NFPA
1582
Standard on
Comprehensive Occupational
Medical Program for
Fire Departments
2018
See ALERT
NEPA
Copyrichi 2018 Notices Fire Protection Assonation (NERA Licensed. Degreement to individual use and download on 07/00200 to Bily Alcom for designated user Will am Swan No other reproduction or transmission in any Tnis NEOSS All Access subscription expires on December 10. 2019 IMPORTANT NOTICES AND DISCLAIMERS CONCERNING NFPA® STANDARDS
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NFPA® 1582
Standard on
Comprehensive Occupational Medical Program for Fire Departments 2018 Edition
This edition of NFPA 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments, was prepared by the Technical Committee on Fire Service Occupational Safety and Health. It was issued by the Standards Council on August 1, 2017, with an effective date of August 21.
This document has been amended by one or more Tentative Interim Amendments (TIAs) and/or Errata. See "Codes & Standards" at www.nfpa.org for more information.
This edition of NFPA 1582 was approved as an American National Standard on August 21, 2017.
Origin and Development of NFPA 1582
The initial mandatory medical requirements for candidates for fire fighter were in the 1974 edition of NFPA 1001, Standard on Professional Qualifications for Fire Fighter. When the first edition of NFPA 1500, Standard on Fire Department Occupational Safety and Health Program, was issued in 1987, it required all members engaged in emergency operation to be examined by a physician at least annually and suggested the medical examination be developed and administered by the fire department physician in recognition of the specific requirements of the members' activities.
In the late 1980s, members of the Technical Committee on Fire Fighter Professional Qualifications (responsible for NFPA 1001) and members of the Technical Committee on Fire Service Occupational Safety and Health (responsible for NFPA 1500) formed a working group to develop a new standard on medical requirements for fire fighters.
The first edition of NFPA 1582 was titled Standard on Medical Reguirements for Fire Fighters and was issued in 1992 under the responsibility of the Fire Service Occupational Safety and Health Committee. A subsequent edition was issued in 1997. The 2000 edition was titled Standard on Medical Requirements for Fire Fighters and Information for Fire Department Physicians, in recognition of the increasing amount of guidance being provided in the document to persons serving as fire The title of the 2003 edition was changed to Standard on Comprehensive Occupational Medical Program jor fire Departments to reflect a comprehensive occupational medical program. The document included references to the LAFC-AFF Fire Service Joint Labor-Management Wellness-Fitness Initiative, and to NFPA 1583, Standard on Health-Related Fitness Programs for Fire Fighters. These two documents outline a health-related fitness program that is medically validated against NFPA 1582.
The 2003 edition delineated between medical issues of a candidate seeking to become a fire fighter, and those of incumbents currenty performing the tasks of fire fighting. The intent with incumbents with a medical condition is to rehabilitate them and only restrict them from performing those essential job tasks where their injury or illness would affect the safety of themselves or others on their crew.
In the 2007 edition, new requirements were added to both the chapter on medical evaluation for candidates and the chapter on specific evaluation of medical conditions in incumbents to allow persons with diabetes to enter the fire service or continue performing essential job tasks associated with fire fighting if they meet defined criteria. All the medical conditions that govern whether z ›erson can become a fire fighter and the specific medical conditions of incumbents that affect their ability to perform certain essential job tasks were reviewed and updated, if appropriate, based on current medical research and knowledge.
NFPA and National Fire Protection Association are registered trademarks of the National Fire Protection Association, Quincy, Massachusetts 02169.
Copyrigh 2019 National Fine Protection Association (FPA Licensed, by agreement, forindivind use and download on 07706/2019 to Billy Aldom for designated use William Swan. No per recreduction ur transmission in any tom permitted without walten parmission of NEPA, Foringuires orto report unauhonzed use contact Kensing @m paorg. Tris NECOS All Access subsolsten expires on December 19. 2019| 1582-2 COMPREHENSIVE OCCUPATIONAL MEDICAL PROGRAM FOR FIRE DEPARTMENTS For the 2013 edition, the committec, with the assistance of several task groups and subject matter experts in specialty areas with regard to medical conditions, updated many of the medical requirements to reflect current practices. Some of the arcas that were addressed were that of diabetes, metabolic syndrome, prosthetic adjuncts, hearing aids, and cochlear implants, as well as pregnancy and reproductive system concerns. Also developed for the 2013 edition was a new annex designed to assist the end user with the subject of pregnancy. The committee, with the assistance of the International Association of Fire Fighters, provided an updated Annex C, which contains the protocols for the evaluation of fitness for members. The committee also updated some of the medical requirements relating to hypertension, anticoagulants, TB testing, and screening for cancer.
For the 2018 edition, the committee, with the assistance of several task groups and subject matter experts in specialty areas with regard to medical conditions, has updated many of the medical requirements to reflect current practices. Some of the areas that were addressed were lung function, spinal injuries/conditions, and seizure disorders. A new section was added to the annual fitness evaluation regarding lung function performance. The committee updated all of the annex material in order to provide the best guidance and references for physicians and fire departments. 2018 Edition
Gopyright 2010 Netlenal Fire Prelection escociation (NFPA Licensed Dy @preement, for individual use and sonicad un: 07/06/2019 to Billy Alcon tor designated user William Swan No omer reproduction or transmission in any temperated without enter permission of NEP4% Foincuires arto report unauthonzed use coract icensing@pa org Tus NEOSS All Access subscripuon sapires on December 19, 2019.
COMMITTEE PERSONNEL 1582-3
Technical Committee on Fire Service Occupational Safety and Health Randy J. Krause, Chair
Port of Seattle Fire Department, WA [E)
Murrey E. Loflin, Nomoting Secretary
National Institute for Occupational Safery & Health, WV [RT) Lawrence T. Bennett, University of Cincinnati, OH [SE] Paul J. Napoli, Association of Fire Districts of the State of New York, David T. Bernzweig, Columbus (OH) Division of Fire, OH [L] NY [U] Rep. Columbus Firefighters Union Rep. Association of Fire Districts/State of New York Sandy Bogucki, Yale University Emergency Medicine, CT [SE] Robert D. Neamy, Gardnerville, NV [M] James E. Brinkley, International Association of Fire Fighters, DC Rep. National Incident Management System Consortium [L] Christopher W. Norris, Westhampton Fire Department, MA (E] Rep. International Association of Fire Fighters Charles J. Popp III, Boston Fire Department, MA [U] Dennis R. Childress, Orange County Fire Authority, CA [C] David J. Prezant, Fire Department City of New York, NY [E] Rep. California State Firefighters Association Rep. Fire Department City of New York Thomas J. Cuff, Jr., Firemens Association of the State of New York, Steven A. Rabine, Volunteer Firemen's Insurance Services, Inc., PA NY [U]
David W. Dodson, Response Solutions LLC, CO [SE] Gregory Reynar, Los Angeles City Fire Department, CA [U] Rep. Fire Department Safety Officers Association Daniel G. Samo, Northwestern Medical Group, IL [SE] Christopher A. Garrett, Owasso Fire Department, OK [M]
Andrew G. Schwartz, Lion Group, Inc., OH [M]
Rep. International Fire Service Training Association
Denise L. Smith, Skidmore College, NY [SE]
Stanley Haimes, UCF College of Medicine, FL [SE]
Donald F. Stewart, Medocracy Inc./Fairfax County Fire & Rescue.
Todd A. Harms, Phoenix Fire Departinent, AZ [E] VA [E]
Scott D. Kerwood, Hutto Fire Rescue, TX [E]
Philip C. Stittleburg, La Farge Fire Department, WI [U] Rep. International Association of Fire Chiefs Rep. National Volunteer Fire Council J. Roger Lackore, Smeal Fire Apparatus, WI [M] Susan Tamme, Tampa Fire Rescue Department, FL [L] Rep. Fire Apparatus Manufacturers Association
Rep. International Association of Women in Fire & Emergency Tamara DiAnda Lopes, Reno Fire Department, NV [U] Services Joseph Mchugh, Fire Department City of New York, NY [U] Fred C. Terryn, U.S. Department of the Air Force, FL [U] Rep. Fire Department City of New York Teresa Wann, Santa Ana College, CA [SE] Steven M. Moffatt, Public Safety Medical, IN [SE]
Kim D. Zagaris, State of California, CA [E]
Alternates
Robert Albanese, Fire Department City of New York, NY [U] Kenneth Desmond, Bath, ME U (Alt. to Joseph Mchugh) (Alt. to Philip C. Stittleburg) Kurt Becker, Clayton, Missouri Fire Department, MO [L] Hayley Fudge, Lion Group, Inc., OH [M] (Alt. to James E. Brinkley) (Alt. to Andrew G. Schwartz) Brett R. Bowman, City of Manassas Fire & Rescue Department, VA Randall W. Hanifen, University of Cincinnati, OH | SE] (E] (Alt. to Lawrence T. Bennett)
(Alt. to Scott D. Kerwood)
Jerome E. Ozog, Volunteer Firemen's Insurance Services, Inc., PA Wesley D. Chestnut, Spartan Motors, Inc., MI [M] [I]
(Alt. to J. Roger Lackore) (Alt. to Steven A. Rabine)
Bradd K. Clark, Ocala Fire Rescue, FL [M] Paul Parrish, Austin Fire Wellness, TX [SE] (Alt. to Christopher A. Garrett) (Alt. to Sandy Bogucki) Steven D. Corrado, UL LLC, NC [RT]
(Voting Alt.) Jack E. to David Bernaen Division of Fire, OH (LI Fabrice Czarnecki, University of Maryland St. Joseph Medical hillip C. Vorlander, Waunakee, WI [N Center, MD [SE] Alt. to Robert D. Neamy
(Alt. to Daniel G. Samo)
2018 Edition
Copengh: 2010 Natiena: Fire Protection Association NFD46) Licansed. By agreement, forindi dual use and downiead on 07/06:2019 te Billy Alcorn for designated user Willen Bean No mer reproduction of tansmssion m any This N° G2E Al scorse subsenption caches on December 19. 2019 form permitted without atten permission of NEPA Pornunes orto repor unasthonged use. comet icensing @@hips.0 1582-4 COMPREHENSIVE OCCUPATIONAL MEDICAL PROGRAM FOR FIRE DEPARTMENTS Nonvoting
William R. Hamilton, L.S. Department of Labor, DC [E] Andrew Levinson, U.S. Department of Labor, DC {E] Rep. Occupational Safety & Health Administration
Ken Holland, NFPA Staff Liaison
This list represents the membership at the time the Committee was balloled on the final lext of this edition.
Since that time, changes in the membership may have occured. A key to classifications is found at the hack of the document.
The so ibe or po commite shal or and of it consine an endorene el 2018 Edition
Copyrch: 2049 Nationa: Fire Protection Ascociaton (NFPA) Licensed, by agreement for individual use and download on 0F/06/2019 to Billy Acorn for designated user Willam: Swan No other reproduction or Iransmission in any form penmited without witten permission ofFRAC. Forinthet arte topon neathensed use. contact hernsig@nipee TIes NFOSS ABAcosS surschaton expires on December 19, 2012 CONTENTS 1582-5
Contents
Chapter 1 Administration 1582-6 7.2
Member Education Regarding Occupational
Scope............ 1582-6 Medical Evaluation Program..... 1582-18
1.2 Purpose. 1582-6 7.3
ming of the Annual Occupational Medic
1.3 Implementation. 1582-6 raluation of Members.....
1582- 18
7.4 Components of the Annual Occupational
Chapter 2 Referenced Publications..... 1582-6
Medical Evaluation of Members. 1582- 18
2.1 General. 1582-6
7.5 Medical History...... 1582-18
2.2 NFPA Publications. 1582-6
7.6 Physical Examination. 1582- 19
2.3 Other Publications. 1582-7
7.7 Ancillary Tests..... 1582- 19
2.4 References for Extracts in Mandatory
Sections........ 1582-7 Chapter 8 Annual Occupational Fitness Evaluation Chapter 3 Definitions... of Members... 1582-21
1582-7 8.1 1582-21
3.1 General. 1582-7 Anita andes Composion...
8.2 1582-21
3.2 NFPA Official Definitions. 1582-7
3.3 General Definitions... 1582-7 Chapter 9 Essential Job Tasks — Specific Chapter 4 Roles and Responsibilities Evaluation of Medical Conditions in 1582-8 Members…..
Fire Department Responsibilities. 1582-8 1582-22
4.2 9.1 Essential Job Tasks. 1582- 22
Fire Department Physician Responsibilities. 1582-9 9.2 Special Teams....
4.3 Candidate and Member Responsibilities. 1582-9 1582- 22
9.3 Fire Department Physician Roles... 1582-22
4.4 Confidentiality of Medical Information. 1582-9
9.4 Cardiovascular Disorders..... 1582- 22
Chapter 5 9.5 Vascular Disorders.... 1582- 25
Essential Tob Tasks ... 1582- 9
5.1 Essential Job Tasks and Descriptions.... 9.6 Endocrine and Metabolic Disorders. 1582- 26 1582-9
5.2 Essential Job Tasks for Specialized Teams. 1582-10 9.7 Lung, Chest Wall, and Respiratory Disorders.... 1582-28
Chapter 6 Medical Evaluations of Candidates 1582-10 9.8 Infectious Diseases. 1582-32
6.1 Medical Evaluation 9.9 Spine Disorders.... 1582- 33 1582-10
6.2 Medical Conditions Affecting Ability to Safely 9.10 Orthopedic Disorders. 1582-34 Perform Essential Job Tasks. 1582- 10 9.11 Disorders Involving the Gastrointestinal Tract
6.3 Head and Neck. 1582-10 and Abdominal Viscera. 1582-36
6.4 Eyes and Vision... 1582-11 9.12 Medical Conditions Involving Head, Eyes,
6.5 Ears and Hearing. 1582- 11 Ears, Nose, Neck, or Throat. 1582- 36
6.6 Dental. ... 1582- 11 9.13 Neurologic Disorders. ..... 1582- 37
6.7 Nose, Oropharynx, Trachea, Esophagus, and 9.14 Psychiatric and Psychologic Disorders. 1582-39 Larynx. .... 1582- I] 9.15 Substance Abuse. 1582-40
6.8 Lungs and Chest Wall. 1582- 11 9.16 Medications... 1582-40
6.9 Aerobic Capacity. 1582- 12 9.17 Tumors — Malignant or Benign. 1582-41
6.10 Heart and Vascular System. 1582-12 9.18 Pregnancy and Reproductive Health. 1582-43
6.11 Abdominal Organs and Gastrointestinal
System. 1582-13 Annex A Explanatory Material.... 1582-43
6.12 Metabolic Syndrome. 1582-13
Annex B Guide for Fire Department
6.13 Reproductive System. 1582-13
Administrators…....... 1582-67
6.14 Urinary System. 1582-13
6.15 Spine and Axial Skeleton. .... 1582-13 Annex C Protocols for Evaluation of Fitness of
6.16 1582-14 Members 1582-69
6.17 Neurogical Disordes...
1582-14
6.18 Skin... 1582-15 Annex D Pregnancy Issues.. 1582-83
6.19 Blood and Blood-Forming Organs... 1582-15
6.20 Endocrine and Metabolic Disorders,.…. 1582-15 Annex E ample Physician Evaluation Form f
6.21 Systemic Diseases and Miscellaneous ire Fighters with Diabetes 1582-87 Conditions..... 1582- 17 Annex F Informational References
6.22 Tumors and Malignant Diseases. 1582-94
1582- 17
6.23 Psychiatric Conditions. 1582-17 Index 1582-97
6.24 Chemicals, Drugs, and Medications. 1582-17
Chapter 7 Occupational Medical Evaluation of
Members. 1582-18
7.1 General. 1582-18
2018 Edition
Copyriaht 2019 National Fire Protection Association (FRAG Licensed, by agreeinent. for indoidual use and download on Di/06r20101o Bily Alcon for designated use filer Swan No other reproud on of transmession in and fore permitted without written permission eNFPAC, foringuiries ceto report unauthonzed use contact licensing@fraorg This NECES All Access subschpion expres on December 19, 2019. 1582-6 COMPREHENSIVE OCCUPATIONAL MEDICAL PROGRAM FOR FIRE DEPARTMENTS NEPA 1582 zations providing rescue, fire suppression, hazardous materials mitigation, special operations, and other emergency services.
Standard on
1.1.4 This standard shall not apply to industrial fire brigades that also can be known as emergency brigades, emergency Comprehensive Occupational Medical Program response teams, fire teams, plant emergency organizations, or for Fire Departments mine emergency response teams.
1.2 Purpose. The purpose of this standard is to outline an 2018 Edition occupational medical program that, when implemented in a fire department, will reduce the risk and burden of fire service IMPORTANT NOTE: This NFPA document is made available for occupational morbidity and mortality while improving the use subject to important notices and legal disclaimers. These notices health, and thus the safety and effectiveness, of fire fighters and disclaimers appear in all publications containing this document operating to protect civilian life and property. and may be found under the heading "Important Notices and
1.2.1 Accordingly, the standard specifies the following infor- Disclaimers Concerning NFPA Standards. " They can also be viewed mation:
at www.nfpa.org/disclaimers or obtained on request from NFPA.
UPDATES, ALERTS, AND FUTURE EDITIONS: New editions of (1) Minimal medical requirements for candidates as delinea- FPA codes, standards, recommended practices, and gurdes (1. ted in Chapter 6 FPA Standards) are released on scheduled revision evcles. Th (2) Occupational medical and fitness evaluations for edition may be superseded by a later one, or it may be amended members as delineated in Chapters 7 and 8 outside of its scheduled revision cycle through the issuance of Tenta- (3) Information regarding fire department activities and tive Interim Amendments (TIAs). An official NFPA Standard at any essential job tasks that assist the department physician in point in time consists of the current edition of the document, together providing proper medical support for members with all TIAs and Errata in effect. To verify that this document is the Methods and types of data that must be collected to current edition or to determine if it has been amended by TIAs or sustain comprehensive occupational medical programs Errata, please consult the National Fire Codes® Subscription Service for fire departments or the "List of NFPA Codes & Standards" at www.nfpa.org/docinfo. of the medical requirements In addition to TIAs and Errata, the document information pages also 1.2.2* The implementation outlined in this standard ensures that candidates and current include the option to sign up for alerts for individual documents and members are medically capable of performing their required to be involved in the development of the next edition.
duties and will reduce the risk of occupational injuries and following the number or letter
designating a paragraph indicates that explanatory material on the paragraph can be found in Annex A. 1.2.3 Nothing herein is intended to restrict any jurisdiction A reference in brackets | ] following a section or paragraph from exceeding these minimum requirements. indicates material that has been extracted from another NFPA document. As an aid to the user, the complete title and edition 1.3 Implementation. of the source documents for extracts in mandatory sections of 1.3.1 For candidates, the medical requirements of this stand- the document are given in Chapter 2 and those for extracts in ard shall be implemented when this standard is adopted by an informational sections are given in Annex F. Extracted text may AHJ on an effective date specified by the AHJ. be edited for consistency and style and may include the revi- sion of internal paragraph references and other references as 1.3.2* When this standard is adopted by a jurisdiction, date(s) appropriate. Requests for interpretations or revisions of extrac- shall be set for members to achieve compliance by establishing ted text shall be sent to the technical committee responsible a phase-in schedule for compliance with specific requirements, if needed.
Information on referenced publications can be found in
Chapter 2 and Annex F.
Chapter I Administration
or Scope Then sian dard connin mescriptive requirem eir Chapter 2 Referenced Publications or a comor
departments.
2.1 General. The documents or portions thereof listed in this A 1.1.1* The medical requirements in this standard are applica- hapter are referenced within this standard and shall b ble to fire department candidates and members whose job onsidered part of the requirements of this documen descriptions as defined by the authority having jurisdiction 2.2 NFPA Publications. National Fire Protection Association. are outlined in NÉPA 1001; NFPA 1002; NFPA 1003; 1 Batterymarch Park, Quincy, MA 02169-7471.
NFPA 1006; NFPA 1021; and NFPA 1051.
1.1.2 This standard provides information and guidance for NEPA 1001, Standard for Fire Fighter Professional Qualifications, physicians and other health care providers responsible for fire 2013 edition. department occupational medical programs. NFPA 1002, Standard for Fire Apparatus Driver/Operator Profes- sional Qualifications, 2017 edition.
A 1.1.3 These requirements are applicable to public, govern- NFPA 1003, Standard for Airport Fire Fighter Professional Qualifi- mental, military, private, and industrial fire department organi- cations, 2015 edition. 2018 Edition Shaded text = Revisions. A = Text deletions and figure/table revisions. • = Section deletions. N = New material.
Copyrght 2019 Nallenai Fire Protection Association: (FLensed by agreement for individual use and download on 07/062019 to Silly Aicon for designated user Willien Swan. No other reproduction or transmission in any lers permitten withoutinter permission eNFRA Forindures entombet unauthenzed use. comtect homsng@nipaord This NEOSS AS Access subsengton expires on Decembm 10 2019 DEFINITIONS 1582-7
NFPA 1006, Standard for Technical Rescuer Professional Qualifica- Merriam-Webster's Collegiate Dictionary, 11th edition, Merriam- tions, 2017 edition. Webster, Inc., Springfield, MA, 2003.
NFPA 1021, Standard for Fire Officer Professional Qualifications, 2.4 References for Extracts in Mandatory Sections. 2014 edition.
NFPA 1051, Standard for Wildland Fire Fighter Professional Quali- NFPA 1002, Standard for Fire Apparatus Driver/Operator Profes- fications, 2016 edition. sional Qualifications, 2017 edition.
NFPA 1500, Standard on Fire Department Occupational Safety, NFPA 1500, Standard on Fire Department Occupational Safety, Health, and Wellness Program, 2018 edition. Health, and Wellness Program, 2018 edition.
NFPA 1561, Standard on Emergency Services Incident Manage ment System, 2008 edition.
Chapter 3 Definitions
NFPA 1581, Standard on Fire Department Infection Control Program, 2015 edition. 3.1 General. The definitions contained in this chapter shall NFPA 1583, Standard on Health-Related Fitness Programs for Fire apply to the terms used in this standard. Where terms are not Department Members, 2015 edition. defined in this chapter or within another chapter, they shall be NFPA 1584, Standard on the Rehabilitation Process for Members defined using their ordinarily accepted meanings within the During Emergency Operations and Training Exercises, 2015 edition. context in which they are used. Merriam-Webster's Collegiate
2.3 Other Publications. Dictionary, 11th edition, shall be the source for the ordinarily accepted meaning.
2.3.1 ANSI Publications. American National Standards Insti-
3.2 NFPA Official Definitions.
tute, Inc., 25 West 43rd Street, 4th Floor, New York, NY 10036.
ANSI Z24.5, Audiometric Device Testing, 1951. 3.2.1* Approved. Acceptable to the authority having jurisdic- tion.
2.3.2 CDC Publications. Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333. 3.2.2* Authority Having Jurisdiction (AHJ). An organization, office, or individual responsible for enforcing the requirements "Measles, Mumps, and Rubella - Vaccine Use and Strategies of a code or standard, or for approving equipment, materials, for Elimination of Measles, Rubella, and Congenital Rubella an installation, or a procedure.
Syndrome and Control of Mumps: Recommendations of the
Advisory Committee on Immunization Practices (ACIP)," 3.2.3 Shall. Indicates a mandatory requirement.
Morbidity and Mortality Weekly Report, May 19, 1998, 47 (No. 3.2.4 Should. Indicates a recommendation or that which is RR-8): 1-57. advised but not required.
"Poliomyelitis Prevention in the United States: Updated 3.3 General Definitions.
Recommendations of the Advisory Committee on Immuniza-
tion Practices (ACIP)," Morbidity and Mortality Weekly Report, 3.3.1 Candidate. A person who has submitted an application 49(No. RR-5): 1-22, May 19, 2000. to become a member of the fire department. [1500, 2018]
2.3.3 U.S. Government Publications. U.S. Government 3.3.2 Category A Medical Condition. See 3.3.14.1.
Publishing Office, Washington, DC 20402. 3.3.3 Category B Medical Condition. See 3.3.14.2.
Title 29, Code of Federal Regulations, Part 1910.95, "Occu- 3.3.4 Emergency Medical Services. The provision of treat- pational noise exposure," 1996. ment, such as first aid, cardiopulmonary resuscitation, basic life Title 29, Code of Federal Regulations, Part 1910.120, support, advanced life support, and other pre-hospital proce- "Hazardous waste operations and emergency response," 2002. dures including ambulance transportation to patients. [1500, 20181
Title 29, Code of Federal Regulations, Part 1910.134, "Respi- ratory protection," 1998. 3.3.5 Essential Job Task. Task or assigned duty that is critical to successful performance of the job. (See Chapter 5 and Title 29, Code of Federal Regulations, Part 1910.1020, Section 9.1.) "Access to employee exposure and medical records." 1996
3.3.6 Evaluation. See 3.3.15, Medical Evaluation.
Title 29, Code of Federal Regulations, Part 1910.1030,
"Bloodborne pathogens," 2001. N 3.3.7* Fire Department. An organization providing rescue, fire suppression, and related activities, including any public, U.S. Dept. of Health & Human Services, National Heart, governmental, private, industrial, or military organization Lung and Blood Institute, Seventh Report of the Joint National engaging in this type of activity. [1002, 2017] Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNG 7), 2004 3.3.8 Fire Department Physician. A licensed doctor of medi- cine or osteopathy who has been designated by the fire depart-
2.3.4 Other Publications. ment to provide professional expertise in the areas of occupational safety and health as they relate to emergency serv- International Council of Ophthalmology, "International
Clinical Diabetic Retinopathy Disease Severity Scale," San Fran- ices. cisco, CA, October 2002, http://www.icoph.org/standards/ 3.3.9 Functional Capacity Evaluation. An assessment of the pdrdetail.html. correlation between that individual's capabilities and the essen- tial job tasks.
Shaded text = Revisions. A = Text deletions and figure/table revisions. • = Section deletions. N = New material. 2018 Edition Copyrich: 2019 National Fire Prolection Association (NFPA). Licensed by agreement for indecual use and chantoad on 07106/2019 to Bly Alcomfor designated user tam Swan No other reproduction o iransmission in any for permitted watout written permission of EDe Foringuines orto report unauthonzed usa, conlact [email protected] Ines NOSE All Access subsepton: expres on Decentbor 19. 2013 1582-8 COMPREHENSIVE OCCUPATIONAL MEDICAL PROGRAM FOR FIRE DEPARTMENTS
3.3.10 Health and Fitness Coordinator. A person who, under 4.1.2 The medical evaluations and any additional medical tests the supervision of the fire department physician, has been ordered by the fire department physician shall be provided at designated by the department to coordinate and be responsible no cost to the members. for the health and fitness programs of the department.
4.1.2.1* This obligation shall not extend to medical tests
3.3.11 Health and Safety Committee. A representative group beyond the basic medical evaluation for candidates. of individuals who serve along with the fire department physi- cian and health and fitness coordinator, and is chaired by the 4 4.1.3* The fire department shall have an officially designated physician who shall be responsible for guiding, directing, and fire department health and safety officer, who oversee
implementation of the fire department occupational safety and advising the members with regard to their health, fitness, and suitability for duty as required by NFPA 1500.
health program.
3.3.12 Health and Safety Officer. The member of the fire 4.1.4* The fire department shall ensure that the fire depart- ment physician is a licensed doctor of medicine or osteopathy department assigned and authorized by the fire chief as the who has completed residency training in an accredited medical manager of the safety and health program. [1500, 2018] training program and/or is American Boards of Medical
3.3.13 Infection Control Program. The fire department's Specialties (ABMS) or American Osteopathic Association formal policy and implementation of procedures relating to (AOA) board certified or international equivalent. the control of infectious and communicable disease hazards
4.1.5 The fire department shall provide the fire department physician with a fire service overview, current job descriptions, and the essential job tasks required for all fire department posi- tions and ranks.
2018]
3.3.14 Medical Condition Classifications. A 4.1.6 The fire department shall provide the fire department physician with the department's organizational statement that
3.3.14.1 Category A Medical Condition. A medical condition outlines types and levels of services provided by the depart- that would preclude a person from performing as a member ment, in accordance with NFPA 1500. in a training or emergency operational environment by
presenting a significant risk to the safety and health of the 4.1.7* The types and levels of services provided by the fire person or others. department shall dictate for candidates and members the essential job tasks that pertain to its members and shall there-
3.3.14.2 Category B Medical Condition. A medical condition fore be correlated to the medical requirements outlined in this that, based on its severity or degree, could preclude a standard. person from performing as a member in a training or emer- gency operational environment by presenting a significant 4.1.8 For the purpose of conducting medical evaluations, the fire department shall assist the fire department physician to risk to the safety and health of the person or others.
understand the physiological and psychological demands
3.3.15 Medical Evaluation. The analysis of information for the placed on members as well as the environmental conditions purpose of making a determination of medical certification. under which they must perform and the personal protective Medical evaluation includes a medical examination. equipment (PPE) they must wear during various types of emer- gency operations.
3.3.16 Medical Examination. An examination performed or directed by the fire department physician. 4.1.9 The fire department shall ensure member access to eval- uation by medical specialists, medical and/or surgical treat-
3.3.17 Medically Certified. A determination by the ment, rehabilitation, and any other intervention prescribed by department physician that the candidate or current member a medical provider, in consultation with the fire department meets the medical requirements of this standard.
physician, following an injury or illness resulting from a
3.3.18* Member. A person involved in performing the duties member's participation in fire department functions. and responsibilities of a fire department, under the auspices of
4.1.10 The fire department shall require that the fire depart- ment health and safety officer and the health and fitness coor-
3.3.19 Occupational Safety and Health Program. An occupa- dinator maintain a liaison relationship with the fire department tion specific program, implemented to reduce the risks associ- physician to ensure that all aspects of the comprehensive occu- ated with the occupation, that outlines the components of a pational medical program are actively engaged. program and the roles and responsibilities of the fire depart- 4.1.11 The fire department shall ensure employee privacy and ment and its members.
confidentiality regarding medical conditions identified during the medical evaluation except as required by law.
Chapter 4 Roles and Responsibilities 4.1.12 Where possible, the fire department shall provide alter- nate duty position for members when the fire department
4.1 Fire Department Responsibilities. physician recommends temporary work restrictions.
4.1.1 The fire department shall establish a comprehensive 4.1.13 Medical Record Keeping. occupational medical program that includes medical evalua- tions for candidates and members. (See Annex B.) 4.1.13.1* The fire department comprehensive occupational medical program shall include collection and maintenance of a confidential medical and health information system for
members.
2018 Edition Shaded text = Revisions. A = Text deletions and figure/table revisions. • = Section deletions. N = New material.
Copyront 2010 mationa Fire Protection Association (FA Licensed By Agreement. for individual use and downinad on 07/00/2019 to Ril Alcon for designated user Willam Swan No omer reproduction or transmission in any torn permited without walten permission grAPPA Foringuires ero report undumensed use comect licensing @ripe pra. INS NOOSE All Access subscription expires on December 10. 2010.
ESSENTIAL JOB TASKS 1582-9
4.1.13.2 All medical record keeping shall comply with the 4 4.2.5 The fire department physician shall provide medical requirements of 29 CFR 1910.1020, "Access to employee expo supervision for the fire department fitness, return-to-duty reha- sure and medical records," and other applicable regulations bilitation, and physical conditioning programs as required by and laws. NFPA 1583.
4.1.14 The provisions of 4.1.13 shall apply to all health and A 4.2.6* The fire department physician shall ensure adequate medical records regarding individual members and to all meth- on-scene medical support at the incident scene rehabilitation ods of communicating or transferring the information sector for members during emergency operations as required contained in these records, including written, oral, electronic, by NFPA 1500; NFPA 1561; and NFPA 1584. and any other means of communication.
A 4.2.7 The fire department physician shall provide supervision
4.2 Fire Department Physician Responsibilities. for the fire department infection contro! program as required by NFPA 1581.
4.2.1 The fire department physician shall fulfill the following responsibilities: 1.3 Candidate and Member Responsibilities. Each candidate (1) Understand the physiological, psychological, and envi- or member shall adhere to the following requirements:
ronmental demands placed on fire fighters (1) Cooperate, participate, and comply with the medical eval- (2) Evaluate fire department candidates and members to uation process identify medical conditions that could affect their ability (2) Provide complete and accurate information to the fire to safely respond to and participate in emergency opera- department physician and other authorized medical care tions providers)
(3) Utilize the essential job task descriptions supplied by the (3) Report any occupational exposure such as exposure to hazardous materials or toxic substances and exposure to member's medical certification infectious or contagious diseases Identify and report the presence of Category A or Report to the fire department physician any medical disqualifying Category B medical conditions if present in condition that could interfere with the ability of the indi- vidual to safely perform essential job tasks, such as illness Inform the fire chief or his/her designee whether or not or injury, use of prescription or nonprescription drugs, the candidate or current member is medically certified and pregnancy to safely perform the essential job tasks
Report the results of the medical evaluation to the candi- 4.4 Confidentiality of Medical Information. date or current member, including any medical condi- 4.4.1* Specific information concerning medical diagnosis tion (s) identified during the medical evaluation, and the shall be released by the fire department physician only with recommendation as to whether the candidate or current written permission from the candidate or member, and/or as member is medically certified to safely perform required by law. essential job tasks
(7) Forward copies of any abnormal results along with 4.4.2 No fire department personnel, other than the fire patient instructions regarding primary care follow-up to department physician or appropriate medical staff, shall have candidates or current members who were instructed to access to another member's medical records without the seek (as appropriate) medical follow-up to address any express written consent of that member. or lab abnormalities, identified
during the medical evaluation Chapter 5 Essential Job Tasks Review results of the annual occupational fitness evalua- tion as described in Chapter 8
5.1 Essential Job Tasks and Descriptions.
(9) Provide or arrange for a prescriptive
and/or fitness program when A5.1.1 The fire department shall evaluate the following 14 member's recovery from illness or injury and enhance essential job tasks against the types and levels of emergency his/her ability to safely perform essential job tasks services provided to the local community by the fire depart- (10) Participate in injury prevention and health promotion ment, the types of structures and occupancies in the commun- programs for fire fighters ity, and the configuration of the fire department to determine which tasks apply to their department members and candi- When medical evaluations are conducted by a physician
or medical provider other than the fire department physician, the evaluation shall be reviewed and approved by the fire (1) * While wearing personal protective ensembles and self- department physician. contained breathing apparatus (SCBA), performing fire- fighting tasks (e.g., hoseline operations, extensive
4.2.3 The fire department physician shall review individual crawling, lifting and carrying heavy objects, ventilating medical evaluations and aggregate data from member evalua- roofs or walls using power or hand tools, forcible entry), tions in order to detect evidence of occupational exposure(s) rescue operations, other emergency response or clusters of occupational disease. actions under stressful conditions, including working in 4 4.2.4 The fire department physician shall be a member of the extremely hot or cold environments for prolonged time Fire Department Occupational Safety and Health Committee periods chaired by the health and safety officer as required by Wearing an SCBA, which includes a demand valve-type NFPA 1500. positive-pressure facepiece or HEPA filter mask, which requires the ability to tolerate increased respiratory
workloads
Shaded text = Revisions. A = Text deletions and figure/table revisions. • = Section deletions. N = New material. 2018 Edition Copynaii 2010 Natonal Fire Protection Association (NFPA Licensed by agreement. for indiv dual use and downicad on: 0706/201810 Billy Acorn for designated use- Willem Swen No other reproduchon or transmission in any form particles whout we ten permissir NEPAD, For inquiries arto repeat arbulenged use comect cenenge pa g This NFOSS All Access subser pron Sapires in focamber 10. 2012. 1582-10 COMPREHENSIVE OCCUPATIONAL MEDICAL PROGRAM FOR FIRE DEPARTMENTS Exposure to toxic fumes, irritants, particulates, biologi- apparatus (SCUBA) teams, technical rescue teams, emergency cal (infectious) and nonbiological hazards, and heated medical services (EMS) teams, or units supporting tactical law gases, despite the use of personal protective ensembles enforcement operations, the fire department shall identify for cach team it operates the additional essential job tasks and Depending on the local jurisdiction, climbing six or specialized personal protective equipment (PPE) not specified more flights of stairs while wearing a fire protective in 5.1.1(1) through 5.1.1 (13) that would apply to the members ensemble, including SCBA, weighing at least 50 lb of that team. (22.6 kg) or more and carrying equipment/tools weigh-
ing an additional 20 to 40lb (9 to 18 kg) 5.2.2 The fire department shall also provide the fire depart- Wearing a fire protective ensemble, including SCBA, ment physician with the list of additional essential job tasks and (5)
specialized PPE specific to each specialized team.
that is encapsulating and insulated, which will result in significant fluid loss that frequently progresses to clinical 5.2.3 When performing the medical evaluation of members of dehydration and can elevate core temperature to levels a specialized team, the fire department physician shall also exceeding 102.2°F (39°C) consider the following:
(6) While wearing personal protective ensembles and SCBA, finding, and rescue-dragging or carrying (1) Additional medical and/or physical requirements that searching,
victims ranging from newborns to adults weighing over are related to the job tasks being performed by the team that are not enumerated in this standard
200 lb (90 kg) to safety despite hazardous conditions
and low visibility (2) The impact on members of having to wear or utilize specialized PPE that can increase weight, environmental (7) While wearing personal protective ensembles and SCBA, advancing water-filled hoselines up to 2½ in. (65 mm) isolation, sensory deprivation, and/or dehydration poten- tial above levels experienced with standard fire suppres- in diameter from fire apparatus to occupancy [approxi-
sion PPE
mately 150 ft (50 m)], which can involve negotiating
multiple flights of stairs, ladders, and other obstacles While wearing personal protective ensembles and SCBA, Chapter 6 Medical Evaluations of Candidates climbing ladders, operating from heights, walking or
6.1 Medical Evaluation. A medical evaluation of a candidate shall be conducted prior to the candidate being placed in train- electrical power lines or other hazards ing programs or fire department emergency response activities.
Unpredictable emergency requirements for prolonged
periods of extreme physical exertion without benefit of 6.1.1* The medical evaluation of a candidate shall include a warm-up, scheduled rest periods, meals, access to medi- medical history, examination, and any laboratory tests required cation (s), or hydration to detect physical or medical condition (s) that could adversely Operating fire apparatus or other vehicles in an emer- affect his/her ability to safely perform the essential job tasks gency mode with emergency lights and sirens outlined in 5.1.1.
Critical, time-sensitive, complex problem solving during 6.1.2* This standard shall provide specific requirements for physical exertion in stressful, hazardous environments, candidates based on medical conditions that can affect a candi- including hot, dark, tightly enclosed spaces, that is
date's ability to safely perform the essential job tasks of a fire further aggravated by fatigue, flashing lights, sirens, and fighter. other distractions
(12) Ability to communicate (give and comprehend verbal 6.2 Medical Conditions Affecting Ability to Safely Perform orders) while wearing personal protective ensembles Essential Job Tasks. and SCBA under conditions of high background noise,
6.2.1 Medical conditions that can affect a candidate's ability to poor visibility, and drenching from hoselines and/or
fixed protection systems (sprinklers) safely perform essential job tasks shall be designated either Functioning as an integral component of a team, where Category A or Category B. (13)
sudden incapacitation of a member can result in mission 6.2.2 Candidates with Category A medical conditions shall not failure or in risk of injury or death to civilians or other be certified as meeting the medical requirements of this stand- team members
(14) Working in shifts, Including during nightime, that can extend beyond 12 hours 6.2.3 Candidates with Category B medical conditions shall be
5.1.2 The fire department shall provide the fire department physician with the list of essential job tasks, as developed per
5.1.1, to be used in the medical evaluation of members and
6.3 Head and Neck.
5.1.3 The fire department physician shall consider the physi- cal, physiological, intellectual, and psychological demands of 6.3.1 Head. the occupation when evaluating the candidate's or member's
6.3.1.1 Category A medical conditions shall include the • ability to perform the essential job tasks. following:
5.2 Essential Job Tasks for Specialized Teams. (1) Defect of skull preventing helmet use or leaving underly- 4 5.2.1 If the fire department operates specialized teams such as ing brain unprotected from trauma hazardous materials units, self-contained underwater breathing Any skull or facial deformity that would not allow for uccessful fit test for respirators used by that departmen 2018 Edition Shaded text = Revisions. A = Texe deletions and figure/ table revisions. • = Section deletions. N = New material.
Copyright 2019 Nationa: fine Protection Association PA Lensed by agreement for indivicease and downiead on 07/05/20 to Sily Alcomfor designated user Willem Swan. No ciner reproduction or transmission in any Ins NECES All Access subscepton expres on December 29. 2018.
MEDICAL EVALUATIONS OF CANDIDATES 1582-11
Any head condition that results in the candidate not 6.5.2 Category B medical conditions shall include the follow- being able to safely perform one or more of the essential job tasks (1)* Unequal hearing loss
6.3.1.2 Category B medical conditions shall include the follow- (2) Average uncorrected hearing deficit at the test frequen- ing: cies 500 Hz, 1000 Hz, 2000 Hz, and 3000 Hz worse than 40 dB in either ear
(1) * Deformities of the skull such as depressions or exostoses (3) Atresia, stenosis, or tumor of the auditory canal
(2)* Deformities of the skull associated evidence of
(4)* External otitis, recurrent
disease of the brain, spinal cord, or peripheral nerves (5) * Agenesis or traumatic deformity of the auricle (3) * Loss or congenital absence of the bony substance of the (6) * Mastoiditis or surgical deformity of the mastoid skull
(7)* Ménière's disease, labyrinthitis, or tinnitus
6.3.2 Neck. (8)* Otitis media, recurrent
(9) Surgical procedures to correct or improve hearing or
6.3.2.1 Category A medical conditions shall include any neck other conditions of the ear condition that results in the candidate not being able to safely perform one or more of the essential job tasks. 6.6 Dental.
6.3.2.2 Category B medical conditions shall include the follow- 6.6.1 Category A medical conditions shall include any dental ing: condition that results in inability to safely perform one or more (I) * Thoracic outlet syndrome of the essential job tasks. (2)* Congenital cysts, chronic draining fistulas, or similar 6.6.2 Category B medical conditions shall include the follow- lesions ing:
(3) * Contraction of neck muscles (1) * Diseases of the jaws or associated tissues
6.4 Eyes and Vision. (2)* Orthodontic appliances
(3) * Oral tissues, extensive loss
6.4.1 Category A medical conditions shall include the follow- (4) * Relationship between the mandible and maxilla that ing: interferes with satisfactory postorthodontic replacement (1)* Far visual acuity worse than 20/40 binocular, corrected or ability to use protective equipment with contact lenses or spectacles, or far visual acuity worse
6.7 Nose, Oropharynx, Trachea, Esophagus, and Larynx.
than 20/100 binocular for wearers of hard contacts or
spectacles, uncorrected 6.7.1 Category A medical conditions shall include the follow- (2)* Color perception - monochromatic vision resulting in ing:
inability to use imaging devices such as thermal imaging (1)* Tracheostomy cameras
(2)* Aphonia
(3) * Monocular vision
(3) Any nasal, oropharyngeal, tracheal, esophageal, or laryng- (4) Any eye condition that results in the candidate not being eal condition that results in inability to safely perform able to safely perform one or more of the essential job one or more of the essential job tasks, including fit testing tasks
for respirators used by the fire department and SCBA for
6.4.2 Category B medical conditions shall include the follow- fire and hazmat operations ing:
6.7.2 Category B medical conditions shall include the follow- (1) * Diseases of the eye such as retinal detachment, progres- ing:
sive retinopathy, or optic neuritis
(2)* Ophthalmological procedures such as radial keratotomy, (1) * Congenital or acquired deformity (2)* Allergic rhinitis
Lasik procedure, or repair of retinal detachment Epistaxis, recurrent (3) Peripheral vision in the horizontal meridian of less than (4) * Sinusitis, recurrent 110 degrees in the better eve or any condition that signifi. (5) * Dysphonia cantly affects peripheral vision in both eyes (6) Anosmia (4) Amblyopia (7) Tracheal stenosis
6.5* Ears and Hearing. Nasopharyngeal polyposis
(9) * Obstructive apneas (e.g., sleep apnea) if unresponsive to A 6.5.1 Category A medical conditions shall include the follow- treatment ing:
6.8 Lungs and Chest Wall.
(1) Chronic vertigo or impaired balance as demonstrated by the inability to tandem gait walk A 6.8.1 Category A medical conditions shall include the follow- (2) On audiometric testing, without the aid of a hearing assis- ing:
tance device, average hearing loss in the unaided better (1) Active hemoptysis
ear worse than 40 decibels (dB) at 500 Hz, 1000 Hz, (2) Current empyema 2000 Hz, and 3000 Hz when the audiometric device is Pulmonary hypertension (3)
calibrated to ANSI Z24.5, Audiometric Device Testing (4) Active tuberculosis (3) Any ear condition or hearing impairment that results in (5)* A forced vital capacity (FVC) or forced expirator the candidate not being able to safely perform one or volume in 1 second (FEV,) less than 70 percent predic more of the essential job tasks ted even independent of disease Shaded text = Revisions. A = Text deletions and figure/table revisions. • = Section deletions. N= New material. 2018 Edition.
