A summary of a NIOSH fire fighter fatality investigation March, 2014

Wildland Fire Fighter Suffers Sudden Cardiac Death During 

Campfire Patrol – New Mexico

Executive Summary

On May 5, 2013, a 26-year-old male seasonal 

wildland fire fighter (FF), along with his two Engine crewmembers, conducted campfire patrol and 

terrain familiarization. After hiking with a wildland fire fighting pack for about 3 miles in hilly 

terrain over approximately 21⁄2-hours at 8000 feet, 

he reported feeling dizzy and suddenly collapsed. 

Initial assessment by crewmembers revealed 

labored breathing with a weak pulse. Shortly after 

crewmembers removed his pack, the FF became 

unresponsive with no pulse or respirations. One 

crewmember began cardiopulmonary resuscitation 

(CPR) as the other crewmember climbed a short 

distance to notify Dispatch by portable radio. Approximately 26 minutes later, the Lifeflight helicopter landed and initiated advanced life support 

(ALS). After 40 minutes of ALS, with no change 

in his clinical status, Medical Control advised the 

paramedics to cease resuscitation efforts and the 

FF was pronounced dead.

The autopsy report, completed by the State 

Medical Investigator, listed the cause of death as 

“dilated cardiomyopathy.” NIOSH investigators 

conclude that the FF’s sudden cardiac death was 

due to his previously undiagnosed dilated cardiomyopathy. His death may have been precipitated 

by the moderate physical exertion associated 

with hiking in hilly terrain at elevation.

NIOSH investigators offer the following recommendations to improve Agency safety and health 

among wildland fire fighters, however none of 

these recommendations would have prevented 

this FF’s death. Implementing these recommendations will demonstrate a continuing commitment to improve the safety culture of the wildland fire service. 

Modify the Health Screening Questionnaire 

(HSQ) to include all cardiovascular risk factors 

identified by the American Heart Association/

American College of Cardiology (AHA/ACC).

Consider providing pre-placement and periodic 

medical evaluations to ALL fire fighters. The 

content of the evaluations should be consistent 

with NFPA 1582 or equivalent to determine 

their medical ability to perform duties without 

presenting a significant risk to the safety and 

health of themselves or others.

Introduction & Methods

On May 5, 2013, a 26-year-old male wildland 

fire fighter suffered sudden cardiac death during 

campfire patrol and terrain familiarization. 

NIOSH was notified of this fatality on May 7, 

2013 by the United States Fire Administration 

and NIOSH contacted the employing Agency 

to gather additional information and initiate the 

investigation. On September 9, 2013, a Safety 

and Occupational Health Specialist from the 

NIOSH Fire Fighter Fatality Investigation Team 

investigated the incident.

2013

22 Death in the line of duty.. Fire Fighter Fatality Investigation 

and Prevention Program

.
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Wildland Fire Fighter Suffers Sudden Cardiac Death During 

Campfire Patrol – New Mexico

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The National Institute for Occupational Safety and Health (NIOSH), an institute within the Centers for Disease Control and Prevention (CDC), is the 

federal agency responsible for conducting research and making recommendations for the prevention of work-related injury and illness. In 1998, Congress 

appropriated funds to NIOSH to conduct a fire fighter initiative that resulted in the NIOSH “Fire Fighter Fatality Investigation and Prevention Program” 

which examines line-of-duty-deaths or on duty deaths of fire fighters to assist fire departments, fire fighters, the fire service and others to prevent similar 

fire fighter deaths in the future. The agency does not enforce compliance with State or Federal occupational safety and health standards and does not 

determine fault or assign blame. Participation of fire departments and individuals in NIOSH investigations is voluntary. Under its program, NIOSH 

investigators interview persons with knowledge of the incident who agree to be interviewed and review available records to develop a description of 

the conditions and circumstances leading to the death(s). Interviewees are not asked to sign sworn statements and interviews are not recorded. The 

agency’s reports do not name the victim, the fire department or those interviewed. The NIOSH report’s summary of the conditions and circumstances 

surrounding the fatality is intended to provide context to the agency’s recommendations and is not intended to be definitive for purposes of determining 

any claim or benefit. For further information, visit the program website at www.cdc.gov/niosh/fire or call toll free 1-800-CDC-INFO (1-800-232-4636).
A Summary of a NIOSH fire fighter fatality investigation Report #2013-22

Wildland Fire Fighter Suffers Sudden Cardiac Death During 

Campfire Patrol – New Mexico

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Introduction & Methods (cont.)

