NIOSH Fire Fighter Fatality Investigation and Prevention Program

F2018-16 PA

Career Lieutenant Suffers a 

Sudden Cardiac Event During 

Fireground Survival Training 

and Dies 2 days LaterPennsylvania
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Summary

• On June 25, 2018, a 62-year-old career Fire Lieutenant (LT) suffered a 

sudden cardiac event during a training evolution at the fire training 

center and died 2 days later at the local hospital. 

• The LT was participating in a 3-day International Association of Fire 

Fighters (IAFF) Fireground Survival Program. 

• He collapsed on the third and final day of training while maneuvering 

through the entanglement prop of the self-contained-breathingapparatus (SCBA) maze course. 

• He was wearing full personal protective equipment (PPE) consisting of 

turnout gear and SCBA. 

• He had exhausted his SCBA’s compressed air and was “filter 

breathing.” 

• Filter breathing is a term some firefighters use when they disconnect 

their mask mounted regulator (MMR) and cover the opening with the 

lower portion of their PPE hood.
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Summary

• The instructor observing the LT 

from outside of the entanglement 

box (see photo) noted he had 

stopped moving and was not 

responding to commands. 

• The instructor opened the 

entanglement prop and removed 

the LT to the drill room floor for 

assessment. The LT was 

unresponsive, and CPR 

(cardiopulmonary resuscitation) 

was begun by fire instructors. 

• On-scene fire department 

paramedics responded with 

advanced life support and 

transported the LT to the local 

hospital’s emergency department. The Lieutenant became unresponsive during the final 

SCBA entanglement prop on the 3-day survival class 

and died 2 days later at the hospital. 

(Photo Courtesy Fire Department.)
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Close up photo of the disentanglement prop. 

(Photo Courtesy of the Fire Department.)
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Summary

• In the emergency department, advanced life support measures 

continued and, although the LT never regained consciousness, his 

cardiac status improved. 

• He was admitted to the hospital’s intensive care unit where 

subsequent testing revealed anoxic (without oxygen) brain damage. 

• He was removed from life support and pronounced deceased on June 

27, 2018. 

• NIOSH investigators concluded that the exertion associated with the 

training activity triggered a sudden cardiac event in an individual with 

underlying cardiovascular disease (CVD). 

• The autopsy report listed the cause of death as “hypertensive 

cardiovascular disease.” 
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Contributing Factors

• Undiagnosed hypertensive CVD

• Infrequent exercise stress tests (ESTs) for firefighters at risk for CVD

• Lack of annual medical clearance for unrestricted firefighting duties which 

includes training involving heavy physical exertion

• Physically strenuous training
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Recommendations

• Fire departments should provide and require annual medical evaluations to all 

firefighters. 

• Fire department physicians should ensure symptom-limiting exercise stress 

tests (ESTs) are provided to firefighters at increased risk of CVD.

• Fire departments physicians should use the information from the annual 

medical evaluation to make final medical recommendations regarding medical 

clearance for unrestricted firefighting duties and participation in physically 

strenuous training exercises. 

• Fire departments should perform annual physical performance evaluations.

• Fire departments should consider phasing in a mandatory comprehensive 

wellness-fitness program for all firefighters to reduce CVD risk factors and 

improve cardiovascular capacity. 
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Recommendations

• Fire Departments and Authorities Having Jurisdiction (AHJs) should ensure 

training maze props and/or trailers used in advanced SCBA confidence training 

have adequate safety features such as emergency egress panels, emergency 

lighting, ventilation and temperature monitoring to measure the ambient 

temperature inside the maze or prop.

• As a part of a respiratory protection program, FDs and AHJs should consider 

which levels of SCBA skills training are essential (awareness level) and which 

levels are advanced (operations level) and may be optional for members. 

• Fire departments and training organizations should ensure that established 

SCBA training protocols are followed for each level of SCBA skills taught, and 

that students are physically capable and medically cleared to participate. 

• Fire departments should ensure a comprehensive rehabilitation program and 

process is in place during training exercises that pose a potential safety and 

health risk to firefighters. 

• During advanced SCBA skills and confidence building training programs, 

students should be cautioned against “filter breathing.” 
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Contact Us

Fire Fighter Fatality Investigation and Prevention Program

Surveillance and Field Investigations Branch

Division of Safety Research

NIOSH 1000 Frederick Lane, MS 1808

Morgantown, West Virginia 26505-2888

FFFIPP Webpage

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