Fire Crew Supervisor Suffers Sudden Cardiac Death During Pack Test – Wyoming
Death in the Line of Duty…A summary of a NIOSH fire fighter fatality investigation
F2014-13 Date Released: December 2014
On May 17, 2014, a 63-year-old male career wildland fire crew supervisor (“Supervisor”) performed the U.S. Forest Service arduous duty work capacity test (WCT) (commonly known as the pack test) to obtain his “red card,” certifying him to fight wildland fires on state property. The pack test requires an individual to complete a 3-mile walk within 45 minutes while wearing a 45-pound weighted vest. After four laps around the track (about 1 mile), the Supervisor grabbed his left leg and collapsed. Crew members found him unresponsive, not breathing, and with a weak pulse. A few seconds later his pulse stopped. Cardiopulmonary resuscitation (CPR) was begun, and an ambulance was requested. A weak pulse and breathing returned briefly as an automated external defibrillator (AED) was retrieved from the vehicle of a responding police officer. The AED was nonfunctional, so a second AED was brought to the scene by the local fire department approximately 2 minutes later. One shock was delivered without any change in the Supervisor’s clinical status. The ambulance arrived at 0826 hours, and ambulance service paramedics provided advanced life support (ALS), which included defibrillation, intubation, and intraosseous line placement. Two additional shocks were administered during transport to the hospital’s emergency department (ED), again with no change in the Supervisor’s clinical status. CPR and ALS continued for an additional 11 minutes in the ED. Despite CPR and ALS performed on the scene, en route to the ED, and inside the ED, the Supervisor was pronounced dead. The death certificate, completed by the county medical examiner, listed “acute myocardial infarction” due to “hypertension, type II diabetes mellitus, and morbid obesity” as the cause of death. No autopsy was performed. Given the Supervisor’s underlying undiagnosed atherosclerotic coronary heart disease (CHD), the NIOSH investigators concluded the physical exertion associated with the pack test triggered a probable acute myocardial infarction (heart attack) and his sudden cardiac death.
NIOSH investigators offer the following recommendations to reduce the risk of heart attacks and sudden cardiac arrest among fire fighters at this and other wildland fire fighting agencies.
Require completion of a health screen questionnaire (HSQ) prior to participating in the WCT.
Require exercise stress tests for fire fighters at increased risk for CHD.
Restrict fire fighters with medical conditions that have an increased risk of sudden incapacitation (e.g., cardiac arrest) as detailed in NFPA 1582.
Check WCT participants’ vital signs before and after testing.
Phase in a mandatory comprehensive wellness and fitness program for fire fighters.
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.