FIREFIGHTER RESCUE SURVEY
Purpose: To increase firefighters success on the primary search and reduce civilian fire fatalities by collection and analysis of data.
Please fill out one survey per victim.
Incident Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Incident Date
*
-
Month
-
Day
Year
Date Picker Icon
Incident Time
*
Hour Minutes
How many victims were rescued from the structure?
*
1
2
3
4 – 9
10 – 25
More than 25
Were any other victims found in this same room/vicinity?
Yes
No
Pre-arrival Conditions
Time from initial dispatch until fire department arrival on scene?
Less than 2 minutes
2 - 4 minutes
4 6 minutes
6 8 minutes
8 10 minutes
+ 10 minutes
What was the arrival order of the crew that found victim?
First in
Second in
Third in
Fourth in or later
Excluding the driver operator, where are the SCBAs located on the rig that found the victim?
SCBAs are in the seat
SCBAs are in the cab but not in the seat
SCBAs are in an exterior compartment
Not applicable
Number of firefighters on scene when the victim was located?
< 3
3 – 6
7 – 10
11 – 13
14 – 16
> 16
Were there reports of a victim or reports that everyone is out?
Yes Reports of victims
Yes - Report of everyone is out
No – No reports of victims
Who made the statement about victims inside?
Dispatch
Bystander
Neighbor
Unknown / Other
Police
Family/Roommate
Resident of Fire Building
Different Unit/Apartment
Were reports of victim location correct?
Yes
No
When was search initiated? (Fire conditions)
Pre fire knockdown
Simultaneous with knockdown
Post fire knockdown
Occupancy & Conditions
What occupancy type was the victim located in?
Single family dwelling
Multi-family dwelling
Mobile/Manufactured home
Care home
Multi-use occupancy
Commercial
Barn/Shed/Out building
Other
What type of multi-family dwelling was the victim in when located?
Exterior access/Garden style apartment (doorways exit to the outside)
Center hall apartment (doorways exit to the public hallway)
Total number of floors in structure above grade / excluding the basement.
1
2
3
4
5
6
7
8
9
10
11 or more
Exterior conditions on arrival of first due?
Nothing showing
Smoke Only
Less than 25% of structure involved
25 - 50% of structure involved
51 - 75% of structure involved
76 - 100% of structure involved
Floor of fire (upon arrival)
Basement
Floor 1
Floor 2
Floor 3
Floor 4
Floor 5
Floor 6
Floor 7
Floor 8
Floor 9
Floor 10
Floor 11 or more
Multiple floors involved
Attic
Location of fire
Bedroom
Bathroom
Kitchen
Family room
Garage
Multiple rooms
Attic
Exterior
Other
Fire conditions upon entry
Incipient
Room and contents (Single room)
Multiple rooms (Rooms and contents)
Structure
Initial mode of operation
Offensive
Defensive
Visibility at victim location
High visibility (Can easily make out shapes over 10 feet in front of your face)
Moderate visibility (Can make out shapes from 1 foot to 10 feet in front of your face)
Low visibility (Can make out shapes up to 1 foot in front of your face)
Zero visibility (Lights out. searching with hands only)
Conditions at victim location
Fire
Fire and smoke
Smoke
No fire and no smoke
Did the structure appear vacant or abandoned?
Yes
No
Did the structure have working smoke alarms?
Yes
No
Unknown
Victim
Which floor was the victim found?
Basement
1
2
3
4
5
6
7
8
9
10
11 or more
Which room was the victim located?
Foyer
Hallway
Stairs
Family
Kitchen
Bathroom
Bedroom
Garage
Basement
Balcony/Porch/Deck
Laundry
Other
Was the victim behind a closed door/isolated from fire?
Yes
No
Location of victim
Closet
In crib
On bed
On top bunk
Under bed
Couch/sofa/chair
On floor within 6 feet of exterior door
On floor under window
Floor
Standing
Bathtub or shower
Vehicle
Other
Victim location relative to fire
Fire floor
Floor above fire
>1 Floor above fire
Floor below fire
>1 Floor below fire
Approximate age of victim?
