Death in the Line of Duty – a NIOSH Investigation

On July 24, 2016, a 56-year-old male volunteer firefighter collapsed as he was pumping the engine at a brush fire. Emergency medical services (EMS) trained personnel and the EMS Medical Director immediately initiated cardiopulmonary resuscitation (CPR) and followed advanced cardiac life support (ACLS) myocardial infarction protocols, shocking the FF multiple times. Care continued en route to the hospital. Hospital emergency department (ED) personnel continued to treat the FF without success for over 30 minutes and pronounced him dead at 1632 hours.

The Medical Examiner’s report listed the cause of death as arteriosclerotic cardiovascular disease. The report documented evidence of arteriosclerotic cardiovascular disease, including previous myocardial infarction (heart attack), multiple stent procedures, evidence of multi-vessel coronary artery bypass grafting (CABG), high-grade arteriosclerotic plaque in the coronary arteries, and a severely enlarged and dilated heart. NIOSH investigators concluded that the physical stress of the emergency response might have triggered the cardiovascular event.

The firefighter had an extensive history of coronary artery disease, including two previous heart attacks. The more recent one had occurred just months earlier (January 2016), after which he underwent CABG surgery to treat multiple arteries having severe blockage. An echocardiogram revealed the pumping function of his main chamber (left ventricle) was reduced. The firefighter had several ongoing risk factors for coronary artery disease, including smoking, high blood pressure, unhealthy cholesterol levels, and obesity.

NIOSH has issued the following recommendations:

  • Ensure that all firefighters receive an annual medical evaluation consistent with National Fire Protection Association (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 fire fighting, the personal protective equipment used by firefighters, and the various components of NFPA 1582;
  • Phase in a mandatory comprehensive wellness and fitness program for firefighters; and
  • Perform an annual physical performance (physical ability) evaluation.