HEALTH & SAFETY
IN RECENT YEARS, fire service professionals have assumed expanding responsibility for many health-related issues. New duties include the management of a variety of programs, ranging from safety issues and OSHA compliance to personal protective equipment to preemployment and periodic medical screening. While fire service professionals have the training and resources to handle most of these duties, few tools are available to them for evaluating occupational medical screening programs. In hope of addressing this need, we offer this compilation of evaluation criteria.
WHEN SHOULD MEDICAL SCREENING OCCUR?
The Vocation Rehabilitation Act of 1973 contains specific regulations that apply to public employers who receive federal financial assistance. Section SO i. which applies to public fire departments, states that medical screening may only be performed after a bona fide offer of employment.
Some public safety agencies prefer to give all applicants a medical examination prior to an offer of employment, even though this is contrary to the federal regulations. This practice adds unnecessary cost to preplacement medical screening, when several comprehensive examinations (X-rays, stress treadmill, etc.) are performed when only one exam is needed. To save resources and to comply with the law, lire service managers should ensure that preplacement medical examinations are given only after employment—which is then contingent on passing the physical examination —is formally offered.
EVALUATING MEDICAL-SCREENING PROGRAMS
IS THE EXAMINATION RELATED TO THE JOB?
The purpose of medical screening is to ensure that the applicant is physically capable of performing the essential duties of a particular position at the time the exam is given. Yet, few medicalscreening programs actually have the basic informational resources to do this.
In order to conduct job-related medical screening, it is important that the doctor has a valid description of the physical requirements and working conditions of the job. Without this information, an accurate physical assessment is very difficult.
For example, the physician should know whether firefighters need to have normal color vision. If he believes that firefighters need normal color vision and they actually do, all applicants who lack this trait would fail, and the physician is providing valuable service to the fire department. However, if firefighters do not actually need normal color vision (they may simply need the ability to discriminate between red, amber, and green), then the doctor’s screening process raises the cost of personnel selection while increasing the chances of a lawsuit charging discrimination. Conversely, if the physician believes color vision is not important for firefighting and therefore passes applicants with defective color discrimination, and if perfect color vision is needed by firefighters, an unacceptable risk is incurred by the public, by other firefighters, and by the firefighter with inadequate vision who passed the exam.
To avoid these problems, the doctor must have specific job information. The fire service manager should ensure that the examining physician has specific information on physical requirements and working conditions for each job (firefighter, paramedic, dispatcher, etc.) for which applicants are examined.
HOW DO PHYSICIANS ACQUIRE JOB INFORMATION?
The primary technique for determining requirements is a job analysis, which should be an accurate, objective, and detailed description of the physical abilities required for safe and efficient job performance. This information is quite different from that found in a traditional job description, which seldom provides meaningful data on physical abilities required or working conditions. The fact that a paramedic may perform rescue operations does not reveal what physical capacities are needed to rescue victims.
The fire service manager should select a job analysis strategy that is capable of producing accurate, reliable, detailed. and comprehensive physical-demand information for the physician. Advantages of having this include:
- ensuring that medical screening
EVALUATING MEDICAL-SCREENING PROGRAMS
- does not screen out qualified persons capable of performing the job;
- ensuring that applicants who can’t perform the job will be screened out;
- protecting employees with existing conditions from further injury by placing them in jobs they can safely perform;
- helping doctors tailor examinations to the requirements of specific jobs, thus saving the cost of unnecessary medical testing.
WHO SHOULD PERFORM THE MEDICAL SCREENING?
Physicians vary greatly in their experience and their knowledge of the workplace. One factor a fire service manager might consider is whether the examining doctor is trained in occupational medicine. Physicians who are boardcertified in this specialty usually have a broad knowledge of occupationally related diseases and legal issues in medical screening. Since only about 1,000 physicians in the United States have this certification, the fire service manager will mainly encounter general practitioners when selecting the examining physician.
It is not uncommon for clinics to give “cut-rate” prices on preplacement and periodic examinations in the hope of securing the contract to treat that department’s injured firefighters. “Cutrate” examinations will not, in the long run, assist fire service managers in lowering overall medical costs or assuring the fitness of the work force. Preplacement examinations arc a serious matter and a critical part of the selection process; therefore, they should not be considered routine.
WHO SHOULD TAKE THE PREPLACEMENT EXAMINATION?
Federal and many state laws require that the preplacement medical examination be given in a nondiscriminatory manner. That is, if any one hiree is required to undergo the medical examination, then all hirees for the same job classification must receive an examination. Federal regulations include this provision to ensure that employers do not capriciously determine which applicants undergo examinations and which do not. However, every examination need not be identical; some firefighter applicants may require specialized assessments.
It is generally agreed that people hired for strenuous or hazardous jobs should undergo medical screening. However, the benefits are less clear for applicants for clerical or administrative posts. At least two studies indicate that costs exceed benefits in screening for sedentary, nonhazardous job classifications. Many large public agencies have stopped screening clerical workers in order to devote scarce resources to preplacement and periodic public safety medical examinations.
