In the US, specific dangers in firefighter safety, health and survival have been designated the "big three" threats to North American firefighters.

Emergency driving incidents, heart disease and risk management failures at callouts are the three top killers of fire personnel.

The targets
- Safety: to improve firefighters safety during emergency driving, focus must be placed vehicle priority allocation on callout to help avoid crashes involving fire service vehicles.

- Health: with heart disease the highest ranked killer of US firefighters, more effort must be put into fitness and nutrition programs.

- Survival: risk management strategies, particularly structural and situational awareness at emergency scenes need attention. For example, a 360 degree walk around - examining every side of a burning building -  before entering is key.

The U.S. Fire Administration says that in 2008, 114 firefighters died across the country; 40 per cent were caused by heart attacks. Up to the end of May this year, 40 firefighter deaths have been reported, with 43 per cent  the result of heart attacks.