Sometimes it’s fun to sit around with the “old salts” and discuss the way things used to be. Things seemed simpler then: Go to fires (a lot of fires), drill a little, and wait for the next one. Most of them (and those of us old enough to have come on in the ’70s) would also agree that as simple and as thrilling as it was, there were problems. Except for rare occasions, safety and health programs were pretty much nonexistent back then. Things have generally gotten better-better apparatus, better working conditions, safer firegrounds, and so on. Several “standards” and strong union involvement in specific issues have improved conditions both on and off the fireground. I believe that medical evaluations are one of the “better” things that the standards have provided.
No one will disagree that this is a tough profession. To work at a structure fire is one of the most physically demanding jobs there is. At times, EMS runs can also require exertion and careful lifting. Another concern is the adrenalin rush and rapid increase in heart rate and blood pressure when the “gong” hits. It is documented that this, too, takes a toll on the cardiovascular system. Medical evaluations can detect problems that could otherwise go unnoticed. Statistically, a large percentage of line-of-duty deaths are attributed to “stress.” Some of the precursors to heart attacks and strokes can be detected by medical examinations.
In the Toledo (OH) Department of Fire and Rescue, we do not provide annual medical evaluations for members. Recruits are given a medical evaluation as part of the selection process. Haz-mat members are given a medical evaluation every two years. The biggest reason for not requiring annual physicals is funding (this is where it may be an advantage to be in a smaller department). Another concern is, What do you do when someone is determined to be physically “unfit” for duty because of a physical problem? It’s easy when the problem results from a fire department activity. The answer is not so simple when the problem is not related to the job.
John (Skip) Coleman, deputy chief of fire prevention, Toledo (OH) Department of Fire and Rescue, is the author of Incident Management for the Street-Smart Fire Officer (Fire Engineering, 1997) and Managing Major Fires (Fire Engineering, 2000). He is an editorial advisory board member of Fire Engineering and is a member of the FDIC Educational Committee.
Question: Does your department provide an annual medical evaluation? If so, does the health care professional deem the person fit or unfit for duty? What occurs when someone is unfit for duty? What is involved in the evaluation?
Leigh Hollins, battalion chief,
Cedar Hammock (FL) Fire Rescue
Response: Our department provides a medical evaluation. However, it is not an “annual” benefit until an employee is over the age of 45 because the evaluation frequency is based on age. The evaluation is provided as an employee “benefit,” not as a “mandate.”
The components of the program are described here:
PURPOSE: To provide employees with an annual medical evaluation that may detect health problems and provide early medical intervention opportunities.
SCOPE: All employees will be offered a medical evaluation annually on a voluntary basis, at no charge to the employee.
POLICY: The medical evaluation will cover the following items and be performed by the department physician or other licensed health care professional approved by the district: height/weight ratio, weight recommendation, age, BP, pulse, respirations, lung sounds, eyesight rating, hearing rating, ears, nose, throat, sinuses, neck, thorax, breast, abdomen, genitalia, rectum D.R.E., heart, lungs, extremities, neurologic, urinalysis, CBC, coronary risk blood screen (cholesterol, LDL, HDL, triglycerides), liver enzymes, CHEM 19, SMAC, potassium, EKG, chest x-ray, stress test, mammogram, and PSA.
Any recommendations or follow-up medical tests and/or procedures would be the responsibility of the employee and fall under the guidelines of the employee’s medical insurance coverage in place at that time.
Medical evaluation results are to be kept by the employees and the physician or licensed health care professional.
The original proposal included a “fit for duty” clause. However, Cedar Hammock’s fire commissioners, on review of the proposal, decided that the best avenue to take with the policy proposal was to offer it strictly as a benefit.
The program has been successful, with an estimated use rate of 75%+ and several personnel identifying potential health problems, which were further evaluated and hopefully corrected.
Joseph Floyd, assistant chief,
Columbia (SC) Fire Department
Response: Our department does provide annual medical evaluations for all its firefighters. The department follows OSHA regulation 1910.156 section (b) part (2), which states, “The employer shall not permit employees with known heart disease, epilepsy, or emphysema to participate in fire brigade emergency activities unless a physician’s certificate of the employee’s fitness to participate in such activities is provided.” The department uses a company in the state that specializes in firefighter medical evaluations. Once a firefighter’s exam is complete and evaluated, he is given one of three statuses: “Fire Brigade Clearance,” “Unclear,” or “Removed from Duty Immediately.” If a firefighter evaluation comes back “Unclear,” the department will allow him to work until he has gotten complete clearance from his personal doctor. He would be allowed a certain amount of time to have this done. If he does not, he will then be removed from duty and placed on sick leave. If the evaluation reveals a serious health problem that will prohibit or endanger a firefighter’s health, he is removed from duty immediately. He is then placed on sick leave until the health problem is corrected. If a firefighter cannot correct the health problem, he may be eligible to retire. If the evaluation reveals a disability, he would then be covered under the Americans with Disabilities Act (ADA). The department then would be obligated to offer him a job that would allow him the opportunity to work somewhere within the department (not firefighting) allowing for his disability. He has the option to accept or turn down this offer.
