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 F2014-01, 2014 Jul; :1-13
On June 24, 2013, a 62-year-old male volunteer fire fighter ("FF") responded on a mutual aid call to a mobile home fire at 1418 hours. Responding in the fire department's engine, the FF arrived on scene at approximately 1500 hours. After trying to remove large debris near the trailer, he became lightheaded and rested in the shade. Paramedics assigned to rehabilitation responded and helped the FF walk to the rehab area. As the FF arrived at rehab he lost consciousness and went into cardiac arrest. Cardiopulmonary resuscitation (CPR) and advanced life support (ALS), including cardiac monitoring, multiple defibrillation attempts, ventilation, and intravenous line placement, began immediately. Despite CPR and ALS for over an hour on the scene, in transport, and at the hospital, the FF died. The death certificate, completed by the state first deputy chief medical examiner listed "sudden death due to ischemic heart disease" as the cause of death. The autopsy report, also completed by the state first deputy chief medical examiner, listed "likely fatal irregularity of the heartbeat occurring in the setting of severe coronary artery disease of the heart with contributory pathologic enlargement of the heart muscle due to long-standing high blood pressure" as the cause of death. Given the FF's underlying cardiovascular disease, NIOSH investigators concluded that responding to the structure fire and the physical exertion of trying to pull heavy debris away from the structure could have triggered a fatal cardiac arrhythmia. The first three recommendations may have prevented the FF's death. The remaining recommendations address general safety and health issues. 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, to identify fire fighters at increased risk for coronary heart disease (CHD). 2. Ensure exercise stress tests are performed on fire fighters at increased risk for CHD. 3. Ensure that fire fighters are cleared for 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 mandatory comprehensive wellness and fitness program for fire fighters. 5. Perform a candidate and an annual physical performance (physical ability) evaluation for all members. 6. Provide fire fighters with medical clearance to wear a self-contained breathing apparatus (SCBA) as part of the fire department's medical evaluation program. 7. Conduct annual respirator fit testing.