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67-Year-Old Volunteer Lieutenant Suffers Sudden Cardiac Death Following Training—Florida

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

F2019-15 Date Released: September 14, 2021

Executive Summary

On May 07, 2019, a 67-year-old volunteer Lieutenant (LT) complained of pain in his pectoralis muscle after completing departmental rapid intervention team training. The LT initially denied that the pain could be related to cardiac issues and refused to be evaluated, but as symptoms of increasing pressure and shortness of breath appeared, the LT agreed to be evaluated by paramedics in the station. The LT was escorted into the station by a fellow firefighter who requested that the paramedics evaluate the LT. The paramedic in the room asked the LT to sit down while he notified dispatch (2125 hours) that there was a walk-in. The LT was now pale and he suffered a syncopal episode within a minute of being seated and had to be lowered to the floor with the help of two other members. Another paramedic entered the room as the firefighter was being lowered to the floor. Paramedics evaluated for a pulse, and finding none, initiated cardiopulmonary resuscitation. After approximately one minute, the LT briefly regained consciousness and fought efforts to provide care. Approximately 30 seconds later, he lost consciousness and had no pulse. The cardiac monitor revealed pulseless electrical activity (PEA). Advanced cardiac life support (ACLS) protocols were continued. The LT was intubated and received cardiac medications, but he never had a shockable rhythm. The LT was transferred to a nearby emergency department where ACLS protocols were continued for approximately 20 minutes to no avail. The LT never regained an organized cardiac rhythm and cardiac ultrasound revealed no cardiac activity. The LT was pronounced dead at 2203 hours.

The Medical Examiner’s report listed the cause of death as “hypertensive atherosclerotic cardiovascular disease”, and offered the opinion that this likely resulted in a myocardial infarction (heart attack). The autopsy found 75% luminal narrowing of the left main artery due to atherosclerotic plaque. There was no intracoronary thrombosis (blood clot) noted. National Institute for Occupational Safety and Health (NIOSH) investigators concluded that the physical activity associated with the training drill triggered a sudden cardiac event in an individual with undiagnosed underlying cardiovascular disease.

Key Recommendations

NIOSH, as a federal agency whose focus is prevention, offers the following recommendations to lower the risk of sudden cardiac events and other incapacitating medical conditions among firefighters at this and other fire departments across the country.

  • Phase in a comprehensive wellness and fitness program for all firefighters.
  • Ensure that all firefighters are aware of the warning signs of a cardiovascular event and the atypical ways it can present.

NIOSH also provides the following as a general recommendation for the fire service:

In addition to fire department fitness-wellness programs and occupational medical exams, firefighters can enhance their heart health and overall health by following a heart-healthy lifestyle away from the firehouse and having regular checkups with their family doctor.


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