This report provides a review of the literature, identifies a number of concerns with the current National Fire Protection Association (NFPA) certification process, and provides details on the feasibility and potential cost to the Federal government of undertaking a program to test and certify personal protective clothing and equipment for firefighters. NIOSH concludes that there is little evidence to support a direct link between inadequacies in testing and certification of firefighter personal protective equipment and firefighter injuries and deaths. While there are some problems with personal protective clothing and equipment, frequently injuries result when some piece of protective gear is not used, or there is improper, or inadequate equipment maintenance. Also, existing NFPA standards for firefighter personal protective clothing and equipment (PPE) are among the most comprehensive set of standards available for protective equipment used by any occupational category. NIOSH recommends that opportunities to strengthen existing testing and certification programs be explored before establishing a new Federal program. NIOSH estimates that it will cost approximately $1.5 million in start up costs and an annual operating budget of approximately $6.0 million to test and certify firefighter and emergency personnel PPE. Estimated program costs include hiring staff with the expertise to conduct these tests, purchasing specialized equipment, and leasing approximately 50,000 square feet of suitable laboratory and office space to conduct the program. NIOSH recognizes that, to date, no systematic study or evaluation of firefighter PPE standards or testing and certification has been undertaken. If desired, a needs assessment could be conducted to systematically evaluate existing standards and testing and certification programs.