On August 5, 1999, two career fire fighters were struck by a motor vehicle on a wet and busy interstate. One 42-year-old male fire fighter (the victim) was killed, and a 41-year-old male fire fighter was seriously injured. Ladder 2 (Captain and two fire fighters) and Squad 2 (two fire fighters, one of which was the victim) responded to a single motor vehicle crash (car #1) that had occurred on an interstate highway. After arriving on scene, the driver of Ladder 2 parked near the median wall approximately 150 yards directly behind Squad 2 with the emergency lights turned on and operating, providing protection from oncoming traffic for both the occupant of the initial motor vehicle crash and Squad 2 personnel. Approximately 2-3 minutes after arriving on scene, Ladder 2 was hit from behind by a motor vehicle (car #2). The personnel from Ladder 2, along with the victim from Squad 2, attended to the injuries of the driver from car #2 that hit Ladder 2. While the fire fighters attended to the injuries of the driver, the Captain from Ladder 2 attempted to flag traffic away from car #2 and the Ladder truck. At this time the fire fighter from Squad 2, who was directing traffic near car #1, noticed a car cresting the top of the overpass (note: the overpass has an elevation change which makes it similar to a hill with both sides having a slope), on the inside lane, and was rapidly approaching Ladder 2. He yelled out two warnings over the radio "Ladder 2 Captain, watch out behind you" as the car lost control. As the fire fighter from Ladder 2 and the victim from Squad 2 were attempting to move the injured driver from car #2 to a safer area between the wall and Ladder 2, the car (#3), which was out of control, spun backward. While traveling backward, the car impacted the median wall (approximately 20 yards east of Ladder 2), sliding between the wall and Ladder 2, missing the Captain and one of the fire fighters from Ladder 2, before striking the other two fire fighters and the injured driver from car #2. The two fire fighters and the injured driver were thrown approximately 47 feet from the point of impact, killing the fire fighter from Squad 2 and seriously injuring both the fire fighter from Ladder 2 and the driver from car #2. NIOSH investigators conclude that, to minimize the risk of similar occurrences, fire departments should: Establish and implement standard operating procedures (SOPs) regarding emergency operations for highway incidents. Ensure that the fire apparatus is positioned to take advantage of topography and weather conditions (uphill and upwind) and to protect fire fighters from traffic. Ensure that fire fighters responding to a scene involving a highway incident or fire must first control the oncoming vehicles before safely turning their attention to the emergency in the event police have not arrived. Ensure that personnel position themselves and any victim(s) in a secure area when it is impossible to protect the incident scene from immediate danger. Additionally, other agencies, such as the Department of Highways (DOH) should consider: The use of a "changeable message sign" to inform motorists of hazardous road conditions or vehicular accidents.