On July 24, 2016, a 56-year-old male volunteer fire fighter (FF) collapsed as he was pumping the engine at a brush fire. Emergency medical services (EMS) trained personnel and the EMS Medical Director immediately initiated cardiopulmonary resuscitation (CPR) and followed advanced cardiac life support (ACLS) myocardial infarction protocols, shocking the FF multiple times. Care continued en route to the hospital. Hospital emergency department (ED) personnel continued to treat the FF without success for over 30 minutes and pronounced him dead at 1632 hours.

The Medical Examiner’s report listed the cause of death as arteriosclerotic cardiovascular disease. The report documented evidence of arteriosclerotic cardiovascular disease, including previous myocardial infarction (heart attack), multiple stent procedures, evidence of multi-vessel coronary artery bypass grafting (CABG), high-grade arteriosclerotic plaque in the coronary arteries, and a severely enlarged and dilated heart. NIOSH investigators concluded that the physical stress of the emergency response might have triggered the cardiovascular event.

The FF had an extensive history of coronary artery disease, including two previous heart attacks. The more recent one had occurred just months earlier (January 2016), after which he underwent CABG surgery to treat multiple arteries having severe blockage. An echocardiogram revealed the pumping function of his main chamber (left ventricle) was reduced. The FF had several ongoing risk factors for coronary artery disease, including smoking, high blood pressure, unhealthy cholesterol levels, and obesity [AHA 2016; NHLBI 2016].