Fire Engineer Suffers Sudden Cardiac Death at Shift Change - California
Death in the Line of Duty…A summary of a NIOSH fire fighter fatality investigation
F2015-01 Date Released: June 15, 2015
Executive Summary
On January 20, 2014, a 49-year-old male career Fire Engineer (FE) was scheduled to work his regular 24-hour shift. This would have been his third consecutive 24-hour shift as he volunteered to work a 24-hour overtime shift the day before. During the first 48 hours, the FE responded to seven medical calls, none of which required heavy physical exertion; he did not complain of any symptoms. When the FE did not attend the third shift change meeting (0800 hours), crew members found him unresponsive in his bunk. Advanced life support (ALS) including cardiac defibrillation was performed and the FE was transported to the hospital’s emergency department (ED). Despite cardiopulmonary resuscitation (CPR) and ALS at the scene, in the ambulance, and in the hospital’s ED, the FE died. The death certificate and the autopsy listed “hypertensive cardiovascular disease with marked cardiomegaly” as the cause of death with “mitral valve prolapse, clinical history of hypertension, and left bundle branch block” as significant other conditions. Given the FE’s undiagnosed underlying coronary heart disease (CHD), NIOSH investigators concluded that an arrhythmia probably triggered his sudden cardiac death.
Key Recommendations
- Provide mandatory annual medical evaluations to all fire fighters consistent with the current edition of National Fire Protection Association (NFPA) 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments
- Perform symptom-limiting exercise stress tests for fire fighters at risk for CHD and sudden cardiac events
- Phase in a mandatory comprehensive wellness and fitness program for fire fighters.
- Perform an annual physical performance (physical ability) evaluation for all members
The following recommendations address general safety and health issues:
- Limit the number of consecutive shifts a fire fighter can work
- Discontinue routine screening chest x-rays for members 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.