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Volunteer fire fighter suffers a fatal cardiac event after fire suppression training - Pennsylvania.

Smith-DL; Hales-T
Cincinnati, OH: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, FACE F2010-21, 2010 Dec; :1-16
On May 1, 2010, a 51-year-old volunteer Fire Fighter (FF) died after participating in fire suppression activities associated with a basic firefighting course (part of a 166 hour course). The incident occurred on the final day of training involving interior structural fire suppression and exterior fire drills. The FF, wearing full turnout gear and a self-contained breathing apparatus (SCBA), participated in one evolution of fire extinguishment lasting approximately 5 minutes and then experienced symptoms consistent with exhaustion and/or dehydration. Following rehydration and monitoring in rehabilitation (Rehab) for 1 hour and 45 minutes, he returned to training and completed a liquid propane drill lasting about 2 minutes. Approximately 5-10 minutes after this drill, the FF was found unresponsive and cyanotic. On scene emergency medical service (EMS) personnel summoned an ambulance, began cardiopulmonary resuscitation (CPR), and attached an automated external defibrillator (AED) to the FF from which two shocks were administered without a change in the FF's clinical condition. Advanced cardiac life support (ACLS) was provided by the ambulance crew and the Emergency Department (ED). Despite these efforts the FF could not be resuscitated. The death certificate listed "stress induced cardiac arrhythmia" as the immediate cause of death and severe coronary disease as the underlying cause of death. The pathologist conducting the autopsy listed "severe occlusive coronary artery" disease (CAD) as the cause of death. Based on the autopsy findings and the clinical scenario, the NIOSH investigators conclude that the FF probably died from a cardiac arrhythmia triggered by the physical exertion associated with firefighting training or a cardiac arrhythmia caused by a heart attack, which was triggered by firefighting training. NIOSH offers the following recommendations to reduce the risk of on-the-job heart attacks and sudden cardiac arrest among fire fighters at this, and other, fire departments (FD) across the country. 1. 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 FDs. 2. 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. 3. Develop a comprehensive wellness/fitness program for fire fighters to reduce risk factors for cardiovascular (CVD) and improve cardiovascular capacity. 4. Perform an annual physical performance (physical ability) evaluation. 5. Provide fire fighters with medical clearance to wear self-contained breathing apparatus (SCBA) as part of the FD's annual medical evaluation program. 6. Provide on-scene emergency medical services with advanced life support and transport capability during live fire training. 7. Ensure emergency medical services staff in rehabilitation have the authority, as delegated from the Incident Command System, to use their professional judgment to keep members in rehabilitation or to transport them for further medical evaluation or treatment. 8. Training Academy participants must be medically cleared for live fire training.
Region-6; Fire-fighters; Emergency-responders; Accident-analysis; Accident-prevention; Accidents; Cardiovascular-disease; Cardiovascular-system-disease; Cardiovascular-system-disorders; Physical-fitness; Medical-screening; Training; Self-contained-breathing-apparatus; Respiratory-protective-equipment; Respiratory-protection; Protective-clothing; Protective-equipment
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Document Type
Field Studies; Fatality Assessment and Control Evaluation
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Identifying No.
NIOSH Division
Priority Area
Services: Public Safety
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National Institute for Occupational Safety and Health
Page last reviewed: September 2, 2020
Content source: National Institute for Occupational Safety and Health Education and Information Division