Death in the Line of Duty…a Summary of a NIOSH Fire Fighter Fatality Investigation

On March 11, 2009, a 60-year-old male volunteer fire fighter (FF) drove a tanker to a 2-acre grass fire. After activating the pump and assisting in pulling the 1¾-inch hoseline, the FF collapsed. Advanced life support treatment was provided at the scene, en route to the hospital's emergency department (ED), and in the ED. The FF was subsequently transferred to a regional hospital where his condition deteriorated, and he died 10 days later. The death certificate, completed by the Office of the Chief Medical Examiner, listed "complications from ventricular tachycardia/ventricular fibrillation arrest due to ischemic heart disease" as the cause of death. The autopsy, also completed by the Office of the Chief Medical Examiner, listed "complications from cardiac arrest secondary to ischemic cardiomyopathy" as the cause of death. Given the FF's underlying atherosclerotic coronary artery disease (CAD), the stress of performing driver/operator duties related to the grass fire probably triggered his cardiac arrhythmia. The NIOSH investigator offers the following recommendations to address general safety and health issues. Had these recommended measures been in place prior to the FF's collapse, his cardiac arrhythmia and subsequent cardiac death may have been prevented. 1. Provide preplacement and annual medical evaluations to fire fighters consistent with National Fire Protection Association (NFPA) 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments. 2. Incorporate exercise stress tests following standard medical guidelines into a Fire Department medical evaluation program. 3. Ensure 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. Perform an annual physical performance (physical ability) evaluation. 5. Phase in a comprehensive wellness and fitness program for fire fighters. 6. Provide fire fighters with medical clearance to wear a self-contained breathing apparatus (SCBA). 7. Conduct annual respirator fit testing.