and imported into all modules

Delete NFIRS - 4

Civilian Fire Casualty

AChange Station FDID Exposure Incident Date

MM DD YYYY

State Incident Number

B - Injured Person

Identifies the name and gender

of the person

,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 PersonB Male Female 1

MI

2

C - Casualty Number

Assign a specific consecutive number to each casualty beginning with 1 usethree digits: 001, 002, etc

,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 Number

CasualtyNumberC

D - Age or Date of Birth

Identifies the age or date of birth of the casualty use months for infants

,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

Months (for infants) Age

OR

Date of Birth

Age or Date of BirthD

Month Day Year

E1 - Race / E2 - Ethnicity

E1 Identifies race of casualty Based upon US Census

categories,

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

White Black Am. Indian, Eskimo Asian Multi-racialUndetermined

RaceE112345 U

,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

E2 Identifies the ethnicity of the victim

Currently the only Census Bureau classification for ethnicity is Hispanic

E2Ethnicity

Hispanic

F - Affiliation

Identifies if the casualty was a civilian or a non-fire service emergency responder

,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

Affiliation

Civilian EMS, not fire department Police Other

F1230

G - Date and Time of Injury

Captures the casualty date Captures the time using a

24 hour clock

midnight is 0000

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 Bedroom

Time of Injury Date of Injury

Date & Time of InjuryG

Month

Midnight is 0000.

Day Year Hour Minutes

H - Severity

Identifies the relative severity of the

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

Severity H

Minor Moderate Severe Life threatening Death

1 2 3 4 5

I - Cause of Injury

Identifies the physical event that caused the injury

Additional codes can be 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

Cause of InjuryIExposed to fire products including flame heat, smoke, & gas Exposed to toxic fumes other than smoke Jumped in escape attempt Fell, slipped, or tripped Caught or trapped Structural collapse Struck by/or contact with object Overexertion Multiple causes Other Undetermined

1

234567890 U

J - Human Factors Contributing to Injury

Identifies the physical or mental state of the person that may have contributed to the 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

Human Factors Contributing to Injury

J

Asleep Unconscious Possibly impaired by alcohol Possibly impaired by other drug Possibly mentally disabled Physically disabled Physically restrained Unattended person

Check all applicable boxes

None

K - Factors Contributing to Injury

Identifies the most significant factors that contributed to the injury Can identify up to three factors

Factors Contributing to InjuryK

Contributing factor (1)

Contributing factor (2)

Contributing factor (3)

None Enter up to three contributing factors

L - Activity When Injured

Identifies the activity in which the person was engaged at the time of the 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

Activity When Injured L

Escaping Rescue attempt Fire control Return to fire before control Return to fire after control Sleeping Unable to act Irrational act Other Undetermined

123456780U

M1 - Location at Time of Incident

Identifies the location of the victim in relation to fire origin

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

Location at Time of Incident M11234U

In area of origin and not involved Not in area of origin & not involved Not in area of origin, but involved In area of origin and involved Undetermined

M2 - General Location at

Time of Injury

Identifies the location of the victim at time of injury If casualty was in area of fire origin, skip

to section N If casualty was outside of the building

and not in area of origin, go to M5

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

34345

1 9 8 5

M2 General Location at Time of Injury

In area of fire origin In building, but not in area Outside, but not in area

Check ONE box. If undetermined, leave blank and skip to Section N.

Skip to Section N

Skip to Section M 5

123

M3 - Story at Start of Incident

Complete only if the injury occurred inside of building

Identifies the floor level where the victim was at the start of the incident

below grade

M3

Story at START of incident

Story at Start of Incident Complete ONLY if injury occurred INSIDE

M4 - Story Where Injury Occurred

Identifies the story (floor level) where the casualty was located at the time of the injury

F3Equipment Portability

Portable

Stationary

Portable equipment normally can be moved by one person, is designed to be used in multiple locations, and requires no tools to install.

1

2

X

Story where injury occurred, if different from M 3

below grade

M4 Story Where Injury Occurred

M5 - Specific Location at

Time of Injury

Identifies the specific location at the time of injury Codes can be found in the

Handbook

F3Equipment Portability

Portable

Stationary

Portable equipment normally can be moved by one person, is designed to be used in multiple locations, and requires no tools to install.

1

2

X

Specific location at time of injury

M5 Specific Location at Time of Injury

Complete ONLY if casualty NOT in area of origin

N - Primary Apparent Symptom

The casualty’s most serious injury other codes can

be found in the Handbook

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 5Primary apparent symptom

Look up a code only if the symptom is NOT found above

Smoke only, asphyxiation Burns & smoke inhalation Burns only Cut, laceration Strain or sprain Shock Pain only

01111221339698

N Primary Apparent Symptom

N - Primary Apparent Symptom

The casualty’s most serious injury other codes can be found in the Handbook

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 5Primary apparent symptom

Look up a code only if the symptom is NOT found above

Smoke only, asphyxiation Burns & smoke inhalation Burns only Cut, laceration Strain or sprain Shock Pain only

01111221339698

N Primary Apparent Symptom

O - Primary Area of Body Injured

Describes the part of the body that sustained the most serious 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

Primary Area of Body Injured O

Head Neck & shoulder Thorax Abdomen Spine Upper extremities Lower extremities Internal Multiple body parts

123456789

P - Disposition

Identifies if the casualty was transported to an emergency care facility

F3Equipment Portability

Portable

Stationary

Portable equipment normally can be moved by one person, is designed to be used in multiple locations, and requires no tools to install.

1

2

X

Transported to emergency care facility

Disposition P

Remarks

The 'remarks' section is an area for any other remarks that might be made concerning the incident. A narrative description of the incident may be written in this block.

F3Equipment Portability

Portable

Stationary

Portable equipment normally can be moved by one person, is designed to be used in multiple locations, and requires no tools to install.

1

2

X

Remarks Local option

Summary

The Civilian Fire Casualty Module (NFIRS 4) captures data regarding any civilian casualty associated with fire-related incidents

Civilian Fire Casualty: private citizen, emergency medical

responder (not fire department), or police

dies or is physically injured as a result of a fire-related incident