36-Year-Old Probationary Firefighter Suffers Cardiac Arrest After Completing SCBA Drill—Arizona
Death in the Line of Duty…A summary of a NIOSH fire fighter fatality investigation
F2019-04 Date Released: November 1, 2022
On October 17, 2018, a 36-year-old probationary firefighter (PF) participated in a joint multi-agency search and rescue training evolution. The training evolution consisted of searching for a rescue mannequin in a house while wearing full turnouts and self-contained breathing apparatus (SCBA). After successfully completing the evolution, the PF went for a walk. Minutes later, a fellow firefighter noticed the PF sitting in the rear of the cab of one of the fire engines and asked him if everything was ok. The PF responded that he was not feeling well. Concerned about the PF’s health, the firefighter notified the incident commander (IC) who directed a medic/firefighter at the drill to assist with the ill PF. The medic/firefighter spoke with the PF and asked him to step out of the engine so he could assess him. The PF was helped to the ground and placed on his back at which time he became unresponsive. The PF was breathing, had a weak radial pulse and was cold and clammy to the touch. As an IV and oxygen were administered, the PF went into cardiac arrest. Chest compressions and ventilation via bag valve mask (BVM) were initiated. There were no basic life support/advanced life support (BLS/ALS) units on standby during the training exercise so staff called dispatch. A BLS ambulance was closest and arrived approximately 25 minutes later. An automatic external defibrillator (AED) cardiac monitor was placed on the PF. Cardiopulmonary resuscitation (CPR) continued en-route to the hospital where the PF was pronounced dead after approximately two and one-half hours of resuscitation efforts. The death certificate listed the cause of death as coronary artery atherosclerosis with dilated cardiomyopathy and obesity as significant contributing conditions.
NIOSH investigators offer the following recommendations to prevent similar deaths, and to address general health and safety issues among firefighters at this and other fire departments across the country:
- Provide pre-placement and annual medical evaluations consistent with National Fire Protection Association (NFPA) 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments, which include a baseline electrocardiogram (EKG) in all individuals prior to engagement in any strenuous physical activity to rule out any underlying cardiac anomalies.
- Ensure all firefighters are cleared for duty by a healthcare provider knowledgeable about the physical demands of firefighting, the personal protective equipment used by firefighters and the various components consistent with NFPA 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments.
The following recommendations may not have prevented the Probationary Firefighter’s death, but NIOSH investigators include them to address general safety and health issues:
- Fire departments should have ALS with automatic external defibrillators (AEDs) and all ALS-required medications on board during training exercises.
- Implement a mandatory wellness and fitness program for fire department members consistent with NFPA 1583, Standard on Health-Related Fitness Programs for Firefighters, and the International Association of Fire Fighters/ International Association of Fire Chiefs (IAFF/IAFC) Wellness-Fitness Initiative.
- All formal training exercises, especially those involving multiple agencies, should utilize a written Incident Action Plan (IAP).