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Lieutenant Suffers Sudden Cardiac Death During the Pack Test – Arizona


FF ShieldDeath in the Line of Duty…A summary of a NIOSH fire fighter fatality investigation

F2014-12 Date Released: November 2014

Executive Summary

On March 8, 2014, a 61-year-old male paid-call lieutenant (LT) performed the
U. S. Forest Service arduous duty Work Capacity Test (WCT), also known as the “Pack Test.” The test is a required component of “red card certification” allowing wildland firefighters to work on federal property. The Pack Test requires a 3-mile walk within 45 minutes while wearing a 45-pound weighted vest. After completing 6 laps around the track (1.5 miles), the LT stumbled, appeared dizzy, and then collapsed. Crewmembers assessed him and found him unresponsive, not breathing, and without a pulse; they initiated cardiopulmonary resuscitation (CPR) and advanced life support (ALS). Despite CPR and ALS on-scene and in the hospital’s emergency department (ED), the LT could not be revived. The death certificate and the autopsy, completed by the County Medical Examiner, listed “complications of acute myocardial infarct (heart attack)” due to “hypertensive and arteriosclerotic cardiovascular disease” as the cause of death. The LT had a left ventricular rupture and cardiac tamponade. Prior to this incident, the LT was not known to have coronary heart disease (CHD). The NIOSH investigators concluded that the physical stress of the Pack Test probably precipitated his left ventricle rupture in an area weakened by an asymptomatic heart attack occurring approximately 1 week earlier.

It is unclear if any of the following recommendations would have prevented the LT’s death. Nonetheless, NIOSH investigators offer the following recommendations to reduce the risk of heart attacks and sudden cardiac arrest among fire fighters at this and other FDs.

  • Provide preplacement and annual medical evaluations to all fire fighters consistent with NFPA 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments, to identify fire fighters at increased risk for CHD.
  • Perform exercise stress tests on fire fighters at increased risk for CHD.
  • Check Pack Test participants’ vital signs before testing.
  • Require the completion of a Health Screen Questionnaire (HSQ) prior to participating in the Pack Test.

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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.

For further information, visit the program Web site at or call toll free 1-800-CDC-INFO (1-800-232-4636).