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

On February 20, 2003, at 0730 hours, a 53-year-old male career Captain (the deceased) began his 24-hour shift at his fire station. During his shift, the Captain was performing normal duties including checking fire extinguishers and participating in training exercises of emergency egress during aircraft rescue operations. He was last seen alive by crew members at 2030 hours as he was preparing for sleep. He was found the next morning in his private quarters at 0700 hours by two crew members. The Captain was unresponsive, wearing the previous night's uniform, laying diagonally on top of his bed. One crew member ran from the room to call 911 (medical emergency) and retrieve an automated external defibrillator (AED) from the station's ambulance. The other crew member checked the Captain's vital signs and found no pulse and no respirations. As he prepared to perform cardiopulmonary resuscitation (CPR), he noted the Captain was stiff and cool to the touch. Since the Captain had obviously been expired for some time, CPR was not begun. The AED showed no heart beat (asystole), and this lack of a heart beat was confirmed by the arriving Advance Life Support ambulance team. He was pronounced dead at the station by the county coroner. The death certificate completed by the county medical examiner, listed "ischemic heart disease" as the immediate cause of death due to "atherosclerotic coronary heart disease." The autopsy, conducted under the supervision of the county medical examiner listed "arteriosclerotic cardiovascular disease" as the cause of death. A number of agencies have developed preventive measures to reduce the risk of on-the-job heart attacks and sudden cardiac arrest among fire fighters. This strategy consists of: 1) minimizing physical stress on fire fighters

2) screening to identify and subsequently rehabilitate high risk individuals

and 3) encouraging increased individual physical capacity. This strategy has not been evaluated by NIOSH, but represents research presented in the literature, consensus votes of Technical Committees of the National Fire Protection Association (NFPA), or labor/management groups within the fire service. Issues potentially relevant to this FD include: 1) Consider slightly modifying FD medical evaluations to be consistent with NFPA 1582

2) Consider adding exercise stress tests to the medical examination on a periodic basis

3) Consider more strenuous physical fitness testing

4) Phase in a mandatory wellness/fitness program for fire fighters to reduce risk factors for cardiovascular disease and improve cardiovascular capacity.