51-Year-Old Firefighter Suffers a Sudden Cardiac Event and

Crashes Engine While Responding to a Residential Structure

Fire - West Virginia

Page i

F2020-07 WV • 2/13/2023 

Executive Summary 

On January 11, 2020, a 51-year-old male volunteer firefighter died while responding to a mutual aid 

call for a residential structure fire. While driving the department’s engine to the fire scene, the 

firefighter suffered a sudden cardiac event causing him to lose control of the apparatus approximately 

1⁄2 mile from the structure fire. At approximately 1524 hours, the engine left the roadway and began to 

roll down an embankment. A hillside tree prevented the engine from rolling all the way down the hill

into a creek. The engine came to rest on its roof in a very unstable position.

A firefighter from a neighboring fire 

department, also responding to the mutual 

aid call, came upon the crash site and 

notified dispatch at 1526 hours. Over the 

next 15 minutes, multiple emergency 

responders, including two members of the 

victim’s fire department working the 

structure fire, responded to the crash scene. 

They found the firefighter unconscious, 

trapped inside the cab. The firefighter was 

wearing his shoulder and lap belt and had 

donned all his turnout gear except for his 

helmet. A Lieutenant (LT) from the 

firefighter’s department and an advanced 

life support (ALS) unit from the 

neighboring department climbed into the 

engine’s cab to take the firefighter’s vital 

signs. The firefighter was unresponsive, did 

not have a pulse, and was not breathing. 

Due to firefighter’s grave condition and the 

engine’s unstable position, no 

Fire engine balancing on its roof after leaving the 

roadway and rolling down a hill.

(Photo courtesy of the Fire Department)
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51-Year-Old Firefighter Suffers a Sudden Cardiac Event and Crashes 

Engine While Responding to a Residential Structure Fire - West Virginia

Report # F2020-07

cardiopulmonary resuscitation (CPR) was administered, and no immediate attempt was made to 

extricate the firefighter.

The wrecker crew arrived on-scene approximately 45 to 60 minutes after the crash. It took a significant 

amount of time to stabilize the engine which was then righted onto the roadway. The roof of the 

engine’s cab had to be cut way to extricate the firefighter. The Medical Examiner was called to the 

scene and pronounced the firefighter deceased at 1636 hours. The Chief Medical Examiner for the 

State of West Virginia performed the autopsy and completed the death certificate. “Sudden death” was

listed as the immediate cause of death, caused by a “likely dysrhythmia,” due to years of “hypertensive 

cardiovascular disease.” “Positional asphyxia” could not be excluded as “contributory.”

Contributing Factors

• Lack of fire department medical evaluations to screen firefighters for risk factors for 

cardiovascular (CV) disease

• Lack of exercise stress tests (ESTs) for firefighters at increased risk for CV disease

• Lack of annual medical clearance for unrestricted firefighting duties, including operations of 

fire department apparatus

• Stress of responding to a fire emergency.

Key Recommendations

• Fire departments should ensure pre-placement and annual medical evaluations are provided to 

all firefighters

• Fire department physicians should ensure ESTs are provided to firefighters at increased risk of 

CV disease

• Fire department medical programs should be under the direction of a physician knowledgeable 

about the physical demands of firefighting, the personal protective equipment used by 

firefighters, and the medical guidance provided by the National Fire Protection Association 

(NFPA) 1582

• Fire department physicians should use the information from the annual medical evaluation to 

make final medical recommendations regarding medical clearance for unrestricted firefighting 

duties and tasks such as driving fire department apparatus.

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 firefighter initiative that resulted in the 

NIOSH Firefighter Fatality Investigation and Prevention Program, which examines line-of-duty deaths or on-duty deaths of 

firefighters to assist fire departments, firefighters, the fire service, and others to prevent similar firefighter 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).
51-Year-Old Firefighter Suffers a Sudden Cardiac Event and Crashes 

Engine While Responding to a Residential Structure Fire - West Virginia

Introduction

On January 11, 2020, a 51-year-old volunteer West Virginia firefighter suffered a sudden cardiac event 

while driving his department’s engine to a mutual aid call for a residential structure fire. The firefighter 

lost control of the engine which veered off the roadway, rolled, and landed on its roof. 

