QUESTION: In your department, what qualifies or disqualifies a line firefighter as it pertains to health? How do you deal with insulin-dependent vs. noninsulin-dependent diabetic firefighters?
MOST OF US COME TO work when we don’t feel 100 percent. Colds, flu, and other maladies as well as minor injuries aren’t enough to keep us away from the station. Where, however, should we draw the line concerning the effect these conditions have on the firefighter’s ability to perform his duties? Is there a line? Should the individual involved draw it since he knows how he feels; or should a professional, who can render a more objective opinion, decide?
In the past, this question was usually left to the individual. I once cut the end of my finger off improperly using a table saw. I worked through it using a popsicle stick, gauze, tape, and our old “red-ball” rubber fire gloves at fires. I worked on a knee with a torn ligament until one night it popped at a fire and I had to be carried out from a burning second floor.
I know countless other stories of firefighters who have worked under less than “normal” medical or physical conditions. Today, we all would have been put “on medical” and would have stayed home or would have been put on light duty in a staff position. (In my day on the line, there was no light duty-you worked or were off. Being the door control man was about as light as it got.)
With the medical screening process for hiring and procedures for sick and injured firefighters, few firefighters “limp” in to work or crawl to a balcony, vomit, and then crawl back into the building again.
-John “Skip” Coleman, deputy chief of fire prevention, Toledo (OH) Department of Fire and Rescue, is author of Incident Management for the Street-Smart Fire Officer (Fire Engineering, 1997) and Managing Major Fires (Fire Engineering, 2000), a technical editor of Fire Engineering, and a member of the FDIC Educational Advisory Board.
Ron Hiraki, assistant chief,
Gig Harbor (WA) Fire & Medic One
Response: We rely on NFPA 1582, Comprehensive Occupational Medical Program for Fire Departments, as a “fit-for-duty” standard. We have a very good and dedicated physician who has worked with our fire department for many years. He makes a great effort to follow the recommendations; it would take an exceptional circumstance for him not to follow those recommendations.
Our Medical Division Chief Paul Berlin is our liaison with our fire department physician for our wellness program and for ensuring that our members are “fit for duty.” According to Berlin, the section on Endocrine and Metabolic Disorders (Diabetes) outlines seven criteria that must be met to qualify or to continue as a firefighter. They include medical testing where the failure of any one test disqualifies the current firefighter from duty. Berlin believes that very few insulin-dependent diabetics may qualify as firefighters, since diabetes could limit their ability to perform essential job tasks safely.
We have a very good wellness program. We have focused much of our effort on medical screening to find problems in the early stages and to prevent injuries.
We offer complete medical exams to our suppression members at recommended intervals. We also have a complete set of fitness equipment in each of our career fire stations and some fitness equipment in our volunteer stations. For our career members, the hour following apparatus and equipment checks on each shift is scheduled for physical training.
Rick Lasky, chief,
Lewisville (TX) Fire Department
Response: As is the case with the majority of fire departments across North America, we want to make sure that we are doing everything possible to ensure that our employees are healthy and safe. Those two aspects are paramount. We take safety into account with everything we do, and that includes our operations away from the fireground as well. Some of our biggest losses injury-wise have occurred in a nonemergency setting, so ensuring that we have a system in place that encourages, and in most cases demands, our members to do everything possible to be safe ranks at the top of our priority list.
We have a safety committee and a process for evaluating injuries, accidents, and damage to equipment. This committee is a segment of the city’s overall safety committee and is objective. Our city does a pretty good job when it comes to wellness issues, but we are fortunate to have a Human Resources Department that goes out of its way to take care of the employees. When it comes to the health and safety of our employees, and that means the confidentiality issues regarding an employee’s health as well, it is adamant about doing it right.
What determines whether line firefighters are fit for duty comes down to whether they can perform the “essentials of the job.” This includes, but is not limited to, crawling, carrying tools and equipment, climbing, as well as some other physical and medical criteria. We also rely on our city’s medical authority and that doctor’s expertise as to whether someone should stay on active duty or should return to work on a modified status or full duty after an illness or an injury. Obviously, there is a process that assists in that determination-for example, the Fit for Duty test given to a member who has been off for 30 days or longer. But, the bottom line is that we always rely on the people with the medical expertise and background to make that type of decision. There are other reasons a member may be sent for a Fit for Duty test, such as a dependency issue, an emotional breakdown, or any time it is felt that a member may not be fit for duty and may pose a risk to himself or those around him. These situations are rare, but being prepared enables us to look out for all of our people. Not being prepared sets you up for disaster.
John O’Neal, chief,
Manassas Park (VA) Fire Department
Response: Our department follows NFPA 1582 recommendations for entry-level medical requirements and annual medical physical requirements for candidates and incumbents, respectively. The city’s contract physician makes the ultimate decision on the candidate’s medical ability to safely perform the tasks of a firefighter without posing a potential risk to others. The contract city physician in conjunction with the incumbent firefighter’s personal physician makes the final determination of whether the firefighter can continue to perform his duties, again based on the NFPA 1582 recommendations and also Occupational Safety and Health Administration requirements for respiratory protection and the ability to wear self-contained breathing apparatus.
