THE MEDICAL PROFILE
VOLUNTEERS CORNER
THERE IS CONSIDERABLE concern in the fire service about toxicity in today’s environment. Hazardous materials are involved in virtually every emergency response, exposure to infectious disease is more probable than ever before, and today’s household furnishings rapidly decompose in fire to produce poisonous by-products.
Another important issue to the fire service is physical fitness. It is encouraged and in some cases mandated by department policy. As a result, it is becoming more common to find firelighters’ pulse rates at SO or lower, blood pressures of these physically fit firefighters are also lower because of cardiopulmonary programs. Imagine a firefighter removed to the hospital from the fire scene. The medical staff, taking vital signs, determines his pulse rate to be 9S. How would the triage personnel know that this firefighter has a resting pulse of t8, and the present measure indicates a SO percent increase over normal levels?
How is it possible for us to measure the exposure levels, the physiological damage, and the degree of medical deterioration of our responders? We must have a standard.
I’he answer is simple (though the logistics may be complicated): A medical profile of each and every member must be available for comparison and related record keeping. This record should be accessible for comparison, with the entries and record keeping for each incident reviewed and updated annually by competent medical personnel (during an annual physical).
The medical form should include basic personal information, background, and history. Areas for recording material exposures, medical events, and interim testing results should be available. This form will provide a benchmark that can be used to evaluate the results of exposure or other medical emergencies. It will also prove invaluable for workman’s compensation, pension, and medical insurance claims.
There are numerous areas that can be covered in the medical examination. Several tests will be listed here, and each department, in consultation with its physician and in compliance with health codes and standards for workers’ safety, will have to determine the extent of its medical exam and data base. The more probable the exposure, the more extensive the testing should be. All tests listed won’t be required for even department member.
General information to record includes blood pressure, pulse, respiration, temperature, height, weight, date of last physical exam, family doctor, allergies, contact lens use, medications, and medical/mental history.
Ears: Audiometric tests for hearing, with particular awareness for high-frequency hearing loss. Condition of the ear drums should also be recorded.
Eyes: Vision tests for refraction and functional vision.
A biochemical profile: This should include blood, enzyme, and urinalysis tests. Complete testing covers more than 30 items, such as blood-forming functions, kidney, and liver.
Pulmonary function testing: Forced expiratory flow, forced expiratory volume (FEV) in one second, forced vital capacity (FVC), the ratio of FEV to FVC, functional residual capacity, maximum expiratory flow rate, maximum voluntary ventilation, residual volume, and total lung capacity.
Others: Chest X-ray, chlorinesterase test for pesticide exposure, serum PCB test when there may be exposure to polychlorinated biphenyls; and, at the discretion of the examining physician, an electrocardiogram and stress test.
In addition to the overall medical condition of the firefighter, the fire department needs to know if there is a susceptibility to heat stroke due to obesity or a lack of physical conditioning. Mental or physiological problems that may surface while wearing selfcontained breathing apparatus or total encapsulation protection equipment should be tested for and recorded.
With complete medical profiles, the department will be able to select those who are medically, physically, and psychologically ready for assignments to additional stress-related functions, such as heavy-rescue crews.
An efficient and effective medical testing program will improve morale of vour department, ensure compliance with governmental regulations, and assist in the detection and treatment of exposure to today’s toxic materials and stressful effects of firefighter response.
