Line of Duty Death Report F2025-04: 46-Year-Old Lieutenant Collapses While Serving as Driver/Engineer at Residential Fire - Maryland

Details

• Journal Article:
  National Institute for Occupational Safety and Health
• Personal Author:
  Barger, Alexandra ; Wilkinson, Andrea F. ; Judah, Lindsay
• Description:
  On October 19, 2024, a 46-year-old Lieutenant (L1) was hospitalized after experiencing a stroke. L1 used the fire department's (FD) shift substitution policy for time off work as he recovered, rather than taking medical leave. He would not report back to work at the fire station until January 8, 2025. On January 11, 2025, (L1's second shift back to work since October), at 16:55, units were dispatched for a working structural fire of a single-family home. The responding FDs were working as part of an automatic aid agreement. At 1709, a firefighter (FF1) from Engine 3 (E3) witnessed L1 collapse after throwing a ladder and notified his Lieutenant (L2). At 1709, L2 sent a priority radio message to command stating they needed EMS side bravo. Battalion Chief 1 (BC1) acknowledged and stated he saw the member down. Due to the snowy and steep conditions of the scene, L2 and Master FF1 (MFF1) (FD1, E3) pulled the unresponsive and unconscious L1 closer to the street (approximately 20-30 yards from site of collapse) so that the paramedic stretcher could be used. At this point, care was transferred to the awaiting advanced life support (ALS) team who moved L1 onto the stretcher at 1711. The ALS team noted L1 to be unresponsive, not breathing (apneic), and without a pulse. Cardiopulmonary resuscitation (CPR) was initiated on the stretcher. Once connected to a monitor, L1 was observed to be in ventricular fibrillation. The patient was defibrillated with no conversion of ventricular fibrillation. Despite the medical interventions, L1 remained in ventricular fibrillation throughout the majority of transport time to the emergency department, with the exception of brief periods of pulseless electrical activity (PEA). Upon arrival at the hospital, hospital staff continued resuscitation efforts. Advanced life support efforts were continued for another 15 minutes after arrival, but L1 never regained a pulse and time of death was declared at 1801. Review of medical records shows that L1 had a history of surgically repaired coarctation of the aorta, a congenital heart condition. During his hospitalization for stroke, L1 was newly diagnosed with congestive heart failure. Heart failure can lead to an increased risk of sudden cardiac death, and in some cases requires restriction from certain work duties per National Fire Protection Association (NFPA) 1582 occupational medical standards. This diagnosis was never reported to the department's physician, and since L1 used shift substitution rather than medical leave for his recovery, a return-to-work medical evaluation was never conducted. Though it is not possible to determine conclusively if this contributed to the fatality, the lack of a return-to-work medical evaluation by a provider with occupational health expertise was a missed opportunity for promotion of firefighter safety. Key Recommendations - NIOSH offers the following recommendations to reduce the risk of firefighter mortality at this and other fire departments across the country. Many of our recommendations cite relevant NFPA standards which are periodically updated. Please note that it is our practice to cite the version of each standard in effect at the time of the fatality. Key Recommendation #1: Ensure that a physician familiar with the essential tasks of firefighting as outlined by the NFPA and the physiologic requirements to complete them safely signs off on return-to-work physicals. Key Recommendation #2: Evaluate department shift substitution and medical leave policies to ensure they are being applied appropriately. Key Recommendation #3: Promote effective fireground communication with all mutual aid companies to ensure critical radio traffic is understood and relayed to on-scene personnel for incident stabilization and safety. Key Recommendation #4: Continuously evaluate staffing and deployment strategy to plan for effective emergency response. Key Recommendation #5: Work with automatic aid companies to establish a policy for clearing the fire scene following an incident of this nature.
• Subjects:
  Cardiovascular Diseases Cardiovascular System Emergency Responders Firefighters Fires Occupational Health Safety
• Keywords:
  Author Keywords: Firefighter; Stroke History; Cardiovascular Disease; Congestive Heart Failure Region 3; Fire Fighters; Fire Fighting; Fatalities; Emergency Responders; Recommendations; Medical Fitness Evaluation; Cardiovascular Disease; Return To Work; Heart Attacks;
• FACE - Firefighter:
  Cause of Death Medical (0000) ; Cardiovascular (0001) ; Non-Cardiac (0002) ; Heart Attack (Myocardial Infarction, Coronary Artery Disease and Coronary Vascular Disease) (0035) ; Congestive Heart Failure (0037) ; Stroke (0042)
• Source:
  Cincinnati, OH: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, FACE F2025-04, 2026 Mar; :1-21
• Series:
  Fatality Assessment and Control Evaluation Reports (FACE)
• Subseries:
  Firefighter Fatality Investigation
• DOI:
  10.26616/NIOSHFFFACEF202504
• Publisher:
  National Institute for Occupational Safety and Health
• Document Type:
  Text
• Genre:
  Field Study
• Place as Subject:
  Maryland ; Ohio ; Philadelphia Region [OSHA] ; Chicago Region [OSHA]
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  DFSE - Division of Field Studies and Engineering
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  23 pdf pages
• NIOSHTIC Number:
  nn:20071264
• Federal Fiscal Year:
  2026
• NORA Priority Area:
  Public Safety
• Peer Reviewed:
  False
• NAICS and SIC Codes:
  92 - Public Administration - (NAICS 2022)
• Start Date:
  20250111
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:7dc8e6fba17398bc925d08da42cb61f8e1428110d911e87d4b598961071f9d6c84f37612daaad3d3eee04c9d4191091615486f1dd8c6a1b79659160409bd7119
• Download URL:
  https://stacks.cdc.gov/view/cdc/258742/cdc_258742_DS1.pdf
• File Type:
  [PDF - 1.40 MB ]