The department’s annual medical evaluation has actually saved a few of our firefighters’ lives by discovering health problems that otherwise would not have been discovered. One evaluation discovered a serious cardiac problem, which resulted in the firefighter’s having heart surgery. He is now back to full duty.
Firefighters are given a copy of their complete evaluation and an exercise program, which should provide improvement over the coming year if followed. The department is also given a report on the overall average health of the department.
The following are minimum specifications for our annual evaluation.
- Blood work-SMAC 21 with CBC.
- Pulmonary Function Assessment.
- Anthropometric measurements and body composition measurements.
- Resting 12 Lead Electrocardiogram.
- Sub maximal Bicycle Ergometer Stress Test (12 Lead E.C.G. and physician monitored).
- Physician’s Clearance for OSHA 1910.156, 1910.120, and 1910.134 and NFPA 1582.
- Prostatic Specific Antigen (PSA).
- CA125 (ovarian cancer test).
A follow-up visit with the health care professional is an individual consultation that includes a coronary risk profile with recommendations for lifestyle changes to reduce the chance of a heart attack; a copy of blood work with an explanation; pulmonary function results and an explanation; body composition results addressing the need for weight and height ratio; aerobic capacity results and explanation, recommended lifestyle changes, and improvement projections; an individualized 12-week exercise program with personal goals and recommendations (including frequency, duration, intensity, and heart rate range); recommended exercise programs to address physical needs; body weight monitoring; sit and reach flexibility assessment to include results given to employee and recommendations in needed areas; and muscular strength and endurance tests to include results given to employee and recommendations in needed areas.
Larry Anderson, assistant chief,
Dallas (TX) Fire-Rescue
Response: We do not currently administer annual physical evaluations to rank-and-file members. The only personnel to receive comprehensive annual medical evaluations are the members of our haz-mat team and our Medical Strike Team (who respond to weapons of mass destruction and terrorist events). Our current fire administration has championed the cause for annual medicals for all our personnel, but budget constraints have precluded that from happening. Hopefully, perseverance by our local labor organizations and fire administration will some day be rewarded with a program that will promote a healthier and more productive workforce.
Nick DeLia, chief/fire marshal,
City of Groton (CT) Fire Department
Response: Our department provides biannual physicals for career and volunteer personnel. The timing and level of the physicals are based on a combination of NFPA standards, OSHA regulations, and language in the Collective Bargaining Agreement. For our career personnel, their personal physician makes the evaluation. Included in this process is a pulmonary loop test. Our volunteer personnel go to the local occupational health center and receive the physical from a staff physician.
The principal goal of the assessment is to ensure the firefighter receives a physical. Presently, there are no written guidelines to cover a situation in which a member fails the physical. The biannual evaluation at the health center is based on the OSHA 29 CFR 1910.134 Respiratory Standard. All combat personnel receive the 1910.134 exam with pulmonary loop as a baseline with TB and Heptivax at the time they join the department. New career personnel receive an NFPA 1582 assessment as well. Volunteer members who will be active but will not be in a combat role receive a more basic physical.
I think another important issue is the age of the member. The USFA line-of-duty-death notices show an increase in members over the age of 60 dying after participating in training events or fighting fires. While we all know this is a “young person’s business,” an active senior who passes his physical and has the passion can create a perplexing situation. What do you do with the enthusiastic senior members of the department, fit or unfit, who are not ready to “take up”?
Ron Hiraki, assistant chief,
Seattle (WA) Fire Department
Response: We have been conducting annual medical examinations for firefighters since the late 1980s. Medical examinations are required for all members working in Operations. Members assigned to Administration are encouraged to participate in the program.
The medical monitoring program consists of several medical exams. The respiratory clearance examination ensures that members can wear self-contained breathing apparatus (SCBA) in a hazardous environment. This is combined with a fit test of the member’s SCBA facepiece. The fit test ensures that the member has a proper seal when wearing the SCBA facepiece. Members are tested for tuberculosis. A hearing test and annual refresher training in hearing conservation are also included. Members of the hazardous-materials team and the dive rescue team are required to have an annual physical examination in addition to the basic exams. The physical exam is optional for all other members.