Copych: 2019 Nationa: Fire Protection Association (NFPA Licensed. by agreement, tondividual use and dowmicad on 7/06/2010 to Billy Alcom for designated user Melier Swan No piner reproduction or transmission any for permiated without entten dermision of NEPAC. Foringuiries onto report undulhonged use, contact licensing@nipa org. Tis NECES All Access subscreen expires on December 19. 2019 1582-12 COMPREHENSIVE OCCUPATIONAL MEDICAL PROGRAM FOR FIRE DEPARTMENTS (6)* Obstructive lung diseases (eg., emphysema, chronic (4) * Interstitial lung diseases bronchitis, asthma) with an absolute FEV,/FVC less than (5)* Pulmonary vascular diseases or history of pulmonary
0.70 and with either the FEV, below normal or both the
FEV, and the FVC below normal (i.e., less than 0.80) (see (6)* Bronchiectasis, if abnormal pulmonary function or recur- references in Section F.2) rent infections
(7)* Hypoxemia (7) Infectious diseases of the lung or pleural space rest or exercise desaturation by 4 percent or to less than (8) Cystic fibrosis 90 percent exercise testing indicated when resting (9) Central or obstructive apnea (e.g., sleep apnea) oxygen is less than 94 percent but greater than
90 percent 6.9 Aerobic Capacity.
(8)* Asthma, including reactive airways disease requiring 6.9.1* Category A medical conditions shall include an aerobic bronchodilator or corticosteroid therapy at least once in capacity less than 12 metabolic equivalents (METs) (12 METs = the previous 2 years, unless the candidate can meet the 42 mL Oz/kg/min). requirement in 6.8.1.1
(9) Any pulmonary condition that results in the candidate 6.10 Heart and Vascular System. not being able to safely perform one or more of the 6.10.1 Heart. essential job tasks
(10) Lung transplant 6.10.1.1 Category A medical conditions shall include the (11) Obstructive sleep apnea with excessive daytime sleepi- following:
ness, unless all the following criteria are met: (1) * Clinically significant coronary artery disease, including (1) Successful treatment history of myocardial infarction, angina pectoris, coro- Documentation of compliance with CPAP, for sleep nary artery bypass surgery, coronary angioplasty, and study with an oral appliance, or of sleep study after similar procedures surgery (2)* Cardiomyopathy or congestive heart failure, including (3) No excessive daytime sleepiness with treatment signs or symptoms of compromised left or right ventricu- lar function or rhythm, including dyspnea, S3 gallop,
6.8.1.1* A candidate who has been diagnosed with asthma or peripheral edema, enlarged ventricle, abnormal ejection has in the past required bronchodilator, corticosteroid, or anti- fraction, and/or inability to increase cardiac output with inflammatory therapy (e.g., a leukotriene receptor antagonist, such as montelukast) shall be evaluated by a pulmonologist or (3) * Acute pericarditis, endocarditis, or myocarditis other expert in asthmatic lung diseases, such as an allergist, to (4) * Syncope, recurrent determine if the candidate meets all the following:
(5) * Any medical condition requiring an automatic implanta- (1) The applicant denies bronchospasm during exertion, ble cardiac defibrillator, unless the condition no longer temperature/humidity extremes, or irritant exposures. requires an automatic implantable cardiac defibrillator, (2) The applicant denies the use of bronchodilator rescue or a medical history of ventricular tachycardia or ventric- medications during exertion, temperature/humidity ular fibrillation due to ischemic or valvular heart disease, extremes, or irritant exposures. or cardiomyopathy
(3) The applicant's asthma has not required systemic cortico- Third-degree atrioventricular block steroids, emergency room treatment, or hospital admis- (7) * Cardiac pacemaker, if the applicant is pacemaker- sion in the past 2 years.
(4) Allergen avoidance or desensitization has been successful. Hypertrophic cardiomyopathy, including idiopathic (5) Spirometry demonstrates adequate reserve (FVC and hypertrophic subaortic stenosis FEV, greater than or equal to 90 percent) and no bron- Any cardiac condition that results in the candidate not chodilator response measured off all bronchodilators on being able to safely perform one or more of the essential the day of testing.
(6) Normal or negative response to provocative challenge Heart transplant testing [e.g., cold air, exercise (12 METs), methacholine (PC. greater than 8 is considered normal because A 6.10.1.2 Category B medical conditions shall include the response at dose greater than 8 mg/ml might not be clin- following:
ically significant), histamine, mannitol, or hypertonic (1) * Valvular lesions of the heart, including prosthetic valves saline] or negative response to exercise challenge. (2)* Recurrent supraventricular or atrial tachycardia, flutter,
6.8.1.1.1 Challenge testing shall be performed off all anti- or fibrillation (3) * Left bundle branch block
inflammatory medications (e.g., inhaled or oral steroids, leuko- (4) Second-degree atrioventricular block in the absence of triene receptor antagonists) for 4 weeks preceding the test, off structural heart disease all antihistamines (e.g., oral allergy medications) for 1 week, Sinus pause of more than 3 seconds and off all bronchodilators on the day of testing.
(6) * Ventricular arrhythmia (history or presence of multifo- A 6.8.2 Category B medical conditions shall include the follow- cal PVCs or nonsustained ventricular tachycardia on rest- ing: ing EKG with or without symptoms; history or presence of sustained ventricular tachycardia with or without
(1)* Pulmonary resection surgery, chest wall surgery, and symptoms)
pneumothorax
(2) Pleural effusion (7)* Cardiac hypertrophy
(8) * History of a congenital abnormality
(3)* Fibrothorax, chest wall deformity, and diaphragm abnor- malities (9)* Chronic pericarditis, endocarditis, or myocarditis 2018 Edition Shaded text = Revisions. A = Text deletions and figure/table revisions. • = Section deletions. IN = New material.
Copyagi: 2018 National Fire Protection Assocation (NFPAP: Licensed My afteement, for individual ase and downied on 07/06/2019 to Bily Alcom for designated use Milliam Swan No amer reprodstion or transmission in any Tom pennitted itout watten permission of NEPA forinaumes orto report unauthonzed use, comact feesng@aipsorg This NECES AB Access subscrioton endires on Decenter 19. 2019.
MEDICAL EVALLATIONS OF CANDIDATES 1582-13
(10): Brugada syndrome Diverticulitis
(11) Long QT syndrome (10) * History of gastrointestinal surgery (12) Arrhythmogenic right ventricular cardiomyopathy (11)* Peptic or duodenal ulcer or Zollinger-Ellison syndrome (13) Cardiac pacemaker, if the applicant is not pacemaker- (12)* Asplenia dependent (13) * Cirrhosis, hepatic or biliary
(14) Coronary artery disease, if not covered by 6.10.1.1 (14)* Chronic active hepatitis
6.10.2 Vascular System. 6.12 Metabolic Syndrome.
6.10.2.1 Category A medical conditions shall include the 6.12.1* Category A medical conditions shall include metabolic following: syndrome with aerobic capacity less than 12 METs. (1) Hypertension 6.12.2 Category B medical conditions shall include metabolic (a)* Uncontrolled or poorly controlled hypertension syndrome with aerobic capacity 12 METs or greater. (b) * Hypertension with evidence of end organ damage 6.13 Reproductive System. See B.1.2.1. (2)* Thoracic or abdominal aortic aneurysm
(3) Carotid artery stenosis or obstruction resulting in greater 6.13.1 Category A medical conditions shall include any genital than or equal to 50 percent reduction in blood flow condition that results in inability to safely perform one or more (4)* Peripheral vascular disease resulting in symptomatic clau- of the essential job tasks. dication
(5) Any other vascular condition that results in inability to 6.13.2 Category B medical conditions shall include the follow- safely perform one or more of the essential job tasks ing:
(1)* Pregnancy, for its duration
6.10.2.2 Category B medical conditions shall include the (2) Dysmenorrhea
following: (3) Endometriosis, ovarian cysts, or other gynecologic condi- (1) Vasospastic phenomena such as Raynaud's phenomenon tions (2)* Thrombophlebitis, thrombosis, or varicosities (1) Testicular or epididymal mass (3)* Chronic lymphedema due to lymphadenopathy or venous valvular incompetency 6.14 Urinary System.
(4) * Congenital or acquired lesions of the aorta or major 6.14.1 Category A medical conditions shall include the follow- vessels ing:
(5)* Circulatory instability as indicated by orthostatic hypoten- sion, persistent tachycardia, and (1) Renal failure or insufficiency requiring continuous ambu- peripheral vasomotor
disturbances latory peritoneal dialysis (CAPD) or hemodialysis (6) History of surgical repair of aneurysm of the heart or (2) Any urinary condition that results in the candidate not major vessel being able to safely perform one or more of the essential job tasks
6.11 Abdominal Organs and Gastrointestinal System. (3) Chronic kidney disease of Stage 4 or greater [glomerular filtration rate (GFR) < 1 oz/min (30 ml/min)1
6.11.1 Category A medical conditions shall include the follow-
6.14.2 Category B medical conditions shall include the follow- (1) Presence of uncorrected inguinal/femoral hernia, if ing:
symptomatic (1) Diseases of the kidney
(2) Any gastrointestinal condition that results in the candi- (2) Diseases of the ureter, bladder, or prostate date not being able to safely perform one or more of the essential job tasks 6.15 Spine and Axial Skeleton.
6.11.2 Category B medical conditions shall include the follow- A 6.15.1 Category A medical conditions shall include the follow- ing:
(1) * Cholecystitis
(2) * Gastritis
(3)* GI bleeding
(4) * Acute hepatitis
(5) Hernia including the following: compression
(3) Any spinal or skeletal condition causing pain that
(a) Uncorrected umbilical, ventral, or incisional frequently or recurrently requires narcotic analgesic hernia if significant risk exists for infection or
strangulation (4) Cervical vertebral fractures with multiple vertebral body (b) Significant symptomatic hiatal hernia if associated compression greater than 25 percent; evidence of poste- with asthma, recurrent pneumonia, chronic pain, rior element involvement, nerve root damage, disc or chronic ulcers involvement, dislocation (Le, partial, moderate, severe), (c)* Surgically corrected hernia more than 3 months abnormal exam, ligament instability, symptomatic, after surgical correction and/or less than 6 months post injury or less than 1 year (6) * Inflammatory bowel disease or irritable bowel syndrome since surgery (7) * Intestinal obstruction
(8) * Pancreatitis
Shaded text = Revisions. A = Text deletions and figure/table revisions. • = Section deletions. N = New material. 2018 Edition Copyrigh: 2019 Nationa: Fire Protection Associetion (SPA6 Licensed. by pereement, for individual use and contad on 07/06/2018 to Bily Alcom for designated user Willem Swer No omer reproducion or transmission in ary fore perited wiet water permission eNFP. Foringues orto repom unauthonzed use. [email protected] Enis NFOSE All Access subscripton expires on December 1* 2013. 1582-14 COMPREHENSIVE OCCUPATIONAL MEDICAL PROGRAM FOR FIRE DEPARTMENTS (5) Thoracic vertebral fractures with vertebral body compres- (c) At least 6 months of prosthetic use in a variety of sion greater than 50 percent; evidence of posterior activities with no functional difficulties element involvement. nerve root damage, disc involve- (d) Amputee limb healed with no significant inflamma- ment, dislocation (eg, severe — with or without tion, persistent pain, necrosis, or indications of surgery), abnormal exam, ligament instability, sympto- instability at the amputee limb attachment point matic, and/or less than 6 months post injury or less than No significant psychosocial issues pertaining to the 1 year since surgery loss of limb or use of prosthesis
Lumbosacral vertebral fractures with vertebral body Evaluated by a prosthetist or orthopedic specialist compression greater than 50 percent; evidence of poste- with expertise in the fitting and function of pros- rior element involvement, nerve root damage, thetic limbs who concurs that the candidate involvement, dislocation (ie., partial, moderate, severe), complete all essential job tasks listed in Chapter 5, fragmentation, abnormal exam, ligament instability, including wearing personal protective ensembles symptomatic, and/or less than 6 months post injury or and SCBA while climbing ladders, operating from less than 1 year since surgery heights, and walking or crawling in the dark along History of spine surgery or injury that results in the candi- narrow and uneven surfaces that may be wet or icy date not being able to safely perform one or more of the Has passed the department's applicant physical abil- essential job tasks ity test as a condition of appointment without accommodations or modification of the protocol
6.15.2 Category B medical conditions shall include the follow- Chronic nonhealing or recent bone grafts History of more than one dislocation of shoulder without (1) Congenital or developmental malformations of the back, surgical repair or with history of recurrent shoulder disor- particularly those that can cause instability, neurological ders within the last 5 vears with pain or loss of motion, deficits, pain, or limit flexibility and with or without radiographic deviations from normal Scoliosis with angle less than 40 degrees Any extremity condition that results in the candidate not Arthritis of the cervical, thoracic, or lumbosacral spine being able to safely perform one or more of the essential Facet tropism, high lumbosacral angle, hyperlordosis,
Schmorl's nodes, Scheuermann's disease, spina bifida
occulta, spondylolisthesis, spondylolysis, or transitional 6.16.2 Category B medical conditions shall include the follow- vertebrae
(5) History of infections or infarcts in the spinal cord, (1)* History of shoulder dislocation with surgical repair epidural space, vertebrae, or axial skeletal joints Significant limitation of function of shoulder, elbow, (6) History of diskectomy or laminectomy or vertebral frac- wrist, hand, or finger due to weakness, reduced range of tures motion, atrophy, unequal length, absence, or partial
6.16 Extremities. Significant lack of full function of hip, knee, ankle, foot, A 6.16.1 Category A medical conditions shall include the follow- or toes due to weakness, reduced range of motion, atro- ing: phy, unequal length, absence, or partial amputation (4)* History of meniscectomy or ligamentous repair of knee (1) Joint replacement, unless all the following conditions are (5) * History of intra-articular, malunited, or nonunion of upper or lower extremity fracture
(a) Normal range of motion without history of disloca- (6) * History of osteomyelitis, septic, or rheumatoid arthritis tions post-replacement (7) Bone hardware such as metal plates or rods supporting (b) Repetitive and prolonged pulling, bending, rota- bone during healing tions, kneeling, crawling, and climbing without pain
or impairment 6.17 Neurological Disorders.
(c) No limiting pain 6.17.1 Category A medical conditions shall include the follow- (d) Evaluation by an orthopedic specialist who concurs ing:
that the candidate can complete all essential job
tasks listed in Chapter 5 (1) All single unprovoked seizures and epileptic conditions, (2) Amputation or congenital absence of upper extremity including simple partial, complex partial, generalized, limb (hand or higher) and psychomotor seizure disorders other than the seiz- (3) Amputation of either thumb proximal to the mid- ure disorders meeting all of the following conditions:
proximal phalanx (a) No seizures for the most recent consecutive 5 years Amputation or congenital absence of lower extremity after single unprovoked seizure limb (foot or above) unless the candidate meets all of the (b) No seizures for the most recent consecutive 10 following conditions: years if the applicant was diagnosed with epilepsy Stable, unilateral below-the-knee (BKA) amputation (C) Currently on a stable regimen of antiepileptic (a)
with at least the proximal third of the tibia present drugs for the most recent 5 years, or on no antiepi- for a strong and stable attachment point with the leptic drugs for the most recent 5 years (d) Normal neurological examination results
prosthesis
Fitted with a prosthesis that will tolerate the condi- (e) Normal brain MRI results (b)
tions present in fire fighting when worn in conjunc- (f) Normal awake and asleep photic stimulation and tion with standard fire-fighting PPE hyperventilation EEG study results (g) A definitive statement from a qualified neurologi-
cal specialist that the candidate meets the criteria
2018 Edition Shaded text = Revisions. A = Text deletions and figure/table revisions. • = Seccion deletions. N = New material.
Depyright 2019 Natiena: Fire Protection Assocstion (NFPA). Lensed by agreement, for individa use and downinad on 07/06/2010ie Pily Alconfe deaignated user Willen: Swan No otner reproduction or transmission in any ion pennuted wotout waiters permiasion CNEPAS Forneunes ortorepon unauthmazed ute contact lemang@eipalong This NFC3S AR Access Ripsopion expires on December 19, 2019.
MEDICAL. EVALUATIONS OF CANDIDATES 1582-15
specified in 6.17.1 (d) and is neurologically cleared (6) * Scleroderma (skin) for fire fighting training and the performance of a (7) * Vasculitic skin lesions fire fighter's essential job task (8)* Atopic dermatitis/eczema (2) Ataxias of heredo-degenerative type (9) * Contact or seborrheic dermatitis (3) Cerebral arteriosclerosis as evidenced by a history of (10) * Stasis dermatitis transient ischemic attack, reversible ischemic neurologi- (11) * Albinism, Darier's disease, ichthyosis, Marfan syndrome, cal deficit, or ischemic stroke neurofibromatosis, and other genetic conditions (4) Hemiparalysis or paralysis of a limb (12)* Folliculitis, pseudo-folliculitis, miliaria, keloid folliculitis (5)* Multiple sclerosis with activity or evidence of progression (13)* Hidradenitis suppurativa, furuncles, carbuncles, or within the previous 3 years Grade IV acne (cystic)
(6) * Myasthenia gravis with activity or evidence of progres- (14) * Mechano-bullous disorders (epidermolysis bullosa, sion within the previous 3 years Hailey pemphigus, porphyria, pemphigoid) (7) Progressive muscular dystrophy or atrophy (15)* Urticaria or angioedema Uncorrected cerebral aneurysm
Dementia (e.g., Alzheimer's and other neurodegenera- 6.19 Blood and Blood-Forming Organs. tive diseases) with symptomatic loss of function or cogni- 6.19.1 Category A medical conditions shall include the follow- tive impairment (e.g., less than or equal to 28 on Mini- ing:
Mental Status Exam)
Parkinson's disease and other movement disorders (1) Hemorrhagic states requiring replacement therapy resulting in uncontrolled movements, bradykinesia, or (2) Sickle cell disease (homozygous) cognitive impairment (e.g., less than or equal to 28 on (3) Clotting disorders Mini-Mental Status Exam) (4) Any hematological condition that results in inability to (11) Narcolepsy with cataplexy safely perform one or more of the essential job tasks (12) Narcolepsy with persistent excessive daytime sleepiness 6.19.2 Category B medical conditions shall include the follow- despite medical treatment ing:
(13) & Amyotrophic lateral sclerosis (ALS)
(14) (1) Anemia
Any neurological condition that results in the candidate (2) Leukopenia
not being able to safely perform one or more of the
essential job tasks (3) Polycythemia vera
(4) Splenomegaly
6.17.2 Category B medical conditions shall include the follow- (5) History of thromboembolic disease (6) Any other hematological condition that results in inability (1) Congenital malformations to safely perform essential job tasks (2)* Migraine 6.20 Endocrine and Metabolic Disorders.
(3) Clinical disorders with paresis, dyscoordination, deform- ity, abnormal motor activity, abnormality of sensation, or A 6.20.1 Category A medical conditions shall include the follow- complaint of pain ing:
(4) History of subarachnoid or intraparenchymal hemor- (1) * Type 1 diabetes mellitus, unless a candidate meets all of rhage the following criteria:
(5) Abnormalities from recent head injury such as severe cerebral contusion or concussion (a) Is maintained by a physician knowledgeable in current management of diabetes mellitus on a
(6) Provoked seizure 03632591033
basal/bolus (can include subcutaneous insulin infu-
6.18 Skin. sion pump) regimen using insulin analogs.
(b) Has demonstrated over a period of at least 6 months
6.18.1 Category A medical conditions shall include the follow- the motivation and understanding required to ing: closely monitor and control capillary blood glucose (1) Metastatic or locally extensive basal or squamous cell levels through nutritional therapy and insulin carcinoma or melanoma administration. Assessment of this shall take into (2) Any dermatologic condition that would not allow for a consideration the erratic meal schedules, sleep successful fit test for any respirator required by the fire disruption, and high aerobic and anaerobic work- loads intrinsic to fire fighting.
(3) Any dermatologic condition that results in the candidate (c) Has a dilated retinal exam by a qualified ophthal- not being able to safely perform one or more of the mologist or optometrist that shows no higher grade essential job tasks of diabetic retinopathy than microaneurysms, as indicated on the International Clinical Diabetic
6.18.2 Category B medical conditions shall include the follow- Retinopathy Disease Severity Scale. ing: (d) Has normal renal function based on a calculated conditions of a chronic or recurrent nature creatinine clearance greater than 60 mL/min and (eczema, cystic acne, psoriasis) that cause skin openings absence of proteinuria. (Creatinine clearance can or inflammation or irritation of the skin surface be calculated by use of the Cockroft-Gault or similar (2) * Surgery or skin grafting formula. Proteinuria is defined as 24-hour urine (3) * Mycosis fungoides excretion of greater than or equal to 300 mg (4)* Cutaneous lupus erythematosus protein or greater than or equal to 300 mg of albu- (5) * Raynaud's phenomenon min per gram of creatinine in a random sample.) Shaded text = Revisions. A = Text deletions and figure/table revisions. • = Section deletions. N = New material. 2018 Edition Copyright 2010 National Fire Pretection Association: (NFPA@) Licensed by agreement, for indivista use and download on 07/06/201910 Bily Aicom for designated user willar Swan No other repruckon or mansission in any tom perited wahout waiter pormission of NFPAR. Fe indunes orto repon unauthenzed use. contact scene [email protected] Inis NFOSS All Access subscripson expires on December 19, 2019 1582-16 COMPREHENSIVE OCCUPATIONAL MEDICAL PROGRAM FOR FIRE DEPARTMENTS (e) Has no autonomic peripheral neuropathy. be calculated by use of the Cockrofi-Gault or similar (Peripheral neuropathy is determined by dimin- formula. Proteinuria is defined as 24-hour urinc ished ability to feel the vibration of a 128 cps tuning excretion of greater than or equal to 300 mg fork or the light touch of a 10 gram monofilament protein or greater than or equal to 300 mg of albu- on the dorsum of the great toe proximal to the nail. min per gram of creatinine in a random sample.) Autonomic neuropathy might be determined by Has no autonomic or peripheral neuropathy. evidence of gastroparesis, postural hypotension, or (Peripheral neuropathy is determined by dimin- abnormal tests of heart rate variability.) ished ability to feel the vibration of a 128 cps tuning (f) Has normal cardiac function without evidence of fork or the light touch of a 10 gram monofilament myocardial ischemia on cardiac stress testing (to at on the dorsum of the great toe proximal to the nail. least 12 MET) by ECG and cardiac imaging. determined by (g) Has a signed statement and medical records from evidence of gastroparesis, postural hypotension, or an endocrinologist or a physician with demonstra- abnormal tests of heart rate variability.) ted knowledge in the current management of diabe- (f) Has normal cardiac function without evidence of tes mellitus as well as knowledge of the essential job myocardial ischemia on cardiac stress testing (to at tasks and hazards of fire fighting as described in least 12 METS) by ECG and cardiac imaging.
5.1.1, allowing the fire department physician to Has a signed statement and medical records from determine whether the candidate meets the follow- an endocrinologist or a physician with demonstra- ted knowledge in the current management of diabe-
tes mellitus as well as knowledge of the essential job
Is being successfully maintained on a regimen
consistent with 6.20.1(1) (a) and 6.20.1(1) (b). tasks and hazards of fire fighting as described in Has had hemoglobin AlC measured at least 5.1.1, allowing the fire department physician to determine whether the candidate meets the follow-
four times a year (intervals of 2 to 3 months)
over the last 12 months prior to evaluation if
the diagnosis of diabetes has been present Is maintained on a stable insulin regimen and over 1 year. A hemoglobin AlC reading of has demonstrated over a period of at least 8 percent or greater shall trigger a medical 3 months the motivation and understanding evaluation to determine if a condition exists in required to closely monitor and control capil- addition to diabetes that is responsible for the lary blood glucose levels despite varied activity hemoglobin AlC not accurately schedules through nutritional and average glucose levels.
evidence of a set schedule for blood glucose Has had hemoglobin AlC measured at least monitoring and a thorough review of data four times a year (intervals of 2 to 3 months) from such monitoring over the last 12 months prior to evaluation if Does not have an increased risk of hypoglyce- the diagnosis of diabetes has been present mia due to alcohol use or other predisposing over 1 year. A hemoglobin AIC reading of 8 percent or greater shall trigger a medical
Has had no episodes of severe hypoglycemia evaluation to determine if a condition exists in (defined as requiring assistance of another) in addition to diabetes that is responsible for the the preceding 1 year, hemoglobin AIC not accurately reflecting severe hypoglycemia average glucose levels.
preceding 3 years. evidence of a set schedule for blood glucose Is certified not to have a medical contraindica- monitoring and a thorough review of data tion to fire-fighting training and operations. from such monitoring. (2) Insulin-requiring Type 2 diabetes mellitus, unless a candi- Does not have an increased risk of hypoglyce- date meets all of the following criteria: mia due to alcohol use or other predisposing (a) Is maintained by a physician knowledgeable in
current management of diabetes mellitus. iv.* Has had no episodes of severe hypoglycemia (defined as requiring assistance of another) in
He demonsian and a period at eamed to the preceding 1 year, with no more than two closely monitor and control capillary blood glucose severe hypoglycemia levels through nutritional therapy preceding 3 years
administration. Assessment of this shall take into Is certified not to have a medical contraindica- consideration the erratic schedules, sleep tion to fire-fighting training and operations. disruption, and high aerobic and anaerobic work- Any endocrine or metabolic condition that results in the loads intrinsic to fire fighting. candidate not being able to safely perform one or more Has a dilated retinal exam by a qualified ophthal- of the essential job tasks mologist or optometrist that shows no higher grade 6.20.2 Category B medical conditions shall include the follow- of diabetic retinopathy than microaneurysms, as
indicated on the International Clinical Diabetic
Retinopathy Disease Severity Scale. 1) * Diseases of the adrenal gland, pituitary gland, parathy roid gland, or thyroid gland of clinical significanc
renal function based on a calculated
creatinine clearance greater than 60 mL/min and Nutritional deficiency diseases or other metabolic disor- absence of proteinuria. (Creatinine clearance can
2018 Edition Shaded text = Revisions. 4 = Text deletions and figure/table revisions. • = Section deletions. N= New material.
Copyright 2019 Nationa: Fire Profection Asscastion (NSPA) Licenser, by agreement for individua' ase and downtoad on 07062019 to Bly Acon for designated user William Swan No ather reproduction or iransmission in any fore permitted without wallen permission of NED foringuines orto report unauteneed dee, confect hersaara mo This Nº CES AR Access subscripton sapres on Decumber 19, 2019.
MEDICAL EVALUATIONS OF CANDIDATES 1582-17
(3) Diabetes mellitus, not on insulin therapy, but controlled to the increased risk for reoccurrence, unless not interfer- by diet, exercise, and/or oral hypoglycemic agents unless ing with the performance of the essential job tasks all of the following are met: (2) Any tumor or similar condition that results in the candi- Has had hemoglobin AlC measured at least four date not being able to safely perform one or more of the times a year (intervals of 2 to 3 months) over the essential job tasks last 12 months prior to evaluation if the diagnosis of 6.22.2 Category B medical conditions shall be evaluated on diabetes has been present over 1 year. A hemoglo- the basis of an individual's current physical condition and on bin AlC reading of 8 percent or greater shall trig- the staging and prognosis of the malignancy (i.e., likelihood ger a medical evaluation to determine if a condition that the disease will recur or progress), and include the follow- exists in addition to diabetes that is responsible for ing:
the hemoglobin AlC not accurately reflecting aver-
age glucose levels. This shall include evidence of a (1)* Benign tumors set schedule for blood glucose monitoring and a (2)* History of CNS tumor or malignancy thorough review of data from such monitoring. (3)* History of head and neck malignancy If on oral hypoglycemic agents, has had no episodes (4)* History of lung cancer of severe hypoglycemia (defined as requiring assis- (5)* History of GI or GU malignancy tance of another) in the preceding year. (6) * History of bone or soft tissue tumors or malignancies Has a dilated retinal exam by a qualified ophthal- (7)* History of hematological malignancy mologist or optometrist that shows no higher grade 6.23 Psychiatric Conditions. than microaneurysms, as
indicated on the International Clinical Diabetic 6.23.1 Category A medical conditions shall include any psychi- Retinopathy Disease Severity Scale. atric condition that results in the candidate not being able to Has normal renal function based on a calculated safely perform one or more of the essential job tasks. creatinine clearance greater than 60 mL/min and 6.23.2 Category B medical conditions shall include the follow- absence of proteinuria. (Creatinine clearance can ing:
be calculated by use of the Cockroft-Gault or similar
formula. Proteinuria is defined as 24-hour urine (1) A history of psychiatric condition or substance abuse than or equal to 300 mg problem
protein or greater than or equal to 300 mg of albu- Requirement for medications that increase an individual's min per gram of creatinine in a random sample.) risk of heat stress, or other interference with the ability to peripheral neuropathy. safely perform essential job tasks (Peripheral neuropathy is determined by dimin- 6.24 Chemicals, Drugs, and Medications. ished ability to feel the vibration of a 128 cps tuning fork or the light touch of a 10 gram monofilament 6.24.1 Category A medical conditions shall include those that on the dorsum of the great toe proximal to the nail. require chronic or frequent treatment with any of the following medications or classes of medications:
evidence of gastroparesis, postural hypotension, or (1) Narcotics, including methadone abnormal tests of heart rate variability.)
(2) Sedative-hypnotics
(3)* Full-dose or low-dose anticoagulation medications or any myocardial ischemia on cardiac stress testing (to at
drugs that prolong prothrombin time (PT), partial
least 12 METs) by ECG and cardiac imaging. chromboplastin time (PTT), or international normalized
6.21 Systemic Diseases and Miscellaneous Conditions. ratio (INR) (1) Beta-adrenergic blocking agents at doses that prevent a
6.21.1 Category A medical conditions shall include any normal cardiac rate response to exercise, high-dose systemic condition that results in the candidate not being able diuretics, or central acting antihypertensive agents (e.g., to safely perform one or more of the essential job tasks. clonidine)
6.21.2 Category B medical conditions shall include the follow- (5)* Respiratory medications: inhaled bronchodilators, inhaled corticosteroids, systemic corticosteroids, theo phylline, and leukotriene receptor antagonists (e.g.,
(1) Connective tissue disease, such as dermatomyositis, montelukast) systemic lupus erythematosus, scleroderma, and rheuma- (6) High-dose corticosteroids for chronic disease toid arthritis Anabolic steroids
(2)* History of thermal, chemical, or electrical burn injury Any chemical, drug, or medication that results in the with residual functional deficit candidate not being able to safely perform one or more (3) Documented evidence of a predisposition to or history of of the essential job tasks heat illness, rhabdomyolysis, metabolic acidosis, or
exertion-related incapacitation 6.24.1.1 Tobacco use shall be a Category A medical condition (where allowed by law).
6.22 Tumors and Malignant Diseases.
6.24.1.2 Evidence of illegal drug use detected through testing,
6.22.1 Category A medical conditions shall include the follow- conducted in accordance with Substance Abuse and Mental ing: Health Service Administration (SAMHSA), shall be a Category (1) Malignant disease that is newly diagnosed, untreated, or A medical condition. currently being treated, or under active surveillance due Shaded text = Revisions. A = Text deletions and figure/table revisions. • = Section deletions. N = New material. 2018 Edition Copyright 2019 Nationa: Fire Protection Asacciation: (FPA@ Licensed, by agreement, for indivich use and downinad on 7/06:2010 to Bily Alcom or designated user Wham Swan No other reproduch on o transmission in any tora pernited wihoul witler permission of NEPAD Forinquines onto report unauthenzed ute contact icensing @hmpa org ns NECES Al Access dubstrpton expres on Decerator 19, 2019 1582-18 COMPREHENSIVE OCCUPATIONAL MEDICAL PROGRAM FOR FIRE DEPARTMENTS
6.24.1.3 Evidence of clinical intoxication or a measured blood Providing members with information and education alcohol level that exceeds the legal definition of intoxication about occupational hazards according to the AHJ at the time of medical evaluation shall be Providing a cost-effective investment in work-related a Category A medical condition. disease prevention, early detection, and health promo- tion for members
6.24.2* Category B medical conditions shall include the use of (8) Complying with federal, state, provincial, local, and/or the following: other jurisdictional requirements
(1) Cardiovascular agents
7.3 Timing of the Annual Occupational Medical Evaluation of (2) Stimulants
Members.
(3) Psychiatric medications
(4) Other than high-dose systemic corticosteroids 7.3.1 All members shall receive a baseline medical evaluation Antihistamines after hiring and prior to performing fire fighter emergency (6) Muscle relaxants functions and at least annually thereafter. (7) Leukotriene receptor antagonists (e.g., montelukast) used for allergies that do not affect the lower respiratory 7.3.2 The baseline medical evaluation shall include the system components of the annual occupational medical evaluation not performed as part of the candidate medical evaluation, provi- ded the candidate medical evaluation was performed within Chapter 7 Occupational Medical Evaluation of Members the past 12 months.
7.1 General. 7.3.3 The annual evaluation shall be completed every 12 months (+3 months).
7.1.1 The fire department shall establish and maintain a confi- dential occupational medical evaluation program for members. 7.3.4 Annual medical evaluations shall be compared to base- line and subsequent evaluations to identify clinically relevant
7.1.2 Occupational medical evaluations shall be conducted as changes. a baseline for surveillance and annually thereafter.
7.3.5 The interval requirements for performance of the
7.1.3* An occupational medical evaluation shall be performed annual occupational medical evaluation shall not preclude following a member's occupational exposure, illness, injury, or more frequent medical evaluations of members for new or protracted absence from the job. recurring conditions when requested by the member, fire department physician, or AHJ.
7.1.3.1 The scope of that evaluation shall be determined by the fire department physician after reviewing the type and 7.4 Components of the Annual Occupational Medical Evalua- severity of the condition. tion of Members.
7.1.4 The components of the medical evaluations shall 7.4.1 All components listed in Section 7.5 through Section 7.7 conform to all applicable U.S. OSHA standards, including shall be included in the baseline and annual occupational 29 CFR 1910.120, "Hazardous waste operations and emergency medical evaluations of members. response"; 29 CFR 1910.134, "Respiratory protection"; 29 CFR 1910.95, "Occupational exposure"; and 29 CFR 7.4.2 It shall be acceptable for certain components of the 1910.1030, "Bloodborne pathogens." annual occupational medical evaluation to be performed by a member's private physician, provided full results are forwarded
7.2 Member Education Regarding Occupational Medical Eval- in the required time frame to the fire department physician. uation Program.
7.4.3 Each medical evaluation shall include a medical history
7.2.1 The fire department, the fire department physician, and (including exposure history), physical examination, blood member organizations where they exist shall be responsible to tests, urinalysis, vision tests, audiograms, spirometry, chest x-ray convey the purposes and importance of the annual occupa- (as indicated), ECG, cancer screening (as indicated), and tional medical evaluation to members and to the AHJ. immunizations and infectious disease screening (as indicated).
2.2 The purpose of the annual occupational medical evalua 7.4.4 Tests for illegal drugs shall not be performed as part of ion of members shall include but cannot be limited to th the annual medical evaluation. following:
7.5 Medical History.
( Thesial or mental anity to intely per vi essenia ers 7.5.1* A medical history questionnaire shall be completed by tasks without undue risk of harm to self or others each member to provide baseline information with which to (2) Monitoring the effects of exposure to specific biological, compare future medical concerns. physical, or chemical agents on individual members
(3) Detecting changes in a member's health that can be rela- 7.5.2 An annual medical history questionnaire, which includes ted to harmful working conditions changes in health status and known occupational exposures (4) Detecting patterns of disease or injury occurrence in the since the previous annual evaluation, shall be completed by workforce that could indicate underlying work-related each member to provide follow-up information. problems 7.5.3 Information on the questionnaire and interval concerns (5)* Providing members with information about their current shall be reviewed with each member by the fire department health, promoting wellness, and referring them for physician or designated medical evaluator. appropriate further evaluation and treatment
2018 Edition Shaded text = Revisions. A = Text deletions and figure/table revisions. • = Section deletions. N= New material.
Copyright 2010 Nationa: Fire Prefection Association NEPALensed, by agreement, for individual use and downind on 07/06/2019t Billy Alcern for designated user William Swan No orner reproduction or transmission in arty form peerited witoet watter permission of MEDRO, Formales onto report chautionzed use. contact licensing@niperore This NORS Al Access subscration expires on Gecember 19, 2019 OCCUPATIONAL. MEDICAL EVALUATION OF MEMBERS 1582-19
7.6 Physical Examination. The annual physical examination 7.7.4 Spirometry. shall include each of the following components:
7.7.4.1* Pulmonary function testing (spirometry) shall be (1) Vital signs [temperature, pulse, and respiratory rate, and conducted annually to measure the member's forced vital blood pressure (BP)] capacity (FVC), forced expiratory volume in 1 second (FEV,), (a) BP shall be measured according to the recommen- and the absolute FEV,/FVC ratio. dations of the Seventh Report of the Joint National
Committee on Prevention, Detection, Evaluation, and 7.7.4.2 The fire department physician or other qualified medi- Treatment of High Blood Pressure (JNC 7) cal evaluator shall compare spirometry results obtained during (2) Head, eyes, ears, nose, and throat (HEENT) yearly evaluations with baseline and subsequent test results. (3) Neck 7.7.4.3* FEV, and FVC results shall be expressed as the abso- (4) Cardiovascular lute value (liters or milliliters) and as percent predicted adjus- (5) Pulmonary ted for gender, age, height, and ethnicity using NHANES III (6) normative equations.
(7) Gastrointestinal with digital rectal exam as clinically indi-
7.7.5 Chest Radiographs.
(8) Hernia
A 7.7.5.1 Chest x-rays shall include an initial baseline and shall (9) Lymph nodes
be repeated as medically indicated.
(10) Neurological
(11) Musculoskeletal 7.7.5.2 The fire department physician or other qualified medi- (12)* Skin (includes screening for cancers) cal evaluator shall compare any chest radiographs with baseline (13) Vision and subsequent radiographs.
7.7 Ancillary Tests. 7.7.6 Electrocardiograms (ECGs).
A 7.7.1* Blood Tests. Blood tests shall be performed for fire 7.7.6.1 A resting 12 lead ECG shall be performed as part of fighters, at minimum, every three years for those under the age the baseline medical evaluation and shall be performed annu- of 40, and every year for those over the age of 40, and shall ally after age 40 or as clinically indicated. include the following:
7.7.6.2 The fire department physician or other qualified medi- (1) CBC with differential, RBC indices and morphology, and cal evaluator shall compare baseline and subsequent ECGs. platelet count
(2) Electrolytes (Na, K, CI, HCO,, or CO,) 7.7.6.3 The fire department physician or other qualified medi- (3) Renal function (BUN, creatinine) cal evaluator shall compare baseline and subsequent stress (4) Glucose tests, when available, to identify clinically relevant changes. 5) Liver function tests (ALT, AST, direct and indirect biliru- N 7.7.7 Risk Stratification. bin, alkaline phosphatase)
(6) Total cholesterol, HDL, LDL, clinically useful lipid ratios N 7.7.7.1 Asymptomatic fire fighters 40 years of age or older (e.g., percent LDL), and triglycerides with no known atherosclerotic cardiovascular disease (ASCVD) shall be assessed annually for their 2-year and 10-year risks of
7.7.2 Urine Laboratory Tests. The urine laboratory tests ASCVD, defined as coronary death, nonfatal myocardial infarc- required shall include the following: tion, or fatal or nonfatal stroke. (1) Dipstick analysis for glucose, ketones, leukocyte esterase, protein, blood, and bilirubin N 7.7.7.2 Asymptomatic fire fighters younger than 40 years of (2) Microscopic analysis for RBC, WBC, casts, and crystals if age known to be at high risk for ASCVD shall be assessed for indicated by results of dipstick analysis coronary artery disease. (3) Analysis for occupational chemical exposure if indicated N 7.7.7.3 The 10 year Heart Risk Calculator created by the American College of Cardiology/American Heart Association (ACC/AHA) shall be used to generate a 10-year risk of ASCVD, taking into consideration the individual's age, sex, race, total (1) 500 Hz cholesterol, high density lipoprotein (HDL) cholesterol, (2) 1000 Hz systolic blood pressure, blood pressure-lowering medication (3) 2000 Hz use, diabetes status, and smoking status.
(4) 3000 Hz.
(5) 4000 Hz N 7.7.7.3.1* Intermediate Risk.
(6) 6000 Hz N 7.7.7.3.1.1 Those assessed as being at intermediate risk (i.e., (7) 8000 Hz
10 to <20 percent risk of ASCVD over the next 10 years) shall
7.7.3.1 The fire department physician or other qualified medi- be further evaluated using symptom-limiting exercise stress test- al evaluator shall compare audiogram results obtained durin ing (EST) with or without imaging [e.g., echocardiography, early evaluations with baseline and subsequent test result technetium (*Tc) sestamibi study] to at least 12 METs.
7.7.3.2 Standard threshold shifts shall be corrected for age as N 7.7.7.3.1.2 Negative ESTs shall be repeated at least every 2 to 5 permitted by OSHA. years or as clinically indicated, and positive tests shall be refer- red to a cardiologist for further evaluation and treatment.
Shaded text = Revisions. A = Text deletions and figure/table revisions. • = Section deletions. N = New material. 2018 Edition Copyngh: 2019 National Fire Prefection Association (NFDAF) Licensed, by agreement, turnedpal use and download on 07206/2019 te Billy Astor for designated user Wisr 3wan No ether nepred chen or hansmasion in any for permited with cut ritten parlesson eNFPAC. For inquires onto report unauthonzed ute. contact kameng@nine org Tire NECES AR Acossa buoson sores on Dacemon 19. 2018 1582-20 COMPREHENSIVE OCCUPATIONAL MEDICAL PROGRAM FOR FIRE DEPARTMENTS N 7.7.7.3.2 High Risk. Those assessed as being at high risk (i.e., 7.7.9.1 Pre-screening and immunization against biological ≥20 percent risk of ASCVD over the next 10 years) shall be threat agents shall be made available to members following referred to a cardiologist for further evaluation and treatment. CDC guidelines or recommendations.
N 7.7.7.4* The Framingham Heart Study 2-year risk prediction 7.7.9.2* All members shall be offered immunizations against score sheets shall be used to generate a 2-year risk of ASGVD, infections diseases as required by the AHJ and by 29 CFR using all of the factors described in 7.7.7.3 except race. 1910.1030, "Bloodborne Pathogens." N 7.7.7.4.1 Intermediate Risk. Those assessed as being at inter- 7.7.9.3 The fire department physician shall ensure that all mediate risk (i.e., 2 to 1 percent risk of ASCVD over the next 2 members are offered currently recommended immunizations. years) shall follow the same evaluation in 7.7.7.3.1. 7.7.10 Post-Exposure Bloodborne Pathogen Testing.
N 7.7.7.4.2 High Risk. Those assessed as being at high risk (i.e., 7.7.10.1 Physicians who care for members shall follow current ≥4 percent risk of ASCVD over the next 2 years) shall be refer- CDC recommendations for post-exposure prophylaxis (PEP) red to a cardiologist for further evaluation and treatment. for bloodborne pathogen (BBP) exposures.
7.7.8 Mammography.
7.7.10.2* There shall be a written protocol for members who 4 7.7.8.1 Mammography shall be performed on each female present with BBP exposures. member bi-annually for those over the age of 40 and annually 7.7.11 HIV Testing. HIV testing shall be offered on a confi- for those over the age 50 or as clinically indicated.
dential basis as part of post-exposure protocols and as reques-
7.7.8.2 A qualified radiologist shall compare mammograms to ted by the fire department physician or member. prior mammograms.
7.7.11.1 All results from HIV tests shall be provided directly to
7.7.8.3 The fire department physician shall compare the member and shall be maintained by the physician as confi- mammography reports to prior reports. dential documents.
A 7.7.9 Immunizations and Infectious Disease Screening. The 7.7.11.2 Results from HIV tests shall not be forwarded to any following infectious disease immunizations or infectious local, state, provincial, national, or international authorities or disease screenings shall be provided, as indicated: databases unless mandated by public health statutes. (1) * Tuberculosis (TB) screening — baseline, by either tuber- 7.7.12 Heavy Metal Evaluation. culin skin testing using the tuberculin purified protein derivative (PPD) or the tuberculin blood test (interferon 7.7.12.1 Baseline testing for heavy metals shall be required gamma release assay); subsequent tuberculosis screening when indicated by known exposure or substantial risk. to be performed annually or at a frequency according to 7.7.12.2 Evaluations shall be performed following known CDC guidelines unless the member has a history of posi- exposures, for recurrent exposures, or where required under tive tuberculin screening test, in which case CDC guide- federal, state, or provincial regulations. radiographic surveillance apply 7.7.13 Colon Cancer Screening.
Hepatitis C virus screening — baseline and following
7.7.13.1 Fecal occult blood testing risks and benefits shall be Hepatitis B virus vaccinations and titers — as specified in discussed with all members above the age of 40, or earlier if clinically indicated.
CDC guidelines, laboratory confirmation of immunity to
be tested 1-2 months after completion of the vaccina- 7.7.13.2* Colonoscopy services shall be recommended to all members above the age of 50, or earlier if clinically indicated (4) * Tetanus/diphtheria /pertussis (Tap) vaccine - can be and repeated at regular intervals. given once to replace the Td booster every 10 years or
the 5-year wound management Td dose 7.7.14* Prostate Cancer. Due to increased prostate cancer (5) * Measles, mumps, rubella vaccine (MMR) - in absence risk, the fire department physician shall discuss the risks and of documented immunity, two doses of MMR to be benefits of prostare cancer screening. including prostate- administered according to current immunization guide, specific antigen (PSA) testing, with all male fire fighters begin- ning at age 50 and annually thereafter.