The National Institute for Occupational Safety and Health’s (NIOSH) Fatality Investigation Prevention 

Program (FFFIPP) was notified about this incident by the United States Fire Administration on January 

13, 2020. On January 27, 2020, a NIOSH FFFIPP investigator and an occupational medicine resident

rotating through NIOSH visited the fire department to initiate the investigation. They conducted 

interviews with the affected fire department (fire chief, his assistant, a lieutenant, and a captain), and 

reviewed the following documents:

• membership requirements

• training requirements

• maintenance records of department apparatus

• fire department’s standard operating procedures

• death certificate. 

The NIOSH team visited the scene of the crash, took photographs, and inspected the damaged engine 

at the storage garage. The NIOSH team also reviewed the West Virginia uniform traffic crash report 

for this incident. While the death certificate completed by the medical examiner was available to 

NIOSH, the dispatch records and the medical examiner’s autopsy report were not available to NIOSH 

at the time of this report.

Fire Department

The department involved is a volunteer fire department, one of six departments in the county. The 

department is staffed with 20 active firefighters and 5 probationary firefighters working out of one 

station. The department serves 754 people and 232 homes in a first due response area of 17.9 square 

miles. The response area expands to 25.1 square miles when mutual aid areas are included. The 

department responds to approximately 40 to 45 calls per year, consisting mostly of motor vehicle 
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crashes. The department does not provide emergency medical team services, although they do have a 

paramedic on staff.

Hiring Process, Training and Experience

Membership in this fire department begins with an application completed by the prospective member. 

The fire department board and fire department members review the application. After a vote is made to 

accept the applicant, a 90-day probation period begins. After the 90 days, the board votes whether to 

accept the probationary firefighter as an active full member. 

During the probationary period, the new member is required to become Firefighter 1 certified [NPFA 

1001, 2019]. After completing Firefighter 1, new members must become first aid and CPR certified,

and complete a hazmat awareness course. During their probationary period and after becoming an 

active firefighter, new members are paired with experienced firefighters in the department during 

emergency responses.

The department requires biweekly training for all active members. The department provides motor 

vehicle crash training conducted with the assistance of a local towing company to ensure firefighters 

can respond appropriately to various vehicle crash scenarios. Additional training is available at the 

West Virginia Fire Schools in Sissonville and Granville. For a member to drive fire department 

apparatus, the member must have a current WV driver’s license and received a completion certificate 

from the West Virginia State Emergency Vehicle Operations Course (EVOC).

The FD does not require a candidate pre-placement medical evaluation nor periodic medical 

evaluations or medical clearance for members. The fire department provides numerous opportunities 

for exercise at the fire station, including the use of extensive gym equipment available at the fire 

station.

The driver involved in this incident was a 20-year firefighting veteran who worked in this fire 

department as a paramedic and a firefighter. He started his firefighting career in the state of Nebraska

in 2000. In January 2002, he earned a certificate of training in confined space rescue and attained 

Firefighter II certification in October 2009. He also earned an Instructor I certificate (NFPA 1041, 

2019) in April 2011. He successfully completed the Emergency Vehicle Operations Course (EVOC) at 

the West Virginia Department of Education through the West Virginia State Fire Commission in 2017. 

