On February 1, 2003, a 52 year-old male career Fire Fighter-Engineer (FF-E) was conducting trail maintenance behind his duty station (Station 18). The portion of the trail he was maintaining was very steep, approximately a 20% grade for a ¼ mile, and served a variety of Fire Department (FD) functions including a jogging path for physical training by FD members. The wild grasses of 1-2 feet high were encroaching on the trail, and the FF-E and his crewmember were cutting the grass using a lawn mower. After cutting the grass up the hill and starting back down, the FF-E suddenly collapsed. The collapse was witnessed by a crew member who ran up the hill to assist the FF-E. He noted the FF-E was unresponsive and not breathing. At 0900 hours the crewmember notified dispatch of a "fire fighter down" and "possible code blue" as he started cardiopulmonary resuscitation (CPR). Station 18's Captain retrieved the Engine's automated external defibrillator (AED) and shocked the FF-E twice without a successful change in the FF-E's heart rhythm. Nineteen minutes later, other advanced life support (ALS) units began to arrive at the fire station and resuscitation efforts continued for an additional 25 minutes before departing for the nearest hospital. CPR and ALS continued for the 20 minute transport and for a few minutes in the Emergency Department (ED), before the FF-E was pronounced dead by the ED physician. The death certificate and autopsy, completed and performed by a pathologist with the County's Coroner's Bureau, listed "atherosclerotic coronary artery disease" as the immediate cause of death with "hypertension" listed as another significant condition. The physical stress of pulling the lawn mower up the hill and his underlying atherosclerotic coronary artery disease contributed to this fire fighter's cardiac arrest and sudden death. The first recommendation below addresses a safety issue specific to this event. The next two recommendations are preventive measures recommended by other fire service groups to reduce the risk of on-the-job heart attacks and sudden cardiac arrest among fire fighters. The final recommendation addresses a potential safety issue unrelated to this particular event: 1. Consider some other method of cutting the grass on the steep hill behind Station 18; 2. 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; 3. The FD and the local Union should negotiate to phase-in a mandatory fitness and wellness program consistent with NFPA 1583 and/or the Fire Service Joint Labor Management Wellness/Fitness Initiative; and, 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 who is knowledgeable about the physical demands of fire fighting, the medical requirements of fire fighters, and the various components of NFPA 1582.
Region-9; 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