CONTRA COSTA, Calif. — Six months after a scathing internal report undressed a drastically inexperienced fire department and its handling of Contra Costa's worst firefighting tragedy, the fire district has accomplished more than a fifth of an investigation team's 115 recommendations.

The Contra Costa Fire District is working on an additional 49 recommendations, sending firefighters "back to the basics," particularly in structure firefighting, said Assistant Chief Rich Grace.

Grace and his investigators compiled a yearlong, 122-page report, revealing core problems in the fire district that culminated in the death of fire engineer Scott Desmond and Capt. Matt Burton on July 21, 2007. The firefighters tried to rescue Gayle and Delbert Moore from their San Pablo home, but all four died in the blaze.

The report found:

• Mishandling of the initial alarm call and communication obstacles that led to a crucial delay in alerting firefighters.
• Insufficient structure fire training.
• A staff shortage that caused a heroic firefighter to attempt rescuing two people instead of coordinating the fight. As a result, engine crews fought the blaze independently of one another.

Since the report, firefighters have improved equipment, increased training and updated firefighting tactics and policies. However, budget concerns have kept the district from implementing expensive recommendations, particularly adding another firefighter to each engine.

"Everybody in the department on that date kind of recommitted themselves to make sure we operate in a safe manner and make sure folks go home at the end of their shifts," Grace said.

Coordinating training in an area that encompasses most of West Contra Costa County, all of Central County and much of East Contra Costa was a significant roadblock outlined in the report. The district, despite dipping deep into its reserves to bridge a $3.5 million budget deficit this year, added three training captain positions, allowing for weekend and night training. County supervisors also approved a health and safety battalion chief position.

The training has changed, too.

"We initiated a back-to-the-basics training and we focused on structural firefighting," Grace said. A task force is combing through the thick structural firefighting manual to update tactics and policies.

Stressing fundamentals became necessary as retirees streamed out in the past five years. The young, inexperienced rank and file have little hands-on experience fighting building fires.

When Grace was younger, he said he would fight one structure fire a shift. But improvements in building design, sprinklers and communication have led to fewer building blazes. At the same time, improved equipment allows firefighters to go deeper into burning structures, placing them in more danger, and environmental regulations prevent firefighters from practicing with intentionally set blazes.

Most firefighters are eager to get the increased training and reach the department's goals, said Capt. Vince Wells, president of the firefighters' union.

Many fire departments need some remedial structure fire training, Wells said, because since the Sept. 11, 2001, terrorist attacks, fire departments have switched their focus to homeland security issues, paramedic training and capacities other than the direct task of safely putting out fires.

"We've been innovative in learning about those type of things to where basic structure firefighting has been sort of forgotten," he said.

One recommendation that will not be completed in the near future is adding a fourth firefighter to the three-person crews.

"We wanted to make sure it was on our radar even with the recognition there's a huge cost to accomplishing that recommendation," Grace said. "I don't believe we'll move toward that any time soon."

Had a fourth firefighter been on the first engine at the fatal Michele Drive fire, Burton could have stayed outside as incident commander, coordinating the fire attack. Instead, he entered the house with Desmond to search for the couple, passing command to another engine, who missed the call for a change. Without a commander, the fire crews acted independently and the situation spiraled into chaos, according to the report.

The district will look to augment crews at stations with more emergency calls, he said. Station 70, the most active in the district, has a fourth firefighter position funded by the city of San Pablo. Richmond fire, a city agency independent of the county department, now dispatches for Station 70 removing a key delay in routing calls in that area.

One of the most damning failures in the 2007 tragedy was a nearly 10-minute delay from the moment the homeowners' fire alarm alerted their private alarm company to when the first firefighter was dispatched. Two mistakes by the alarm company employee calling a nonemergency line and not making clear that the house was actually burning sent the call plummeting down the priority list, leading to the critical delay and a lesser response. The alarm company actions have also led to two lawsuits by surviving family members against the company.

The district has contacted numerous fire alarm companies to ensure they have the correct emergency line for dispatch. It has also allowed dispatchers to send crews immediately to a reported alarm, rather than calling the house to get confirmation.

A $60,000 Fireman's Fund grant helped the district upgrade its tactical radio traffic equipment. The insurance company also helped the district buy $10,000 thermal imaging cameras for every truck and engine, another recommendation. The equipment enables firefighters to see through smoke inside burning buildings.

Although not much time has passed, Grace said firefighters have done better in fighting structure fires.

"Most definitely people have a heightened awareness to procedures, communications, making sure the (incident commander) does a 360 size-up of a structure," he said.

Departments from across the country and within Contra Costa have requested the report. The Dallas Fire Department plans to use the Michele Drive incident at a training workshop. District officers have sent the report to the San Ramon Valley Fire District and the National Park Service has requested the same assistance.

Contra Costa investigators reviewed other departments' firefighter death reports and found many failing to accomplish recommendations from earlier fatal incidents.

"We wanted to make sure we wouldn't be in that situation," Grace said.

"It's all hands on deck moving forward and always remembering Matt and Scott and their young families they left behind."

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