Polio vaccine - a single booster of IPV for members
N 7.7.14.1 For male fire fighters of African-American heritage areas in the line of duty, or as
who are at a higher risk for prostate cancer, the physician shall outlined in the Morbidity and Mortality Weekly Report arti- discuss the risks and benefits of prostate cancer screening, "Poliomyelitis Prevention in the United States: including PSA testing, beginning at age 40 and annually there- Updated Recommendations of the Advisory Committee
on Immunization Practices (ACIP)"
(7) Hepatitis A vaccine N 7.7.15 Lung Cancer Screening.
Varicella vaccine — offered to all non-immune person-
N 7.7.15.1 Low-dose computed tomography (LDCT) shall be (9) Influenza vaccine (seasonal and novel) - offered to all performed annually on fire fighters over the age of 55 who have a 30-pack-a-year smoking history and currently smoke or personnel annually
(10) HIV screening — available to all personnel have quit within the past 15 years.
N 7.7.15.2 Screening shall be discontinued once a fire fighter has not smoked cigarettes for 15 years or is too ill to benefit. 2018 Edition Shaded text = Revisions. A = Text deletions and figure/table revisions. • = Section deletions. N. = New material.
Copgn: 2019 Natiena Fire Protection Association: INFPA Licensed By agreement. for indivictatuse and download on 07/06/2018 to Billy Arom for designated user William Swan. No omer reproduction: or transmission in any fore permittes withou wiltten permission of NiPa. For inelines or to report unaumneed use. contect cerseg@n/ta.org. ThIs NOSS AR Accass subscapron axpines on December 19. 2019 ANNUAL OCCUPATIONAL FITNESS EVALUATION OF MEMBERS 1582-21 N 7.7.16 Cervical Cancer Screening. Chapter 8 Annual Occupational Fitness Evaluation of Members
N 7.7.16.1 Female fire fighters shall be screened for cervical cancer with cytology (Pap smear) every 3 years or screened for 8.1 Weight and Body Composition. a combination of cytology and human papillomavirus (HPV) testing every 5 years. 8.1.1* Body weight shall be measured and recorded annually.
N 7.7.17 Testicular Cancer Screening. 8.1.2 A body composition evaluation including the following shall be conducted on personnel solely for the purpose of N. 7.7.17.1 A baseline examination shall be performed by a departmental health surveillance:
health care provider.
(1) * Circumferential measurements
N 7.7.18 Bladder Cancer Screening. (2) Hydrostatic weighing or Bod-Pod N 7.7.18.1 Urine shall be evaluated for blood (hematuria). (3) * Skinfold measurements (4) Bio impedance analysis
N 7.7.18.2 A positive dipstick for hematuria shall require
8.2 Annual Fitness Evaluation.
follow-up and referral which could involve upper tract imaging, cystoscopy, and/or urine cytology. 8.2.1 A mandatory fitness evaluation that is not punitive or N 7.7.19 Oral Cancer Screening. competitive shall be conducted annually as part of an individu- alized program.
N 7.7.19.1 The entire mouth shall be examined for signs of oral and oropharyngeal cancers. 8.2.1.1 All component results of the mandatory fitness evalua- tion shall be used to establish an individual's baseline or meas- N 7.7.20 Thyroid Cancer Screening. ured against the individual's previous assessments and not against any standard or norm.
N 7.7.20.1 Physical exam for palpable nodules shall be part of the annual physical examination. 8.2.2 The mandatory fitness evaluation shall include a manda- tory pre-evaluation procedure and the components in 8.2.2.1 N 7.7.21 Sleep Disturbance Screening. through 8.2.2.4. (For additional information, see Annex C.) N 7.7.21.1 Screening for sleep disorders using a validated ques- 8.2.2.1* An evaluation of aerobic capacity shall be performed tionnaire, such as the Berlin Questionnaire or Epworth Sleepi- after appropriate medical evaluation. ness Scale, shall be provided annually.
8.2.2.1.1 Testing shall be conducted using an appropriate N 7.7.21.2* For fire fighters with a high index of suspicion for a maximal or submaximal protocol (see C.2.1 and C.2.1.J). Bicy- sleep disorder based on questionnaires or biometric data, the cle ergometry is not appropriate because it underestimates true physician shall discuss the risks and benefits of testing and aerobic capacity and is not work-task specific. treatment.
8.2.2.1.2* At levels below 12 METs, a firefighter shall be coun- N 7.7.22* Cancer and Cardiovascular Disease Risk Reduction. seled to improve his/her fitness.
N 7.7.22.1 The fire department physician shall annually inform N 8.2.2.1.3 At levels below 10 METs, participation in a prescri- members of the heightened risks of cardiovascular disease and bed aerobic fitness program shall be required. various types of cancer associated with fire fighting.
8.2.2.1.4 At levels at or below 8 METs, a prescribed aerobic N. 7.7.22.2 In addition to medical screening for these entities as fitness program shall be required, and the AHJ shall be advised outlined in this standard, the member shall be apprised of to consider restriction from essential job tasks 1, 2, 4, 5, 6, 7, 8, occupational routes of hazardous exposures related to fire 9, and 13. fighting, as well as common signs, symptoms, and preventive measures for both cardiovascular disease and cancers. 8.2.2.2 An evaluation of muscular strength shall be conducted using each of the following protocols:
N 7.7.23 Occupational Stress Awareness Consultation.
(1) Grip strength evaluation (See C.2.1.5 for the protocol.) N 7.7.23.1 The fire department physician shall, during the (2) Leg strength evaluation (See C. 2.1.6 for the protocol.) annual physical, inform the member of, and assess for the (3) Arm strength evaluation (See C. 2.1.7 for the protocol.) heightened risks of, stress associated with occupational expo sures related to fire fighting. 3.2.2.3 An evaluation of muscular endurance shall be conduc ed using each of the following protocol:
N 7.7.23.2 The fire department physician shall make the (1) Push-up evaluation (See C.2. 1.9 for the protocol.) (2) Curl-up evaluation (See C. 2.1.11 for the protocol.)
8.2.2.4 An evaluation of flexibility shall be conducted using the member with referral to licensed behavioral health special- the sit-and-reach protocol. (See C.2.1.12 for the protocol.) ists trained to recognize and treat stress-related disorders in first responders as indicated.
Shaded text = Revisions. A = Text deletions and figure/table revisions. • = Section deletions. N = New material. 2018 Edition Copyght 2019 Nationat Fine Protection Association (NFPAy Loansed. by apreement, for individual use and download on D7/06/2019 to Billy A comfor designated user Willem @xen Neater reproduct on or rensmission in any lome permitted whout vantten permission of NFPAD. Foringumes cato report unpumenzed use. contact licensing @ripe.ag Thes NFOGS Al Mocess subsonoien expres no precenter "9. 2019. 1582-22 COMPREHENSIVE OCCUPATIONAL MEDICAL PROGRAM FOR FIRE DEPARTMENTS Chapter 9 Essential Job Tasks — Specific Evaluation of further aggravated by fatigue, flashing lights, sirens, and Medical Conditions in Members other distractions
(12) Ability to communicate (ie, give and comprehend
9.1 Essential Job Tasks. verbal orders) while wearing personal protective ensem- bles and SCBA under conditions of high background
9.1.1 The essential job tasks listed by number in this chapter noise, poor visibility, and drenching from hoselines are the same as those listed in Chapter 5 and shall be validated and/or fixed protection systems (e.g-, sprinklers) by the fire department as required by Chapter 5. (13) Functioning as an integral component of a team, where 4 9.1.2 The fire department physician shall use the list of essen- sudden incapacitation of a member can result in mission tial job tasks in evaluating the ability of a member with specific failure or in risk of injury or death to civilians or other medical conditions to perform specific job tasks. team members (14) Working in shifts, including during nighttime, that can A 9.1.3 Essential job tasks referenced throughout this chapter by extend beyond 12 hours number only shall correspond to the following model list:
9.2 Special Teams.
(1)* Wearing personal protective ensemble and SCBA,
performing fire-fighting tasks (e.g., hoseline operations, 4 9.2.1 In addition to essential job tasks specified in 9.1.3(1) extensive crawling, lifting and carrying heavy objects, through 9.1.3(13), members of specialized teams such ventilating roofs or walls using power or hand tools, hazardous materials units, SCUBA teams, technical rescue forcible entry, rescue operations, and other emergency teams, EMS teams, or units supporting tactical law enforcement response actions under stressful conditions, including operations shall be evaluated for their ability to perform essen- working in extremely hot or cold environments for tial job tasks and wear specialized PPE related to the duties of prolonged time periods those specialized teams.
(2) Wearing an SCBA, which includes a demand valve-type positive-pressure facepiece or HEPA filter masks, which 9.2.2 The fire department shall define those essential job tasks requires the ability to tolerate increased and shall provide the fire department physician with a descrip- respiratory
tion of the risks associated with those tasks and specialized PPE workloads
Exposure to toxic fumes, irritants, particulates, biologi- as well as any additional medical and/or physical requirements (3)
that are not enumerated in this standard.
cal (i.e., infectious) and nonbiological hazards, and/or heated gases, despite the use of personal protective 9.2.3 In defining those tasks, the fire department shall ensembles and SCBA consider the impact on the members required to wear or (4) Depending on the local jurisdiction, climbing six or utilize specialized PPE that can increase weight, environmental isolation, sensory deprivation, and/or dehydration potential above levels experienced with standard fire suppression PPE.
A 9.3 Fire Department Physician Roles. After individually evalu- Wearing fire protective ensemble that is encapsulating ating the member and the member's medical records, includ- and insulated, which will result in significant fluid loss ing job-related medical rehabilitation records, the fire that frequently progresses to clinical dehydration and department physician shall recommend restricting members can elevate core temperature to levels exceeding 102.2°F from performing only those specific job tasks that cannot be safely performed by the member given his/her medical condi- Wearing personal protective ensemble and SCBA,
finding, and rescue-dragging or carrying 9.3.1 The fire department physician shall perform an individ- victims ranging from newborns to adults weighing over ualized assessment of the fire department member. 200 lb (90 kg) to safety despite hazardous conditions
4 9.3.2* The fire department shall, on a case-by-case basis.
Wearing personal provide the AHI) a statement that documents the specific essen- advancing water-filled hoselines up to 2 ½ in. (65 mm) tial job task(s) (see 9.1.3) the member shall be restricted from in diameter from fire apparatus to occupancy [approxi-
mately 150 ft (50 m)], which can involve negotiating A 9.3.3* The fire department physician shall not comment on multiple flights of stairs, ladders, and other obstacles Wearing personal protective ensemble and SCBA, climb- whether or not the member can continue employment in the ing ladders, operating from heights, walking or crawling fire department. in the dark along narrow and uneven surfaces, and oper- 9.3.4 There shall be no blanket exclusions. ating in proximity to electrical power lines and/or other
9.3.5 The AHJ shall determine whether or not the restrictions Unpredictable emergency requirements for prolonged put forth by the fire department physician can or cannot be periods of extreme physical exertion without benefit of accommodated. warm-up, scheduled rest periods, meals, access to medi- 9.4* Cardiovascular Disorders. cation (s), or hydration
(10) Operating fire apparatus or other vehicles in an emer- 9.4.1 Cardiovascular disorders shall include any disorder of gency mode with emergency lights and sirens the cardiovascular system including but not limited to supra- (11) Critical, time-sensitive, complex problem solving during ventricular or ventricular arrhythmias (abnormal heart beats), physical exertion in stressful, hazardous environments, coronary artery disease, and cardiac muscle disease or valve including hot, dark, tightly enclosed spaces, that is
2018 Edition Shaded text = Revisions. A = Text deletions and figure/table revisions. • = Section deletions. N = New material.
Copyngh: 2010 National Fire Protection Association (NFPA Licensed By agreement, for individual use and downind or: 01/06/2010t0 Pill Alcom for designated user William Swan No oner reproduction or transmission in any ter permitted wilhout wetter permissica diNED. Forinquines onto report unaußiated use, contact beensing@nipa meg. TS NOGS Al AcCasa Subscroton expres on December 19 2010 ESSENTIAL JOB TASKS — SPECIFIC EVALUATION OF MEDICAL CONDITIONS IN MEMBERS 1582-23
9.4.2 If the member has any cardiovascular disorders, the cian shall report the applicable job limitations to the fire member shall be individually evaluated in accordance with department.
9.4.3 through 9.4.23 to determine if the disorders compromise the member's ability to safely perform the essential job tasks. 9.4.4.2 Physician Guidance. The physician shall consider that if the heart failure is due to a reversible process that ultimately
9.4.3 Coronary Artery Disease. results in no abnormality in cardiac performance off all cardiac medications (e.g., hyperthyroidism, anemia), then a history of
9.4.3.1* Physician Evaluation. The following clinical condi- congestive heart failure does not permanently prevent a tions referable to coronary artery disease, including a history of member from safely performing the essential job tasks. myocardial infarction, coronary artery bypass surgery, coronary angioplasty with or without stent placement, or similar proce- 9.4.5 Restrictive Cardiomyopathy and Constrictive Pericarditis. dures, compromise the member's ability to safely perform essential job tasks 1, 2, 4, 5, 6, 7, 9, and 13, and the physician 9.4.5.1 Physician Evaluation. Restrictive cardiomyopathy and report the applicable job limitations to the fire depart- constrictive pericarditis when resulting in heart failure compro- ment unless all of the following are present: mise the member's ability to safely perform essential job tasks 1, 2, 4, 7, and 9, and the physician shall report the applicable (1) Absence of angina pectoris, even if relieved by medica- job limitations to the fire department.
Absence of significant stenosis in any coronary artery 9.4.6 Acute Pericarditis, Acute Endocarditis, and (i.e., greater than 70 percent lumen diameter narrow- Myocarditis. ing) following treatment 9.4.6.1 Physician Evaluation. Acute pericarditis, acute endo Normal left ventricular ejection fraction as measured by carditis, and acute myocarditis compromise the member's abil- radionuclide scan, contrast ventriculography, or echo- ity to safely perform essential job tasks 1, 4, 5, 6, 7, 9, and 13, cardiography
Maximal exercise tolerance of at least 12 METs and the physician shall report the applicable job limitations to (4)
the fire department.
arrhythmias, or conduction abnormalities observed by 9.4.7 Chronic Pericarditis, Endocarditis, or Myocarditis. radionuclide stress test during an evaluation reaching a workload of at least 12 METs 9.4.7.1 Physician Evaluation. Chronic pericarditis, endocardi- Control of modifiable risk factors) for acute coronary tis, or myocarditis when resulting in heart failure or significant plaque rupture (e.g., tobacco use, hypertension despite valvular incompetence or arrhythmias compromises the member's ability to safely perform essential job tasks 1, 4, 5, 6, hypercholesterolemia cholesterol
greater than or equal to 180 or low density lipoproteins 7, and 13, and the physician shall report the applicable job limitations to the fire department.
greater than or equal to 100 despite treatment, or glyco- sylated hemoglobin greater than 8 percent despite exer- 9.4.7.2 Physician Guidance. Members with pericarditis, endo cise and/or weight reduction) carditis, or myocarditis shall be carefully assessed for cardiac (7) At least 6 months since most recent myocardial infarc- function, rhythm, and valvular competence at least annually by tion cardiac echo or other noninvasive or invasive monitoring in At least 6 months since coronary artery bypass surgery consultation with a cardiologist.
At least 3 months since most recent angioplasty with
or without stent placement 9.4.8 Hypertrophic Obstructive Cardiomyopathy. (10) Completion of cardiac rehab, if indicated 9.4.8.1 Physician Evaluation. Hypertrophic obstructive cardio-
9.4.3.2 Physician Guidance. The physician shall consider the myopathy (HCM) (including idiopathic hypertrophic subaortic following when evaluating a member: stenosis) can compromise the member's ability to safely perform essential job tasks 1 and 13, and after further evalua- (1) / Evaluation of coronary artery disease requires a stress test tion and a final medical determination of the member's condi- with imaging and/or coronary angiogram and some
tion, the physician shall report any applicable job limitations to assessment of left ventricular function. Following a the fire department. myocardial infarction or a coronary revascularization
procedure, a radionuclide stress test shall be performed 9.4.8.2 Physician Guidance. HCM is associated with life- to evaluate exercise tolerance and the presence of threatening arrhythmias and sudden cardiac death without exercise-induced myocardial ischemia or ventricular previous symptoms of heart failure. In specific populations of arrhythmias. patients with cardiomyopathies under normal environmental (2) Reports of left ventricular ejection fraction for evaluation conditions, the following risk factors for sudden cardiac death of 9.4.3.1(3) should include "normal" values for the lab shall be considered by the physician:
performing the test and formal interpretation by a cardi- (1) Unexplained syncope ologist. (2) History of cardiac arrest
Workload demands of fire fighting have been shown to (3) Sustained ventricular tachycardia (VT) exceed the levels shown in 9.4.3.1(4).
(4) Nonsustained VT (3 beats or more of at least 120 beats/
9.4.4 Congestive Heart Failure. minute documented on a Holter monitor) (5) Left ventricle thickness of 30 mm or more on echocardio-
9.4.4.1 Physician Evaluation. Congestive heart failure due to gram any etiology including any disease leading to a lower than (6) * Abnormal systolic blood pressures during the exercise normal left or right ventricular ejection fraction, even if correc- stress test (EST), defined as either a failure to increase by ted by medication, compromises the member's ability to safely at least 20 mm Hg or a drop of at least 20 mm Hg during perform essential job tasks 1, 2, 4, 7, 9, and 13, and the physi- effort Shaded text = Revisions. A = Text deletions and figure/table revisions. • = Section deletions. N= New material. 2018 Edition Copyrigit 2018 Nationer Fire Pretention Aseociation NEPA) Licensed. by agreement. for incividual use and downnad on 07/06/2019 to Billy Alent for designated user Willem: Swan No oner repreduction or transpission in any for pemmed without walte permission of NED, Foringuiries orto report urbuthonzed use, contact licensing@nipa so ThIs NEOSS AN Access sunscopson expires on December 12. 2013. 1582-24 COMPRETIENSIVE OCCUPATIONAL MEDICAL PROGRAM FOR FIRE DEPARTMENTS
9.4.9 Recurrent Syncope. 9.4.16 Wolff-Parkinson-White (WPW) Syndrome.
9.4.9.1* Physician Evaluation. Recurrent syncope compromi- 9.4.16.1* Physician Evaluation. ses the member's ability to safely perform essential job task 13, N 9.4.16.1.1 Wolff-Parkinson-White (WPW) syndrome with struc- and the physician shall report the applicable job limitations to tural heart disease compromises the member's ability to safely the fire department.
perform essential job task 13, and the physician shall report the
9.4.10 Pacemaker or Automatic Implantable Defibrillator. applicable job limitations to the fire department.
9.4.10.1* Physician Evaluation. A medical condition requir- N 9.4.16.1.2 WPW syndrome with a history of supraventricular ing a pacemaker or automatic implantable defibrillator- tachycardia (SVT) compromises the member's ability to safely unless the member is not pacemaker-dependent or the condi- perform essential job task 13, and the physician shall report the tion no longer requires an automatic implantable cardiac applicable job limitations to the fire department, unless the defibrillator — compromises the member's ability to safely member has been treated with ablation and has no inducible perform essential job task 13, and the physician shall report the arrhythmias as demonstrated by electrophysiology testing. applicable job limitations to the fire department. 9.4.17 Other Supraventricular Arrhythmias, Atrial Fibrillation,
9.4.11 Mitral Valve Stenosis. or Atrial Flutter.
9.4.11.1 Physician Evaluation. Moderate to severe mitral valve 9.4.17.1* Physician Evaluation. Other stenosis defined as valve area less than or equal to 1.5 cm? or arrhythmias, atrial fibrillation, or atrial flutter when persistent pulmonary artery systolic pressure greater than 35mm Hg (even if rate controlled) or if anticoagulation is required compromises the member's ability to safely perform essential compromise the member's ability to safely perform essential job tasks 1, 4, 5, 7, and 9, and the physician shall report the 13 and essential job task 8 if anticoagulation is applicable job limitations to the fire department. required, and the physician shall report the applicable job limi- tations to the fire department.
9.4.12 Mitral Valve Insufficiency.
9.4.17.2 Physician Guidance. The physician shall consider
9.4.12.1 Physician Evaluation. Moderate to severe mitral valve that if the atrial fibrillation is recurrent but self-limited off insufficiency, defined as the presence of left ventricular cardiac medications, there is no evidence of ischemia, and the dysfunction, compromises the member's ability to safely echocardiogram reveals both a normal mitral valve and a perform essential job tasks 1, 4, 5, 7, and 9, and the physician normal-sized left atrium, then the member might be able to shall report the applicable job limitations to the fire depart- safely perform full duties. Paroxysmal atrial tachycardia can ment. sometimes be resolved with modification of diet or treatment
9.4.12.2 Physician Guidance. Mitral valve prolapse only inter- of other underlying noncardiac conditions. feres with safe performance of critical job tasks if associated 9.4.18 Ventricular Arrhythmias and Ectopy. with arrhythmias or if moderate to severe mitral regurgitation is present. 9.4.18.1 Physician Evaluation.
9.4.13 Aortic Valve Stenosis. 9.4.18.1.1 The physician shall evaluate the member to deter- mine if a history of ventricular arrhythmias (e.g., ventricular
9.4.13.1 Physician Evaluation. Moderate to severe aortic valve tachycardia and ventricular fibrillation) compromises the stenosis defined as mean aortic valvular gradient greater than member's ability to safely perform essential job task 13, and the or equal to 20 mm Hg and/or valve area less than or equal to physician shall report the applicable job limitations to the fire
1.0 cm' compromises the member's ability to safely perform department. essential job tasks 1, 4, 5, 6, 7, 9, and 13, and the physician shall report the applicable job limitations to the fire department. 9.4.18.1.2 A history of ventricular ectopy might compromise the member's ability to safely perform essential job task 13, and
9.4.14 Aortic Valve Insufficiency. after evaluation and a final medical determination of the
9.4.14.1 Physician Evaluation. Moderate to severe aortic valve member's condition, the physician shall report any applicable insufficiency when the cause of left ventricular dysfunction job limitations to the fire department. compromises the member's ability to safely perform essential 9.4.18.2 Physician Guidance. The physician shall consider the job tasks 1, 4, 7, and 9, and the physician shall report the appli- following when evaluating the member:
cable job limitations to the fire department.
(1) A history of ventricular arrhythmias, including ventricular
9.4.15 Prosthetic Cardiac Valves. tachycardia or ventricular fibrillation, poses significant risk for life-threatening sudden incapacitation in the pres-
9.4.15.1 Physician Evaluation. Prosthetic cardiac valves ence of structural abnormalities, functional abnormali- compromise the member's ability to safely perform essential ties, or ectopy that occurs during exercise.
A history of ventricular ectopy might pose a significant 1, 4, 6, 7, and 9 if left ventricular dysfunction is present, and risk for life-threatening sudden incapacitation if struc- the physician shall report the applicable job limitations to the tural or ischemic heart disease is present or if ventricular fire department. ectopy increases during exercise.
Holter monitoring (i.e.. 24-hour ECG recording) might
show ventricular ectopy but should show no evidence of
ventricular arrhythmias.
Echocardiograph must show normal function and no
evidence of structural abnormalities.
2018 Edition Shaded text = Revisions. A = Text deletions and figure/table revisions. • = Section deletions. N = New material.
Copyright 2019 National Fire Protection Aseociation (FPA: Ucensed. Dy agreement, for individual use and downind on 07/06/2019 to Pily Alcon for designated user Willam Swan No other reproduction or iransmission in any ter haunes one fewer: unautoned use comesticens agripe 000 TO NOSES A Acoss sorscroton exores on Decantber 19 2019 ESSENTIAL JOB TASKS - SPECIFIC EVALLATION OF MEDICAL CONDITIONS IN MEMBERS 1582-25 Stress testing off cardiac medications must show no test to 12 MEIs is performed with normal results every 1 to 3 evidence for ischemia, ventricular tachycardia, or ventric- years. ular fibrillation.
Premature ventricular contractions (PVCs) should resolve 9.4.21 Metabolic Syndrome. with increasing levels of exercise up to 12 METs. 9.4.21.1* Members with metabolic syndrome are at increased
9.4.19 Atrioventricular Block. risk for cardiovascular ischemic disease, diabetes, and acceler- ated hypertension and shall undergo a stress test with imaging;
9.4.19.1 Physician Evaluation. if the results are abnormal or the member is unable to achieve a symptom limiting cardiac exercise test to 12 METs every 1 to
9.4.19.1.1 Third-degree or complete atrioventricular block the member's ability to safely perform essential job compromises the member's ability to safely perform essential tasks 1, 2, 4, 5, 6, 7, 8, 9, 10, and 13 will be compromised. job task 13, and the physician shall report the applicable job limitations to the fire department. 9.4.22 Cardiac Congenital Abnormality.
9.4.19.1.2 Other types of atrioventricular block with sinus 9.4.22.1 Physician Evaluation. A history of a cardiac congeni- pause greater than 3 seconds, left bundle branch block, right tal abnormality that has been treated by surgery but with resid- bundle branch block, or second-degree Type I atrioventricular ual complications or that has not been treated by surgery, block might compromise the member's ability to safely perform leaving residuals or complications, might compromise the job task 13 if cardiac structural (i.e., coronary arteries, valves, member's ability to safely perform essential job tasks 1, 4, 5, 6, myocardium) abnormalities are present, if left ventricular func- 7, 9, and 13, and after further evaluation and a final medical tion is abnormal, or if heart rate does not increase with exer- determination of the member's condition, the physician shall cise in the absence of a mechanical pacemaker, and after report any applicable job limitations to the fire department. further evaluation and a final medical determination of the member's condition, the physician shall report any applicable 9.4.23 Cardiac Hypertrophy. job limitations to the fire department. 9.4.23.1 Physician Evaluation. Cardiac hypertrophy without a
9.4.20 Hypertension. normal response to exercise of the heart might compromise the member's ability to safely perform essential job task 13 and N 9.4.20.1 Stage 1 Hypertension. other job functions due to limitations of endurance, and after further evaluation and a final medical determination of the
9.4.20.1.1* Physician Evaluation.
member's condition, the physician shall report any applicable job limitations to the fire department.
9.4.23.2* Physician Guidance. The physician shall consider that this condition can result in the potential for sudden inca- damage. pacitation in addition to hypertension.
N 9.4.20.1.1.2 End-organ damage, or a 10 percent or greater risk 9.4.24 Heart Transplant. of ASCVD over the next 10 years determined by using the ACC/AHA Heart Risk Calculator, compromises the member's 9.4.24.1 Physician Evaluation. Cardiac transplantation ability to safely perform essential job tasks 1, 5, 7, 9, and 13, prevents a normal rise in heart rate and increases risk of and the physician shall report the applicable job limitations to syncope and sudden cardiac death and therefore shall be the fire department, unless a symptom-limiting cardiac exercise considered as compromising the member's ability to safely test to 12 METs is performed with normal results every 1 to 3 perform essential job tasks 1, 2, 4, 5, 6, 7, 8, 9, 10, and 13.
9.4.24.2 Physician Guidance. The physician shall consider N 9.4.20.2 Stage 2 Hypertension. that this condition can result in the potential for sudden inca- pacitation and that the many immunosuppressive drugs
N 9.4.20.2.1 Physician Evaluation. required to prevent rejection increase the likelihood for infec- A 9.4.20.2.1.1 Stage 2 hypertension (i.e., systolic pressure tion. greater than or equal to 160 mm Hg or diastolic pressure 9.5 Vascular Disorders. greater than or equal to 100 mm Hg) compromises the
member's ability to safely perform essential job tasks 1. 5. 7. 9. 9.5.1 Vascular disorders shall refer to any disorder of the and 13, and the physician shall report the applicable job limita- vascular (arterial or venous) system including but not limited tions to the fire department. to aneurysm, peripheral vascular insufficiency, and throm- boembolic disease.
N 9.4.20.2.1.2 Once the physician has acted in accordance with
9.4.20.2.1.1, if the member's blood pressure is subsequently 9.5.2 If the member has any vascular disorders, the member controlled, end-organ damage and risk of ASCVD over the next shall be individually evaluated in accordance with 9.5.3 10 years shall be assessed by using the ACC/AHA Heart Risk through 9.5.11 to determine if the disorders compromise the Calculator. member's ability to safely perform the essential job tasks, recog- nizing that heart rate, blood pressure, and shear forces on N 9.4.20.2.1.3 End-organ damage, or a 10 percent or greater risk vessel walls are increased when performing many of the essen- of ASCVD over the next 10 years determined by using the tial job tasks, increasing the risk of acute dissection, rupture, ACC/AHA Heart Risk Calculator, compromises the member's and/or embolic phenomena that even in a normal environ- ability to safely perform essential job tasks 1, 5, 7, 9, and 13, ment can result in life-threatening sudden incapacitation. and the physician shall report the applicable job limitations to the fire department, unless a symptom-limiting cardiac exercise Shaded text = Revisions. A = Text deletions and figure/table revisions. • = Section deletions. N= New material. 2018 Edition Copyrign: 2010 Natienal Fire Protection Association (NFPA Loansed, cy agreement. for individual use and downicad on 0f/06/201810 Bily Aleorn fer designated user Witar. Swen, No oner regeduction or transmisson in any town pemmitted sakeset walten pornission of NEPACI For ingues onto nepon cheuter 200 we comast bensmg nipe org. This NOSS AN Acossa sunstupror: expires on Decembe: 19 2019. 1582-26 COMPREHENSIVE OCCUPATIONAL MEDICAL PROGRAM FOR FIRE DEPARTMENTS
9.5.3 Aortic Aneurysm. further evaluation and a final medical determination of the member's condition, the physician shall report any applicable
9.5.3.1 Physician Evaluation. Aortic aneurysm (thoracic aortic job limitations to the fire department. aneurysm of any size or abdominal aortic aneurysm greater than or equal to 4 cm) compromises the member's ability to 9.5.10 Lymphedema.
9.5.10.1 Physician Evaluation. Chronic, severe lymphedema or massive edema of any type (e.g., due to lymphadenopathy, department. severe venous valvular incompetency, endocrine abnormalities,
9.5.3.2 Physician Guidance. When evaluating a member with or low flow states) compromises the member's ability to safely an abdominal aortic aneurysm less than 4 cm, the physician perform essential job tasks 1, 4, 5, and 8, and the physician shall recognize that treatment requires careful control of blood shall report the applicable job limitations to the fire depart- pressure and regular follow-up with cardiac imaging. ment.
9.5.11 Lesions of Aorta or Major Vessels.
aortic aneurysm shall be required before the member can be evaluated for return-to-duty status. 9.5.11.1 Physician Evaluation.
9.5.11.1.1 Congenital or acquired lesions of the aorta or
9.5.4 Carotid Artery Disease.
major blood vessels might interfere with circulation and
9.5.4.1 Physician Evaluation. Carotid artery disease when prevent the safe performance of essential job tasks 1, 4, and 7 symptomatic and/or reduction in blood flow of greater than due to limitations of endurance, and after further evaluation 70 percent is present compromises the member's ability to and a final medical determination of the members condition, safely perform job task 13, and the physician shall report the the physician shall report any applicable job limitations to the applicable job limitations to the fire department. fire department.
9.5.5 Thoracic Outlet Syndrome. 9.5.11.1.2 Congenital or acquired lesions of the aorta or major blood vessels could increase the potential for life-
9.5.5.1 Physician Evaluation. Thoracic outlet syndrome threatening sudden incapacitation, which might compromise (symptomatic) compromises the members ability to safely the member's ability to safely perform essential job task 13, and perform essential job tasks 1 and 13, and the physician shall after further evaluation and a final medical determination of report the applicable job limitations to the fire department. the member's condition, the physician shall report any applica-
9.5.6 Peripheral Vascular Disease. ble job limitations to the fire department.
9.5.6.1 Physician Evaluation. Peripheral vascular disease 9.6* Endocrine and Metabolic Disorders. (arterial or venous) when symptomatic (claudication) or severe 9.6.1 Endocrine and metabolic disorders shall include disor- peripheral edema is present compromises the member's ability ders of the hypothalamic-pituitary-thyroid-adrenal axis. to safely perform essential job tasks 1, 4, 5, 7, and 9, and the physician shall report the applicable job limitations to the fire 9.6.2 If the member has any endocrine and metabolic disor- department. ders, the member shall be individually evaluated in accordance with 9.6.3 through 9.6.7 to determine if the disorders compro
9.5.7 Thrombophlebitis. mise the member's ability to safely perform the essential job tasks.
9.5.7.1 Physician Evaluation.
9.5.7.1.1 Thrombophlebitis or deep venous thrombosis that is 9.6.3 Type 1 Diabetes Mellitus That Requires Treatment with recurrent or persistent or requires anticoagulation compromi- Insulin. ses the member's ability to safely perform essential job tasks 1, 9.6.3.1* Physician Evaluation. Type I diabetes mellitus that 4,5, 7, and 9, and the physician shall report the applicable job requires treatment with insulin compromises the member's limitations to the fire department. ability to safely perform essential job tasks 5, 9, and 13, and the
9.5.7.1.2 Full-dose or low-dose anticoagulation compromises physician shall report the applicable job limitations to the fire the member's ability to safely perform essential job task 8, and department, unless the member meets all of the following crite- the physician shall report the applicable job limitations to the fire department. Is maintained by a physician knowledgeable in current management of diabetes mellitus on a basal/bolus (can
9.5.8 Circulatory Instability.
include subcutaneous insulin infusion pump) regimen
9.5.8.1 Physician Evaluation. using insulin analogs.
ted by orthostatic hypotension or persistent tachycardia Has demonstrated over a period of at least 6 months the compromises the member's ability to safely perform essential motivation and understanding required to closely moni- job tasks 1, 5, 9, and 13, and the physician shall report the tor and control capillary blood glucose levels through applicable job limitations to the fire department. nutritional therapy and insulin administration. Assess- ment of this shall take into consideration the member's
9.5.9 Peripheral Vascular Disease. experience and history dealing with erratic meal sched-
9.5.9.1 Physician Evaluation. Peripheral vascular disease, such ules, sleep disruption, and high aerobic and anaerobic as severe Raynaud's phenomenon, might compromise workloads intrinsic to fire fighting. member's ability to safely perform essential job rasks (e.g., under certain conditions, including cold weather), and after 2018 Edition Shaded text = Revisions. A = Text deletions and figure/table revisions. • = Section deletions. N = New material.
Copyrght 2019 Nationa Fire Protection spociation NFA Licensed By agreement for individual use and downined on 07/062018 tRify Riconfor deeignated use William Swan No oner reproducion or transmission in any fome pennuted wiloul written permiasion dINER Foringunes onto repom aneutronava use, contact hensing@@nipe org TS NEGOS AR Across subscepton expires on December 19, 2019.
ESSENTIAL JOB TASKS - SPECIFIC EVALUATION OF MEDICAL CONDITIONS IN MEMBERS 1582-27 Has a dilated retinal exam by a qualified ophthalmologist 9.6.4 Type 2 Diabetes Mellitus That Requires Treatment with or optometrist that shows no higher grade of diabetic Insulin. retinopathy than microaneurysms, as indicated on the
International Clinical Diabetic Retinopathy Disease 9.6.4.1* Physician Evaluation. Type 2 diabetes mellitus that Severity Scale. requires treatment with insulin compromises the member's (4) Has normal renal function based on a calculated creati- ability to safely perform essential job tasks 5, 9, and 13, and the nine clearance greater than 60 mL/min and absence of physician shall report the applicable job limitations to the fire proteinuria. (Creatinine clearance can be calculated by department, unless the member meets all of the following crite- use of the Cockroft-Gault or similar formula. Proteinuria is defined as 24-hour urine excretion of greater than or (1) Is maintained by a physician knowledgeable in current equal to 300 mg protein or greater than or equal to management of diabetes mellitus. 300 mg of albumin per gram of creatinine in a random Has demonstrated over a period of at least 3 months the motivation and understanding required to closely moni-
Has no autonomic or peripheral neuropathy. (Peripheral tor and control capillary blood glucose levels through neuropathy is determined by diminished ability to feel nutritional therapy and insulin administration. Assess- the vibration of a 128 cps tuning fork or the light touch ment of this shall take into consideration the member's of a 10-gram monofilament on the dorsum of the great experience and prior history dealing with the erratic meal toe proximal to the nail. Autonomic neuropathy can be schedules, sleep disruption, and high aerobic and anaero- determined by evidence of gastroparesis, postural hypo bic workloads intrinsic to fire fighting. tension, or abnormal tests of heart rate variability.) Has a dilated retinal exam by a qualified ophthalmologist Has normal cardiac function without evidence of myocar- or optometrist that shows no higher grade of diabetic dial ischemia on cardiac stress testing (to at least 12 retinopathy than microaneurysms, as indicated on the METs) by ECG and cardiac imaging. International Clinical Diabetic Retinopathy Disease (7) Has a signed statement and medical records from an Severity Scale. endocrinologist or a physician with demonstrated knowl- Has normal renal function based on a calculated creati- edge in the current management of diabetes mellitus as nine clearance greater than 60 mL/min and absence of well as knowledge of the essential job tasks and hazards of proteinuria. (Creatinine clearance can be calculated by fire fighting as described in Section 9.1, allowing the fire use of the Cockroft-Gault or similar formula. Proteinuria department physician to determine whether the member is defined as 24-hour urine excretion of greater than or meets the following criteria: equal to 300 mg protein or greater than or equal to Is maintained on a stable basal/bolus regimen using 300 mg of albumin per gram of creatinine in a random insulin analogs and has demonstrated over a period
of at least 6 months the motivation and understand- Has no autonomic or peripheral neuropathy. (Peripheral ing required to closely monitor and control capil- neuropathy is determined by diminished ability to feel through nutritional the vibration of a 128 cps tuning fork or the light touch therapy and insulin administration despite varied of a 10-gram monofilament on the dorsum of the great activity schedules. toe proximal to the nail. Autonomic neuropathy can be Has had hemoglobin AlC measured at least four determined by evidence of gastroparesis, postural hypo times a year (intervals of two to three months) over tension, or abnormal tests of heart rate variability.) the last 12 months prior to evaluation if the diagno- Has normal cardiac function without evidence of myocar- sis of diabetes has been present over 1 year. Hemo- dial ischemia on cardiac stress testing (to at least 12 globin AlC reading of 8 percent or greater shall METs) by ECG and cardiac imaging. trigger a medical evaluation to determine if a condi- Has a signed statement and medical records from an tion exists in addition to diabetes that is responsible endocrinologist or a physician with demonstrated knowl- edge in the current management of diabetes mellitus as
for the hemoglobin AlC not accurately reflecting
well as knowledge of the essential job tasks and hazards of average glucose levels, including evidence of a set
fire fighting as described in Section 9.1, allowing the fire schedule for blood glucose monitoring and a thor-
ough review of data from such monitoring. department physician to determine whether the member Does not have an increased risk of hypoglycemia meets the following criteria:
(a) Is maintained on a stable insulin regimen and has
due to alcohol use or other predisposing factors.
no episodes hypoglycemia demonstrated over a period of at least 3 months the (defined as requiring assistance of another) in the motivation and understanding required to closely preceding 1 year, with no more than two episodes of monitor and control capillary blood glucose levels severe hypoglycemia in the preceding 3 years. despite varied activity schedules through nutritional Is certified not to have a medical contraindication therapy and insulin administration. to fire-fighting training and operations. (b) Has had hemoglobin AlC measured at least four times a year (intervals of 2 to 3 months) over the
9.6.3.2 Physician Guidance. When evaluating a member with last 12 months prior to evaluation if the diagnosis of Type 1 diabetes mellitus, the physician shall recognize that diabetes has been present over 1 year. Hemoglobin episodes of severe hypoglycemia are associated with an
AlC reading of 8 percent or greater shall trigger a
increased risk of subsequent episodes and that hypoglycemia medical evaluation to determine if a condition can interfere with cognitive function and judgment. Presence exists in addition to diabetes that is responsible for of microvascular and neurological complications of diabetes the hemoglobin AlC not accurately reflecting might increase the risk of hypoglycemic events. average glucose levels, including evidence of a set Shaded text = Revisions. A = Text deletions and figure/table revisions. • = Section deletions. N = New material. 2018 Edition Copyright 2019 National Fire Protection 4stocation (FAcensed by egreement. forindia use and download on 07/06/20100 Hiv Arom for designated user Miliam Swan Mo other reproduct on or transmissien in arty even permates without witter permission dE NEPA forenquines cite repon undumented use contact omarg @nipaterg This NECES All access supaciesen expires on Secumcer 19. 2012 1582-28 COMPREHENSIVE OCCUPATIONAL MEDICAL PROGRAM FOR FIRE DEPARTMENTS schedule for blood glucose monitoring and a thor- 9.6.6 Nutritional Deficiencies. ough review of data from such monitoring
Does not have an increased risk of hypoglycemia 9.6.6.1 Physician Evaluation. Nutritional deficiencies, includ- (c) ing those caused by congenital or acquired disorders of metab- due to alcohol use or other predisposing factors. member's ability Has had no episodes of severe hypoglycemia olism, might compromise (d) perforın essential job tasks 1, 5, and 9, and after further evalua- (defined as requiring assistance of another) in the
tion and a final medical determination of the member's condi- preceding 1 year, with no more than one episode of
severe hypoglycemia in the preceding 5 years. tion, the physician shall report any applicable job limitations to Is certified not to have a medical contraindication the fire department. (e)
to fire-fighting training and operations. 9.6.6.2 Physician Guidance. When evaluating a member with
9.6.4.2 Physician Guidance. When evaluating a member with nutritional deficiencies, the physician shall perform an assess- ment of severity and functional impact and should include Type 2 diabetes mellitus, the physician shall recognize that episodes of severe hypoglycemia are considered best percent of ideal body weight, body mass index (BMI), muscle strength, endurance, energy levels, and abilities to feed, predictors of an increased risk of subsequent episodes and hydrate, and absorb essential nutrients pre- and post-fire activi- hypoglycemia interferes with cognitive function and judgment. ties.
9.6.5 Diabetes Mellitus That Does Not Require Insulin Ther-
9.6.7 Diseases of the Adrenal Gland, Pituitary Gland, Parathy- roid Gland, or Thyroid Gland.
9.6.5.1 Physician Evaluation, Diabetes mellitus that does not 9.6.7.1 Physician Evaluation. Untreated require insulin therapy and that is controlled by diet, exercise, and/or oral hypoglycemic agents compromises the member's controlled diseases of the adrenal gland, pituitary gland, para- ability to safely perform essential job tasks 5, 9, and 13, and the thyroid gland, or thyroid gland of clinical significance compro- mise the member's ability to safely perform essential job tasks physician shall report the applicable job limitations to the fire department, unless the member meets all of the following crite- 1, 5, and 9, and the physician shall report the applicable job limitations to the fire department.
(1) Has had hemoglobin AIC measured at least four times a 9.6.7.2 Physician Guidance. When evaluating a member, the year (intervals of 2 to 3 months) over the last 12 months physician shall recognize that clinically controlled diseases of prior to evaluation if the diagnosis of diabetes has been the adrenal gland, pituitary gland, parathyroid gland, or thyroid gland with normal exam and serum levels do not
present over 1 year. Hemoglobin AIC reading
8 percent or greater shall trigger a medical evaluation to compromise the member's ability to safely perform essential determine if a condition exists in addition to diabetes that is responsible for the hemoglobin AlC not accurately 9.7* Lung, Chest Wall, and Respiratory Disorders. reflecting average glucose levels, shall including evidence of a set schedule for blood glucose monitoring and a 9.7.1 Lung, chest wall, and respiratory disorders shall include thorough review of data from such monitoring. disorders of breathing and the exchange of respiratory gases If on oral hypoglycemic agents, has had no episodes of (oxygen and carbon dioxide), central neurologic control of severe hypoglycemia (defined as requiring assistance of respiratory drive, nose, another in the preceding year). trachea, airways, lungs, pleura, and chest wall.
Has a dilated retinal exam by a qualified ophthalmologist or optometrist that shows no higher grade of diabetic 9.7.2 When evaluating a member for lung, chest wall, and retinopathy than microaneurysms, as indicated on the respiratory disorders, the physician shall consider the follow- International Clinical Diabetic Retinopathy Disease
Severity Scale. Efficient breathing and respiratory gas exchange is Has normal renal function based on a calculated creati- required for essential job tasks 1, 2, 3, 4, 5, 7, 9, and 13. nine clearance greater than 60 mL/min and absence of
proteinuria. (Creatinine clearance can be calculated by consumption required to safely perform these tasks and, use of the Cockroft-Gault or similar formula. Proteinuria therefore, increases the respiratory workload. is defined as 24-hour urine excretion of greater than or SCA is a positive-pressure demand valve respirator that equal to 300 mg protein or greater than or equal to provides a barrier against the inhalation of noxious/toxic 300 mg of albumin per gram of creatinine in a random gases and particulate matter but at increased metabolic cost due to its weight and increased respiratory workload Has no autonomic or peripheral neuropathy. (Peripheral (resistance and dead space). neuropathy is determined by diminished ability to feel If respiratory function or gas exchange is already compro- the vibration of a 128 cps tuning fork or the light touch mised (increased work of breathing from structural or of a 10-gram monofilament on the dorsum of the great functional abnormalities, hypoxia, and/or hypercapnia) toe proximal to the nail. Autonomic neuropathy can be prior to the performance of essential job tasks, then the determined by evidence of gastroparesis, postural hypo- increased oxygen demand of strenuous physical exertion. tension. or abnormal tests of heart rate variabilitv.) while wearing a personal protective ensemble and/or Has normal cardiac function without evidence of myocar- SCBA, leads to early onset of fatigue or respiratory insuffi- dial ischemia on cardiac stress testing (to at least 12 METs) by ECG and cardiac imaging. Lung, chest wall, and respiratory disorders can compro- mise the member's ability to safely perform essential job tasks 1, 2, 3, 4, 5, 7, 9, and 13.
