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2010 08 Death in the line of duty... Fire Fighter Fatality Investigation and Prevention Program A summary of a NIOSH fire fighter fatality investigation June, 2010 Major Suffers Sudden Cardiac Death During Physical Fitness Training – Kentucky Executive Summary Introduction & Methods On January 17, 2010, a 51-year-old male volunteer On January 17, 2010, a 51-year-old male volun- Major responded to a reported residential fire. The teer Major died after performing physical fitness reported fire turned out to be steam from a shower. training. NIOSH was notified of this fatality on Three hours after returning home, the Major went January 19, 2010, by the U.S. Fire Administration. to exercise at a local fitness facility with his trainer. NIOSH contacted the affected FD on February After walking on a treadmill for approximately 25 5, 2010, to gather additional information, and on minutes, the Major had a short cool down period March 17, 2010, to initiate the investigation. On when he suddenly collapsed. Cardiopulmonary March 25, 2010, a safety and occupational health resuscitation (CPR) and advanced life support were specialist from the NIOSH Fire Fighter Fatality begun as an ambulance was requested. Despite CPR Investigation Team traveled to Kentucky to con- and advanced life support by the fitness center staff, duct an on-site investigation of the incident. fire department (FD) emergency medical technicians, ambulance paramedics, and hospital’s emergency During the investigation, NIOSH personnel inter- department (ED) staff, the Major died. The death viewed the following people: certificate, completed by the attending physician, • Fire Chief listed “ischemic heart disease with cardiac arrest” • Fire Marshal due to “coronary artery disease” as the cause of death. • Safety Officer The autopsy, completed by the County Coroner, • Crewmembers listed “ischemic heart disease” as the cause of death. • Fitness center Director Given the Major’s severe underlying coronary artery disease (CAD), NIOSH investigators concluded that NIOSH personnel reviewed the following docu- the physical exertion involved in performing physical ments: fitness training triggered his sudden cardiac death. • FD training records • FD annual report for 2009 NIOSH investigators offer the following • FD incident report recommendations to address general safety and health • FD medical records issues. It is unclear if these recommendations would • Emergency medical service (ambulance) inci- have prevented the Major’s death. dent report • Hospital ED records Perform an annual physical performance (physical • Death certificate ability) evaluation. • Autopsy report • Primary care provider medical records Phase in a comprehensive wellness and fitness • Fitness center report program for fire fighters. A Summary of a NIOSH fire fighter fatality investigation Report #2010-08 Major Suffers Sudden Cardiac Death During Physical Fitness Training – Kentucky The National Institute for Occupational Safety and Health (NIOSH) initiated the Fire Fighter Fatality Investigation and Prevention Program to examine deaths of fire fighters in the line of duty so that fire departments, fire fighters, fire service organizations, safety experts and researchers could learn from these incidents. The primary goal of these investigations is for NIOSH to make recommendations to prevent similar occurrences. These NIOSH investigations are intended to reduce or prevent future fire fighter deaths and are completely separate from the rulemaking, enforcement and inspection activities of any other federal or state agency. Under its program, NIOSH investigators interview persons with knowledge of the incident and review available records to develop a description of the conditions and circumstances leading to the deaths in order to provide a context for the agency’s recommendations. The NIOSH summary of these conditions and circumstances in its reports is not intended as a legal statement of facts. This summary, as well as the conclusions and recommendations made by NIOSH, should not be used for the purpose of litigation or the adjudication of any claim. For further information, visit the program website at www.cdc.gov/niosh/fire or call toll free 1-800-CDC-INFO (1-800-232-4636). Page 2 A Summary of a NIOSH fire fighter fatality investigation Report #2010-08 Major Suffers Sudden Cardiac Death During Physical Fitness Training – Kentucky Investigative Results Incident. On January 17, 2010, the FD was dis- AED to the Major, which advised a shock (defi- patched to a residential structure fire at 1330 brillation). One shock was delivered. hours. The Major, on call for the weekend, re- sponded from his home to the scene. Units arrived The advanced life support ambulance staffed with on the scene at 1337 hours and determined the paramedics arrived on the scene at 1749 hours. “smoke” was actually steam from a shower. Units The AED advised to shock again, and a second were released from the scene at 1340 hours. shock was delivered. CPR