On June 13, 2016, a 43-year-old male paid-on-call fire fighter (FF) took part in a weekly training drill involving rescue equipment. The FF had a history of cardiac events including prior heart attack and stenting. Medical records indicate that he had complained of chest pains to his fiancée in the previous 2 weeks. However, interviews revealed that he had not reported symptoms at work in the preceding 2 weeks or during the drill. Upon awakening at home the next morning, the FF reported having chest pain. He asked that an ambulance be called. Shortly after the 911 call was made he collapsed and lost consciousness. When EMS (emergency medical services) staff arrived, the FF was receiving CPR (cardiopulmonary resuscitation). He was unresponsive, pulseless, and not breathing. Cardiac monitoring showed ventricular fibrillation, and a shock was delivered. EMS provided CPR and ACLS (advanced cardiac life support) measures on scene and en route to the hospital for almost an hour. The FF arrived at the hospital ED (emergency department) in asystole. ED staff treated the FF without success for another 15 minutes and pronounced him dead.

The autopsy report listed the cause of death as myocardial infarction (heart attack), due to coronary artery thrombosis, due to coronary artery atherosclerosis. The report documented evidence of hypertensive and atherosclerotic cardiovascular disease, including previous myocardial infarction with multiple stent procedures, left ventricular hypertrophy, and a severely enlarged heart (cardiomegaly). Severe coronary atherosclerosis was noted, and an occlusive thrombus was evident in the right coronary artery. NIOSH investigators concluded that the physical stress of participating in training might have exacerbated the cardiac symptoms that the FF had reported in the preceding weeks.

The FF had multiple risk factors for heart disease to include smoking, dyslipidemia, high blood pressure, diabetes mellitus, obesity, lack of physical activity, and family history. He suffered his first heart attack at age 39, after which he entered a cardiac rehabilitation program but did not achieve aerobic capacity beyond 4.9 METs (metabolic equivalents).