On February 6, 2005, a 31-year-old male volunteer Fire Fighter (FF) responded to his station during a 911 call for smoke in the basement of a residence. After arriving at his fire station, he waited for a volunteer driver/operator to drive the engine to the scene. In the meantime the First Assistant Chief (FAC) responded directly to the scene and determined that an over-tightened steam valve had caused the problem. He notified Dispatch to hold all equipment in station. The FF, hearing the message over the radio, apparently began to leave the station and walk toward his vehicle when he suffered an unwitnessed collapse. About 36 minutes later, a civilian driving by the fire station noticed the FF lying just inside the station and notified 911. Despite cardiopulmonary resuscitation (CPR) and advanced life support (ALS) performed by ambulance paramedics and hospital emergency department (ED) personnel, the FF died. The death certificate and autopsy, completed by the Medical Examiner, listed "acute intoxication by the combined effects of propoxyphene (Darvon) and cyclobenzaprine (Flexeril)" as the cause of death and "hypertension" as another condition. The NIOSH investigator, like the medical examiner, concluded the FF died due to a drug intoxication, but cannot rule out the possibility of a cardiac arrhythmia associated with his hypertensive heart disease and subsequent left ventricular hypertrophy (LVH). NIOSH investigators offer the following recommendations to prevent similar incidents or to address general safety and health issues: 1. Ensure members are knowledgeable of, and comply with, fire department requirements regarding reporting any medical condition that could interfere with their ability to safely perform essential job tasks. 2. Ensure that fire fighters are cleared for duty by a physician knowledgeable about the physical demands of fire fighting, the various components of NFPA 1582, Standard on Comprehensive Occupational Medicine Program for Fire Departments, and the US Department of Transportation (DOT), Physical Qualifications for Drivers. 3. Provide pre-placement and annual medical evaluations to fire fighters in accordance with NFPA 1582 to determine their medical ability to perform duties without presenting a significant risk to the safety and health of themselves or others. 4. Consider conducting exercise stress tests for male fire fighters with two or more risk factors for coronary artery disease. 5. Phase in a mandatory wellness/fitness program for fire fighters to reduce risk factors for cardiovascular disease and improve cardiovascular capacity. 6. 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.
Region-2; Fire-fighters; Emergency-responders; Cardiovascular-disease; Cardiovascular-system-disease; Cardiovascular-system-disorders; Cardiac-function; Cardiovascular-function; Medical-examinations; Medical-screening; Physical-stress; Physical-fitness; Cardiovascular-system; Medical-monitoring; Substance-abuse