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 F2014-08, 2014 Aug; :1-13
On November 20, 2013, at 2311 hours, a 58-year-old male volunteer assistant fire chief ("the AC") responded to a structure fire. After driving Engine 9 to the scene, he prepared to charge a 2-inch handline when he developed difficulty breathing, nausea, and vomiting. About 5 minutes later crew members noted the AC having difficulty prepping the handline, and the fire chief requested an ambulance. The ambulance arrived 2 minutes later, and emergency medical technicians began basic life support. Oxygen was given via bag-valve-mask as the AC was placed onto a stretcher. The AC became unresponsive 20 seconds later (2334 hours). The AC was placed into the ambulance as cardiopulmonary resuscitation (CPR) began. En route to the hospital's emergency department (ED), an automated external defibrillator (AED) advised to shock, and a shock was administered without a change in the AC's clinical status. Paramedics from an advanced life support unit met the ambulance en route (2338 hours) at which time the AC was intubated, intraosseous venous access was obtained, and advanced cardiovascular life support resuscitation protocols were initiated. The AC was still in cardiac arrest (asystole) when the ambulance arrived at the ED (2355 hours). After approximately 5 minutes of treatment in the ED, the AC was pronounced dead at 0000 hours on November 21, 2013. The death certificate completed by the county coroner listed "acute myocardial infarction" as the cause of death. The autopsy completed by the forensic pathologist revealed an acute plaque rupture and thrombus in the AC's right coronary artery, severe coronary artery disease (CAD), an old (remote) heart attack, and stents in the left anterior descending coronary artery and circumflex coronary artery. Given the AC's underlying heart disease, NIOSH investigators concluded that responding to the structure fire and the physical stress of operating the engine's pump panel probably triggered the AC's heart attack, which resulted in his death. NIOSH investigators offer the following recommendations to reduce the risk of heart attacks and sudden cardiac arrest among fire fighters at this and other fire departments.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 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. 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. 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.
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; Physical-fitness; Self-contained-breathing-apparatus; Respiratory-protective-equipment; Personal-protective-equipment