47-Year-Old Firefighter Suffers Cardiac Arrest at Gym After Shift—Massachusetts
Death in the Line of Duty…A summary of a NIOSH fire fighter fatality investigation
F2018-01 Date Released: February 11, 2019
On March 30, 2017, at approximately 1100 hours a 47-year-old male career firefighter (FF) went to a cross training gym for a workout a few hours after completing a 24-hour shift. It was a light-recovery day workout, and after one set of three exercises, he suddenly collapsed. Bystanders on scene initiated cardiopulmonary resuscitation (CPR) and delivered one shock as advised by an automated external defibrillator (AED). An ambulance was dispatched at 1136 hours and arrived on scene at 1141 hours. Emergency medical services (EMS) staff initiated advanced cardiac life support, which was continued en route to the hospital emergency department (ED). Hospital ED personnel continued resuscitation efforts unsuccessfully for approximately 15 minutes. The FF was pronounced dead at 1220 hours.
The Medical Examiner’s report listed the FF’s cause of death as hypertensive cardiovascular disease. The autopsy report found an enlarged heart (weight of 470 grams) and no significant atherosclerosis. National Institute for Occupational Safety and Health (NIOSH) investigators concluded that given the evidence of an enlarged heart, the physical exertion of his workout may have triggered a cardiac arrest.
Regarding cardiovascular risk factors, the FF was male and older than 45 (two non-modifiable risks), but was a nonsmoker and very physically fit. The fire department does not require annual medical evaluations and NIOSH investigators did not have access to private physician records, so it is unknown if the FF had been diagnosed with hypertension or had other cardiovascular disease risk factors.
NIOSH offers the following recommendations to help reduce the risk of sudden cardiac events among firefighters at this and other fire departments across the country.
- Ensure that all firefighters receive an annual medical evaluation consistent with National Fire Protection Association (NFPA) 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments
- Ensure firefighters are cleared for duty by a physician knowledgeable about the physical demands of firefighting, the personal protective equipment used by firefighters, and the various components of NFPA 1582
- Phase in a mandatory comprehensive wellness and fitness program for firefighters
- Perform an annual physical performance evaluation (physical ability test)
- Provide annual medical clearance for self-contained breathing apparatus (SCBA) use