During the investigation, NIOSH personnel interviewed 

the following people by phone or in person:

● Agency Regional Safety Manager 

● Assistant District Fire Management Officer 

● Agency Fire Fighter Medical Qualifications 

Program Manager 

● Crewmembers

NIOSH personnel reviewed the following documents:

● FF’s personnel folder

● Agency policies and operating guidelines

● Agency training records

● Agency “Fatality Facilitated Learning Analysis”

● Lifeflight helicopter medical incident report

● Autopsy report

● Agency medical records

Investigative Results

Incident. On May 5, 2013, the crew began their day 

at 0830 hours at their satellite wildland fire station. 

The Engine Captain briefed the crew on weather reports, a situational awareness report, and safety (stress 

and fatigue). At approximately 1011 hours, they refueled their Engine at the District office and headed out 

for campfire patrol and terrain familiarization.

At approximately 1300 hours, after lunch, the crew 

hiked into the hilly area to check for campfires and 

to train on various aspects of the terrain and potential 

fire behavior. Weather conditions included a temperature in the mid-sixties Fahrenheit (°F) with a 

relative humidity of about 25%. Crewmembers were 

wearing/carrying their typical wildland gear (green 

Nomex® pants, cotton tee-shirt, long sleeve Nomex 

shirt, boots, hardhat, gloves, and a 20-25 pound pack) 

and carried four canteens of water (about 1 gallon 

total). The hike covered 2-3 miles in hilly terrain over 

approximately 2 hours at an altitude of 8,000 feet.

At approximately 1500 hours, the crew turned around 

for the return hike to their Engine. At 1520 hours, 

they were about 1 mile from the Engine facing a steep 

incline. A crewmember asked the FF how he was feeling. The FF reported that he “was a little tired, but was 

fine.” Hiking further up the incline, the crew stopped 

briefly to catch their breath. After hiking resumed, the 

FF began to wobble and reported feeling dizzy. The 

FF then fell to the ground but supported himself on 

his right elbow (1523 hours). The two crewmembers 

assessed him and found him to be unresponsive, with 

labored breathing and a weak pulse. Crewmembers 

removed his pack and within 30 seconds he stopped 

breathing and was pulseless. One crewmember began 

CPR while the other crewmember hiked about 30 feet 

up the incline to radio Dispatch (1526 hours).

After alerting Dispatch, the crewmember hiked back 

to the FF’s location and assisted with CPR as a Lifeflight helicopter and a ground ambulance were dispatched (1532 hours). CPR continued for 32 minutes with no change in the FF’s clinical status. The 

helicopter landed at 1558 hours and the flight medics found the FF unresponsive, not breathing, and 

pulseless with CPR in progress. A cardiac monitor 

showed ventricular fibrillation; three shocks were 

administered. The FF was intubated, oxygen was 

administered via bag-valve-mask, an intravenous 

line was placed, and cardiac resuscitation medications were administered with no positive change in 

the FF’s clinical status. At 1638 hours, after conferring with Medical Control, resuscitation efforts were 

stopped and the FF was pronounced dead.

Medical Findings. The autopsy report, completed 

by the State Medical Investigator, listed the cause of 

death as “dilated cardiomyopathy.” Pertinent findings 

from the autopsy (Appendix A) included the following: an enlarged heart (470 grams), evidence of left 
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Wildland Fire Fighter Suffers Sudden Cardiac Death During 

Campfire Patrol – New Mexico

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Investigative Results (cont.)

ventricular hypertrophy, normal heart valves, no conduction system abnormalities, and no coronary artery 

disease or thrombus. Other pertinent findings included 

positive blood tests for medications (antidepressant, 

muscle relaxant, and sedative), nicotine, and caffeine. 

The FF had no previous cardiac problems, however, according to the medical examiner’s report, 

the FF suffered a syncopal episode witnessed by 

his sister about 6-8 months prior to his death. At 

the time of this report, the FF’s personal medical 

records were not available to the NIOSH investigator. He was 78′′ tall and weighed 199 pounds, 

giving him a body mass index (BMI) of 23. A 

BMI of 18.5–24.9 is considered “normal” [CDC 

2011]. He was physically fit and active on a daily 

basis. The FF passed his most recent pack test (see 

description in the following section) in April 2013. 

