Fatality Assessment and Control Evaluation (FACE) Report: Fire Fighter Trainee Suffers Fatal Exertional Heat Stroke During Physical Fitness Training in Texas

摘要

On April 20, 2009, a 26-year-old male career Fire Fighter Trainee began a 2-month fire fighter certification program at the City Fire Training Academy. On April 29, 2009, the Trainee participated in a 4.4-mile jog as part of the physical fitness portion of the program. The temperature was approximately 73 degrees Fahrenheit (DGF) dry bulb (70DGF wet bulb) with 87% relative humidity. About 50 feet from the finish line, the Trainee became unsteady and told a crew member that he 'just wanted to finish.' A few steps further, a crew member assisted him to the ground as help was summoned. Vital signs revealed low blood pressure (60 millimeters of mercury (mmHg) systolic) and a fast heart rate (170 beats per minute). An ambulance arrived and treated the Trainee for heat-related illness with ice packs to the skin and intravenous fluids before departing to the hospital. In the hospital's emergency department (ED), a rectal temperature of 105.3DGF was documented 45 minutes after the Trainee's collapse and at least 30 minutes after ice packs were placed on his skin. Despite treatment in the ED and hospital for exertional heatstroke, the Trainee died 5 days later. The autopsy report listed the cause of death as 'complications of hyperthermia and dehydration.' NIOSH investigators agree with the Medical Examiner's assessment. In addition, NIOSH investigators concluded that the Trainee's hyperthermia and exertional heatstroke were precipitated by the heavy physical exertion associated with the physical fitness training. NIOSH investigators offer the following recommendations to address safety and health issues. Had these recommendations been in place, the Trainee's death probably could have been prevented. (1) Structure the recruit physical fitness training program to be consistent with the IAFF/IAFC Candidate Physical Ability Test (CPAT). (2) Ensure trainees are hydrated at all phases of physically demanding tasks. (3) Ensure ice water immersion therapy is rapidly available at the Fire Training Academy. The following recommendations are based on general health and safety considerations and would not have prevented the Trainee's death: (1) Ensure the personnel responsible for the physical training program are knowledgeable about the Fire Department (FD) heat stress program. (2) Ensure the FD Trainee Code of Conduct and Standards does not penalize students for seeking medical attention. (3) Use a checklist to screen fire fighters for individual heatstroke risk factors. (4) Provide annual medical evaluations consistent with NFPA 1582 to all fire fighters. (5) Perform annual physical performance (physical ability) evaluations for all fire fighters. (6) Phase in a comprehensive wellness and fitness program. (7) Provide fire fighters with medical clearance to wear self-contained breathing apparatus (SCBA) as part of the FD medical evaluation program.