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Friday, July 17, 2015

NIOSH Firefighter Fatality Investigation: California Firefighter who suffered sudden cardiac death working third consecutive 24-hour shift

NIOSH Firefighter Fatality Report: California Fire Engineer Suffers Sudden Cardiac Death

Undiagnosed coronary heart disease combined with consecutive 24-hour shifts lead to an arrhythmia

The NIOSH Firefighter Fatality Investigation and Prevention Program has released the line of duty death report of a California Fire Engineer who suffered sudden cardiac death on January 20, 2014.

Read the Report Here

Fire Engineer Suffers Sudden Cardiac Death at Shift Change

On January 20, 2014, a 49-year-old male career Fire Engineer (FE) was scheduled to work his regular 24-hour shift. This would have been his third consecutive 24-hour shift as he volunteered to work a 24-hour overtime shift the day before.

During the first 48 hours, the FE responded to seven medical calls, none of which required heavy physical exertion; he did not complain of any symptoms. When the FE did not attend the third shift change meeting (0800 hours), crew members found him unresponsive in his bunk. Advanced life support (ALS) including cardiac defibrillation was performed and the FE was transported to the hospital’s emergency department (ED).

Despite cardiopulmonary resuscitation (CPR) and ALS at the scene, in the ambulance, and in the hospital’s ED, the FE died. The death certificate and the autopsy listed “hypertensive cardiovascular disease with marked cardiomegaly” as the cause of death with “mitral valve prolapse, clinical history of hypertension, and left bundle branch block” as significant other conditions.

Given the FE’s undiagnosed underlying coronary heart disease (CHD), NIOSH investigators concluded that an arrhythmia probably triggered his sudden cardiac death.

Key Recommendations:

  • Provide mandatory annual medical evaluations to all fire fighters consistent with the current edition of National Fire Protection Association (NFPA) 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments
  • Perform symptom-limiting exercise stress tests for fire fighters at risk for CHD and sudden cardiac events
  • Phase in a mandatory comprehensive wellness and fitness program for fire fighters.
  • Perform an annual physical performance (physical ability) evaluation for all members
The following recommendations address general safety and health issues:
  • Limit the number of consecutive shifts a fire fighter can work
  • Discontinue routine screening chest x-rays for members unless clinically indicated.

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