Fatality Assessment and Control Evaluation (FACE) Report: Fire Apparatus Operator Suffers Fatal Heart Attack During Annual Fire Department Medical Evaluation in Missouri

摘要

On January 7, 2011, a 54-year-old male career Fire Apparatus Operator (FAO) participated in the Fire Department (FD) mandatory annual medical evaluation program scheduled while the FAO and his crew were on-duty. After completing several portions of the evaluation, the FAO began the exercise stress test component. After exercising for 3 minutes, 10 seconds, the FAO developed a life threatening arrhythmia (ventricular tachycardia), and the test was stopped. While being assisted to the examination table and while an ambulance was summoned, the FAO lost consciousness. Cardiopulmonary resuscitation (CPR) and advanced life support (ALS) were administered at the medical clinic, in the ambulance, and in the hospital's emergency department (ED). In the ED, the FAO regained a heart rhythm, and an electrocardiogram (EKG) showed signs consistent with a heart attack (myocardial infarction). The FAO was taken to the catheterization lab with a very low blood pressure (cardiogenic shock). A 95% blockage of one of his main coronary arteries was opened via angioplasty and a stent. While still in the catheterization lab, the FAO suffered another cardiac arrest from which he could not be revived. The death certificate and the autopsy listed 'atherosclerotic cardiovascular disease' as the cause of death. Given the FAO's severe underlying heart disease, NIOSH investigators concluded that the physical exertion involved in the exercise stress test probably triggered a heart attack resulting in the FAO's death. NIOSH investigators offer the following recommendations to address general safety and health issues.