Agency’s Wildland Fire Fighter Program

Employment and Training. The Agency requires 

all new wildland fire fighter I or II applicants to 

complete an application and possess wildland firefighting certification otherwise known as the “Red 

Card.” The red card is acquired by the following:

1) completing five initial courses: Introduction to 

ICS (I-100), Firefighter Training (S-130), Introduction to Wildland Fire Behavior (S-190), Human Factors on the Fireline (L-180), NIMS: An 

Introduction (IS700), and Annual Fireline Safety 

Refresher (RT-130)

2) completing a health screening questionnaire 

(HSQ) (Appendix B), and 

3) passing a work capacity test (for the fire fighter 

position this requires the “arduous pack test”). The 

pack test requires the applicant to hike 3 miles in 

45 minutes or less while wearing a 45-pound pack.

The full-time applicant is then referred for a drug test 

and a background check before receiving a job offer 

from the Agency. If any applicant responded with a 

“yes” on their HSQ, the applicant is referred for a preplacement medical evaluation. The FF did not receive 

a medical evaluation, but received his red card on April 

8, 2013 and certified as a fire fighter type II (FFT2).

The Agency has listed the essential job functions and 

work conditions for Forestry Aides (wildland fire 

fighters) (Appendix C). Once certified, wildland fire 

fighters can work on a variety of fire units. Engine 

crews consist of three crewmembers who operate out 

of a wildland fire station. The FF had worked on an 

engine crew for 1 month prior to his death.

Preplacement and Periodic Medical Evaluations.

The Agency does not require a preplacement 

(baseline) or a periodic medical evaluation for any 

fire fighter positions. However, the applicant must 

complete the HSQ. If the applicant answers “yes” 

to any question, a medical evaluation by a physician is required. The FF completed his HSQ on 

April 2, 2013 and answered “no” to all the health 

questions. The HSQ does not query about prescription medications, smoking status, or weight. 

The Agency plans to implement a medical evaluation program that will require all personnel with 

an arduous duty qualification to obtain a preplacement medical evaluation and a periodic medical 

evaluation every 3 years. The Agency will not 

distinguish between temporary or permanent positions or by age.

Fitness Programs. The Agency supports fitness 

activities for all its employees by encouraging 

participation in daily exercise. The FF regularly 

exercised by hiking and by performing pushups 

and situps.
A Summary of a NIOSH fire fighter fatality investigation Report #2013-22

Wildland Fire Fighter Suffers Sudden Cardiac Death During 

Campfire Patrol – New Mexico

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Discussion

Cardiomyopathy. Although the FF was asymptomatic, the autopsy revealed dilated cardiomyopathy. Cardiomyopathies involve damage to the 

heart muscle not due to hypertension, ischemia 

(coronary artery disease), valvular, pericardial, or 

congenital heart disease [Wynne and Braunwald 

2008]. The three types of cardiomyopathy based 

on functional impairment are:

1) dilated, the most common form, accounts for 

60% of all cardiomyopathies 

2) hypertrophic, recognized by left ventricular hypertrophy, often with involvement of the interventricular septum and right ventricle

3) restrictive, the least common form in Western 

countries, marked by impaired diastolic filling 

and in some cases with endocardial scarring of 

the ventricle [Wynne and Braunwald 2008]

Dilated cardiomyopathy is characterized by cardiac enlargement and impaired systolic function 

of one or both ventricles, congestive heart failure, 

arrhythmias, and emboli [Dec and Fuster 1994]. 

As the ventricular function deteriorates, the following signs and symptoms of congestive heart 

failure appear: shortness of breath with exertion 

or when lying flat, ankle swelling, fatigue, and/

or weakness. Laboratory studies such as cardiac 

catheterization, echocardiogram, or imaging studies are necessary to make the diagnosis of dilated 

cardiomyopathy. Microscopic findings are nonspecific, typically being myocyte hypertrophy (best 

appreciated as nuclear hypertrophy [“boxcar nuclei”]) with varying degrees of interstitial fibrosis 

[Dec and Fuster 1994; Virmani 1997; Wynne and 

Braunwald 2008].

