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 F2011-25, 2012 Feb; :1-13
On July 23, 2010, a 46-year-old male career lieutenant (LT) was working a 24-hour shift. During the day he responded to three non-fire emergency calls. At about 1800 hours, the LT prepared and ate dinner followed by physical fitness training on equipment in the fire station's basement. Shortly thereafter, a crew member found the LT unresponsive, sitting beside the treadmill. Although the LT appeared sweaty, it was unclear what stage of the workout he had completed. Crew members were summoned and cardiopulmonary resuscitation (CPR) and advanced life support were initiated. After approximately 45 minutes of resuscitation, the LT regained a heartbeat in the emergency department (ED). A heart attack was diagnosed by electrocardiogram (EKG) and an emergent cardiac catheterization was performed. A thrombus was revealed and two coronary artery stents were placed in two occluded arteries. Although the LT's cardiac status was stabilized, he suffered hypoxic brain injury due to the extended resuscitation time. Over the next 7 days, his condition did not improve and, after consultation with the family, physicians removed life support and the LT died. The death certificate listed "hypertensive and atherosclerotic cardiovascular disease" as the cause of death. No autopsy was performed. Given the LT's underlying cardiovascular disease, NIOSH investigators concluded that the physical stress of physical fitness training triggered a heart attack, resulting in cardiogenic shock and subsequent hypoxic brain injury. NIOSH investigators offer the following recommendations to address general safety and health issues. It is unclear whether these recommendations could have prevented the LT's death, however his underlying cardiac disease may have been identified sooner, possibly allowing for further evaluation and treatment. 1. Provide annual medical evaluations to all fire fighters in accordance with NFPA 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments.2. Ensure on-duty fire fighters exercise in pairs or within viewing/hearing distance of another crew member. 3. Incorporate exercise stress tests following standard medical guidelines into a Fire Department medical evaluation program. The following recommendations would not have prevented the LT's death, but they address safety and health issues that all fire departments should consider. 1. Phase in a mandatory comprehensive wellness and fitness program for fire fighters. 2. Perform an annual physical performance (physical ability) evaluation for all members.3. Use a secondary (technological) test to confirm appropriate placement of the endotracheal tube.4. Provide fire fighters with medical clearance to wear a self-contained breathing apparatus (SCBA) as part of the Fire Department's medical evaluation program.5. Perform an autopsy on all on-duty fire fighter fatalities.