Firefighter Suffers Cardiac Event Following Residential Fire – NY

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

F2015-10 Date Released: April 25, 2016

Executive Summary

On May 4, 2015, at 0700 hours, a 54-year-old male career fire fighter (FF) began his 24-hour shift. At 1058 hours, the FF and his crew were dispatched to a residential fire with reports of a possible victim. The FF assisted in the rescue attempt and fire suppression activities for approximately 40 minutes, when he reported to incident scene rehabilitation. During his 20 minutes in rehab the FF reported no signs or symptoms of distress. However, as the FF was preparing to take his gear to the apparatus, he reported left shoulder pain and was transported by ambulance (no lights or siren) to the local emergency department (ED). As the FF was walking into the ED at 1224 hours, he reported severe chest pain and shortness of breath. Shortly thereafter, he suffered a cardiac arrest. The FF was successfully resuscitated but he remained in cardiogenic shock. An electrocardiogram (ECG) showed findings consistent with an acute heart attack and an emergency cardiac catheterization showed complete occlusion of his left main coronary artery. The catheterization and efforts to open the occluded artery were complicated by two episodes of cardiac arrest and referral for emergency coronary artery bypass graft (CABG) surgery. Despite these intensive measures, the FF had suffered anoxic brain damage. The next day, after discussion with family members, the medical staffed withdrew life support measures and shortly thereafter the FF was pronounced dead.

The autopsy and the death certificate, completed by the County Deputy Medical Examiner, listed "myocardial infarction due to atherosclerotic cardiovascular disease” “in a fireman sustained during a housefire.” The autopsy revealed cardiac hypertrophy, marked coronary atherosclerotic stenosis in two vessels, and evidence of infarction (myocardium had area of reddish mottled hemorrhage). NIOSH investigators concluded that the physical stress of responding to and participating in fire suppression activities at the structure fire triggered a heart attack which resulted in his cardiac arrest and subsequent death.

Key Recommendations

• Ensure that all fire fighters receive an annual medical evaluation consistent with NFPA 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments.
• Ensure fire fighters are cleared for duty by a physician knowledgeable about the physical demands of firefighting, the personal protective equipment used by fire fighters, and the various components of NFPA 1582.
• Phase in a mandatory comprehensive wellness and fitness program for fire fighters.

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