BY DAVE DENNISTON
What comes to mind when someone asks, “Are your responders fit for duty?” Many of us immediately think of their physical condition. After all, physical fitness is extremely important in any fire or emergency medical services setting because of the demanding characteristics of the job, but is physical fitness the only thing we should consider?
Truth be told, many responders who can bench press 225 pounds or run a 5K in less than 25 minutes have no business jumping on the rig to answer the call. Physical fitness is only one small factor in the equation that determines if your team is ready to respond. You must also consider mental fitness.
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Are your teammates in the right frame of mind to complete the job safely? If your head is not in the game, neither are you. You must consider impairments, temporary or permanent, when you determine if someone is fit to do the job. You must evaluate and handle each of these a little bit differently.
The first step in determining responder fitness is to have a plan and policy in place to address it. Your policy needs to address the important aspects of fitness, such as physical and mental conditions, impairments, training standards, and equipment needs.
Determining Impairment
Policies must dictate that responders be free from or have only limited impairments. Being under the influence of alcohol has long been a concern for fire and emergency medical services agencies; many additional impairments must also be considered. Many states have now legalized cannabis and cannabidiol products for both adult medical and recreational use. One main difference between these products and alcohol is that there are no proven tests currently available to judge the amount of the intoxicants in the human body and its correlation to impairment. Unlike alcohol, where a blood alcohol concentration (BAC) of .08% or higher is legally impaired, the science has yet to be proven for determining tetrahydrocannabinol (THC) levels and their effects on safe job performance.1 Further complicating the matter, traces of THC can be found in the human blood system for more than 30 days.
There are standards that show that one 12-ounce bottle of beer has the same alcohol concentration as a 5-ounce glass of wine or a single shot (1.5 ounces) of 80-proof liquor.2 With cannabis, a single joint can have THC levels ranging from 40 to 250 milligrams (mg), making it difficult to understand the effects and level of impairment based on the number of products consumed.
Even more challenging is that federal and state laws are not in alignment with each other. As of this writing, federal laws dictate that medical and recreational cannabis use is still illegal, while 46 states have legalized medical use of cannabis products and 22 states have legalized recreational adult use. Some states go as far as to limit an employer’s right to discriminate against an employee who may be using it.
Additional sources of impairment include over-the-counter drugs, prescription drugs, sleep deprivation, anger, depression, and mental or physical injuries. It would be daunting for a first response agency to have a specific policy for each of these impairments. While it may be practical to have a policy to cover certain levels of fitness and impairment, your agency would be well served to also have a single policy that addresses any condition that makes a responder unfit for any reason at any given time. The goal of a “fit-for-duty” policy is not to address specific impairments such as alcohol or drugs; separate policies should cover these once the cause of the impairment is discovered. A fit-for-duty policy would allow an officer to remove any responder from active duty at the time of a recognized concern. It takes the immediate burden off the officer of proving what the level of impairment is or if, in fact, the responder is legally impaired. The only burden on the officer at this point is to determine if, after reasonable consideration, a responder can safely and effectively do his job.
At this point, many officers often express concerns that they are not qualified or are simply uncomfortable deciding on whether to remove a member from duty. One could argue that those same officers make even more serious decisions regularly—for example, deciding whether a situation is a go or a no-go one, if a call warrants use of lights and siren, if a fire should be fought from the interior or the exterior, or whether a call is a rescue or a recovery. The only difference is that an officer deciding to remove a member because the officer believes that person to be unfit for duty creates an uncomfortable situation with a fellow responder. For the safety of your members, your teams, and the public, it is imperative that you as the leader step up and lead, even when your call is uncomfortable or unpopular.
What’s Normal Behavior?
For a fit-for-duty policy to be effective, leaders must first understand each responder’s “normal” behavior. Let’s face it: We all have responders who are quiet and reserved, while others are high-strung and aggressive. We have responders with exceptional precision and skills, while others would struggle to hit the broad side of a barn with a handline. To determine temporary impairment, we must have a baseline to judge the behavior we’ve observed against for each responder.
The next step is to have a checklist or form available to document your observations. This form will help you to determine reasonable suspicion and be the baseline for your determination. It will also help bring consistency to the process and remove personal bias from the equation.
Many of us would be quick to call someone out who we dislike for one reason or another and yet turn a blind eye to our most experienced or well-liked members. A solid policy and documentation are fundamental in avoiding discrimination when making these decisions.
