By Tommy Baldwin and Tom Hales
Firefighters have hazardous jobs—jobs that put them at risk for injury and illness. 1-5 Many of these injuries/illnesses involve the musculoskeletal system, (2, 4, 5) whose treatment may involve the short-term prescription of painkilling medications, including narcotics. Typically, these injuries/illnesses resolve before work restrictions are needed. However, in some cases, the pain persists and work restrictions, for the condition or for the prescribed medications, are appropriate. This article highlights the potential dangers of taking pain medications by describing the on-duty deaths of two firefighters whose deaths were ascribed to prescribed narcotics and other painkillers. The article includes guidance on this topic as set forth in National Fire Protection Association (NFPA) 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments…
Case #2 involved a 28-year-old male volunteer chief attending an emergency medical services conference. The evening before the conference, [On May 13, 2004] the chief and his wife went to bed at 2230 hours. The next morning, at 0900 hours, the chief’s spouse awoke and found the chief unresponsive. She called 911, and an ambulance responded. From the chief’s clinical condition, it was obvious he had expired some time earlier. Cardiopulmonary resuscitation and advanced life support treatment were not performed, and he was pronounced dead at the scene. The death certificate and the autopsy, conducted by the chief medical examiner, listed “accidental multiple drug intoxication” as the cause of death.
The chief had a history of a back injury with subsequent surgery. He had been prescribed pain medications for eight years, which included narcotics (MS Contin®), muscle relaxants (Flexeril®, Robaxin®, Valium®), antidepressants (Effexor®, Paxil®), and sleeping pills (Ambien®).8 At autopsy, the chief had a morphine (MS Contin®) blood level of <50 nanograms per milliliter (ng/mL); well within the therapeutic level of 80 ng/mL. He also had a diazepam (Valium®) blood level of 514 ng/mL; well within the therapeutic level of 1,000 ng/mL. (8) Although both medicines were within therapeutic level, the chief medical examiner felt the interaction of the two drugs was responsible for the chief’s death.
The department did not require preplacement or periodic medical evaluations. However, according to the department, all firefighter applicants must be in self-reported excellent health and physically fit. The chief’s personal physician was aware of NFPA 1582 guidance regarding narcotic use but cleared the chief for light duty based on the chief’s self-assessment that he did not respond to “emergencies.”
These two cases illustrate the dangers of taking multiple pain medications. Table 1 lists the generic and brand names of the medications prescribed over a five- and eight-year period for these two firefighters. These medications are dangerous not only because of the risk of overdosing but because they also have side effects that can impair the performance of firefighting duties. Table 2 lists the side effects of the medications, which can affect firefighter work performance. Taking pain medications when working jeopardizes that firefighter’s safety as well as the safety of other firefighters operating at the emergency scene. This risk extends to the general public if the firefighter is operating apparatus under emergency conditions.