1. NFIRS 4 - Civilian Fire Casualty Module Captures data regarding civilian casualties resulting from a fire

2. Civilian Fire Casualty Module Captures data regarding civilian and/or non-fire service casualties The injury must be the result of a fire

3. A - Header Header information is repeated on all modules... ­ In an automated system, this information is entered once and imported into all modules

4. B - Injured Person Identifies the name and gender of the person 1 2 First NameLast NameSuffix Injured Person B MaleFemale1 MI 2

5. C - Casualty Number  Assign a specific consecutive number to each casualty beginning with 1 use three digits: 001, 002, etc 1 2 Casualty Number Casualty Number C

6. D - Age or Date of Birth  Identifies the age or date of birth of the casualty use months for infants 1 2 Months (for infants) Age OR Date of Birth Age or Date of Birth D MonthDay Year

7. E 1 - Race / E 2 - Ethnicity E 1 Identifies race of casualty Based upon US Census categories 1 2 White Black Am. Indian, Eskimo Asian Multi-racial Undetermined Race E 1 1 2 3 4 5 U 1 2 E 2 Identifies the ethnicity of the victim Currently the only Census Bureau classification for ethnicity is Hispanic E 2 Ethnicity Hispanic

8. F - Affiliation Identifies if the casualty was a civilian or a non-fire service emergency responder 1 2 Affiliation Civilian EMS, not fire department Police Other F 1 2 3 0

9. G - Date and Time of Injury Captures the casualty date Captures the time using a 24 hour clock midnight is 0000 21 Bedroom Time of InjuryDate of Injury Date & Time of Injury G Month Midnight is 0000. DayYearHour Minutes

10. H - Severity  Identifies the relative severity of the casualty 1 2 Severity H Minor Moderate Severe Life threatening Death 1 2 3 4 5

11. I - Cause of Injury Identifies the physical event that caused the injury Additional codes can be found in the handbook or QRG x Cause of Injury I Exposed 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 2 3 4 5 6 7 8 9 0 U

12. J - Human Factors Contributing to Injury Identifies the physical or mental state of the person that may have contributed to the injury 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

13. K - Factors Contributing to Injury Identifies the most significant factors that contributed to the injury Can identify up to three factors Factors Contributing to Injury K Contributing factor (1) Contributing factor (2) Contributing factor (3) None Enter up to three contributing factors

14. L - Activity When Injured Identifies the activity in which the person was engaged at the time of the injury 632Hot Plate XRS 130 34-2345 1985 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 1 2 3 4 5 6 7 8 0 U

15. M 1 - Location at Time of Incident Identifies the location of the victim in relation to fire origin 632Hot Plate XRS 130 34-2345 1985 Location at Time of Incident M 1 1 2 3 4 U 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

16. M 2 - 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 632Hot Plate XRS 130 34345 1985 M 2 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 1 2 3

17. M 3 - 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 M 3 Story at START of incident Story at Start of Incident Complete ONLY if injury occurred INSIDE

18. M 4 - Story Where Injury Occurred Identifies the story (floor level) where the casualty was located at the time of the injury X Story where injury occurred, if different from M 3 below grade M 4 Story Where Injury Occurred

19. M 5 - Specific Location at Time of Injury Identifies the specific location at the time of injury Codes can be found in the Handbook X Specific location at time of injury M 5 Specific Location at Time of Injury Complete ONLY if casualty NOT in area of origin

20. N - Primary Apparent Symptom The casualty’s most serious injury other codes can be found in the Handbook 632Hot Plate XRS 130 34-2345 1985 Primary 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 01 11 12 21 33 96 98 N Primary Apparent Symptom

21. N - Primary Apparent Symptom The casualty’s most serious injury other codes can be found in the Handbook 632Hot Plate XRS 130 34-2345 1985 Primary 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 01 11 12 21 33 96 98 N Primary Apparent Symptom

22. O - Primary Area of Body Injured Describes the part of the body that sustained the most serious injury 632Hot Plate XRS 130 34-2345 1985 Primary Area of Body Injured O Head Neck & shoulder Thorax Abdomen Spine Upper extremities Lower extremities Internal Multiple body parts 1 2 3 4 5 6 7 8 9

23. P - Disposition Identifies if the casualty was transported to an emergency care facility X Transported to emergency care facility Disposition P

24. 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. X Remarks Local option

25. 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