2018 Edition Shaded text = Revisions. A = Text deletions and figure/table revisions. • = Section deletions. N = New material.
Copyright 2019 Nationa Fire Protection Assostion INPAcicensed Py apreement, for individual use and downipad on 01/06.2019to Rily Alcon for designated user William Swan No oner reproductien or trensmission in any ferre pennilted without watter porniese of MEDRE Poundines ea10 teport mauthented use, contact licenseg@pipe co Te NFOSS Al Acos shsompfon expres on Decembe: 10. 2013.
ESSENTIAL JOB TASKS — SPECIFIC EVALUATION OF MEDICAL CONDITIONS IN MEMBERS 1582-29
9.7.3 If the member has any lung, chest wall, or respiratory cative challenge testing or less than 13 percent decline in disorders, the member shall be individually evaluated in FEV, from baseline for exercise challenge testing using accordance with 9.7.4 through 9.7.24 to determine if the disor- cold air, methacholine (PCon greater than 8 is considered ders compromise the member's ability to safely perform the normal, as response at dose greater than 8 mg might not be clinically significant), histamine, mannitol, or exercise.
9.7.4 Tracheostomy. Failure to wear an SCBA during all phases of fire suppres- sion places an asthmatic fire fighter at risk for sudden
9.7.4.1 Physician Evaluation. Tracheostomy compromises the incapacitation. member's ability to safely wear SCBA (essential job task 2), The member has a signed statement from a pulmonary or communicate effectively due to oropharyngeal dysfunction asthma specialist, knowledgeable in the essential job tasks (essential job task 12), and effectively clear secretions or and hazards of fire fighting, that the member meets the inhaled particulate matter (essential job task 3), and the physi- criteria specified in 9.7.6.1(1) through 9.7.6.1(5) and can cian shall report the applicable job limitations to the fire safely perform essential job tasks 1, 2, 3, 4, 5, 7, 9, and 13 without the use of bronchodilator rescue medications.
9.7.4.2 Physician Guidance. The physician shall consider that 9.7.6.2 Physician Guidance. The physician shall consider the a member with a history of tracheostomy that is now sealed and following when evaluating the member's asthmatic condition:
without persistent respiratory disease or dysfunction does not (1) Exposures to exertion, temperature extremes, cold dry prevent safe performance of essential job tasks. air from SCA, combustion by-products, irritants, and
9.7.5 Chronic Cough. particulate matter are all potent provokers of asthma
9.7.5.1 Physician Evaluation. Chronic cough with or without Bronchodilator medications are not adequate mainte- hemoptysis might compromise the member's ability to safely nance therapy to control symptoms in the irritant envi- wear SCBA (essential job task 2) and to safely perform in an ronment of the fireground or hazardous materials irritant environment (essential job task 3), and after further incident scene because their use has not been approved evaluation and a final medical determination of the member's by the FDA for use on the fireground or hazardous mate- condition, the physician shall report any applicable job limita- rials incident scene and because several studies have tions to the fire department. implicated the frequent use of beta-agonists (i.e., short- and long-acting bronchodilators) as an independent
9.7.5.2 Physician Guidance.
predictor or risk for sudden death and myocardial infarc- severity of the cough, the impact of irritants and SCBA use on tion in the United States, Canada, Britain, New Zealand cough severity, and the impact of cough severity on the ability to safely wear SCBA and perform strenuous exertion. The There is a high probability that acute hyperreactivity in cause of chronic cough and/or hemoptysis needs to be evalu- this environment can induce immediate or progressive
ated, as the underlying conditions can also produce increased clinical asthma (ie., bronchospasm and wheeze) that can work of breathing, gas exchange abnormalities, or airway lead to sudden incapacitation from status asthmaticus hyperreactivity. and/or cardiac ischemia. There are no studies that
9.7.6* Asthma. support or deny that asthma in this environment can be prevented or adequately controlled by anti-inflammatory A 9.7.6.1 Physician Evaluation. Asthma compromises the inhaled corticosteroids, cromolyn, member's ability to safely perform essential job tasks 1, 2, 3, 4, leukotriene modifiers). It is not acceptable to use or rely 5, 7, 9, and 13, and the physician shall report the applicable job on bronchodilator medications for this purpose because limitations to the fire department, unless the following provi- in a hazardous environment, SCBA cannot be removed to sions are met: use a rescue inhaler, and there are no studies that (1) The member has no bronchospasm during exertion, support or deny that their use is preventive or effective in temperature/humidity extremes, irritant exposures, fire a fire/smoke environment. activities, or hazmat activities. The member's work history, as well as clinical findings on (2) The member does not use bronchodilator rescue medica- annual evaluation, should be used as an assessment of the tions during exertion, temperature/humidity extremes, member's practical ability to safely perform the essential irritant exposures, fire activities, or hazmat activities. job tasks. (3) A review of the member's fire department records (e.g.,
9.7.7* Allergic Lower Respiratory Disorders.
training, operations, rehabilitation, and medical) verifies that no asthmatic episodes have occurred during fire 9.7.7.1 Physician Evaluation. Allergic lower respiratory disor- suppression or hazardous materials operations or train- ders might compromise the member's ability to safely perform essential job tasks 1, 2, 3, 4, 5, 7, 9, and 13, and after further The member's asthma has not required systemic cortico evaluation and a final medical determination of the member's steroids, emergency room treatment, or hospital admis- condition, the physician shall report any applicable job limita- sion in the past 2 years. tions to the fire department. (5) The member shows adequate reserve in pulmonary func- tion (ie. FVC and FEV, greater than or equal to 9.7.7.2 Physician Guidance. The physician shall consider that 90 percent) and no bronchodilator response measured allergic lower respiratory disorder, a term used to define asthma (clinical reversible bronchospasm), is triggered by a off all bronchodilators on the day of testing.
(6) * The member has a normal or negative response of less known allergic insult and once triggered these patients have than 20 percent decline in FEV, from baseline for provo demonstrable airway hyperreactivity for weeks to months; it can be recurrent and/or become permanent.
Shaded text = Revisions. A = Text deletions and figure/table revisions. • = Section deletions. N = New material. 2018 Edition Copynght 2010 National Fine Pretection Association (PPA) censed, by agreement for indiyual use and downined en 706/2019 to Pill Alcon ter designaled user Willer: Swen No ether reproduction of transmission in any lem parmited without enden permission of NEPAL. For munes (to repent sna hensed use comest hones geom pa.000 This NEOES All ARCAs: subsongson expires on Decemost ' 2019 1582-30 COMPREHENSIVE OCCUPATIONAL MEDICAL PROGRAM FOR FIRE DEPARTMENTS
9.7.8* Chronic Obstructive Airways Diseases. 9.7.10 Hypercapnic Disorders.
9.7.8.1 Physician Evaluation. Chronic obstructive airways 9.7.10.1 Physician Evaluation. Hypercapnic disorders (eleva- diseases (e.g., chronic bronchitis, emphysema), if moderate to ted carbon dioxide with serum Pcoz greater than or equal to severe (i.e., absolute FEV,/FVC ratio less than or equal to 0.70 45 mm Hg) found during evaluation of respiratory complaints and an FEV, less than 70 percent predicted), compromises the or disease compromise the members ability to salely pertorm member's ability to safely perform essential job tasks 1, 2, 3, 4, essential job tasks 1, 2. 3, 4, 5, 7, and 13, and the physician shall 5, 7, 9, and 13, and the physician shall report the applicable job report the applicable job limitations 10 the fire department. limitations to the fire department unless the following provi- 9.7.10.2 Physician Guidance. The physician shall consider sions are met: that hypercapnia can be the result of central regulatory disturb- (1) The FEV, is 50 percent or greater. ance, medications, obstructive sleep apnea, severe asthma, end- (2) The member has no bronchospasm during exertion, stage chronic obstructive airways diseases, or end-stage temperature/humidity extremes, SCBA use, irritant expo- interstitial lung disease. In this environment, gas exchange sures, fire activities, or hazmat activities. abnormalities and respiratory insufficiency no matter the cause (3) The member does not require daily bronchodilator ther- have the potential for life-threatening sudden incapacitation apy. from cardiopulmonary insufficiency.
(1) The member has experienced continuous tobacco cessa- tion for more than 3 months. 9.7.11 Pulmonary Hypertension. (5) The member has not required systemic corticosteroids, 9.7.11.1 Physician Evaluation. Pulmonary hypertension emergency room treatment, or hospital admission for compromises the member's ability to safely perform essential pulmonary disease, including chronic bronchitis or pneu- job tasks 1, 3, 4, 7, and 13, and the physician shall report the monia, in the past 2 years. applicable job limitations to the fire department. (For further The member can perform an exercise test to 12 METs details see sections on hypoxia (9.7.9), pulmonary embolism (9.7.20), without exercise-induced evidence for the following: and cardiac valve dysfunction (9.4.11).J (a) Bronchospasm (i.e., a decline FEV, of more than
9.7.12 Tracheal Stenosis.
13 percent from baseline)
Oxygen desaturation (ie., a fall in oxygen satura- 9.7.12.1 Physician Evaluation. Tracheal stenosis might tion on room air by 4 percent from baseline or to compromise the member's ability to safely perform essential 94 percent or less) job tasks 1, 2, 3, 4, 5, 7, and 12 if pulmonary dysfunction is (c) Cardiac ischemia or clinically significant arrhyth- reduced (FVC less than 60 percent of predicted or abnormal mias inspiratory flow volume loop) or if the underlying cause of the (7) There is no evidence of pulmonary hypertension on stenosis prevents the successful and safe performance of the echocardiography. essential job tasks, and after further evaluation and a final medical determination of the member's condition, the physi-
9.7.9 Hpoxemic Disorders. cian shall report any applicable job limitations to the fire A 9.7.9.1 Physician Evaluation. Hypoxemic disorders, when department. moderate to severe (i.e., oxygen saturation less than 90 percent 9.7.13 Pulmonary Resection Surgery, Chest Wall Surgery, or or a Po, less than 65 mm Hg, measured at rest and corrected to Traumatic Pneumothorax. sea level on room air), or the presence of significant exercise desaturation (i.e., a fall in oxygen saturation by 4 percent from 9.7.13.1 Physician Evaluation. baseline or to less than 90 percent) compromise the member's
9.7.13.1.1 If the member has had pulmonary resection
surgery, chest wall surgery, and/or traumatic pneumothorax, the fire department.
A 9.7.9.2 Physician Guidance. The physician shall recognize the following situations when evaluating the member: oxygen saturation. (1) A resting oxygen saturation of 90 percent to 93 percent 9.7.13.1.2 Abnormal PFTs or decreased gas exchange might corrected to sea level requires measurement at exercise to compromise the member's ability to safely perform essential 12 METs determine if desaturation (i.e. decrease job tasks 1, 2, 3, 4, 7, and 13, and after further evaluation and a oxygen saturation by greater than or equal io 4 percent final medical determination of the member's condition, the from baseline or to less than 90 percent) occurs. physician shall report any applicable job limitations to the fire Hypoxia can be the result of central regulatory disturban- department. ces, obstructive sleep apnea, asthma, chronic obstructive
9.7.13.2 Physician Guidance. The physician shall consider the hypertension, chronic pulmonary embolism, and so following when evaluating the member:
Pulmonary function tests should be performed
(3) In this environment, gas exchange abnormalities and adequate healing and pain resolution and clearance by respiratory insufficiency no matter the cause have the the thoracic surgeon; generally, this is 4 weeks after thora- potential for life-threatening sudden incapacitation from coscopic surgery and 6 to 8 weeks after open-chest cardiopulmonary insufficiency.
(2) Pulmonary function tests should be either normal or show only a minimal restrictive disorder without evidence for interstitial disease or gas exchange abnormalities. 2018 Edition Shaded text = Revisions. 4 = Text deletions and figure/table revisions. • = Section deletions. N= New material.
Copinght 2010 Nationa Fire Protection Asedistion (NFP Licensed, sy agreement or individual use and downipad on 0006/2010 to Sily Alcom for designated user Witani Swen. No otner teproduction or transmission in any is NEGES Aladooss supectionor expires on Decerter 19, 2019.
ESSENTIAL JOB TASKS — SPECIFIC EVALUATION OF MEDICAL CONDITIONS IN MEMBERS 1582-31 (3) Moderate to severe restriction (i.e., FVC less than 9.7.18 Interstitial Lung Diseases. 60 percent of predicted with an absolute FEV,/FVC ratio greater than or equal to 0.90) or hypoxia compromises 9.7.18.1 Physician Evaluation. Interstitial lung diseases includ- the member's ability to safely perform essential job tasks ing pneumoconiosis (anthracosis, silicosis, asbestosis), hyper- unless a more complete evaluation of gas exchange and sensitivity pneumonitis, eosinophilic pneumonitis, idiopathic pulmonary fibrosis, inhalation pneumonitis, and extensive exercise capacity shows the ability to exercise at a work- load of 12 METs without evidence of exercise hemoglobin pulmonary infections might compromise the member's ability oxygen desaturation. to safely perform essential job tasks 1, 2, 3, 4, and 7, and after further evaluation and a final medical determination of the
9.7.14* Spontaneous Pneumothorax. member's condition, the physician shall report any applicable job limitations to the fire department.
9.7.14.1 Physician Evaluation. Spontancous pneumothorax, when present, might compromise the member's ability to safely 9.7.18.2 Physician Guidance. The physician shall consider perform essential job tasks 1, 2, 3, 4, 7, and 13 due to pain and that moderate to severe restriction (FVC less than 60 percent of dyspnea, and after further evaluation and a final medical deter- predicted with an absolute FEV,/FVC ratio greater than or mination of the member's condition, the physician shall report equal to 0.90) compromises the member's ability to safely any applicable job limitations to the fire department. perform essential job tasks unless a more complete evaluation of gas exchange and exercise capacity shows the ability to exer-
9.7.14.2 Physician Guidance. The physician shall consider cise at a workload of 12 METs without evidence of hypoxia or that members with a history of spontaneous pneumothorax and cystic/bullous disease (e.g., as demonstrated on chest CT scan) whose essential job task 4 includes SCUBA diving cannot 9.7.19 Sarcoidosis. safely perform this task since pressure changes during diving can induce recurrence. 9.7.19.1 Physician Evaluation. Sarcoidosis resulting in moder- ale or severe pulmonary dysfunction, significant visual impair-
9.7.15 Fibrothorax, Chest Wall Deformity, and/or Diaphragm ment, cardiac dysfunction (cardiomyopathy or arrhythmia) at Abnormalities. rest or exercise, other moderate to severe end-organ dysfunc-
9.7.15.1 Physician Evaluation. Fibrothorax, chest wall deform- tion, or the need for current treatment with systemic corticoste- roids compromises the member's ability to safely perform ity, and/or diaphragm abnormalities might compromise the essential job tasks 1, 2, 3, 4, 7, 8, and 13, and the physician shall members ability to safely perform essential job tasks 2, 4, and report the applicable job limitations to the fire department. 7, and after further evaluation and a final medical determina- tion of the member's condition, the physician shall report any 9.7.19.2 Physician Guidance. The physician shall consider the applicable job limitations to the fire department. following when evaluating a member with sarcoidosis:
9.7.15.2 Physician Guidance. The physician shall consider (1) Most patients with sarcoidosis are asymptomatic with that moderate to severe restriction (FVC less than 60 percent of abnormal chest imaging studies but normal function. predicted with an absolute FEV,/FVC ratio greater than or assessment by individual examination, equal to 0.90) compromises the member's ability to safely a an an entic membets grace them or pulmonary function tests, ECG, Holter ECG, and echo- perform essential job tasks unless a more complete evaluation cardiogram are normal, the member is capable of safely of gas exchange and exercise capacity shows the ability to exer- performing essential job tasks. cise at a workload of 12 METs without evidence of hypoxia or Moderate to severe restriction (le., FVC less than exercise hemoglobin oxygen desaturation. 60 percent of predicted with an absolute FEV,/FVC ratio greater than or equal to 0.90) compromises the member's
9.7.16* Pleural Effusions. ability to safely perform essential job tasks unless a more
9.7.16.1 Physician Evaluation. Pleural of gas exchange and exercise compromise the member's ability to safely perform essential capacity shows the ability to exercise at a workload of 12 job tasks 2, 1, and 7, and after further evaluation and a final METs without evidence of exercise hemoglobin oxygen medical determination of the member's condition, the physi- cian shall report any applicable job limitations to the fire Cardiac function should be formally assessed with echo department. cardiography, Holter ECC, and ECG.
9.7.17 Bronchiectasis and/or Bronchiolitis Obliterans. 9.7.20 Pulmonary Embolism.
9.7.17.1 Physician Evaluation. Bronchiectasis and/or bron- 9.7.20.1 Physician Evaluation. chiolitis obliterans might compromise the member's ability to 9.7.20.1.1 Acute, recent, recurrent, or chronic pulmonary safely perform essential job tasks 1, 2, 3, 4, 5, and 7, and after embolism requiring anticoagulation compromises further evaluation and a final medical determination of the member's ability to safely perform essential job task 8, and the member's condition, the physician shall report any applicable physician shall report the applicable job limitations to the fire job limitations to the fire department. department.
9.7.17.2 Physician Guidance. The physician shall consider 9.7.20.1.2 Moderate to severe pulmonary dysfunction (restric- that the ability to safely perform essential job tasks is based on tion or gas exchange abnormalities) or pulmonary hyperten- ymptom (frequent productive cough, wheezing, and/or dysr sion is rare but if present compromises the member's ability to lea) and disease severity (chest CT scan demonstrating mult safely perform essential job tasks 1, 2, 4, and 7, and the physi- lobar disease and pulmonary function tests demonstrating cian shall report the applicable job limitations to the fire moderate to severe obstructive or restrictive dysfunction or gas department. exchange abnormalities).
Shaded text = Revisions. A = Text deletions and figure/table revisions. • = Section deletions. N= New material. 2018 Edition Copyright 2019 Natone Sire Protecton Association iNFPA Licensed. by agreement, fond dual use ano downinad on: 01106/2010 to Bily nicor for designated user Willer: Swan No ether reproduction or transmission in any ice pennitted without written permission NAPAD Forinquiries orto repert unbuthonzed use, corest icerse pati EnS NFOSE All Access 3006c10100 capres on December ' 2013. 1582-32 COMPREHENSIVE OCCUPATIONAI MEDICAL PROGRAM FOR FIRE DEPARTMENTS
9.7.21 Disorders of Respiratory Regulation. 9.8.3 If the member has any infectious diseases, the member shall be individually evaluated in accordance with
9.7.21.1 Physician Evaluation, Disorders of respiratory regula- through 9.8.12 to determine if the diseases compromise the tion can result in gas exchange abnormalities that might member's ability to safely perform the essential job tasks. compromise the member's ability to salcly perform essenua! job tasks 1, 2, 4, 7, and 9, and after further evaluation and a 9.8.4 Skin Infections and Draining Ulcers or Cysts. final medical determination of the member's condition, the
9.8.4.1 Physician Evaluation. Skin infections and draining physician shall report any applicable job limitations to the fire ulcers or cysts might compromise the member's ability to wear department. PPE (essential job tasks 2 and 5) or present too high a risk for
9.7.21.2 Physician Guidance. The physician shall consider exposure to infectious agents and toxins (essential job task 3), that conditions including but not limited to obstructive sleep and after further evaluation and a final medical determination apnea, central apnea, and disordered central breathing regula- of the member's condition, the physician shall report any appli- cion require evaluation of medical history, physical exam, cable job limitations to the fire department. pulmonary function tests, gas exchange, exercise tests, sleep
9.8.5 Upper or Lower Respiratory Infections.
tests, and other tests as deemed necessary.
9.8.5.1 Physician Evaluation. Upper or lower respiratory
9.7.22 Cystic Lung Diseases.
infections that result in excessive cough, inability to use SCBA,
9.7.22.1 Physician Evaluation. or pulmonary dysfunction might compromise the member's ability to safely perform essential job tasks 1, 2, 3, 4, 5, and 7,
9.7.22.1.1 Cystic lung diseases (e.g., congenital bullous and after further evaluation and a final medical determination disease, pneumatocele, blebs, cystic fibrosis) with significant of the member's condition, the physician shall report any appli- abnormalities on chest film or moderate to severe pulmonary cable job limitations to the fire department. dysfunction (FVC less than 60 percent predicted or gas
exchange abnormalities) compromise the member's ability to 9.8.6 Ear Infections. safely perform essential job tasks 1, 2, and 4, and the physician 9.8.6.1 Physician Evaluation. Ear infections that interfere with shall report the applicable job limitations to the fire depart- balance and/or hearing might compromise the member's abil- ment.
ity to safely perform essential job tasks 8 and 12, and after
9.7.22.1.2 Members shall be restricted from SCUBA diving if further evaluation and a final medical determination of the disease is moderate to severe on chest CT imaging, even if member's condition, the physician shall report any applicable pulmonary function tests are normal. job limitations to the fire department.
9.7.23 Tuberculosis. See Section 9.8. 9.8.7 Gastrointestinal Infections.
9.7.24 Lung Cancer. See Section 9.17. 9.8.7.1 Physician Evaluation. Gastrointestinal infections including parasites that result in dehydration or frequent use
9.7.25 Lung Transplant. of toilet facilities at least temporarily might compromise the
9.7.25.1 Physician Evaluation. Lung function post-lung member's ability to safely perform essential job tasks 1, 5, 8, transplantation shall be considered compromising and 9, and after further evaluation and a final medical determi- member's ability to safely perform essential job tasks (1, 2, 4, 5, nation of the member's condition, the physician shall report 6, 7, 8, 9, 10, 13). any applicable job limitations to the fire department.
9.8 Infectious Diseases. 9.8.8 Kidney or Urinary Infections.
9.8.1 Infectious diseases shall include systemic, local, acute, 9.8.8.1 Physician Evaluation. Kidney or urinary infections that and chronic infections as well as post-infectious processes.
9.8.2 When evaluating a member for infectious diseases, the essential job tasks 1, 5, and 9, and after further evaluation and a physician shall consider the following: final medical determination of the member's condition, the (1) Many infections interfere with control of body tempera- physicimental report any applicable job limitations to the fire ture, hydration, and nutritional status.
Many infections also produce severe pain, muscle weak- 9.8.9* Infection That Results in Dizziness, Weakness, Signifi ness, compromise mobility, and/or ability to safely cant Weight Loss, or Pain. perform heavy physical exertion.
9.8.9.1 Physician Evaluation. Any infection that results in dizziness, significant weakness, significant weight loss, or signifi health risk due to contagious disease. ant pain limiting functional capacity compromises th (4)
Amperary wore restricd in examples cessese in regi
emporary work restriction.
or upper respiratory tract infection, which can interfere with safe performance of essential job tasks 2 and 3, or acute dermatitis, which would
performance of essential job task 3.
(5) Following resolution of these acute processes, members can return to full duty.
2018 Edition Shaded text = Revisions. 4 = Text deletions and figure/table revisions. • = Section deletions. N= New material.
Copyrigin: 2010 Netonal Fire Protection Association (NFRA Licensed, by agreement, for individal use and downicad on 07/00/2019 to Billy Alcor for designated user William Swen No other saproduction or transetission in any for: permitted withau! sentien parmission of NEPAS Formovines date report unauthonzed ase, conteet lomsig@nipaorg IS NECES Agaccase subscaptor expres on December 19. 2019 ESSENTIAL JOB TASKS - SPECIFIC EVALUATION OF MEDICAL CONDITIONS IN MEMBERS 1582-33
9.8.10* Active Pulmonary Tuberculosis. (2) The personal protective ensemble and SCBA can place the fire fighter's spine at a biomechanical disadvantage
9.8.10.1 Physician Evaluation. Active pulmonary tuberculosis, due to added weight and altered center of gravity.
by posing a public health risk to the community and
members, compromises the member's ability to safely perform 9.9.3 If the member has any spine disorders, the member shall essential job tasks 2, 4, 5, and 12, and the physician shall report be individually evaluated in accordance with 9.9.4 through the applicable job limitations to the fire department. 9.9.9 to determine if the disorders compromise the member's ability to safely perform the essential job tasks.
9.8.11* Hepatitis.
9.9.4 Spinal Fusion.
9.8.11.1 Physician Evaluation. Hepatitis, specifically infectious diseases of the liver caused by viruses including but not limited 9.9.4.1 Physician Evaluation. Spinal fusion that results in the to A, B, C, D, and E, and the treatment of hepatitis might member not being able to safely perform essential job tasks 1, compromise the member's ability to safely perform essential 2, 4, 5, 6, 7, 8, and 13 shall be reported to the fire department job tasks 1, 2, 4, 5, 7, 9, and 13, and after further evaluation and by the physician. a final medical determination of the member's condition, the physician shall report any applicable job limitations to the fire 9.9.5 Ankylosing Spondylitis. department. 9.9.5.1 Physician Evaluation. Ankylosing spondylitis might
9.8.11.2 Physician Guidance. Medical compromise the member's ability to safely perform essential management
members following occupational exposure or development of job tasks 1, 2, 4, 5, 6, 7, and 8, and after further evaluation and any viral hepatitis shall conform to the current CDC guidelines, a final medical determination of the member's condition, the which includes recommendations for restriction from various physician shall report any applicable job limitations to the fire types of duty. (See 7.7.9(2).] department.
9.8.12* Human Immunodeficiency Virus (HIV) Infection. 9.9.6 Spinal Condition with Significant Radiculopathy.
9.8.12.1 Physician Evaluation. If the member has been diag- 9.9.6.1 Physician Evaluation. Spinal condition with significant nosed with human immunodeficiency virus (HIV) infection, radiculopathy resulting in peripheral motor weakness, loss of strength, loss of sensation, and loss of reflexes affecting endur- the physician shall evaluate the member to determine if the member can perform the essential job tasks. ance, strength, flexibility, pain, and/or gait disturbances compromises the member's ability to safely perform essential
9.8.12.1.1 AIDS and significant organ damage or dysfunction job tasks 1, 2, 4, 5, 6, 7, 8, and 13, and the physician shall report resulting from HIV infection compromise the member's ability the applicable job limitations to the fire department. to safely perform essential job tasks 1, 2, 4, 5, 7, 8, and 9 due to
9.9.7 Use of Narcotics or Muscle Relaxants.
debilitation, and the physician shall report the applicable job limitations to the fire department. 9.9.7.1 Physician Evaluation. The use of narcotics or muscle
9.8.12.1.2 Anemia, cardiopulmonary dysfunction, or neuro- relaxants to treat any spinal condition compromises the logic dysfunction compromises the member's ability to safely member's ability to safely perform essential job tasks 1, 2, 4, 5, perform essential job tasks 1, 2, 3, 4, 5, 7, 9, and 13, and the 6, 7,8, and 13, and the physician shall report the applicable job limitations to the fire department.
physician shall report the applicable job limitations to the fire department. 9.9.7.2 Physician Guidance. The physician shall consider that
9.8.12.1.3 Peripheral neuropathy compromises the member's medication-induced somnolence, discoordination, and/or dise- ability to safely perform essential job tasks 1, 3, and 5, and the quilibrium compromise a member's ability to safely operate in hazardous environments.
physician shall report the applicable job limitations to the fire department. 9.9.8 Spine Structural Abnormality, Fracture, or Dislocation.
9.8.12.1.4 Dementia compromises the member's ability to 9.9.8.1 Physician Evaluation. Spine structural abnormality, safely perform essential job tasks 1, 11, and 12, and the physi- fracture, or dislocation that causes progressive or recurrent cian shall report the applicable job limitations to the fire impairment might compromise the member's ability to safely department. perform essential job tasks 1, 2, 4, 5, 6, 7, 8, and 13 due to limi-
9.9* Spine Disorders. tations of endurance, strength, flexibility, or pain, and after further evaluation and a final medical determination of the
9.9.1 Spine disorders shall include conditions of the cervical, member's condition, the physician shall report any applicable thoracic, and lumbosacral spine such as strains, fractures, and job limitations to the fire department. discogenic disease as well as cord, cauda equina, and paraspi- nous syndromes. 9.9.8.2 Physician Guidance. The physician shall consider that spinal structural abnormality, a fracture, or a dislocation can
9.9.2 When evaluating a member for spine disorders, the also result in ligament instability, increasing the risk for future physician shall consider the following: dislocation and neurologic compromise. (1) Fire fighters with active, ongoing, or recurrent spinal 9.9.9 Herniation of Nucleus Pulposus. disorders can have difficulty due to reduced motor
strength, sensation, and flexibility as well as problems 9.9.9.1 Physician Evaluation. Herniation of nucleus pulposus with fatigue, coordination, gait, and equilibrium. or a history of laminectomy, discectomy, or single-level fusion might compromise the member's ability to safely perform essential job tasks 1, 2, 4, 5, 6, 7, 8, and 13 due to pain or limita- tions of endurance, strength, or flexibility, and after further Shaded text = Revisions. A = Text deletions and figure/table revisions. • = Section deletions. N = New material. 2018 Edition Copynply 2019 National re Protection is cocation (NFPA Libensed. cy agreement. for individual use and downinad on 0770642218 to Be Alcorn for designated user William Swan No other reproduckon or transmission in any 1582-34 COMPREHENSIVE OCCUPATIONAL MEDICAL PROGRAM FOR FIRE DEPARTMENTS evaluation and a final medical determination of the member's and a state-of-the-art prosthesis shall meet all of the following condition, the physician shall report any applicable job limita- requirements:
tions to the fire department. (1) A stable, unilateral BKA with at least the proximal third of
9.10* Orthopedic Disorders. the tibia present for a strong and stable attachment point with the prosthesis
9.10.1 Orthopedic disorders shall include injuries and (2) Fitted with a prosthesis that will tolerate the conditions illnesses involving upper extremities, pelvis, and lower extremi- present in fire fighting, when worn in conjunction with ties including nerves, muscles, tendons, joints, and bones.
At least 6 months of prosthetic use in a variety of physi-
9.10.2 When evaluating a member for orthopedic disorders, the physician shall consider the following: cally demanding activities with no functional difficulties The amputee limb is healed with no significant inflamma- (1) Fire fighters with active, ongoing, or recurrent orthope- ton, persistent pain, necrosis, or indications of instability dic disorders can have difficulty due to reduced motor at the amputee limb attachment point strength, sensation, and flexibility as well as problems Demonstrates no disabling psychosocial issues pertaining with fatigue, coordination, gait, and equilibrium. to the loss of limb and/or use of prosthesis (2) The personal protective ensemble and SCBA can place Evaluated by a prosthetist or orthopedic specialist with the fire fighter's involved extremity (upper or lower) at a expertise in the fitting and function of prosthetic limbs biomechanical disadvantage due to added weight and who concurs that the candidate can complete all essential altered center of gravity. job tasks listed in Chapter 9, including wearing personal (3) Certain medications (narcotics and muscle relaxants) protective ensembles and SCBA while climbing ladders, used to treat orthopedic conditions can produce or operating from heights, and walking or crawling in the worsen somnolence, discoordination, and disequilibrium. dark along narrow and uneven surfaces that might be wet
9.10.3 If the member has any orthopedic disorders, the
member shall be individually evaluated in accordance with 9.10.6 Amputation of Fingers) Other than Thumb.
9.10.4 through 9.10.20 to determine if the disorders compro- mise the member's ability to safely perform the essential job 9.10.6.1 Physician Evaluation. Amputation of fingers) other tasks. than a thumb might compromise the member's ability to safely perform essential job tasks 1, 2, 6, 7, and 8, and after further
9.10.4 Amputation of Arm, Hand, or Thumb. evaluation and a final medical determination of the member's condition, the physician shall report any applicable job limita-
9.10.4.1 Physician Evaluation. Amputation of an arm, hand, or thumb compromises the member's ability to safely perform tions to the fire department. essential job tasks 1, 2, 6, 7, and 8, and the physician shall 9.10.6.2 Physician Guidance. The physician shall consider report the applicable job limitations to the fire department. that the amputation of these limbs or joints might interfere with grip and other physical abilities required to safely perform
9.10.4.2 Physician Guidance. When evaluating a member with an amputation of the arm, hand, or thumb, the physician shall essential job tasks. consider the following: 9.10.7 Amputation of Partial Foot or Toe(s). (1) The amputation of these limbs or joints impairs grip and 9.10.7.1 Physician Evaluation. Amputation of a partial foot or other physical abilities required to safely perform essen- toe(s) might compromise the member's ability to safely tial job tasks. perform essential job tasks 1, 4, 6, 7, and 8, and after further Prosthetic limbs do not provide adequate function to evaluation and a final medical determination of the member's safely perform these essential job tasks rapidly in a life- condition, the physician shall report any applicable job limita- threatening, unforgiving environment. tons to the fire department.
9.10.5 Amputation of Leg. 9.10.7.2 Physician Guidance. The physician shall consider
9.10.5.1 Physician Evaluation. Amputation of a leg above the that the amputation of these limbs or joints might prevent knee ambulation and other physical abilities required to safely essential job tasks 1, 4, 6, 7, and 8, and the physician shall perform essential job tasks. report the applicable job limitations to the fire department. 9.10.8 Dislocation of a Joint.
9.10.5.2 Physician Guidance. 9.10.8.1 Physician Evaluation. Single episode of joint disloca- N 9.10.5.2.1 When evaluating a member with an amputation of a tion or dislocation with residual limitation of motion (depend- leg (above or below the knee) or entire foot, the physician shall ing upon degree) might compromise the member's ability to consider the following: safely perform essential job tasks 1, 2, 4, 6, 7, and 8, and after further evaluation and a final medical determination of the (1) The amputation of these limbs or joints significantly member's condition, the physician shall report any applicable impacts ambulation and other weight-bearing activities job limitations to the fire department. required to safely perform essential job tasks.
(2) Prosthetic limbs might not provide adequate function to 9.10.8.2 Physician Guidance. The physician shall consider safely perform these essential job tasks in an immediately hat successful surgery for shoulder dislocation, if range of dangerous to life and health (IDLH) environment. notion and strength were intact, would not interfere with the safe performance of essential job tasks.
N 9.10.5.2.2 To safely perform the essential job tasks in Chap- ter 5, an incumbent with a below-the-knee (BKA) amputation 2018 Edition Shaded text = Revisions. A = Text deletions and figure/table revisions. • = Section deletions. N = New material.
Copyngin: 2010 Natone: Fire Protection Assadation FPAD! Licensed By agreement, for individia use and downicad on 07/06/2018 to Bill Almon: or designated use Willien: Swan, No otpes teproduction or transmission in any fears permitted without walter parmisse biNPA fortreumesseto report unauda sed usa, centect kensing@nitatoro Ties NOSS AR acones sunschotion spores on December 19, 2019.
ESSENTIAL JOB TASKS — SPECIFIC EVALUATION OF MEDICAL CONDITIONS IN MEMBERS 1582-35
9.10.9 Recurrent Joint Dislocation of a Major Joint. 9.10.13 Joint Reconstruction.
9.10.9.1 Physician Evaluation. Recurrent joint dislocation of a 9.10.13.1 Physician Evaluation. Joint reconstruction in cases major joint (e.g., shoulder) compromises the member's ability where there is significant residual limitation of motion or to safely perform essential job tasks 1, 2, 4, 6, 7, and 8, and the strength compromises the member's ability to safely perform physician shall report the applicable job limitations to the fire essential job tasks 1, 4, 6, 7, and 8, and the physician shall department. report the applicable job limitations to the fire department.
9.10.9.2 Physician Guidance. When evaluating a member for 9.10.13.2 Physician Guidance. The physician shall consider recurrent joint dislocation, the physician shall consider the that surgery for a torn anterior cruciate ligament or meniscus following: can interfere with safe performance of essential job tasks 1, 4, (1) Unrepaired, repeated joint dislocations indicate an unsta- 6, 7, and 8 if quadriceps strength is reduced or if the knee is ble shoulder or hip, which can easily dislocate leading to unstable or develops pain or swelling when stressed. sudden incapacitation, placing the member or the person 9.10.14 Fractures. depending on the member at life-threatening risk.
(2) Post-surgical repair, the member can safely perform 9.10.14.1 Physician Evaluation. Fracture(s) might compro- essential job tasks if joint exam shows full functional mise the member's ability to safely perform essential job tasks motion, strength, and stability. I, 4, 6, 7, and 8, and after further evaluation and a final medi- cal determination of the member's condition, the physician
9.10.10 Ligament and/or Meniscus Knee Disease. shall report any applicable job limitations to the fire depart-
9.10.10.1 Physician Evaluation. Ligament and/or meniscus ment. knee disease with symptoms of locking, buckling, or giving-way 9.10.14.2 Physician Guidance. When evaluating a member compromises the member's ability to safely perform essential with a fracture, the physician shall consider the following:
job tasks 1, 4, 6, 7, and 8, and the physician shall report the applicable job limitations to the fire department. (1) Fractures, including hip fractures requiring internal fixa- tion, should not interfere with safe performance of essen-
9.10.10.2 Physician Guidance. When evaluating a member for tial job tasks as long as the radiograph demonstrates ligament and/or meniscus knee disease, the physician shall healing and exam is normal. consider the following: (2) Non-union fractures are not healed, and members cannot (1) Ligament and/or meniscus knee disease can lead to safely perform essential job tasks 1, 4, 6, 7, and 8 until union is achieved
sudden incapacitation, placing the member or the person depending on the member at life-threatening risk. 9.10.15 Appliances. (2) Post-surgical repair, the member can safely perform essential job tasks if joint exam shows full functional 9.10.15.1 Physician Evaluation. Appliances (screws, motion, strength, and stability. and/or metal plates) might compromise the member's ability to safely perform essential job tasks 1, 4, 6, 7, and 8, and after
9.10.11 Joint Replacements or Artificial Joints. further evaluation and a final medical determination of the member's condition, the physician shall report any applicable
9.10.11.1 Physician Evaluation. Joint replacements or artifi- cial joints compromise the member's ability to safely perform job limitations to the fire department. essential job tasks 1, 4, 6, 7, and 8, and the physician shall 9.10.15.2 Physician Guidance. When evaluating a member report the applicable job limitations to the fire department. with appliances, the physician shall consider the following
9.10.11.2 Physician Guidance. When evaluating a member (1) If the appliances are superficial, they could lead to perfo with joint replacements or artificial joints, the physician shall ration of the skin under the normal abrasive conditions verify that all of the following conditions are met: of fire fighting. (1) Normal range of motion without history of dislocations (2) If the underlying condition responsible for the surgical post-replacement implantation has healed, surgical consultation is adviser to determine the risk-benefit analysis for removing the (2) Repetitive and prolonged pulling,
Keeting, crand prood cle biling ben dais orations. appliance. ment
(3) No limiting pain
(4) An evaluation by an orthopedic specialist concurring that the incumbent can complete all essential job tasks listed in Chapter 9 9.10.16 Bone Grafts.
9.10.12 Limitation of Joint Motion. 9.10.16.1 Physician Evaluation. Bone grafts might compro mise the member's ability to safely perform essential job tasks
9.10.12.1 Physician Evaluation. Limitation of joint motion (depending upon degree) might compromise the member's 1, 4, 6, 7, and 8, and after further evaluation and a final medi- ability to safely perform essential job tasks 1, 2, 4, 6, 7, and 8 cal determination of the member's condition, the physician shall report any applicable job limitations to the fire depart lue to reduced flexibility, and after further evaluation and inal medical determination of the member's condition, the ment. physician shall report any applicable job limitations to the fire .10.16.2 Physician Guidance. The physician shall conside hat bone grafts, if well healed, do not interfere with the saf Shaded text = Revisions. A = Text deletions and figure/table revisions. • = Section deletions. N. = New material. 2018 Edition Copyngh: 2019 Natichel Fire Protection Association (NFPA) Licensed, by agreement, for individ la use and downinad on 07/06/201910 Mily Act for depignated user Wiler Swan No other reproduction or transmission in any torn pennated wahat walten permission of NEPRE, Forthodines orto report unputhorted use comedthcensing @hope org Fins NECeS All Acess sapschoot expres on December 19 2013 1582-36 COMPRFHENSIVE OCCUPATIONAL MEDICAL PROGRAM FOR FIRE DEPARTMENTS performance of job tasks as long as the radiograph demon- (8) History of gastrointestinal surgery strates healing and the exam is normal. (9) Gastric or other GI ulcers, including Zollinger-Ellison syndrome
9.10.17 Chronic Osteoarthritis or Traumatic Arthritis. (10) Cirrhosis
9.10.17.1 Physician Evaluation. Chronic osteoarthritis or trau- (11) Splenectomy, if healed, does not compromise the matic arthritis resulting in frequent episodes of pain and/or member's ability to safely perform essential job tasks. To reduced range of motion, strength, or endurance compromises prevent infections, Pneumovax® is recommended at the member's ability to safely perform essential job tasks 1, 4, 6, regular intervals. 7, and 8, and the physician shall report the applicable job limi- (12) Hernias, such as the following:
tations to the fire department. Hernias of the abdominal wall, especially inguinal and femoral hernias, might compromise
9.10.18 Inflammatory Arthritis. member's ability to safely perform essential job
9.10.18.1 Physician Evaluation. Inflammatory arthritis tasks 1, 4, 6, 7, and 13 due to the risk of incarcera- cases where it is severe, recurrent, or a progressive illness or tion and bowel strangulation during heavy exer- associated with deformity or limitation of range of motion), tion and lifting. can result in frequent episodes of pain, reduced Large ventral hernias have a low risk of incarcera- strength, and reduced flexibility, compromises the member's tion but can weaken the abdominal wall muscula- ability to safely perform essential job tasks 1, 4, 6, 7, and 8, and ture and might compromise the member's ability the physician shall report the applicable job limitations to the to safely perform essential job tasks 1, 4, 6, and 7. fire department. (c) Umbilical hernias that are small and asymptomatic will not generally interfere with fire-fighting duties.
9.10.19 Complex Regional Pain Syndrome. (d) Abdominal wall hernias at any site that have been
9.10.19.1 Physician Evaluation. Complex regional pain surgically corrected do not prevent otherwise syndrome, where pain is severe, narcotics or muscle relaxants qualified members from safely performing essen- tial fire-fighting tasks, provided the incision site is and the surgeon has cleared the
member for full lifting.
tations to the fire department. N 9.11.4 Renal Disease. Chronic kidney disease of Stage 4 or
9.10.20 Osteomyelitis or Septic Arthritis. greater [glomerular filtration rate (GFR) < 1 oz/min (30 ml/ min)], hemodialysis or continuous ambulatory peritoneal dialy-
9.10.20.1 Physician Evaluation. Osteomyelitis or septic arthri- sis compromises the member's ability to safely perform essen- tis, if active and causing pain, local drainage, systemic infection, tial job task 13, and the physician shall report the applicable and/or increased risk for pathologic or traumatic fractures, job limitations to the fire department. compromises the member's ability to safely perform essential tasks 1, 4, 6, 7, and 8, and the physician shall report the appli- 9.12 Medical Conditions Involving Head, Eyes, Ears, Nose, cable job limitations to the fire department. Neck, or Throat.
9.11 Disorders Involving the Gastrointestinal Tract and 9.12.1* Physician Evaluation.
Abdominal Viscera.
9.12.1.1 If the member has any medical conditions involving
9.11.1 Disorders involving the gastrointestinal (GI) tract and the head, eyes, ears, nose, neck, or throat, the member shall be abdominal viscera shall include conditions of the abdominal individually evaluated for conditions that interfere with the wall and peritoneum, as well as esophagus, stomach, small member's ability to comfortably wear and be protected by the bowel, colon, mesenteric structures, and intra-abdominal fire fighter's protective ensemble and that might compromise organs. the member's ability to safely perform essential job tasks 2, 4, 5,
9.11.2 If the member has any disorders involving the gastroin- testinal tract and abdominal viscera, the member shall be indi- 9.12.1.2 After the evaluation and a final medical determina- idually evaluated for the likelihood of inadequate nutrition, i tion of the member's condition, the physician shall report any propensity for symptomatic dehydration, anemia, or incapaci- applicable job limitations to the fire department. tating pain syndromes. 9.12.2 Physician Guidance. When evaluating a member with
9.11.3 Where the following GI disorders result in the compli- medical conditions involving the head, eyes, ears, nose, neck, cations defined in 9.11.2, the physician shall evaluate the or throat, the physician shall consider the following:
member's ability to safely perform essential job tasks 1, 4, 6, 7, (1) Deformities of the skull associated with evidence of 9, and 13, and after the evaluation and a final medical determi- disease of the brain, spinal cord, or peripheral nerves can nation of the member's condition, the physician shall report result in the potential for sudden incapacitation and the any applicable job limitations to the fire department: inability to properly wear protective equipment. (1) Cholecystitis (2) Contraction of head and neck muscles can interfere with (2) Gastritis wearing of protective equipment, impair speech, or other- (3) GI bleeding wise compromise a member's ability to safely perform (4) Inflammatory bowel disease or irritable bowel syndrome essential job tasks. (5) Intestinal obstruction
(6) Pancreatitis
(7) Diverticulitis
2018 Edition Shaded text = Revisions. 4 = Text deletions and figure/table revisions. • = Section deletions. N= New material.
