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54-Year-Old Firefighter Suffers Carbon Monoxide Toxicity and Cardiac Event During Overhaul – Massachusetts


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

F2018-02 Date Released: January 25, 2019

Executive Summary

On March 17, 2017, at 1020 hours a 54-year-old male career firefighter (FF) responded to a structure fire in a 2½-story single family home. The FF coordinated interior attack operations, gave an in-person report to the Incident Commander, changed his air bottle, and returned to the interior to assist with overhaul. At 1041 hours, the FF collapsed while performing overhaul. Fellow firefighters immediately removed him from the fire room, transported him down stairs, and lifted him onto a stretcher that was brought to the front of the house. Firefighters initiated cardiopulmonary resuscitation (CPR) as the stretcher was wheeled to the ambulance. Paramedics provided advanced life support (ALS) protocols en route to the hospital, including cardiac medication and multiple defibrillations. The ambulance arrived at the hospital emergency department (ED) at 1058 hours. Hospital ED personnel continued resuscitation efforts unsuccessfully for approximately 30 minutes. The FF was pronounced dead on March 17, 2017, at 1126 hours.
The Medical Examiner’s report and death certificate listed “carbon monoxide toxicity in a person with hypertensive and atherosclerotic cardiovascular disease” as the immediate cause of death. NIOSH concludes that the physical exertion associated with firefighting and the elevated levels of carbon monoxide (CO) in the presence of severe underlying cardiovascular disease likely triggered an arrhythmia in this FF.

Key Recommendations

  • 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 (physical ability) evaluation.
  • Provide annual medical clearance for self-contained breathing apparatus (SCBA) use.
  • Ensure firefighters wear SCBA when working in a potentially hazardous atmosphere.


Read the full report