On October 24, 2003, a 47-year-old male District Chief (DC) responded to a motor vehicle accident (MVA) involving a fire engine and a civilian vehicle. After assisting with unloading fire equipment, he transported three fire fighters with minor injuries to the hospital and returned to his station. He expressed that he "did not feel right and had throat tightness," and then told his supervisor that he needed to go home. After lying down in the station for approximately two hours, he drove home (approximately 60 miles away). After changing clothes, he drove to his primary care physician's office where he was diagnosed as having an acute myocardial infarction (MI)(heart attack). He was then treated at the local hospital, then transferred to a regional hospital for an arteriogram and balloon angioplasty (stent placement). Twelve days later, while recuperating at home, he was found unresponsive and an ambulance was summoned. Ambulance paramedics determined that the DC had sustained cardiac and respiratory arrest at an earlier time, and no resuscitation efforts were initiated. The death certificate, completed by the Justice of the Peace, listed "myocardial infarction" as the immediate cause of death. No autopsy was performed. 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 individuals at higher risk; and 3) encouraging increased individual physical capacity. The following issues are relevant to this fire department: 1. Phase in a mandatory wellness/fitness program for fire fighters to reduce risk factors for cardiovascular disease and improve cardiovascular capacity; 2. Provide mandatory annual medical evaluations to ALL fire fighters consistent with NFPA 1582 to determine their medical ability to perform duties without presenting a significant risk to the safety and health of themselves or others; 3. Provide fire fighters with medical evaluations and clearance to wear SCBA; 4. Perform an annual physical performance (physical ability) evaluation to ensure fire fighters are physically capable of performing the essential job tasks of structural fire fighting; and, 5. Perform an autopsy on all on-duty fire fighter fatalities. Although unrelated to this fatality, the fire department should consider this additional recommendation based on safety and economic considerations: 1. Discontinue the routine use of annual chest x-rays unless specifically indicated; and, 2. Discontinue the routine use of annual electrocardiograms (EKG) unless medically indicated.
Region-6; 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