To date, we have not had to deal with insulin-dependent members. NPFA 1582 recommendations list insulin dependency as a Category A condition-not meeting the standards to safely perform the work as a firefighter without posing a potential risk to self or others. Again, the ultimate decision would fall on the contract physician’s medical clearance for duty.
William Hickey, captain,
Toledo (OH) Fire Department
Response: We contract with a local occupational health facility to provide medical evaluations of our firefighters. All recruits are given a physical prior to their hire and are required to be in general good health. Any time firefighters suffer an on-duty injury or are off for an extended period of time because of illness, they must be cleared for duty by a physician. If it is an off-duty injury or an ailment of significance, the individual is sent to the facility for a fitness-for-duty exam. At this time, we do not conduct regular physicals for our firefighters other than for those exams for haz-mat personnel and divers. Medical evaluations for these individuals are listed only as fit for duty or not fit for duty. We do not have any work stipulations regarding diabetic firefighters.
Mike Mason, lieutenant,
Downers Grove (IL) Fire Department
Response: We are very proactive and responsible for the health and welfare of our firefighters. We strongly advocate physical fitness and have various members involved in maintaining and providing members’ general and private physical fitness programs. Following is a summary of what our department has accomplished within the past 10 years.
We acknowledge and support NFPA 1582, which requires departments to conduct fitness testing or assessments. Line firefighters and chief officers are tested in the areas of muscle capabilities, endurance, flexibility, and strength. We use a push-up test for muscle, a curl-up test (sit-ups) for endurance, a sit and reach for flexibility, and a hand and leg dynamometer for arm and leg strength. We apply a body fat analysis test as well. Two tests are used to evaluate aerobic fitness. Both are based on the Gerkin test requirements. One is for members over 40 years of age, who are required to have a full fitness stress test with a 12-lead application; this also determines their VO2 max (the maximum capacity for transporting and using oxygen during incremental exercise). The other version is for members under 40 years old; it is treadmill-based but without the 12 lead; the individual’s VO2 is also determined. Our department is concerned about aerobic and anaerobic thresholds as they relate to an individual’s capacity to function on the fireground. Such information determines human limitations under adverse conditions on the fireground.
We have had insulin-dependent and noninsulin-dependent diabetics within our ranks. These individuals go through the same physical and cardiac testing process provided for the general membership. Our department supports them and does everything possible for their safety and well-being, making sure that they are able to perform within the context of the job.
Gary Seidel, chief,
Hillsboro (OR) Fire Department
Response: Our main intent on any injury/illness is to bring our employees back to full capacity to perform their job functions. When assessing the functional capacities of firefighters after significant injuries or illnesses, physicians and therapists familiar with firefighting job requirements should make informed decisions. The process of rehabilitation must be controlled to ensure complete and safe reintroduction to normal duties. Employees on extended leave from normal duties may undergo a medical and fitness evaluation before returning to full duty. Extended-leave status includes alternate assignment; leave of absence; and leave due to illness, injury, pregnancy, or other qualifying situation. When the physician identifies a medical condition or injury that impacts the member’s ability to perform assigned duties, the physician coordinates an exercise and rehabilitation program, which employees follow until they can return to normal duty.
Work-related rehabilitation is conducted in conjunction with the employee, the state’s accident insurance fund, the physician, and the city. Nonwork-related rehabilitation is coordinated with the employee’s physician and the city. Should the employee, for medical reasons, not be able to return to full duty in his present job classification, we make every attempt to provide alternate duty within another division that will accommodate the employee’s medical condition.
Jeffrey Schwering, lieutenant,
Crestwood (MO) Department of Fire Services
Response: Our department physician is responsible for qualifying or disqualifying a member from duty because of health reasons. Many factors play into the decision. All members are required to have a minimum of one physical exam annually so that early detection of health issues can be handled immediately and effectively.
An insulin-dependent diabetic is held to the same standard as other members. All reasonable measures to ensure the member’s health and safety are followed, as dictated by federal, state, and municipal law. The fire service is a brotherhood. It is every member’s responsibility to lend a helping hand to another member and his family when health issues are involved.
Bobby Shelton, firefighter,
Cincinnati (OH) Fire Department
Response: Diabetes is a very real concern for many firefighters. It is on the rise nationwide. The question boils down to whether firefighters with insulin-dependent diabetes can safely and effectively do the job without endangering themselves or their coworkers. The simple answer is yes.
We have no written policy; however, in the past if a firefighter was insulin dependent, the city Employee Health Service recommended that the firefighter be medically separated. The firefighters can and should be allowed to continue working on the line as long as they are aware of the ramifications of not taking care of themselves.
The situation is similar to that of taking cholesterol or high blood pressure medications, as many firefighters around the country do. Again, as long as the firefighters understand their condition, recognize the signs and symptoms of hypoglycemia, take steps such as keeping a power bar or snack with them in case they do not have access to food for long periods, regularly monitor blood glucose, and see their personal physician, that should be sufficient.
