Firefighter Dies from Exercise Induced Pulmonary Hemorrhage During Physical Fitness Training–Texas

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

F2021-01 Date Released: January 26, 2022

Executive Summary

On April 21, 2020, a 43-year-old male career fire engine operator (FEO) died during a physical fitness training run while on-duty. The engine company consisted of a four-person crew, including a lieutenant (LT), the FEO and two firefighters. On the day of the incident, the FEO arrived at his regular single engine company fire station. The crew began their shift by conducting ladder inspections and training, followed by flushing the engine pump just prior to dinner. At approximately 1830 hours, the crew began physical fitness training that included weight training, pull-ups, stationary bicycling, and running.

As the crew participated in various types of physical fitness training at the station, the FEO chose to run several laps around the fire station neighborhood by himself. Crew members stated that was a change for the FEO, as he normally chose weightlifting and did not typically run for his physical fitness training.

As the LT was doing his own workout, he could see the FEO outside as he passed the fire station. After a few laps the LT noticed the FEO had not passed the fire station as he expected, so he looked down the street and witnessed the FEO fall to the ground. The LT called for the two firefighters working out to assist checking on the FEO. They found him unresponsive with his jaw clenched and arms in rigid extension. The LT immediately called fire dispatch at approximately 1915 and requested an ambulance for a “firefighter down.” The transporting ambulance arrived at 1917 hours and assisted the station crew initiate advanced life support (ALS). ALS efforts were continued en-route to the nearest hospital, located two blocks away. On arrival to the Emergency Department, the FEO became pulseless. Resuscitation efforts were continued but were unsuccessful and the FEO was pronounced dead at 1952 hours. The autopsy revealed the cause of death to be exercised induced pulmonary hemorrhage (EIPH).

Key Recommendations

NIOSH investigators offer the following recommendations to prevent similar fatal events, and to address general health and safety issues among firefighters at this and other fire departments across the country.

Key Recommendation 1: Consider including information on training intensity and EIPH on physical fitness training materials

Key Recommendation 2: Provide annual medical evaluations consistent with National Fire Protection Association (NFPA) 1582 Standard on Comprehensive Occupational Medical Program for Fire Departments, which includes an evaluation of aerobic capacity in all individuals prior to engagement in any strenuous physical activity by conducting an exercise stress test [NFPA 2018].

Key Recommendation 3: Implement a mandatory wellness and fitness program for fire department members consistent with NFPA 1583 Standard on Health-Related Fitness Programs for Fire Departments Members and the IAFF/IAFC Wellness-Fitness Initiative, which includes determining intensity of exercise [IAFF/IAFC 2018; NFPA 2015].

Key Recommendation 4: Consider methods to stay in communication during physical exercise such as carrying a department radio or exercising in pairs when possible.

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Page last reviewed: May 18, 2022