In 2019 he joined the fire department and completed the department’s apparatus driver training and 

was an active participant in the department’s various training sessions. According to the traffic crash 

report prepared by the county sheriff’s, the driver had a valid driving license with no history of driving 

violations.
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Fire Department Apparatus

The department’s fleet of vehicles at the time of the incident was comprised of:

- 2018 International Fire Engine (Engine 22) which had a 1000-gallon pump and a 750-

gallon tank. This engine was involved in the crash (Photo 1 and 2, post-crash)

- 2018 Kiota Mechron (Utility 21)

- 2001 Ford Explorer (Squad 21)

- 1994 Freightliner FL80 (Rescue 21) which had a 1000-gallon pump and a 750-gallon tank

- 1991 GMC Tanker with a 500-gallon power take-off (PTO) pump and a 1500-gallon tank

Minor fleet maintenance is performed by the members of the department who also complete monthly 

apparatus maintenance checklists on each apparatus. Other apparatus maintenance is conducted by a 

garage with certified heavy-equipment mechanics. Engine 22 was last serviced in July 2019.

 

Photo 1. Damage to the front of Engine 

22 stored at the wrecking/salvage yard.

(NIOSH photo)

Photo 2. Damage to the rear of Engine 

22 stored at the wrecking/salvage yard.

(NIOSH photo)
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Weather and Road Conditions

The incident occurred on a dry, level, two-lane asphalt road divided by a double yellow line. Where the 

crash occurred, the roadway had a slight left curve and had a width of approximately 18 feet. At the 

time of this incident (about 1524 hours), the weather was clear with a high of 80 degrees Fahrenheit 

with no precipitation [Weather Underground 2022]. The roadway was dry, however, rains over the 

previous days made the shoulder soft. During recovery efforts (approximately 1630 to 1730 hours), 

rain began to fall (Photo 3).

 

Photo 3. Engine 22 righted onto the roadway after the deceased firefighter was removed. 

Rain was falling at the time of this photograph, about 2 to 3 hours after the crash. 

(Photo courtesy of the Fire Department)
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Investigation

On January 11, 2020, a 51-year-old male volunteer firefighter reported to his fire station to drive 

Engine 22 to a residential structure fire. Approximately 18 miles from the station and 1⁄2 mile from the 

reported structure fire, the rear passenger side tires went off the pavement onto a soft shoulder/berm. 

The engine travelled approximately 70 feet with the right rear passenger tires on the shoulder/berm 

when the right rear tires hit a large boulder. The boulder was located about 3 feet off the roadway. The 

impact dislodged Engine 22’s rear axle causing the driver to lose control of the engine. Tire skid marks

show the vehicle returned to the roadway and crossed the double yellow line as it rotated 180 degrees. 

Approximately 120 feet from the initial impact of the boulder, Engine 22 exited the left side of the 

roadway (Photo 4). At this point the engine began to roll on its longitudinal axis down an embankment 

landing on its roof (Photo 5). The engine was dangerously balancing on a tree that prevented it from 

cascading farther down the hill to the creek below (Photo 5). 

 

Photo 4. Gouges in the asphalt 

where the engine left the shoulder of 

the roadway.

(NIOSH photo)

Photo 5. Overturned Engine 22 with tire skid 

marks on the roadway where the driver lost 

control of the engine. 

(Photo courtesy of the Fire Department)
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The firefighter was driving the engine alone. He was wearing his turnout gear (jacket, bunker pants, 

rubber boots) and was buckled in with his shoulder and lap seatbelt when the crash occurred. The 

crash/rollover was not witnessed. There were no other injuries or fatalities caused by this crash.

The driver of a tanker from a neighboring fire department, also responding to the mutual aid call for 

the structure fire, came upon the crash scene approximately 1⁄2 mile from the location of the structure 

fire. The driver exited the tanker and surveyed the crash scene. While standing below the overturned 

engine, he could see the victim. The victim was unable to speak but was able to wave his arm out the 

driver side window. The tanker driver told the victim that he was going to get help. The driver climbed 

back up the embankment to his tanker and called dispatch at 1526 hours. In addition to requesting 

emergency responders, he told dispatch to notify a local wrecker/recovery operator.

Over the next 15 minutes, several emergency response units responded to the crash scene. This 

included three members of the local sheriff’s office, an ALS unit from a neighboring fire department, 

two members of the State Fire Marshal’s office, and two members of the victim’ fire department. The 

two members of the victim’s fire department (the assistant chief and a lieutenant) left the structure fire 

to assist with the rescue operation. All units found Engine 22 overturned, dangerously balancing on a 

tree with the firefighter unconscious, pinned to the driver’s seat of the cab.

