On December 8, 2008, a 42-year-old Lieutenant (LT) in a Volunteer Fire Department (FD) died after completing live fire training drills that were part of a certified Fire Fighter II training course. The live fire training involved two separate drills: 1) extinguishing a simulated natural gas fire, and 2) discharging a foam line. The LT complained of cold symptoms during the training and became short of breath during the last evolution. Upon completion of the last drill, as other students cleaned up the hose lines, he indicated that he was going to his FD vehicle to rest. Approximately 10 minutes after leaving the training area, the LT was found pulseless, breathless, and non-responsive in the area between the training site and his FD vehicle. Cardiopulmonary resuscitation (CPR) was initiated by firefighters followed by advanced life support (ALS) by the arriving ambulance personnel. Despite these efforts the LT died. The autopsy report listed the cause of death as "Cardiac arrhythmia following strenuous physical activity (firefighter training) in individual with hypertensive and atherosclerotic cardiovascular disease." NIOSH investigators agree with this assessment and conclude that the physical exertion associated with the training drills performed in full personal protective equipment triggered the LT's sudden cardiac death. NIOSH investigators offer the following recommendations to reduce the risk of fatalities from sudden cardiac arrest among fire fighters at this and other fire departments across the country. Had these recommended measures been in place prior to the FF's collapse, his sudden cardiac death may have been prevented at this time. 1. Ensure that an automated external defibrillator is available during planned training drills. 2. Provide on-scene emergency medical services with advanced life support and transport capability during live fire training. 3. Provide mandatory pre-placement and periodic medical evaluations to all fire fighters consistent with the National Fire Protection Association (NFPA) Standard 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments. 4. Ensure fire fighters are cleared for duty by a physician knowledgeable about the physical demands of firefighting, the personal protective equipment used by fire fighters, and the various components of NFPA 1582. 5. Develop a comprehensive wellness/fitness program for fire fighters to reduce risk factors for cardiovascular disease (CVD) and improve cardiovascular capacity. 6. Discontinue lumbar spine x-rays as a screening test administered during the pre-placement medical evaluation.
Region-9; Fire-fighters; Emergency-responders; Cardiovascular-disease; Cardiovascular-system-disease; Cardiovascular-system-disorders; Cardiac-function; Cardiovascular-function; Medical-examinations; Medical-screening; Physical-stress; Physical-fitness; Cardiovascular-system; Medical-monitoring; Training; Personal-protective-equipment