Firefighter Cardiac Arrest: Chain of Survival

By Robert C. Owens, Sr.

Heart disease is not only the number-one killer of firefighters, but the number-one killer of humans. Firefighters present unique challenges because of exposure to smoke particulates, stress, sleep deprivation, personal protective equipment (PPE), and the environment in which we perform our duties. In the case of the firefighter cardiac arrest, we must adjust our everyday tactics and treatment to provide an avenue for the most successful outcome.

All emergency service providers and even many citizens are familiar with the American Heart Association Chain of Survival, which works very well for the everyday citizen cardiac arrest. With a little adaptation, it can work well for the firefighter cardiac arrest. Let’s examine the links in the chain.

Early Access:  If a firefighter goes into cardiac arrest, it’s imperative that treatment teams get to them rapidly. This starts before the alarm by having adequate resources on the initial alarm assignment  to properly staff rapid intervention companies (RIC) and perform EMS functions. In the event of a Mayday, the RIC must rapidly deploy, access, and remove the down firefighter to the exterior of the fire building and turn them over to a dedicated EMS crew for treatment. If the event occurs on the exterior, rapid deployment of EMS resources needs to be the priority. In the case of limited EMS resources, the RIC can deploy to that location and begin treatment. Mutual aid should also be considered to properly staff critical fireground components.

Early Cardio Pulmonary Resuscitation (CPR): Early CPR is imperative in any cardiac arrest. Hard and fast compressions with little to no pausing are a critical link in the chain to obtain Return of Spontaneous Circulation (ROSC). American Heart Association statistics also indicate the quality of CPR is directly related to the percentage of ROSC, as well as successful discharge from medical facilities after cardiac arrest1. However, the obstacle for the firefighter is the PPE we often wear while performing our tasks. Rapid removal of gear must take place. Initial RICs can initiate hands only CPR while EMS resources are being deployed and the remainder of PPE is being removed. Take caution while removing PPE as it may be super-heated and could cause burn injuries to unprotected hands of EMS providers. Structural firefighting gloves are recommended for removal of PPE.

Early Defibrillation:  Defibrillation is a crucial component to correct dangerous arrhythmias or electrical activity in the heart. At minimum, EMS resources need rapid access to an Automated External Defibrillator (AED). If possible, this should become a part of the RIC tool compliment and should be on the minimum equipment list for all apparatus. This will ensure the AEDs are readily available and replaceable if one is deployed2.

Early Advanced Care: Advanced care and post arrest care are the final pivotal link to surviving the firefighter cardiac arrest. This again can be put into place prior to the incident by ensuring that advanced care can be provided on scene to victims of cardiac arrest. Add additional units to alarm assignments, formulate mutual aid agreements, and speak with local hospitals about deployment of medical teams to major events–whatever it takes to get advanced care to cardiac arrest victims. If ROSC is established, post resuscitative care by advanced care providers is even more critical to prevent re-arrest. Once the event occurs, resources need to be able to rapidly deploy and exit the scene to an appropriate medical facility.

Using this firefighter cardiac arrest chain of survival can provide a guide on how to treat the on-scene firefighter cardiac arrest. It is important to address resource needs with all response partners that could be involved with treatment and transport of the firefighter patient. As with any skill set, training must take place in order to ensure success. The firefighter cardiac arrest is a very real concern; these events are rapidly becoming a “when” it is going to happen, not an “if.” We owe it to our brothers and sister firefighters, as well as their families to be ready to take care of them as well as we take care of the citizens we serve. Will you be ready?


Sunde, K. (2013, June 25). Wake up, CPR providers: High-quality CPR is wanted and needed!. Accessed October 15, 2014, from

American Heart Association. (2012, Feb. 21). Defibrillation. Accessed October 15, 2014, from

ROBERT C. OWENS SR. is an engine company lieutenant with the Henrico County (VA) Division of Fire. He began his fire service career with the Mechanicsville (VA) Volunteer Fire Department. He previously served as a career firefighter in Stafford County, Virginia. He is a Virginia Department of Fire Programs-certified instructor 2 and fire officer level 4 and a mass casualty incident management instructor for the Virginia Office of EMS. He has a BS degree in fire science from Columbia Southern University.

No posts to display