By Dr. Marilyn A Bishop, MD, MPH, MRO, Medical Director, Medworks
Occupational health programs involved in firefighter (FF) medical evaluations must understand the physiological, psychological, and environmental demands associated with firefighting. NFPA 1582 (Standard on Comprehensive Occupational Medical Program for Fire Departments 2018) provides guidance for physicians and healthcare providers responsible for fire department occupational medical programs.
Medical evaluation of a candidate involves assessing their medical history, conducting a physical examination, and performing any necessary lab tests to detect physical or mental conditions that could hinder their ability to safely perform essential job tasks. NFPA 1582 designates medical conditions as Category A or B, with Category A conditions disqualifying a candidate from meeting the standard.
NFPA 1582 Chapter 6 outlines minimal medical requirements for candidates and FF, while Chapter 7 addresses the components of the Occupational Medical Evaluation of FF. The medical evaluation is conducted at baseline, annually (±3 months), and following FF occupational exposure, illness, injury, or protracted absence from the job.
Components of the Medical Evaluation:
- 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: 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:
- Spirometry – FVC, FEV1, FEV1/FVC; Acceptable threshold 80% predicted (NHANES III)
- 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.
- Presumptive Legislation for Firefighter Cancer (State-Specific)
- Sleep Disorder Screening using a validated questionnaire: Berlin or Epworth Sleepiness Scale. (May use STOP BANG for risk)
Guidance for the specific evaluation of medical conditions in members is comprehensive, notably in the cardiovascular and diabetes sections. Control of hypertension is essential for FF safety. A FF should achieve 12 METS on an exercise treadmill test without a hypertensive response (BP<200/100) or arrhythmia. Diabetes Type 1 and 2 requirements are detailed.
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. Additional statements 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.
