The NIOSH Firefighter Fatality Investigation Program has released the report of a Illinios Deputy Chief who died of sudden cardiac arrest during physical fitness training in 2010.
Report: Deputy Chief Suffers Sudden Cardiac Death During Physical Fitness Training — Illinois
On September 20, 2010, a 55-year-old male career Deputy Chief (DC) responded to a medical call and provided assistance. Later in the day, the DC exercised as part of the Fire Department (FD) fitness program. The DC was about 5 minutes into his exercise program when the duty crew was dispatched to a call in which the DC did not respond. Approximately 90 minutes later, the DC was found unresponsive lying alongside the Stairmaster®. Despite cardiopulmonary resuscitation (CPR) and advanced life support (ALS) at the fire station, in the ambulance, and in the hospital’s emergency department (ED), the DC died.
The death certificate and the autopsy listed “hypertrophic cardiomyopathy” as the cause of death with “arteriosclerotic coronary artery disease” as a contributing condition. Given the DC’s severe underlying heart disease, NIOSH investigators concluded that moderately strenuous physical exertion during exercise probably triggered an arrhythmia causing his sudden cardiac death.
Medical Findings
The death certificate and the autopsy listed “hypertrophic cardiomyopathy” as the cause of death with “arteriosclerotic coronary artery disease” as a contributing condition. The DC’s coronary arteries showed “mild” atherosclerosis of his left anterior descending artery and “no significant narrowing” of his two other main coronary arteries. No blood carboxyhemoglobin was detected suggesting the DC had not inhaled significant amounts of carbon monoxide. Toxicology results for drugs and alcohol were also negative. Specific findings from the autopsy are listed in Appendix A.
On autopsy, the DC was found to have mild/minimal CAD, for which his only risk factor was obesity (body mass index of 36.0 kilograms per meters squared) [CDC 2011]. The DC underwent annual FD medical evaluations including exercise stress tests (ESTs) with periodic echocardiography using the Bruce protocol [Sport Fitness Advisor 2011]. Table 1 lists the dates and results of his ESTs. An EST with echocardiography was performed 1 month prior to his death. The DC exercised for 11 minutes, 37 seconds on the Bruce protocol, expending 11.6 metabolic equivalents. The DC reached a maximum heart rate of 148 beats per minute, 89% of his age-predicted maximum heart rate, before stopping due to fatigue and dyspnea (shortness of breath). He reported no angina, and his blood pressure response was normal. The EKG revealed rare isolated premature ventricular complexes with exercise. Because of a previously noted resting ST-segment abnormality, changes in the ST-segment with exercise could not be definitively interpreted for ischemia. His echocardiogram was reported to show a normal left ventricular size and function.
Overall, the test was interpreted as normal with good exercise capacity. At his annual exam 1 month prior to death, a spirometry test revealed moderate obstructive disease. The physician recommended the DC follow up with a pulmonologist. He was cleared to wear a respirator but the FD restricted from fire response that would require wearing a self-contained breathing apparatus.
NIOSH Recommendations
NIOSH investigators offer the following recommendations to address general safety and health issues. It is unclear, however, if these recommended programs would have prevented the DC’s death.
Ensure fire fighters are cleared for return to duty by a healthcare provider knowledgeable about the physical demands of fire fighting, the personal protective equipment used by fire fighters, and the various components of National Fire Protection Association (NFPA) 1582.
Ensure on-duty fire fighters exercise in pairs or within viewing/hearing distance of another crew member.
