NIOSH recommendations target cardiovascular risks for firefighters
In the aftermath of two firefighter deaths from cardiac arrest last fall, the National Institute for Occupational Safety and Health (NIOSH), through its Fire Fighter Fatality Investigation and Prevention Program, has issued recommendations aimed at reducing the incidence of cardiovascular risks.
Incident 1 (NIOSH #99/F-10)–December 18, 1998. A 55-year-old male volunteer fire-police officer responded to a motor vehicle accident in his privately owned vehicle. His vehicle, equipped with emergency light bars, stopped on the highway shoulder about 500 yards in front of the motor vehicle accident scene, presumably to warn oncoming motorists. He didn`t respond to the radio message releasing his fire company from the scene and shortly thereafter was found unresponsive, slumped over the steering wheel, with his foot on the brake and the vehicle still in gear. Basic life support and advanced life support were applied in the field, in the ambulance, and in the hospital`s emergency department. The death certificate listed the immediate cause of death as “sudden cardiac death” due to “coronary artery disease” due to “diabetes mellitus.” No autopsy was performed.
Eight years before his death, the firefighter had a heart attack and later underwent coronary artery bypass surgery. Four months before he died, he was hospitalized for congestive heart failure (CHF). A persantine/thallium stress test taken at that time showed a moderate amount of scarring from his previous heart attack and a mild amount of myocardial ischemia (reduced blood supply to the heart). About five weeks after he was discharged (his CHF was stabilized), he requested that he be medically released to fire/police duties.
NIOSH made the following recommendations:
Individuals with medical conditions that would present a significant safety and health risk to themselves or others should be precluded from emergency response activities.
Emergency response personnel should have annual medical evaluations to determine their medical ability to perform duties without presenting a significant risk to the safety and health of themselves or others.
Carboxyhemoglobin levels should be tested on symptomatic or unresponsive emergency response personnel. (No blood was sent for laboratory analysis; therefore, no carboxyhemoglobin level, cardiac isoenzyme, or drug tests were available.)
An autopsy should be performed on all emergency response personnel who were fatally injured while on duty.
Incident 2 (NIOSH#99/F-11)–September 30, 1998. A 56-year-old male volunteer fire chief collapsed while monitoring pumper operations during a training drill at a local nursing home. He was wearing full turnout gear but no self-contained breathing apparatus (SCBA). He was not engaged in strenuous activities at the time, but it was a hot and humid day. Despite the intervention of on-scene emergency rescue personnel who initiated cardiopulmonary resuscitation (CPR) followed by advanced cardiac life support (ACLS), the victim could not be revived. The death certificate indicated “acute coronary insufficiency” as the cause of death. No autopsy was done.
According to witnesses, the chief showed no signs of distress when talking briefly with firefighters during the drill. Later he was seen walking to the rear of the pumper (without his bunker coat). He collapsed about five minutes later as he was walking around back toward the pumper panel.
NIOSH made the following recommendations concerning health and safety issues, noting that “it cannot be determined whether these recommendations could have prevented the sudden cardiac arrest and subsequent death of the chief”:
Firefighters should undergo annual medical evaluations to determine their medical ability to perform duties without presenting a significant risk to the safety and health of the firefighter or others.
Firefighters wearing self-contained breathing apparatus (SCBA) should be given medical evaluations and clearance [per the Occupational Safety and Health Administration (OSHA) revised respiratory protection standard].
An autopsy should be performed on all firefighters who are fatally injured while on duty.
A wellness/fitness program for firefighters should be implemented to reduce risk factors for cardiovascular disease and improve cardiovascular capacity.
Copies of these reports may be obtained from the NIOSH Program Web site at (http://www.cdc.gov/niosh/firehome.html) or by calling (800) 35-NIOSH.
