The medical ecology of public safety. I. Sudden death due to coronary heart disease

A total of 1,348 instances of sudden and unexpected death due to coronary heart disease in persons 65 years of age and under in Dade County, Florida, was studied in order to determine the hazard to the general population created by these sudden deaths. Only 348 (25.8 per cent) of these patients had had known coronary heart disease at the time of their death. There were 451 (33.4 per cent) instances of sudden death in patients with undiagnosed cardiovascular symptoms, and 529 (40.8 per cent) cases in which there were no premonitory symptoms at all. There were 122 persons (9.1 per cent of the total) whose occupations were potentially hazardous to the public. Twentyeight of these persons were involved in their work at the time of their death, with no serious accidents occurring as a result of their deaths. One hundred and one persons (7.5 per cent) were involved in hazardous terminal activities at the time of their death; 52 of these were driving automobiles. Again, no serious damage or injuries occurred. The conclusion is that, with certain specific exceptions, there is at the present time no justification in interfering with the occupations or avocations of coronary patients on the basis of the hazard of sudden death which they present to the general population. Activities and work for these persons are best individualized for each patient on the basis of his functional capacity and symptomatology.