Victim suffered a fatal heart attack during medical evaluation
Going into the new year, the “On-Duty Deaths in Detail” posts will be partnered with posts providing NIOSH followup to the Unites States Fire Administration firefighter fatality announcement. Since it is common practice culturally that the majority of NIOSH firefighter fatality reports to be shared are ones involving firefighting, we’ll work to make readers aware of those involving the majority causes and natures of our on-duty deaths. This information may be subject to change.
Victim with known risk of coronary heart disease physically engaged in firefighting efforts at two incidents. First sign of trouble noted at first incident and continued to end of second incident. No report of EMS on scene at moment victim sought help. Department has no annual medical evaluations. Fitness and wellness are voluntary.
On 28 January 2014 a 53-year old career Arkansas fire chief suffered a heart attack while working on the scene of a grass fire that had spread to a residential structure. His death was the seventh on-duty death of the month and year. The cause of death was listed as ‘Stress/Overexertion’ and the nature as ‘Heart Attack’. The victim’s activity type was listed as ‘Incident Command’.
0835 hours – 0945 hours: The victim’s day was a nine-hour shift. He had spent an hour fighting a grass fire with a hoseline and wildland hand tools. While returning to the station he reported experiencing heartburn.
1214 hours: Victim responded to a grass fire which was upgraded to a structure fire based on the initial on-scene report. In PPE (minus SCBA) victim and a line officer stretched a 1 3/4-inch hoseline and began an exterior fire attack.
@1245 hours: An engine and mutual aid firefighters arrive (number of staffing not reported) and victim and line officer don SCBA and advance a 1 3/4-inch hose line to begin exterior attack. The line is stretched inside the structure with the victim at the rear assisting in the advance.
@1255 hours: Victim exits structure to retrieve a PPV fan. He returns appearing sluggish and disoriented according the the line officer. The victim exits the structure a second time when his SCBA low air alarm is activated.
1358 hours: Victim reports indigestion getting worse (four hours after initial report), contacts EMS Director about symptoms and is told to drive to office for evaluation. Victim drives himself, with a firefighter passenger to EMS headquarters. Note: NIOSH report does not mention if an ambulance and EMS personnel were on the scene.
1418 hours: Evaluation at EMS headquarters
The paramedic found the Chief sweating heavily, short of breath, and belching often. A cardiac monitor revealed a lateral ST segment elevation consistent with a heart attack (myocardial infarction). His vital signs included a blood pressure of 162/102 millimeters of mercury, a pulse rate of 110 beats per minute, and a respiratory rate of 30 breaths per minute. The Chief reported left arm tingling, nausea, and chest pain. The paramedic advised immediate transport for an acute heart attack.
1423 hours: Transport by ambulance to local hospital
1430 hours: Unresponsive, no pulse, no respirations
1441 hours: Arrival at hospital; cardiac resuscitation efforts for 10 minutes return heartbeat, victim still unconscious. 1522 hours: Cath lab. 1630 hours: ICU. @1735 hours: Cardiac arrest; CPR and ALS measures for thirty-minutes. Pronounced dead at 1830 hours.
Cause of Death, Autopsy
Hypertensive Arteriosclerotic Cardiovascular Disease. Fresh thrombus inside the LAD stent partially occluding the lumen. No elevated carboxyhemoglobin levels, suggesting the victim did not have carbon monoxide poisoning.
53-year old male. 71″ tall, 241 lbs. Hypertension diagnosed in 2009, under control in 2012. Two year history of gastroesophageal reflux disease, treated. Worked a Monday through Friday 0800 – 1700 hours shift. 28 years of experience. Last medical evaluation was by personal physician in August 2013. Participated in physical fitness activities five days a week.
Preplacement medical evaluation by personal physician. Annual medical evaluations not required. Personal physician must clear injured personnel; department makes final determination. Voluntary wellness and fitness program. Annual, required job performance physical abilities test. Note: NIOSH report neither confirms or denies if victim participates in this test.
Candidate and Annual Physical Ability Test (pass/fail)
1. Drag 3-inch uncharged hoseline 100 feet.
2. Roll the hose into a donut, unroll the hose, place a nozzle on the hoseline.
3. Advance the hoseline to the chopping block.
4. Using the axe, strike the chopping block five to six times.
5. Walk to the ladder. Climb the ladder and perform a leg lock. Descend the ladder.
6. Drag a 175-pound manikin 100 feet
NIOSH concludes that the victim’s death could have been prevented by:
1. Conduct exercise stress tests as part of the fire department medical evaluation program for fire fighters at increased risk for coronary heart disease (CHD).
The victim was over the age of 45 and had one modifiable risk factor for CHD (high blood pressure)
2. Provide preplacement and annual medical evaluations to all fire fighters in accordance with NFPA 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments.
To overcome the financial obstacle of medical evaluations, the fire department could urge current members to get annual medical clearances from their private physicians. Another option is having the annual medical evaluations completed by paramedics and emergency medical technicians from the local ambulance service (vital signs, height, weight, visual acuity, and EKG).
Contrast with USFA
Victim’s activity type is listed as “Incident Command”  however the NIOSH report does not state, other than by identifying rank, that the victim was in command of the incident. If the activity type is determined at the onset of the medical condition, then it is noted that the victim was physically engaged in firefighting operations for a grass, brush fire at first and a grass/brush fire and residential structure fire second:
During the morning he spent over an hour fighting a grass fire using an attack line to knock down the flames and then wildland fire suppression tools to extinguish hot spots.
While waiting for the fire departmentâ€™s engine to arrive, the Chief began exterior fire attack.Once the engine arrived, the Chief and a lieutenant donned their self-contained breathing apparatus (SCBA) and began interior fire attack.
A more closely related activity type could be “Advancing Hoselines/Fire Attack (including Wildland).” This coincides with the USFA narrative.
January 2014 On-Duty Deaths in Detail, BackstepFirefighter.com
Bill Carey is the online public safety news and blog manager with PennWell Public Safety, or more specifically FireRescue Magazine/FirefighterNation.com, JEMS.com, LawOfficer.com and FireEMSBlogs.com. Bill started in the fire service, as a third generation firefighter in 1986, on the eastern shore of Maryland and then continued after moving to Prince Georgeâ€™s County. He served as a volunteer sergeant and lieutenant at Hyattsville. Billâ€™s writing has been on Firehouse.com, Fire Engineering, FireRescue Magazine, FirefighterNation.com, the Jones and Bartlett 2010 edition of â€œFire Officer: Principles and Practiceâ€, The Secret List and Tinhelmet.com. His recent writing on firefighter behavioral health has been nominated for 2014 Neal Award for Best Subject-Related Series.