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 F2013-03, 2013 Sep; :1-11
On January 8, 2013, at 0700 hours, a 33-year-old male career airport fire fighter ("FF") began a 12-hour overtime shift. During the day the FF and a crew member performed standby during a structural fire suppression system test, checked the apparatus equipment, and pressure washed the apparatus bay and both trucks assigned to the station. At approximately 1715 hours, the FF and a crew member checked for animals, debris, and inoperable lights on the runway. After spotting a deer near the runway, the FF exited the truck and prepared to shoot the deer. As he aimed the rifle, the FF suddenly collapsed (1736 hours). The crew member notified dispatch to request an ambulance and then began cardiopulmonary resuscitation. After the ambulance arrived 11 minutes later, intubation was performed and a cardiac monitor was placed. The FF had a heart rhythm of ventricular fibrillation; three shocks were administered, an intravenous line was inserted, and cardiac resuscitation medications were administered. Advanced life support by the ambulance personnel continued during transport to the local hospital emergency department (ED). Inside the ED, advanced life support continued for an additional 8 minutes with no change in the FF's clinical condition. At 1820 hours the FF was declared dead, and resuscitation efforts were discontinued. The death certificate and the autopsy report, both completed by the state medical examiner, listed "cardiac dysrhythmia due to systemic sarcoidosis with cardiac involvement" as the cause of death. Prior to his sudden cardiac death, the FF was asymptomatic; he had not been diagnosed with sarcoidosis. NIOSH investigators concluded that the FF's sarcoidosis triggered a cardiac arrhythmia that resulted in sudden cardiac death. NIOSH investigators offer the following recommendations to address general safety and health issues, but it is unclear if these recommendations would have prevented the death of this fire fighter. 1. Provide preplacement and annual medical evaluations to all fire fighters in accordance with NFPA 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments. The preplacement medical evaluation should include a baseline chest x-ray. 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. Phase in a mandatory comprehensive wellness and fitness program for fire fighters. 4. Perform a preplacement and an annual physical performance (physical ability) evaluation for all members. 5. Provide fire fighters with medical clearance to wear a self-contained breathing apparatus as part of the fire department's medical evaluation program.