1. Firefighter Fatality Case Study
Farwest Truck & Auto Supply
Coos Bay, Oregon
November 25, 2002

2. Objectives
To analyze firefighter fatality incidents in the name of eliciting lessons learned to prevent future occurrences.
To increase the knowledge base of firefighters, and in particular fire officers, in the spirit of making firefighting safer.

3. Those who cannot remember the past are condemned to repeat it.
- George Santayana

4. Community Profile Coos Bay, Oregon
Population – 16,000
10.5 square miles
Major industries
Fishing
Logging

5. Fire Department Profile Coos Bay, Oregon
Combination Department
3 Stations
Career Chief
Battalion Chief (Operations/Training)
1 Captain, 3 Lieutenants, 4 Firefighter/Engineers
19 Career Firefighters
25 Volunteer Firefighters (Residents, Cadets)
4 Engines (3 Frontline, 1 Reserve)
1 Quint (75’)
1 Rapid Attack/Rescue
1 Water Tender
1400 runs per year

6. Coos Bay Fire Station 1 Central Station 150 S. 4th St.
Personnel
Career:
Captain - 1 Firefighter/Engineer - 2 Administration Chief Battalion Chief (operation/training) Office Manager
Cadet Firefighters (Up to 6)  
Apparatus located at Central
1 - Class A Pumper
1 - Rapid Attack/Rescue Vehicle
ft. Quint
1 - Hazardous Materials Response Unit
ft. Jet boat for Water Rescue
1 - Command Vehicle
2 - Staff Vehicles for Chief and
Operations Chief

7. Coos Bay Fire Station 2 Empire Station 189 Wall St.
Personnel
Career: Lieutenant - 1 Firefighter/Engineer - 1
Cadet Firefighters: Up to 3
Apparatus
1 - Class A Pumper
1 - Rapid Attack /Rescue Vehicle
2 - Jet Skis for water rescue

8. Coos Bay Fire Station 3 Eastside Station 365 D St.
Personnel
Career : Firefighter/Engineer - 1
Resident Volunteers: Up to 3
Industrial Fire Brigade (SOMAR):
7 personnel Duty Hours 7am to 4 pm
Apparatus
2 - Class A Pumpers
1 - 3,200 gallon tender
      Additional Equipment
1 - Class A Pumper
Gallon Foam Tender
1 - 3/4 ton Pick-Up Truck

9. Farwest Truck & Auto Supply
Constructed approximately 1938
Type IV – Heavy Timber
Numerous Modifications

10. Construction Features
Warehouse Addition
Mezzanine
Non-sprinklered
13,250 square feet
Ceiling – 8” x ¾” old growth fir ship lap with 3/8” Furtex glued to surface.
2” x 10” wood ceiling joists

11. Construction Features
Sales area ceiling height – 14’
Mezzanine area ceiling height – 7’
Roof support structure
2” x 13” wood rafters
9” x 9” wood posts
9” x 13” wood beams

12. The Fire (1320 hours “D”) Store employees return from lunch.
Light haze and burning odor noted.
Search for source begins.
Chimney found hot to touch (on roof).
Red glow noted in bathroom area on mezzanine.
First aid extinguishment begins – unsuccessful.
911 contacted at 1351 hours (D+ 31).

13. Coos Bay FD Response (D+32)
Engine 8132 (5)
(Victims 1, 2 & 3)
Engine 8131 (3)
Ladder* 8151 (3)
Rescue 8171 (2)
Staff 8101 (1) (Chief/IC)
Command 8111 (1)(BC)
*Quint

14. Mutual Aid Response (Requested After Initial Alarm)
Engine 8306 (6)
Staff Vehicle 8301 (1 chief officer)
Staff Vehicle 8302 (1 chief officer)
Staff Vehicle 8303 (3 firefighters)
Ladder 8310 (3 firefighters)
Additional personnel from both departments in POVs.

15. Operations (D+33)
Command 8111 AOS and reports nothing showing, assumes command.
Property owner informs 8111 that fire is near chimney in bathroom on mezzanine. All occupants out.
IC notes light haze at drop ceiling level.
Ladder 8151 arrives. IC shows crew location of fire.

16. D+36 1356 hours Staff 8101 arrives. Command transferred from 8111.
Brown smoke visible from roof near chimney.
2 FFs from Ladder 8151 advance 1 ¾”, 200’ pre-connect through Side A door.
Observe fire at ceiling level 20-25’ from front wall.
Visible fire knocked.

17. 8111 assists Ladder 8151 with establishing supply line.
IC orders 8111 to take a lap.
Mutual aid units requested.
Engine 8132 arrives and pulls back-up line from Ladder 8151.
Initial attack line advances to mezzanine. Finds fully involved bathroom, light haze and little heat.

18. Ceiling opened, fire in rafters knocked.
3 firefighters from 8132 (Victim #3, Firefighters #3 & #4) advance two handlines from Ladder 8151.
Line #1 goes to sales counter.
Line #2 goes to mezzanine.
Grayish/brown smoke noted at ceiling level.*
*Ceiling height deceptive due to suspended lights and drop ceiling.

