Firefighter Suffers Fatal Heart Attack While Providing Emergency Medical Services – Washington
Death in the Line of Duty…A summary of a NIOSH fire fighter fatality investigation
F2014-16 Date Released: December 2014
On May 14, 2013 at 0700 hours, a 59-year-old male career firefighter (FF) began his 24-hour shift on Ladder 2 (L-2). At 0917 hours L-2 was dispatched to its second medical call of the morning and arrived on scene at 0922 hours. The FF carried two bags of medical equipment up to the second floor and down a long hallway (about 225 feet) to the patient’s apartment. The medical bags weighed approximately 25 to 35 pounds each. As the FF positioned the patient’s airway, the FF stated he did not feel well. The FF continued to assist the patient, who weighed between 300 and 400 pounds, by lifting him from his motorized wheelchair to the floor. After struggling to get the wheelchair out of the room to give the paramedics room to work, the FF stated he was not doing well (0959 hours). L-2’s Driver asked one of the paramedics to evaluate the FF and requested a second ambulance from dispatch. Minutes later, the FF had a cardiac arrest.
Advanced life support (ALS) and cardiopulmonary resuscitation (CPR) were immediately initiated. The FF was loaded into the ambulance at 1004 hours and arrived at the emergency department (ED) at 1008 hours with CPR and ALS in progress. After receiving an oral aspirin on scene and intravenous antithrombus medication in the ED, he was taken emergently to the cardiac catheterization lab where a thrombus in his left main coronary artery confirmed the diagnosis of an acute heart attack. Despite the successful opening of the left main and left anterior descending coronary arteries, the FF died in the cath lab. Both the death certificate and post-mortem examination report were completed by the County Medical Examiners Office which listed “ischemic heart disease” as the cause of death. Given the FF’s undiagnosed underlying coronary heart disease (CHD), the National Institute for Occupational Safety and Health (NIOSH) investigator concluded that the alarm response and the physical exertion associated with carrying the medical equipment and moving the patient and his wheelchair triggered a heart attack resulting in the FF’s sudden cardiac death.
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 (FD) across the country.
Require preplacement and annual medical evaluations to identify fire fighters with CHD risk factors.
Perform symptom-limiting exercise stress tests (ESTs) on firefighters at increased risk for CHD and sudden cardiac events.
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 components of National Fire Protection Association (NFPA) 1582.
Phase in a mandatory comprehensive wellness and fitness program for fire fighters.
The following recommendations would not have prevented the FF’s death, but NIOSH investigators include them to address general safety and health issues.
Develop and conduct annual physical performance (physical ability) evaluations for all members.
Ensure staffing levels consistent with NFPA 1710.
Discontinue routine screening chest x-rays for candidates, unless clinically indicated.
Discontinue routine screening lumbar sacral spine x-rays for candidates, 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.