Cincinnati, OH: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, FACE F2009-27, 2010 May; :1-12
On October 21, 2009, a 54-year-old male career Captain was jogging alone on a paved trail behind his fire station as a component of the Fire Department's (FD) physical fitness program. The Captain was last seen by crew members at approximately 1630 hours. Approximately 35 minutes later, a civilian found the Captain lying on the trail, unresponsive, and not breathing. The civilian called 911, and a police officer was dispatched. Crew members heard the dispatch and responded to the trail. They found the Captain unresponsive, without a pulse, and not breathing. Crew members began cardiopulmonary resuscitation (CPR) while requesting an ambulance. Despite CPR and advanced life support administered on scene, en route to the hospital's emergency department (ED), and in the ED, the Captain died. The autopsy, completed by the medical examiner, listed "severe coronary artery atherosclerosis with acute plaque change: hemorrhage into an atherosclerotic plaque and rupture of the plaque" as the cause of death. Given the Captain's underlying heart disease, NIOSH investigators conclude that the physical stress of jogging probably triggered a fatal heart attack due to the acute plaque rupture of his right coronary artery. The NIOSH investigators offer the following recommendations to address general safety and health issues. Had the first recommended measure been in place prior to the Captain's collapse, perhaps his underlying coronary artery disease would have been identified, he would have been referred for treatment, and his sudden cardiac death may have been prevented. The third recommendation may have hastened emergency treatment after the Captain's collapse. 1. Ensure fire fighters over the age of 45 with two or more risk factors for CAD have a maximal (symptom-limiting) exercise stress test (EST). 2. 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. 3. Ensure on-duty fire fighters exercise in pairs or within viewing distance of another crew member.