On September 27, 2003, a 40-year-old male Fire Fighter (FF), assigned as the Chauffeur (Driver/Operator) of a ladder truck, responded to a rubbish fire at a two-story apartment building. On the fire scene, the FF wore his turnout gear but no self-contained breathing apparatus (SCBA). He remained with the ladder truck and passed search and overhaul equipment to his crew. Nine minutes after arrival, his ladder company was released and returned to quarters. Observing the FF's pale appearance, crew members were concerned about his health. He stated that he would be fine and was going home soon. At the end of his shift, he drove the 45 miles to his home. On the way home, he called his wife and explained that he was ill. As he pulled into his driveway, his wife went outside and checked on him, noting his shortness of breath and chest pain, and called 911. An ambulance responded and transported him to the local hospital, providing advanced life support (ALS) for 15 minutes. In the hospital's emergency department (ED), his condition deteriorated. Cardiopulmonary resuscitation (CPR) (chest compressions and assisted ventilations via bag-valve-mask, intubation, and oxygen) and ALS was administered for 77 minutes. Despite ALS administered by ambulance paramedics and ALS and CPR by hospital personnel, the FF died. The death certificate, completed by the attending physician listed "acute myocardial infarction" as the immediate cause of death and "diabetes mellitus" and "hypertension" as other significant conditions. No autopsy was performed. His moderate physical exertion during the response coupled with his underlying coronary artery disease (CAD), probably triggered his heart attack and sudden cardiac death. NIOSH investigators offer the following recommendations to prevent similar incidents: 1. Ensure members' primary care physicians are knowledgeable of NFPA 1582 guidelines regarding medical conditions compromising a member's ability to safely perform essential job tasks. 2. Ensure members are knowledgeable of, and comply with, fire department requirements regarding reporting any medical condition that could interfere with their ability to safely perform essential job tasks. 3. Consider symptom-limiting (i.e., maximal) exercise stress tests for asymptomatic fire fighters with multiple CAD risk factors. 4. Negotiate with the Union to phase in a MANDATORY wellness/fitness program for fire fighters.
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; Endocrine-system-disorders; Hypertension