On March 9, 2008, a 62-year-old male volunteer fire fighter (FF) was dispatched to a residential fire. On-scene, he assisted crew members in pulling 200 feet of uncharged 1¾-inch hoseline while wearing full turnout gear and self-contained breathing apparatus (SCBA) and carrying a 10-pound flat-head axe. The FF used the axe to strike the front door to gain entry. Once inside, the hoseline was charged, and the FF and two crew members crawled through the dwelling to locate the fire. The fire was extinguished shortly thereafter, and the FF and crew members checked void spaces for hidden fire. Finding none, the crew began to ventilate by opening windows in adjacent rooms. Suddenly, the FF collapsed. Crew members called a mayday and pulled the FF outside where the on-scene ambulance crew began its assessment. Finding the FF unresponsive, without a pulse, and not breathing, the crew began cardiopulmonary resuscitation (CPR). Despite CPR and advanced life support administered on-scene, en route to the hospital, and at the hospital, the FF died. The death certificate, completed by the township registrar, and the autopsy, completed by the assistant state medical examiner, listed "atherosclerotic and hypertensive cardiovascular disease" as the cause of death. Given the FF's underlying atherosclerotic coronary artery disease (CAD), the stressful environmental conditions and the physical stress of performing fire fighting training duties triggered a heart attack or a cardiac arrhythmia, resulting in his sudden cardiac death. The NIOSH investigator offers the following recommendations to address general safety and health issues. Had these recommended measures been in place prior to the FF's collapse, his sudden cardiac death may have been prevented. 1. Provide preplacement and annual medical evaluations to fire fighters consistent with National Fire Protection Association (NFPA) 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments, to determine their medical ability to perform duties without presenting a significant risk to the safety and health of themselves or others. 2. Conduct symptom-limiting exercise stress tests on some fire fighters based on their risk for coronary heart disease. 3. Ensure fire fighters are cleared for return to 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. 4. Phase in a comprehensive wellness and fitness program for fire fighters to reduce risk factors for cardiovascular disease and improve cardiovascular capacity. 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. Provide fire fighters with medical clearance to wear self-contained breathing apparatus as part of the Fire Department's annual medical evaluation program. 7. Use a secondary (technological) test to confirm appropriate placement of the endotracheal tube.
Region-2; Fire-fighters; Emergency-responders; Cardiovascular-system-disease; Cardiovascular-system-disorders; Cardiovascular-disease; Medical-examinations; Medical-screening; Physical-fitness; Cardiovascular-system; Medical-monitoring; Cardiac-function; Cardiovascular-function; Training; Respiratory-protective-equipment; Personal-protective-equipment; Self-contained-breathing-apparatus; Fire-fighting-equipment