0 - 2 years of age
3 - 5
6 - 12
13 - 18
19 - 39
40 - 60
> 60
Approximate weight of victim?
< 25 pounds
25 – 50 pounds
51 – 100 pounds
101 – 200 pounds
201 – 300 pounds
> 300 pounds
Who found the victim?
Not applicable / Victim showing upon arrival
Fire Attack
Primary Search*
Secondary Search*
Police
Salvage and Overhaul
Ventilation
Other
Did search crew that located the victim physically have a hose line with them during search?
Yes
No
What methods of search were used in locating the victim?
Left/Right Hand - A left or right-hand search with 2 or more firefighters moving in the same direction
Split Search- 2 or more firefighters searching independently.
Oriented Search - 1 crewmember stays oriented to the exit and doesn't actively participate in search.
VES - A search initiated from a window
Rope Assisted Search/Search Line - Searching directly off of a previously placed rope or hoseline.
VES, (search from a window) was victim found in the initial room of entry?
Yes
No
Number of firefighters assigned to search before victim was located?
0
1
2
3
4
5
6 or more
How was victim initially located?
TIC (Thermal Imaging Camera)
Eyes (No TIC)
Hands
Ears (Responded to call out)
Ears (Heard victim cough, cry, move, etc.)
Time from fire department arrival on scene until arrival at victim?
Less than 2 minutes
2 - 4 minutes
4 - 6 minutes
6 - 8 minutes
8 - 10 minutes
10 - 15 minutes
15 - 20 minutes
20 - 30 minutes
30 minutes - 1 hour
+ 1 hour
Time from fire department arrival on scene until water on the fire?
Less than 2 minutes
2 - 4 minutes
4 - 6 minutes
6 - 8 minutes
8 - 10 minutes
10 - 15 minutes
15 - 20 minutes
20 - 30 minutes
30 minutes - 1 hour
+ 1 hour
Victim Extraction
Time from arrival at victim to victim removed from structure?
Less than 2 minutes
2 - 4 minutes
4 - 6 minutes
6 - 8 minutes
8 - 10 minutes
10 - 15 minutes
15 - 20 minutes
20 - 30 minutes
30 minutes - 1 hour
+ 1 hour
Time from fire department arrival on scene to victim removed from structure?
Less than 2 minutes
2 - 4 minutes
4 - 6 minutes
6 - 8 minutes
8 - 10 minutes
10 - 15 minutes
15 - 20 minutes
20 - 30 minutes
30 minutes - 1 hour
+ 1 hour
How was victim moved inside the structure?
Walk or crawl under victim’s own power
Drag or carry with firefighter(s) hands
Drag or carry with webbing
Other
Path of extraction?
Window (head first)
Window (feet first)
Door
Other
Not removed
How was victim brought to ground level?
Ground ladder
Aerial ladder
Not applicable/First floor window
Interior stairs
Exterior stairs
Other
Was victim moved up or down interior stairs?
No
Yes – Victim was moved up stairs
Yes – Victim was moved down stairs
Was victim ever purposefully sheltered in placed (for over 2 minutes)?
Yes
No
Number of personnel that were needed for removal
1
2
3
4 - 6
7+
Outcomes
Was a Cyanokit used on scene?
Yes
No – Cyanokit was present but not used
No – Cyanokit was not available on scene
Was CPR performed on victim?
Yes
No
Was victim transported to hospital?
Yes
No
Was victim conscious upon removal from structure?
Yes
No
Victim burns
None
Mild
Severe
Did victim suffer smoke inhalation?
Yes
No
Victim outcome (based on most current information)
Alive
Deceased
Miscellaneous
If you would like to attach a video/article/press release about this grab, please add link here:
If you attached a link may we share this link online/social media?
Yes
No
Can we contact you?
Yes
No
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Would you like to enter another survey for the same incident?
*
Yes
No
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