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 F2014-04, 2014 Aug; :1-16
On the morning of January 28, 2014, a 53-year-old male career fire chief ("Chief") began his 9-hour shift. During the morning he spent over an hour fighting a grass fire using an attack line to knock down the flames and then wildland fire suppression tools to extinguish hot spots. During the ride back to the fire station, the Chief reported experiencing heartburn. At 1214 hours, the Chief used his command vehicle to respond to another grass fire. When the Chief arrived, the fire had spread to the land owner's residence. While waiting for the fire department's engine to arrive, the Chief began exterior fire attack. Once the engine arrived, the Chief and a lieutenant donned their self-contained breathing apparatus (SCBA) and began interior fire attack. During the attack, the Chief appeared sluggish and somewhat disoriented and did not communicate well. After about 15 minutes, the Chief's and the lieutenant's SCBA low air alarms sounded, and both exited the structure. Once outside, the Chief reported feeling sick and called the emergency medical services (EMS) director who recommended he come to their headquarters for an electrocardiogram (EKG). The Chief drove the command vehicle to headquarters with a mutual aid fire fighter as a passenger. He underwent an EKG, which revealed changes consistent with an acute heart attack. He was loaded into an ambulance for transport to the emergency department (ED) (1423 hours). Approximately 5 minutes into the transport, the Chief suffered cardiac arrest. Cardiopulmonary resuscitation (CPR) and advanced life support were begun, which included multiple defibrillation attempts, intubation, intravenous line placement, and cardiac resuscitation medications. The Chief was still in cardiac arrest when the ambulance arrived at the ED (1441 hours). After approximately 10 minutes of treatment in the ED, the Chief regained a heart rhythm and pulse. He was taken (1522 hours) to the cardiac catheterization lab where he was found to have 100% blockage of his proximal left anterior descending (LAD) coronary artery. Percutaneous transluminal coronary angioplasty successfully opened the blockage; a stent was placed to keep the LAD artery open. Approximately 1 hour after being transferred to the intensive care unit, the Chief suffered another cardiac arrest (1735 hours). Subsequent resuscitation efforts were unsuccessful, and the Chief was pronounced dead at 1800 hours. The death certificate and autopsy report, both completed by the associate state medical examiner, listed "hypertensive atherosclerotic cardiovascular disease" as the cause of death. Given the Chief's underlying heart disease, NIOSH investigators concluded that the physical stress of performing interior fire suppression in turnout gear with SCBA probably triggered his heart attack. Had the first two of the following recommendations been followed, the Chief's death may have been prevented. 1. Conduct exercise stress tests as part of the fire department medical evaluation program for fire fighters at increased risk for coronary heart disease (CHD). 2. 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 recommendations below address general safety and health issues. 1. 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. 2. Phase in a mandatory comprehensive wellness and fitness program for fire fighters. 3. Provide fire fighters with medical clearance to wear a self-contained breathing apparatus as part of the fire department's medical evaluation program. 4. Conduct annual respirator fit testing. 5. Ensure fire attack team continuity.
Region-6; Fire-fighters; Emergency-responders; Cardiac-function; Cardiovascular-system; Cardiovascular-system-disorders; Medical-examinations; Heart; Preemployment-examinations; Medical-monitoring; Preventive-medicine; Physical-capacity; Physical-stress; Job-analysis; Physical-fitness; Men; Self-contained-breathing-apparatus; Respiratory-protective-equipment