U. S. Fire Administration

The purpose of this handbook is to provide assistance to both new and experienced medical directors as they strive to provide the highest quality of out-of-hospital emergency medical care to their communities and foster excellence within their agencies. The handbook will provide the new medical director with a fundamental orientation to the roles that define the position of the medical director while providing the experienced medical director with a useful reference tool. The handbook will explore the nuances found in the EMS industry-a challenge to describe in generalities due to the tremendous amount of diversity among EMS agencies and systems across the Nation. The handbook does not intend to serve as an operational medical practice document, but seeks to identify and describe the critical elements associated with the position.

When an organization moves away from a generations-long tradition of being all-male toward a future that includes men and women equally, a significant change takes place. Change can be upsetting and threatening to those who are used to, and invested in, the way things "have always been." Fire may know no gender, but people do, and the fire chief of the 1990's spends more time managing people than controlling fire. Increasing numbers of women are becoming firefighters and fire officers, entering and advancing in a field that is still heavily male by both population and tradition. Fire service leaders who are not prepared to manage these workforce changes may find their workforce is managing them instead.

Fires started by lighted tobacco products, principally cigarettes, constitute the leading cause of residential fire deaths. The U. S. Fire Administration (USFA) has partnered with the National Fire Protection Association (NFPA) "to research what types of behaviors cause smoking fire fatalities and develop sound recommendations for behavioral mitigation strategies to reduce smoking fire fatalities in the United States...." The scope of the study included all lighted tobacco products, but cigarettes account for nearly all consumption and fires. Lighting implements such as matches and lighters were not included. Most fires involving these objects occur during incendiarism or fireplay. An extensive literature review on behaviors related to smoking, or to fires or fatalities due to smoking-material fires was conducted to provide the broadest possible fact base for recommendations. In addition, data were collected from: - analysis of the 1980 to 2001 U. S. smoking-material fire problem, using The National Fire Incident Reporting System (NFIRS) national estimates; - analysis of several hundred 1997 to 1998 fatal smoking-material fires, not necessarily representative but documented in greater detail in NFPA's major fires database called the Fire Incident Data Organization (FIDO); - analysis of other risk factors correlated with smoking, based on the U. S. Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor database for 2002.

This report compiles the best practices and common problems of fire protection and criminal justice agencies in identifying, investigating, prosecuting, and preventing arson. Commonly, the crime of arson is motivated by spite and revenge. Perpetrators strike with fire at buildings where people live, work, or socialize-causing injury, property loss, and death. Civilians and firefighters alike die in arson fires every year. Thirty years ago, arson captured media attention because so-called arson-for-profit rings were burning down decaying urban neighborhoods that had ceased to be profitable, and then rebuilding them at a substantial profit. Other high-profile cases involved arsonists who were connected to gangs and drug lords, and who set fires to intimidate their rivals or as retribution for deals gone bad. Some of the most publicized cases occurred in the cities of New York, Boston, Houston, Los Angeles, Miami, Baltimore, and others. There even were situations where neighborhood vigilantes, who were frustrated with crime and run-down buildings, took it upon themselves to torch structures to rid the neighborhood of vagrants, prostitutes, and drug dealers. Insurance companies were perceived as the main victims from intentional fires. As a crime com¬mitted against property, the economics of arson played center stage to the less well-defined statistics on injuries and deaths. Since arson fires do, on average, cause proportionately higher losses than fires from other causes, insurance companies committed many resources toward investigation and control. From establishing tip reward programs, training accelerant detection canines (ADC's), supporting arson reporting immunity legislation, and establishing the property insurance loss register (PILR), the insurance industry was a strong partner at that time. There is a dichotomy between arson as a property crime and arson as a crime against people, and that lies at the heart of today's challenges with cases of arson. As a crime, arson's long-standing definition as the willful and malicious burning of property does not do justice to the fact that today arson is usually a personal crime that is directed intentionally against specific victims. It is time for arson to be dealt with as a violent crime against persons, not just a crime against property. Today, spite and revenge dominate as the motives in intentional property fires, especially where there are casualties. Revenge-minded arsonists torch nightclubs, occupied residences, hotels, and other settings where their intended victims, and often other innocent people, are injured and killed. First responders get injured or die battling these blazes and trying to save others. Even though a portion of incendiary fires are motivated by other reasons (e.g., excitement, economic relief, peer pressure, a cry for help, and so forth) most set fires happen because someone wanted to inflict harm on another person using fire as the weapon of choice. Fire investigation units from The U. S. Fire Administration's (USFA's) project indicated that spite and revenge were the most common motives behind incendiary fires. Among project sites from the past 5 years, spite and revenge ranked as the highest leading motives, when investigation units were queried about prevailing motives.

The purpose of this U. S. Fire Administration special report is to document the problem of older chil¬dren who set fires resulting in serious or potentially serious consequences. The report also examines the factors that commonly are associated with intentional firesetting by teenagers and discusses a number of community programs that intervene to control arson. Historically, the term "juvenile firesetting" has been viewed as a "curious" kids' problem. Fires set by youngsters playing with matches and lighters tend to be categorized as "accidental" or "children playing." However, juvenile firesetting also includes the deliberate destruction of property by juveniles through fire, which sometimes results in casualties. This is an increasingly serious problem in most U. S. cities. Information from a 10-year U. S. Fire Administration project of direct technical assistance to over 60 jurisdictions verifies the high rate of juvenile-set fires. This report focuses on adolescent firesetters between 14 and 18 years of age. Several case studies are presented to demonstrate the impact of these arson fires and to outline the family circumstances of the youth who were involved. The report also covers how the criminal justice system has been handling teen arson and reviews and compares several treatment and intervention programs.