Death in the line of duty…A summary of a NIOSH fire fighter fatality investigation

On May 31, 2002, a 59-year-old male career Fire Fighter (FF) was scheduled for a "Pack Test." The Pack Test is one of three work capacity tests (WCT) designed to simulate the physical demands of wildland fire fighting. The Pack Test requires an individual to complete a 3-mile walk within 45 minutes while wearing a 45-pound vest. Successful completion of the Pack Test within the 45 minutes allows fire fighters to participate in federal wildland fire fighting operations. The FF began the Pack Test at approximately 0910 hours and had completed about 1.3 miles of the test when he suddenly collapsed. Crew members (emergency medical technicians [EMTs]) witnessed the collapse and initial assessment found the FF unresponsive with no pulse or respirations. Cardiopulmonary resuscitation (CPR) was begun. On-scene ambulance paramedics quickly began advanced life support (ALS) measures. Despite these measures by crew members, ambulance paramedics, air ambulance paramedics, and hospital emergency department (ED) personnel, the FF died. The death certificate and autopsy, completed and performed by the County Chief Deputy Medical Examiner, listed "coronary atherosclerosis" as the immediate cause of death. The Medical Examiner further stated, "the death is attributed to a sudden cardiac arrhythmia during physical exertion as a result of myocardial ischemia due to longstanding coronary atherosclerosis." The NIOSH investigator agrees with this conclusion. Additionally, the screening mechanism for coronary artery disease (CAD) is inadequate. Recommendations 1-2 below address safety issues unique to this event. Recommendations 3-5 are preventive measures often recommended by fire service groups to reduce the risk of on-the-job heart attacks and sudden cardiac arrest among fire fighters. These recommendations should be implemented by the Southern California Agency (SCA). 1. Check WCT participants' vital signs before testing. 2. Modify the Health Screening Questionnaire (HSQ) in the Pacific Regional Handbook to include all cardiovascular risk factors identified by the American Heart Association/American College of Cardiology (AHA/ACC). 3. Consider providing pre-placement and periodic medical evaluations to ALL fire fighters consistent with NFPA 1582 or equivalent to determine their medical ability to perform duties without presenting a significant risk to the safety and health of themselves or others. 4. Ensure that fire fighters are cleared for duty by a physician knowledgeable about the physical demands of fire fighting. 5. Ensure that fire fighters participate in a mandatory wellness/fitness program designed for wildland fire fighters to reduce risk factors for cardiovascular disease and improve cardiovascular capacity.