The NIOSH Firefighter Fatality Investigation and Prevention Program have released the line of duty death report of a Utah fire marshal who suffered cardiac arrest during a department physical ability test on August 2011.
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Fire Marshal Suffers Cardiac Arrest, Probable Heart Attack during a Fire Department Physical Ability Test
On August 26, 2011, a 55-year-old male Fire Marshal suffered a sudden cardiac event during a fire department (FD) physical ability test (PAT). The test, a job-related simulation, involved completing 10 evolutions of essential fire fighter tasks in full turnout gear and self-contained breathing apparatus (off-air / no mask) within 19 minutes. The test began about 0715 hours at the FD headquarters with two test proctors and two FD members from the adjoining fire station in attendance. The Fire Marshal completed the first 8 evolutions without any difficulty. About halfway along the ninth evolution the Fire Marshal stumbled and fell while dragging a 175-pound manikin. After taking a short break to catch his breath, he said “I gotta finish,” and proceeded to the apparatus bay for the last evolution. The Fire Marshal looked exhausted; he was very short of breath and had ashen skin color and cyanotic lips. He was unable to complete the evolution before the 19-minute PAT completion time elapsed.
He flopped into a chair and then asked to lie down. His breathing became very shallow and fast as his turnout coat was removed. He was treated at the scene for low oxygen saturation and low blood pressure. As the Fire Marshal was loaded into the ambulance he suffered a cardiac arrest, but regained a heart rhythm enroute to the local hospitals emergency department (ED). Upon arrival at the ED, the Fire Marshal was hypotensive and unresponsive. Subsequent blood tests indicated a probable heart attack. The Fire Marshal did not regain consciousness and died on August 28, 2011.
The death certificate and the autopsy, both completed by the assistant medical examiner, listed “hypertensive cardiovascular disease” as the cause of death. Given the Fire Marshal’s cardiac findings at autopsy (concentric left ventricular hypertrophy (LVH) and focal acute myocardial infarction [heart attack] of the posterior wall), the NIOSH investigator concludes that the heavy physical exertion required to complete the PAT in full turnout gear triggered a heart attack and/or a heart arrhythmia (asystole) which resulted in cardiogenic shock.
NIOSH offers the following recommendations to reduce the risk of heart attacks and sudden cardiac arrest among fire fighters at this and other fire departments across the country.
Strengthen the FD’s Annual Medical Assessment Program to be consistent with the National Fire Protection Association (NFPA) 1582 by:
- Ensuring that fire fighters are medically cleared for duty by a physician knowledgeable about the physical demands of fire fighting, the personal protective equipment used by fire fighters, and the various components of NFPA 1582.
- Including a comprehensive medical and work history form in the medical assessment.
- Ensuring that the annual 12-lead resting electrocardiogram (EKG) conducted by the FD paramedics is reviewed by the FD physician and included in the member’s FD medical file.
- Conducting symptom-limiting exercise stress tests for fire fighters at risk of coronary heart disease (CHD).
- Eliminating annual chest x-ray for members, unless clinically indicated.
- Including an annual urinalysis or a urine dipstick test.
Consider modifying the physical fitness policy by:
- Developing a separate physical ability policy.
- Removing the employment consequences for members who fail to achieve the established benchmarks.
Avoid back-to-back work shifts.
