We're Killing Our Own People in Training
I want you to sit with that sentence for a second. Not on the fireground. Not in a collapse. Not pulling someone from a wreck on the highway. In training. The thing we control. The environment we design. The evolutions we plan, staff, and supervise.
Ten firefighters died in training-related events in 2025. Ten people who showed up to get better at the job and never went home. Most of those deaths were cardiac events — heart attacks suffered during or immediately after training activities.
I've been doing this for 20 years. I've lost friends on the fireground and I've carried that weight. But losing people in training hits different. Because on the fireground, there are variables we can't control — building construction, fire behavior, weather. In training, we control everything. Or at least we're supposed to.
So let's have this conversation. Not the comfortable version. The real one.
What Happened in 2025
Of the 76 total on-duty firefighter deaths in 2025, 48 were cardiac-related — that's 63% of all line-of-duty deaths. The ten training fatalities fit that same grim pattern. The majority involved firefighters who experienced cardiovascular events during physical training, skills drills, or emergency operations exercises.
In North Carolina in June 2025, a Riceville firefighter was killed and two others were injured during an ATV training accident. That incident stands out because it wasn't cardiac — it was a training scenario involving all-terrain vehicles where something went catastrophically wrong. It raises questions about risk assessment, safety controls, and whether the training activity's benefits justified its inherent hazards.
In Pennsylvania, a captain suffered a fatal cardiovascular event during water rescue training. Water rescue drills are physically demanding — cold water immersion, swimming in current, hauling equipment. The physiological stress is significant, and for someone with undiagnosed or undermanaged cardiac disease, it can be lethal.
These aren't isolated failures. They're symptoms of systemic issues that we've known about for years and haven't adequately addressed.
The Cardiac Connection
Let's connect the dots. Fire suppression accounts for just 1 to 5 percent of a firefighter's total annual work time, yet it's associated with more than 30% of cardiac line-of-duty deaths. Training activities that simulate fire suppression — live burns, forcible entry, search and rescue drills, hose advancement exercises — generate similar cardiovascular stress without the benefit of the adrenaline that actually helps sustain performance during real emergencies.
Here's what that means in practical terms. When you send a crew into a live burn training evolution, their bodies experience many of the same cardiovascular stressors as an actual structure fire: elevated core temperature, dehydration, sympathetic nervous system activation, physical exertion at or near maximum heart rate, and restrictive PPE that impairs thermoregulation. The heart doesn't know the difference between a training fire and a working fire. The metabolic demand is real.
And unlike a real incident — where you're responding to a situation you didn't choose and can't postpone — training is scheduled. Planned. Under our control. Which means every cardiac death in training is, at some level, a failure of screening, oversight, or both.
The Medical Clearance Problem
Here's the uncomfortable truth that we don't talk about enough. Many fire departments in this country do not require annual medical evaluations for their members. Some don't require any ongoing medical evaluation after the initial hiring physical. A firefighter can pass a physical at age 24, develop hypertension, high cholesterol, and early coronary artery disease over the next 15 years, and never be screened again.
NFPA 1582, updated in 2024, establishes clear standards for firefighter medical evaluations, including age- and sex-adjusted cardiorespiratory benchmarks with a minimum performance threshold at the 35th percentile. NFPA 1580 has consolidated 1582 and related standards into a unified health and wellness framework. The standards exist. The science is established. The implementation is where we fail.
Adoption of NFPA 1582 is voluntary unless a jurisdiction or state has mandated it. Many haven't. Smaller departments — particularly volunteer departments — often lack the budget for comprehensive annual medical evaluations. And even in departments that have adopted the standard, enforcement can be inconsistent when pulling a member from active duty means creating a staffing hole that nobody wants to fill.
We have to stop treating medical clearance as a bureaucratic hurdle and start treating it as what it is: the single most effective tool we have for preventing cardiac deaths in the fire service.
Training Oversight: Where We're Falling Short
Medical screening addresses the individual firefighter's fitness to train. But the training environment itself needs scrutiny.
Risk Assessment
Every training evolution should begin with a formal risk assessment. What are the hazards? What are the controls? What is the risk-benefit calculus? A live burn in an acquired structure carries inherent risks that are well-documented and manageable with proper controls. An ATV training exercise on rough terrain carries different risks that require different controls. A water rescue drill in cold, moving water carries still different risks.
The question every training officer should ask — and document the answer to — is: does the training value of this evolution justify the risk, and have we implemented adequate controls to manage that risk? If the answer to either half of that question is no, don't run the evolution.
Safety Officer Presence
High-risk training evolutions require a dedicated safety officer — not the lead instructor pulling double duty, but a separate individual whose sole job is monitoring conditions and personnel for signs of distress. This is standard practice for live burn training under NFPA 1403. It should be standard practice for any training activity that generates significant physiological stress.
