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 F2012-17, 2012 Aug; :1-12
On September 2, 2011, at 2323 hours, a 32-year-old male volunteer fire fighter ("the FF") was dispatched via mutual aid to a campground structure fire. The FF arrived at the scene at 0014 hours on September 3, 2011, and staged for about 45 minutes. Then, while wearing full turnout gear, he assisted in exterior overhaul operations for about 15 minutes, before being assigned to rehabilitation (Rehab). Weather conditions included a temperature of 76 degrees Fahrenheit (degrees F) and 79% relative humidity, giving a heat index of 77 degrees F and a wet bulb globe temperature of 71 degrees F [NOAA 2011]. Wet bulb globe temperature is a measure of ambient air temperature cooled by the evaporation of water from the wet temperature sensing element [NIOSH 1986]. Shortly after climbing a 300-foot hill to the Rehab area, the FF collapsed and became unresponsive. Crewmembers began cardiopulmonary resuscitation (CPR) as the on-scene ambulance paramedics provided advanced life support treatment and transported the FF to the hospital's emergency department (ED). Treatment in the ED continued for 17 minutes but the resuscitation effort was not successful and the FF died. Two other fire fighters also suffered heat-related illnesses, one requiring treatment at the ED. The death certificate, completed by the County Coroner, listed "cardiac arrhythmia due to focal severe coronary artery disease" as the cause of death. The autopsy report, completed by the County Medical Examiner, listed "cardiac arrhythmia resulting from severe focal atherosclerosis of his left anterior descending coronary artery with clot formation" as the cause of death. Given the FF's underlying coronary heart disease, NIOSH investigators concluded that the physical stress of exterior overhaul activities triggered his heart attack (myocardial infarction as diagnosed by the coronary artery blood clot [thrombus]), arrhythmia, and subsequent cardiac death. NIOSH investigators offer the following recommendations to address safety and health issues and prevent similar incidents in the future. 1. Provide preplacement and annual medical evaluations to all fire fighters consistent with NFPA 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments. 2. Phase in a mandatory comprehensive wellness and fitness program for fire fighters. 3. Perform an annual physical performance (physical ability) evaluation for all members. 4. Measure carboxyhemoglobin levels on symptomatic or unresponsive fire fighters exposed to fire smoke.