On October 20, 2004, a 58-year-old male career Fire Chief responded to a motor vehicle crash (MVC). After assisting with traffic control for about 30 minutes and with other operations for about 20 minutes, he went home. About three hours later, while taking a shower, the Chief collapsed. When discovered by his wife a minute later, he was unresponsive, but still breathing. She called 911 and an ambulance was dispatched. Despite cardiopulmonary resuscitation (CPR) and advanced life support (ALS) performed by fire department (FD) crew members, ambulance service paramedics, and hospital emergency department (ED) personnel, the Chief died. The death certificate, completed by the attending physician, listed "arrhythmia" as the cause of death due to "coronary artery disease" (CAD) with "atrial fibrillation and sleep apnea" as other significant conditions. No autopsy was performed. The NIOSH investigator concluded that the physical stress of responding to the MVC, the Chief's underlying arteriosclerotic CAD, and his history of atrial fibrillation and sleep apnea contributed to his sudden cardiac death. To reduce the risk of on-the-job heart attacks and sudden cardiac arrest among fire fighters, NIOSH investigators offer the following recommendations: 1. Provide pre-placement and annual medical evaluations to ALL fire fighters to determine their medical ability to perform duties without presenting a significant risk to the safety and health of themselves or others. 2. Consider conducting periodic exercise stress tests for male fire fighters over the age of 45 years with two or more risk factors for coronary artery disease. 3. Phase in a mandatory wellness/fitness program for fire fighters to reduce risk factors for cardiovascular disease and improve cardiovascular capacity. 4. 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. 5. Perform an annual physical performance (physical ability) evaluation to ensure fire fighters are physically capable of performing the essential job tasks of structural fire fighting. 6. Perform an autopsy on all on-duty fire fighter fatalities.
Region-6; 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