The lieutenant and the paramedic from the neighboring department’s ALS unit climbed into the 

engine’s cab to take the firefighter’s vital signs. The firefighter, still belted in with his shoulder and lap 

belt, was unresponsive, did not have a pulse, and was not breathing. This information was passed onto

the crash scene’s incident commander from a neighboring fire department. Due to engine’s unstable

position and the poor prognosis of the victim, a decision was made to not perform cardiopulmonary 

resuscitation (CPR). Efforts to remove the firefighter from the cab would need to wait until the engine 

was stabilized by the wrecking crew. This information was passed to on-scene officers with the county 

sheriff’s office and the State Fire Marshal Office who shifted their focus from rescue to recovery.

Officers from the county sheriff’s office and State Fire Marshal’s office collected crash scene data for 

the West Virginia uniform traffic crash report. Upon arrival of the wrecker and completion of data

collection, the engine was righted onto the roadway (Photo 3). The deceased firefighter was extricated 

by cutting the roof off the engine’s cab (Photo 3). The medical examiner was called, arrived on-scene, 

and pronounced the firefighter deceased at 1636 hours.

According to those present at the scene, the deceased firefighter had a small head laceration and a

small indentation on the back of his head suggestive of him being pinned to the seat. There was no 

significant bleeding visible inside the cab. He was transported to the Office of the Chief Medical 

Examiner for an autopsy. The crash scene was cleared about 2330 hours. According to the traffic crash 

report, there was no evidence that Engine 22 was speeding, and there was no evidence of alcohol or 

other drug use by the driver.
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Cause of Death

The death certificate was completed by the state’s chief medical officer after conducting the autopsy. 

The immediate cause of death was “sudden death” caused by a “likely dysrhythmia” due to years of 

“hypertensive cardiovascular disease.” Since the firefighter was trapped and pinned inside the 

apparatus, “positional asphyxia,” could not be excluded as “contributory.” At the time of this report, 

NIOSH was unable to access the autopsy report performed by the chief medical officer in the West 

Virginia Office of the Medical Examiner. 

The firefighter was not reported to have any medical problems, and NIOSH was also unable to locate 

any personal medical records of the deceased firefighter. Therefore, NIOSH was unable to determine if 

the firefighter had any known cardiac conditions or cardiac risk factors, other than the evidence of 

long-standing high blood pressure (hypertension) found at autopsy and listed on the death certificate.

Discussion

Sudden Cardiovascular (CV) Events

Sudden CV events (heart attacks, sudden cardiac death, and strokes) are the leading cause of on-thejob deaths among firefighters, constituting approximately 40%–45% of all duty-related fatalities [Fahy 

and Petrillo 2021]. Coronary heart disease (CHD) and cardiomyopathies are the most common 

underlying medical conditions for sudden CV events in the general population and in firefighters 

[Farioli et al. 2015; Myerburg and Junttila 2012]. Many individuals are unaware of these underlying 

medical conditions and the sudden CV event is frequently the first sign of their underlying disease 

[Myerburg and Junttila 2012]. According to the cause of death certificate completed by the chief 

medical officer of the West Virginia Office of the Medical Examiner, the firefighter had hypertensive 

CV disease. Hypertensive CV disease is the result of longstanding high blood pressure (hypertension). 

It is unclear if the firefighter was aware of his high blood pressure and its potential for adverse health 

outcomes. 