The incidence rate of dilated cardiomyopathy in 

the United States is 5 to 8 cases per 100,000 per 

year, with an age-adjusted prevalence of 36 cases 

per 100,000 [Virmani 1997]. Although most cases 

of dilated cardiomyopathy are of unknown etiology (idiopathic), a variety of acquired or hereditary 

disorders can cause the disorder. These secondary 

and potentially reversible forms are listed in Appendix D [Dec and Fuster 1994]. It is unlikely the 

FF had any of these secondary causes.

Inherited factors account for approximately one 

third of all idiopathic dilated cardiomyopathy 

cases [Fatkin et al. 1999]. Although the FF did 

not have a family history of idiopathic dilated 

cardiomyopathy, this is the most likely etiology. 

The FF’s first-degree relatives (parents, siblings, 

and children) should consult with their physicians 

regarding if or when a screening echocardiogram 

is warranted.

Dilated cardiomyopathy is associated with an 

increased incidence of sudden cardiac death [Dec 

and Fuster 1994; Bansch et al. 2002; Wynne and 

Braunwald 2008]. Although sudden death is rarely 

the initial presentation [Komajda et al. 1990; 

Sugrue et al. 1992], it is a common cause of death 

among idiopathic dilated cardiomyopathy patients, accounting for 28% of all idiopathic dilated 

cardiomyopathy deaths [Dec and Fuster 1994]. 

Although a variety of symptoms and medical tests 

can provide prognostic information, patients at 

greatest risk of sudden cardiac death are hard to 

identify [Dec and Fuster 1994]. In this case the 

FF’s initial presentation of his dilated cardiomyopathy was sudden cardiac death.

Epidemiologic studies have found that heavy 

physical exertion sometimes precedes and triggers 

sudden cardiac death [Albert et al. 2000]. Among 

structural fire fighters, sudden cardiac events have 
A Summary of a NIOSH fire fighter fatality investigation Report #2013-22

Wildland Fire Fighter Suffers Sudden Cardiac Death During 

Campfire Patrol – New Mexico

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Discussion (cont.)

been associated with alarm response, fire suppression, and heavy exertion during training (including physical fitness training) [Kales et al. 2003; 

Kales et al. 2007; NIOSH 2007]. The FF was hiking at 8,000 feet in hilly terrain for about 3 miles 

over a period of 21⁄2 hours while wearing/carrying 

a traditional wildland fire fighter gear pack weighing approximately 25 pounds). This activity would

have expended about 8 METs, which is considered moderate physical activity [AIHA 1971; 

Sharkey and Gaskill 2009; Ainsworth et al. 2011]. 

NIOSH investigators conclude that the FF had a 

fatal cardiac arrhythmia due to his dilated cardiomyopathy. His death possibly was triggered by 

his moderate physical activity during the terrain 

familiarization hike.

Primary Arrhythmia. A primary cardiac arrhythmia (e.g., ventricular tachycardia/fibrillation) was 

probably responsible for the FF’s sudden cardiac 

death. Lethal ventricular arrhythmias account for 

most sudden cardiac deaths [Kelesidis and Travin 

2012]. Risk factors for arrhythmias include cardiac disease, heart attack, sleep apnea, dietary supplements, smoking, alcohol, drug abuse, medications, diabetes, and hyperthyroidism [AHA 2012; 

Mayo Clinic 2013]. The FF’s autopsy revealed 

dilated cardiomyopathy and two other cardiac 

findings associated with dilated cardiomyopathy: 

cardiomegaly and left ventricular hypertrophy. All 

three of these cardiac findings increase the risk for 

primary arrhythmia [Levy et al. 1990; AHA 2012; 

Tavora et al. 2012].

Occupational Medical Standards for Structural 

Fire Fighters. To reduce the risk of sudden cardiac arrest or other incapacitating medical conditions among fire fighters, the NFPA developed 

NFPA 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments 

[NFPA 2013]. This voluntary industry standard 

provides the components of a preplacement and 

annual medical evaluation and medical fitness 

for duty criteria. The FF was young and asymptomatic. There was no indication or suspicion 

of any underlying cardiac conditions, therefore 

he was given medical clearance for unrestricted 

duty based on his answers on his HSQ and having 

passed his “pack test.”

