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Lieutenant suffers sudden cardiac death during the "Pack Test" - Arizona.

Baldwin T; Hales T
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 F2014-12, 2014 Nov; :1-15
On March 8, 2014, a 61-year-old male paid-call lieutenant (LT) performed the U.S. Forest Service arduous duty Work Capacity Test (WCT), also known as the "Pack Test." The test is a required component of "red card certification" allowing wildland firefighters to work on federal property. The Pack Test requires a 3-mile walk within 45 minutes while wearing a 45-pound weighted vest. After completing 6 laps around the track (1.5 miles), the LT stumbled, appeared dizzy, and then collapsed. Crewmembers assessed him and found him unresponsive, not breathing, and without a pulse; they initiated cardiopulmonary resuscitation (CPR) and advanced life support (ALS). Despite CPR and ALS on-scene and in the hospital's emergency department (ED), the LT could not be revived. The death certificate and the autopsy, completed by the County Medical Examiner, listed "complications of acute myocardial infarct (heart attack)" due to "hypertensive and arteriosclerotic cardiovascular disease" as the cause of death. The LT had a left ventricular rupture and cardiac tamponade. Prior to this incident, the LT was not known to have coronary heart disease (CHD). The NIOSH investigators concluded that the physical stress of the Pack Test probably precipitated his left ventricle rupture in an area weakened by an asymptomatic heart attack occurring approximately 1 week earlier. It is unclear if any of the following recommendations would have prevented the LT's death. Nonetheless, NIOSH investigators offer the following recommendations to reduce the risk of heart attacks and sudden cardiac arrest among fire fighters at this and other FDs. 1. Provide preplacement and annual medical evaluations to all fire fighters consistent with NFPA 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments, to identify fire fighters at increased risk for CHD. 2. Perform exercise stress tests on fire fighters at increased risk for CHD. 3. Check Pack Test participants' vital signs before testing. 4. Require the completion of a Health Screen Questionnaire (HSQ) prior to participating in the Pack Test.
Region-9; Fire-fighters; Emergency-responders; Cardiac-function; Cardiovascular-system; Cardiovascular-system-disorders; Heart; Physical-capacity; Physical-stress; Physical-fitness; Men; Mortality-data; Autopsies; Medical-examinations; Work-capacity; Emergency-treatment; Myocardial-disorders; Cardiovascular-system-disease; Physiological-testing; Questionnaires; Medical-screening; Vital-capacity
Publication Date
Document Type
Field Studies; Fatality Assessment and Control Evaluation
Fiscal Year
NTIS Accession No.
NTIS Price
Identifying No.
FACE-F2014-12; M102014
NIOSH Division
Priority Area
Public Safety
SIC Code
Source Name
National Institute for Occupational Safety and Health
Page last reviewed: February 3, 2023
Content source: National Institute for Occupational Safety and Health Education and Information Division