Senior Captain Suffers Sudden Cardiac Death During Training – Alaska
Death in the Line of Duty…A summary of a NIOSH fire fighter fatality investigation
F2014-10 Date Released: August 2014
On March 7, 2014, a 51-year-old male career fire department captain (“Captain”) participated in his fire department’s rules of air management training. Wearing his bunker gear and self-contained breathing apparatus (SCBA), and carrying a 50-foot section of 2½-inch hoseline, the Captain and his team climbed the stairs of the drill tower to the fifth floor and returned to the ground floor. Per department protocol, the Captain repeated the tower climb with his group. Approximately 30 seconds after completing the second climb, the Captain collapsed. A nearby fire department member immediately responded and found the Captain unresponsive but with a pulse and breathing rapidly. An engine company and an ambulance response were requested via fire department radio by the member as the Captain was carried into a nearby fire apparatus bay. Cardiac monitoring in the bay revealed ventricular tachycardia (a heart rhythm incompatible with life), and cardiopulmonary resuscitation (CPR) and advanced life support (ALS) were begun. These procedures included defibrillation, delivery of cardiac resuscitation medications via the intraosseous route, and oxygen administration via bag-valve-mask. En route to the hospital’s emergency department (ED), the Captain was shocked four times; the Captain’s pulse returned briefly but he never regained consciousness. Inside the ED, the Captain was intubated (placement confirmed by capnography [Neumar et al. 2010]), and an electrocardiogram (EKG) revealed tracings consistent with a heart attack. The Captain was taken to the cardiac catheterization lab at 1224 hours; the procedure was complicated by intermittent cardiac arrest requiring CPR and ALS. The cardiologist found a 95% blockage of the Captain’s proximal left anterior descending (LAD) coronary artery, but no obvious thrombus. Percutaneous transluminal coronary angioplasty successfully opened the blockage, and a stent was placed to keep the artery open. The Captain was never able to sustain a viable heart rhythm, pulse, or blood pressure despite the placement of a pacemaker and an intra-aortic balloon pump and extensive use of cardiac resuscitation medications. After approximately 2.5 hours of intermittent ALS and CPR, the Captain was pronounced dead (1445 hours), and resuscitation efforts were discontinued.
The death certificate and the autopsy report, completed by the state medical examiner, listed “hypertensive and atherosclerotic cardiovascular disease” as the cause of death. Given the Captain’s previously unidentified coronary heart disease (CHD), NIOSH investigators concluded that the physical stress of the training probably triggered a fatal heart attack.
NIOSH offers the following recommendations to reduce the risk of heart attacks and sudden cardiac arrest among fire fighters at this and other fire departments across the country.
- Conduct exercise stress tests as part of the fire department medical evaluation program for fire fighters at increased risk for CHD.
- 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.
- Phase in a mandatory comprehensive wellness and fitness program for fire fighters.
The following recommendations would not have prevented the Captain’s death, but NIOSH investigators include them to address general safety and health issues.
- Include medical monitoring in rehabilitation programs.
- Perform an annual physical performance (physical ability) evaluation for all members.
- Discontinue routine screening chest x-rays for members unless clinically indicated.
- Discontinue preplacement and routine screening lumbar spine x-rays unless clinically indicated.
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.