The death of a Chesterfield County fire recruit who collapsed during a 2-mile run with his academy class has all the characteristics of “exertional sickling,” a life-threatening condition resulting from the sickling of red blood cells during intense exercise, said an expert in the field who tracks such deaths nationally and has studied the condition for 35 years.

“This is a classical exertional sickling,” Dr. Randy Eichner, professor emeritus of medicine of the Oklahoma Health Sciences Center, said after reviewing a 150-page report released Thursday by Chesterfield Fire & EMS into the July 2021 death of fire recruit TyVaughn Eldridge, 26.

A multidisciplinary and multijurisdictional “fatality review team,” which included fire officials from Richmond, Henrico and Hanover, spent months examining Eldridge’s death and the events leading up to it. He died on his 26th birthday.

Eldridge was the fifth line-of-duty death in the department’s history and first that occurred during training activities.

During his academy’s first physical training exercise at 8 a.m. on July 1, 2021, Eldridge was with fellow recruits running a 2.15-mile course with a pace of 9 minutes, 44 seconds. The temperature was 79 degrees. He began to falter at the 1.4-mile mark and fell to the ground shortly thereafter, according to the report.

Although he said he wanted to continue, Eldridge was unable to walk or stand on his own. His level on consciousness soon decreased and he was taken to CJW Medical Center, where he was admitted into intensive care. He died two days later, on July 3, 2021.

The Office of the Chief Medical Examiner performed an autopsy and determined Eldridge’s cause of death to be “complications related to hyperthermia,” or an abnormally high body temperature.

Following the incident, Eldridge’s fellow recruits were interviewed and asked to rate the intensity of the physical training on the day Eldridge collapsed. The class rated the run an average of five or six on a scale of 1 to 10.

“They rated the pace of the run as either average or moderate,” the report said.

‘Long family history’ in the fire service

Eichner and colleagues in his field of study track nontraumatic exertional deaths, mainly in athletes, but also in the military and in police and firefighter academies.

They are aware of the deaths of at least eight fire recruits and one firefighter who had sickle cell traits and died of exertional sickling during training exercises dating to 1988. Eichner said his group is working to confirm three or four others, including Eldridge’s death and that of another firefighter recruit who died Wednesday during a pre-employment fitness exercise in Greensboro, N.C.

Eldridge’s collapse and death that followed a timed, paced run is indicative of exertional sickling, Eichner said.

“It was a conscious collapse, classical for exertional sickling,” Eichner said. “He complained of leg pain and was unable to stand on his own even after a few minutes rest, with the [fire instructor] saying he was responsive and denied chest pain or shortness of breath upon collapse.”

Eldridge told the instructor that he just needed a minute to collect himself and that he wanted to finish the run. But he “failed to improve” after a few minutes of rest, so fire officials called an ambulance.

Eichner said what’s missing from Chesterfield’s report are Eldridge’s medical and hospital records, which with some help from detailed EMS records could provide more answers as to the underlying causes of the recruit’s death.

The fatality review team noted high in the report that their investigation had limitations and lacked access to Eldridge’s completed medical records and history beyond the pre-employment medical records that were in Chesterfield’s possession.

“Moreover, neither the investigative team nor Chesterfield Fire & EMS had the authority or resources to require additional post-mortem testing for which to draw definitive conclusions of pre-existing medical conditions or causal factors that may have precipitated or contributed to the medical emergency Firefigher Recruit Eldridge suffered and his ultimate death,” the report states.

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Eldridge was 25 when hired by Chesterfield with a “long family history” in the fire service. He expressed from an early age his desire to continue in that tradition as a career firefighter, according to the report.

He was active in many sports but preferred baseball and was involved in the Henrico Police Athletic League as a participant and later as a counselor/mentor for other youth in the league. On his pre-employment questionnaire, Eldridge indicated he engaged in regular physical activity and worked out at the gym five times a week, the report said.

On Nov. 5, 2020, Eldridge successfully completed the Chesterfield Fire & EMS physical ability test, which consists of eight skill stations that represent the common physical tasks required of firefighter-EMTs, according to the report. After being offered employment in April 2021, Eldridge was sent an email the following month with an orientation letter that noted recruit school “will be very physically demanding.”

“For most of you, this will be the most difficult thing you have ever done,” the letter stated. “If you have not already done so, I would suggest you start to train on your own and be prepared to run at least 2 miles, two days a week at a pace of 9 minutes per mile. You will be performing many anaerobic and strength training exercises.”

As a condition for employment, Eldridge was required to complete a medical evaluation performed by a physician that is based on recommendations from the National Fire Protection Association. Chesterfield Fire & EMS’s operational medical director reviewed Eldridge’s medical evaluation and concurred he met the established requirements. There was no exclusionary findings in his evaluation.

Eldridge’s family could not immediately be reached for comment on the report. A Chesterfield fire spokesperson reached out to the family at the request of the Richmond Times-Dispatch and provided a reporter’s number to call if they desired to speak.

"We are still trying to put this one together," police said. "We do not have any (definitive) suspect or lead information at this point."

Supporting documents attached to the report shows that Chesterfield fire officials notified Virginia Occupational Safety and Health authorities about Eldridge’s hospitalization and death within the required time frame, and after an investigation and inspection of the department’s workplace, VOSH did not find any violations.

In a September letter to Chesterfield that included a “health narrative,” the agency wrote that Chesterfield Fire & EMS has policies and procedures to reduce strenuous physical activity during emergency incidents and training. And the policy specifically requires determining the weather for the day, the need for hydration and the physical and mental rest of employees that are training.

Based on interviews VOSH conducted, the agency determined that fire instructors followed the policy as required. They checked the heat index that day and provided recruits with water and the ability to rest and stop

“The employer had in place and utilized procedures to address heat stress and physical strain,” the agency said. “No violations of standards were observed.”

Unemployment rates, while significantly lower than the alarming pandemic peak of 14.7% experienced in April 2020, remain a subject of concern, notably as economic experts bandy around the idea of a potential recession by 2023. The last economic recession—the Great Recession of 2008-2010—sent rates up to 10% as of October 2009. It was not until the spring of 2019 that unemployment finally went down to the same level it sits at now.

As of May of this year, national unemployment is at 3.6%—as it was in both March and April, marking a three-month stagnation—following a steady drop since that aforementioned COVID-affected peak. Seasonally adjusted unemployment rates by state demonstrate a rather sizable spectrum, ranging from just 1.9% in Nebraska and Utah, to 5.3% in New Mexico and 5.8% in the District of Columbia. Further breakdown by the U.S. Bureau of Labor Statistics shows yet another county-based spectrum within each state.

To that end, Stacker compiled a list of localities with the highest unemployment rate in Virginia using data from the BLS. Counties are ranked by unemployment rate in April 2022, which as of this writing is the most current Bureau data.

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