The NFPA 1500 section on endocrine problems is pretty clear about new hires; but, to me, it seems somewhat vague concerning incumbent firefighters.
Last year, I was diagnosed with insulin-dependent diabetes. After much research, a concerted effort by our union local representative and executive board, personal physicians and endocrinologists, a third-party nonbiased endocrinologist appointed by the city, and our chief to keep me on the line, I am happy to say I am doing quite well and that my diabetes is under good control.
Skip Heflin, captain,
Hall County (GA) Fire Services
Response: We have insulin-dependent firefighters and have experienced problems when one member’s sugar level dropped critically low. Normally, our members manage their diabetes by taking their medicine as needed and watching their diets, and it causes no problems. A physician works with us when we are looking to hire new members; he examines them and recommends using NFPA 1582 as a guideline.
Personally, I feel we hire too many people we shouldn’t-people with histories of heart, lung, or other serious problems. It boils down to this: Sometimes our members begin to have health issues that should end their career. What if you are the chief and the member you got hired on with, whose career has paralleled yours through the years, has a heart attack eight years from retirement? Are you going to tell him he can’t come back to work-that his career is over because of his heart condition? This is the friend with whom you came up in the fire service. Most times, we try to put them in a place to help them make it to retirement, to take care of them. Sometimes we don’t and leave them at a slow house and hope they will make it. Until there are state or federal guidelines that prohibit someone with such conditions from being a firefighter-read, until the feds or the state provides us with an excuse or someone else to blame-the fire service will continue to take care of its own in more ways than one.
Brian Arnold, lieutenant,
Oklahoma City (OK) Fire Department
Response: Recently the State of Oklahoma Firefighters Pension system was revised to disallow an insulin-dependent person from being accepted into the state pension system. I’m curious about how this will hold up if and when it is challenged by the Americans with Disabilities Act. Several members of our department are insulin dependent and manage their disease very well. They also bring about a wealth of knowledge and understanding when we deal with diabetic patients during our shift work. We allow firefighters who are overweight or who have high blood pressure and high cholesterol and are “heart attacks waiting to happen.” Firefighters who are amputees or who are infected with tuberculosis and other communicable diseases are allowed to perform their duties as long as they are able to without harming our patients. Why shouldn’t a firefighter who is successfully managing his diabetes be allowed to work in his chosen profession?
Ted J. Pagels, chief (ret.), FIREPROSe, LLC, Green Bay, WI
Response: NFPA 1582 addresses diabetes mellitus as it relates to firefighters in chapters 3-16 and sub items 3-16.1 and 3-16.2.
Departments that hire a person (or allow a person to volunteer) as a firefighter without a medical evaluation (physical) are flirting with disaster. Ignorance is not bliss in today’s litigious society. Even the smallest fire department needs to have a physician evaluate candidates for a firefighter position.
NFPA standards related to firefighting are not created for a specific type of fire department. The standards are just that-standards. Many states have adopted NFPA documents as law. If you ignore the standards and you have an incident where a firefighter is injured or killed and it is found to be the result of your department’s failure to determine if the person was physically (or mentally) capable of being a firefighter, you are opening your department up to a lawsuit.
Current firefighters should also be held to the standards, as may be adopted by the authority having jurisdiction. Firefighters of all ranks should be in condition and medically certified to perform firefighting tasks. There should be no “hiding” behind one’s rank or seniority when it involves a medical condition that may jeopardize fellow firefighters should the person become incapacitated during station duty, an incident, or a training situation. NFPA 1582 does not require annual physicals for everyone. The requirement for physicals on an ongoing basis is dictated by age.
All firefighters should be held to physical (and mental) health fitness-for-duty standards. I understand the fears a firefighter, especially a career firefighter, may have in finding out he has a potentially deadly physical condition, but I can’t fathom the reason the individual would not want to know, possibly in time for successful medical intervention and recovery, regardless of whether he could continue as a firefighter. These individuals should ask their family and friends what they would prefer.
Christopher J. Weir, division chief,
Port Orange (FL) Department of Fire & Rescue
Response: Our department follows NFPA 1500 guidelines and NFPA 1582 as it relates to qualifying a firefighter fit for duty. However, if the firefighter is injured or has incurred a health-related event, such fitness-for-duty evaluations include a series of evaluations beginning with the physician of record, a human resources evaluation, fire chief determination, and whether that firefighter can be assigned in a light-duty mode while the firefighter convalesces until reevaluated for duty or, in some cases, is pensioned out as a permanent disability.
Firefighters must meet the physical requirements relative to strenuous activity, such as the ability to crawl, stoop, kneel, climb, and lift, at any given point. Cardio feedback is essential, given the “Everyone Goes Home” campaign whereby personal physical fitness and medical evaluations are paramount to remaining fit for duty.
The status of a diabetic firefighter is determined by the physician as well as a physician appointed by the city for an independent evaluation and recommendation for front-line work. I have never experienced such a situation; however, medical consults will determine the course in such cases.
