Death in the Line of Duty…a Report from the NIOSH Fire Fighter Fatality Investigation and Prevention Program

On September 27, 2017, at approximately 2000 hours, a 41-year-old male career Captain (CAPT) staged for a multi-unit training scenario in an abandoned restaurant. The CAPT was the officer of a 4-person ladder truck and responded along with two engines and a battalion chief. The CAPT and his crew performed forcible entry and began a primary search (on air). They were then assigned to meet up with the engine crew and take over their hoseline. The CAPT and another firefighter advanced the hoseline about 10 feet to extinguish the simulated fire. The training drill lasted approximately 20-25 minutes (min). Following the drill, crews cleaned up and then met for a debriefing. After the debriefing the CAPT went to use the bathroom while others went in to view the building without smoke obscuring visibility. The CAPT returned from the bathroom and told an on-site paramedic that his arm was numb. After further questioning he affirmed that he was having pressure in his chest and stated that he did not feel well. The paramedic and the Assistant Chief (serving as Safety Officer) escorted the CAPT to the engine. The paramedic began an assessment, provided oxygen to the CAPT, and requested that an ambulance be dispatched. The CAPT indicated that he was feeling dizzy, leaned forward, lost consciousness, and collapsed. On-scene personnel retrieved an automatic external defibrillator from the engine, attached it to the CAPT, and delivered a shock. The ambulance was dispatched at 2124 hours and medics arrived on scene about 1 min later. Advanced life support was provided on scene, including defibrillation (x8), cardiac medications, and assisted ventilation. The ambulance left the scene at 2205 hours and arrived at the emergency department at 2212 hours. The emergency department staff continued resuscitation efforts for approximately 20 min. The CAPT was pronounced dead at 2231 hours. The death certificate and the Medical Examiner's report listed the cause of death as "intracoronary thrombus (myocardial infarction) due to severe, occlusive arteriosclerotic cardiovascular disease". The autopsy found a thrombus (clot) in the left anterior descending coronary artery and severe atherosclerosis in multiple coronary arteries. The heart had thickened ventricles (hypertrophy), was heavier than normal, and had microscopic changes indicative of hypertensive cardiovascular disease. National Institute for Occupational Safety and Health investigators concluded that the physical exertion associated with the training activity triggered a heart attack in an individual with underlying cardiovascular disease. Key Recommendations - NIOSH offers the following recommendations to reduce the risk of heart attacks and sudden cardiac arrest among firefighters at this and other fire departments across the country. 1) Ensure firefighters are cleared for duty by a physician knowledgeable about the physical demands of firefighting, the personal protective equipment (PPE) and self-contained breathing apparatus (SCBA) used by firefighters, and the various components of National Fire Protection Association (NFPA) 1582. 2) Adopt a mandatory comprehensive wellness and fitness program for firefighters.