Fire crews in and around Edinburgh need to do more to stem the area's casualty rate, which is the highest in Scotland, officials have warned.
A report by the Accounts Commission, which monitors public spending, found "no evidence" Lothian and Borders Fire and Rescue had analysed why casualties were so high.
There are four casualties for every 10,000 people in the area, one-third higher than both the national average and Scotland's largest fire service in Strathclyde, and four times higher than Dumfries and Galloway. Overall, the report found "an effective service with a clear strategic vision" but said the fatal and non-fatal casualty rate is "a significant concern".
The report said: "Although the absolute numbers are not high, the relative level of casualties compared to other services is high. While the high number of houses of multiple-occupancy is likely to be a factor, the service has not identified the under- lying reason for this high level of casualties and has not been able to target preventative work accordingly."
It added: "The service needs to do more to use information about incidents to identify common factors and use this to target preventative work."
Half of Scotland's houses of multiple-occupancy, widely recognised as high-risk properties, are within the Lothian and Borders area, and more than half of the area's 950,000 population live in Edinburgh.
Despite a steady fall in incidents, casualty rates have been consistently above national levels for many years.
The report continued: "This is a significant concern and there is no evidence that the service has analysed why the level of casualties in the area is relatively high. Members have not been provided with comparative information on this issue and have consequently not challenged the service.
"The service needs to consider how it can use data on incidents and casualties to identify common factors so it can target preventative work."
The Accounts Commission said Lothian and Borders must "review the factors contributing to the service having a higher proportion of casualties than other services, using the range of information available within the service and from partners to identify issues that can be targeted through partnership working and prevention activity".
The commission found "a heightened focus on health and safety of firefighters" following the death of firefighter Ewan Williamson in 2009. The 35-year-old died as he helped to rescue 20 people at a blaze in the Balmoral Bar in Edinburgh.
However, it also highlighted "concern" about high levels of sickness absence and said the service needs to invest more resources in the development of retained firefighters.
The service has a "strong approach" to financial management but improvements need to be made in management of its assets and equipment, the commission found. Workforce planning has "some strengths" and the service has a "clear focus" on preventative work and community engagement, most notably with young people.
The Fire and Rescue Board has "good self-awareness" but it should strengthen its scrutiny of the service, which should be supported by better performance information.
Chair of the Accounts Commission, John Baillie, said: "Lothian and Borders Fire and Rescue provides an effective service with a clear strategic vision supported by good planning for matching its resources to levels of risk.
"It needs to do more to establish the reasons behind the relatively high casualty rate in the region."
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