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 F2011-29, 2012 May; :1-23
On July 9, 2011, a 50-year-old male volunteer fire department (FD) engineer (the Engineer) began a 40-hour technical rescue and structural collapse training program. The training occurred on three consecutive weekends for 8 hours each day. The training occurred when the weather was hot and humid; daily heat indexes ranged from 84.5 degrees Fahrenheit (F) to 103 deg. F. In addition, the Engineer had a number of medical conditions that should have restricted his work as a structural fire fighter according the National Fire Protection Association (NFPA). After the first weekend of training, the Engineer expressed no cardiac or respiratory symptoms, but according to others at the training program, he did not appear well. During the second and third weekends of training, July 16-17, 2011, and July 23-24, 2011, the Engineer reduced his level of participation because of nausea. After the training, he missed 2½ days of work (as a commercial truck driver) because he was not feeling well. On July 30, 2011, 6 days after the last training session, the Engineer was hospitalized for respiratory distress. After 6 days of treatment in the hospital, the Engineer suffered a heart attack and subsequent cardiac arrest on August 5, 2011. Cardiac resuscitation efforts were unsuccessful, and the Engineer died. The death certificate listed "cardiopulmonary arrest due to hypercapneic/hypoxic respiratory failure due to obesity-induced hypoventilation" as the cause of death. No autopsy was performed. Given the Engineer's underlying pulmonary problems, NIOSH investigators concluded that the physical stress of the training in elevated environmental temperatures may have contributed to the respiratory decline that preceded his heart attack and death. NIOSH investigators offer the following recommendations to address general safety and health issues. If in place before this incident, these recommendations may have prevented the Engineer's death. 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 that 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. 3. Incorporate exercise stress tests following standard medical guidelines into an FD medical evaluation program. Recommendations for the Regional Training Academy: 1. Strengthen the Training Academy's heat stress program with the following components: Measure environmental heat conditions with a wet bulb globe temperature (WBGT). 2. Discontinue physically demanding training when heat stress criteria are exceeded according to the guidelines developed independently by the U.S. Army/Air Force and the American College of Sports Medicine. 3. Require hourly work/recovery cycles when heat stress criteria are exceeded according to NIOSH and American Conference of Governmental Industrial Hygienists (ACGIH) guidelines. 4. Monitor fire fighters' vital signs in rehab. The following recommendations address general safety and health issues for the FD. These recommendations would not have prevented the Engineer's death but are good health and safety measures to follow. 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. Perform an autopsy on all on-duty fire fighter fatalities.
Region-5; Fire-fighters; Fire-fighting; Cardiovascular-disease; Cardiovascular-system-disease; Cardiovascular-system-disorders; Heart; Heat; Heat-stress; Respiratory-system-disorders; Pulmonary-system-disorders; Training; Medical-screening; Physical-stress; Physical-fitness; Cardiopulmonary-system-disorders