Copyright 2019 Natienal Fire Pretection Association (NA, Licensed. By agreement, for individuause and dewmoad on 07/06200 Bily Acor for designated user Willem Swan No oter reproduction or transmission in any jean pemcted winout vitten pension ef REPA Formalmet onto teper unduhonzed use contact licensing @nipa ore. This NECES All Access bubsonpuon Papres on Decampg: 10 2019.
ESSENTIAL JOB TASKS — SPECIFIC EVALLATION OF MEDICAL CONDITIONS IN MEMBERS 1582-37
9.12.3 Disorders of the Eyes or Vision. gait and balance compromises the member's ability to safely perform essential job tasks 1, 8, 10, and 13, and the physician
9.12.3.1* Physician Evaluation. Disorders of the eyes or shall report the applicable job limitations to the fire depart- Vision; including the following might compromise the
ment.
member's ability to safely perform essential job tasks 6, 8, 10, or Il, and after further evaluation and a final medical determina- 9.12.6 Nose, Nasopharynx, Oropharynx, or Dental Structures. tion of the member's condition, the physician shall report any applicable job limitations to the fire department: 9.12.6.1* Physician Evaluation. Any deformity or disease of the nose, nasopharynx, oropharynx,
(1) * Far visual acuity worse than 20/40 in each eye corrected anosmia and sinusitis, might compromise with contact lens or spectacles, and far visual acuity melders ahis to safely perism essenial jo masks 2, 3, 5,3. uncorrected worse than 20/100 binocular for wearers of 12, and 13, and after further evaluation and a final medical hard contacts or spectacles. determination of the member's condition, the physician shall (2)* Monocular vision, stereopsis without fusional capacity, report any applicable job limitations to the fire department. night blindness, or loss of peripheral vision (i.e., horizon- tal field of vision less than 110 degrees in each eye 9.12.6.2* Physician Guidance. Obstructive sleep apnea, if not compromise the member's ability to safely perform essen- properly treated, might compromise the member's ability to tial job task 10. safely perform essential job tasks 2, 3, 5, 8, 12, and 13, and after (3) Far visual acuity worse than 20/100 in the worse eye, further evaluation and a final medical determination of the corrected or uncorrected, compromises the member's member's condition, the physician shall report any applicable ability to safely perform essential job task 10. job limitations to the fire department.
Peripheral vision in the horizontal meridian of less than 9.13* Neurologic Disorders. 110 degrees in the better eye, or any condition that signif- icantly affects peripheral vision in both eyes. 9.13.1 Neurologic disorders shall refer to ongoing, chronic, or (5) Near visual acuity less than 20/40 binocular, uncorrected recurrent disorders that impair an individual's neurological or corrected. functions, including central regulation, cognitive abilities, strength, perception, reflexes, coordination, gait, and equili- N 9.12.3.1.1 Successful soft contact lens wearers shall not be subject to the uncorrected standard in 9.12.3.1(1) if the member has been wearing soft contact lenses for more than 9.13.2 If the member has any neurologic disorder that signifi- 6 months with good tolerance. cantly impairs the member's neurologic functions, including central regulation, cognitive abilities, strength, perception,
9.12.3.2 Physician Guidance. The physician shall consider reflexes, coordination, gait, and equilibrium, the member shall that new monocular vision requires a minimum of 6 months be individually evaluated in accordance with 9.13.3 through for depth perception accommodation in order to safely to determine if the disorders compromise the perform other essential job tasks. member's abilicy to safely perform the essential job tasks.
9.12.4 Abnormal Hearing. 9.13.3 Ataxias.
9.12.4.1* Physician Evaluation. Abnormal hearing that 9.13.3.1 Physician Evaluation. Ataxias of the hereditary or impairs a member's ability to hear and understand the spoken degenerative type compromise a member's ability to safely voice under conditions of high background noise, or hear, perform essential job tasks 1, 4, 6, 7, and 8, and the physician recognize, and directionally locate cries or audible alarms, shall report the applicable job limitations to the fire depart- compromises the member's ability to safely perform essential ment. job tasks 2, 6, 8, 10, 12, and 13, and the physician shall report the applicable job limitations to the fire department. 9.13.4 Cerebrovascular Disease.
N 9.12.4.2* Minimum Hearing Standard. The use of hearing 9.13.4.1* Physician Evaluation. Cerebrovascular disease as aids or other hearing assistive devices shall be used by members evidenced by documented episodes of focal, reversible, or who, on audiometric testing, have an average hearing loss in neurological impairment might interfere with the member's the unaided better ear better than 10 decibels (dB) at 500 Hz, ability to safely perform essential job tasks 1 through 13, and 1000 Hz, 2000 Hz, and 3000 Hz when the audiometric device is after further evaluation and a final medical determination of calibrated to ANSI Z24.5, Audiometric Device Testing. the member's condition, the physician shall report any applica- ble job limitations to the fire department.
N 9.12.4.3 Physician Guidance.
9.13.4.1.1 Cerebrovascular disease as evidenced by documen- N 9.12.4.3.1 Hearing assistive devices shall not be used during ted episodes of focal, reversible, or neurological impairment, if audiometric testing irreversible, compromises the member's ability to safely N. 9.12.4.3.2 Hearing assistive devices shall be used by someone perform essential job tasks 1 through 13, and the physician who meets 9.12.4.2. shall report the applicable job limitations to the fire depart- ment, unless all of the following criteria are met:
N 9.12.4.3.3 If the device fails, the member shall still have suffi- cient hearing acuity to meet 9.12.4.2, the minimum hearing (1) At least 12 months since last transient ischemic attack, if risk factors are controlled and member is treated with an standard.
antiplatelet agent
9.12.5 Vertigo, Ataxia, or Disturbance of Gait and Balance. (2) At least 12 months since last ischemic stroke (or longer, depending on estimated risk of seizure)
9.12.5.1* Physician Evaluation. Any condition causing
chronic or recurring vertigo, ataxia, or other disturbance of Shaded text = Revisions. 4 = Text deletions and figure/table revisions. • = Section deletions. N = New material. 2018 Edition Copyright 2019 National Fire Protection Association (NFPA). Lidensed by agreement, for individual use and download on 01/00/29t Pily Aldom fer den gnated user Witam Swan Ne other reprodection or transmission in any fern permitted without atten parmission of NEPAID. for inquines ario repon unauthenzed use. contact kenst apa org This NECES All Access subscripton expires on December 19, 2019 1582-38 COMPREHENSIVE OCCUPATIONAL, MEDICAL PROGRAM FOR FIRE DEPARTMENTS (3) No decreased sensation or weakness that interferes with (4) There has been at least 12 months since last hemorrhagic essential job tasks stroke or subarachnoid hemorrhage or longer, depend- (4) No physical or cognitive limitations that interfere with ing on the estimated risk of scizure. essential job tasks There is no decreased sensation or weakness that inter- feres with essential job tasks.
9.13.4.1.2 Cerebrovascular disease as evidenced by documen- There are no physical or cognitive limitations that inter- ted episodes of focal, reversible, or neurological impairment, if fere with essential job tasks. requiring anticoagulation treatment, compromises the
member's ability to safely perform essential job task 8, and the 9.13.8 Head Trauma. physician shall report the applicable job limitations to the fire
9.13.8.1* Physician Evaluation. Head trauma including
department.
concussion, brain contusion, subarachnoid hemorrhage,
9.13.5 Neuromuscular, Demyelinating, and Other Progressive subdural, and/or epidural hematoma might compromise the Neurologic Diseases. member's ability to safely perform essential job tasks 1 through 13, and after further evaluation and a final medical determina-
9.13.5.1* Physician Evaluation. Neuromuscular, demyelinat- tion of the member's condition, the physician shall report any ing, and other progressive neurologic diseases compromise the applicable job limitations to the fire department. member's ability to safely perform essential job tasks 1, 4, 6, 7, 8, 12, and 13, and the physician shall report the applicable job 9.13.8.2 Physician Guidance. The physician shall consider limitations to the fire department, unless the member is free of having the member evaluated and cleared to return to duty by a qualified neurosurgeon or neurologist following significant head trauma.
9.13.9 CNS Tumors.
function.
9.13.5.2 Physician Guidance. The physician shall consider 9.13.9.1 Physician Evaluation. CNS tumors, depending that this category refers to but is not limited to multiple sclero- their location and the size of the mass, might compromise the sis, myasthenia gravis, muscular dystrophies, Huntington's member's ability to safely perform essential job tasks 1 through 13, and after further evaluation and a final medical determina- chorea, amyotrophic lateral sclerosis, and bulbar palsy. tion of the member's condition, the physician shall report any
9.13.6 Single Unprovoked Seizure and Epileptic Conditions. applicable job limitations to the fire department.
9.13.6.1* Physician Evaluation. Single unprovoked seizure 9.13.9.2 Physician Guidance. The physician shall consider and epileptic conditions, including simple, partial complex, that after successful resection of a CNS tumor a member can generalized, and psychomotor seizure disorders, compromise safely return to duty with a neurosurgeon's certification if exam the member's ability to safely perform essential job tasks 8, 9, and imaging studies are normal (except for surgical site) and 10, 11, and 13, and the physician shall report the applicable job EEG shows no epileptic activity off all anti-convulsant medica- limitations to the fire department unless the member meets all tions. of the following provisions:
9.13.9.2.1 Where applicable, metastatic workup shall be nega- No seizures for the most recent consecutive 5 years after tive. single unprovoked seizure.
(2)No seizures for the most recent consecutive 10 years if the 9.13.10 Parkinson's and Other Diseases with Tremor. applicant was diagnosed with epilepsy. 9.13.10.1 Physician Evaluation. Parkinson's and other disea- (3) Currently on a stable regimen of antiepileptic drugs for ses with functionally significant tremor or abnormal gait or the most recent 5 years, or on no antiepileptic drugs for balance compromise the member's ability to safely perform the most recent 5 years. essential job tasks 1, 2, 4, 5, 6, 7, 8, and 9, and the physician (4) Neurological examination is normal.
15) Brain MRI is normal. small report the applicable job limitations to the fire depart- (6) ke and ascep tc nure with photic simulation
and hyperventilation are normal. 9.13.10.2 Physician Guidance.
9.13.7 History of Cerebral Vascular Bleeding. 9131021 The plans reginal evane gai, balance, move. .13.7.1* Physician Evaluation. Cerebral vascular bleedin ompromises the member's ability to safely perform essentia .13.10.2.2 The impact of the operational environmen job tasks 1, 4, 6, 7, 8, 9, 10, I1, 12, and 13, and the physician eed did spect hay ads, eres, and exertion shall be consid shall report the applicable job limitations to the fire depart- ment unless all of the following criteria are met: 9.13.11 Progressive Dementia. (1) The cause of bleeding is surgically corrected (when indi- cated). 9.13.11.1 Physician Evaluation. Progressive dementia (e.g., (2) Physical exam, including blood pressure, is normal. Alzheimer's) compromises the member's ability to safely (3) Studies (e.g., imaging and EEG) are normal off antiepi- erform essential job tasks 1 through 13, and the physicia leptic drugs. hall report the applicable job limitations to the fire depar ment.
2018 Edition Shaded text = Revisions. A = Text deletions and figure/table revisions. • = Section deletions. iN = New material.
Copyrial! 2019 Nationa Fire Protection Association INFRA Lucensed by @preement, for indu use and download on on to Pill Acom for designated user Willam Swan No ciner recroduction or transmission in any fore permitter without watter cermission GENERAS Foringuines eid report unauthenzed use. coract icensng@nipe org This NEGGS All Access surecipion expires on December 19. 2013.
ESSENTIAL JOB TASKS - SPECIFIC EVALUATION OF MEDICAL CONDITIONS IN MEMBERS 1582-39 N 9.13.12 Narcolepsy. Narcolepsy with cataplexy or narcolepsy (1) Compliance with treatment, if indicated with persistent excessive daytime sleepiness despite medical (2) No disqualifying side effects from treatment treatment compromises the member's ability to safely perform (3) Treatment of comorbidities (including substance abuse essential job task 13, and the physician shall report the applica- and sleep disorders) ble job limitations to the fire department. (4) Evaluation that the member's condition does not inter- fere with the safe performance of his/her duties
9.14* Psychiatric and Psychologic Disorders.
N 9.14.2.5 A delusional disorder might compromise the
9.14.1 Psychiatric and psychologic disorders shall include member's ability to safely perform essential job tasks 1, 3, 4, 5, acute, ongoing, chronic, or recurrent disorders that impair 7, 8, 11, 12, and 13, and after further evaluation by a qualified psychological or emotional function. mental health provider before the member returns to work, the
9.14.2 Specific Psychiatric Disorders. physician shall report any applicable job limitations to the fire department unless all of the following conditions are met N 9.14.2.1 An anxiety disorder might compromise the member's ability to safely perform essential job tasks 1, 3, 4, 5, 7, 8, 11, 12, (1) No psychotic symptoms in the past 6 months and 13, and after further evaluation by a qualified mental (2) Compliance with treatment, if indicated health provider, the physician shall report any applicable job (3) No disqualifying side effects from treatment limitations to the fire department unless all of the following (4) Treatment of comorbidities (including substance abuse conditions are met: and sleep disorders)
(5) No suicide attempts in the past 12 months
(1) Compliance with treatment, if indicated (6) Evaluation that the member's condition does not inter- (2) No disqualifying side effects from treatment fere with the safe performance of his/her duties (3) Treatment of comorbidities (including substance abuse and sleep disorders) N 9.14.2.6 Brief psychotic disorder might compromise the (4) Evaluation that the member's condition does not inter- member's ability to safely perform essential job tasks 1, 3, 4, 5, fere with the safe performance of his/her duties 7, 8, 11, 12, and 13, and after further evaluation by a qualified mental health provider before the member returns to work, the N 9.14.2.2 Bipolar disorder might compromise the member's physician shall report any applicable job limitations to the fire ability to safely perform essential job tasks 1, 3, 4, 5, 7, 8, 11, 12, department unless all of the following conditions are met:
and 13, and after further evaluation by a qualified mental (1) No psychotic symptoms in the past 6 months
health provider before the member returns to work, the physi- cian shall report any applicable job limitations to the fire (2) Compliance with treatment, if indicated department unless all of the following conditions are met: (3) No disqualifying side effects from treatment (4) Treatment of comorbidities (including substance abuse (1) Compliance with treatment, if indicated and sleep disorders) (2) No disqualifying side effects from treatment (5) No suicide attempts in the past 12 months (3) Ongoing evaluation by a health care provider (after (6) Evaluation that the member's condition does not inter- return to work) fere with the safe performance of his/her duties (4) Treatment of comorbidities (including substance abuse and sleep disorders) N 9.14.2.7 Schizophreniform disorder might compromise the (5) No suicide attempts in the past 12 months member's ability to safely perform essential job tasks 1, 3, 4, 5.
No manic episodes in the past 12 months 7, 8, 1l, 12, and 13, and after further evaluation by a qualified Evaluation that the member's condition does not inter- mental health provider before the member returns to work, the fere with the safe performance of his/her duties physician shall report any applicable job limitations to the fire department unless all of the following conditions are met:
N 9.14.2.3 A depressive disorder might compromise
member's ability to safely perform essential job tasks 1, 3, 4, 5, (1) No psychotic symptoms in the past 6 months (2) Compliance with treatment, if indicated
7, 8, 11, 12, and 13, and after further evaluation by a qualified No disqualifying side effects from treatment mental health provider before the member returns to work, the (3) physician shall report any applicable job limitations to the fire (4) No suicide attempts in the past 12 months department unless all of the following conditions are met: (5) Evaluation that the member's condition does not inter- fere with the safe performance of his/her duties
(1) Compliance with treatment, if indicated
(2) No disqualifying side effects from treatment N 9.14.2.8 Schizophrenia might compromise the member's abil- a ra eat car protec acer ity to safely perform essential job tasks 1, 3, 4, 5, 7, 8, 11, 12, (3) Ongoing evaluation by
return to work) and 13, and after further evaluation by a psychiatrist or a (4) Treatment of comorbidities (including substance abuse licensed doctoral-level psychologist be-fore the member returns and sleep disorders) to work, the physician shall report any applicable job limita- (5) No suicide attempts in the past 12 months tions to the fire department unless all following conditions are (6) Evaluation that the member's condition does not inter- met:
fere with the safe performance of his/her duties (1) No psychotic symptoms in the past 6 months (2) Compliance with treatment, if indicated
N 9.14.2.4 Post-traumatic stress disorder (PTSD) might compro- mise the member's ability to safely perform essential job tasks (3) No disqualifying side effects from treatment 1, 3, 4, 5, 7, 8, 11, 12, and 13, and after further evaluation by a (4) Treatment of comorbidities (including substance abuse and sleep disorders)
qualified mental health provider, the physician shall report any (5) No suicide attempts in the past 12 months
applicable job limitations to the fire department unless all of Evaluation that the member's condition does not inter- (6)
the following conditions are met:
fere with the safe performance of his/her duties
Shaded rext = Revisions. A = Text deletions and figure/table revisions. • = Section deletions. N - New material. 2018 Edition Sopragh: 2010 National #re Protection Association (FPA) Licensed 2y agreement for indivisual use and downied on 01706/2010 to Bily Alcom or designated user Willan Swan No elher reproduction or transmission in any toms permitted without watter permission of NEP«B. For latines orto repon unauthonged use, contact [email protected]. This NOSE ah access subwempton expires on December 19, 2018 1582-40 COMPREHENSIVE OCCUPATIONAL MEDICAL PROGRAM FOR FIRE DEPARTMENTS N 9.14.2.9 Schizoaffective disorder might compromise the 9.16.3 If the member is taking medications, the member shall member's ability to safely perform essential job tasks 1, 3, 4, 5, be individually evaluated in accordance with 9.16.4 through 7, 8, 11, 12, and 13, and after further evaluation by a qualified to determine if the medications compromise the mental health provider before the member returns to work, the member's ability to safely perform the essential job tasks. physician shall report any applicable job limitations to the fire department unless all following conditions are met: 9.16.4 Anticoagulation. (1) No disqualifying side effects from treatment 9.16.4.1 Physician Evaluation. Full-dose or low-dose anticoa- (2) No manic episodes in the past 12 months gulation or any drugs that prolong prothrombin time, partial (3) No suicide attempts in the past 12 months thromboplastin time, or international normalized ratio (INR) (4) Evaluation that the member's condition does not inter- compromise the member's ability to perform essential job task fere with the safe performance of his/her duties 8 due to the risk of internal bleeding from trauma with poten- tial for rapid incapacitation from shock or central nervous
9.15* Substance Abuse. system hemorrhage, and the physician shall report the applica-
9.15.1 Substance abuse shall refer to the frequent and/or ble job limitations to the fire department. persistent use of alcohol or other substances causing the follow- 9.16.5 Narcotics. ing:
9.16.5.1 Physician Evaluation. Narcotics compromise the (1) Failure to fulfill major obligations either at work or at member's ability to safely perform essential job tasks 1, 3, 4, 5, home
6, 7, 8, 9, 10, 11, 12, and 13 due to alterations in mental status (2) Verifiable physical or emotional harm to the member including vigilance, judgment, and other neurologic functions, (3) Recurrent legal problems
and the physician shall report the applicable job limitations to (4) Exacerbation of social and/or other interpersonal prob- the fire department.
lems
9.16.6 Muscle Relaxants.
9.15.2 If the member has any substance abuse problem, the member shall be referred for counseling/treatment and indi- 9.16.6.1 Physician Evaluation. Muscle relaxants compromise vidually evaluated in accordance with 9.15.3 through 9.15.4 to the member's ability to safely perform essential job tasks 1, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, and 13 due to alterations in mental safely perform the essential job tasks. status and other neurologic functions, and the physician shall
9.15.3 DSM 5 Criteria. report the applicable job limitations to the fire department.
9.16.7 Sedatives and Hypnotics.
9.15.3.1 Physician Evaluation. Substance abuse disorder according to DSM 5 criteria compromises the member's ability 9.16.7.1 Physician hypnotics to safely perform essential job tasks 1, 3, 4, 5, 6, 7, 8, 9, 10, II, (including benzodiazepines, dronabinol, and medical mari- 12, and 13, and the physician shall report the applicable job juana) compromise the member's ability to safely perform limitations to the fire department. essential jöb tasks 1, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, and 13 due to alterations in mental status, vigilance, judgment, and other
9.15.3.2 Physician Guidance. neurologic functions, and the physician shall report the appli-
9.15.3.2.1 The physician shall use medical evaluations, super- cable job limitations to the fire department. visory evaluations, and/or performance evaluations coupled 9.16.8 Psychiatric Medications. with urine screening and blood toxicology to form a basis for determining and documenting substance abuse. 9.16.8.1 Physician Evaluation. Psychiatric medications might
9.15.3.2.2 Although there is a high recidivism rate with treat- compromise the member's ability to safely perform essential ment, members shall be offered counseling/treatment because job tasks 5, 8, 11, and 13 due to increased risk of heat stress, substance abuse disorder is a treatable illness. movement disorders, and somnolence, and after further evalu-
9.15.4 Methadone Maintenance.
tions to the fire department
9.15.4.1 Physician Evaluation. Methadone maintenance inter- feres with cognitive functions, energy, coordination, and equili- 9.16.9 Anti-Hypertensive Agents.
9.16.9.1 Physician Evaluation. Certain classes of anti- nember's ability to safely perform essential job tasks 1, 4, 5, 7 hypertensive agents (e.g., beta-blockers, high-dose diuretics, limitations to the fire department. and central agents such as clonidine) might compromise the member's ability to safely perform essential job tasks 5 and 8
9.16 Medications.
disequilibrium, and the physician shall report the applicable
9.16.1 Medications shall include prescribed and over-the- job limitations to the fire department. counter medications.
9.16.9.2 Physician Guidance. If the member is on beta-
9.16.2 When evaluating a member, the physician shall recog- blockers, high-dose diuretics, or central agents such as cloni- nize that the medications in Section 9.16 are listed because of line, the physician shall refer the member back to his/he noteworthy side effects that might interfere with the perform- hysician for consideration of a change in anti-hypertensive ance of essential job tasks. medications.
2018 Edition Shaded text = Revisions. A - Text deletions and figure/table revisions. • = Section deletions. N = New material.
Copyright 2018 National Fire Protection Association (FPA Licensed. My agise tent, for indivista use and download on 07/00:2018 to Bill Alcon for vee gnated user Whem Swan No other reproducion or transmission in any fome permated without wattan permission ofINEPAD Forinasiries orto report unbuthenged use, contact bomang @nipa orel This NEO3S As Access Bussciplich expires on December 10, 2019 ESSENTIAL JOB TASKS — SPECIFIC EVALLATION OF MEDICAL CONDITIONS IN MEMBERS 158241
9.16.9.2.1 Once stable off these medications, the member uation and a final medical determination of the member's shall be medically re-evaluated for duty. condition, the physician shall report any applicable job limita- tions to the fire department.
9.16.9.2.2 Calcium channel blockers shall be acceptable as anti-hypertensive medications, but if used for other cardiac 9.17.4.2 Physician Guidance. The physician shall consider reasons, refer to Section 9.4. that benign tumors will compromise the member's ability to safely perform essential job tasks 1 through 13 only if the space-
9.16.10 High-Dose Corticosteroids. occupying lesion and/or its treatment affects energy levels or
9.16.10.1 Physician Evaluation. High-dose corticosteroids for the involved organ system's function. chronic disease compromise the member's ability to safely 9.17.5 Acute Illness Related to Malignancy or Its Treatment. perform essential job tasks 5 and 8 due to the underlying dehydration, electrolyte disorders, 9.17.5.1 Physician Evaluation. Acute illness related to malig- myopathy, altered sensorium, and/or lethargy, and the physi- nancy or its treatment might compromise the member's ability cian shall report the applicable job limitations to the fire to safely perform essential job tasks 1, 2, 3, 4, 5, 6, 7, 8, 9, and 13, and after further evaluation and a final medical determina- tion of the member's condition, the physician shall report any
9.16.10.2 Physician Guidance. If the member is on systemic applicable job limitations to the fire department. corticosteroids, other than high-dose corticosteroids, the physi- cian shall refer the member back to his/her physician for 9.17.5.2 Physician Guidance. The physician shall consider consideration of the underlying disease that might compromise acute illness related to malignancy or its treatment the member's ability to safely perform the essential job tasks. compromises the member's ability to safely perform essential job tasks 1, 2, 3, 4, 5, 6, 7, 8, 9, and 13 if low energy levels,
9.16.11 Anabolic Steroids. anemia, weight loss, or specific aspects of that organ's dysfunc-
9.16.11.1 Physician Evaluation. Anabolic steroids compromise tion lead to debilitation. the member's ability to safely perform essential job tasks 1, 3, 4, 9.17.6 Central Nervous System Tumors. 5, 6, 7, 8, 9, 10, 11, 12, and 13 due to alterations in mental status including vigilance, judgment, and other neurologic 9.17.6.1 Physician Evaluation. Central nervous system tumors functions, and the physician shall report the applicable job might compromise the member's ability to safely perform limitations to the fire department. essential job tasks 1, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, and 13, and after further evaluation and a final medical determination of
9.16.12 Other Medications. the member's condition, the physician shall report any applica-
9.16.12.1 Physician Evaluation. The physician shall evaluate ble job limitations to the fire department. the member to determine if other medications might compro- 9.17.6.2 Physician Guidance. mise the member's ability to safely perform essential job tasks 5, 8, 11, and 13, and after further evaluation and a final medi- 9.17.6.2.1 When evaluating the member for central nervous cal determination of the member's condition, the physician system tumors, the physician shall consider that central nervous shall report any applicable job limitations to the fire depart- system tumors compromise the member's ability to safely ment. perform essential job tasks 1, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, and 13 if low energy levels, anemia, undernutrition, weight loss, and
9.16.12.2 Physician Guidance. The physician shall consider specific organ dysfunction (seizures, loss of balance, inability to that the member might require careful evaluation for increased communicate, inability to process complicated commands in risk of heat stress and other side effects of certain medications an emergency situation, weakness) are present or lead to a (e.g., MAOIs, phenothiazines, anti-cholinergics, tricyclic antide- debilitated state affecting anaerobic and aerobic job tasks and pressants), and shall ensure specialized annual follow-up of the ability to wear personal protective ensembles and SCBA. members taking these medications.
9.17.6.2.2 If treated successfully, the member shall undergo
9.17 Tumors -- Malignant or Benign. evaluation by a specialist who must certify that the exam is
9.17.1 Malignant conditions of any organ system can produce normal, imaging studies are normal (except for surgical site), specific organ dysfunction or generalized debilitation. and seizures have not occurred in the absence of anticonvul- sant medications, and there is no further evidence of malig-
9.17.2 When evaluating a member, the physician shall recog- nancy. nize that malignancy or its treatment can result in anemia, malnutrition, pain, and generalized weakness, temporarily or 9.17.7 Head and Neck Malignancies. permanently compromising the member's ability to safely 9.17.7.1 Physician Evaluation. Head and neck malignancies perform essential job tasks 1 through 13. might compromise the member's ability to safely perform
9.17.3 If the member has tumor, whether malignant or essential job tasks 1 through 13, and after further evaluation benign, the member shall be individually evaluated in accord- and a final medical determination of the member's condition, ance with 9.17.4 through 9.17.12 to determine if the tumors the physician shall report any applicable job limitations to the compromise the member's ability to safely perform the essen- fire department. tial job tasks. 9.17.7.2 Physician Guidance.
9.17.4 Benign Tumors. 9.17.7.2.1 When evaluating the member for head and neck
9.17.4.1 Physician Evaluation. A benign tumor, depending on malignancies, the physician shall consider that head and neck its location, might compromise the member's ability to safely malignancies compromise the member's ability to safely perform essential job tasks 1 through 13, and after further eval- perform essential job tasks 1 through 13 if low energy levels, Shaded text = Revisions. A = Text deletions and figure/table revisions. • = Section deletions. N = New material. 2018 Edition Copynglit 2010 Natione: Fire Protection Association (FPAS:, Licensed. by agreement, for individual use and download on 07/00/2019 to Bily Alcom for designated user Willan Swen No ener reproduction or hansmiss.on in any lore pemmates without eniten permission of NEPAS Forguiries onto report unauthonzed use. Contact [email protected] This NEOSS AR AccesS Bubscreton shores on Decembar 19, 2013 1582-42 COMPREHENSIVE OCCUPATIONAL MEDICAL PROGRAM FOR FIRE DEPARTMENTS anemia, undernutrition, weight loss, inability to clear oral 9.17.10.2 Physician Guidance. secretions, or other specific organ dysfunction interfere with respiration, communication, hydration, and/or eating. 9.17.10.2.1 When evaluating the member with a history of genitourinary malignancy, the physician shall consider that
9.17.7.2.2 If treated successfully, a member shall undergo eval- genitourinary malignancies compromise the members ability uation by a specialist, who must certify that exam shows normal to safely perform job tasks if altered urinary function prevents function, imaging studies show no tumor, and overall medical prolonged activity without use of toilet facilities or if the under- evaluation reveals no condition that might compromise safe lying tumor has produced low energy levels, anemia, undernu- performance of essential job tasks. trition, weight loss, or specific organ dysfunction.
9.17.8 Lung Cancer. 9.17.10.2.2 If treated successfully, the member shall undergo evaluation by a specialist who must certify that exam is normal
9.17.8.1 Physician Evaluation. Lung cancer might compro- (including nutrition intake and excretion), imaging studies mise the member's ability to safely perform essential job tasks show no tumor, and overall medical evaluation reveals no 1, 2, 3, 4, 5, 7, 8, 9, and 13, and after further evaluation and a condition that might compromise safe performance of essen- final medical determination of the member's condition, tial job tasks. physician shall report any applicable job limitations to the fire department. 9.17.11 Hematologic or Lymphatic Malignancies.
9.17.8.2 Physician Guidance. 9.17.11.1 Physician Evaluation. Hematologic or lymphatic malignancies might compromise the member's ability to safely
9.17.8.2.1 When evaluating the member for lung cancer, the perform essential job tasks 1, 2, 3, 4, 5, 7, 8, and 9, and after physician shall consider that lung cancer compromises the further evaluation and a final medical determination of the member's ability to safely perform job tasks if low energy levels, member's condition, the physician shall report any applicable anemia, undernutrition, weight loss, weakness, paraneoplastic job limitations to the fire department. syndromes, or specific organ dysfunction (abnormal secretions, dyspnea, or pulmonary dysfunction interfering with or prohib- 9.17.11.2 Physician Guidance. iting use of SCBA or strenuous physical activities) are present. 9.17.11.2.1 When evaluating the member for hematologic or
9.17.8.2.2 If treated successfully, the member shall undergo lymphatic evaluation by a specialist who must certify that the member has hematologic or lymphatic malignancies (e.g., leukemias, normal function, imaging studies show no tumor, and overall lymphomas) compromise the member's ability to safely medical evaluation reveals no condition that might compro- perform essential job tasks 1, 2, 3, 4, 5, 7, 8, and 9 if anemia, mise safe performance of essential job tasks. lymphopenia, or thrombocytopenia is present or if adverse effects of treatment are present.
9.17.9 Gastrointestinal Malignancies.
9.17.11.2.2 If treated successfully, the member shall undergo
9.17.9.1 Gastrointestinal malignancies might compromise the evaluation by a specialist who must certify that exam is normal, member's ability to safely perform essential job tasks 1, 3, 4, 5, imaging and laboratory studies show no cancer, and overall 7, 8, and 9, and after further evaluation and a final medical medical evaluation reveals no condition that could compro- determination of the member's condition, the physician shall mise safe performance of essential job tasks. report any applicable job limitations to the fire department.
9.17.12 Skin Cancer.
9.17.9.2 Physician Guidance.
9.17.12.1 Physician Evaluation. Skin cancer might compro-
9.17.9.2.1 When evaluating the member for gastrointestinal mise the member's ability to safely perform essential job tasks malignancies, the physician shall consider that gastrointestinal 1, 3, 4, 5, 7, 8, and 9, and after further evaluation and a final malignancies compromise the member's ability to safely medical determination of the member's condition, the physi- perform job tasks if low energy levels, anemia, undernutrition, cian shall report any applicable job limitations to the fire weight loss, weakness, paraneoplastic syndromes, or specific department.
organ dysfunction (abnormal secretions or bowel function interfering 9.17.12.2 Physician Guidance.
9.17.12.2.1 When evaluating the member for skin cancer, the are present.
physician shall consider that skin cancer that requires signifi-
9.17.9.2.2 If treated successfully, the member shall undergo cant resection, chemotherapy or other systemic anti-neoplastic evaluation by a specialist who must certify that exam and therapy, or that results in the loss of skin integrity, compromi- gastrointestinal functioning appear to be normal (including ses the member's ability to safely perform job tasks because of nutrition intake and excretion), imaging studies show low energy levels, anemia, undernutrition, and weight loss, as tumor, and overall medical evaluation reveals no condition that well as increased risk of burns, infection, dehydration, and heat could compromise safe performance of essential job tasks. rash while fire fighting and wearing PPE.
9.17.10 Genitourinary Malignancies. 9.17.12.2.2 If treated successfully, the member shall undergo evaluation by a specialist who must certify that exam is normal,
9.17.10.1 Physician Evaluation, Genitourinary malignancies imaging and laboratory studies show no cancer, and overall might compromise the member's ability to safely perform medical evaluation reveals no condition that could compro- essential job tasks 1, 3, 4, 5, 7, 8, and 9, and after further evalua- mise safe performance of essential job tasks.
tion and a final medical determination of the member's condi- tion, the physician shall report any applicable job limitations to the fire department.
2018 Edition Shaded text = Revisions. A = Text deletions and figure/table revisions. • = Section deletions. N = New material.
Copyrght 2018 Mationa: Fine Pretection Association:FP; Licensed by prepent, for ind vibe use and download on 07/00/2010 to Dily Aico for designated user Willam Awn No other reproduntion or transmuss on in any dom permated without witten permession of NEPAD. For Inauires orto teport unashonzed use. comact samsing @nice.ong Tis N° CES All AccesS Sueschelon ezares on Gecember 19, 2019 ANNEX A 1582-43
9.18 Pregnancy and Reproductive Health. political entity that is responsible for the operation of the fire this standard is legally adopted and
9.18.1 Fire Departments shall make available to all male and enforced by a body having regulatory authority over a fire female fire fighters educational materials outlining the risks department, such as federal, state, or local government or polit- from fire fighting on reproductive health. ical subdivision, this body is responsible for making those
9.18.2* It is recommended that members who become preg- determinations as the authority | having jurisdiction. The nant report the pregnancy immediately to the fire department compliance program should take into account the services the physician. Once informed of the pregnancy the fire depart- fire department is required to provide, the financial resources ment physician shall inform the pregnant member of the available to the fire department, the availability of personnel, numerous hazards to the pregnancy and the fetus encountered the availability of trainers, and such other factors as will affect during routine fire fighting tasks. the fire department's ability to achieve compliance.
9.18.2.1 If the member requests an alternative duty assign- A.1.3.3 The most vital resource of any fire department is its ment in an environment deemed safe for the pregnancy and members. This standard is to be implemented in a process the fetus, the physician shall provide appropriate restrictions aimed at improving member health and wellness. Due to the for essential job tasks 1, 3, 5, 6, 7, and 8 that are unsafe for her hazardous nature of the occupation, methods to reduce the risk of occupational injury, illness, and exposures to communi- cable diseases are warranted. Annual reports repeatedly indi-
9.18.3 During later stages of pregnancy the member will even- cate over 100 line-of-duty deaths and 100,000 occupational tually be unable to safely perform essential job tasks 1, 2, 3, 4, injuries and illnesses among career and volunteer fire fighters. 5, 6, 7, 8, and 9 due to issues with diminished aerobic capacity, Another concern is the fire fighters who experience disabling balance, speed, and agility. As with any other member, when injuries or develop occupational diseases and conditions, which performance due to medical issues is of concern, the AHJ shall often have debilitating or fatal results, forcing them to leave inform the fire department physician and a medical evaluation their fire service activities. There is an increased risk of respira- will be performed to determine the need for restricting the tory and heart disease in fire fighters and strong evidence of a member from those activities that they are not able to safely link to some cancers and other conditions related to occupa- perform. tional exposures to carcinogens, toxic products of combustion, and hazardous materials.
Annex A Explanatory Material Safety and health are two of the many components of the Annex A is not a part of the requirements of this NFPA document but is risk management process. The intent of this standard is to included for informational purposes only. This annex contains explan- reduce the risk and burden of fire service occupational morbid- atory material, numbered to correspond with the applicable text para- ity and mortality while improving the welfare of fire fighters. By graphs. implementing the medical requirements of this standard, a fire department commits to a process that evaluates and enhances A.1.1.1 Some of the medical requirements in this standard are the health and fitness for duty of members. not applicable to candidates and members whose essential job A.3.2.1 Approved. The National Fire Protection Association NFPA 1001, NFPA 1002, NFPA 1003, NFPA 1006, NFPA 1021, does not approve, inspect, or certify any installations, proce- and NFPA 1051. However, particular attention must be paid to dures, equipment, or materials; nor does it approve or evaluate the essential job tasks of individual candidates or members testing laboratories. In determining the acceptability of installa- when applying this standard (for example, administrative staff authority personnel, some EMS personnel, fire/police, and others who having jurisdiction may base acceptance on compliance with do not have responsibility for structural fire fighting and are NFPA or other appropriate standards. In the absence of such not required to wear personal protective ensembles and use standards, said authority may require evidence of proper instal- SCBA). Medical requirements should reflect essential job tasks, lation, procedure, or use. The authority having jurisdiction and all might not be specifically addressed in this standard. (See may also refer to the listings or labeling practices of an organi- also Chapter 5 and Chapter 9.) zation that is concerned with product evaluations and is thus in a position to determine compliance with appropriate standards A.1.2.2 A direct relationship exists between the medical for the current production of listed items. requirements and the job description of members. The job description should include all essential job functions of A.3.2.2 Authority Having Jurisdiction • (AHJ). The phrase members, both emergency and nonemergency. Members "authority having jurisdiction," or its acronym AHJ, is used in perform a variety of emergency operations including fire fight- NFPA documents in a broad manner, since jurisdictions and ing, emergency medical care, hazardous materials mitigation, approval agencies vary, as do their responsibilities. Where driving/operating fire apparatus, and special operations. None- public safety is primary, the authority having jurisdiction may mergency duties can include, but are not limited to, training, be a federal, state, local, or other regional department or indi- station and vehicle maintenance, and physical fitness. Each fire vidual such as a fire chief; fire marshal; chief of a fire preven- department needs to identify and develop a written job descrip- tion bureau, labor department, or health department; building tion for members. official; electrical inspector; or others having statutory author- ity. For insurance purposes, an insurance inspection depart- A.1.3.2 The specific determination of the authority having rating bureau, company jurisdiction depends on the mechanism under which this representative may be the authority having jurisdiction. In standard is adopted and enforced. Where this standard is adop- many circumstances, the property owner or his or her designa- ted voluntarily by a particular fire department for its own use, ted agent assumes the role of the authority having jurisdiction; the authority having jurisdiction should be the fire chief or the Shaded text = Revisions. A = Text deletions and figure/table revisions. • = Section deletions. N= New material. 2018 Edition Copyright 2019 Nationa: Pine Protection Aspcoaton (NFPAD). Licensed By agreement, for individual use and sownicad on 07/00/2019 to Billy A com for designated user Willem Swen No other repression or tansmission in any for permitted without watten permission of NEDA For incuires orto tepor: uncurioned ate cortect [email protected] This N° GR6 All accoss aubsorption expires on December 10 2019 1582-44 COMPREHENSIVE OCCUPATIONAL MEDICAL PROGRAM FOR FIRE DEPARTMENTS at government instaliations, the commanding officer or depart- ensembles and SCBA to conduct fire-fighting operations. The mental official may be the authority having jurisdiction. tasks on this list should be verified by the fire department to be NA.3.3.7 Fire Department. The term fire department can include essential to the job under consideration for each individual candidate or member. A sample list based on NFPA 1001,
any public, governmental, private, industrial, or military organi- NFPA 1006, NFPA 1021, and zation engaging in this type of activity. [1002, 2017] NFPA 1051 is provided in 5.1.1 and Section 9.1. An effective A.3.3.18 Member, A fire department member can be a full- way to transmit this information to the physician is to use the time or part-time employee or a paid or unpaid volunteer, can list with checkboxes in front of each essential job task. This list occupy any position or rank within the fire department, and is taken by a candidate or member to the medical provider at can engage in emergency operations. [1500, 2013] the time of medical evaluation. A check in the box indicates that there is no medical reason why an individual cannot safely A.4.1.2.1 Fire departments can require candidates to provide perform that particular essential job task. some form of medical clearance for candidate participation in pre-employment physical strength and agility tests. When there A.4.1.13.1 Suggested fields (data points) include but are not is such a requirement, the medical clearance forms should necessarily limited to the following:
enumerate the tasks that the candidate will be asked to safely (1) Medical history including the following:
perform during the test.
(a) Date of exam
NA.4.1.3 The physician plays a central role in all medical (b) Medical history aspects of the Wellness Fitness Initiative (WFI). The following (c) Smoking history parameters should be considered in selecting a physician for (d) Tobacco (smokeless) use this program: Smoking in the past year
Tobacco cessation program participation
(1) The provider has experience in occupational medicine, including wellness and fitness health components related Family history of heart disease or cancer
The provider is board-eligible or board-certified in a rele- Personal history of past disease, disorders, or cancer
as emergency, family, internal, or
(j Exercise history
occupational medicine. Current medical and fitness results including the follow- (3) The provider has experience in coordinating referrals to a variety of medical specialties for care of occupational ing:
injuries, cancer, cardiac and pulmonary issues, behavioral (a) Blood pressure and heart rate issues, and other health problems affecting fire fighters. (b) ICD10 codes for physician assessment (4) The provider should also be familiar with data collection, (c) Height and weight risk management, and environmental conditions relevant (d) Body composition (local recording only) to Labor/Management Wellness Fitness Initiatives. (e) Blood analysis results (f) Urinalysis results
This standard contains a number of options that fire depart- Vision (g)
ments can implement to increase physician knowledge regard- (h) Hearing ing fire fighter occupational hazards and their management. (i) Spirometry These include, but are not limited to, the following:
(i)
(1) Providing the physician with an overview of all fire fighter (k) Resting electrocardiogram essential job tasks and current job descriptions, as well as Cancer screening results an outline of the types and levels of service provided by Allow opportunitics (e.g., participation in a ride along, Muscle strength results presence at fire scenes) for the physician to better under- (p) Muscle endurance results stand the physiological and psychological demands of fire (q) Flexibility results fighters, their work conditions and environments,
their PPE requirements, though this might be difficult if A A.4.2.6 Incident scene rehabilitation is an important compo- the position is contracted out to a health care company nent of incident scene management that protects the health Ensuring that the physician has a thorough working and safety of fire department members. NFPA 1500, and NFPA 1561, require the establishment of "rehab" during inci- knowledge of this standard and is actively engaged in the health and safety, behavioral health, rehabilitation, and dent scene operations. A significant component of member rehabilitation is ongoing medical evaluation. The standard wellness and fitness programs in their fire department
Ensuring that the physician remains current in the medi- does not require the fire department physician to be at every cal literature pertaining to the fire service and consensus incident but does require that the physician coordinate with clinical practice with relevant Continuing Medical Educa- the EMS medical director to provide protocols for medical eval- tion (CME) credits uation and management of members in emergency incident rehab. This medical planning process ensures optimal medical A.4.1.4 This physician should also have experience with support for members at the scene and should include criteria running an occupational medicine program for public safety for transportation to a medical facility for additional evaluation workers, preferably fire fighters. and treatment. Fire departments can develop specific standard operating procedures establishing conditions under which fire A A.4.1.7 The fire department should provide the fire depart- department physician (s) are dispatched to emergency inci- ment physician with a representative list of essential job tasks dents. (See NFPA 1584.)
for members of fire departments who wear personal protective 2018 Edition Shaded text = Revisions, A = Text deletions and figure/table revisions. • = Section deletions, N = New material.
Copyright 2019 National Fire Protecton Associafion (NA Liamsed, by agreement for individuause and downiend on: 07/06:20 to Bilk Altor for designated user Willam Swen No omer reproducion or transmission in any team pennited without writer permission of NEPAC. For inques to report unahended use. contest lemeng@nipa org. Tis NFOSS All Accose sunseption expires on December 19, 2013 ANNEX A 1582-45
A.4.4.1 Confidentiality of all medical data is critical to the Checking for hernias success of the program. Members need to feel assured that the information provided to the physician will not be inappropri- ately shared.
