By Travis Dotson
This is about a firefighter physical training fatality. Let me tell you why this scares the crap out of me. This PT description sounds very familiar. We get up and go for a group run fairly regularly. You might point out that this instance is different because it’s a structural department. That is exactly why it scares me even more. These folks are medically trained to a much higher degree than any wildland crew out there.
And he died.
Read this and reflect on your own PT program.
Are you ready?
The following is an excerpt from the NIOSH report “Fatal Exertional Heat Stroke During Physical Fitness Training“.
On April 20, 2009, a 26-year-old male career Firefighter Trainee began a 2-month firefighter certification program. On April 29, 2009, the Trainee participated in a 4.4-mile jog as part of the physical fitness portion of the program.
The temperature 73 degrees °F with 87% relative humidity.
The 36 students began the day (Day 6 of the program) with physical fitness training consisting of stretching and jogging two laps around the track (1/4 mile per lap) as a warm-up exercise. At about 0610 hours, the group began a 4.4-mile run/jog in formation on neighboring streets. The group was led by a FD vehicle and followed by a FD squad. Four instructors participated in the run, which lasted approximately 1 hour, 10 minutes.
A Captain led the group, calling cadence while another Captain ran in the back of the class. Nearing the end of the run, students were instructed to break formation and sprint to the finish line, approximately 1/8 mile. Three students were lagging behind, including the Trainee. Two nearby classmates went to encourage the Trainee, who was stumbling and seemed disoriented. When asked if he was okay, he said “just let me finish.” The Trainee stopped running and began walking in an unsteady gait. A class officer, a FD Captain, ran over and helped the Trainee lie down with assistance from the other students. Water and a medical bag (containing oxygen, blood pressure cuff, and a glucometer) were retrieved. According to the students, the Trainee was pale, sweaty, shivering, incoherent, and unable to communicate.
911 was called (0727 hours), and an ambulance was dispatched (0728 hours). A paramedic on the scene found the Trainee to be unresponsive, with a rapid pulse of 170 beats per minute, a rapid breathing rate of 24 breaths per minute, and low blood pressure of 60 mmHg by palpation. Ice packs were placed on the Trainee’s skin, oxygen was administered, and an intravenous (IV) line was placed. His blood glucose level was normal (95 milligrams per deciliter [mg/dL]).
The ambulance responded at 0730 hours and arrived on scene at 0739 hours. Paramedics found the Trainee unresponsive, with essentially no change in his vital signs from 0729 hours. A 12-lead electrocardiogram (EKG) revealed sinus tachycardia (rapid heart rate) with inverted T-waves (a nonspecific finding). A second IV line was placed, and the Trainee was given fluids to treat dehydration and heat exhaustion. His axillary (under the arm) temperature was 103.4°F, and four new ice packs were placed on his skin. The ambulance departed the scene at 0752 hours en route to the local hospital’s ED. En route, the Trainee’s blood pressure increased to 80 mmHg systolic (by palpation), but his fast pulse and respiratory rate remained unchanged. He remained unconscious throughout the remainder of the 19-minute transport.
The ambulance arrived at the hospital’s ED at 0811 hours. The Trainee’s vital signs revealed a blood pressure of 106/52 mmHg, a heart rate of 150 beats per minute (tachycardia), and a respiratory rate of 24 breaths per minute. He was sweating heavily and had a core body (rectal) temperature of 105.3°F. The initial diagnoses were hyperthermia, severe dehydration, and heatstroke, followed by heatstroke complications including the following:
- Rhabdomyolysis (breakdown of muscle fibers resulting in the release of myoglobin into the bloodstream)
- Acute renal failure due to rhabdomyolysis
- Disseminated intravascular coagulation (DIC) (a blood clotting disorder)
- Electrolyte imbalances (low potassium and calcium)
He was treated in the ED with ice packs, cooling fans, cool IV fluids, and cold towels. Despite this treatment, his rectal temperature was 104.7°F 3 hours after his arrival in the ED, and 101°F 12 hours after his arrival in the ED.
The Trainee was transferred to the intensive care unit where IV fluids and cooling blanket therapy continued. Over the next 4 days his mental status improved; however, many of his organ systems (i.e., muscles, liver, kidneys, and blood coagulation) began to fail from heatstroke complications. On May 3 his neurological status declined, and he began to have respiratory failure that required intubation. A computed tomography (CT) scan of his brain revealed marked cerebral edema with herniation. After consulting with the family, the physician removed the Trainee from life support on May 4; he died 41 minutes later.
Read the full report here: