On June 6, 2008, a 50-year-old male volunteer fire fighter (FF) taught a morning class that consisted of fire suppression topics and personal protective equipment use at the fire training center of a local community college. After lunch, in stressful environmental conditions (i.e., high temperature and high humidity), he stretched 100 feet of uncharged 1½-inch hoseline and prepared the fire engine for the live fire training session. He then led an interior search team during the smoke exercise in the burn building while wearing full bunker gear and his self-contained breathing apparatus (SCBA) on air. After exiting the building and taking a 15-minute break, the FF led the portable fire extinguisher evolution. About halfway through the exercise, the FF complained of not feeling well and took a break in the air-conditioned cab of the fire engine. While the students were performing the next evolution (hose training), the FF remained at the engine and monitored apparatus operation. The FF cancelled the next exercise, the burn box, due to the heat and his not feeling well, but another instructor volunteered to lead this evolution. The FF agreed and stayed with the engine. The training ended at approximately 1530 hours. Shortly after refilling the engine's water tank, the FF collapsed. Despite cardiopulmonary resuscitation (CPR) and advanced life support delivered on scene, in the ambulance, and in the hospital's emergency department, the FF died. The death certificate, completed by the Coroner, listed "sudden death, probable arrhythmia" as the cause of death and "atherosclerotic heart disease, dilated cardiomyopathy, and atrial fibrillation" as underlying causes. The autopsy, completed by the Medical Examiner, listed "congestive heart failure" as the cause of death and "severe coronary atherosclerotic disease and hypertensive heart disease" as contributing factors. Given the FF's underlying atherosclerotic coronary artery disease (CAD), the stressful environmental conditions and the physical stress of performing fire fighting training duties triggered a heart attack or a cardiac arrhythmia, resulting in his sudden cardiac death. The NIOSH investigator offers the following recommendations to address general safety and health issues. Had these recommended measures been in place prior to the FF's collapse, perhaps his sudden cardiac death may have been prevented at this time. 1. Formulate and institute a heat stress program and a rehabilitation (rehab) program in accordance with NFPA 1584, Standard on the Rehabilitation Process for Members During Emergency Operations and Training Exercises. 2. Provide on-scene emergency medical service with advanced life support capability during live fire training. 3. Provide preplacement and annual medical evaluations to fire fighters consistent with National Fire Protection Association (NFPA) 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments, to determine their medical ability to perform duties without presenting a significant risk to the safety and health of themselves or others. 4. Incorporate exercise stress tests following standard medical guidelines into a Fire Department medical evaluation program. 5. Ensure fire fighters are cleared for return to 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. 6. Phase in a comprehensive wellness and fitness program for fire fighters to reduce risk factors for cardiovascular disease and improve cardiovascular capacity. 7. 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. 8. Provide fire fighters with medical clearance to wear a self-contained breathing apparatus (SCBA) as part of a Fire Department medical evaluation program. 9. Conduct annual respirator fit testing.
Region-2; Fire-fighters; Emergency-responders; Cardiovascular-system-disease; Cardiovascular-system-disorders; Cardiovascular-disease; Medical-examinations; Medical-screening; Physical-fitness; Cardiovascular-system; Medical-monitoring; Cardiac-function; Cardiovascular-function; Training; Respiratory-protective-equipment; Personal-protective-equipment; Self-contained-breathing-apparatus; Fire-fighting-equipment