In January 2003, a 50-year-old male fire Captain requested, and received a transfer to a new Engine company (E-30). The company's Battalion Chief (BC-3) had not previously supervised the Captain and, among other things, he wanted to assess the Captain's skills as incident commander during a fire. In early January 2003, a residential property became available for a live-burn, and the exercise was scheduled for January 25, 2003 at 1330 hours. On January 23, BC-3 informed the Captain about the training and its purpose. On January 25th, the Captain and his crew began their 24-hour shift at 0800 hours. There were no alarms or response calls prior to the scheduled training. After eating lunch, the Captain and his crew of three fire fighters arrived at the property and were briefed on the exercise and took a quick tour of the house. After support crews prepared the house and laid safety and protection hose lines, E-30 backed down the street. At 1330 hours, the drill began and the Engine pulled in front of the house. The Captain gave assignments and then exited the cab portion of the truck in bunker gear with his self-contained breathing apparatus (SCBA), and SCBA mask over his face. He proceeded to the rear of the truck, where he began to have breathing problems. After being helped out of this SCBA and turnout gear, he collapsed. An ambulance was called, while two on-scene crew members/paramedics started cardiopulmonary resuscitation (CPR) as the other on-scene fire fighters retrieved the Engine's automated external defibrillator (AED). Unfortunately, the AED did not detect a shockable rhythm and CPR continued until the ambulance arrived approximately six minutes later. Despite advanced life support (ALS) administered on-scene, in the ambulance, and in the hospital's emergency department (ED), the Captain died. The County Medical Examiner completed both the death certificate and autopsy report which listed "acute myocardial infarction" (heart attack) as the cause of death due to "coronary atherosclerosis" with a "prior myocardial infarction" being a significant contributing factor. Other agencies have proposed a three-pronged strategy for reducing the risk of on-duty sudden cardiac death 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 (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; 2. Consider incorporating exercise stress tests (EST) into the annual medical evaluation for fire fighters with multiple risk factors for coronary artery disease (CAD); 3. Annual medical evaluations should be conducted by the fire department physician who is knowledgeable about the physical demands of fire fighting, the medical requirements of fire fighters, and the various components of National Fire Protection Association (NFPA) 1582; 4. Following an injury/illness, the final determination of a fire fighter's return-to-work status should be made by the fire department physician after requesting, receiving, and reviewing all relevant medical information; and, 5. Fire fighters should be medically cleared prior to participating in the FD's Physical Fitness Qualification (PFQ) test, specifically, the aerobic capacity (treadmill) test. Although unrelated to this fatality, the FD should consider these three additional recommendations based on safety considerations: 1. Provide fire fighters with medical evaluations and clearance to wear SCBA as required by the Occupational Safety and Health Administration (OSHA); 2. Complement the impressive mandatory fitness program with a mandatory, rather than voluntary, wellness program; and, 3. During live-fire training, ensure all components of NFPA 1403, Standard on Live Fire Training Evolutions, are followed.
Region-4; 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