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 F2011-08, 2011 Jun; :1-20
On January 26, 2011, a 38-year-old male career fire fighter recruit ("Trainee") participated in an entry-level fire fighter certification class. The training included maneuvering through a tunnel maze while wearing full turnout gear and self-contained breathing apparatus (SCBA). After he completed most of the maze evolution, the Trainee's SCBA became stuck inside the tunnel. He tried to free himself for several minutes; meanwhile, his SCBA became low on air. Instructors removed the Trainee from the maze and noted that he was breathing hard and complaining of nausea. After rehabilitation, his symptoms resolved, and his vital signs returned to normal. The Trainee went on to complete the basement search portion of the smokehouse training without difficulty. After lunch, the Trainee repeated the maze evolution and became stuck in the same location. After assuring instructors he was okay, the Trainee suddenly became unresponsive. Instructors removed the Trainee from the maze and found him unresponsive, not breathing, and without a pulse. An ambulance was requested, cardiopulmonary resuscitation (CPR) was begun, and an automated external defibrillator was utilized; no shock was advised. Paramedics assigned to a nearby flight ambulance responded and began advanced life support including the administration of intravenous cardiac resuscitation medications. A cardiac monitor was placed, revealing asystole (no heart beat) and pulseless electrical activity. The ambulance arrived about 11 minutes later and transported the Trainee to the hospital's emergency department (ED), where CPR and advanced life support treatment continued. Approximately 47 minutes after his collapse, despite CPR and advanced life support, the Trainee died. The death certificate and the autopsy, completed by the medical examiner, listed "dilated cardiomyopathy" due to "hypertensive cardiovascular disease" as the cause of death. NIOSH investigators concluded that the Trainee's underlying cardiomyopathy coupled with the physical exertion involved in performing the fire fighter training triggered his sudden cardiac death. NIOSH investigators offer the following recommendations to address general safety and health issues. It is unlikely, however, that any of these recommendations would have prevented the Trainee's death. 1. Provide preplacement and annual medical evaluations compliant with National Fire Protection Association (NFPA) 1582 to fire fighters. 2. Perform an annual physical performance (physical ability) evaluation. 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. 5. Provide fire fighters with medical clearance to wear a self-contained breathing apparatus (SCBA) as part of the Fire Department's medical evaluation program. 6. Ask an independent third party entity such as the NIOSH National Personal Protective Technology Laboratory (NPPTL) to perform post-incident SCBA inspection and testing.
Region-6; Fire-fighters; Emergency-responders; Accident-analysis; Accident-prevention; Accidents; Cardiovascular-disease; Cardiovascular-system-disease; Cardiovascular-system-disorders; Physical-fitness; Medical-screening; Physical-stress; Training; Personal-protective-equipment; Self-contained-breathing-apparatus; Protective-equipment