19. Crews reach mezzanine and begin pulling walls/ceilings and extinguishing fire.
Firefighter #5 and Victim #2 enter and follow handlines to mezzanine.
Victim #1 enters and proceeds to mezzanine.
8 firefighters in building operating 2 handlines and pulling ceilings and walls.
Victim #1 requests (via radio) roof ventilation and PPV on Side A.

20. D hours
Mutual aid Engine 8306 arrives. 5 members to roof for ventilation.
Staff 8301 arrives. Assigned Division C.
Staff 8302 arrives. Assigned Safety.
Engine 8306 arrives.
Roof reports small flame visible near chimney.
Firefighters pull handlines from Engine 8306 and begin attacking fire through Side C doors.

21. FARWEST AUTO AND TRUCK SUPPLY
8306
FARWEST AUTO AND TRUCK SUPPLY
11/25/2002
1408 HOURS
(D+48)
8151
8132

22. 1408 + (D+48+) Crews lose water momentarily.
Firefighters 1, 2 & 4 low on air - exit.
Firefighter 3 calls for more manpower.
Firefighter #4 passes line to Victim #3.
Firefighter #4 runs into Victim #1 while exiting and gives briefing.
Visibility zero, heat relatively mild.

23. 1408 + D+48++ Operating inside: V2 & V3 - handlines
Victim #1
Victim #2
Victim #3
Firefighter #3
Firefighter #5
V2 & V3 - handlines
V1, F3, F5 - hooking

24. 1408 + (D+48+) Skylights broken out by roof vent crew.
First skylight initially yields no smoke. Then heavy, dark, gray smoke pours out.
Second skylight yields heavy smoke immediately.
IC ( Staff 8101) passes command back to 8111 to check on roof ops.
Senior firefighter on roof notes “spongy” feeling.

25. Senior firefighter orders crew roof.
Staff 8101 reaches roof and notes bubbling tar, heavy smoke pushing from skylights, “soft and spongy” feel near Side A wall.
Staff 8101 orders building evacuation.

26. Firefighters 3 & 5 exit the building due to low air.
Major ceiling collapse ensues knocking Firefighter down stairs. Firefighter at bottom of stairs forced to exit.
Victim #3 trapped at top of stairs or knocked over railing.
Victim #1 & Victim #2 buried under full force of collapse.
Firefighter 5 calls out. No replies. Turns to see mezzanine fully involved. Runs out of air and exits building.

27. D+48+
As Staff 8101 exits roof he sees skylights drop into building. Deep red flame and heavy black smoke begin blowing out of hole.
Firefighter #5 exits and tells ISO that firefighters are trapped.
ISO & other officers call
missing on radios.
No response.

28. Staff 8101 resumes command.
Orders Roof team to RIT.
Additional handlines pulled to protect Side A entrances.
Division C enters building on Side C and hears PASS alarms sounding overhead on mezzanine.
RIT enters Side A.
Driven back by high heat, and rolling flame front.

29. D+55
Firefighter #1 reports hearing PASS alarm while operating 2 ½” handline on Side A.
Firefighters 1 & 5 enter structure and recover Victim #3.
Victim #3 – Full PPE on, including SCBA, found near front counter.
Apparently followed hoseline before collapsing.

30. 1608+ (D+175) Defensive operations in effect.
Victim #1 & Victim #2 recovered and pronounced dead approximately 1708 (D+235).

31. NIOSH Recommendations
FD’s should ensure that:
firefighters provide the IC with interior size up reports.
firefighters open concealed spaces to determine if a fire has spread.
Pre-emergency planning is completed for mercantile and business occupancies.
RIT teams are established and in position.

32. NIOSH Recommendations
FD’s should consider the use of thermal imagers to assist with interior size-up.
FD’s should ensure that local citizens call the fire department immediately when they smell smoke or feel heat.

33. NIOSH Recommendations
FDs should always maintain good accountability.
(Not a factor in this incident)
Building owners should ensure that building permits are obtained local codes are followed.
Chimney was improperly installed.

35. Coos Bay Fire and Rescue
Lt. Randall Carpenter
46 YO, 20+ years
Firefighter Jeffrey Common
30 YO, 8 years
Firefighter Robert Hanner
33 YO, 13 years

36. NIOSH Firefighter Fatality Investigation and Prevention Program
Sources
NIOSH Firefighter Fatality Investigation and Prevention Program
Report #

37. “Roof Collapse Takes Three Oregon Firefighters”
Firehouse.com
“Roof Collapse Takes Three Oregon Firefighters”
“Community in Shock Over Deaths of Three Firefighters”
“Oregon Firefighters Leave Legacy of Bravery, Fellowship”
“Coos Bay Tragedy: The Victims and Memorial Information”
“Investigators: Hidden Fire Likely Burned for Hours”