Abstract
On June 4, 1999, a 47-year-old male Fire Fighter collapsed in the fire station after 8 hours on duty. Although the victim was dispatched to three calls during his shift, only one of the calls resulted in strenuous activity, and none of the responses involved exposure to hazardous chemicals capable of causing his collapse. After going to bed, the victim collapsed onto the floor and was found in cardiac arrest. Despite cardiopulmonary resuscitation (CPR) administered by fellow crew members and advanced life support (ALS) administered by ambulance service personnel and in the hospital's emergency department, the victim died. The death certificate, completed by the Medical Examiner, listed "hypertensive and atherosclerotic cardiovascular disease" as the immediate cause of death. Pertinent autopsy findings included "occlusive coronary artery disease with total stenosis of his left circumflex coronary artery, and atherosclerotic change of his left anterior descending coronary artery." Other agencies have proposed a three-pronged strategy for reducing the risk of on-duty heart attacks and cardiac arrests among fire fighters. This strategy consists of: 1. minimizing physical stress on fire fighters; 2. screening to identify and subsequently rehabilitate high-risk individuals, and; 3. encouraging increased individual physical capacity. Issues relevant to this Fire Department include the following: Fire fighters should have annual medical evaluations to determine their medical ability to perform duties without presenting a significant risk to the safety and health of themselves or others. Exercise stress tests should be incorporated into the Fire Department's periodic medical evaluation program; Phase in a mandatory wellness/fitness program for fire fighters to reduce risk factors for cardiovascular disease and improve cardiovascular capacity; Review the department's policy regarding resuscitation equipment provided on fire apparatus and the training necessary to use the equipment.
