Synopsis
Brief Synopsis
A firefighter (Ff) died due to the injuries sustained following a fall from a ladder (House & Settle, 2016).
It is understood that the retained duty system (RDS) Ff fell approximately 20 ft from the top section of the ladder when it ‘telescoped’ into the main section. He died after reaching hospital a short time later. It was suggested from Unknown Author, 1956, that the pawls of the ladder might not have been engaged properly. An Assistant Divisional Officer (ADO) from the service was said to have ‘tested the ladder after the accident and found it in perfect working condition’ (Unknown Author, 1956).
A verdict of Misadventure was recorded on the following day. According to the jury statement, the pawls of the ladder may not have been engaged properly allowing the extended part of the ladder to drop from its fixed position. According to the Sub-Officer (SubO) at the time, the incident took place whilst carrying out a ladder drill up against the local library. Three Ff were involved in the drill. One Ff footed the ladder; another extended the ladder using the extension mechanism, and a third climbed the ladder. As the third Ff climbed on the extended part of the ladder he became out of direct sight of the Ff on the ground. At this point a scrapping sound could be heard against the wall. The second Ff looked up to see the Ff who was up the ladder fall to the ground (Unknown author 2, 1956).
The injured Ff was taken to Hospital via fire appliance. The injured Ff later died in hospital due to injuries sustained in the fall. It was responsibility of the Ff extending the ladder to acknowledge that the pawls were seated correctly in their position. However, it was also the responsibility of the Ff climbing the ladder to ensure that the pawls were engaged properly as they pass them, according to Brigade orders (Unknown author 2, 1956).
Further information hoping to be identified and still to be located.
Main findings, key lessons & areas for learning
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Fire & Rescue Service summary of main findings, conclusions, key lessons & recommendations
According to information received in the inquest, during the standard ladder drill it was responsibility of the Firefighter extending the ladder to acknowledge that the pawls were seated correctly in their position. However, it was also the responsibility of the Firefighter climbing the ladder to ensure that the pawls were engaged properly as they pass them, according to Brigade orders at that time (Unknown author 2, 1956).
According to the Assistant Divisional Officer, the ladder was found to be in perfect working order. Brigade records showed that the ladder had received a monthly check a week previously and there was no sign of a fault with the ladder then (Unknown author 2, 1956).
As there were adequate procedures in place and no fault with the ladder could be found it was decided that the death was an accident. The verdict concluded that the death was caused by Misadventure, (Unknown author, 1956).
Current service orders in accordance with Health and Safety dictate the use of commands and safe systems of work which identify the correct operation of pawls systems whilst extending a ladder during both, training and operational situations (LFRS Service order – Equip 13, adders).
In addition adequate maintenance schedules and daily equipment checks are used to ensure the condition of that piece of equipment prior to use (LFRS Service order – Equip 13, adders).
Further information hoping to be identified and still to be located.
FBU summary of main findings, conclusions, key lessons & recommendations
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Other report summary of main findings, conclusions, key lessons &recommendations
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IFE Commentary & lessons if applicable
None produced at this time.
Known available source documents
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FRS Incident Report/s
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FBU Incident Report/s
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Health & Safety Executive (HSE) Incident Report/s and/or improvement notices
No information identified to date and/or still to be located.
Lancashire Constabulary Incident Report/s
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North West Ambulance Service Incident Report
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Building Research Establishment (BRE) Reports/investigations/research
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Coroner’s report/s and/or Rule 43 and/or Regulation 28 Notices etc
According to the Corner, ‘there were two questions to consider. Either the ladder had not been properly extended or it was defective in some way’. ‘Had there been no regulations in place to ensure that the Firefighter climbing the ladder checks the pawls, there would grounds to investigate further’ (Unknown author 2, 1956).
Further information hoping to be identified and still to be located.
Dear Chief Officer Letters (DCOL), FRS Circulars, FRS Notices and/or Bulletins etc
No information identified to date and/or still to be located.
Notifications from National Operational Learning User Group (NOLUG) and/or Joint Emergency Services Interoperability Principles (JESIP)
No information identified to date and/or still to be located.
Other information sources
House, A. & Settle, P. et al. (2016). The firefighter memorial trust book of remembrance [online]. Available at. http://www.theonlinebookcompany.com/OnlineBooks/FirefighterMemorialTrust/Content/Filler [Accessed 20th September 2017]. The Firefighters Memorial Trust.
Note. With the above source reference, it is not currently possible to link directly to the relevant page of the memorial book.
Unknown Author. (1956). Retained man dies after drill fall. Fire. (February). Page 427.
Unknown author 2. (1956). Father of four dies after 20ft. fall [online]. Available at; https://www.britishnewspaperarchive.co.uk/search/results/1950-01-01/1999-12-31?basicsearch=fireman%20dies&somesearch=fireman%20dies&country=england&retrievecountrycounts=false&mostspecificlocation=england®ion=north%20west%2c%20england [Accessed 25th April 2018]. British News Paper Archive.
Further information hoping to be identified and still to be located.
Service learning material
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Videos available
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