Medical evaluations (medical history, physical examination, medical tests) can help identify 

individuals at risk for a sudden CV event. The well-established personal risk factors for CHD include 

both non-modifiable and modifiable risk factors. The non-modifiable risk factors include male sex, 

older age (males >45, females >55), race, and family history of premature heart disease or sudden 

cardiac death [AHA 2016]. The firefighter had two of these risk factors (age and male sex). The 

modifiable risk factors include hypertension, hyperlipidemia, smoking, diabetes, overweight/obesity, 

and physical inactivity [AHA 2016]. Based on the firefighter’s autopsy and death certificate, the 

firefighter had long standing hypertension, but NIOSH has no information about any of the other 

modifiable risk factors. 
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The American Heart Association/American College of Cardiology (AHA/ACC) developed an on-line 

calculator to estimate the risk of future CV events [AHA/ACC 2020]. Using the following 12 risk 

factors (age, sex, race, total cholesterol, LDL cholesterol, HDL cholesterol, use of statins to control 

cholesterol, systolic blood pressure (BP), BP lowering medication use, diabetes mellitus status, 

smoking status, and aspirin therapy), the AHA/ACC’s CV risk calculator estimates an individual’s 10-

year risk of developing atherosclerotic CV disease [AHA/ACC 2020]. NIOSH was unable to estimate 

the firefighter’s 10-year CV disease risk due to the lack of personal risk factor information.

Physical Activity and Sudden Cardiovascular (CV) Events

Strenuous physical activity has been shown to “trigger” heart attacks and sudden death in susceptible 

individuals (e.g., those with underlying CV disease or CHD) [Thompson et al. 2007; Mittleman and 

Mostofsky 2011]. Since firefighting tasks require heavy physical exertion, this association is also 

found in firefighters [Hales et al. 2007; Hales 2016; Haller and Smith 2019; Kales et al. 2007; Smith et 

al. 2016]. While the task of driving the fire engine to a fire emergency is not strenuous physical 

activity, it can be stressful. It is possible the stress of responding to the fire emergency triggered his 

sudden CV event. 

Occupational Medical Standards for Structural Firefighters

To reduce the risk of sudden CV events or other incapacitating conditions among firefighters, NFPA 

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

[NFPA 1582, 2021]. This voluntary consensus-based standard outlines the specific medical evaluation 

(medical history, physical examination, medical tests) recommended assessing a firefighter’s medical 

ability to perform their duties safely and effectively. The standard also provides specific medical 

criteria used to determine fitness-for-duty for certain diseases or conditions. While the 2021 edition of 

NFPA 1582 is now available, the 2018 edition was in effect at the time of this investigation [NFPA

1582, 2018 and 2021]. The death certificate identified that the firefighter had one health issue 

addressed in NFPA 1582: hypertension. 

Hypertension

The 2018 edition of NFPA 1582 recommended referral of firefighters with Stage 1 hypertension 

(systolic BP 140–159 millimeter of mercury (mmHg) or diastolic 90–99 mmHg) to their primary care 

provider for BP control and to “consider” screening for end-organ damage (cardiac findings, 

nephropathy, retinopathy, etc.). Given the medical examiner’s conclusion that the firefighter had 

hypertensive cardiovascular disease, this suggests the firefighter had a long history of hypertension, 

suggesting that screening for these complications was indicated. According to NFPA 1582, these 

screening tests would include [NFPA 1582, 2018]:

• medical history for possible symptoms of heart failure 

• dilated eye examination for possible retinopathy

• blood creatinine for possible nephropathy
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• an electrocardiogram (EKG) or echocardiogram for possible left ventricular 

hypertrophy.

Contributing Factors

Occupational injuries and fatalities are often the result of one or more contributing factors or key 

events in a larger sequence of events that ultimately result in the injury or fatality. NIOSH 

investigators identified the following items as key contributing factors in this incident that ultimately 

led to the fatality:

• Lack of fire department medical evaluations to screen firefighters for risk factors for 

cardiovascular (CV) disease

• Lack of exercise stress tests (ESTs) for firefighters at increased risk for CV disease

• Lack of annual medical clearance for unrestricted firefighting duties, including operations of 

fire department apparatus

• Stress of responding to a fire emergency.

Recommendations

Recommendation #1: Fire departments should ensure pre-placement and annual medical 

evaluations are provided to all firefighters. 