The fire service manager should be sure that the medical examinations are given in a nondiscriminatory manner. Second, the exams must be truly necessary. Experienced managers concur that it makes more sense to have comprehensive exams for entry into physically demanding jobs than to have the same general medical exams for all jobs.
EVALUATING MEDICAL-SCREENING PROGRAMS
ARE THE MEDICAL STANDARDS VALID?
The process of validating medical standards involves, first, gathering data that describes the job. Second, the job data is analyzed to determine the necessary physical abilities needed to perform the job. Next, medical or physical tests are selected which measure the appropriate abilities. Fourth, the standards are set on the basis of the first three steps, resulting in standards which are job-related. In 1982, the International Personnel Management Association’s nationwide survey of local governments concluded that few public jurisdictions had validated their medical standards. Since then, many public agencies have done so, sometimes as a result of a consent decree following a complaint of discrimination.
In two agencies where our company conducted medical standards validation projects, the fire service management played a critical role in determining which job classifications suffered the highest accident rates, which incurred the greatest number of workers’ compensation claims, and which accrued the greatest incidence of disability retirements. These classifications were then subjected to detailed analysis to determine the physical abilities required for each. Board-certified occupational medicine physicians (with specializations in toxicology, dermatology, cardiology, orthopedics, and other areas) then devised medical-screening guidelines for each classification.
One of the primary objectives of these studies was to develop a placement-oriented set of guidelines for the physician. The standards were not intended to demand slavish adherence, but rather, as guidelines for evaluating and placing new hires. They also served to screen out those individuals who could not perform the job or could do so only at an unduly high risk of injury to themselves or others. More than 400 medical conditions (for example, hypertension, respiratory problems, epilepsy, etc.) were included in the guidelines. The conditions were based on:
- occurrence of the disease or condition in the applicant population;
- relation between the disease or medical condition and firefighting tasks;
- evidence that the disease or condition was currently incorporated into the medical standards of various fire departments.
Other components included streamlined examination procedures, protocols for compliance with OSHA regulations regarding medical surveillance, and the policies which guaranteed the confidentiality of medical records.
In the cases outlined above, the fire service was able to reduce the costs of their medical examinations because the opinions of outside experts were required less frequently. Indeed, the examining physicians reviewed the jobanalysis results, conducted the examination, and then consulted the medical standards prior to reaching a final recommendation. Physicians have reported a higher degree of confidence in making screening decisions if they have first reviewed results of a careful job analysis.
EVALUATING MEDICAL-SCREENING PROGRAMS
ARE THE MEDICAL STANDARDS CURRENT?
Fire service managers may want to research the origin of their current medical standards and consider their relevance to job conditions today. One local government that recently contacted our company was using back X-ray standards proposed by the Southern Pacific Railroad many years ago. Unbeknownst to the local government, these standards had been the subject of costly litigation, and the railroad subsequently discarded them as discriminatory. Another jurisidiction used standards developed by the U. S. Air Force for screening fighter pilots. In both cases, these standards may have served the railroad and the Air Force, but when adopted by fire departments, they resulted in greater direct costs and exposed the departments to increased liability.
ARE MEDICAL EXAMINATION RESULTS KEPT CONFIDENTIAL?
When obtaining information on medical history and conditions, the examining physician usually needs more information about an individual to determine the current physical ability to perform the job than the employer does to make a final hiring decision. In addition, the doctor requires knowledge of existing medical conditions as documentation for future disability and workers’ compensation claims. It is, however, inadvisable for this general medical information to be used by management in determining an applicant’s employment status. The American Occupational Medical Association’s code of ethics states that employers need only know about an individual’s fitness in relation to work, but need not know specific details of the applicant’s medical history.
Each state has specific laws regarding the confidentiality of medical records. The fire service manager should ensure that such laws are maintained to avoid liability, which could result from improper disclosure or use of medical information.
WHAT ABOUT PHYSICAL ABILITY TESTING?
Firefighting requires extraordinary amounts of physical strength and endurance. Because of the extreme hazards encountered routinely, firefighters have exceptionally high injury rates. More than 100 firefighters are killed in the line of duty each year. California statistics show the number of injuries and illnesses for firefighters have risen steadily each year for the past six years. Given such unusual demands, the medical-screening process for firefighters requires physical assessments that are more comprehensive than those taken during a typical medical exam.
Many fire departments use physical ability tests not only to assist in the selection of entry-level firefighters, but also to regularly assess the health and fitness of those currently employed. In fact, the National Fire Protection Association has issued standards calling for the annual medical and physical fitness screening of currently employed firefighters. Prior to developing any physical ability testing program, the fire service manager should review the appropriate federal and state laws.
Physical ability tests usually require documentation of their content validity, or relatedness to the job. They often require professional validation to ensure that appropriate cutoff scores are applied, that the extent of adverse impact against protected groups has been investigated, and that alternative testing methods were considered.
These guidelines should assist fire service managers in the evaluation of physical and medical-screening programs. Following a program evaluation, fire service managers may question maintaining their current screening system. Unless most of the evaluation criteria as outlined here are judged satisfactory, it is likely that the screening system is too costly and may be increasing employer liability—rather than reducing it.
