On February 23, 2004, a 55-year-old male volunteer fire fighter (FF) responded to a car fire in the garage of a residential home. Traveling in his personal vehicle, he was the first FF to arrive on-scene. While putting on his turnout gear and waiting for fire department (FD) apparatus to arrive, he watched as the fire spread to involve the entire garage and portions of the house. As other FD personnel and equipment arrived, the FF assisted the driver/operator of the first FD engine on the scene. This involved stretching a 1½-inch attack line and a 5-inch hydrant supply line while controlling water flow to the attack lines. After being on-scene for approximately 5 to 10 minutes he was asked to retrieve a pike pole from the Engine. While standing on the engine's tail board to reach the pike pole, the FF suddenly fell backward and struck his head on the concrete roadway. Witnesses stated that he did not slip or try to break his fall. They immediately assessed the FF and found him unresponsive with labored respirations and a weak pulse. While an ambulance was being requested from dispatch, other FD members retrieved the advanced life support (ALS) equipment from on-scene apparatus while another protected his cervical spine. Ambulance personnel arrived approximately 4 minutes after his collapse, and found the FF to be in ventricular fibrillation (a heart rate incompatible with life). Despite defibrillation numerous times at the scene, in the ambulance, and at the emergency department (ED), resuscitation efforts failed to revive the FF. The death certificate and autopsy, both completed by a forensic pathologist (the deputy county coroner), listed "arteriosclerotic and hypertensive heart disease" as the immediate cause of death with "morbid obesity" as a contributory condition. The physical stress of responding to the residential house fire and assisting with operator duties coupled with his underlying atherosclerotic coronary artery disease contributed to this fire fighter's sudden cardiac death. The first five recommendations are preventive measures recommended by other fire service groups to reduce, among other things, the risk of on-the-job heart attacks and sudden cardiac arrest among fire fighters. The last two recommendations, while only indirectly related to this fatality, raise potential safety issues that may be encountered by this FD. 1. Provide mandatory preplacement medical evaluations to ALL fire fighters to determine their medical ability to perform duties without presenting a significant risk to the safety and health of themselves or others. 2. Provide annual medical evaluations for all members. 3. When appropriate, incorporate exercise stress tests (EST) into the annual medical evaluations for fire fighters with multiple risk factors for coronary artery disease (CAD). 4. Clear fire fighters for duty and for respirator use though a physician knowledgeable about the physical demands of fire fighting, the personal protective equipment used by fire fighters, and the various components of NFPA 1582, the National Fire Protection Association's Standard on Comprehensive Occupational Medical Program for Fire Departments. 5. Phase in a mandatory wellness/fitness program for fire fighters to reduce risk factors for cardiovascular disease and improve cardiovascular capacity. 6. Consider annual respirator fit testing. 7. Provide adequate fire fighter staffing to ensure safe operating conditions.
Region-5; Cardiovascular-system-disease; Heart; Physical-stress; Physical-fitness; Fire-fighters; Emergency-responders; Medical-screening; Cardiovascular-disease; Cardiovascular-function; Cardiovascular-system; Cardiovascular-system-disorders; Medical-examinations; Medical-monitoring; Medical-screening