Whenever possible, have another officer conduct his own evaluation of the person and compare notes before acting. If the time or availability of the second officer does not allow this consultation, act on your own before someone gets hurt.
Addressing the Issue
Once you make the decision that someone is not fit for duty, now what? How you handle the next steps can make or break the success of the program. Never call a firefighter over and use a phrase like, “You are drunk” or “I think you’re stoned.” You have no proof at this point that either of these is the case and you are setting the person up to become defensive. Try not to embarrass the person in front of his peers.
Instead, try calling the person over to the side and starting with something like, “You don’t seem like yourself today, and I am concerned for your safety and that of your teammates. I need you to sit this one out.” Use this conversation to further document your suspicions. Be careful not to allow the firefighter to persuade you that there is no issue.
Did you ever watch an intoxicated person try to get another drink from a bartender after he has been cut off? Your firefighters will most likely react in the same manner. If the member is fit enough to perform a less critical and dangerous function, you might consider allowing him to do that. If the impairment level or safety dictates otherwise, simply remove the firefighter from duty completely. Make sure he has safe transportation back to the firehouse or another situation-appropriate destination while the rest of the team completes the task.
At your earliest convenience, set up a meeting with the firefighter back at the station. Here is where you will have a serious conversation about what occurred and see if other more specific policies (e.g., your alcohol use or impairment policies) may apply to the situation. It is always a good idea to have a second witness in these meetings. Depending on your organization, you may also request that legal, personnel, or union representatives be involved. Always document what occurred at this meeting and include both that documentation and the reasonable suspicion form in a confidential personnel file.
At this point, you are probably wondering, “How would we even start to implement this in our organization?” The QR code below will take you to a sample policy and form that you may consider implementing in your organization.
Like any sample policy, the authority having jurisdiction must carefully consider modifications to meet your own organization’s needs. Also, ask your legal counsel to review the policy to ensure everyone is on the same page and that it meets local legal standards.
Next, train your personnel. Be sure all members understand that if they are not deemed fit for duty, they will, at a minimum, be asked to sit this one out. That may include shifts, emergency calls, training activities, and even meetings. Encourage other members to pay attention to the conditions of other personnel around them and suggest to a brother or sister that that member sit this one out prior to initiating a reasonable suspicion action. Anyone having concerns about another member’s condition should also be encouraged to report concerns to an officer.
Train your officers to know their role within this policy. Prepare them for the fact that these can be difficult decisions and actions but they are necessary for the safety of all involved. Monitor the success of the program and policy and adjust as necessary.
“Fit for duty” is not just a catchy buzzword or fad. Studies have proven that fire and EMS responders use and abuse alcohol and drugs at a much higher rate than the general public.3 Our responders see, hear, smell, and taste things that no human being should ever have to encounter. We turn to vices to help cope with the daily stress of the job and try to work when we physically should not. It is imperative that we have the tools in place to prevent injuries and death.
By working together, we can and must accomplish this goal by implementing a fit-for-duty policy in our organizations. The safety of our firefighters, their fellow responders, and the public can no longer tolerate less-than-fit crews. Take action now before an incident occurs that causes anyone to question if a responder should have been functioning for your organization to begin with.
References
1. National Library of Medicine. Blood Alcohol Level: MedlinePlus Medical Test. (n.d.). Medlineplus.gov. Retrieved July 24, 2023, from https://medlineplus.gov/lab-tests/blood-alcohol-level/.
2. National Institute on Alcohol Abuse and Alcoholism (NIAAA). (n.d.) What Is A Standard Drink?. Retrieved July 24, 2023.
3. Bordini, Ernest J. Firefighter and First Responder Alcohol and Drug Issues Part I. (n.d.). Clinical Psychology Associates of North Central Florida, P.A. Retrieved July 24, 2023, from http://cpancf.com/articles_files/Firstresponderfirefighteralcoholdrugs1.html.
DAVE DENNISTON is the director of risk management for McNeil and Company Inc. and is the executive director of the National Farmedic Training Program. He has more than 30 years of experience in risk management, fire, and emergency medical services. Denniston has served as chief, president, and chairman of the board for the Cortlandville Fire District, where he is department chaplain. He is a fire commissioner in the Virgil Fire District and second vice president for the Association of Fire Districts, State of New York.