Checking the skin (includes screening for cancers)
A A.5.1.1(1) A member, while wearing full protective clothing Vision testing (turnout coat and pants, helmet, boots, and gloves) and SCBA, BP should be measured according to the seven recommenda- is required to safely perform a variety of fire-fighting tasks that tions of the Seventh Report of the Joint National Committee on require upper body strength and aerobic capacity. For those Prevention, Detection, Evaluation, and Treatment of High Blood Pres- not familiar with fire suppression, the following specific details sun (JNG 7). BP should be measured with a properly calibrated inherent to the activities in essential job task 1 are offered: and validated instrument. Patients should be seated quietly in a (1) Lifting and carrying tools and equipment (e.g., axe, halli- chair for at least 5 minutes, with their feet on the floor and the gan tool, pike pole, chain saw, circular saw, rabbet tool, arm supported at heart level. appropriately sized cuff (cuff high-rise pack, and hose) that weigh between 7 lb and bladder encircling at least 80 percent of the arm) should be 20 lb (3.2 kg and 9 kg) and are used in a chopping used to ensure accuracy, and at least two measurements should motion over the head, extended in front of the body, or be made. Systolic BP is the point at which the first of two or in a push/pull motion. more sounds is heard (phase 1), and diastolic BP is the point Advancing a 14 in. (45 mm) or a 2½ in. (65 mm) diame- before the disappearance of sounds (phase 5):
ter hose line, which requires lifting, carrying, and pulling the hose at grade, below or above grade, or up ladders. In Laboratory tests on candidates should include the following:
addition to the weight of the hose itself, a 50 ft (15 m) (1) Blood tests, including the following:
section of charged 1% in. (45 mm) hose contains approxi- (a) CBC with differential, RB indices and morphology, mately 90 lb (41 kg) of water, and a 50 ft (15 m) section and platelet count
of 2½ in. (65 mm) hose holds approximately 130 1b (b) Electrolytes (Na, K, CI, HCO3, or CO,) (59 kg) of water. Renal function (BUN, creatinine)
(c)
Performing forcible entry while utilizing tools and equip- (d) Glucose ment (e.g., axe, halligan tool, chain saw, circular saw, or Liver function tests (ALT, AST, direct and indirect (e)
rabbet tool) that requires chopping, pulling, or operating bilirubin, alkaline phosphatase) these items to open doors, windows, or other barriers to (1) Total cholesterol, HDL, LDL, clinically useful lipid gain access to victims or possible victims or to initiate fire- ratios (e.g., percent LDL), and triglycerides fighting operations.
(2) Urinalysis, with a dipstick test for glucose, ketones, leuko- (4) Performing ventilation (horizontal or vertical) utilizing cyte esterase, protein, blood, and bilirubin. tools and equipment (e.g., axe, circular saw, chain saw, Audiology. Hearing assessed in each ear at each of the (3)
pike pole) while operating on a flat or pitched roof or following frequencies: 500 Hz, 1000 Hz, 2000 Hz, operating off a ground or aerial ladder. This task requires 3000 Hz, 4000 Hz, 6000 Hz, and 8000 Hz. Results should the fire fighter to chop or push tools through roofs, walls, be corrected for age as permitted by OSHA. Baseline or windows.
audiometry is performed in accordance with 29 CFR
Other tasks that could be performed can include search and 1910.95, "Occupational Noise Exposure." The basics of rescue operations and other emergency response actions under this standard include the following:
stressful conditions, including working in extremely hot and The first audiogram (for members, this will proba- cold environments for prolonged time periods. bly be done during their pre-placement exam) is A.6.1.1 The medical history should include the candidate's health problems, such as major illnesses, If a subsequent audiogram is better than the base- known surgeries,
line, then that becomes the baseline. All audio-
medication use, and allergies. Symptom review is also impor- grams should be done with no exposure to
tant for detecting early signs of illness. A medical history should also include a personal health history, a health habit industrial noise for the preceding 14 hours. history, an immunization history, and a reproductive history. Spirometry. Pulmonary function testing (spirometry) is conducted to measure the member's forced vital capacity An occupational history should also be obtained to collect (FVC), forced expiratory volume in I second (FEV,), and information about the person's past occupational and environ- the absolute FEV,/FVC ratio. FEV, and FVC results will mental exposures. be expressed as the absolute value (liters or milliliters) and as percent predicted adjusted for gender, age, height, 4 A.6.1.2 Physical examination should include the following: ethnicity using NHANES III normative equations, (1) Checking vital signs [temperature, pulse, respiratory with the acceptable threshold being 80 percent predicted rate, and blood pressure (BP)] FEV,/FVC ratio results are expressed as the absolute FEV, (2) Head, eyes, ears, nose, and throat exams value divided by the absolute FVC value, with 0.71 as the (3) Neck exam acceptable threshold value being 0.71. However, because (4) Cardiovascular exam these norms are population-based, it is possible for indi- (5) Pulmonary exam viduals to be normal just below these thresholds or to (6) Breast exam have minimal but potentially significant abnormalities (7) Gastrointestinal exam (includes rectal exam for mass, just above these thresholds. occult blood) FEV, or FVC values are minimally below threshold (typi- (8) Genitourinary exam (includes pap smear, testicular cally 74 percent to 79 percent of predicted), the lower exam, rectal exam for prostate mass) limits of normal (LLN) for the appropriate population Shaded text = Revisions. A = Text deletions and figure/table revisions. • = Section deletions. N= New material.
Copyright 2010 National Fire Prolection Asscoton (FAS Licensed. 0y agreement. for individial use and download on 07/06/2010 to Billy Arcom for designated user fan Swan No piner repreduction or transmission in any fore permitted without witten permission of NFPAD. Potingunes orto report unbuthonzed use contactlicensing @nipa ag This AFOES All Acores abscription: expires on December 19, 2019. 1582-46 COMPREHENSIVE OCCUPATIONAL MEDICAL PROGRAM FOR FIRE DEPARTMENTS can, at the discretion of the physician, be used instead of Category B medical condition. However, it is felt that within the 80 percent predicted threshold value. For example, most cases this condition will not affect the ability of a member the LLN might be more appropriate for taller and older to safely perform the essential functions of his or her job. The individuals. (See F.2.5.) fire service physician should consider the color vision defi- 5) Chest radiography (chest x-ray posterior-anterior and ciency of the individual and consider the color vision require- lateral views). ments of the member's job and reach an individual (6) A resting 12-lead electrocardiogram (ECG). A resting 12- determination. lead ECG
Immunizations and infectious disease screening. The A.6.4.1(3) A DOT/CDL exemption can be applied for after (7)
following infectious disease immunizations or infectious passing a special test. But this exemption is not applicable to disease screenings are to be provided, as indicated: fire fighters because this exemption specifically excludes the driving of vehicles with passengers (e.g., fire trucks) and does Tuberculosis screen, purified protein derivative not apply to emergency response driving (PPD) tuberculin skin test, or blood test.
Hepatitis C virus screen (baseline) A.6.4.2(1) These diseases of the eye can result in the failure to (c) Hepatitis B virus vaccinations read placards and street signs or to see and respond to immi- (d) Tetanus, diphtheria, pertussis (TDAP) vaccine nently hazardous situations. (booster every 10 years) A.6.4.2(2) Sufficient time (approximately 2 weeks for radial (e) Measles, mumps, rubella (MMK) vaccine
keratotomy and Lasik-type surgeries, and 3 months for retinal (f) Polio vaccine given to uniformed personnel if vacci- detachment) must have passed to allow stabilization of visual nation or disease is not documented acuity and to ensure that there are no post-surgical complica- (g) Hepatitis A vaccine due to contaminated water
tions. These ophthalmological procedures can result in the fail- exposures during normal firefighting activities, not ure to be able to read placards and street signs or to see and just hazmat/rescue activities
respond to imminently hazardous situations.
(h) Varicella vaccine, offered to all nonimmune person- A.6.5 Currently, no hearing tests will allow the fire department (i) Influenza vaccine, seasonal and novel, offered to all physician to accurately predict whether the fire fighter will personnel adequately be able to safely perform essential job duties. Job- specific hearing tests should be individualized for each depart- A.6.3.1.2(1) Deformities of the can result in the
ment and its specific job functions. The following list of member's inability to properly wear protective equipment. hearing-specific tasks can assist to direct development of hear- A.6.3.1.2(2) These deformities can result in the potential for ing protocols:
sudden incapacitation, the inability to properly wear protective (1) Understanding spoken commands, both over che radio equipment, and the inability to communicate effectively due to and while wearing SCBA oropharyngeal dysfunction. (2) Hearing alarm signals, including building evacuation, low air alarm on the SCBA, and PASS alarms
A.6.3.1.2(3) Loss of or congenital absence of the bony
substance of the skull can result in the inability to properly Hearing and locating the source of calls for assistance from victims or other fire fighters
wear protective equipment and the inability to communicate effectively due to oropharyngeal dysfunction. All of these tasks will need to be performed with reasonably A.6.3.2.2(1) Thoracic outlet syndrome can result in frequent simulated incident scene background noise and SCBA noise. episodes of pain or inability to safely perform work. The inability to hear sounds of low intensity or to distinguish voice from background noise can lead to failure to respond to A.6.3.2.2(2) Congenital cysts, chronic draining fistulas, or imminently hazardous situations. (See 5.1.1.) similar lesions can result in the inability to properly wear • A.6.5.2(1) Unequal hearing can result in the inability to local- protective equipment and the inability to communicate effec- tively due to oropharyngeal dysfunction.
search and rescue and other localization tasks.
A.6.3.2.2(3) The contraction of neck muscles can result in the inability to properly wear protective equipment and the inabil- A.6.5.2(4) Severe external otitis - that is, recurrent loss of ity to safely perform functions as a member due to limitation of hearing — can result in the inability to hear sounds of low flexibility. intensity or to distinguish voice from background noise, lead- ing to failure to respond to imminently hazardous situations.
A.6.4.1(1) Far visual acuity is at least 20/30 binocular, correc- A.6.5.2(5) Severe agenesis or traumatic deformity of the auri- ted with contact lenses or spectacles. Far visual acuity uncorrec- ted is at least 20/40 binocular for wearers of hard contacts or cle can result in the inability to properly wear protective equip- spectacles. Successful long-term soft contact lens wearers (i.e., ment and the inability to hear sounds of low intensity or to 6 months without a problem) are not subject to the uncorrec- distinguish voice from background noise, leading to failure to ted standard. Inadequate far visual acuity can result in the fail- respond to imminently hazardous situations. ure to be able to read placards and street signs or to see and A.6.5.2(6) Severe mastoiditis or surgical deformity of the respond to imminently hazardous situations.
maid can nestle in the in abile to props of locat persity ver A.6.4.1(2) This does not refer to abnormal color perception such as red/green color blindness. to distinguish voice from background noise, leading to failure to respond to imminently hazardous situations.
Persons with severe color vision loss will likely fail the acuity requirement. Formerly, color vision deficiency was listed as a 2018 Edition Shaded text = Revisions. A = Text deletions and figure/table revisions. • = Section deletions.(N = New material.
Copyright 2019 Nalina: Fire Prefection Association (NFPA. Licensed By agreement for individualse and sownina on DF/06.2)19 to Billy Alcom for designated user William Swan No ome: reproduction or transmission in any form permited wilhout witten penniasion of NEPAG foringuires corto tepert unasthonzed use, contact bensing@nipa org TAS NEGRO AR Access Bubschption expires on Decembor 19, 2013.
ANNEX A 1582-47
A.6.5.2(7) Ménière's syndrome or severe labyrinthitis can requirements leading to the earlier than expected depletion of result in the potential for sudden incapacitation and the inabil- air in the SCBA cylinder:
ity to safely perform job functions due to limitations of balance.
A.6.8.1(6) Chronic obstructive airways disease can result in A.6.5.2(8) Otitis media (chronic) can result in frequent the inability to safely perform essential job tasks due to limita- episodes of pain and the inability to hear sounds of low inten- tions of endurance and the inability to safely wear SCBA. sity or to distinguish voice from background noise, leading to Obstruction is suspected when the absolute FEV,/FVC ratio failure to respond to imminently hazardous situations. (using absolute values rather than percent predicted values) is equal to or less than 0.70. However, obstruction can also occur A. 6.6.2(1) Diseases of the jaws or associated tissues can result with normal FEV,/FVC ratios due to airtrapping or mucous in the inability to communicate effectively and/or to properly plugging. For most individuals, the definition of an abnormal wear protective equipment.
FEV, or FVC is less than 80 percent predicted adjusted for A.6.6.2(2) The wearing of orthodontic appliances can result in gender, age, height, and ethnicity, using NHANES III. When the inability to communicate effectively and/or to properly percent predicted FEV, or FVC values are just below threshold wear protective equipment. (typically 74 percent to 79 percent of predicted), the LLN for A.6.6.2(3) Extensive loss of oral tissues can result in the inabil- the appropriate population can, at the discretion of the physi- cian, be used. For example, the LLN might be more appropri- ity to properly wear protective equipment and the inability to ate for taller and older individuals. In asymptomatic individuals communicate effectively due to oropharyngeal dysfunction. with minimal reductions in spirometry measures (FEV,, FVC, A.6.6.2(4) This condition can result in the inability to prop- or the absolute FEV,/FVC ratio), further evaluation (complete erly wear protective equipment and the inability to communi- pulmonary function tests, exercise testing, or challenge testing) cate effectively due to oropharyngeal dysfunction. might be necessary to determine if essential tasks can be performed safely (see references in Annex F.
A.6.7.1(I) A tracheostomy results in the inability to properly wear protective equipment, the inability to safely perform job A.6.8.1(7) Hypoxemic disorders can result in the inability to functions due to limitations of endurance, and the inability to safely perform essential job tasks due to limitations of endur- communicate effectively due to oropharyngeal dysfunction.
A.6.7.1(2) Aphonia can result in the inability to communicate A.6.8.1(8) The term asthma, or reactive airways dysfunction effectively due to oropharyngeal dysfinction. syndrome, is not meant to include acute, nonrecurring bronchi- tis treated with bronchodilators for a period of only days to A.6.7.2(1) A congenital or acquired deformity can result in weeks. Recurrent or persistent allergic, irritant, exertional, or the inability to properly wear protective equipment. other forms of asthma are included. Bronchial asthma or reac- A.6.7.2(2) Allergic rhinitis can result in frequent episodes of tive airways disease can result in frequent unpredictable pain, the inability to safely perform work, and the inability to episodes of shortness of breath and the potential for sudden safely perform essential job tasks due to limitations of endur- incapacitation, leading to the inability to safely perform essen- tial job tasks due to limitations of endurance. Acute hyperreac- fire or hazardous materials environment can
A.6.7.2(4) Recurrent sinusitis can result in frequent episodes induce immediate or progressive clinical asthma (broncho- of pain and the inability to safely perform essential job tasks ні і сенсі сано. spasm and wheeze), which can lead to sudden incapacitation due to limitations of endurance and the inability to safely wear from status asthmaticus and/or resulting cardiac ischemia.
SCBA from facial pain, sinus congestion and/or coughing. True asthma is a chronic condition with a clinical history of A.6.7.2(5) Severe dysphonia can result in the inability to recurrent reversible bronchospasm or long-standing, persistent communicate effectively due to oropharyngeal dysfunction. reversible bronchospasm. Based on the pathophysiology of this disease, it is reasonable that exposure to smoke irritants or A.6.7.2(9) Untreated obstructive sleep apnea is associated with exertion (especially while breathing cold dry SCBA air) on the fatigue, cognitive defects, pulmonary hypertension, hypertro fire ground or hazardous materials environment not only can phic heart disease, arrhythmias, and early onset dementia. lead to acute exacerbations but can also worsen the progres- These issues can reduce the ability to perform all essential job sion of the underlying obstructive inflammatory disease. If this for developing obstructive sleep apnea occurs in an environment that is immediately dangerous to life include male gender, increased body mass index (BMI), short/ and health (IDLH) (e.g., interior fire suppression or certain wide neck, and/or narrow throat. Screening questionnaires, hazardous material operations), it can have potentially devas- such as the Berlin Questionnaire (assessing snoring, fatigue, tating consequences for the member, the team, or the mission. obesity, and hypertension) can be used to determine those who There are no studies that support or deny that asthma in this require formal sleep testing. In those with obstructive sleep environment can be prevented or adequately controlled by apnea, additional testing is required to determine the level of anti-inflammatory medications (inhaled corticosteroids, cromo- positive pressure (CPAP or BIPAP) required to overcome the lyn, leukotriene modifiers). It is not acceptable to use or rely obstruction. Compliance with treatment can be assessed using on bronchodilator medications for this purpose for three home monitoring devices attached to the CPAP or BIPAP
machine. Target organ damage can be screened for by cardiac (1) Their use is for rescue after attack and not for prevention echo for evidence of pulmonary hypertension or right ventricu- of bronchospasm in an irritant environment. lar hypertrophy. (2) There are no studies that support or deny that their use is A.6.8.1(5) An FVC or FEV, of less than 70 percent prevents effective in a fire/smoke environment. the safe use of SCBA due to increased minute ventilation Shaded text = Revisions. A = Text deletions and figure/table revisions. • = Section deletions. N = New material 2018 Edition Copyrich: 2018 National Fire Protection Association (FPA, Licensed ay agreement, for individual use and deminad on 07/00/2010 le Billy Alcom for designated user ran swen No pher represucon of mansmssor in any for permited without willer permission of NP40 For inquires orto report unauthonged use contact [email protected] This NEOSS Al Access subscriopon sadires on Cocembo 19. 2019 1582-48 COMPREHENSIVE OCCUPATIONAL MEDICAL PROGRAM FOR FIRE DEPARTMENTS (3) Several studies have implicated the usc of beta-agonists A.6.8.2(5) Pulmonary vascular discases and pulmonary embo- (short- and long-acting bronchodilators) as an independ- lism can result in frequent cpisodes of pain and the inability to ent risk for sudden death and myocardial infarction in safely perform essential job tasks due to limitations of endur- the United States, Canada, Britain, New Zealand, and ance and the potential for sudden incapacitation.
Australia. The presumed mechanism is catecholamine
A.6.8.2(6) Bronchiectasis can result in the inability to safely related, and catecholamines are already elevated while perform essential job tasks due to limitations of endurance and fighting fires. frequent respiratory infections.
A.6.8.1.1 Because the clinical definition of asthma is reversible A.6.9.1 An evaluation of aerobic
bronchospasm, spirometry, or pulmonary
performed in the absence of a clinical attack is expected to be performed after appropriate medical evaluation. normal and might not even show a bronchodilator response. should be conducted using an appropriate maximal or submax- imal protocol (e.g., see C.2.1 and C.2.1.1). Bicycle ergometry is Only if performed during an attack will spirometry or other because it underestimates true aerobic pulmonary function tests show obstructive airway flow limita- not appropriate capacity. A low aerobic capacity can be an indicator of, and is a tions. Therefore, in candidates who report that their broncho- risk factor for, ischemic heart disease. For fire fighting, 12 spasm was temporary and has resolved, spirometry should show adequate reserve (FVC and FEV, greater than or equal to METs or greater is necessary based on several studies. 90 percent predicted) without significant bronchodilator A.6.10.1.1(1) Angina pectoris can result in frequent episodes response (less than 12 percent change and less than 200 mL of pain or the inability to safely perform essential job tasks, increase) when performed off bronchodilators on the day of progressive illness leading to functional impairment, and the testing. For population studies, pulmonary function is consid- potential for sudden incapacitation. ered normal when greater than or equal to 80 percent predic- ted, but for an individual with a history of asthmatic A.6.10.1.1(2) Heart failure can result in frequent episodes of bronchospasm who is being considered for job tasks performed pain or the inability to sately perform work, progressive illness in a potentially irritant environment, it is reasonable diligence leading to functional impairment, and the potential for sudden to require pulmonary function with a greater specificity for incapacitation. demonstrating adequate reserve (greater than or cqual to A.6.10.1.1(3) These conditions can result in frequent episodes 90 percent predicted). Challenge testing should also be of pain or the inability to safely perform essential job tasks. performed to show no evidence for clinically significant airway hyperreactivity [i.e., to be normal or negative, there should be A.6.10.1.1(1) Recurrent syncope can result in the potential for less than 20 percent decline in FEV, from bascline with cold sudden incapacitation. air, methacholine (PCo greater than 8 is considered normal A.6.10.1.1(5) A medical condition requiring an automatic since response at dose greater than 8 mg might not be clini- implantable cardiac defibrillator can result in the potential for cally significant), histamine, or mannitol. When challenge test- sudden incapacitation. ing includes exercise alone, normal or negative should be less than 13 percent decline in FEV, from baseline]. Challenge test- A.6.10.1.1(7) If the person is pacemaker-dependent, then the ing should be performed off all anti-inflammatory medications risk for sudden failure due to trauma is not acceptable. Those (steroids and leukotriene antagonists) for 4 weeks preceding with cardiac pacemakers can have the potential for sudden the test, off antihistamines for 1 week preceding the test, and incapacitation. off all bronchodilators the day of testing. Challenge testing A.6.10.1.2(1) Specific recommendations include the follow- should be performed only by an experienced specialist. It ing:
should not be performed in candidates without a history suggestive of asthma, since there is no indication for testing. It (1) Mitral stenosis. Mitral stenosis is acceptable if in sinus also should never be performed in candidates with abnormal rhythm and stenosis is mild — that is, valve area is greater pulmonary function, because these candidates have already than 1.5 cm? or pulmonary artery systolic pressure is less demonstrated that they cannot safely perform essential job than 35mm Hg. tasks, and further testing might induce life-threatening bron- (2) Mitral insufficiency: Mitral insufficiency is acceptable if in chospasm. Normal spirometry with adequate reserve, a nega- sinus rhythm with normal left ventricular size and fune- tive challenge test las described by the American Thoracic Society (ATS)], and no recent episode of bronchospasm (3) Aortic stenosis. Aortic stenosis is acceptable if stenosis is nedications should be considered evidence that the candidate mild - that is, mean aortic valvular pressure gradient is loes not have clinically significant airway hvperactivity or less than 20 mm Hg. (4) Aortic regurgitation. Aortic regurgitation is acceptable if left ventricular size is normal or slightly increased and systolic A.6.8.2(1) These conditions can result in the inability to safely function is normal. perform essential job tasks due to limitations of strength or (5) Prosthetic valves. Prosthetic valves are acceptable unless endurance and can result in the potential for sudden incapaci- anticoagulation is in effect. tation.
A.6.10.1.2(2) Recurrent paroxysmal tachycardia can result in A.6.8.2(3) Fibrothorax, chest wall deformity, and diaphragm the potential for sudden incapacitation and the inability to abnormalities can result in the inability to safely perform essen- tial job tasks due to limitations of endurance. safely duraorm essential job tasks due to limitations of strength A.6.8.2(4) Interstitial lung diseases can result in the inability A.6.10.1.2(3) These blocks will result in disqualification unless to safely perform essential job tasks due to limitations of endur- exercise can be performed with an adequate heart rate ance.
response. They can result in the inability to safely perform 2018 Edition Shaded text = Revisions. A = Text deletions and figure/table revisions. • = Section deletions. N = New material.
Copyright 2018 National Fire Protection Association (NFP). Licensed by agreement. for individual use and Cownioad on O7706:2019 to Billy Alcon for designated user William Swan No other reprodiction or transmission in any tom permites without watter permission cy NPPA Por inquiries orto report unauthenzed use, contect loensing nira org TENS NEGGS Ail Acess subscrolion exoires on Cecember 19, 2019.
ANNEX A 1582-49
essential job tasks, and have the potential for sudden incapaci- episodes of pain or the inability to safely perform essential job tation. tasks due to limitations of endurance.
A.6.10.1.2(6) Ventricular ectopy or nonsustained ventricular A.6.10.2.2(2) Recurrent thrombophlebitis can result in tachycardia can result in sudden incapacitation and the inabil- frequent episodes of pain or the inability to safely perform ity to safely perform job functions due to limitations of strength essential job tasks and the inability to safely perform functions or endurance. Medical clearance requires the following: as a member due to limitations of endurance. (1) An cchocardiograph that shows normal function and no A.6.10.2.2(3) Chronic lymphedema can result in the inability evidence of structural abnormalities to safely perform essential job tasks due to limitations of endur- (2) Stress testing with imaging to a workload of at least 12 ance.
METs off cardiac medications that shows no evidence of
ischemia, ventricular tachycardia, or ventricular fibrilla- A.6.10.2.2(4) Congenital or acquired lesions of the aorta or tion. Premature ventricular contractions (PVCs) should major vessels — for example, syphilitic aortitis, demonstrable resolve with increasing levels of exercise. atherosclerosis that interferes with circulation, and congenital acquired dilatation of the aorta — can result in the potential A.6.10.1.2(7) Hypertrophy of the heart can result in the for sudden incapacitation and the inability to safely perform potential for sudden incapacitation and the inability to safely essential job tasks due to limitations of endurance. perform essential job tasks due to limitations of endurance.
A.6.10.2.2(5) Marked circulatory instability can result in the A.6.10.1.2(8) A history of a congenital abnormality that has inability to safely perform job functions due to limitations of been treated by surgery but with residual complications or that endurance and the inability to safely perform essential job tasks has not been treated by surgery, leaving residuals or complica- due to limitations of balance tions, can result in frequent episodes of pain or the inability to safely perform essential job tasks and the potential for sudden A.6.11.2(1) Cholecystitis (that which causes frequent pain due incapacitation. to stones or infection) can result in frequent episodes of pain and the inability to safely perform essential job tasks.
A.6.10.1.2(9) These conditions can result in the inability to safely perform job functions due to limitations of endurance. A.6.11.2(2) Gastritis (that which causes recurrent pain and impairment) can result in frequent episodes of pain and the A.6.10.2.1(1)(a) Uncontrolled or poorly controlled hyperten- inability to safely perform essential job tasks. sion increases the risk of a sudden cardiac or cerebrovascular event. A sudden cardiac or cerebrovascular event would cause A.6.11.2(3) GI bleeding can cause fatigue and/or hemody- sudden incapacitation, which would interfere with the safe namic instability resulting in the inability to safely perform performance of essential job tasks. Uncontrolled or poorly essential job tasks. controlled hypertension can be defined as the presence of end A.6.11.2(4) Acute hepatitis (until resolution of acute hepatitis organ damage [see A.6.10.2.1(1)(b)) or stage 2 hypertension (BP as determined by clinical examination and appropriate labora- systolic >160 mm Hg or BP diastolic >100 mm Hg). Individuals tory testing) can result in frequent episodes of pain and the with stage 1 or stage 2 hypertension should be referred to their inability to safely perform essential job tasks.
primary care physician for evaluation, lifestyle modification, and/or treatment. Patients with pre-hypertension should be A.6.11.2(5)(c) The member should be evaluated for persistent counseled about appropriate lifestyle modification (s). After abnormality causing increased risk of infection and/or strangu- appropriate and successful management of stage 1 or stage 2 lation. hypertension, a candidate can be re-evaluated after at least A.6.11.2(6) Inflammatory bowel disease (that which causes 1 month's time.
disabling pain or diarrhea) can result in frequent episodes of A.6.10.2.1(1)(b) Chronic hypertension can damage the eye pain and the inability to safely perform essential job tasks. It is (retinopathy), the kidneys (nephropathy), the vascular system a progressive illness leading to functional impairment. (stroke, transient ischemic attack, peripheral artery disease), and the heart (left ventricular hypertrophy, heart failure). A.6.11.2(7) Intestinal obstruction (that is, recent obstruction These hypertension complications are known as end organ with impairment) can result in frequent episodes of pain, the inability to safely perform essential job tasks, and the potential damage. The cardiac and vascular complications are associated with an increased risk of sudden incapacitation and sudden for sudden incapacitation. cardiac death (Koren et al. 1991). Unfortunately, cardiac A.6.11.2(8) Pancreatitis (chronic or recurrent) can result in complications are frequently asymptomatic, and valid screening frequent episodes of pain and the inability to safely perform tests are not fast or inexpensive. Therefore, determining which essential job tasks. candidates to screen for cardiac complications [such as ECG for left ventricular hypertrophy (LVH) or a measurement of A.6.11.2(10) A bowel resection (if frequent diarrhea precludes left ventricular ejection fraction for heart failure] should be performance of duty) can result in frequent episodes of pain based on the severity and the duration of hypertension. and the inability to safely perform essential job tasks.
A.6.11.2(11) A gastrointestinal ulcer (where symptoms are uncontrolled by drugs or surgery can result in frequent perform essential job tasks and the potential for sudden inca- episodes of pain and the inability to safely perform essential pacitation. job tasks.
4.6.10.2.1(4) Peripheral vascular disease can impair sensation, A.6.11.2(12) The member should be evaluated for underlying can increase the likelihood of injury, and can result in frequent disease, history of trauma, or associated infections.
Shaded text = Revisions. A = Text deletions and figure/table revisions. • = Section deletions. N = New material. 2018 Edition Sopyrigh: 2010 Nationa Fire Protection Association (NFPA) Wicensed, By agreement, for individual use and download or D7/08/2019 to Bily Acorn for designated user Willer, Swen. No ether reproducion of trensmission in any fom permitted without warten pentession of NFPAE. Coringuines onto report unauthenzed use, contact teensingdenica cro This NEOSS All Acpass subscappon expires on Decenter 15, 2019 1582-50 COMPREHENSIVE OCCUPATIONAL MEDICAL PROGRAM FOR FIRE DEPARTMENTS A.6.11.2(13) Cirrhosis, hepatic or biliary (that which is symp- (as needed) should be normal, and medications needed tomatic or in danger of bleeding), can result in frequent to control pain should not affect nervous system function episodes of pain and the inability to safely perform essential (energy, cognitive ability, equilibrium, etc.). job tasks. (2) Myopathy and/or myositis. Motor strength is normal, pain is controlled without narcotics, renal function is A.6.11.2(14) Chronic active hepatitis can result in weakness, normal, and neither heart nor diaphragm is involved. general malaise, and the inability to safely perform essential job (3) History of infectious myoneuropathies (e.g., Guillain- tasks.
Barré, post-botulism, post-polio syndrome). Cognitive
A A.6.12.1 Metabolic syndrome includes three or more of the function, neurologic exam, and diagnostic imaging stud- following components: ies (as needed) should be normal. (1) Abdominal obesity, defined as a waist circumference A.6.18.2(1) The candidate should be evaluated for severity, >40 in. (>102 cm) in men, >35 in. (>88 cm) in women chronicity, pain, likelihood of serious occupational infectious (2) Triglycerides > 150 mg/dl exposure, requirement for continuous medication, and impair- (3) HDL cholesterol <40 mg/dl for men, <50 mg/di for ment of ability to safely perform essential job tasks. women
A.6.18.2(2) The candidate should be evaluated for thinned, (4) Blood pressure >135/85 mmg
(5) Fasting blood glucose >110 mg/dl. stretched skin that is at risk for easy breakdown, burn damage, abnormal sensations, or infection.
Metabolic syndrome is associated with reduced aerobic capacity that interferes with the ability to safely train to be a fire fighter A.6.18.2(3) The candidate should be evaluated for systemic and to safely perform essential job tasks 2, 4, 5, 6, 7, 8, 9, 10, involvement, skin involvement that interferes with essential job and 13. Metabolic syndrome is also an increased risk for cardio- tasks, or presence of localized complications such as fissures, vascular disease, hypertension, and insulin resistant hyperglyce- weeping, or ulcerations, due to risk of burn injury and/or mia. infection.
A.6.13.2(1) Heavy physical exertion has been associated with A.6.18.2(4) The candidate should be evaluated for associated spontaneous abortions. Lifting heavy objects should be avoided systemic lupus, skin integrity, and Raynaud's phenomenon. during pregnancy. Excessive heat, toxic chemicals and cate- cholamine surges have the potential for fetal harm. A.6.18.2(5) The candidate should be evaluated for functional limitation of hand and/or foot when exposed to cold or
A.6.16.2(1) The member should be evaluated for residual systemic involvement of skin, muscles, heart, lungs, or neuro- instability (subluxation) or significant limitation of motion. logic system that would compromise the safe performance of A.6.16.2(4) The member should be evaluated for residual essential job tasks. instability or laxity of ligament or intra-articular arthritis, which A.6.18.2(6) The candidate should be evaluated for sclerodac- could cause instability in limb, inadequate range of motion, or tyly with significant loss of function or systemic involvement. increased pain or would limit crawling, kneeling, jumping, safe ladder use, or safe stretcher carrying. A.6.18.2(7) The candidate should be evaluated for associated leg swelling, loss of function, or systemic involvement.
A.6.16.2(5) The member should be evaluated for residual signs or symptoms (e.g., pain, swelling, atrophy, range of A.6.18.2(8) The candidate should be evaluated for percent motion, gait). body involvement with redness and scaling, requirement for regular application of lubrication/medication, and/or poten- A.6.16.2(6) The member should be evaluated for resulting tial effect on safe performance of essential job tasks. functional impairment, disease activity, and chronicity.
A.6.18.2(9) The candidate should be evaluated for extent, A.6.17.1(5) The candidate should be free of clinical disease severity, chronicity, and known precipitants with attention to for 3 years, a neurologic exam should be normal, and the potential risk of serious, occupational infectious exposures or candidate should not require drugs that can impair ability to other interference with safe performance of essential job tasks. safely perform essential job tasks. In considering performance of essential job tasks, the impact of the operational environ- 4.6.18.2(10) The candidate should be evaluated for swelling, ment (e.g., heat, stress, activity, variable night shifts) on exacer- redness, scaling, itching, weeping, and/or cracking, pain, loss ations should be considered and specifically addressed by a of function (e.g., cannot stand for long periods of time), or neurological specialist so that an informed determination can ulceration. be made by the fire department's medical officer. A.6.18.2(11) The candidate should be evaluated for functional A.6.17.1(6) The candidate should be free of clinical disease limitations, ability to wear helmet, SCBA other respirators for 3 years and off all drug and other treatment. Cognitive required by the AHJ with proper fit-testing, and protective function, neurologic exam, and respiratory status should all be clothing, and requirements for continuous treatment. normal, and the candidate should be free of disease exacerba- tions for 3 years and off all drug treatment. A.6.18.2(12) The candidate should be evaluated for extent, chronicity, and interference with safe performance of essential A.6.17.2(2) Exam and imaging studies should be normal, and job tasks. medications needed to control chronic pain should not affect A.6.18.2(13) The candidate should be evaluated for extent, neurologic or cardiac function (energy, cognitive ability, equili- chronicity, pain, ability to wear protective ensemble, and risk of brium, etc.). Examples include the following: occupational infectious exposure. (1) Neuropathy (cranial, peripheral, plexus, etc.). Motor and sensory neurologic exams and diagnostic/imaging studies 2018 Edition Shaded text = Revisions. A = Text deletions and figure/table revisions. • = Section deletions. N= New material.
Copysight 2010 Nationa Fire Protection 4sacation: (NF) Lensed, by agreement for individual use and downied on D7/08/2019 Billy Alcom for designated user Milian Swan No piner reproduction or transmission in any foam permilted without warten permission of NEPAS Forindumes orto report unauthonzed vee conlact lessing @nipa ore This NECES Ail Accoss subscripiich expires on December 19, 2019.
ANNEX A 1582-51
A.6.18.2(14) The candidate should be evaluated for extent Members engaged in fire suppression are at greater risk than and acuity of blistering, loss of function, aggravating agent (s) if those engaged in other emergency activities (EMS, law enforce- known, ability to wear protective ensemble, ability to tolerate ment) for this reason. moderate, incidental, job-related trauma to skin, risk of occu- pational infectious exposure, or inability to safely perform A review of current published data suggests that with careful essential job tasks. individualized assessment it is possible to identity those with diabetes who can function fully as fire fighters and who do not A.6.18.2(15) The candidate should be evaluated for severity, present a significant risk to themselves, their fellow fire fight- chronicity, association with underlying medical condition, and ers, or to those they serve. requirement for medications (antihistamines) that interfere with the ability to safely perform essential job tasks. The individualized assessment process and criteria included in this standard were set up to assure that only those who are A A.6.20.1(1) Type 1 diabetes was previously called insulin- managing their diabetes conscientiously using the most up-to- dependent diabetes mellitus (IDDM) or juvenile-onset diabe- date approaches would be eligible to be a fire fighter. In addi- tes. Type 1 diabetes develops when the body's immune system tion, certain patients have a greater tendency for significant destroys pancreatic beta cells, the only cells in the body that hypoglycemia despite the quality of their diabetes manage- make the hormone insulin, which regulates blood glucose. This ment. Such individuals are not good candidates to be fire fight- form of diabetes usually strikes children and young adults, ers and, accordingly, are excluded from service under the although disease onset can occur at any age. Type 1 diabetes criteria in this standard. accounts for 5 percent to 10 percent of all diagnosed cases of diabetes. In order to survive, people with Type 1 diabetes must This individualized assessment is possible in large part have insulin delivered by a pump or injections. because a great deal of change has occurred in the treatment of diabetes in recent years. Previously patients used insulins Type 2 diabetes was previously called non-insulin-dependent that were somewhat unpredictable in the time course of their diabetes mellitus (NIDDM) or adult-onset diabetes. Type 2 action and generally took two injections per day. Today, there diabetes accounts for about 90 percent to 95 percent of all are insulins that are far more predictable and are either very diagnosed cases of diabetes. It usually begins as insulin resist- long acting and essentially treat only endogenous glucose ance, a disorder in which the cells do not use insulin properly. production (and therefore do not depend on a patient eating As the need for insulin rises, the pancreas gradually loses its on a regular schedule) or are very rapid and therefore can be ability to produce insulin. Type 2 diabetes is associated with administered directly before, during, or even shortly after one older age, obesity, family history of diabetes, prior history of eats, significantly decreasing the chance of insulin being taken gestational diaberes, impaired glucose tolerance, physical inac- and then the meal being interrupted due to fire-fighting tivity, and race/ethnicity. Type 2 diabetes is increasingly being duties. diagnosed in children and adolescents. Many people with Type Regimens now referred to as "basal bolus" are composed of a 2 diabetes control their blood glucose by following a careful diet and exercise program, losing excess weight, and taking very long-acting basal (or background) insulin, which controls glucose levels overnight and in the absence of glucose intake, oral medication. Among adults with diagnosed diabetes, about and rapid-acting (bolus) insulins that are dosed just prior to, 12 percent take both insulin and oral medications, 19 percent during, or even after meals based on blood glucose levels at take insulin only, 53 percent take oral medications only, and 15 percent do not take either insulin or oral medications. that time, the amount of carbohydrate that the person expects to consume, and any anticipated change in physical activity Risk of hypoglycemia (low blood sugar) remains the major patterns over the next number of hours. concern in regard to those with diabetes being or becoming These regimens have resulted in improved overall blood fire fighters. This risk is greatest in those with Type 1 diabetes. glucose control with significantly less risk of hypoglycemia for In general, patients treated with oral diabetes medications many patients. are at little risk of significant hypoglycemia. Patients treated Additional major advances in the size, speed, and sophistica- with metformin, alpha-glucosidase inhibitors, or thiazolidine- diones alone or in combination with each other are at no risk tion of blood glucose meters provide for easy, accurate, and rapid assessment of blood glucose levels. Such monitoring tech- of hypoglycemia, as these classes of drug do not increase insu- niques, as well as the generally increased self-awareness that lin levels. Patients treated with sulfonylureas and related drugs accompanies consistent self-monitoring, enable the motivated have a risk of severe hypoglycemia less than l percent of the fire fighter with diabetes to assess blood glucose levels and risk associated with insulin treatment. Patients treated with diet ingest a safety net of carbohydrates before entering a hazard- and exercise alone (no oral diabetes medications or insulin) ous environment. Similarly, major advances in insulin delivery are at no risk of hypoglycemia. systems have greatly increased the ability of the motivated indi- Fire fighting entails a unique set of conditions that need to diabetes to achieve a level of diabetes self- be considered in regard to those with diabetes and the risks of management consistent with the duties of fire fighting. hypoglycemia. Unpredictable meal schedules, periods of physi- In order to get maximum effect from medical advances and cal exertion, adrenergic stimulation, and sleep deprivation all to minimize the risk of hypoglycemia, patients with diabetes present challenges to fire fighters with diabetes. There are must check their blood glucose level frequently (as recommen- occasions when there is no safe access to food or other forms of ded based on factors such as type of therapy and glycemic oral glucose while wearing respiratory protection in a hazard- history), review those results on a regular basis, and see their ous environment, and the typical symptoms of hypoglycemia diabetes care provider regularly for discussion in regard to any might not be recognized as easily in the midst of fighting a fire. necessary changes in treatment. Patient evaluation needs to As well, it is not always possible to exit a hazard zone rapidly look for any of the known risk factors for serious hypoglycemia to treat hypoglycemic symptoms when detected.
Shaded text = Revisions. 4 = Text deletions and figure/table revisions. • = Section deletions. IN = New material. 2018 Edition fore perited without witten cerission DEAD Foringuries onto report unauthorped usa, contact censing@/pa.org This NFOSS Al Access Subscapton expires o: December 19. 2019. 1582-52 COMPREHENSIVE OCCUPATIONAL MEDICAL PROGRAM FOR FIRE DEPARTMENTS or evidence of any of the known microvascular (eye disease, 3 months. Physicians may then prescribe more aggressive kidney disease, or nerve disease) or macrovascular (cardiovas- treatments, resulting in increased episodes of hypoglyce- cular disease, peripheral arterial disease) complications mia. Some assay methods used with some hemoglobino- diabetes. A 12 MET stress test is required because myocardial pathies may result in falsely low outcomes, infarction remains the major cause of line-of-duty fatalities, and under-treatment of diabctes." Also according diabetes is a risk factor for myocardial ischemia, especially NDIC: "About one in 12 African Americans has sickle cell asymptomatic silent myocardial ischemia. trait. About 14.7 percent of African Americans aged 20 years or older have diabetes. Therefore, many African
The individualized assessment described previously demands Americans have both diabetes and sickle cell trait. People a very close and good working relationship between the patient of Southeast Asian descent are at risk for having hemoglo- and the diabetes care provider. The experience of those who bin E (HE), another hemoglobin variant." care for current fire fighters with diabetes is that many are highly motivated and will do whatever it takes to perform their Clinical Studies. A comparison of HAIC with average jobs at a high level and in a safe manner. glucose derived from 2 days of continuous monitoring that there is variability in the relationship and 3 months of 7 point glucose profiles at least three between the hemoglobin AlC and the 3-month average blood times a week. The confidence interval for average glucose glucose, we recommend that hemoglobin AlC levels greater with an AlC of 8 percent was 147-217 mg/dl. [Nathan than the 8 percent threshold in Sections 6 and 9 be confirmed by a second determination before action is taken. RBC Lifespan: Hemoglobin AlC levels are a "snapshor" of what is truly a rolling average. Subclinical variation in The physician evaluating an individual with a hemoglobin RBC lifespan can have a significant effect on the relation- AIC >8 percent should consider a discordance between the ship between mean glucose and AlC, with increases in AlC and the 3-month average glucose if any of the following average RBC lifespan increasing net glycosylation and decreases (as in some hemoglobinopathies or in recovery (1) A repeated value is below the threshold. from hemorrhage or anemia) decreasing net glycosyla- (2) A single AIC determination is discordant with prior or tion. [Herman and Cohen 2010, Cohen 2008] subsequent determinations with no RBC Glucose Transport. Variations in transport across the deterioration in glycemic control. RBC membrane result in different intracellular and The patient's reported capillary blood glucose determina- extracellular glucose levels, thus affecting intracellular tions and/or venous glucose determinations in the physi- hemoglobin exposure to glucose and resultant glycosyla- cian's office are significantly lower than those reflected by average glucose (eAG) (eAG calculator Variations in Glycosylation Rates. Patients vary in activity of at http//professional.diabetes.org/glucosecal- the glycosylation reaction; genetically determined "high" and "low" rates of glycosylation have been described in a The patient has a personal or family history or other number of studies, explaining about one third of interin- evidence of a hemoglobinopathy. dividual variation in AlC levels. [Hudson 1999, Snieder The patient is a member of an ethnic group 2001, Hempe 2002, Cohen 2006, Soranzo 2010] increased risk of hemoglobinopathy. Interethnic Variation. Numerous studies have identified the effect of ethnicity on the relationship between average If the evaluating physician suspects that the AlC overesti- glucose and AlC. In general, Caucasians have signifi- mates average blood glucose, further evaluation can include cantly lower AlC levels at comparable glucose. [Herman the following: 2007, Cohen 2007, Viberti 2006, Herman 2009, Ziemer 2010, Kirk 2006]. This variability is independent of the effect of hemoglobinopathies noted in (2).
Serum fructosamine determination A.6.20.1(1) (g)iv. Episodes of severe hypoglycemia are associ- Downloaded reports from a memory glucometer ated with an increased risk of subsequent episodes. Hypoglyce- (5) Downloaded reports from a 72-hour continuous glucose function and judgment. mia can interfere with cognitive
monitor
Presence of microvascular and neurological complications of (6) Downloaded reports from a personal continuous glucose diabetes can increase the risk of hypoglycemic events. monitoring device
A.6.20.1(2) (g)iv. Episodes of severe hypoglycemia might Possible explanations for discordance between the eAG
predict an increased risk of subsequent episodes. Hypoglyce- based on AlC and the patient's true average glucose include mia can interfere with cognitive function and judgment. Pres- the following: ence of microvascular and neurological complications of (1) Assay Precision. The American College of Pathology diabetes can increase the risk of hypoglycemic events. accepts variation within 7 percent in AlC assays. Thus, a person with an AlC of 8 percent might have a value A.6.20.2(1) The candidate should be evaluated for absence of between 7.5 percent and 8.5 percent on repeat testing of orthostatic hypotension, electrolyte disorders, ability to main- the same sample. [Cohen 2010] tain hydration during exercise under extreme environmental (2) Hemoglobinopathies. According to the National Diabetes conditions, and normal thyroxine levels with supplementation.
Information Clearinghouse (NDIC): "With A.6.21.2(2) Previous burn injury per se does not interfere with methods, AlC tests in patients with hemoglobinopathies the essential job tasks of fire fighting. Extensive burn injury result in falsely high outcomes, overestimating actual with or without the need for skin grafting can result in skin average blood glucose levels for the previous 2 to surfaces that are easily damaged, sensitive to chemical or 2018 Edition Shaded text = Revisions. A = Text deletions and figure/table revisions. • = Section deletions. N = New material.
