26-Year-Old Firefighter Dies of Complications from Acute Promyelocytic Leukemia – Connecticut

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

F2021-18 Date Released: December, 2023
Revised February 6, 2024

Executive Summary

On August 10, 2021, a 26-year-old volunteer firefighter (VF) collapsed at the scene of a working building fire. The VF was part a mutual aid engine company working a three-alarm fire in a neighboring town. The VF’s crew had been assigned RIT (Rapid Intervention Team) upon arrival at the incident and were given a staging position, designated as the RIT staging area. Several physical tasks were completed from this position including forcing doors and moving a large diameter hoseline. The crew had returned to the RIT staging area when the VF collapsed onto a kneeling crew member and was assisted to a supine position on the ground. The initial assessment of the VF by crew members revealed the VF was conscious but disoriented. The crew summoned a nearby staged ambulance medical crew for assistance and transport to the emergency department (ED). The VF’s mental status and neurological status deteriorated during transport. Shortly after arrival to the ED, the VF was intubated, and a head CT scan showed a large intracranial bleed. Initial blood tests confirmed the diagnosis of acute promyelocytic leukemia (APL) and associated disseminated intravascular coagulation (DIC), which caused the bleed. The VF underwent an emergency surgery to evacuate the blood and relieve pressure on his brain. Following surgery, the VF was admitted to the intensive care unit (ICU). Despite treatment of the APL and administration of blood products to correct the coagulopathy, he died 2 days later. The cause of death was noted as right heart failure caused by APL and DIC.

Contributing Factors

Gastrointestinal bleeding and prolonged bruising that occurred before the VF’s collapse may have been early signs of the leukemia, which caused his subsequent collapse. Early diagnosis of the APL and initiation of treatment has been shown to improve clinical prognosis and long-term survival.

Key Recommendations

NIOSH offers the following recommendations to reduce the risk of heart attacks and sudden cardiac arrest among firefighters at this and other fire departments across the country.

• Key Recommendation #1: Fire Departments should educate members on the signs and symptoms of leukemia and other cancers with a young adult age of onset.
• Key Recommendation #2: Fire Departments should ensure there is a communication protocol regarding abnormal results of a medical screening examination so that timely follow-up can occur.

Read the full report