Rehabilitation During Training
We staff rehab sectors at incidents. We should staff them at training too. Any training evolution that involves SCBA use, heavy physical exertion, heat exposure, or cold water immersion should include a rehab component with vital sign monitoring. If a member's heart rate or blood pressure is outside acceptable parameters, they sit out. Period. No exceptions for seniority, pride, or schedule pressure.
Environmental Monitoring
Heat-related illness and cardiac events are closely linked. Training during extreme heat — and I'm talking about summer months in much of the country — requires wet bulb globe temperature monitoring and activity modification protocols. The military has been doing this for decades. The fire service is catching up, but not fast enough.
The USFA Safety Culture Change Initiative
The U.S. Fire Administration's National Safety Culture Change Initiative is the number-one initiative of the "Everyone Goes Home" program, which was established with the goal of reducing firefighter line-of-duty deaths. The initiative emphasizes a fundamental shift in how the fire service views risk — moving from a culture that celebrates endurance and minimizes personal vulnerability to one that treats safety as a professional obligation.
That's the right framework. But as behavioral health experts note, culture change doesn't happen through proclamations. It happens through daily decisions made by officers and firefighters at the company level. It happens when a lieutenant stops a drill because a member doesn't look right. It happens when a chief mandates annual physicals even though the union pushes back. It happens when a training captain designs an evolution around the actual fitness level of the crew, not the fitness level they wish they had.
What Every Fire Chief Needs to Do
If you're a fire chief or a training chief, here's your action list. Not recommendations. Actions.
- Mandate annual medical evaluations aligned with NFPA 1582/1580. If budget is an obstacle, prioritize cardiac screening for members over 40 and those with known risk factors. Find the money. This is cheaper than a line-of-duty death — financially and in every other way.
- Require physician clearance before high-stress training. Any member participating in live burn, physical agility, dive, or rescue training should have current medical clearance on file. No clearance, no participation.
- Assign dedicated safety officers to high-risk training. Not instructors. Not bystanders. A designated safety officer with the authority to stop the evolution. Staff the position. Protect the position.
- Establish rehab protocols for training. Vital sign monitoring. Hydration. Rest cycles. Apply the same rehab standards you'd apply at a working incident.
- Review and update all training SOPs. When was the last time your live burn SOP was revised? Your vehicle extrication training SOP? Your water rescue SOP? If you can't answer that question, the answer is "too long ago."
- Invest in officer development for training officers. The person designing and running your training program should have formal education in adult learning, risk management, and exercise physiology. This isn't a collateral duty. It's a specialized skill set.
What Every Firefighter Needs to Do
This isn't just a leadership problem. It's personal.
- Know your cardiac risk profile. Get a physical. Get bloodwork. If you're over 40 and you haven't had a stress test, get one. Your doctor can help you understand your individual risk factors and what to do about them.
- Maintain your fitness year-round. Not three weeks before the pack test. Not after the New Year's resolution. Year-round cardiovascular fitness is the single best defense against a cardiac event during high-stress activity. A hundred fifty minutes per week of moderate cardio. Make it non-negotiable.
- Speak up if something feels wrong. Chest tightness. Unusual shortness of breath. Lightheadedness. Palpitations. These are your body telling you something is wrong. Pushing through is not toughness. It's gambling with your life. Tell your officer. Step out of the evolution. It's the bravest thing you can do.
- Hold your department accountable. If your department doesn't provide annual physicals, ask why. If training evolutions don't have safety officers, raise it. If rehab isn't available during high-stress drills, push for it. You have the right to a safe training environment.
We Owe Them Accountability
Ten firefighters died in training in 2025, as recorded in the USFA Firefighter Fatalities database. I won't name them here — this isn't about individual tragedies. It's about the system that produced them. A system that we built and that we have the power to change.
Every one of those deaths should have been survivable. Proper medical screening would have identified the members at highest cardiac risk. Proper training oversight would have included safety officers and rehab. Proper risk assessment would have matched the training activity to the participants' documented fitness levels.
We know what to do. The standards exist. The science is clear. The tools are available. What's been missing is the will to implement them consistently — even when it's expensive, even when it's inconvenient, even when it means telling a 20-year veteran that they can't participate in a drill until they pass a cardiac stress test.
That conversation is hard. Burying a colleague is harder.
If you're considering joining the fire service, know this: the best departments take your health seriously from day one. They screen you, train you, and monitor you — not because they doubt your toughness, but because they want you to go home after every shift. For every shift. For your entire career. Explore our career guides to find the path that fits you.
Train hard. Train smart. But for God's sake — train safe. We can't afford to lose ten more.