Copyright 2019 Natiene: Fire Prolection Association NEPAl, Licenser, by agreement, for individuatuse and download on 07/06/2019 to Bily Alcom for designated user William Swan No other reproduction or transmission in any fore permitted without wetter permission of NEPA. For incules ento report unzumorsed us somect hensingdolpa.@g/ This NECES At coass Bunscaption expires on Dacember 15. 2019.
ANNEX A 1582-53
solvent exposure, or lacking in sweat or sebaceous glands. The modify these risk factors. Clearly, risk reduction is easier if candidate should be evaluated for heat or cold intolerance, there is early intervention and if the department promotes range of motion and motor strength, and ability to wear wellness and fitness. Tobacco cessation programs should be personal protective clothing and equipment. available to the member, and all fire department facilities should be tobacco-free zones. Control of weight, hypertension, A.6.22.2(1) The candidate should be evaluated for space- cholesterol, and blood sugar are all improved with dietary occupying lesion, treatment, or sequelae affecting ability to education and regular exercise. perform essential job tasks.
NA.7.5.1 The Genetic Information Nondiscrimination Act
A.6.22.2(2) The candidate should be evaluated for history or (GINA) prohibits discrimination on the basis of genetic infor- risk seizure; residual effects on balance, coordination, mation (including family medical history). The Equal Opportu- strength, speech, judgment; and medication requirements. nity Employment Commission (EEOC) has stated that
A.6.22.2(3) The candidate should be evaluated for ability to collection of genetic information is only permitted in very limi- wear SCBA and maintain nutrition and oral hydration. ted circumstances, including voluntary wellness programs, and with specific informed
A.6.22.2(4) The candidate should be evaluated for residual means that participation is not required and that employees pulmonary function and medication requirements. will not be penalized for non-participation. For instance, if an A.6.22.2(5) The candidate should be evaluated for abnormal employer requires an employee to submit family medical bowel or urinary function that would interfere with emergency history to a medical provider, even if that provider will not in operations where toilet facilities are unavailable, the ability to turn give that information to the employer, the disclosure is maintain nutrition and hydration, and medication require- not voluntary and is considered a violation of GINA. ments. Even though it might prove to be useful to medical providers A.6.22.2(6) The candidate should be evaluated for muscle screening for potential medical conditions, fire fighters are not strength, deformity interfering with function, or the ability to required to provide family medical history under this law.
When collected, family medical history must only be utilized as wear protective ensemble.
part of a voluntary wellness and fitness program. Specifically, it A.6.22.2(7) The candidate should be evaluated for anemia, cannot be used in employment decisions. In cases where such leukopenia, or thrombocytopenia, or residual cardiac, pulmo history is collected, the employee must sign a statement nary, GI, dermatological, or neurological effects of surgery, confirming that the information is being voluntarily disclosed radiation, or chemotherapy. Additionally, the health care provider must maintain the indi- vidual's confidentiality and only report such information in N A.6.24.1(3) Examples of anticoagulation medications include aggregate terms so that it cannot be tracked back to the indi- antithrombin (ATryn®), apixaban (Eliquis®), argatroban, biva- vidual. lirudin (Angiomax®), dabigatran etexilate (Pradaxa®), dalte- parin (Fragmin®), enoxaparin (Lovenox®), fondaparinux NA.7.6(12) Studies have found increased risk for both mela- sodium (Arixtra"), rivaroxaban (Xarelto®), and warfarin noma and non-melanoma skin cancer in fire fighters. Compre- sodium (Coumadin®). hensive inspection of the skin, especially in sun-exposed areas, is recommended. Any suspicious lesions should be referred for Antiplatelet agents are not anticoagulation medications and dermatological assessment. do not lead to restrictions (unless the underlying medical include A.7.7.1 If performing these tests as part of an automated condition does). Examples of antiplatelet agents
aspirin, combination aspirin-extended-release panel that includes additional tests is more cost-effective, it is dipyridamole acceptable to do so.
(Aggrenox®), clopidogrel bisulfate (Plavix®), prasugrel (Effient®), ticagrelor (Brilinta®), and ticlopidine hydrogen NA.7.7.3 Baseline and annual audiometry is performed on each chloride (Ticlid®). fire fighter. This should be done in accordance with 29 CFR 1910.95, "Occupational noise exposure." The basics of this A.6.24.1(5) Leukotriene receptor antagonists are not Category standard include the following:
A condition if used to treat conditions not affecting the lower respiratory system. The first audiogram done (for members this will probably be done during their pre-placement exam) becomes the
A.6.24.2 The candidate should be evaluated for an underlying condition requiring the medication and effects of medication If subsequent audiograms are better than the baseline, that could affect ability to safely perform essential job tasks. then the best one becomes the baseline. All audiograms A.7.1.3 A department should set protocols regarding length of should be done with no exposure to industrial noise for time absent from duty and/or medical conditions that require the department physician to evaluate a member. Physical ther- Each subsequent audiogram is compared to the baseline audiogram (not to the previous year's) to determine if
apy, strength training, work hardening, functional capacity eval- uations, and alternate duty are all activities that can be helpful. there is a threshold shift, which is an average loss of 10 dB or more at 2000 Hz, 3000 Hz, and 4000 Hz in either ear.
A.7.2.2(5) Universal agreement exists that wellness, fitness, This number should be corrected for presbycusis by age and tables [see Table A.7.7.3(a) and Table A.7.7.3(b)]. Thus, for disease, each of the three frequencies the baseline reading is regular exercise, and control of weight, hypertension, choles- subtracted from the current reading, and the presbycusis terol, and blood sugar. The annual medical evaluation should correction is subtracted from this result. The results from serve as one of many opportunities in the fire department to Shaded text = Revisions. A = Text deletions and figure/table revisions. • = Section deletions. N= New material. 2018 Edition Comman: 2010 National Fire Protect on: Assocation: (FPA. Licensed by egreement, for individual use and download on 0M/C/2019 to Pilly Alcon: for designaled user Witam Swan No other recroducho: or transmission in pry em permied without watten permission of NEPAL Forinquiries onto report unauthenged use contact lcensing@enipaorg This NOOS ARmccess suesciten expires on December 19 2319 1582-54 COMPREHENSIVE OCCUPATIONAL MEDICAL PROGRAM FOR FIRE DEPARTMENTS the three frequencies are averaged, and if this number is Table A.7.7.3(b) Age Correction Values in Decibels for 10 or greater, then there is a threshold shift. Females If there is a threshold shift, the AH] must be notified.
AHIs are responsible for initiating evaluation of personal Audiometric Test Frequency (Hz) protective equipment (PPE) and engineering controls.
If there is a threshold shift, the member should be Years 1000 2000 3000 4000 6000 advised in writing and referral to an audiologist and/or ≤20 6 an otolaryngologist should be made. - 6
If the threshold shift is determined to be permanent, 7 4 4 then this audiogram becomes the "revised baseline." 4
7 5 1 4
5 4 4
8 7
8 5
Table A.7.7.3(a) Age Correction Values in Decibels for Males 8 8 5 5
Audiometric Test Frequency (Hz) 8 5 5 9
Years 1000 2000 3000 4000 6000
-
34 35
36 37 2
~ IN 0 00 00 10 12
8 2
40 10 7 8
6 41 10
42 11 3
43 11
44 9
11 800=2 89==
45 11 10 10
5 11 46 11 10 10 15
12 47 10 11
NANAN 12 • . 11
48 12 11
38 13 49 12 9 11 11 16
39 6 10 18
50 12 10 12
10 14 51 12 10 12 12
14 52 12 10 12 13
16 10 13
54 13 11 14 19
55 13 11 14 14 19
13 18 56 13 14 15 20
13 19 57 13 15 15 20
14 19 58 14 12 15 16 21
14 20 59 14 12 16 16 21
15 21 26 ≥60 14 12 16 17 22
16 22 Source: 29 CFR 1910.95
16 23
17 24
18 25
18 26
10 19 27
10 20 28
10 21 29
Source: 29 CFR 1910.95.
2018 Edition Shaded text = Revisions. A - Text deletions and figure/table revisions. • = Section deletions. N = New material.
Copyright 2019 National Fire Protection Association (NFPA)Ucersed by apicament, for at visual use and downind on 0206/20100 Bel Alcom for designated user Willien Swan. No oter reproducien or transmission in any term perminted without witish commission ef For tradines orto report anothensed use, comact hesing@nito bra This NECES Al Access Babscropon expires on December 19 2019.
ANNEX A 1582-55
A.7.7.4.1 Pulmonary spirometry is an essential further evaluation (complete pulmonary function tests, exer- annual medical evaluation of fire fighters wearing personal cise testing, or challenge testing) might be necessary to deter- protective clothing and SCBA. Spirometric measures include mine if essential tasks can be performed safely (see F.2.5). the forced vital capacity (FVC), the forced expiratory volume in the first second of expiration (FEV,), and the absolute NA.7.7.7.3.1 An exercise stress test (EST) provides valuable FEV,/FVC ratio calculated by dividing the FEV, by the FVC in prognostic, and exercise tolerance capacity) information. The EST should be conducted accord- liters. Other spirometric measures of small airway flow limita- ing to the American College of Cardiology/American Heart tions le.g., forced expiratory flow (FEF) 25 percent to Association (ACC/AHA) protocol. Although the EST is
75 percent] should not be used for screening evaluations. For frequently ended when the patient reaches 90% of the target spirometric measurements to be properly interpreted, they heart rate [e.g., 90 percent × (220 - age)], the ACC/AHA need to be performed according to American Thoracic Society recommends a symptom-limiting end point. The test must be recommendations. Modern spirometry uses computer-assisted completed to 12 METS to ensure this level of cardiac work will quality control of both calibration and testing procedures. FEV, not precipitate a sudden cardiac event. Individuals with a nega- and FVC results are expressed not only as absolute values tive (normal) EST should be retested every 2 to 5 years based (liters) but also as percent predicted adjusted for gender, age, on individual clinical assessment and ASCVD risk scores. height, and ethnicity. Currently, the preferred method uses NHANES III normative equations with the acceptable thresh- Imaging with an EST increases the sensitivity and specificity old being 80 percent predicted. When percent predicted FEV, of the test, but also significantly increases the costs. Stress echo- or FVC values are minimally below threshold (typically cardiography is the preferred imaging test for individuals with 74 percent to 79 percent of predicted), the LLN for the appro- an abnormal resting ECG (e.g., left bundle branch block), left priate population can, at the discretion of the physician, ventricular hypertrophy, or long-standing hypertension. Stress used instead of the 80 percent predicted threshold value. For myocardial perfusion imaging might be indicated for asympto- the LLN may be more appropriate for taller and matic individuals with diabetes mellitus or a strong family older individuals. (See references in F.2.5.) However, because these history of congenital heart defect (CHD). norms are population-based, it is possible for individuals to be There is increasing evidence that a coronary artery calcium normal just below these thresholds or to have minimal but (CAC) score can provide important clinical and prognostic potentially significant abnormalities just above these thresh- information. A CAC score provides a structural assessment of olds. In asymptomatic individuals with minimal reductions in coronary artery obstruction. When negative, the screening test spirometry measures (FEV,, FVC, or the absolute FEV,/FVC provides a high level of assurance that no obstructing lesions in ratio), further evaluation (complete pulmonary function tests, the coronary arteries are present (greater than 90 percent exercise testing, or challenge testing) can be necessary to deter- predictive value negative). A positive test prompts referral to a mine if essential tasks can be performed safely. Such tests are cardiologist for further evaluation and treatment, which typi- not screening tests and therefore should be performed in a cally includes an EST with imaging and/or cardia catheteriza- laboratory setting by an experienced specialist. tion. There is insufficient evidence to determine the frequency A.7.7.4.3 When the FVC or FEV, is reduced below 70 percent for a repeat CAC, but not less than 5 years would appear of predicted, substantial dysfunction is present. Moderate chronic obstructive pulmonary disease is considered to be Defining the criteria for a positive or negative EST is beyond present when the absolute FEV,/FVC ratio is equal to or less the scope of this document. than 0.70 and the FEV, is less than 70 percent predicted.
NA.7.7.7.4 See https://www.framinghamheartstudy.org/risk- functions/coronary-heart-disease/2-year-risk.php.
and the FEV, is less than 30 percent predicted. Moderate to 4 A.7.7.9(1) An annual TB program should include the follow- severe restriction is considered when the FVC is less than ing:
60 percent predicted with an absolute FEV,/FVC ratio greater (1) Documentation of a two-step purified protein derivative than 0.90. Again, in certain cases, additional pulmonary func- (PPD) tuberculin skin test prior to this PPD, a 0mm PPD tion testing can be required, such as pre- and post-spirometry, within the past year, or a negative TB blood test for inter- lung volumes, diffusing capacity, exercise testing, and/or chal- feron gamma release assay within the past year. [Morbidity lenge testing. Because these tests are for diagnostic purposes, and Mortality Weekly Review, December 16, 2005, and they should be performed in a laboratory setting by an exper- NFPA 1581]
enced specialist. [Hankinson 1999]. For most individuals, the If the TB skin test (PPD) is used, the following is
definition of an abnormal FEV, or FVC is less than 80 percent required:
predicted adjusted for gender, age, height, and ethnicity using NHANES III. However, because these norms are population- Placement of the PPD and subsequent reading by a based, it is possible for individuals to be normal just below trained, designated reader within 48 hours to these thresholds or to have minimal but potentially significant 72 hours of placement. Members with a history of abnormalities just above these thresholds. When percent positive PPD should instead fill out a questionnaire predicted FEV, or FVC values are just below threshold (typi- and might be required to have a chest radiograph. cally 74 percent to 79 percent of predicted), the LLN for the (b) PPD results should be documented in millimeters appropriate population can, at the discretion of the physician, (mm). A test with no skin reaction should be recor- ded as 0 mm. PPD measurement should not include
be used. For example, the LLN might be more appropriate for taller and older individuals. In asymptomatic individuals with erythema and should include only induration in the minimal reductions in FEV, or FVC values (70 to 79 percent axis perpendicular to the forearm. predicted) and a normal FEV,/FVC ratio (0.71 to 0.90),
Shaded text - Revisions. 4 = Text deletions and figure/table revisions. • = Section deletions. N= New material. 2018 Edition Copynan: 2019 Nationa: Fire Protection Association: (SPPA ticensed by agreement, or indisgual use and downind on 0770620110 Bly Alcon for designated user Whom Swan No other reproduction or transmission in any form permitted without written permission ofFP fornoures arto report unauthonzed use contact icensing@n/pa.org The NECES All Access subsongtion expires on December 19. 2019. 1582-56 COMPREHENSIVE OCCUPATIONAL MEDICAL PROGRAM FOR FIRE DEPARTMENTS (c) A PPD skin test will be considered positive if the A.7.7.10.2 The BBP protocol should include the following following conditions are present: elements:
5 mm or greater in a member who is immuno- (1) Fact sheet that explains in lay language the risks of infec- suppressed, who has a household contact with tion, the various prophylactic and therapeutic options, active tuberculosis, or who has an abnormal the testing and follow-up that will be needed, and chest radiograph consistent with prior tuber- recommendations for personal behavior (safe sex, blood donation, etc.) following an exposure
10 mm or greater in a member with a normal (2) Classification table to determine the exposure type and immune system who has an increased proba- recommendation for prophylaxis bility of recent infection or has other clinical (3) Current recommendations of the U.S. Department of conditions that increase the risk for progres- Health and Human Services, Centers for Disease sion to active TB. This includes all members, Control and Prevention, and Public Health Services fire fighters are considered health (4) List of tests to be done on exposed member, including care workers if they perform EMS or rescue the following:
(a) HIV
5 mm increase from previous reading occur- (b) Hepatitis B surface antibody (HBsAb), if not previ- ring within last 2 years. ously known to be positive
(3) TB blood tests are now readily available. Their cost effec- (c) Hepatitis B surface antigen (HBsAg), if not previ- tiveness must be judged by considering the fact that false ously known to be positive HBsAb positives from atypical mycobacterium or BCG vaccina- Hepatitis C antibody (HCAb) tion do not occur and that this test requires only one visit If HIV prophylaxis is to be given, the following for blood drawing, thus eliminating a return visit for PPD tests:
skin test reading. False positives and false negatives can occur if the blood specimens are not properly obtained, i. CBC handled, and processed prior to and after arrival in the ii. Glucose, renal, and hepatic chemical func- laboratory. tion
(4) If the PPD or the tuberculin skin test is positive (conver- ili. Pregnancy test for females sion), the following steps should be taken: (5) List of tests to be done on source patient, including the following:
(a) Member fills out questionnaire.
(b) Member obtains chest x-ray. (a) HIV
(c) Member is evaluated for active disease. (b) HBsAg
(d) Member is evaluated for preventative therapy. (c) HCAb If active disease is suspected, the member should be (6) If source is available, interview for HIV, hepatitis B, and removed from any duty until he/she has been deter- hepatitis C risk/status mined to be noninfectious. This will occur when the diag- (7) Determination of risk and need for post-exposure nosis of tuberculosis is ruled out or, if confirmed, when prophylaxis (PEP) adequate therapy has been instituted, the cough has (8) Member counseling regarding PEP medication(s) and resolved, and three consecutive sputum smears for acid- side effects of treatment; a printed fact sheet for the fast bacillus (AFB) on different days are negative. member to review (9) PEP, if appropriate, given as soon as possible after the In the event of an exposure to TB, the following steps should incident, preferably within 2 hours be taken: (10) Follow-up of members on prophylaxis for the duration (1) Member without a recent PPD (in the last 6 months) of their treatment should receive a PPD, tuberculin skin test, or TB blood (11) Assessment of tetanus status and administration of dT test within 14 days of exposure. Members with a history of booster, if appropriate positive PPD, tuberculin skin test, or TB blood iest, (12) Assessment of hepatitis B status as follows:
should fill out a TB questionnaire. (a) If previously immunized with a positive post- (2) Another PPD, tuberculin skin test, or TB blood test and immunization titer, no further treatment is the questionnaire should be repeated 6 weeks to 12 weeks needed. after the first PPD. (b) If previously immunized, titer was negative, and (3) If the PPD skin test or TB blood test turns positiv source is HBsAg positive or high risk, give hepatitis conversion) or the questionnaire is positive, proceed a B immune globulin (HBIG) as soon as possible, described in A.7.7.9(1) (5) and A.7.7.9(1) (6). preferably within 24 hours, and give a dose of N A.7.7.9(4) The Tdap vaccine should not be administered for 2 hepatitis B vaccine. (c) If previously immunized and titer is unknown,
years following a Td dose.
draw titer and proceed as follows:
NA.7.7.9(5) Women who receive the MMR vaccine should not i. If titer is positive, no further treatment is become pregnant for three months after the vaccination is needed. administered.
ii. If titer is negative and source is HBsAg posi-
A.7.7.9.2 for further guidelines and requirements, refer to tive or high risk, then give HBIG as soon as local and state departments of health and the Centers for possible, preferably within 24 hours, and give Disease Control (CDC); also see the references in E.2.6. a dose of hepatitis B vaccine. 2018 Edition Shaded text = Revisions. A = Text deletions and figure/table revisions. • = Section deletions. N = New material.
Copyrigh: 2019 Matina Fire Protection secoaton (FPA) Licensed by agreement for indiydual use and sowntead on 07/06:2010 to Billy A com for designated user Willien: Swan. No other reproduction or transmission in any fern permitted wthout watter permission of NEP foringuiries onto report unauthorned use, contactlicensing@nipa dig This NAGES All Access subscepton soires on December 19 2019.
ANNEX A 1582-57
ili. If previously immunized with negative titer colonoscopy shall also be performed, regardless of age or and revaccinated with a negative titer, give schedule, when FOBT results are positive or when there is a HBIG immediately and a second dose consistent change in bowel habits. 1 month later.
iv. If never immunized, give HBIG and begin A.7.7.14 Screening for prostate cancer in asymptomatic men hepatitis B vaccine series. using the PSA test is controversial; however, studies suggest that (13) Follow-up instructions should include the following fire fighters have increased rates of prostate cancer. Therefore, information: prostate screening using the PSA is indicated. There is consen- sus regarding the serial measurements of PSA, known as the (a) Adverse events and side effects of PEP PSA velocity, for comparison over time. An increase over time (b) Signs and symptoms of retroviral illness (fever, indicates an increased risk for prostate cancer. A PSA test might adenopathy, rash) detect small cancers that would never become life-threatening (c) Appointments for follow-up blood work, including It is unclear whether the benefits of PSA screening outweigh the following: the risks of follow-up cancer tests and cancer treatments. i. HIV at 6 weeks, 3 months, 6 months, and Several noncancerous conditions might result in an elevated 9 months PSA level, including benign prostatic hypertrophy (BPH) and ii. HBsAb and/or HCAb at 6 weeks, 3 months, other conditions related to acute or chronic inflammation. and 6 months, if source is hepatitis B and/or When testing reveals an elevated PSA level, it is important that hepatitis C positive the benefits and risks of prostate diagnostic procedures and Every other week CBC, renal, and liver func- treatment be discussed with the member. tion, if receiving PEP N.A.7.7.21.2 Fire fighters with a high index of suspicion for N.A.7.7.13.2 Fire department members are exposed to a variety sleep disorders should be referred to a specialist for diagnostic of particulate materials, chemicals and asbestos which can sleep studies. See 9.12.6.2 for guidance regarding obstructive increase the risk for colon cancer. Current research suggests sleep apnea. that fire fighters are at increased risk of colorectal cancer. N.A.7.7.22 The following information should be included in an Health care providers should discuss the possible increased risk annual program designed to educate fire fighters regarding of colorectal cancer resulting from occupational exposures reduction of risk for occupational cancer and cardiovascular along with the risks and benefits of initiating screening at age disease:
40 in fire fighters. If the fire fighter decides to start screening 40, fecal occult blood testing (FOBT) is the method (1) Evidence of increased occupational risk recommended for use as it has the lowest risk for adverse (2) Lifestyle and occupational risk factors for cancer and patient events and is the most cost effective.
Strategies to reduce both occupational and lifestyle risk The USPSTF recommended screening methods for colorec- factors for cancer and cardiovascular disease, including, tal cancer include fecal occult blood testing, sigmoidoscopy, or but not limited to, equipment cleaning, bygiene, and life- colonoscopy beginning at age 50 and continuing until age 75. style modifications The risks and benefits of these screening methods vary. The (4) Evidence-based medical screening for cancer and cardio- USPSTF concludes there is insufficient evidence to assess the vascular disease benefits and harms of computed tomographic colonography and fecal DNA testing as screening modalities for colorectal Research has supported an increased risk for cardiovascular events and for many types of cancer in fire fighters. Risk reduc- tion methods for prevention of both cardiovascular disease and The USPSTF concluded that screening programs incorporat- cancer are similar and include the following:
ing fecal occult blood testing, sigmoidoscopy, or colonoscopy will all be effective in reducing mortality using any of the (1) Reduction of occupational exposure to carcinogens and following 3 regimens, assuming 100% adherence to the same particulates through hygiene methods regimen for that period:
equipment
(1) Annual screening with high-sensitivity fecal occult blood (3) Elimination of nonoccupational exposure to carcinogens testing including, but not limited to, tobacco use
(2) Sigmoidoscopy every 5 years, with high-sensitivity fecal Optimization of health through lifestyle modification occult blood testing every 3 years including, but not limited to, use of sunscreen and main- (3) Screening colonoscopy every 10 years tenance of optimal physical fitness and body weight Fecal occult blood testing uses stool specimens applied to Awareness of the appropriate use of evidence-based screen- guaiac cards by the patient at home that are sent to a labora- ing tests is important for early detection of both cardiovascular tory for later analysis. Multiple different stool samples, usually disease and cancer:
three, from different days can increase the sensitivity of this colorectal cancer screening test. Diet restrictions apply to this The fire department physician should ensure the quality, test. accuracy, currency, and content of educational materials. This information can be disseminated using a variety of teaching Colonoscopy is used to examine the full lining of the colon methods including, but not limited to, in-person didactic class- and rectum. During the colonoscopy, polyp removal or excising room sessions, discussions, videotaped materials, or web-based a small piece of tissue for biopsy may be performed if indica- modules. This should be supplemented with take-home written ted. Colonoscopy should start at an earlier age (40 years) and/or web-based resources to ensure effective communica- and/or be conducted more frequently if clinically indicated. A Shaded text = Revisions. A = Text deletions and figure/table revisions. • = Section deletions. N= New material. 2018 Edition Copyright 2019 National Fine Pepiection Association INPAS Wensed, by agreement, for indisual use and downpad on 07106201910 Billy Alcom for designated user Wilier: Swan No other aproduc on or transmission in any tom permited without atten permission of NFPAG. Formquires onto report unauthensed use contact [email protected] 1582-58 COMPREHENSIVE OCCUPATIONAL MEDICAL PROGRAM FOR FIRE DEPARTMENTS Examples of available resources for this information include, The guide for measurement is as follows:
but are not limited to, the IAFF cancer awareness and preven- (1) Hips at the widest part bclow the waist; landmark is the tion training course, which was developed in conjunction with greater trochanter, feet together the Firefighter Cancer Support Network, American Cancer (2) Neck just below the larynx perpendicular to the long axis Society, American Heart Association, American Lung Associa- of the neck tion, and IAFF/IAFC Wellness-Fitness Initiative.
Equations for body fat prediction from circumferences and A.8.1.1 Besides the methods of determination of body fat height measured in inches are as follows:
mentioned in 8.1.2, other, cruder methods have been used.
Insurance companies have used height-weight tables to esti Males (N = 592; R = 90; S.E. meas = 3.52 percent fat) percent mate risk of mortality. These tables of "ideal" weight for a given fat = + [85.20969 × log (abdomen I circumference - neck height simply reflect the norm for the U.S. population without circumference) | - [69.73016 x log (height)] + 37.26673 consideration of relationship of the norm to health or fitness.
Females = + [161.27327 × log (abdomen II circumference + Another means of determining obesity that has more scientific basis is the measurement of body mass index (BMI) or the hip-neck circumference)] - [100.81032 × log (height)] - Quetelet index. This is defined as body weight in kilograms 69.55016 divided by height in meters squared. Studies have shown that A.8.1.2(3) The most widely used method for determining the Quetelet index correlates rather well (r = 0.70) with actual obesity is based on the thickness of skinfolds. The measures, measurement of body fat from hydrostatic weighing - better when performed correctly, have a high correlation (r = 0.80+) than do height-weight tables. BMI also correlates with risks with body density from underwater weighing. associated with obesity. Some experts feel that the major limita- tion of the BMI is that it is difficult to interpret to patients and Many researchers in the United States (including those to use in counseling about weight loss. It does have the advant- performing the large national surveys of the U.S. population age of being more precise than weight tables and of permitting that form the basis for normative data worldwide) take skinfold comparison of populations. However, skinfold measurements measurements on the right side of the body. U.K. and Euro- correlate more highly with data from hydrostatic weighing, pean investigators, on the other hand, tend to take measure- measuring percent body fat, and are thus more accurate for fat- ments on the left side of the body. Most research, however, related classification than the Quetelet index. Researchers reveals that it matters little on which side measurements are from the Panel on Energy, Obesity, and Body Weight Standards have recommended that Table A.8.1.1 be used when using the A suggested way to conduct measurements is as follows:
Quetelet index for obesity classification.
(1) As a general rule, those with little experience in skinfold The health risks associated with obesity begin in the range of measurement should mark the site to be measured with 25 kg/m? to 30 kg/m?. For example, someone with a large fat- a black felt pen. A flexible steel tape can be used with free mass (e.g., a bodybuilder) would be classified by the sites when it is necessary to locate a bodily midpoint.
Quetelet index as obese, though not to the same extent as With experience, however, the sites can be located with- he/she would be with relative weight or the height-weight out marking. tables. Another example of exception to this standard would be The measurer should feel the site prior to measurement, members of the Phoenix Fire Department, whose average BMI to familiarize himself and the person being measured is 28. This would place the members in the mildly obese range, with the area where the skinfold will be taken. yet on their fitness evaluations they score in the excellent The skinfold should be firmly grasped by the thumb and index finger of the left hand and pulled away from the
A.8.1.2(1) A number of researchers have found that the ratio body. While this is usually easy with thin people, it is of waist-to-hip circumference (WHR) and the following circum- much harder with the obese and can be somewhat ference measurements are an accurate and convenient method uncomfortable for the person being tested. The amount of determining the type of obesity present: of tissue pinched up must be enough to form a fold with approximately parallel sides. The thicker the fat layer under the skin, the wider the necessary fold (and the
more separation needed between thumb and index
The caliper is held in the right hand, perpendicular to the skinfold and with the skinfold dial facing up and
easily readable. The caliper heads should be placed ¼ in. to ½ in. away from the fingers holding the skinfold, so that the pressure of the caliper will not be affected.
A Table A.8.1.1 Quetelet Index for Obesity The skinfold caliper should not be placed too deep into the skinfold or too far away on the tip of the skinfold.
Try to visualize where a true double fold of skin thick- BMI (kg/m?) Classifications ness is and place the caliper heads there. It is good prac- 20-24.9 Desirable range for men and women tice to position the caliper arms one at a time, first the Grade 1 obesity fixed arm on one side and then the lever arm on the 25-29.9
30-40 Grade 2 obesity
(6) The dial is read approximately 4 seconds after the pres- Greater than 40 Grade 3 obesity (morbid obesity) sure from your hand has been released on the lever arm of the caliper jaw.
2018 Edition Shaded text = Revisions. A = Text deletions and figure/table revisions. • = Section deletions. N = New material.
Copyright 2018 Nationa: Fire Protection Association (FALcersed by agreement for indyiual se and downind on 01106/2019 to Billy Alcomfor designated user Willam Swan No other reproduction or transmission in any form permited without watten parmission of NFPie. Forinquiries orto report unauthoned use. comect [email protected]| Ins NFOSS Al Mccess subscripton excites on December 19, 2019 ANNEX A I582-59
(7) A minimum of two measurements should be taken at (3) Performing forcible entry while utilizing tools and equip- each site. Measurements should be at least 15 seconds ment (e.g., axe, halligan tool, chain saw, circular saw, or apart to allow the skinfold site to return to normal. If rabbet tool) that requires chopping, pulling, or operating consecutive measurements vary by more than 1 mm, these items to open doors, windows, or other barriers to more should be taken until there is consistency. gain access to victims, possible victims, or to initiate fire- (8) Maintain the pressure with the thumb and forefinger fighting operations. throughout each measurement. (4) Performing ventilation (horizontal or vertical) utilizing (9) tools and equipment (e.g., axe, circular saw, chain saw, elevate a skinfold with parallel sides, particularly pike pole) while operating on a flat or pitched roof or operating off a ground or aerial ladder. This task requires pull the skinfold away while a partner attempts to meas- the fire fighter to chop or push tools through roofs, walls, ure the width. If the skinfold is too wide for the calipers, or windows. underwater weighing or another technique will have to
Other tasks that could be performed can include search and Measurements should not be taken when the skin is rescue operations and other emergency response actions under moist because there is a tendency to grasp extra skin, stressful conditions, including working in extremely hot and obtaining inaccurately large values. Also measurements cold environments for prolonged time periods. should not be taken immediately after exercise or when A.9.3.2 Possible accommodations include but are not limited the person being measured is overheated, because the to changes in assignment, provision of special devices to assist shift of body fluid to the skin will inflate normal skinfold the member in accommodating the medical disability, revision of standard operating procedures, and/or techniques.
It takes practice to be able to grasp the same amount of skinfold consistently at the same location every time. A.9.3.3 What this chapter does is provide guidance to fire Accuracy can be tested by having several technicians take department physicians for determining a member's ability to the same measurements and comparing results. It can medically and physically function using the individual medical take up to 20 to 50 practice sessions to become profi- assessment for the conditions listed in the chapter. cient. Calipers should be accurately calibrated and have A.9.4 Fire-fighting activities have a high static component (i.e., constant pressure of 10 g/mm? throughout the full inducing predominantly an increase in blood pressure) and a measurement range. The accuracy of skinfold measure- moderate to high dynamic component (i.e., inducing predomi- ments can be reduced by many factors, including meas- nantly an increase in heart rate). Sports with a similar set of urement at the wrong sites, inconsistencies among demands include wrestling, body building, and boxing. Recom- different calipers and testers, and the use of inconsistent mendations made by the task force with respect to athletic equations. However, when testers practice together and activities that have these physical demands (high static, moder- take care to standardize their testing procedures, incon- ate dynamic) have been followed in this document. among testers can usually be held under
1 percent. Performance of the aerobic and anaerobic critical job tasks in a stressful, noxious fire or rescue environment with low A.8.2.2.1 An appropriate target level should be to a predicted oxygen, high carbon monoxide, and numerous toxic gases has level of 12 METs or greater, which is necessary for firefighting significant risk for acutely aggravating pre-existing arrhythmias activities. and cardiac ischemia (oxygen delivery) and decreasing cardiac A.8.2.2.1.2 A prescribed aerobic program might be a consider- valve or muscle function (oxygen supply). To protect from this ation. environment requires that the fire fighter wear personal protective equipment (PPE) and SCBA. The PPE provides a 4 A.9.1.3(1) A member, while wearing full protective clothing thermal barrier at the cost of added weight, encapsulation, (turnout coat and pants, helmet, boots, and gloves) and SGBA dehydration, and increased metabolic cost for a given work- is required to safely perform a variety of fire-fighting tasks that load. The SCBA is a positive pressure demand valve respirator require upper body strength and aerobic capacity. For those that provides a barrier against the inhalation of noxious/toxic not familiar with fire suppression, the following specific details gases and particulate matter but at increased metabolic cost inherent to the activities in essential job task 1 are offered: due to its weight and increased respiratory workload.
Lifting and carrying tools and equipment (e.g., axe, halli- fighting activities have a high static component (i.e., inducing gan tool, pike pole, chain saw, circular saw, rabbet tool, predominantly an increase in blood pressure) and a moderate high-rise pack, and hose) that weigh between 7 Ib and to high dynamic component (i.e., inducing predominantly an 20 lb (3.2 kg and 9 kg) and are used in a chopping increase in heart rate). These factors increase physiologic stress motion over the head, extended in front of the body, or and cardiac demand and can precipitate acute cardiac collapse, in a push/pull motion. heart attack, syncope (blackout), or sudden death. (2) Advancing a 14 in. (45 mm) or a 2½ in. (65 mm) diame- absence of sudden death, the fact that the fire fighter was oper- ating in an isolated, dangerous environment when a cardiac event occurred would make the subsequent risk for such an addition to the weight of the hose itself, a 50 ft (15 m) event leading to death unacceptably high for that fire fighter, section of charged 1¾ in. (45 mm) hose contains approxi- for the civilian who depends upon that fire fighter, or for other mately 90 lb (41 kg) of water, and a 50 ft (15 m) section fire fighters who not only depend upon that fire fighter but can of 2½ in. (65 mm) hose holds approximately 130 lb also be called upon to rescue that fire fighter. (59 kg) of water.
Shaded text = Revisions. A = Text deletions and figure/table revisions. • = Section deletions. N= New material. 2018 Edition Copyngh: 2018 Netione: Fire Protection Ascociation (NEPA) Licensed, by egreement, for individual use and dewntead on 07/06/2010 to Billy Alcon: for designated user Willem, Swan No aner reproducton or transmission in any for permitted without artton permision of NFPAR. Forinquiries onto report unauthorzed use, contest kcersing@@aparg This NECES All Access subsorpion exoles on Decambar *# 2013 1582-60 COMPREHENSIVE OCCUPATIONAL MEDICAL PROGRAM FOR FIRE DEPARTMENTS N A.9.4.3.1 The criteria listed in 9.4.3.1(1) through 9.4.3.1 (6), (c) Blood creatinine measurement for nephropathy including annual radionuclide stress tests, should be re- (d) Tests for left ventricular hypertrophy (Use of the evaluated on an annual basis by the fire department physician. resting ECG to detect left ventricular hypertrophy is insensitive, e.g., 5 percent sensitivity, so echocardio- A.9.4.8.2(6) Those without any of the above risk factors have a gram is the currendy accepted test for diagnosing less than 1 percent risk of sudden death. left ventricular hypertrophy.) A.9.4.9.1 A first episode of syncope must be fully evaluated 1o (2) Chronic hypertension can damage the eye (retinopathy). determine that the underlying cause does not compromise a the kidneys (nephropathy), the vascular system (stroke, member's ability to safely perform job tasks. Underlying neuro- TIA, or PAD), or the heart (left ventricular hypertrophy logic, cardiovascular, circulatory, and/or endocrine disturb- and heart failure). These hypertension complications are ance must be ruled out. If after evaluation there is no evidence known as end organ damage. The cardiac and vascular for underlying disease, exam is normal, and there has been no complications are associated with an increased risk of reoccurrence, then the member need not be restricted from sudden incapacitation and sudden cardiac death (Koren performing job tasks. If underlying disease is present and not el al. 1991), With proper evaluation, lifestyle modifica- reversible, then the member's ability to safely perform essential tion, and/or treatment, these complications can be avoi- job tasks 1, 4, 5, 7, 8, 9, and 13 is compromised due to risk for ded. Lifestyle modification includes weight reduction, life-threatening sudden incapacitation. (For additional recommen- dietary plan, reduction in dietary sodium, an increase in dations, see section relevant to the underlying disease.) If recurrent aerobic physical activity, and moderation in alcohol and no underlying disease, then the member's ability to safely consumption [Chobanian 20031 01 perform essential job tasks 1, 4, 5, 7, 8, 9, and 13 might be Because of the high risk of a sudden cardiovascular events compromised. (e.g., due to undiagnosed cardiac disease), members with stage 2 hypertension should be restricted until their
A.9.4.10.1 This technology has not been FDA approved for blood pressure can be brought under control. Once their operating effectively under conditions commonly found on the blood pressure is brought under control, end stage organ fire ground (electromagnetic interference). In addition, complications should be regularly evaluated as described requirement for pacemaker implantable defibrillator in A.9.4.20.1.1(2). The frequency of such evaluation is defines the underlying cardiac condition as life-threatening. based on the severity and duration of their elevated blood Many pacemakers do not have the ability to automatically increase heart rate upon demand during the critical job tasks performed on the fire ground. A A.9.4.21.1 Metabolic syndrome includes three or more of the following components:
A.9.4.16.1 Evaluation with ECG, Holter monitor, and/or stress (1) Abdominal obesity, defined as a waist circumference test should be further supplemented with electrophysiologic >102 cm (>40 in.) in men or >88 cm (>35 in.) in women
study (EPS). If rapid supraventricular tachycardia is inducible and surgical ablation is successful, there is no medical reason (2) Triglycerides >150 mg/dl (3) HDL cholesterol <40 mg/dl for men, <50 mg/dl for
to restrict the member from performing essential job task 13. women
A.9.4.17.1 Even if rate controlled (with or without medica- (4) Blood pressure >135/85 mmHg the added catecholamine stress and dehydration (5) Fasting blood glucose >110 mg/di produced when performing critical job tasks on the fire Members with metabolic syndrome should receive a cardiac ground makes the potential for life-threatening sudden incapa- stress. Members should be counseled as to lifestyle adjustments, citation associated with this rhythm disturbance too great a risk. If persistent or recurrent, these arrhythmias, even if rate receive an exercise prescription, and be referred to their personal physician for treatment of their elevated cholesterol, controlled, can result in embolic events, which prevent the triglycerides, insulin resistant hyperglycemia, and/or hyperten- successful and safe performance of critical job tasks on the fire ground or during emergency responses.
A A.9.4.20.1.1 Members with prehypertension (systolic 120- N A.9.4.23.2 Obesity is independently predictive of cardiac 139 mmHg or diastolic 80-89 mmHg), Stage 1 hypertension hypertrophy. (systolic 140-159 mmHg or diastolic 90-99 mmHg), or stage 2 A.9.6 All disorders of the hypothalamic-pituitary-adrenal axis hypertension (systolic 160 mmHg or greater or diastolic can potentially affect fire fighters because these hormonal 100 mmHg or greater) should be referred to their primary care systems play an essential role in maintaining homeostasis when physician for valuation, lifestyle modification, and/or treat- exposed to physiologic and emotional stress while performing ment. critical tasks on the fire ground or during emergency opera- (1) Members with stage I hypertension whose BP returns to tions. Homeostatic regulation is further impaired under condi- either prehypertension or normal with lifestyle modifica- tions of extreme temperature and dehydration, both of which tion can return to an annual medical evaluation. For are common when performing the critical tasks of fire fighting members with long-standing stage I hypertension whose while wearing personal protective clothing on the fire ground.
BP has not been reduced, additional evaluation for possi- Without treatment, the risk of life-threatening dehydration, ble end organ damage should be considered, including extreme alterations in body temperature, electrolyte disturban- any or all of the following: ces, and muscle weakness while operating at a fire scene is (a) Complete patient history for symptoms of heart fail- unacceptably high. Mineralocorticoid deficiency also increases ure (e.g., shortness of breath upon exertion) or the risk of life-threatening hypotension and/or arrhythmias transient ischemic attacks (TIAs) associated with exertion and dehydration. For this reason, (b) Dilated eye examination for retinopathy untreated or uncorrected hypothalamic, hypopituitarism, 2018 Edition Shaded text = Revisions. A = Text deletions and figure/table revisions. • = Section deletions. N= New material.
Copyrigh! 2019 National Fire Protection Association (NFDA) Licensed. by egreement, for incidual use and download on 07/06/2019 15 Billy Alcon for designated user William Swan No oner reproducton or transmission in any lore commited without wetter pennission of NEPAL Foringuiries onto teport unauthenzed use. Comect licensing @nipe worg This NECES All Acoses subscation expires on Docerb-or 19. 2013.
ANNEX A 1582-61
hypothyroidism, hyperthyroidism, thyroid storm, hypoadrenal- drugs have a risk of severe hypoglycemia less than 1 percent of the risk associated with insulin treatment. Members treated with diet and exercise alone (no oral diabetes medications or safely perform essential job tasks. insulin) are at no risk of hypoglycemia.
A.9.6.3.1 Type 1 diabetes was previously called Fire fighting entails a unique set of conditions that need to dependent diabetes mellitus (IDDM) or juvenile-onset diabe- be considered in regard to those with diabetes and the risks of tes. Type 1 diabetes develops when the body's immune system hypoglycemia. Unpredictable meal schedules, periods of physi- destroys pancreatic beta cells, the only cells in the body that cal exertion, adrenergic stimulation, and sleep deprivation all make the hormone insulin, which regulates blood glucose. This present challenges to fire fighters with diabetes. form of diabetes usually strikes children and young adults, occasions when there is no safe access to food or other forms of although disease onset can occur at any age. Type 1 diabetes oral glucose while wearing respiratory protection in a hazard- can account for 5 percent to 10 percent of all diagnosed cases ous environment, and the typical symptoms of hypoglycemia of diabetes. In order to survive, people with Type 1 diabetes might not be recognized as easily in the midst of fighting a fire. must have insulin delivered by a pump or injections. As well, it is not always possible to exit a hazard zone rapidly enough to treat hypoglycemic symptoms when detected.
Type 2 diabetes was previously called non-insulin-dependent Members engaged in fire suppression are at greater risk than diabetes mellitus (NIDDM) or adult-onset
those engaged in other emergency activities (EMS, law enforce- diabetes can account for about 90 percent to 95 percent of all diagnosed cases of diabetes. It usually begins as insulin resist- ance, a disorder in which the cells do not use insulin properly. A review of current published data suggests that with careful As the need for insulin rises, the pancreas gradually loses its individualized assessment it is possible to identify those with ability to produce insulin. Type 2 diabetes is associated with diabetes who can function fully as fire fighters and who do not older age, obesity, family history of diabetes, prior history of present a significant risk to themselves, their fellow fire fight- gestational diabetes, impaired glucose tolerance, physical inac- ers, or to those they serve. tivity, and race/ethnicity. Type 2 diabetes is increasingly being diagnosed in children and adolescents. Many people with Type The individualized assessment process and criteria included 2 diabetes can control their blood glucose by following a care- in this standard were set up to assure that only those who are ful diet and exercise program, losing excess weight, and taking managing their diabetes conscientiously using the most up-to- oral medication. Among adults with diagnosed diabetes, about date approaches would be eligible to be a fire fighter. In addi- 12 percent take both insulin and oral medications, 19 percent tion, certain patients have a greater tendency for significant take insulin only, 53 percent take oral medications only, and hypoglycemia despite the quality of their diabetes manage- 15 percent do not take either insulin or oral medications. ment. Such individuals would not be good candidates to be fire fighters and, accordingly, are excluded from service under the Diabetic members should be carefully monitored for control criteria in this standard. of blood sugar because lack of glycemic control increases the This individualized assessment is possible in large part risk for dehydration, hypotension, and target organ damage (e.g., myocardial infarction), which that can result in life- because a great deal of change has occurred in the treatment threatening sudden incapacitation during performance of criti- of diabetes in recent years. Previously, patients used insulins cal job tasks. Such members should be monitored at regular that were somewhat unpredictable in the time course of their intervals to ascertain that blood glucose and blood hemoglobin action and generally took two injections per day. Today, there AlC levels remain under control. According to the American are insulins that are far more predictable and are either very Diabetes Association 2010 guidelines, lowering hemoglobin long. acting and essentially treat only endogenous glucose AlC to below or around 7 percent has been shown to reduce production (and therefore do not depend on a patient eating microvascular and neuropathic complications of type 1 and on a regular schedule) or are very rapid and therefore can be type II diabetes. The recommendation for microvascular administered directly before, during, or even shortly after one disease prevention in nonpregnant adults in general is for a cats, significantly decreasing the chance of insulin being taken hemoglobin AlC level of less than 7 percent. Exceptions to this and then the meal being interrupted due to fire fighting duties.
