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NIOSH Medical-LODD Reports: Texas, North Carolina
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The NIOSH Fire Fighter Fatality Investigation and Prevention Program has released the investigation reports of two 2009 medical line of duty deaths.
The first report is that of a Texas firefighter trainee who suffered a fatal exertional heart stroke while participating in the jogging part of the department's physical fitness program.
On April 20, 2009, a 26-year-old male career Fire Fighter Trainee began a 2-month fire fighter certification program at the City Fire Training Academy. On April 29, 2009, the Trainee participated in a 4.4-mile jog as part of the physical fitness portion of the program. The temperature was approximately 73 degrees Fahrenheit (°F) dry bulb (70°F wet bulb) with 87% relative humidity.
About 50 feet from the finish line, the Trainee became unsteady and told a crew member that he “just wanted to finish.” A few steps further, a crew member assisted him to the ground as help was summoned. Vital signs revealed low blood pressure (60 millimeters of mercury [mmHg] systolic) and a fast heart rate (170 beats per minute). An ambulance arrived and treated the Trainee for heat-related illness with ice packs to the skin and intravenous fluids before departing to the hospital.
In the hospital’s emergency department (ED), a rectal temperature of 105.3°F was documented 45 minutes after the Trainee’s collapse and at least 30 minutes after ice packs were placed on his skin. Despite treatment in the ED and hospital for exertional heatstroke, the Trainee died 5 days later. The autopsy report listed the cause of death as “complications of hyperthermia and dehydration.”
NIOSH investigators agree with the Medical Examiner’s assessment. In addition, NIOSH investigators concluded that the Trainee’s hyperthermia and exertional heatstroke were precipitated by the heavy physical exertion associated with the physical fitness training.
The following recommendations may have prevented the trainee's death:
The second report is of North Carolina firefighter who suffered a probable fatal cardiac arrhythmia while particiapting in a mandatory on-duty physical fitness program.
On December 29, 2009, a 24-year-old male career fire fighter (FF) participated in the mandatory Fire Department (FD) physical fitness program while on duty. The FF lifted weights for over 1 hour, ran on the treadmill for 2.3 miles in approximately 12 minutes, and then paused the treadmill’s timer. Shortly thereafter, a crew member entered the exercise room and found the FF unresponsive, lying on the treadmill. Despite cardiopulmonary resuscitation (CPR) and advanced life support delivered on scene, in the ambulance, and in the hospital’s emergency department (ED), the FF died.
An autopsy was conducted by the local hospital pathologist. That autopsy report noted that the FF possibly experienced a fatal cardiac arrhythmia and that hypoglycemia may have contributed to his death, but that “Overall, there is no definite anatomic cause of death.” The Office of the Chief Medical Examiner listed the cause of death as “Undetermined” on their investigation report and on the death certificate.
NIOSH investigators agree with these assessments, but consider the diagnosis of hypoglycemia unlikely; even if the FF had hypoglycemia, it is very unlikely that it contributed to his death. The more likely scenario is a fatal cardiac arrhythmia possibly triggered by the heavy physical exertion during fitness training.
The NIOSH investigation finds that the following recommendations could not have prevented the firefighter's death, however departments should still use them to address general safety and health issues.
The NIOSH Fire Fighter Fatality Investigation and Prevention Program has released the investigation reports of two 2009 medical line of duty deaths.
The first report is that of a Texas firefighter trainee who suffered a fatal exertional heart stroke while participating in the jogging part of the department's physical fitness program.
On April 20, 2009, a 26-year-old male career Fire Fighter Trainee began a 2-month fire fighter certification program at the City Fire Training Academy. On April 29, 2009, the Trainee participated in a 4.4-mile jog as part of the physical fitness portion of the program. The temperature was approximately 73 degrees Fahrenheit (°F) dry bulb (70°F wet bulb) with 87% relative humidity.
About 50 feet from the finish line, the Trainee became unsteady and told a crew member that he “just wanted to finish.” A few steps further, a crew member assisted him to the ground as help was summoned. Vital signs revealed low blood pressure (60 millimeters of mercury [mmHg] systolic) and a fast heart rate (170 beats per minute). An ambulance arrived and treated the Trainee for heat-related illness with ice packs to the skin and intravenous fluids before departing to the hospital.
In the hospital’s emergency department (ED), a rectal temperature of 105.3°F was documented 45 minutes after the Trainee’s collapse and at least 30 minutes after ice packs were placed on his skin. Despite treatment in the ED and hospital for exertional heatstroke, the Trainee died 5 days later. The autopsy report listed the cause of death as “complications of hyperthermia and dehydration.”
NIOSH investigators agree with the Medical Examiner’s assessment. In addition, NIOSH investigators concluded that the Trainee’s hyperthermia and exertional heatstroke were precipitated by the heavy physical exertion associated with the physical fitness training.
The following recommendations may have prevented the trainee's death:
- Structure the recruit physical fitness training program to be consistent with the IAFF/IAFC Candidate Physical Ability Test (CPAT).
- Ensure trainees are hydrated at all phases of physically demanding tasks.
- Ensure ice water immersion therapy is rapidly available at the Fire Training Academy.
The second report is of North Carolina firefighter who suffered a probable fatal cardiac arrhythmia while particiapting in a mandatory on-duty physical fitness program.
On December 29, 2009, a 24-year-old male career fire fighter (FF) participated in the mandatory Fire Department (FD) physical fitness program while on duty. The FF lifted weights for over 1 hour, ran on the treadmill for 2.3 miles in approximately 12 minutes, and then paused the treadmill’s timer. Shortly thereafter, a crew member entered the exercise room and found the FF unresponsive, lying on the treadmill. Despite cardiopulmonary resuscitation (CPR) and advanced life support delivered on scene, in the ambulance, and in the hospital’s emergency department (ED), the FF died.
An autopsy was conducted by the local hospital pathologist. That autopsy report noted that the FF possibly experienced a fatal cardiac arrhythmia and that hypoglycemia may have contributed to his death, but that “Overall, there is no definite anatomic cause of death.” The Office of the Chief Medical Examiner listed the cause of death as “Undetermined” on their investigation report and on the death certificate.
NIOSH investigators agree with these assessments, but consider the diagnosis of hypoglycemia unlikely; even if the FF had hypoglycemia, it is very unlikely that it contributed to his death. The more likely scenario is a fatal cardiac arrhythmia possibly triggered by the heavy physical exertion during fitness training.
The NIOSH investigation finds that the following recommendations could not have prevented the firefighter's death, however departments should still use them to address general safety and health issues.
- Provide preplacement and annual medical evaluations to fire fighters consistent with National Fire Protection Association (NFPA) 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments.
- Ensure fire fighters are cleared for return to duty by a physician knowledgeable about the physical demands of fire fighting, the personal protective equipment used by fire fighters, and the various components of NFPA 1582.
- Provide fire fighters with medical clearance to wear a self-contained breathing apparatus (SCBA) as part of a Fire Department medical evaluation program.
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