The FF was prescribed a sedative, an antidepressant, and a muscle relaxant. It is unclear when 

these were prescribed. NFPA 1582 lists sedatives 

as Category A medications and antidepressant and 

muscle relaxants as Category B medications. A 

candidate with Category A medication or condition shall not be certified as meeting the medical 

requirements of the standard [NFPA 2013]. A candidate with Category B medication or condition 

shall be certified as meeting the medical requirements of the standard only if they can perform the 

essential job tasks without posing a significant 

safety and health risk to themselves, members, or 

civilians [NFPA 2013]. The HSQ does not provide 

any questions or space to report current prescription medications.

Recommendations

Recommendation #1: Modify the Health Screening 

Questionnaire (HSQ) to include all cardiovascular 

risk factors identified by the American Heart Association/American College of Cardiology (AHA/ACC).

The HSQ does not cover all coronary artery disease 

risk factors identified by the AHA/ACC. Specifically, 

the HSQ includes no question regarding prescription 

medications, smoking status, and weight. We suggest 
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Wildland Fire Fighter Suffers Sudden Cardiac Death During 

Campfire Patrol – New Mexico

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Recommendations (cont.)

replacing these yes/no questions with questions that 

require the fire fighter to enter specific information 

(see Appendix E). The WCT Administrator would 

then decide whether the fire fighter was fit to perform 

the WCT. Using these “fill in the blank” type of questions puts more responsibility on fire fighters to know 

the results of their medical tests.

Recommendation #2: Consider providing preplacement and periodic medical evaluations to 

ALL fire fighters. The content of the evaluations 

should be consistent with NFPA 1582 or equivalent to determine medical ability to perform 

duties without presenting a significant risk to the 

safety and health of themselves or others.

Guidance regarding medical evaluations can be found 

in NFPA 1051, Standard for Wildland Fire Fighter 

Professional Qualifications [NFPA 2012], which 

refers the reader to NFPA 1582, Standard on Comprehensive Occupational Medical Program for Fire 

Departments [NFPA 2013]. NFPA 1051 states the 

guidance in NFPA 1582 might need to be modified for 

individuals involved in the suppression of wildland 

fires. Additional guidance can be found in the report 

of the International Association of Fire Fighters/International Association of Fire Chiefs (IAFF/IAFC) 

wellness/fitness initiative [IAFF/IAFC 2008]. 

The Agency is not legally required to follow any of 

these standards. The success of medical programs 

hinges on protecting the affected fire fighter. The 

Agency must 1) keep the medical records confidential, and 2) if the fire fighter is not medically qualified for active fire fighting duties, notify the fire 

fighter of the medical findings. The Agency is currently providing both preplacement medical evaluations only to personnel who answer “yes” on their 

HSQ. No periodic medical evaluations are offered.

AHA [2012]. Understand your risk for arrhythmia. 

Dallas, TX: American Heart Association. [http://

www.heart.org/HEARTORG/Conditions/Arrhythmia/UnderstandYourRiskforArrhythmia/Understand-Your-Risk-for-Arrhythmia_UCM_002024_

Article.jsp]. Date accessed: December 2013.

AHA [2013]. Chain of survival. Dallas, TX: 

American Heart Association. [http://www.heart.

org/HEARTORG/CPRAndECC/WhatisCPR/

EC¬CIntro/Chain-of-Survival_UCM_307516_Article.jsp]. Date accessed: December 2013.

AIHA [1971]. Ergonomics guide to assessment of 

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Ainsworth BE, Haskell WL, Herrmann SD, 

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JL, Vezina J, Whitt-Glover MC, Leon AS [2011]. 

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update of codes and MET values. Med Sci Sports 

Exerc 43(8):1575–1581. 

Albert CM, Mittleman MA, Chae CU, Lee IM, 

Hennekens CH, Manson JE [2000]. Triggering 

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J, Kuck KH [2002]. Primary prevention of sudden 

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Wildland Fire Fighter Suffers Sudden Cardiac Death During 

Campfire Patrol – New Mexico

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M, Frenneaux M, Atherton J, Vidaillet HJ, Spudich S, De Girolami U, Seidman JG, Seidman CE, 

Muntoni F, Muehle G, Johnson W, McDonough B 

[1999]. Missense mutations in the rod domain of 

the Lamin A/C gene as causes of dilated cardiomyopathy and conduction-system disease. N Engl 

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IAFF, IAFC [2008]. The fire service joint labor 

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United States. N Engl J Med 356(12):1207–1215.

