Fatality Assessment and Control Evaluation (FACE) Report: Fire Chief Suffers Sudden Cardiac Death at Home After Performing Apparatus Maintenance and Conducting Training in Texas

摘要

On February 22, 2005, a 39-year-old male volunteer Fire Chief performed apparatus maintenance on two fire department (FD) vehicles, conducted traffic control and hazardous materials classroom training, and demonstrated the force required to pull a box of extrication tools out of an apparatus compartment. Later that evening, he complained of 'stomach discomfort.' On February 23, 2005, the Chief pulled the extrication tool box out again to verify its contents. After going home and preparing to retire for the evening, his stomach discomfort became more severe. His wife, a fire fighter/emergency medical technician (FF/EMT), prepared to call 911 but the Chief wanted to be driven to the hospital. As the Chief was getting dressed, he collapsed (2358 hours). His wife found him unresponsive, not breathing, but with a pulse. She cleared his airway, called 911, and began rescue breathing. The Chief soon became pulseless, and she began cardiopulmonary resuscitation (CPR). FD units and an ambulance were dispatched and provided advanced life support (ALS). Despite CPR and ALS performed by FD crew members, ambulance service paramedics, and hospital emergency department (ED) personnel, the Chief died. The death certificate, completed by the Justice of the Peace, and the autopsy, completed by the forensic pathologist, both listed 'severe three vessel atherosclerotic coronary artery disease' (CAD) as the cause of death. The NIOSH investigator concluded that the physical stress of performing apparatus maintenance, conducting training, and the Chief's underlying atherosclerotic CAD contributed to his sudden cardiac death. To reduce the risk of on-the-job heart attacks and sudden cardiac arrest among fire fighters, NIOSH investigators offer the following recommendations: (1) Provide pre-placement and annual medical evaluations to ALL fire fighters to determine their medical ability to perform duties without presenting a significant risk to the safety and health of themselves or others; (2) Provide fire fighters with medical evaluations and clearance to wear SCBA; (3) Phase in a mandatory wellness/fitness program for fire fighters to reduce risk factors for cardiovascular disease and improve cardiovascular capacity; (4) Perform an annual physical performance (physical ability) evaluation to ensure fire fighters are physically capable of performing the essential job tasks of structural fire fighting; (5) Use a secondary (technological) test to confirm appropriate placement of the endotracheal (ET) tube during emergency intubations.