On November 18, 2002, a 50-year-old male volunteer Fire Chief responded with his fire department (FD) to a medical call, then proceeded to respond to a separate incident involving a carbon monoxide (CO) alarm at a private residence. He responded to this second incident alone and found no carbon monoxide using the departmentís CO detector. Upon returning to the fire station he complained to his wife by telephone of not feeling well. His wife called 911, and responding members of his department arrived shortly before he lost consciousness. Cardiopulmonary resuscitation (CPR) was begun immediately following his cardiac arrest. Despite defibrillation attempts, intubation, and advanced life support (ALS) medications, resuscitation efforts were unsuccessful. The death certificate listed "ASCVD" (atherosclerotic coronary vascular disease) as the immediate cause of death, with hyperlipidemia and smoking as contributing factors. An autopsy revealed near-total occlusion of two coronary arteries. The following recommendations address general health and safety issues relating to line of duty deaths due to cardiovascular events in firefighters. These are preventative measures that may reduce the risk of sudden cardiovascular deaths in the fire service. These selected recommendations have not been evaluated by the National Institute for Occupational Safety and Health (NIOSH) but represent published research, consensus standards issued by the National Fire Protection Association (NFPA) and fire service labor/management fitness and wellness initiatives; 1) Place and maintain automated external defibrillators (AEDs) on all fire department apparatus that are not equipped and staffed for manual defibrillation; 2) Phase-in a mandatory wellness/fitness program for fire fighters to reduce modifiable risk of cardiovascular disease and improve cardiovascular capacity. Specifically address: regular exercise, weight control, smoking cessation, and low fat, low cholesterol diet; 3) Phase in the recommendations of NFPA 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments, regarding evaluation of cardiovascular fitness for duty; 4) Ensure ability to exercise to 12 metabolic equivalents (METS) without symptoms or electrocardiographic changes of coronary artery disease (CAD); 5) While likely not contributing to the outcome of the present incident, staffing patterns and procedures that prevent fire personnel from being alone on duty should be instituted; 6) Autopsies performed on fire service personnel should follow the U.S. Fire Administration and U.S. Department of Justice Public Safety Officer Benefits protocols. This includes obtaining carboxyhemoglobin levels to rule out carbon monoxide exposure as a contributor to the cause of death.
Region-1; Cardiovascular-disease; Cardiovascular-function; Cardiovascular-system; Cardiovascular-system-disease; Cardiovascular-system-disorders; Fire-fighters; Fire-safety; Medical-examinations; Medical-monitoring; Medical-screening; Occupational-hazards; Occupational-safety-programs; Safety-measures; Safety-practices; Training