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Career Lieutenant Suffers a Sudden Cardiac Event During Fireground Survival Training and Dies 2 days Later-Pennsylvania

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

F2018-16 Date Released: June 30, 2022

Executive Summary

On June 25, 2018, a 62-year-old career Fire Lieutenant (LT) suffered a sudden cardiac event during a training evolution at the fire training center and died 2 days later at the local hospital. The LT was participating in a 3-day International Association of Fire Fighters (IAFF) Fireground Survival Program. He collapsed on the third and final day of training while maneuvering through the entanglement prop of the self-contained-breathing-apparatus (SCBA) maze course. He was wearing full personal protective equipment (PPE) consisting of turnout gear and SCBA. He had exhausted his SCBA’s compressed air and was “filter breathing.” Filter breathing is a term some firefighters use when they disconnect their mask mounted regulator (MMR) and cover the opening with the lower portion of their PPE hood.

The instructor observing the LT from outside of the entanglement box (see Cover Photo) noted he had stopped moving and was not responding to commands. The instructor opened the entanglement prop and removed the LT to the drill room floor for assessment. The LT was unresponsive, and CPR (cardiopulmonary resuscitation) was begun by fire instructors. On-scene fire department paramedics responded with advanced life support and transported the LT to the local hospital’s emergency department. In the emergency department, advance life support measures continued and, although the LT never regained consciousness, his cardiac status improved. He was admitted to the hospital’s intensive care unit where subsequent testing revealed anoxic (without oxygen) brain damage. He was removed from life support and pronounced deceased on June 27, 2018. NIOSH investigators concluded that the exertion associated with the training activity triggered a sudden cardiac event in an individual with underlying cardiovascular disease (CVD). The autopsy report listed the cause of death as “hypertensive cardiovascular disease.”

Contributing Factors

  • Undiagnosed hypertensive CVD
  • Infrequent exercise stress tests (ESTs) for firefighters at risk for CVD
  • Lack of annual medical clearance for unrestricted firefighting duties which includes training involving heavy physical exertion
  • Physically strenuous training.

Key Recommendations

  • Fire departments should provide and require annual medical evaluations for all firefighters
  • Fire department physicians should ensure symptom-limiting ESTs are provided to firefighters at increased risk of CVD
  • Fire department physicians should use the information from the annual medical evaluation to make final medical recommendations regarding medical clearance for unrestricted firefighting duties and participation in physically strenuous training exercises
  • Fire departments should complete annual physical performance evaluations
  • Fire departments should phase in a mandatory comprehensive wellness-fitness program for all firefighters to reduce CVD risk factors and improve cardiovascular capacity.


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