On April 18, 2003 a fire fighter/engineer (FF/E) suffered a knee injury while battling a two alarm apartment building fire. After five months of unsuccessful conservative therapy, the FF/E underwent arthroscopic surgery. On November 30, 2003, six weeks after surgery, the FF/E awoke from sleep at with acute chest pain and shortness of breath. Despite advance life support (ALS) provided by ambulance paramedics and physicians in the hospitalís emergency department (ED), and cardiopulmonary resuscitation (CPR) in the hospitalís ED, the FF/E died. An autopsy conducted by a pathologist from the Office of the County Medical Examiner determined the cause of death to be a massive pulmonary embolism (PE) due to a deep vein thrombus (DVT) due to knee injury that was treated surgically. Given the cause of death, it is unlikely the Fire Department (FD) could have done anything to prevent the tragic and untimely death of this FF/E. Therefore, the following recommendations address general health and safety issues identified during the National Institute for Occupational Safety and Health (NIOSH) evaluation. This list includes some preventive measures that have been recommended by other agencies to reduce the risk of sudden cardiac arrest and or death among fire fighters. These recommendations have not been evaluated by NIOSH, but represent research presented in the literature or of consensus votes of Technical Committees of the National Fire Protection Association (NFPA) or labor/management groups within the fire service. 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 FD include: 1. Provide annual medical evaluations to fire fighters to determine their medical ability to perform duties without presenting a significant risk to the safety and health of themselves or others. The Department and Union should negotiate the content and frequency to be consistent with NFPA 1582; 2. Following an injury/illness, the final determination of a fire fighterís return-to-work status should be made by the FD physician who is knowledgeable about the physical demands of fire fighting, the medical requirements of fire fighters, and the various components of NFPA 1582. Only after requesting, receiving, and reviewing all relevant medical information should the fire department physician clear fire fighters for full duty; 3. Fire fighters should be medically cleared prior to participating in the FDís Physical Fitness Qualification (PFQ) test; 4. Provide fire fighters with medical evaluations and clearance to wear self-contained breathing apparatus ( SCBA) as required by the Occupational Safety and Health Administration (OSHA); and, 5. Complement the impressive mandatory fitness program with a mandatory, rather than voluntary, wellness program. Specific programs that can reduce modifiable coronary artery disease (CAD) risk factors include smoking cessation, weight control, and low fact/ low cholesterol diets.
Region-4; Cardiopulmonary-system-disorders; Veins; Blood-vessels; Cardiovascular-system-disease; Heart; Physical-stress; Physical-fitness; Fire-fighters; Emergency-responders; Medical-screening; Cardiovascular-disease; Cardiovascular-function; Cardiovascular-system; Cardiovascular-system-disorders; Medical-examinations; Medical-monitoring; Medical-screening; Occupational-hazards; Occupational-safety-programs; Physical-fitness