A 43-year-old male career Fire Fighter/Emergency Medical Technician (FF/EMT) began his 24-hour shift on April 9, 2004, at 0745 hours. During his tour, his crew responded to five calls. The first four calls were EMS runs and the fifth a false alarm fire run. The last call occurred at 0658 hours on April 10 and entailed a false alarm call in a warehouse-type building. The FF/EMT responded in his bunker gear and donned SCBA for the walk-through/size-up. After walking throughout the one-story building (approximately 5 minutes) he returned to the engine. He returned to quarters with the engine, and he departed the station at approximately 0745 hours with no complaints. Later that day, at approximately 1235 hours, he died suddenly while driving his personal vehicle. Witnesses described the FF/EMT slumping over the steering wheel of his car as it jumped a curb and came to a stop. The death certificate, completed by the Medical Examiner, listed "atherosclerotic coronary artery disease" as the immediate cause of death. The autopsy listed "acute cocaine intoxication" as the immediate cause of death with hypertension and atherosclerotic coronary heart disease as contributing factors. The NIOSH investigators concluded that, given the autopsy findings and the FF's past medical history, his sudden death could have been due to any combination of the following: 1. Myocardial infarction (MI) related to underlying coronary artery disease (CAD); 2. MI, triggered by the stress of responding to the earlier alarm or cocaine use; 3. Cardiac arrhythmia, triggered by MI or cocaine use. NIOSH investigators offer the following recommendations to prevent similar episodes from occurring in this and other fire departments (FD). 1. Provide pre-placement and annual medical evaluations consistent with National Fire Protection Association (NFPA) 1582, Standard on Comprehensive Occupational Medicine Program for Fire Departments, or equivalent to determine FF medical ability to perform duties without presenting a significant risk to the safety and health of themselves or others. 2. Phase in a mandatory wellness/fitness program for FFs to reduce risk factors for cardiovascular disease and improve cardiovascular capacity. 3. Perform a pre-placement physical performance (physical ability) evaluation to ensure FFs are physically capable of performing the essential job tasks of structural fire fighting. 4. Ensure that 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 makes the final determination of a FF's return-to-work status following an injury or illness. 5. Provide a member assistance program that identifies and assists members with substance abuse problems.
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; Substance-abuse; Drug-abuse