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Campfire Patrol – New Mexico

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Campfire Patrol – New Mexico

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This incident was co-investigated by the two 

members of the NIOSH Fire Fighter Fatality 

Investigation and Prevention Program, 

Cardiovascular Disease Component located 

in Cincinnati, Ohio. Tommy Baldwin, MS, 

is a safety and occupational health specialist, 

a National Association of Fire Investigators 

(NAFI) certified fire and explosion 

investigator, an International Fire Service 

Accreditation Congress (IFSAC) Certified 

Fire Officer I, and a former fire chief and 

emergency medical technician. Thomas 

Hales, MD, MPH, is board certified in 

Occupational and Environmental Medicine, 

and Internal Medicine as is a member of the 

NFPA Technical Committee on Occupational 

Safety and Heath, and vice chair of the 

Public Safety Medicine Section of the 

American College of Occupational and 

Environmental Medicine (ACOEM). NIOSH 

investigators acknowledge the cooperation 

and assistance of Agency managers and 

crewmembers during the investigation.

Investigator Information
A Summary of a NIOSH fire fighter fatality investigation Report #2013-22

Wildland Fire Fighter Suffers Sudden Cardiac Death During 

Campfire Patrol – New Mexico

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Appendix A

Autopsy Findings

	Dilated cardiomyopathy

o Ventricles and atrioventricular valves dilated bilaterally; the right ventricle more than the left (no 

measurement documented)

•	 Tricuspid valve measured 15.4 centimeters (cm)

	Normal is 11.63 cm [Westaby et al. 1984]

•	 Mitral valve measured 12.9 cm

	Normal is 9.79 cm [Westaby et al. 1984]

	Cardiomegaly (enlarged heart; heart weighed 470 grams [g]; predicted normal weight is 371 g [ranges 

between 281 g and 489 g as a function of sex, age, and body weight]) [Silver and Silver 2001]

	Left ventricular hypertrophy

o Left ventricle and interventricular septum thickened (1.3 centimeter [cm] and 1.1 cm respectively)

•	 Normal at autopsy is 0.76–0.88 cm [Colucci and Braunwald 1997] 

•	 Normal by echocardiographic measurement is 0.6–1.0 cm [Connolly and Oh 2012]

	Normal cardiac valves

	No evidence of a coronary artery thrombus (blood clot)

	No evidence of coronary artery atherosclerosis

	No evidence of a pulmonary embolus (blood clot in the lung arteries)

	Blood tests for drugs and alcohol revealed therapeutic levels of:

o Sertraline (34 nanograms per millileter [ng/mL]), an antidepressant

o Desmethylsertraline (55 ng/mL), Sertraline’s metabolite

o Cyclobenzaprine (8.6 ng/mL), a muscle relaxant

o Nordiazepam (34 ng/mL), a sedative

	Microscopic evidence of myocyte hypertrophy, focal areas of interstitial fibrosis, and scattered areas 

of contraction band necrosis

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Braunwald E, eds. Heart disease: a text of cardiovascular medicine. 9th ed. Vol. 1. Philadelphia, PA: 

Elsevier Saunders, p. 216.

Silver MM, Silver MD [2001]. Examination of the heart and of cardiovascular specimens in surgical 

pathology. In: Silver MD, Gotlieb AI, Schoen FJ, eds. Cardiovascular pathology. 3rd ed. Philadelphia, 

PA: Churchill Livingstone, pp. 8–9.

Westaby S, Karp RB, Blackstone EH, Bishop SP [1984]. Adult human valve dimensions and their surgical significance. Am J Cardiol 53(4):552-556.
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Wildland Fire Fighter Suffers Sudden Cardiac Death During 

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WCT LEVEL 

___ Arduous 

___ Moderate 

___ Light 

USDA Forest Service/Department of the Interior FS-5100-31 (Rev 8/2009) OMB 0596-0164 (Expires1/2013) 

HEALTH SCREENING QUESTIONNAIRE (HSQ) 

Assess your health needs by marking all true statements. 

