On October 13, 2008, a 24-year-old male volunteer fire fighter (FF) drove a fire department tanker during rural water supply training. After dumping one load of water and refilling the tanker, the FF and a fire fighter cadet returned to the water drop site. En route to the site, a truck pulled out ahead of the tanker. The FF forcibly applied the brakes, causing the tanker to skid and roll into a ditch. The cadet got himself out of the tanker and summoned help to extricate the FF trapped in the tanker. After approximately 5 minutes, the FF was almost extricated when he lost consciousness. The FF had no visible evidence of major trauma. Cardiopulmonary resuscitation (CPR) was begun, an automated external defibrillator (AED) was applied and advised not to shock, and an oral airway was placed. The medical helicopter arrived, and the FF was airlifted to a local hospital. En route to the hospital, a combitube airway was inserted, a cardiac monitor showed asystole, and an intravenous line was placed. The FF's condition did not improve during the flight, and the helicopter arrived at the hospital's emergency department where CPR and advanced life support treatment continued. Approximately 67 minutes after his collapse, despite CPR and advanced life support, the FF died. The death certificate and the autopsy completed by the coroner listed "severe coronary artery atherosclerosis" as the cause of death. Given the FF's underlying coronary artery disease (CAD), the physical stress of crashing the tanker probably 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. Phase in a comprehensive wellness and fitness program for fire fighters to reduce risk factors for cardiovascular disease and improve cardiovascular capacity. 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. 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.
Region-5; Fire-fighters; Fire-fighting; Emergency-responders; Biological-effects; Biological-systems; Cardiac-function; Cardiovascular-disease; Cardiovascular-function; Cardiovascular-system; Cardiovascular-system-disease; Cardiovascular-system-disorders; Heart; Medical-examinations; Medical-monitoring; Physical-fitness; Physical-stress; Physiological-disorders; Physiological-response; Safety-education; Safety-practices