On February 27, 2009, a 45-year-old male career Fire Fighter/Paramedic (FF/P) responded to two medical calls and a fire alarm during the morning of his shift. At lunchtime, the FF/P did
On February 27, 2009, a 45-year-old male career Fire Fighter/Paramedic (FF/P) responded to two medical calls and a fire alarm during the morning of his shift. At lunchtime, the FF/P did not eat and retired to the upstairs bunkroom because he did not feel well. The crew was dispatched to a structure fire 3.5 hours later. As his crew prepared to respond, the FF/P was found unconscious on the bathroom floor. Cardiopulmonary resuscitation (CPR) did not revive the FF/P. The death certificate and the autopsy listed the cause of death as “cardiac tamponade due to aortic dissection due to hypertensive cardiovascular disease.” NIOSH investigators agree with these conclusions.
NIOSH investigators offer the following recommendations to address general safety and health issues. However, it is unclear if these recommended programs could have prevented the FF/P’s death.
Provide annual medical evaluations to all fire fighters consistent with National Fire Protection Association (NFPA) 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments.
Phase in a comprehensive wellness and fitness program for fire fighters.
Perform an annual physical performance (physical ability) evaluation.
INTRODUCTION & METHODS
On the morning of February 27, 2009, a 45-year-old male career FF/P responded to three emergency calls. He subsequently retired to the bunkroom because he was not feeling well. The FF/P was found unconscious on the bathroom floor of the fire station 3.5 hours later. Resuscitation efforts were unsuccessful. The U.S. Fire Administration notified NIOSH of this fatality on March 2, 2009. NIOSH contacted the affected fire department (FD) to gather additional information on March 30, 2009, and on July 26, 2010, to initiate the investigation. On August 2, 2010, a Safety and Occupational Health Specialist from the NIOSH Fire Fighter Fatality Investigation Team conducted an on-site investigation of the incident.
During the investigation, NIOSH personnel interviewed the following people:
NIOSH personnel reviewed the following documents:
Incident. On February 27, 2009, the FF/P arrived for his 24-hour shift at Station 14 (Engine 14) at 0700 hours. Two fire fighters and a lieutenant were on duty with the FF/P. At that time he exhibited no signs or symptoms of medical problems. The crew checked out the engine and equipment and cleaned the station. At 0900 hours, the crew began a tabletop training exercise on completing emergency medical reports and driving.
At 0907 hours, Engine 14 was dispatched to an emergency medical call for a seizure patient at the airport. After providing treatment and transport, Engine 14 returned to service at 0931 hours. At 0937 hours, Engine 14 was dispatched to an emergency medical call for an unconscious person. The FF/P provided medical treatment on the scene and during transport to the hospital. The crew returned to service at 1024 hours.
At approximately 1205 hours, a crew member alerted the crew that lunch was ready. The FF/P, who was upstairs in the bunkroom, did not come down to eat. The crew member walked to the bottom of the stairs (1210 hours) and called out to the FF/P, who responded “okay” but did not come downstairs. At 1238 hours, Engine 14 was dispatched to a vehicle fire. After the crew donned their gear, but before they left the station, the call was cancelled. At approximately 1310 hours the FF/P returned to the bunkroom upstairs saying he did not feel well.
At 1608 hours, Engine 14 was dispatched to a structure fire. The crew donned their gear, but the FF/P did not respond. A crew member called to the FF/P from the bottom of the stairs. The crew member then walked to the stair landing and called again but did not receive a response. The crew member went upstairs and looked through the rooms, but did not locate the FF/P. The crew member went downstairs and checked the rooms without success. He went upstairs again and checked the bathroom where he found the FF/P unconscious on the floor.
The FF/P was unresponsive with no pulse or respirations. The crew member then ran downstairs and alerted the crew. Dispatch was notified of a man down as the crew responded upstairs with resuscitation equipment, including oxygen equipment and an automated external defibrillator (AED). (Dispatch cancelled Engine 14’s response to the structure fire and added other FDs’ engines to the call).
CPR was begun, and the AED was applied. The AED advised no shocks as oxygen was supplied by bag-valve-mask. CPR continued for approximately 2 minutes when Squad 5 (two paramedics) arrived at 1622 hours. A cardiac monitor was applied, revealing asystole (no heart beat). The FF/P was repositioned and it was noted that he had cool skin and rigor mortis of the upper extremities and mandible, signs that the FF/P had been deceased for several hours. The FD Medical Director responded to the scene and pronounced the FF/P dead at 1625 ho