On August 27, 2003, a 52-year-old male volunteer fire fighter (FF) responded to a structure fire at a lumber yard. The FF performed physically demanding exterior and interior fire suppression activities for over 20 minutes in turnout gear before resting at the on-scene rehabilitation unit. While in rehabilitation, the FF did not initially complain of symptoms, although others noted that he was short of breath and diaphoretic (sweating). The FF initially refused cardiac (heart) monitoring and transport to the local hospital, but since his condition did not improve, he eventually consented to ambulance transport. En route to the hospital a cardiac monitor showed changes consistent with a heart attack and the FF's blood pressure began to fall. At the hospital an acute myocardial infarction was confirmed, and an emergent cardiac catheterization showed triple vessel coronary artery disease (CAD) including an acute 100% blockage in one of the main coronary arteries. Due to his critical condition (cardiogenic shock) the FF was not considered a surgical candidate and was given aggressive medical management which included endotracheal intubation, intravenous (IV) fluids, IV medications, and placement of an intra-aortic balloon pump for blood pressure support. Despite these aggressive supportive measures, his condition deteriorated, and he was transferred to a tertiary care facility for possible heart transplantation. On September 2, 2003, shortly after his arrival at the tertiary care center he died. The physical stress of fighting the fire and his underlying atherosclerotic CAD contributed to this FF's heart attack and subsequent death. The following recommendations are preventive measures recommended by other fire service groups to reduce, among other things, the risk of on-the-job heart attacks and sudden cardiac arrest among fire fighters. These recommendations are listed in order of priority as related to this investigation. 1. Incorporate exercise stress tests (EST) into the annual medical evaluations for fire fighters with multiple risk factors for CAD. 2. Ensure that fire fighters are cleared for duty by a physician knowledgeable about the physical demands of fire fighting, the personal protective equipment used by fire fighters, and the various components of NFPA 1582, Standard on Comprehensive Occupational Medicine Program for Fire Departments. 3. Ensure that FFs in Rehabilitation Units follow incident command orders. 4. Expand the current annual medical evaluation requirement to include Driver/Operators. 5. Phase in a mandatory wellness/fitness program for fire fighters to reduce risk factors for cardiovascular disease and improve cardiovascular capacity. 6. Perform an autopsy on all on-duty fire fighter fatalities.
Region-2; 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