By Dr. Marilyn A Bishop, MD, MPH, MRO, Medical Director, Medworks
Occupational Health Programs and Firefighter (FF) Medical Evaluations: An Overview
Occupational health programs performing firefighter (FF) medical evaluations should be familiar with the responsibilities associated with these evaluations, and understand the physiological, psychological, and environmental demands of FF. See NFPA 1582 (4.2). NFPA 1582 (Standard on Comprehensive Occupational Medical Program for Fire Departments 2018) provides information and guidance for physicians and other healthcare providers responsible for fire department occupational medical programs.
Medical evaluation of a candidate is conducted before the candidate is placed in a training program or any emergency response activities, including a medical history, examination, and any lab tests required to detect physical or mental conditions that could prevent their ability to safely perform essential job tasks (NFPA 1582 (5)). NFPA 1582 designates medical conditions that can affect a candidate’s ability to safely perform essential job tasks as either Category A or B.
Candidates with Category A medical conditions shall not be medically certified as meeting the standard. Category B conditions shall be certified if they can perform essential job tasks without posing a significant safety or health risk to themselves, members, or the public.
NFPA 1582 Chapter 6 outlines minimal medical requirements for candidates and FF. Chapter 7 addresses the components of the Occupational Medical Evaluation of FF. The medical evaluation is conducted at baseline and annually (+/- 3 mos), and, following a FF occupational exposure, illness, injury, or protracted absence from the job. Components of the medical evaluation include:
- Medical History
- Physical Exam – note; Skin (includes cancer screening), BP (standard JNC7)
- Blood tests – every 3 years <40 years of age and annually > 40 years. (many fire dept. will perform annually): CBC with diff, Electrolytes, Renal Function, Glucose, Liver function, total cholesterol, HDL, LDL, triglycerides (Hgb A1C)
- Urine dipstick
- Audiology (500Hz – 8000Hz)-29 CFR 1910.95
Ancillary Tests included in the medical evaluation:
- Spirometry – FVC, FEV1, FEV1/FVC; Acceptable threshold 80% predicted (NHANES III) and testing performed to American Thoracic Society standards.
- Chest x-ray – Baseline; repeated as medically indicated
- ECG – Baseline; annually >40 years of age or as clinically indicated
- Risk Stratification, 10-year Heart Risk Calculator (ACC/AHA) – Asymptomatic >40 years with no known ASCVD annually, or <40 years if known to be high risk for ASCVD.
- Mammography – biannually >40 years, annually >50 years of age
- Immunizations and Infectious Disease Screening – baseline and following exposure: TB screening, Hep C, Hep B vaccinations and titers, Tdap booster every 10 years, MMR vaccine and titers, Hep A Vaccine, Varicella vaccine and titer, Flu vaccine annually, HIV screening
- Cancer Screening (NFPA 1582): Colon, Prostate, Lung, Cervical, Testicular, Bladder, Oral and Thyroid Cancer.
- Cancer Presumption Benefits for Full-Time Firefighters are State Specific and require screening beyond the recommendations in NFPA 1582: www.firstrespondercenter.org/cancer/toolsresources/presumptive-legislation-firefighter-cancer-state
- Sleep Disorder Screening using a validated questionnaire: Berlin or Epworth Sleepiness Scale. (May use STOP BANG for risk)
Guidance for specific evaluation of medical conditions in Members is comprehensive, notably the cardiovascular and diabetes sections. Control of hypertension to prevent cardiac events at the fire suppression scene is essential for FF safety. An FF should achieve 12 METS on an exercise treadmill test without hypertensive response (BP<200/100) or arrhythmia. Diabetes Type 1 and 2 requirements are detailed. See NFPA 1582 Annex E Figure E.1 Physician Evaluation Form.
Report results of the FF medical evaluation by issuing a Written Opinion as required under the Respiratory Protection Standard 29 CFR 1910.134. Firefighters are medically cleared for negative pressure, PAPR, SCBA, and supplied air respirators. An additional statement to the Written Opinion may be added, stating compliance with NFPA 1582. Restrictions are addressed in a comment section of the Opinion. Cancer screening confirmation is reported to the fire department, and results are provided to FF in states with Cancer Presumption Benefits.