The medical exams are conducted by nurse practitioners who specialize in occupational medicine. All medical results are reviewed by a physician. If the nurse practitioners discover that a member has a medical condition that is an immediate concern, they contact the department’s health and safety officer (HSO), who will arrange for the member to be placed on disability leave pending a more through examination. The Seattle Fire Department has a battalion chief on duty 24 hours a day, seven days a week, dedicated solely to health and safety functions. Medical conditions discovered in the review of exam results or in the physician’s review are reported to the HSO, who arranges for the appropriate follow-up exams or disability leave. Members who believe their medical condition was caused by fire or EMS duties may file an industrial insurance claim. Other conditions are treated; time off is covered using the standard health care benefits and sick leave.
Through the years, a small number of members have reported that they have consulted with their personal physicians on a variety of conditions discovered in the medical monitoring program. Those members received appropriate follow-up treatment. We are working to expand our medical monitoring program to include the exams and follow-up procedures developed by the IAFF/IAFC Joint Labor-Management Initiative. Most of the challenges are related to funding. However, our Wellness Committee recognizes the need to have the infrastructure and procedures in place to support a comprehensive wellness program.
Steve Kreis, assistant chief,
Phoenix (AZ) Fire Department
Response: We have provided annual medical evaluations from our own Health Center since the early 1980s. The center provides physicals, industrial injury treatment, wellness education, peer fitness trainers, and medical consultation. Although an annual physical evaluation is mandatory for every sworn member, they are not required to participate within the department’s system. Members do have the option to have their personal physician complete an annual physical exam (that is medically equivalent to the department’s) at their own expense. The results must then be forwarded to the Health Center for evaluation.
In our system, the Health Center physicians typically do not “officially” deem a member fit or unfit for duty; instead they make a recommendation to management as to the member’s fitness. If a member is deemed to be medically unfit for duty, the fire department deputy chief who manages the Health Center “officially” places the member on an “alternate duty” assignment. The member is then referred to a personal family physician for further evaluation and follow-up treatment if necessary. Any discrepancies between the fire department’s physician and the member’s personal physician are resolved by a third party evaluation. “Alternate Duty” assignments range from administrative duties with the member being placed on a 40-hour workweek assignment to staying on a 56-hour work shift and operating a support vehicle such as one of the Rehab Units at incidents.
The components of the annual evaluation are a complete head-to-toe exam and a 30-minute consultation with the doctor during which the member’s medical history, health habits, recent injuries, surgeries, and possible health problems are discussed. The medical tests administered during the physical consist of audiometry; urinalysis; chest x-ray; pulmonary function; vision; and full blood test including cholesterol, HDL, CBC, Chem 20, PSA, and hep C. Members also receive either a resting EKG or an annual or biannual treadmill stress test, depending on their age.
Annual medical evaluations are a critical component of the IAFF/IAFC Health and Fitness Initiative. It is a vital step toward improving the survivability of our most valuable resource, our members. The annual medical evaluation is intended to provide members an opportunity to improve their current lifestyle, which will lead to a more proficient/productive member and hopefully to a long, healthy retirement.
Bob Oliphant, lieutenant,
Kalamazoo (MI) Department of Public Safety
Response: Our department does not conduct annual medical evaluations. Employees may use their medical benefits to obtain a general physical exam, but it is not required; the results do not have to be reported to the department.
The closest we came to a mandatory medical evaluation was when the new OSHA respiratory standard took effect. Personnel were medically evaluated to ensure they were capable of using SCBA. The unions within the department raised a lot of concerns about personnel who might be deemed medically unfit to use SCBA. Chief among the concerns was to what extent the department would rehabilitate or reassign personnel who failed the evaluation. Fortunately, everyone passed, and the issues never materialized.
If the OSHA respiratory standard had merely been a recommendation and not a requirement, I don’t believe the unions would have accepted it. Union approval would be the biggest challenge for implementing annual medical evaluations in our department.
Frank C. Shaper, chief,
St. Charles (MO) Fire Department
Response: Our department participates in the IAFF/IAFC Health and Wellness Initiative. The annual physical exam under this program is quite comprehensive. Along with the actual physical, each firefighter receives a fairly lengthy written report on his physical condition. Reports are classified A, B, or C. An “A” report means there are no noted physical problems and the firefighter is cleared to work. A “B” report signals that something nonlife-threatening needs to be checked, and the firefighter is referred to his private doctor (for example, high blood pressure). A “C” report signals something life-threatening; the firefighter is taken off work and must get a clearance from his private doctor to return to work. The private physcian works with our health care provider. If the firefighter is unable to return to work, his case is turned over to the Personnel Department for evaluation.
Although this sounds simple, it can get complicated quickly. When developing health and wellness programs, it pays to move slowly and think it all through.