The purpose is to identify individuals who may be at risk in taking the Work Capacity Test (WCT) and recommend an exercise program and or medical 

examination prior to taking the WCT. 

Employees are required to the following questions. The questions were designed, in consultation with occupational health physicians, to identify 

individuals who may be at risk when taking a WCT. The HSQ is not a medical examination. Any medical concerns you have that place you or your 

health at risk should be reviewed with your personal physician prior to participating in the WCT. 

Check ‘Yes’ or ‘No’ in response to the following questions: 

[ ] Y [ ] N 1) During the past 12 months have you at any time (during physical activity or while resting) experienced pain, discomfort or 

pressure in your chest? 

[ ] Y [ ] N 2) During the past 12 months have you experienced difficulty breathing or shortness of breath, dizziness, fainting, or blackout? 

[ ] Y [ ] N 3) Do you have a blood pressure with systolic (top #) greater than 140 or diastolic (bottom #) greater than 90? 

[ ] Y [ ] N 4) Have you ever been diagnosed or treated for any heart disease, murmur, chest pain (angina), palpitations (irregular beat), or 

heart attack? 

[ ] Y [ ] N 5) Have you ever had heart surgery, angioplasty, a pacemaker, valve replacement, or heart transplant? 

[ ] Y [ ] N 6) Do you have a resting pulse greater than 100 beats per minute? 

[ ] Y [ ] N 7) Do you have any arthritis, back trouble, hip/knee/joint pain, or any other bone or joint condition that could be aggravated or made 

worse by the Work Capacity Test? 

[ ] Y [ ] N 8) Do you have personal experience or a doctor’s advice of any other medical or physical reason that would prohibit you from 

taking the Work Capacity Test? 

[ ] Y [ ] N 9) Has your personal physician recommended against taking the Work Capacity Test because of asthma, diabetes, epilepsy 

or elevated cholesterol or hernia? 

Regardless of whether you are taking the Work Capacity Test at the Arduous, Moderate or Light duty level, a “Yes” answer requires a determination 

from your personal physician stating that you are able to participate. 

I understand that if I need to be evaluated by a physician, it will be based on the fitness requirements of the position(s) for which I am qualified. 

Signature:______________________________ Printed Name ___________________________________Date ______________ 

Unit: ________________________________________________ City __________________________State ___________________ 

USDA Forest Service/Department of Interior FS-5100-30 (Rev 8/2009) 

OMB 0596-0164 (Expires 1//2013) 

Appendix B
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Appendix B (cont.)

Work Capacity Test: Informed Consent 

Risks 

 There is a slight risk of injury (blisters, sore legs, sprained ankles) especially for those who have not 

practiced the test. If you have been inactive and have not practiced or trained for the test, you should 

engage in several weeks of specific training before you take the test. Be certain to warm up and stretch 

before taking the test, and to cool down after the test. The risk of more serious consequences (such as 

respiratory or heart problems) is diminished by completing the (HSQ) physical activity readiness 

questionnaire. 

 Pack Test- Arduous The 3-mile test with a 45 

pound pack in 45 minutes is strenuous, but no 

more so than the duties of wildland firefighting. 

 Field Test-Moderate The 2-mile test with a 25 

pound pack in 30 minutes is fairly strenuous, 

but no more so than the field duties. 

 Walk Test-Light The 1-mile walk in 16 minutes is 

moderately strenuous, but no more so than the 

duties assigned. 

[ ] I have read the information on this form, the brochure “Work Capacity Test” and understand the 

purpose, instructions, and risks of the job related to work capacity test. 

[ ] I have read the information, understood, and truthfully answered the HSQ. 

Test to be Taken (check one) Pack test [ ] Field Test [ ] Walk Test [ ] 

Signature Date ________________________________________________ Date ____________________ 

Printed Name _________________________________________________ 

Baseline Vitals: Time __________ Heart Rate _________ Blood pressure ___________ 

Emergency Contact Information: 

Name ______________________________________ Phone _________________________ 

Relationship _________________________________ 

Privacy Statement

The information obtained in the completion of this form is used to help determine whether an individual being considered for wildland firefighting can carry out those duties 

in a manner that will not place the candidate unduly at risk due to inadequate physical fitness and health. Its collection and use are covered under Privacy Act System of 

Records OPM/Govt-10 and are consistent with the provisions of 5 USC 552a (Privacy Act of 1974). 

