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

On June 17, 2004, a 47-year-old male career fire fighter (FF) performed his normal duties. Because no emergency calls came in during the shift, the day was spent in training on policy issues. At approximately 1900 hours, a crew member thought the FF was asleep in a chair in the fire station's bedroom. Upon closer observation, the crew member noticed that the FF's chest was not rising for falling. The FF was unresponsive with no pulse and no respirations. An automated external defibrillator (AED) was applied, cardiopulmonary resuscitation (CPR) was begun, and an ambulance was requested. After approximately 35 minutes of CPR and advanced life support (ALS) administered on the scene, in the ambulance, and at the hospital, the FF was pronounced dead at 1948 hours. The death certificate completed by the county coroner, listed "cardiac dysrhythmia" as the immediate cause of death due to "massive cardiomegaly" due to "hypertensive heart disease." The autopsy conducted by a medical examiner of the Georgia Bureau of Investigation, Division of Forensic Sciences, reported "cardiac dysrhythmia secondary to a massively enlarged heart" that "was the consequence of hypertensive heart disease" as the cause of death. NIOSH investigators offer the following recommendations to prevent similar incidents or to address general safety and health issues: 1. Conduct periodic medical evaluations to determine a fire fighter's medical ability to perform duties without presenting a significant risk to the safety and health of themselves or others. 2. Consider conducting exercise stress test (EST) for male fire fighters over the age of 45 years with two or more factors for coronary artery disease (CAD). 3. Ensure that fire fighters are cleared for duty by a physician knowledgeable about the physical demands of fire fighting. 4. Phase in a mandatory wellness/fitness program for fire fighters to reduce risk factors for cardiovascular disease and improve cardiovascular capacity. 5. Designate an employee to administer the pre-placement and annual medical evaluations and their outcomes. 6. Perform an annual physical performance (physical ability) evaluation. 7. Provide fire fighters with medical evaluations and clearance to wear self-contained breathing apparatus (SCBA).