On June 23, 2016, a 38-year-old male volunteer captain responded to an emergency medical call. While helping transfer a patient from a car onto a stretcher, he started to feel as though “someone had dropped the car” on his chest.
After the ambulance left with the patient, the Captain drove a private vehicle to the fire station, then drove to his parents’ home. His chest pain continued and his mother drove him to the hospital emergency department, where testing showed he was having a heart attack.
In the coronary catheterization laboratory (“cath lab”), a stent placed a year earlier was found to be blocked. A balloon was inserted to open the blockage, blood flow was restored, and the Captain’s chest pain resolved.
Because of a decline in his heart’s pumping function and a history of multiple stents, coronary artery bypass graft (CABG) surgery was offered. CABG uses healthy vessels from other parts of the body to bypass blocked arteries in the heart. Before he could undergo surgery, the Captain suffered cardiac arrest and died despite multiple rounds of cardiopulmonary resuscitation (CPR) and advanced life support (ALS) measures.
The death certificate was completed by the attending physician. The cause of death was listed as “cardiac arrhythmia” due to “coronary artery disease” due to “diabetes.” No autopsy was performed. NIOSH investigators concluded that the physical exertion of loading a patient may have exacerbated the Captain’s underlying coronary artery disease and triggered a heart attack (myocardial infarction).
The Captain had multiple risk factors for coronary artery disease, including long-standing diabetes, smoking, high blood pressure, dyslipidemia, and family history of early heart disease. He suffered his first heart attack at age 30 and subsequently underwent multiple hospitalizations and interventions for severe disease.
NIOSH has provided the following 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 firefighters at increased risk for sudden cardiac events; and
- Ensure that firefighters are cleared for duty by a physician knowledgeable about the physical and mental demands of firefighting, the personal protective equipment used, and other guidance in NFPA 1582.
NIOSH investigators include the following recommendations to address general safety and health issues:
- Perform an annual physical ability test (physical performance evaluation);
- Phase in a mandatory wellness and fitness program to benefit all firefighters; and
- Provide fire fighters with medical clearance to wear a self-contained breathing apparatus (SCBA) as part of the fire department’s medical evaluation program.