Fire Fighter Suffers Sudden Cardiac Death at Structure Fire – West Virginia
Death in the Line of Duty…A summary of a NIOSH fire fighter fatality investigation
F2014-01 Date Released: July 2014
On June 24, 2013, a 62-year-old male volunteer fire fighter (“FF”) responded on a mutual aid call to a mobile home fire at 1418 hours. Responding in the fire department’s engine, the FF arrived on scene at approximately 1500 hours. After trying to remove large debris near the trailer, he became lightheaded and rested in the shade. Paramedics assigned to rehabilitation responded and helped the FF walk to the rehab area. As the FF arrived at rehab he lost consciousness and went into cardiac arrest. Cardiopulmonary resuscitation (CPR) and advanced life support (ALS), including cardiac monitoring, multiple defibrillation attempts, ventilation, and intravenous line placement, began immediately. Despite CPR and ALS for over an hour on the scene, in transport, and at the hospital, the FF died. The death certificate, completed by the state first deputy chief medical examiner listed “sudden death due to ischemic heart disease” as the cause of death. The autopsy report, also completed by the state first deputy chief medical examiner, listed “likely fatal irregularity of the heartbeat occurring in the setting of severe coronary artery disease of the heart with contributory pathologic enlargement of the heart muscle due to long-standing high blood pressure” as the cause of death. Given the FF’s underlying cardiovascular disease, NIOSH investigators concluded that responding to the structure fire and the physical exertion of trying to pull heavy debris away from the structure could have triggered a fatal cardiac arrhythmia.
The first three recommendations may have prevented the FF’s death. The remaining recommendations address general safety and health issues.
- Provide preplacement and annual medical evaluations to all fire fighters in accordance with NFPA 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments, to identify fire fighters at increased risk for coronary heart disease (CHD).
- Ensure exercise stress tests are performed on fire fighters at increased risk for CHD.
- 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.
- Phase in a mandatory comprehensive wellness and fitness program for fire fighters.
- Perform a candidate and an annual physical performance (physical ability) evaluation for all members.
- Provide fire fighters with medical clearance to wear a self-contained breathing apparatus (SCBA) as part of the fire department’s medical evaluation program.
- Conduct annual respirator fit testing.
The National Institute for Occupational Safety and Health (NIOSH), an institute within the Centers for Disease Control and Prevention (CDC), is the federal agency responsible for conducting research and making recommendations for the prevention of work-related injury and illness. In 1998, Congress appropriated funds to NIOSH to conduct a fire fighter initiative that resulted in the NIOSH Fire Fighter Fatality Investigation and Prevention Program which examines line-of-duty-deaths or on duty deaths of fire fighters to assist fire departments, fire fighters, the fire service and others to prevent similar fire fighter deaths in the future. The agency does not enforce compliance with State or Federal occupational safety and health standards and does not determine fault or assign blame. Participation of fire departments and individuals in NIOSH investigations is voluntary. Under its program, NIOSH investigators interview persons with knowledge of the incident who agree to be interviewed and review available records to develop a description of the conditions and circumstances leading to the death(s). Interviewees are not asked to sign sworn statements and interviews are not recorded. The agency’s reports do not name the victim, the fire department or those interviewed. The NIOSH report’s summary of the conditions and circumstances surrounding the fatality is intended to provide context to the agency’s recommendations and is not intended to be definitive for purposes of determining any claim or benefit.