On December 13, 2004, a 56-year-old male career Fire Chief responded to three fire calls, including two residential and one commercial fire. After the last fire, the Chief returned to the scene to "cordon off" the scene. As he was driving the rescue truck back to the fire station, he suddenly collapsed. The truck left the roadway, struck a culvert, and came to a stop. Witnesses called 911 and removed the Chief from the truck. Despite cardiopulmonary resuscitation (CPR) and advanced life support (ALS) performed by bystanders, crew members, ambulance service paramedics, and hospital emergency department (ED) personnel, the Chief died. The death certificate, completed by the Deputy Coroner, listed "cardiorespiratory arrest" due to "ASCVD" (atherosclerotic cardiovascular disease) as the cause of death. No autopsy was performed. The NIOSH investigator concluded the physical stress of responding to three structure fires, assisting with on-scene operations, and the Chief's underlying atherosclerotic cardiovascular disease all contributed to his sudden cardiac death. NIOSH investigators offer the following recommendations to prevent similar incidents or to address general safety and health issues: 1. Provide pre-placement and annual 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.Consider including exercise stress tests (EST) for male fire fighters over the age of 45 years with two or more risk factors for coronary artery disease (CAD) as part of the annual medical evaluation. 3. Phase in a mandatory wellness/fitness program for fire fighters to reduce risk factors for cardiovascular disease and improve cardiovascular capacity. 4. Ensure that fire fighters are cleared for duty by 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, Standard on Comprehensive Occupational Medicine Program for Fire Departments. 5. Perform an annual physical performance (physical ability) evaluation to ensure fire fighters are physically capable of performing the essential job tasks of structural fire fighting. 6. Use a secondary (technological) test to confirm appropriate placement of the endotracheal (ET) tube during emergency intubations. 7. Perform an autopsy on all on-duty fire fighter fatalities. 8. Provide fire fighters with medical evaluations and clearance to wear self-contained breathing apparatus (SCBA). 9. Consider annual respirator fit testing.
Region-5; Cardiac-function; Cardiovascular-disease; Cardiovascular-function; Cardiovascular-system-disease; Cardiovascular-system-disorders; Fire-fighters; Medical-examinations; Medical-screening; Heart; Physical-stress; Physical-fitness; Emergency-responders; Cardiovascular-system; Cardiovascular-system-disorders; Medical-monitoring