continued; the Major was placed into the ambulance where he was intu- The Major went home for approximately 3 hours. bated. Tube placement was confirmed by end tidal At approximately 1700 hours, he went to a local CO2 detector [AHA 2005]. Intravenous access fitness facility to exercise. He had joined the facil- was attained and cardiac resuscitation medications ity at the beginning of January and a trainer was were administered as the ambulance departed the assigned to assist him with his fitness program. scene at 1758 hours en route to the hospital’s ED. After speaking with the trainer, the Major walked Advanced life support continued during the 9 min- on the treadmill for 5 minutes to warm up and ute trip to the hospital. have his heart rate checked; his heart rate was 100 beats per minute. The trainer then showed the Ma- The ambulance arrived at the ED at 1807 hours. jor various aspects of the treadmill and the Major Inside the ED, advanced life support continued walked for an additional 20 minutes. The Major’s without change in the Major’s condition until heart rate was checked three times and remained 1817 hours, when the attending physician pro- around 100 beats per minute. After cooling down, nounced the Major dead and resuscitation efforts the Major walked to the hallway, drank some were discontinued. water, and returned to the exercise room and the trainer. As the trainer turned to speak to someone, Medical Findings. The death certificate, completed the Major collapsed. by the attending physician, listed “ischemic heart disease with cardiac arrest” due to “coronary ar- 911 was called and an advanced life support tery disease” as the cause of death. The autopsy, ambulance and the FD were dispatched at 1740 completed by the County Coroner, listed “ischemic hours. Fitness center staff retrieved an automated heart disease” as the cause of death. Specific find- external defibrillator (AED) as CPR was begun. ings from the autopsy are listed in Appendix A. Two off-duty nurses were exercising at the facility and came to render aid. As the fitness center staff The Major was 74 inches tall and weighed 253 attempted to apply the AED, a nurse said she felt a pounds, giving him a body mass index (BMI) of pulse; the AED was not used. 32.5 kilograms per meters squared (kg/m2). A BMI > 30.0 kilograms per meter squared is con- The FD engine arrived on the scene at 1744 hours. sidered obese [CDC 2010]. The Major’s risk fac- Fire fighter/EMTs found the Major unresponsive, tors for coronary artery disease (CAD) included not breathing, with no pulse, and CPR in progress. hypercholesterolemia (high blood cholesterol) and EMTs inserted a nasal airway and attached the obesity/lack of exercise. He had not been pre- Page 3 A Summary of a NIOSH fire fighter fatality investigation Report #2010-08 Major Suffers Sudden Cardiac Death During Physical Fitness Training – Kentucky Investigative Results (cont.) Description of the Fire Department scribed any lipid-lowering medications and had At the time of the NIOSH investigation, the com- begun a self-initiated exercise program in January bination FD consisted of one fire station with 54 2010. uniformed personnel that served 28,000 residents in a geographic area of 7.3 square miles. In 2009, In 2001, the Major was evaluated for acute chest the FD responded to 791 calls including 287 struc- discomfort. An echocardiogram revealed right ture fires, 16 field fires, 11 trash fires, 10 vehicle ventricular hypertrophy (thickened right ven- fires, 2 dumpster fires, 82 hazardous condition tricle). He performed an exercise stress test at calls, 18 hazardous material calls, 24 false calls, which he exercised for 11 minutes, 15 seconds on 30 assist calls, 157 other calls, and 154 first re- the Bruce protocol and stopped due to shortness of sponder calls. breath and fatigue. The test was deemed negative for ischemia and infarction, and the Major was Employment, Membership, and Training. The cleared for duty. FD requires new career fire fighter applicants to be State-certified to the 150-hour level, complete At a FD medical evaluation in 2001, the Major an application, be 18 years of age (21 years old to was diagnosed with mild sleep apnea but this was drive fire apparatus), have a valid State driver’s li- not considered serious enough to restrict his duties cense, pass a written examination, pass a physical as a fire fighter. However, in 2007 his primary care ability test, and pass an interview prior to being physician referred the Major to a sleep clinic. At hired. The new hire must then pass a drug screen, a FD medical evaluation in 2008, the physician a preplacement medical evaluation (including required the Major to get a clearance from his exercise stress test), and a self-contained breathing primary care physician regarding his sleep apnea; apparatus mask fit test. The new hire is placed on specifically, that the condition had been treated a shift where the hours of duty are 24 hours on- adequately for over 30 days.

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