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 F2012-11, 2012 Jul; :1-12
On March 4, 2012, a 45-year-old male volunteer fire chief ("the Chief") was dispatched to a residential structure fire. At the scene, the Chief assisted in exterior fire suppression operations for about 30 minutes. Smoke exposure was intermittent, and the Chief did not wear self-contained breathing apparatus (SCBA). The Chief and a crew member suddenly began coughing, became nauseated, and vomited. They took a rest break to drink some water, but both remained nauseated and became dizzy. The on-scene deputy police chief transported both to the hospital's emergency department (ED), where the Chief began complaining of chest pain; an acute heart attack was diagnosed. Despite care in the ED for approximately 75 minutes, the Chief suffered a cardiac arrest and died. Neither the ED nor the medical examiner's office measured carboxyhemoglobin levels to assess carbon monoxide exposure or possible carbon monoxide poisoning. The other crew member was treated for heat illness and released with no complications. The death certificate, completed by the county medical examiner investigator, listed "myocardial infarction" as the cause of death. The autopsy report, completed by the state deputy chief medical examiner, listed "atherosclerotic and hypertensive heart disease" as the cause of death. Given the Chief's long history of underlying coronary heart disease, NIOSH investigators concluded that the physical stress of fire suppression activities triggered his heart attack and subsequent cardiac death. NIOSH investigators offer the following recommendations to address safety and health issues and prevent similar incidents in the future. 1. Measure carboxyhemoglobin levels on symptomatic or unresponsive fire fighters exposed to fire smoke. 2. Provide preplacement and annual medical evaluations to all fire fighters consistent with NFPA 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments. 3. Ensure that 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. 4. Phase in a mandatory comprehensive wellness and fitness program for fire fighters. 5. Perform an annual physical performance (physical ability) evaluation for all members.