Discussion: NFPA 1582, Standard on Comprehensive Occupational Medical Program for Fire 

Departments, requires pre-placement and annual medical evaluations for firefighters. The standard also 

provides guidance on the components of the evaluations (e.g., laboratory tests) [NFPA 1582, 2021]. 

Regular medical evaluations help determine a firefighter’s medical ability to perform duties without 

undue risk to the safety and health of self or others. Although fire departments are not legally obligated 

to follow NFPA 1582, annual/periodic medical evaluations are strongly encouraged by fire service 

organizations. To help smaller volunteer departments, the United States Fire Administration (USFA) 

published the Health and Wellness Guide for the Voluntary Fire and Emergency Services, and the 

National Volunteer Fire Council (NVFC) published the Fit for Duty, Fit for Life: Firefighter Physicals 

and the Volunteer Fire Service, and Health and Wellness Tips to help address these important medical 

issues [NVFC 2015; NVFC 2021a; USFA 2009].

Applying this recommendation involves funding and may be particularly difficult for small volunteer 

fire departments, such as the one fire department involved in this incident, to implement. To overcome 

these financial obstacles, volunteer fire departments could urge current members to get annual medical 

clearances from their private physicians. Another option is having the annual medical evaluations 

completed by paramedics and emergency medical technicians (EMTs) from the local emergency 

medical service (vital signs, height, weight, visual acuity, and EKG). This information could then be 
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provided to a community physician (perhaps volunteering his or her time), who could review the data 

and provide medical clearance (or further evaluation, if needed). The more extensive portions of the 

medical evaluations could be performed by a private physician at the firefighter’s expense (personal or 

through insurance), provided by a physician volunteer, or paid for by the fire department. Sharing the 

financial responsibility for these evaluations between firefighters, the fire department, and physician 

volunteers may reduce the negative financial impact on recruiting and retaining needed firefighters.

Recommendation #2: Fire department physicians should ensure symptom-limiting exercise stress 

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

Discussion: NFPA 1582 requires all firefighters 40 years and older be assessed for asymptomatic 

atherosclerotic CV disease [NFPA 1582, 2021]. As mentioned in the discussion section of this report, 

this assessment includes a 10-year cardiac risk estimate from the American College of Cardiology/

American Heart Association, and/or a 2-year cardiac risk estimate from the Framingham Heart Study 

[AHA/ACC 2020; D’Agostino 2000]. According to NFPA 1582, firefighters with a 10-year risk 

between 10%–19.9%, or a 2-year risk between 2 to 4%, shall be further evaluated with a symptom 

limiting EST to at least 12 metabolic equivalents (METS) with negative tests repeated every 2 to 5 

years or when clinically indicated [NFPA 1582, 2021]. Given the lack of CV risk factor information 

available for the firefighter involved in this incident, it is unclear whether the firefighter should have 

been referred for an EST. It is important to point out that the AHA/ACC does not recommend ESTs for 

young adults (<40 years old) due to validity issues. Finally, some fire departments use the EST to 

assess a firefighter’s aerobic capacity rather than as a screening test for CV disease. This represents an 

unnecessary expense for the department because one’s aerobic capacity can be easily determined in a 

non-medical setting (e.g., the Cooper test) [Cooper HK 1968; The Cooper Institute 2006].

Recommendation #3: Fire department medical programs should be under the direction of a 

physician knowledgeable about the physical demands of firefighting, the personal protective 

equipment (PPE) used by firefighters, and the medical guidance provided by NFPA 1582.

Discussion: NFPA 1582 requires fire departments designate a physician responsible for guiding, 

directing, and advising the members about their health, fitness, and suitability for duty [NFPA 1582,

2021]. This physician should be familiar with the essential job tasks of firefighting, the physical 

demands and environmental conditions under which firefighters must perform, the PPE required 

during various emergency operations, and the medical guidance provided by NFPA 1582. Additional 

guidance is available from the Healthcare Provider’s Guide to Firefighter Physicals prepared by the 

International Association of Fire Chiefs [IAFC 2016]. 