Paperwork Reduction Act Statement 

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it 

displays a valid OMB control number. The valid OMB control number for this information collection is 0596-0164. The time required to complete this information collection 

is estimated to average 5 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, 

and completing and reviewing the collection of information. The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the 

basis of race, color, national origin, gender, religion, age, disability, political beliefs, sexual orientation, and marital or family status. (Not all prohibited bases apply to all 

programs.) Persons with disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA’s 

TARGET Center at 202-720-2600 (voice and TDD). To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, 1400 Independence Avenue, SW, 

Washington, DC 20250-9410 or call (800) 975-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer. 
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Appendix C

Forestry Aide Job Description

The position may be filled as a temporary appointment up to 6 months or as a not to exceed 1 year 

which can be extended 1 additional year.

Serves on crews performing duties in fire prevention and suppression. Performs prescribed burning 

crew duties in order to reduce fuel hazards and disease, while protecting wildlife. Assists with 

fire dispatch through operation of radios, telephones, and other necessary equipment to exchange 

information for fire weather and other forest suppression activities.

Lays or directs hose in the use of water. Moves dirt, chops brush, and fells small trees to build fireline 

using various hand tools such as axes, shovels, Pulaskis, and McLeods to control spreading wildland 

fire and/or to prepare lines prior to controlled burning. Chops, carries, and piles logging slash. Searches 

out and extinguishes burning materials by moving dirt, applying water by hose or backpack pump. 

Patrols fireline to locate and extinguish sparks, flare-ups, and hot sports that may threaten loss of 

control of the fire. Cleans, reconditions, and stores simple fire tools and equipment.

Performs basic duties in support of fire, timber, silviculture, recreation, wilderness, or research 

programs, projects, or activities.
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Appendix D

Known Causes of Dilated Cardiomyopathy [Dec and Fuster 1994]

Toxins

 Ethanol

 Chemotherapeutic agents (doxorubicin, bleomycin)

 Cobalt 

 Anti-retroviral agents (zidovudine, didanosine, zalcitabine)

 Phenothiazines

 Carbon monoxide

 Lead

 Cocaine

 Mercury

Metabolic Abnormalities

 Nutritional deficiencies (thiamine, selenium, carnitine)

Endocrinologic disorders (hypothyroidism, acromegaly, thyrotoxicosis, 

 Cushing disease, pheochromocytoma, diabetes mellitus)

 Electrolyte disturbances (hypocalcemia, hypophosphatemia)

Infectious

 Viral (coxsackie virus, cytomegalovirus, human immunodeficiency virus)

 Rickettsial

 Bacterial (diphtheria)

 Mycobacterial

 Fungal

 Parasitic (toxoplasmosis, trichinosis, Chagas disease)

Noninfectious

 Collagen vascular disorders (scleroderma, lupus erythematosus, dermatomyositis)

 Hypersensitivity myocarditis

 Sarcoidosis

 Peripartum dysfunction

Neuromuscular Causes

 Duchenne muscular dystrophy

 Facioscapulohumeral muscular dystrophy

 Erb limb-girdle dystrophy

 Myotonic dystrophy
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Appendix E

History:

• Male older than 45 years

• Female older than 55 years

• Father or brother has had a heart attack before age 55

• Mother or sister has had a heart attack before age 65

• Smoker

• Previously diagnosed with hypertension (high blood pressure)

o Take prescription medication for high blood pressure

o Most recent blood pressure measurement

o Date of most recent blood pressure measurement

• Previously diagnosed with hypercholesterolemia/hyperlipidemia (high blood 

 cholesterol)

o Take prescription medication for high blood cholesterol

o Most recent cholesterol levels (e.g., low density lipoprotein [LDL], total 

 cholesterol/high density lipoprotein [HDL] ratio)

o Date of most recent cholesterol measurement

• Previously diagnosed with diabetes mellitus

o Take prescription medication for diabetes

o Most recent blood sugar measurement

o Date of most recent blood sugar measurement

Current height:

Current weight:

Current prescription medications: 

Physically inactive (i.e., you get less than 30 minutes of exercise at least 3 days per week)