On September 26, 2004, a 42-year-old male volunteer Assistant Chief (AC) responded to his fire station after being dispatched to a boat fire. As he donned his turnout gear, he collapsed. Despite cardiopulmonary resuscitation (CPR) and advanced life support (ALS) performed by crew members, emergency medical service (EMS) personnel, and hospital emergency department (ED) personnel, the AC died. The death certificate, completed by the County Medical Examiner, listed "severe arteriosclerotic cardiovascular disease" as the cause of death and "previous myocardial infarction" as other significant condition. The autopsy, performed by another County Medical Examiner, listed "severe coronary artery disease due to arteriosclerotic cardiovascular disease" as the cause of death. The first six 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 last three recommendation address potential safety issues related to this particular event. These recommendations are listed in order of priority. 1. Provide pre-placement and periodic medical evaluations to ALL fire fighters consistent with 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. Conduct exercise stress tests for fire fighters with two or more risk factors for coronary artery disease (CAD). 3. Provide fire fighters with medical evaluations and clearance to wear self-contained breathing apparatus (SCBA). 4. Ensure a City/County/FD-contracted physician reviews all "return to work" clearances. 5. Ensure that fire fighters are cleared for duty by a physician knowledgeable about the physical demands of fire fighting. 6. Phase in a mandatory wellness/fitness program for fire fighters to reduce risk factors for cardiovascular disease and improve cardiovascular capacity. 7. Provide automated external defibrillators (AEDs) as part of the basic life support equipment for fire apparatus. 8. Use a secondary (technological) test to confirm appropriate placement of the endotracheal (ET) tube during emergency intubations. 9. Perform a pre-placement and an annual physical performance (physical ability) evaluation to ensure fire fighters are physically capable of performing the essential job tasks of structural fire fighting.
Region-5; 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