The estimated cost of fire in the United States is about $329 billion a year, yet there are gaps in the literature to measure the effectiveness of investment and to allocate resources optimally in fire protection. This article fills these gaps by creating data-driven empirical and theoretical models to study the effectiveness of nationwide fire protection investment in reducing economic and human losses. The regression between investment and loss vulnerability shows high R2 values (≈0.93). This article also contributes to the literature by modeling strategic (national-level or state-level) resource allocation (RA) for fire protection with equity-efficiency trade-off considerations, while existing literature focuses on operational-level RA. This model and its numerical analyses provide techniques and insights to aid the strategic decision-making process. The results from this model are used to calculate fire risk scores for various geographic regions, which can be used as an indicator of fire risk. A case study of federal fire grant allocation is used to validate and show the utility of the optimal RA model. The results also identify potential underinvestment and overinvestment in fire protection in certain regions. This article presents scenarios in which the model presented outperforms the existing RA scheme, when compared in terms of the correlation of resources allocated with actual number of fire incidents. This article provides some novel insights to policymakers and analysts in fire protection and safety that would help in mitigating economic costs and saving lives.

Background Sudden cardiac death accounts for the greatest proportion of duty-related deaths among US firefighters. Increased understanding of the pathoanatomic causes of sudden cardiac death and the risk associated with underlying cardiac pathologies is needed to develop evidence-based screening recommendations. Methods and Results Using autopsy data for duty-related firefighter fatalities occurring between 1999 and 2014, this retrospective case-control study compared cardiac findings of male firefighters aged 18 to 65 years who died on duty of cardiac-related causes with those who died of noncardiac trauma-related causes. Data from 276 cardiac cases and 351 noncardiac trauma controls were analyzed. Among cardiac cases, the most prevalent (82%) underlying pathoanatomic substrate was comorbid coronary heart disease and cardiomegaly/left ventricular hypertrophy. Cardiac cases had a higher prevalence of cardiomegaly (heart weight >450 g), left ventricular hypertrophy (left ventricular wall thickness ≥1.2 cm), and severe coronary artery stenosis (≥75%) than trauma controls (all P<0.001). In multivariate analyses, heart weight >450 g, coronary artery stenosis ≥75%, and evidence of a prior myocardial infarction were strong independent predictors of cardiac death, with odds ratios of 6.1 (95% confidence interval, 3.6-10.4), 9.3 (95% confidence interval, 5.3-16.1), and 6.2 (95% confidence interval, 3.4-11.3), respectively. Conclusions The majority of cardiac fatalities had evidence of both coronary heart disease and increased heart mass, and each condition was independently associated with a markedly elevated risk of cardiac death. Targeted screening for coronary heart disease, increased heart mass, and evidence of prior myocardial infarction should be considered to reduce duty-related cardiac deaths among firefighters.