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 F2014-13, 2014 Dec; :1-15
On May 17, 2014, a 63-year-old male career wildland fire crew supervisor ("Supervisor") performed the U.S. Forest Service arduous duty work capacity test (WCT) (commonly known as the pack test) to obtain his "red card," certifying him to fight wildland fires on state property. The pack test requires an individual to complete a 3-mile walk within 45 minutes while wearing a 45-pound weighted vest. After four laps around the track (about 1 mile), the Supervisor grabbed his left leg and collapsed. Crew members found him unresponsive, not breathing, and with a weak pulse. A few seconds later his pulse stopped. Cardiopulmonary resuscitation (CPR) was begun, and an ambulance was requested. A weak pulse and breathing returned briefly as an automated external defibrillator (AED) was retrieved from the vehicle of a responding police officer. The AED was nonfunctional, so a second AED was brought to the scene by the local fire department approximately 2 minutes later. One shock was delivered without any change in the Supervisor's clinical status. The ambulance arrived at 0826 hours, and ambulance service paramedics provided advanced life support (ALS), which included defibrillation, intubation, and intraosseous line placement. Two additional shocks were administered during transport to the hospital's emergency department (ED), again with no change in the Supervisor's clinical status. CPR and ALS continued for an additional 11 minutes in the ED. Despite CPR and ALS performed on the scene, en route to the ED, and inside the ED, the Supervisor was pronounced dead. The death certificate, completed by the county medical examiner, listed "acute myocardial infarction" due to "hypertension, type II diabetes mellitus, and morbid obesity" as the cause of death. No autopsy was performed. Given the Supervisor's underlying undiagnosed atherosclerotic coronary heart disease (CHD), the NIOSH investigators concluded the physical exertion associated with the pack test triggered a probable acute myocardial infarction (heart attack) and his sudden cardiac 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 wildland fire fighting agencies: 1. Require completion of a health screen questionnaire (HSQ) prior to participating in the WCT; 2. Require exercise stress tests for fire fighters at increased risk for CHD; 3. Restrict fire fighters with medical conditions that have an increased risk of sudden incapacitation (e.g., cardiac arrest) as detailed in NFPA 1582; 4. Check WCT participants' vital signs before and after testing; 5. Phase in a mandatory comprehensive wellness and fitness program for fire fighters; 6. Perform a candidate and member physical ability evaluation; 7. Provide fire fighters with medical clearance to wear a self-contained breathing apparatus (SCBA) as part of the fire department's medical evaluation program; 8. Conduct annual respirator fit testing; and 9. Perform an autopsy on all on-duty fire fighter fatalities.
Region-8; Fire-fighters; Fire-fighting; Physical-fitness; Physical-stress; Physiological-effects; Physiological-measurements; Cardiac-function; Cardiovascular-system-disease; Cardiovascular-disease; Heart; Weight-factors; Blood-sugar-disorders; Body-burden; Body-weight; Supervisory-personnel; Emergency-treatment; Autopsies; Work-capability; Men