Saving Our Own: Sudden Death with No Overtime

Today, firefighters dying in the line-of-duty almost always receive a comprehensive autopsy and for many, it is the closest thing they have had to a medical exam in years.Scalpel, please.


Today, firefighters dying in the line-of-duty almost always receive a comprehensive autopsy and for many, it is the closest thing they have had to a medical exam in years.

Scalpel, please.

The actual procedure has altered little over time. A "Y" incision is made beginning near the shoulders and converges at the sternum. This cut continues all the way to the pubic area and is deep enough to reach the rib cage and slices completely through the abdominal wall. The skin is peeled back to expose the ribs and the sternum which are then sawn away to reveal the vital organs. Using the most common method, known as Rokitansky, all of the body organs are removed at once. Each is then carefully weighed and examined, often microscopically to gather information about the presence of various diseases that may have contributed to the death of the individual.

Autopsy means, literally, see for one's self. Humans have been dissecting other humans for thousands of years but the "modern" autopsy can be traced to the nineteenth century when the practice became commonplace in European hospitals. This practice and the Napoleonic battlefields ensured that there would be plenty of bodies available for physicians to investigate the link between a diagnosis and the actual cause of death. Currently, autopsies are used to confirm clinical diagnosis, for research and for teaching purposes.

Today, firefighters dying in the line-of-duty almost always receive a comprehensive autopsy. In fact, for many, it is the closest thing they have had to a medical exam in years. It's the ultimate physical, only a little late. These autopsies reveal some stunning facts. Roughly 50 percent of the deaths that occur while firefighters are on duty are related to cardiovascular events. This compares with 22 percent for police and detectives, and 11 percent for EMS workers.

In 2005 the NFPA conducted a study of 1,006 firefighter fatalities spanning a 10-year period. The report found that 440 of the fatalities were due to sudden cardiac death. Researchers were able to obtain medical information in 308 of these cases. Almost half of the time, the dead firefighters had a prior, identified history of Cardiovascular Disease (CVD). Cardiovascular disease is an umbrella term which includes heart attacks, Coronary Heart Disease (CHD) and Coronary Artery Disease (CAD).

Died On-Duty
In 2003 researchers published a paper describing their findings on occupational and personal risk factors associated with firefighters dying of Coronary Heart Disease (CHD). They studied NIOSH Fire Fighter Fatality reports and other sources of information to explore the relationship between coronary fatalities and firefighting. Annually, in the US, firefighters spend less than two percent of their time on actual fire suppression duties yet firefighting accounted for 36 percent of CHD deaths. Fire suppression related training activities were also associated with an elevated risk of a fatal cardiac event.

The researchers also noted a time related correlation in their study. Despite the fact that most CHD deaths in the general population occur between 6 a.m. and noon, peak deaths for firefighters occur between noon and midnight, when the call load is the heaviest.

Their overall conclusion was well worth noting: Most on-duty CHD fatalities are work precipitated and occur in firefighters with underlying CHD.

The Role of Risk
Individual life risk can be defined as the quantifiable likelihood of loss under certain circumstances with all the circumstances being equal for all individuals. For firefighters, the risk of losing your life from CHD during fire suppression activity is not equal for all. Studies have consistently shown that the risk of dying of CHD during firefighting increases when the following factors or conditions are present:

  • Older than 45 years
  • Current smoker
  • Hypertension
  • Diabetes Mellitus
  • Cholesterol great than 200 mg/dl
  • Prior diagnosis of CHD or other evidence of arterial-occlusive disease.
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