Recommendation #4: Fire department physicians should use the information from the annual 

medical evaluation to make final medical recommendations regarding medical clearance for 

unrestricted firefighting duties and tasks such as driving fire department apparatus. 
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Discussion: In addition to outlining the components of a medical evaluation, NFPA 1582 also provides 

guidance on when certain medical conditions might require restrictions from full duty [NFPA 1582, 

2021]. This not only includes medical clearance for firefighting duties, but also the driving of fire 

department apparatus during emergency responses.

Implementing this recommendation (the recruitment and retention of medically qualified firefighters) 

may be particularly difficult for small, rural, volunteer fire departments. Several individuals and 

organizations have addressed the broader issue of recruiting and retaining volunteer firefighters 

[Aitken 2020; Carter 2005; Decremer 2018; Maruca 2021; NVFC 2021b; USFA 2007; Wilson 2002].

The USFA, in partnership with the NVFC, has traced some of the recruitment and retention problems 

to [USFA 2007, page 2]:

• “more demands on people’s time in a hectic modern society

• more stringent training requirements

• population shifts from smaller towns to urban centers

• changes in the nature of small-town industry and farming

• internal leadership problems, and 

• a decline in the sense of civic responsibility.”

The USFA and NVFC believe individuals are still willing to give their time to volunteer emergency 

services organizations provided the following [USFA 2007, page v]: 

• “the experience is rewarding and worth their time

• the training requirements are not excessive

• the time demands are adaptable and manageable

• they are rewarded with a personal sense of value

• there is good leadership minimizing conflict, and

• there is ample support for the organization.”

The USFA and NVFC document not only identifies the challenges of recruitment and retention but

provides several categories of potential solutions including leadership, department image, 

consolidation, risk, cohesiveness, emotional support, training requirements, time demands, recognition, 

fun factors, and recruitment strategies [USFA 2007]. The NVFC website also provides 46 resources 

specifically on the recruitment and retention of volunteer firefighters. In addition, by searching on the 

term “recruitment and retention,” the NVFC website provides information on recent and upcoming 

meetings and webinars on the topic. 

NIOSH recommends that small, volunteer fire departments review the documents and websites cited 

above for ideas and suggestions relevant to their department to help recruit and retain medically 

qualified volunteer firefighters. 
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Recommendations #5, 6, and 7 would not have prevented this firefighter’s death, however they are 

included to address general health and safety issues for this fire department.

Recommendation #5: Fire departments should consider phasing in a mandatory comprehensive 

wellness-fitness program for all firefighters to reduce CV disease risk factors and improve 

cardiovascular capacity. 

Discussion: NFPA 1583, Standard on Health-Related Fitness Programs for Fire Department 

Members, allows firefighters to build and maintain a level of health and fitness which reduce their risk 

of illness, injury, and premature death [NFPA 1583, 2022]. Fire service health promotion programs 

have been shown to improve fitness, reduce CHD risk factors, reduce absenteeism, reduce workrelated injuries, reduce lost workdays, and reduce worker compensation claims, reduce medical costs, 

and have a favorable return on investment with mandatory programs showing the most benefit [Blevins 

et al. 2006; Dempsey et al. 2002; Griffin et al. 2016; Kuehl et al. 2013; Poston et al. 2013; Sokoloski et 

al. 2020]. The fire department involved in this incident encouraged physical fitness and wellness but

did not require participation in a mandatory comprehensive wellness-fitness program.

Recommendation #6: Fire departments should follow applicable NFPA apparatus standards to 

reduce the risk of firefighters becoming injured or dying in fire department apparatus crashes.

Discussion: In 2020, fire department vehicles were involved in an estimated 18,775 collisions while 

responding to or returning from incidents resulting in 600 injuries and 16 deaths [Campbell and Everts 

2022]. While fire department vehicle collisions, injuries, and fatalities have been steadily decreasing 

over the past 20 years, they still represent a significant number of firefighter fatalities and warrant 

continued prevention efforts [Vatter 2021].

At least three NFPA standards are relevant to reducing the number and severity of firefighter injuries 

related to vehicle crashes. These standards have focused on:

• Improving the training and certification of the apparatus operator, and 

• Improving the maintenance of the apparatus.

NFPA 1451: Standard for a Fire and Emergency Service Vehicle Operations Training Program.

This standard provides for the development of a written vehicle operations training program, including 

the organizational procedures for training, vehicle maintenance, and identifying equipment deficiencies 

[NFPA 1451, 2018]. The firefighter and driver of the engine in this incident had completed the West 

Virginia State Emergency Vehicle Operations Course (EVOC) and had been cleared to drive the 

engine per the department’s apparatus standard operating procedure (SOP).
51-Year-Old Firefighter Suffers a Sudden Cardiac Event and Crashes 

Engine While Responding to a Residential Structure Fire – West Virginia

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NFPA 1002, Standard on Fire Apparatus Driver/Operator Professional Qualifications.

This standard identifies the minimum job performance requirements for firefighters who drive and 

operate fire apparatus in both emergency and nonemergency situations [NFPA 1002, 2017]. The 

standard also provides guidance on conducting annual proficiency evaluations. The fire department 

involved in this incident provided formal and informal apparatus driving training. NIOSH encourages 

the fire department to review all components of its apparatus training procedures to ensure compliance 

with NFPA 1002.

NFPA 1911, Standard for the Inspection, Maintenance, Testing, and Retirement of In-Service 

Automotive Fire Apparatus.

This standard details a program to ensure that fire apparatus are serviced and maintained in safe 

operating condition [NFPA 1911, 2017]. This department performs minor maintenance of their 

apparatus in house. More extensive maintenance is provided by a local garage employing certified 

heavy equipment mechanics. While a mechanical failure was not responsible for this incident, NIOSH 

encourages the fire department to review all components of this maintence procedure to ensure 

compliance with NFPA 1911.

Recommendation #7: Fire departments should ensure members have access to critical incident 

stress counseling services.

Discussion: During the NIOSH interviews, firefighters voiced concerns that their emotional needs

surrounding this incident were not met. Losing a firefighter is a very emotionally and stressful event 

for all members of the fire department. The fire service recognizes the importance of making available 

counseling sessions for grieving firefighters. Typically, this is administered by a department’s 

behavioral health or employee assistance programs. Unfortunately, most small, rural, volunteer FD do 

not have the resources to provide these programs. 

The NVFC recognizes this service gap and has developed a first responder helpline. This confidential 

line is available 24/7 to help responders cope with a variety of behavioral health issues and work-life 

stresses. The helpline is staffed by master’s level clinicians with an average of five years of experience 

specially trained in assisting and supporting first responder groups. For volunteer departments that are 

not members of the NVFC, it costs $21 to join NVFC and have access the First Responder Helpline. 

Alternatively, a department can sign up for a complimentary membership for access to the Helpline 

along with all the NVFC member benefits [NVFC 2022].
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Investigator Information

The field investigation was conducted by Karis Kline-Field, a Safety and Occupational Health 

Specialist with the NIOSH Fire Fighter Fatality Investigation and Prevention Program, Division of 

Safety Research, located in Morgantown, WV. She was assisted in the field by Dr. Cletus Oppong, 

MD, MPH from the West Virginia University School of Public Health. Ms. Kline-Field and Dr. 

Oppong drafted the report. The final report was written by Dr. Thomas Hales, MD, MPH, with the 

NIOSH Fire Fighter Fatality Investigation and Prevention Program, Division of Safety Research

located in Morgantown, WV.

Disclaimer

Mention of any company or product does not constitute endorsement by the National Institute for 

Occupational Safety and Health, Centers for Disease Control and Prevention. In addition, citations to 

websites external to NIOSH do not constitute NIOSH endorsement of the sponsoring organizations or 

their programs or products. Furthermore, NIOSH is not responsible for the content of these websites. 

All web addresses referenced in this document were accessible as of the publication date.