On June 8, 2004, a 46-year-old male volunteer Assistant Chief (AC) performed the Walk Test portion of the U.S. Forest Service Work Capacity Test (WCT). The Walk Test requires an individual to complete a 1-mile walk within 16 minutes; the AC completed the walk in approximately 14 minutes. After the test, he told other fire fighters he was short of breath. He drove home and began experiencing heart palpitations and a rapid heart rate. After an hour at home with no symptom abatement, he drove to his fire station in search of an emergency medical technician (EMT) to check his pulse and blood pressure. Upon finding no EMT at the fire station he drove back home approximately 10 minutes later. Shortly after returning home, he collapsed in front of his wife, who called 911. Despite cardiopulmonary resuscitation (CPR) and advanced life support (ALS) performed by crew members, ambulance service EMTs, and paramedics, the AC died. Due to the rural location of the incident, the AC was not transported to a hospital. The Deputy County Coroner pronounced the AC dead at the scene from a "sudden cardiac event" due to "acute coronary thrombosis." The autopsy performed by the State Medical Examiner listed "sudden arrhythmia" as the immediate cause of death and "acute coronary artery thrombosis" as a contributing factor. The NIOSH investigator concluded the physical stress of walking briskly and the AC underlying atherosclerotic CAD contributed to his sudden cardiac death. Recommendations 1-3 below address safety issues unique to this event. Recommendations 4-6 are preventive measures often recommended by fire service groups to reduce the risk of on-the-job heart attacks and sudden cardiac arrest among fire fighters. 1. Check WCT participants' vital signs before and after testing. 2. Use a secondary (technological) test to confirm appropriate placement of the endotracheal (ET) tube during emergency intubations. 3. Modify Section B of the Health Screening Questionnaire (HSQ) in the Administrators Guide for the Work Capacity Test to include all cardiovascular risk factors identified by the American Heart Association/American College of Cardiology (AHA/ACC). 4. Provide pre-placement and periodic medical evaluations to ALL fire fighters consistent with NFPA 1582 or equivalent to determine medical ability to perform duties without presenting a significant risk to the safety and health of themselves or others. 5. Conduct exercise stress tests for male fire fighters above the age of 45 with two or more risk factors for coronary artery disease (CAD). 6. Phase in a mandatory wellness/fitness program for fire fighters to reduce risk factors for cardiovascular disease and improve cardiovascular capacity.
Region-8; 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