On March 25, 2004, a 45-year-old male volunteer fire fighter (FF) responded to a roadside vehicle fire. As his engine company exited the fire station, the call was cancelled. The engine was backed into the fire station and, as the FF began to exit the apparatus, he suddenly collapsed. Despite cardiopulmonary resuscitation (CPR), defibrillation, and advanced life support (ALS) performed by crew members, emergency medical technicians (EMTs), paramedics, and hospital emergency department (ED) personnel, the FF died. The autopsy, completed by the Coroner, listed "a cardiac event (arrhythmia) due to hypertensive and atherosclerotic cardiovascular disease" as the cause of death. NIOSH investigators concluded that the physical stress of responding to the alarm, donning turnout gear, and underlying atherosclerotic coronary artery disease (CAD) all contributed to the FF's sudden cardiac death. The first five recommendations below are preventive measures recommended by NIOSH and other fire service groups to reduce the risk of on-the-job heart attacks and sudden cardiac arrest among FFs. The final recommendation addresses a procedural safety issue. 1. Provide pre-placement and periodic medical evaluations to ALL FFs consistent with National Fire Protection Association (NFPA) 1582 or equivalent to determine their medical ability to perform duties without presenting a significant risk to the safety and health of themselves or others. 2. Ensure that FFs are cleared for duty by a physician knowledgeable about the physical demands of fire fighting and the various components of NFPA 1582, and that the results of the exam are discussed with the FF. 3. Consider conducting exercise stress tests for male FFs above the age of 45 years with two or more risk factors for CAD. 4. Phase in a mandatory wellness/fitness program for FFs to reduce risk factors for cardiovascular disease and improve cardiovascular capacity. 5. Perform an annual physical performance (physical ability) evaluation to ensure FFs are physically capable of performing the essential job tasks of structural fire fighting. 6. Use a secondary (technological) test to confirm appropriate placement of the endotracheal (ET) tube during emergency intubations.
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