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34-Year-Old Assistant Fire Chief Suffers Heart Attack At a Motor Vehicle Accident Scene—Maryland

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

F2019-17 Date Released: November 1, 2022

Executive Summary

On September 1, 2018, a 34-year-old male volunteer Assistant Chief (AC) had a heart attack after performing a difficult extrication at the scene of a motor vehicle accident. Just as the AC finished the extrication and was about to enter an air-conditioned vehicle and rehydrate, he began experiencing chest pain and nausea. An ambulance that had been dispatched to the accident scene was redirected to care for the AC. An electrocardiogram (ECG) revealed the AC was having a myocardial infarction (heart attack). The AC went into cardiac arrest en route to the hospital emergency department (ED). The AC was taken emergently to the catheterizaiton laboratory but he did not survive.

The Medical Examiner’s report listed the cause of death as acute cardiac arrest with hypertensive atherosclerotic cardiovascular disease. Diabetes mellitus was listed as a contributing factor. The autopsy report noted anatomical changes consistent with chronic hypertension (heart weight was greater than predicted for age and gender and thickening of the left ventricle wall). Evidence of chronic atherosclerosis was evident with 75% narrowing of several coronary arteries. The heart also showed evidence of previous myocardial damage. The National Institute for Occupational Safety and Health (NIOSH) investigators concluded that the strenuous rescue work triggered a myocardial infarction in an individual with severe underlying atherosclerotic and hypertensive heart disease.

Key Recommendations

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.
  • Consider incident scene rehabilitation (rehab) during rescue operations as dictated by weather conditions and the work performed.
  • Phase in a comprehensive wellness and fitness program for firefighters.

Read the full report