Lieutenant Suffers Heart Attack During Fire Suppression Operations at Residential Fire and Dies Ten Days Later - Georgia

Death in the Line of Duty...A summary of a NIOSH fire fighter fatality investigation

F2015-07 Date Released: October 8, 2015

Executive Summary

On April 24, 2015, a 54-year-old male career lieutenant (“LT”) responded to a fire in an unoccupied residential structure. The LT drove a service engine alone to the scene, and then stretched about 200 feet of uncharged 1½-inch hoseline from Engine 200 to the structure as crewmembers arriving separately began donning self-contained breathing apparatus (SCBA). After the hoseline was charged, the LT performed exterior fire suppression for about 5 minutes when the crewmembers advanced the hoseline to the rear of the structure. As the LT returned to the front of the structure he collapsed.

On-scene crewmembers and ambulance service paramedics immediately began cardiopulmonary resuscitation (CPR) and advanced life support. A cardiac monitor revealed ventricular fibrillation; one shock was administered on-scene and one shock was administered during transport to the emergency department (ED). Inside the ED, two additional shocks were administered with return of a pulse. The LT’s condition stabilized over the next hour and he was flown to a regional advanced care hospital for emergency cardiac catheterization. Despite some success opening the blocked coronary artery and 10 days in the intensive care unit, the LT remained unconscious and tests revealed anoxic brain damage. After consultation with the family, the LT was unhooked from the machines and transferred to hospice where he died 5 hours later.

The death certificate (completed by the County Coroner) and the autopsy report (completed by the State Deputy Chief Medical Examiner) both listed “myocarditis in varying stages of healing” as the cause of death with “atherosclerotic and hypertensive cardiovascular disease and diabetes mellitus” as contributing factors. The LT’s myocarditis and coronary heart disease were both undiagnosed prior to this incident. These two underlying conditions set the stage for the physical stress of advancing the hoseline and performing exterior fire suppression to trigger a heart attack, which ultimately resulted in his death.

Key Recommendations

• Provide preplacement and annual medical evaluations to all fire fighters consistent with National Fire Protection Association (NFPA) 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments, to identify fire fighters at increased risk for coronary heart disease (CHD)
• Perform symptom-limiting exercise stress tests (ESTs) on fire fighters at increased risk for CHD
• Ensure that fire fighters are cleared for return to duty by a physician knowledgeable about the physical demands of fire fighting, the personal protective equipment used by fire fighters, and the components of NFPA 1582

The following recommendations would not have prevented the FF’s death, but NIOSH investigators include them to address general safety and health issues:

• Phase in a mandatory comprehensive wellness and fitness program for fire fighters
• Provide fire fighters with medical clearance to wear a self-contained breathing apparatus (SCBA) as part of the fire department’s medical evaluation program
• Use a secondary (technological) test to confirm appropriate placement of the endotracheal tube

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