7 percent level would be any condition that exists in addition to diabetes that is responsible for the hemoglobin AlC not accu- Regimens now referred to as "basal bolus" are composed of a rately reflecting average glucose levels (e.g., hemoglobinopa- very long acting basal (or background) insulin, which controls thies such as sickle cell disease). Additional exceptions to this 7 glucose levels overnight and in the absence of glucose intake level would occur in individuals already not meeting and rapid-acting (bolus) insulins that are dosed just prior to.
NFPA 1582 requirements (e.g., history of severe hypoglycemia luring, or even after meals based on blood glucose levels at or end organ complications). See reference in F.2.3. that time, the amount of carbohydrate that the person expects With medical control of diabetes, the risk of hypoglycemia to consume, and any anticipated change in physical activity patterns over the next number of hours.
(low blood sugar) becomes a major concern in regard to those with diabetes being or becoming fire fighters. This risk is great- These regimens have resulted in improved overall blood est in those with Type 1 diabetes. glucose control with significantly less risk of hypoglycemia for In general, members treated with oral diabetes medications many patients. are at little risk of significant hypoglycemia. Members treated Additional major advances in the size, speed, and sophistica- with metformin, alpha-glucosidase inhibitors, or thiazolidine- tion of blood glucose meters provide for easy, accurate, and diones alone or in combination with each other are at no risk rapid assessment of blood glucose levels. Such monitoring tech- of hypoglycemia, as these classes of drugs do not increase insu- niques, as well as the generally increased self-awareness that lin levels. Members treated with sulfonylureas and related Shaded text = Revisions. A = Text deletions and figure/table revisions. • = Section deletions. N = New material. 2018 Edition Copyrgly 2049 Natore: Fire Prelecton Aseociation (NFPALicensed, Py aglement, for individual use and domined on on to Billy Alcom for designated user Willian Swan, No one: eproduction er Inansnission in any om permitted without writer permission of NEP4 ornatines orto report unaulenzed use. comact licensing@@nipa.org This NOSE Al Access Bubscripro: exotes on Gecember 19 2013 1582-62 COMPREHENSIVE OCCUPATIONAL MEDICAL PROGRAM FOR FIRE DEPARTMENTS asthma is a chronic condition with a clinical history of recur- rent reversible bronchospasm or longstanding, persistent rever- sible bronchospasm. For asthmatics, exposure to smoke
ous environment. Similarly, major advances in insulin delivery other irritants on the fire ground or a hazardous materials envi- systems have greatly increased the ability of the motivated indi- ronment has a high probability of causing acute asthma attacks with diabetes to achieve a level of diabetes self- and can also worsen the progression of the underlying obstruc- management consistent with the duties of fire fighting. tive inflammatory disease. If this occurs in an environment that is immediately dangerous to life and health (e.g., interior fire In order to get maximum effect from these medical advan- suppression or certain hazardous materials operations), it can ces, and to minimize the risk of hypoglycemia, members with have potentially devastating consequences for the member, the diabetes must check their blood glucose level frequently (as team, or the mission. There are no studies that support or deny recommended based on factors such as type of therapy and this environment can be prevented glycemic history), review these results on a regular basis, and anti-inflammatory medications see their diabetes care provider regularly for discussion in (inhaled corticosteroids, cromolyn, leukotriene modifiers). It is regard to any necessary changes in treatment. Member evalua- not acceptable to use or rely on bronchodilator medications tion needs to look for any of the known risk factors for serious for this purpose because in a hazardous environment, SCBA hypoglycemia or evidence of any of the known microvascular cannot be removed to use a rescue inhaler. There are no stud- (eye disease, kidney disease, or nerve disease) or macrovascular ies that support or deny that the use of such medications is (cardiovascular disease, peripheral arterial disease) complica- preventive or effective in a fire/smoke environment, and tions of diabetes. A 12 MET stress test is required because several studies have implicated the use of beta-agonists (short- myocardial infarction remains the major cause of line-of-duty and long-acting bronchodilators) as an independent risk for fatalities, and diabetes (Type 1 and Type 2) is not only a risk sudden death and myocardial infarction in the United States, factor for myocardial ischemia but also for silent myocardial Canada, Britain, New Zealand, and Australia.
Identifying asthmatics who are not only stable in a normal The individualized assessment just described demands a very environment but also do not have asthmatic attacks in a fire or close and good working relationship between the member and irritant environment is difficult. Because the clinical definition the diabetes care provider. The experience of those who care of asthma is reversible bronchospasm, spirometry or pulmo- for current fire fighters with diabetes is that this works for a nary function testing performed in the absence of a clinical highly motivated member who will do whatever it takes to attack is expected to be normal and might not even show a perform his/her job at a high level and in a safe manner. bronchodilator response. Only if performed during an attack A.9.6.4.1 See A.9.6.3.1. will spirometry or other pulmonary function tests show obstruc- tive airway flow limitations with a positive bronchodilator A.9.7 Theoretically, respiratory protection from this environ- response (greater than 12 percent and 200 mL increase in ment is afforded by SCBA use. Experience shows that SCBA are FEV,). Therefore, in these fire fighters who report good frequently taken off to improve visibility and that SCBA air control without asthma exacerbations on the fire ground, supply is often insufficient to last for the entire fire operation spirometry should show adequate reserve (FVC and FEV, (ingress, suppression, overhaul, and egress). Thus, perform- greater than or equal to 90 percent predicted), without signifi- ance of essential job tasks is regularly done for short time peri- cant bronchodilator response when performed off bronchodi- ods in a noxious fire or hazardous materials environment with lators on the day of testing. For population studies, pulmonary function is considered normal when greater than or equal to Working in this environment has added potential for increas- 80 percent predicted, but for an individual with a history of ing carbon monoxide levels, decreasing oxygen levels, and asthmatic bronchospasm who is being considered for job tasks BAE reducing oxygen delivery, and the extent of this reduction and performed in a potentially irritant environment, it is reasona- resulting risk is directly related to the degree of dysfunctional ble diligence to require pulmonary function with a greater gas exchange already present prior to the performance of these specificity for demonstrating adequate reserve (greater than or essential job tasks. It also has potential for acutely aggravating equal to 90 percent predicied). The first time this member is pre-existing airway hyperreactivity commonly found in patients being evaluated for asthma control, challenge testing should be with asthma and other obstructive pulmonary conditions performed to demonstrate no evidence for clinically significant (bronchitis, etc.). Acute hyperreactivity in this environment is airway hyperreactivity [i.e., to be normal or negative there likely to induce immediate clinical asthma (bronchospasm and should be less than 20 percent decline in FEV, with provocative wheeze) with a significant increased work of breathing and gas challenge testing to cold air, exercise (12 METs), or a metha- exchange abnormalities. Respiratory insufficiency, no matter choline (PCo greater than 8 is considered normal, as response the cause, has the potential for arrhythmias, cardiac ischemia at dose greater than 8 mg might not be clinically significant)]. (oxygen delivery), decreased respiratory and cardiac function Challenge testing should be performed off bronchodilators the (oxygen delivery to tissues), acidosis, and life-threatening day of testing. If the member reports good control only when sudden incapacitation. taking prescribed control medications (inhaled corticosteroids, A.9.7.6 Asthma, defined as reversible bronchospasm, can be cromolyn, or leukotriene modifiers), then consideration "Temporary asthma," should be given to continuing these medications during the referred to as acute bronchitis with wheezing, is a brief episode testing. The member should not use bronchodilators (short-or lasting days to months, usually following allergic or infectious long-acting bronchodilators) the day of testing because these medications could undermine the purpose of this test - that exposure. When this occurs without prior history, it most likely will resolve over the next few weeks or months. Such temporary is, demonstrating normal pulmonary function without clinically incidents, once resolved, do not compromise the member's significant bronchodilator response or airway hyperreactivity. ability to safely perform essential job tasks. In contrast, true Challenge testing should be performed only by an experienced 2018 Edition Shaded text = Revisions. 4 = Text deletions and figure/table revisions. • = Section deletions. iN = New material.
Copyright 2010 Notional Fire Protecton Association (NEPAR). censed by agreement need use and commitas on on to Billy Acorn for designated user Millem Swan Me other reproduction on transmission in any tomi parmitted without witten permissior cE NEPAD Foringunes orto report unawhenized use comest lensing@nipe ores Tos NEOSS All Accose suescapton expres on December 15 2019 ANNEX A 1582-63
specialist. Testing should not be performed in members with- tis, etc.). Acute hyperreactivity in this environment can induce out a history suggestive of asthma, since there is no indication immediate or progressive clinical asthma (bronchospasm and for testing. It should never be performed in members with that can lead to sudden incapacitation moderate to severe pulmonary dysfunction, as these members asthmaticus and/or cardiac ischemia. In contrast, asympto have already demonstrated that they cannot safely perform matic members with mild chronic obstructive essential job tasks, and further testing might induce life- disease (an absolute FEV,/FVC equal to or less than 0.70 and threatening bronchospasm. Challenge testing should not be an FEV, above 70 percent predicted) and without airway hyper- performed annually and should be repeated only if clinically reactivity might be able to safely perform essential job tasks.
However, if members with mild chronic obstructive pulmonary A A.9.7.6.1(6) If the member reports good control only when disease are symptomatic, especially during exercise or on the taking prescribed control anti-inflammatory medications (e.g., fire ground, then appropriate additional testing can be useful, inhaled corticosteroids or cromolyn or oral leukotriene modifi- including pre- and post-spirometry, lung volumes, gas exchange ers), then consideration should be given to continuing these parameters (diffusing capacity, oxygen saturation, arterial medications during the testing. The member should not use gases), exercise testing, and/or provocative challenge bronchodilators (short- or long-acting bronchodilators) the day because these medications can undermine the A.9.7.14 Members who are otherwise qualified can purpose of the test, that is, to demonstrate normal pulmonary resume fire-fighting duties as long as they have recovered from function without clinically significant bronchodilator response their pneumothorax (with or without surgery) and their or airway hyperreactivity. Provocative challenge testing should pulmonary function has returned to acceptable limits. Most be performed the first time the member is evaluated for patients with spontaneous pneumothorax have cysts or bullous asthma and only if all the provisions in 9.7.6.1(1) through disease from congenital or infectious etiology. Some have
9.7.6.1(7) indicate that the member's asthma is under accepta- bullous disease due to chronic pulmonary disease. Usually, ble control. Provocative challenge testing is not required annu- those with congenital or infectious cause will have pulmonary ally and should be repeated only if clinically indicated. function tests that are compatible with the safe use of SCBA A.9.7.7 A member with current or recent history of allergic- while those with chronic pulmonary disease can have pulmo induced, reversible bronchospasm is no different from a non- nary function tests that are not compatible with the safe allergic asthmatic in his/her ability to safely perform the performance of essential job tasks 1, 2, 3, 4, 5, and 7. Regard- essential job tasks associated with non-allergic irritant expo less of cause, many (10 percent to 20 percent) will have a recur- sures, as the majority will remain hyperreactive for 4 to 8 weeks rence on the same side unless surgically corrected. After the after allergic-induced bronchospasm. Two caveats exist. First, pneumothorax has resolved, surgical correction of underlying some members could have a distant history of allergic asthma, cystic/bullous disease is not a prerequisite for returning to fire- fighting duty as long as pulmonary function allows for the safe are unlikely to be exposed to this allergen again, or have successfully been desensitized by an allergist. These members, if asymptomatic off asthma medications for 2 months, A.9.7.16 Significant pleural effusions should be referred for perform all essential job tasks with reasonable safety. If asthma diagnostic tests, as new or increasing effusions can be a sign of is still suspected then the member should be evaluated as in cardiac, liver, or renal disease, pneumonia, empyema, tubercu-
9.7.6. Provocative challenge testing should only be to general losis, or cancer. When these illnesses are severe enough to irritants (e.g., cold air, exercise, or methacholine). Specific cause pleural effusions, they compromise the ability to safely allergen challenge testing should not be performed, as the risk perform essential job tasks due to limitations of endurance or for life-threatening asthma outweighs the benefit. Second, inability to safely wear SCBA. If not the illnesses causing pleural members can have allergic rhinitis, sinus or skin conditions effusions, then pulmonary function tests should be assessed. without a history, or suspicion of clinical asthma. These Moderate to severe restriction (FVC less than 60 percent of members do not need specialized pulmonary testing. predicted with an absolute FEV/FVC ratio greater than or A.9.7.8 Moderate to severe chronic obstructive pulmonary equal to 0.90) compromises the member's ability to safely disease is characterized by an FEV,/FVC ratio of 0.45 to 0.59 perform essential job tasks unless a more complete evaluation of gas exchange and exercise capacity shows the ability to exer- (absolute ratio rather than percent of predicted) and severe chronic obstructive pulmonary disease by an absolute cise at a workload of 12 METs without evidence of hypoxia or exercise desaturation.
FEV,/FVC ratio equal to or less than 0.07 and an FEV, less than
0.70 percent predicted. Additional tests that can be of value are A.9.8.9 After acute infection has resolved, the fire fighter can lung volumes, gas exchange parameters (diffusing capacity, return to work if weight, muscle strength, cardiac function, and oxygen saturation, arterial blood gases), chest radiograph, and function of other involved organs have returned to levels chest CT scan. With moderate to severe chronic obstructive required for safe performance of essential job tasks. Concepts pulmonary disease, elevated respiratory workload and lack of used within this document for each of these organ systems respiratory reserve will not provide adequate gas exchange for should be applied here. the safe performance of essential job tasks. Working in this environment has the potential for increasing carbon monoxide A.9.8.10 After active infection has resolved (e.g., sputum AFB levels, decreasing oxygen levels, and reducing oxygen delivery, or sputum culture negative for 3 successive days) and the fire and the extent of this reduction and resulting risk is directly fighter is no longer contagious (usually within 2 weeks of related to the degree of dysfunctional gas exchange already successful treatment), the fire fighter can return to work but present prior to the performance of essential job tasks. It also perform only essential job tasks 1, 2, 3, 4, 5, 7, and 9 if weight, has the likely potential for acutely aggravating pre-existing muscle strength, pulmonary function, and function of other airway hyperreactivity commonly found in patients with moder- involved organs have returned to acceptable levels for safe ate to severe chronic obstructive pulmonary diseases (bronchi- performance. Concepts used within this document for each of Shaded text = Revisions. 4 = Text deletions and figure/table revisions. • = Section deletions. N = New material. 2018 Edition Copyngh: 2010 Natienai Fire Protecton Assocaton (FPAN Licensed. by agreement, for individual use and Conned on 07/06/2019 to Pilv Aicom for denignated user Willan: Swen No other reproductien or transmission in ary form permited without watter permission Of NEPAO Foringuiries orto report unattended use, confect hensinge rips dig This NEOSS AR Acesa superiotion Capires on December 19 2019 1582-64 COMPREHENSIVE OCCUPATIONAL MEDICAL, PROGRAM FOR FIRE DEPARTMENTS these organ systems should be applied here. A positive tubercu- A.9.10 Fire fighters with active, ongoing, or recurrent ortho- lin (PPD) skin test or a positive tuberculin blood test without pedic disorders can have difficulty due to reduced motor symptoms and with a normal chest radiograph indicates expo- strength, sensation, and flexibility as well as problems with fati- sure, and latent infection without evidence for active infection gue, coordination, gait, and equilibrium. These physical abili- does not prevent a fire fighter from performing essential job ties are required to safely perform essential job tasks 1, 2, 4, 5, tasks. Alternatively, a positive TB skin test (PPD) can be a false- 6, 7, 8, and 13. The protective uniform and SCBA can place the positive from exposure to atypical mycobacterium or from fire fighter's involved extremity (upper or lower) at a biomc- prior BCG vaccination. The TB blood test does not produce chanical disadvantage due to added weight and altered center these false positives, but experience with false negatives is limi- of gravity. Certain medications (narcotics and muscle relax- ted [Mortality and Morbidity Weekly Review, December 16, 2005]. ants) used to treat orthopedic conditions can produce or If conversion from negative to positive tuberculin test (PPD or worsen somnolence, discoordination, and disequilibrium. blood test) occurred within the last 2 years, there is increased A.9.12.1 The fire fighter works in hazardous environments, risk for the development of active contagious tuberculosis, which requires either treatment or frequent monitoring for both on the fire ground and during other emergency opera- symptoms and chest radiograph changes (annually for at least 2 tions. Heavy debris can fall on the fire fighter. The helmet offers some protection when it fits well and is worn properly. years or during evaluation of current symptoms). Members on The fire fighter with a defect in the skull is more vulnerable to prophylactic treatment can perform all essential job tasks with- head trauma and life-threatening sudden incapacitation. The out restrictions. Treatment is a personal decision, but in its fire fighter is also exposed to biological aerosols, particulates, absence, monitoring with chest radiographs at prescribed inter- smoke, and hazardous materials. Defects in the structure of the vals is mandatory because development of active disease is a public health hazard to other members and the public. face, nose, mouth, or throat can prevent acceptable fit testing of a respirator (N-95, P-100, or SCBA).
A.9.8.11 Hepatitis, when not acute or when chronic but with- out symptoms and without significant liver dysfunction or other A.9.12.3.1 Diseases of the eye such as retinal detachment, organ system dysfunction, does not prevent the successful and progressive retinopathy, optic neuritis (severe or progressive), safe performance of essential job tasks during fire fighting or macular degeneration, cataracts, and glaucoma can result in EMS work. Hepatitis A, when not acute, is no longer a public the failure to read placards and street signs or to see and to imminently hazardous situations. Evaluation of
health risk. Hepatitis B, C, and so forth, are bloodborne patho- visual acuity and visual fields with consultation by an ophthal- gens and are not a public health risk, as standard precautions to prevent the spread of bloodborne infections are a manda- mologist is suggested. tory part of all emergency operations. Treatment to prevent Ophthalmological procedures such as radial keratotomy and Hepatitis C from progressing to liver insufficiency or failure repair of retinal detachment require sufficient time (approxi- (cirrhosis) is now available and FDA approved. Members receiv- mately 2 weeks for radial keratotomy and Lasik-type surgery ing this treatment need to be regularly evaluated to determine and 3 months for retinal detachment) to allow stabilization of their ability to safely perform their essential job tasks. This visual acuity and to ensure that there are no post-surgical combination drug therapy protocol can produce dehydration, complications. Members should be cleared for duty by the anemia, thrombocytopenia (bleeding ophthalmologic surgeon who understands the essential job tasks associated with fire fighting. These ophthalmological A.9.8.12 HIV without AIDS does not prevent the successful procedures can result in the failure to be able to read placards and safe performance of essential job tasks during fire fighting and street signs or to see and respond to imminently hazardous situations.
or EMS work. HIV is a bloodborne pathogen and is not a
public health risk, as standard precautions to prevent the The fire service physician should also consider any color spread of bloodborne infections are a mandatory part of all vision deficiency of the member in view of the color vision emergency operations. The fire fighter with AIDS but without requirements of the member's specific job in a given fire significant organ dysfunction is able to safely perform essential department. job tasks after careful evaluation. Treatment to prevent AIDS from occurring when HIV infection occurs or to control the A.9.12.3.1(1) Far visual acuity is at least 20/40 binocular, progression of AIDS is available and FDA approved. Members corrected with contact lens or spectacles. Far visual acuity receiving this treatment need to be regularly evaluated to uncorrected is at least 20/100 binocular for wearers of hard determine their ability to safely perform the essential job tasks contacts or spectacles. Successful long-term soft contact lens on the fire ground, during emergency operations, and when wearers (i.e., 6 months without a problem) are not subject to wearing protective clothing. This combination drug therapy the uncorrected standard. Inadequate far visual acuity can produce dehydration, result in the failure to be able to read placards and street signs anemia, thrombocytopenia (bleeding disorder), and so forth. or to see and respond to imminently hazardous situations Successful soft contact lens wearers are not subject to the A.9.9 The personal protective ensemble and SCBA can place uncorrected standard. the fire fighter's spine at a biomechanical disadvantage due to added weight and altered center of gravity. Certain medications A.9.12.3.1(3) Most persons with monocular vision, after a (narcotics and muscle relaxants) used to treat spinal conditions 6 month accommodation period, are able to function well. can frequently produce or worsen somnolence, discoordina- There is some loss of depth perception and peripheral vision. tion, and disequilibrium. Neurologic dysfunction, regardless of The loss of depth perception has not been shown to be of a cause, can produce sudden incapacitation, which when work- type that will affect a member's ability to safely perform essen- ing in dangerous environments can result in life-threatening tial fire-fighting tasks. Some very specialized tasks can be diffi- injuries. cult to safely perform, and the fire service physician should consider the depth of field deficiency of the individual and 2018 Edition Shaded text = Revisions. A = Text deletions and figure/table revisions. • = Section deletions. N= New material.
Copyright 2019 Natena Fire Protecton Association NFPAO Licensed, By agreement, for individual use and downicad on 07/05/2010 to Silly Alcom for designated user William Swan. No other reproduction or transmission in any feat permee winous criten permission of NEPAM, Foringaines cato report unauthonzed use, comact scensing @impo org Tens NECES All Access subscrotion expires on Docembor 19. 2019.
ANNEX A 1582-65
consider the depth of field requirements of the member's job A.9.12.5.1 Intact gait and balance are required to safely in order to reach an individual determination. It should be perform critical tasks such as climbing stairs, carrying heavy noted that the FAA will award all classes of pilor's licenses to items (tools, equipment, victims, stretchers), climbing ladders, monocular pilots. The loss of peripheral vision is compensated and walking on narrow/elevated/inclined areas (roofs). A fire for by increased scanning and head movements. There are fighter's balance can be further stressed by the need to safely studies that show some detriment of driving function in the perform these critical job tasks wearing personal protective driving lab. As of the writing of this section the DOT does not clothing and SCBA. allow monocular persons to hold a commercial driver's license.
In view of this and the increased dependence on visual cues Any symptomatic balance disturbance, vertigo, change of when driving emergency vehicles, monocular fire fighters gait and coordination, or history of these that has not resolved should be restricted from driving fire apparatus and other completely should be fully investigated. Examples include but are not limited to Ménière's syndrome, severe labyrinthitis, and emergency vehicles.
cerebellar syndromes. Current use of medications needs care- A A.9.12.4.1 Audiometric pure tone threshold testing includes ful evaluation to be certain that the condition is completely the frequencies 500 Hz, 1000 Hz, 2000 Hz, 3000 Hz, 4000 Hz, controlled and that the side effects of the medication do not and 6000 Hz. Tests are performed using audiometric instru- impose additional unacceptable risks for the successful and safe mentation calibrated to ANSI S3.6, Specification for Audiometers. performance of critical job tasks.
Fire fighters should have adequate hearing to hear a victim A.9.12.6.1 The face, nasal, oropharyngeal, and dental struc- cry for help, to hear a PASS alarm, to hear noises associated tures should be of sufficient structure and function to allow the with imminent collapse, or to hear noise associated with proper use and fitting of required respiratory protection (N-95, changes in the fire pattern. Hearing and the ability to localize P-100, SCBA) and other protective clothing and gear. These sounds is crucial in a fire-fighting environment where smoke structures should allow sufficient function for proper nutrition, often minimizes visual cues, and there is a high degree of back- balance, communication, and respiration. Aphonia, severe ground noise and stress-related distractions. Fire fighters dysphonia, or a speech pattern that prevents oral communica- should be able to hear fire department portable and vehicle tion during fire or emergency operations should resolve or be radio communications. They should be able to hear, discrimi- corrected. nate, and localize safety-related acoustic cues such as air horns, Anosmia (loss of smell) can interfere with the ability to safely perform critical tasks on the fire ground. Evaluation of anos- and fire rescue. mia is difficult, as objective testing is not available in most medical settings.
These critical job tasks need to be safely performed under conditions of extreme background noise and SCBA noise as Recurrent sinusitis (severe, requiring repeated hospitaliza- typically found at the incident scene. The inability to hear tions or repeat surgery) can interfere with the successful and sounds of low intensity or to distinguish voice from background safe performance of critical tasks due to inability to effectively noise can lead to failure to respond to imminently hazardous wear SCBA and inability to safely perform other critical tasks situations and thus lead to life-threatening sudden incapacita- during emergency operations due to limitations of pain, endur- tion to the member or others depending on the member. ance, or respiration.
NA.9.12.4.2 There are several reasons that the use of hearing Severe and recurrent epistaxis can prevent successful and safe performance of critical tasks due to inability to wear SCBA assistive devices might not be appropriate for the hearing impaired member, including the following: on the fire ground.
Hearing assistive devices do not restore normal hearing. Orthodontic and certain other maxillofacial appliances or Hearing assistive devices cannot compensate for asymmet- prostheses can preclude safe and effective use of protective rical hearing loss, and thus will not totally resolve the equipment and compromise nutritional or hydration status or difficulty in sound localization of those with asymmetric ability to communicate. hearing loss. Pharyngeal or laryngeal stenosis, mass, or accessory tissues (3) Hearing assistive devices will improve hearing in noise can interfere with speech, communication, or respiration, (e.g., fire scene, rescue scene, traffic), but this noise will which will not permit the successful and safe performance of always be the most challenging environment critical tasks on the fire ground and during emergency opera- hearing-impaired member. tions, especially when wearing SCBA and personal protective (4) It is unknown if hearing assistive devices will continue to function normally when exposed to the heat, moisture,
and smoke of the fire scene. A.9.12.6.2 Untreated obstructive sleep apnea is associated with fatigue, cognitive defects, pulmonary hypertension, hypertro Understanding the above limitations, hearing assistive devi- phic heart disease, arrhythmias, and early onset dementia. ces will improve a hearing-impaired member's hearing func- These issues can reduce the ability to perform all essential job tioning. Thus, it is the consensus of the technical committee tasks. Risk factors for developing obstructive sleep apnea that members should be allowed to use hearing assistive devices include male gender, increased body mass index (BMI), short/ if their unaided average hearing loss in the unaided better ear wide neck, and/or narrow throat. Screening questionnaires, is better than 40 decibels (dB) at 500 Hz, 1000 Hz, 2000 Hz, as the Berlin Questionnaire (assessing snoring, fatigue, and 3000 Hz. If the device fails, the member will still have suffi- obesity and hypertension) can be used to determine those who cient hearing acuity to meet 9.12.4.2, the minimum hearing require formal sleep testing. In those with obstructive sleep apnea, additional testing is required to determine the level of positive pressure (CPAP or BIPAP) required to overcome the Shaded text = Revisions. A = Text deletions and figure/ table revisions. • = Section deletions. N= New material. 2018 Edition Copynch: 2019 Natera: Sue Profection Association (NFPA, Licensed by agreement, for individual use and downtoad on 07/06/2019 to Billy Acorn for designated user Wam Swan No piner reproduction or transmission in any for perilted wahout walter parmission of NEPA Forquiries orto report unauthented use. contact licensingenina org TiS NEORS AR Accosa Sunsciencr expres on December 19 2012. 1582-66 COMPREHENSIVE OCCUPATIONAL MEDICAL PROGRAM FOR FIRE DEPARTMENTS obstruction. Compliance with treatment can be assessed using active and likelihood for exacerbation and life-threatening home monitoring devices attached to the CPAP or BIPAP sudden incapacitation exists during emergency operations. machine. Target organ damage can be screened for by cardiac echo for evidence of pulmonary hypertension or right ventricu- A.9.13.6.1 Epilepsy is defined as the presence of "unprovoked, recurrent seizures — paroxysmal disorders of the central nerv- lar hypertrophy: ous system characterized by an abnormal cerebral neuronal A.9.13 Fire fighters with active, ongoing, or recurrent neuro- discharge with or without loss of consciousness." Generalized, logic disorders can have difficulty following orders, communi- complex, partial, simple epilepsy, or recurrent seizures, even cating information, and working in a coordinated manner with those that do not impair consciousness, prevent safe perform- workers, victims, and involved civilians (essential job tasks 11, ance of essential job tasks 1, 3, 4, 5, 6, 7, 8, 9, 10, I1, 12, and 13 12, and 13). Fire fighters with neurologic disturbances can also because of the uncertainty regarding how much of the brain have difficulty with fatigue, somnolence, cognitive function, could be involved and the risk of propagation to other regions motor strength, sensation, coordination, gait, and equilibrium, of the brain, particularly in the highly epileptogenic environ- all required to safely perform essential job tasks. The fire fighter often is exposed to considerable stress (temperature, physical exertion, and psychological during emergency opera- Treatment of patients with epilepsy is only variably success- tions. Stress conditions can exacerbate or highlight neurologic ful, with roughly 40 percent of patients attaining remission on deficiencies when the fire fighter is performing essential job anticonvulsant therapy. Remission is defined as 5 years without recurrence of seizure activity. Further complicating the fitness- tasks rapidly during an emergency operation where there is for-duty issue is the fact that only 50 percent of patients who little room for error and where such errors can have life- threatening consequences for the fire fighter, colleagues, or achieve remission do so without toxic side effects of the anti- victims. Removing oneself from the scene, even temporarily, SEES can significantly impact on the success of the operation. Medi- As much as 10 percent of the population will experience at cations used to treat neurologic conditions can frequently least one seizure in a lifetime, whereas less than 1 percent of produce or worsen somnolence, discoordination, and/or dise- the population qualifies for a diagnosis of epilepsy.
Many conditions producing seizures in the pediatric age A.9.13.4.1 Cerebral vascular insufficiency includes the spec- group are known to remit prior to adulthood, and many adults trum of syndromes from transient ischemic attack (TIA) to sustain a reactive seizure that can be attributed to a reversible, stroke, and its cause should be investigated. If due to arteriove- underlying precipitant. These circumstances do not necessarily nous malformation, cerebral aneurysm, or bleeding, then see represent an ongoing risk of sudden, unpredictable incapacita- specific recommendations. If due to hypertension, then this is tion of a member. After a provoked seizure, with the precipi- evidence of end organ disease. Stroke does not permit safe tant identified and alleviated, the member can be cleared for performance of essential job tasks (1, 2, 4, 5, 6, 7, 8, 9, 10, 11, duty if anticonvulsants are not prescribed and the conditions 12, and 13) since the physiological stress associated with strenu- described in 9.13.6.1(2) through 9.13.6.1(5) are met. ous physical exertion can increase the likelihood for new strokes leading to life-threatening sudden incapacitation. Cere- A.9.13.7.1 The cause of cerebral bleed needs to be deter- bral vascular insufficiency can affect control of respiration, mined. If due to hypertensive bleed, then this is evidence for cognitive abilities, communication, motor strength, sensation, target organ disease. Hypertension with target organ disease coordination, and equilibrium. If stroke is due to embolic does not permit safe performance of essential job tasks 1, 4, 5, disease, then risk factors (hypercoagulable state, collagen 6, 7, 8, 9, 10, 11, 12, and 13, as the hypertension and stress asso- vascular disease, carotid vascular disease, patent foramen ovale, ciated with strenuous physical exertion can increase the likeli- cardiac disease) need to be evaluated. Ability to safely perform hood for new bleeds and strokes leading to life-threatening essential job tasks is based on an evaluation of current neuro- sudden incapacitation due to central nervous system instability logic status, treatment, and any contributory underlying condi- affecting control of respiration, cognitive abilities, communica- (For example, and other anticoagulant tion, motor skills, sensory abilities, coordination, and equili- treatment regimens do not allow the safe performance of Arteriovenous malformation or cerebral aneurysm does not A.9.13.5.1 Myasthenia gravis could compromise a member's allow for the safe performance of essential job tasks 1, 4, 5, 6, 7, ability to safely perform essential job tasks 1, 2, 4, 5, 6, 7, 8, 9, 8, 9, 10, 11, 12, and 13 since hypertension and stress associated 10, 11, 12, and 13. In considering performance of essential job with strenuous physical exertion can increase the likelihood for tasks, the impact of the operational environment (heat, stress, acute rupture and stroke leading to life-threatening sudden activity, duration, variable night shifts, etc.) on exacerbations incapacitation. Members can safely return to duty after evalua- should be considered and specifically addressed by a knowl- tion by a neurosurgeon if resection was successful, exam and edgeable neurological specialist and the fire department physi- imaging studies are normal (except for surgical site), and EEG The neurologist shows no epileptic activity off all anticonvulsant medications. cognitive function and neurological exam are normal and the A.9.13.8.1 Essential job tasks 1, 4, 6, 7, 8, 9, 10, 11, 12, and member is off all drug treatment. The member cannot safely 13 might not be performed safely unless after evaluation by a perform essential job tasks if there is evidence of respiratory specialist it is concluded that exam is normal and imaging stud- muscle weakness or prior episode of respiratory muscle weak- ies are normal. If trauma produced seizures, then see recom- ness in the last 3 years. The member cannot safely perform mendations for seizures in A.9.13.6.1. essential job tasks if on drug treatment for myasthenia includ- ing corticosteroids, cytotoxic drugs (e.g., Imuran®), and/or A.9.14 Fire fighters perform individually and as a team. Fire plasmapheresis; these treatments indicate that disease is still fighters with active, ongoing or recurrent, psychiatric and/or psychological conditions can have difficulty following orders, 2018 Edition Shaded text = Revisions. A = Text deletions and figure/table revisions. • = Section deletions. (N = New material.
Copyright 2018 Neticnai Fire Pretection Associaton (PA: Licensed. By agreement, for indivictat use and downinad on #ly # Aicomfor designated user William Swan No omer reproduction or transmission in any fore peraten wethou! water permesion d' NFP40) For inquines ento report unauthonged use. contest [email protected]. This NECSS Al access supscapeen sapires on December 19, 2019 ANNEX B 1582-67
communicating information, and working in a coordinated Post-delivery. Return-to-work decisions should be based on an manner with workers, victims, and involved civilians. The fire individualized evaluation of the member's current status, the fighter with a personality disorder might not respond appropri- requirements of her work assignment, and the type of delivery ately to command or adequately control his/her and its complications.
Behavior that undermines command
Lactation. Exposure to toxic substances might result in the structure, group function, and/or group cohesion is not safe to the member or others performing essential job tasks. Fire fight- substances being present in breast milk. ers are exposed to gruesome tragedy during emergency opera- tions, further exacerbating the stress of the job. Removing Annex B Guide for Fire Department Administrators oneself from the scene, even temporarily, can significantly impact on the success of an emergency operation. Medications This annex is not a part of the requirements of this NFPA document but is included for informational burboses only.
used to treat psychiatric or psychological conditions
somnolence, impair coordination, and B.1 Legal Considerations in Applying the Standard. The consideration of an application or continued employment of a interferes with cognitive functions, member based on medical or physical performance evaluations energy, command structure, communication, strength, sensa- involves a determination that is not without legal implications. tion, gait, coordination, To this end, prior to making an adverse employment decision and equilibrium, and therefore
compromises the member's ability to safely perform essential based on the current standard, the authority with jurisdiction job tasks 1, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, and 13. There is might wish to consult with legal counsel. increased risk for auto accidents when driving departmental B.1.1 Legal Protections for Individuals with Handicaps or vehicles. Dehydration, arrhythmia, and disequilibrium can be Disabilities. The Rehabilitation Act of 1973, as amended, 29 life threatening in a toxic/traumatic/stress environment. Fire U.S.C. § 791 et seq., and implementing regulations prohibit fighting requires members to perform independently and in discrimination against those with handicaps or disabilities coordination with others. Behavior that undermines command under any program receiving financial assistance from the structure, group function, and/or group cohesion during federal government. The Americans with Disabilities Act emergency operations is not safe to the member or others at (ADA) of 1990, 42 U.S.C. § 12101 et seq., also prohibits the scene. employment discrimination by certain private employers A A.9.18.2 Medical Information Regarding Issues Related to against individuals with disabilities. In addition, many states have enacted legislation prohibiting discrimination against Pregnancy in Fire Fighters. The following information is intended to help female fire fighters make informed decisions those with handicaps or disabilities. Generally speaking, these regarding their job activities if they are pregnant or consider- laws prevent the exclusion, denial of benefits, refusal to hire or ing pregnancy. The majority of pregnant fire fighters will be promote, or other discriminatory conduct against an individual able to continue to work throughout pregnancy, with some based on a handicap or disability, where the individual involved accommodations. They should discuss with their treating physi- can, with or without reasonable accommodation, perform the cian any individual conditions that may require limitation of essential functions of the job without creating undue hardship activities during pregnancy. on the employer or program involved.
The following occupational hazards can have adverse effects Beginning in 1999, the United States Supreme Court has at any time during pregnancy: issued a series of decisions limiting the scope of the ADA. As a result, persons with certain kinds of impairments that are miti- (1) Products of combustion, especially carbon monoxide gated by corrective measures such as medication for high blood (2) Excessive heat pressure or eyeglasses for myopia are not "disabled" under the Other toxic chemicals, including prolonged exposure to ADA. See Sutton v. United Airlines, Inc., 527 U.S. 471 (1999); vehicular exhaust Murphy v. United Parcel Service, Inc., 118 S. Ct. 2133 (1999); and (4) Trauma (even simple falls) Albertsons, Inc. v. Kirkingburg, 527 U.S. recently the Supreme Court held that an impairment is not a First trimester. In addition to the above, there are no other activities with an adverse effect. The risk to the fetus created by disability covered by the ADA unless it severely restricts a heat is highest during the first two months of pregnancy. person from doing activities that are of central importance to most people's daily lives. See Toyota Motor Mfgr., Kentucky, Inc. v.
Second trimester: In addition to the above, the following activi- Williams, 534 U.S. 184 (2002). These cases significantly limit ties may have adverse effects: the persons who can claim the protections of the federal ADA, (1) Alternating shift work, prolonged standing, and heavy lift- but do not, by any means, eliminate the ADA as an important consideration in fire service-related employment decisions. ing
(2) Noise exposure Moreover, it should be borne in mind that separate disability protections exist under laws of many states, and some of these Third trimester. In addition to the above, there are no other laws have been interpreted to afford greater protections than activities with an adverse effect. Activities that involve or that afforded by the ADA. See, for example, Dahill v. Boston require aerobic fitness, speed, agility, and balance can be Department of Police, 434 Mass. 233 (2001), where the Supreme adversely affected by body changes during pregnancy. Judicial Court of Massachusetts ruled that a corrective device to alleviate a disability is not relevant in determining whether Personal protective equipment. PPE is not designed to protect someone is disabled under the state's disability law. the fetus. The PPE fitted pre-pregnancy might not offer the same level of protection during pregnancy and might need to The disability discrimination laws, therefore, continue to be be refitted. an important part of the legal framework that governs employment-related decisions. Although this standard has been Shaded text = Revisions. 4 = Text deletions and figure/table revisions, • = Section deletions. N= New material. 2018 Edition Copyright 2019 Nationa: Fire Protection Association INFRA Licensed by agreement, to indindual use and downicad on 07/08/201010 Rif Ascom for designated user Willem Swan No other reproduction or frensmission in any fome parmated without written pennessior of NAPA, forinquines onto report unauthensed use. contest kerang@@nipa.omg This NEGGS All Access subsorpton expires on Deceniber 10. 2019. 1582-68 COMPREHENSIVE OCCUPATIONAL MEDICAL PROGRAM FOR FIRE DEPARTMENTS developed with this in mind, these laws can, depending on the task performance and the consequences of failure to safely jurisdiction and the circumstances, affect the degree to which perform the task should be specified. The working conditions the authority having jurisdiction can implement the standard and environmental hazards in which the work is performed in an individual case. Users of this standard should be aware should be described. that, while courts, in assessing disability discrimination claims, The job description should be made available to the fire department physician for use during the pre-placement medi- cal examination for the individual determination of the medi- cal suitability of applicants for membership.
(1993)], reliance on the standard alone might not be sufficient to withstand a challenge to an adverse employment decision. B.3 Choosing a Fire Department Physician. Several factors should be considered in choosing a fire department physician.
B.1.2 Legal Protections for Individuals Who Are Members of Protected Classes (Race, Sex, Color, Religion, or National There are relatively few physicians with formal residency train- ing and certification in occupational medicine. The fire depart- Origin). Title VIl of the Civil Rights Act of 1964, as amended, ment physician should be qualified to provide professional 42 U.S.C. § 2000e, and implementing regulations by the Equal (EEOC) prohibit expertise in the areas of occupational safety and health as these Employment Opportunity Commission areas relate to emergency services. For the purpose of conduct- discrimination in employment on the basis of race, sex, color, religion, or national origin (i.e., protected classes). Under Title ing medical evaluations, the fire department physician should understand the physiological and psychological demands
VII, an "employer" is defined, generally, to mean a person with "15 or more employees for each working day in each of 20 or placed on members as well as the environmental conditions more calendar weeks in the current or preceding calendar under which members have to perform. year" (42 U.S.C. § 2000e). Several federal jurisdictions have Knowledge of occupational medicine and experience with held that unpaid volunteers are not considered to be "employ- occupational health programs are essential for physicians not formally trained in occupational medicine.
Additionally, many states, cities, and localities have adopted The physician must be committed to meeting the require- similar legislation. Generally, physical performance or other ments of the program, including appropriate record keeping. requirements that result in "adverse impact" on members of a The physician's willingness to work with the department to protected class (e.g., on the basis of gender) are required to be continually improve the program is also important. Finally, the validated through a study in accordance with EEOC guidelines, physician's concern and interest in the program and in the if such requirements are to be relied on in making employ- individuals in the program are vital. ment decisions. Under EEOC guidelines, a study validating employment standards in one jurisdiction can be transportable The following are some of the many options for obtaining to another jurisdiction (and therefore used in lieu of conduct- physician services:
ing a separate study). However, specific preconditions must be (1) Physicians can be paid on a service basis or through a met in this regard, and the authority having jurisdiction should contractual arrangement. seek the advice of counsel before relying on a transported vali- For volunteer departments, local physicians might be will- ing to volunteer their services for the program, with other B.1.2.1 Pregnancy and Reproduction. Federal regulations, as arrangements for payment of laboratory testing, x-rays, and so forth.
well as many court decisions, including the U.S. Supreme Court's decision in International Union, et al. v. Johnson Controls, (3) Some departments might utilize a local health care Inc. [499 U.S. 187, 111 S. Ct. 1196 (1991)], have interpreted facility for medical care. However, in that case, the depart- ment should have one individual physician responsible
the requirements of Title VIl with respect to pregnancy and reproduction. The AH] should seek the advice of counsel in for the program, record keeping, and so forth. resolving specific questions concerning these requirements as (4) A military reserve or a National Guard unit can be used. well as other requirements that can be imposed by state or local B.4 Coordinating the Medical Evaluation Program. An indi- vidual from within the department should be assigned the B.2 Determining Essential Job Tasks. The medical require- responsibility for managing the health and fitness program, ments in this edition of the standard were revised based on the including the coordination and scheduling of evaluations and examinations. This person should also act as liaison between essential job tasks contained in Chapter 5 and Chapter 9. It is the department and the physician to make sure that each has recognized that some fire-fighting functions and tasks can vary from location to location due to differences in department size, information necessary for decisions about placement, functional and organizational differences, geography, level of scheduling appointments, and so forth. urbanization, equipment utilized, and other factors. Therefore, B.5 Confidentiality. Confidentiality of all medical data is criti- it is the responsibility of each individual fire department to cal to the success of the program. document, through job analysis, the essential job functions that assured that the information provided to the physician will not are performed in the local jurisdiction. be inappropriately shared. No fire department supervisor or There are a wide variety of job analytic techniques available manager should have access to medical records without the to document the essential functions of the job of a member. express written consent of the member. There are occasions, However, at a minimum, any method utilized should be however, when specific medical information is needed to make a decision about placement, return to work, and so forth, and a current, in writing, and meet the provisions of the Department of Labor regulations [29 CFR 1630.2(n) (3)]. Job descriptions fire department manager should have more medical informa- should focus on critical and important work behaviors and tion for decision making. In that situation, written medical specific tasks and functions. The frequency and/or duration of 2018 Edition Shaded text = Revisions. A = Text deletions and figure/table revisions. • = Section deletions. N = New material.
Copyright 2049 National Fire Protection Assocation INFPA Licensed by agreement to nonda use ang downicad on 07/06/2010o Bily Alcom for designated user Willem Smen, No other reprodhation or transmission in any or permittee without witten permission of NfPa? Poregunes are repor unaudionzed use contact [email protected]. This NEOSS All Access subscaption excres on December 10. 2019.
ANNEX C 1582-69
consent should be obtained from the member to release the (c) Body mass index (optional) specific information necessary for that decision. (f) Waist-to-hip ratio (optional) (3) Muscular strength
Budgetary constraints can affect the medical program.
Therefore, it is important that components of the program be (a) Handgrip dynometer prioritized such that essential elements are not lost. With addi- (b) Static bicep curl with dynometer tional funding, other programs or testing can be added to (c) Static leg press with dynometer enhance the program. (d) Bench press (1 rep maximum or percent of body weight)
(e) Leg press (1 rep maximum or percent of body
Annex C Protocols for Evaluation of Fitness of Members weight) This annex is not a part of the requirements of this NFPA document (4) Muscular endurance but is included for informational purposes only. (a) Push-ups A C.l Annual Fitness Evaluation. The copyrighted material in (b) Modified push-ups C.l.1 is extracted from Chapter 4 of NFPA 1583, 2008 edition. (c) Pull-ups (d) Bent knee sit-ups
C.1.1 General. (e) Crunches given time
(f) Crunches to cadence
C.l.I.1 All members shall participate in a periodic fitness assessment under supervision of the department health and (5) Flexibility fitness coordinator (HFC) and shall provide the HFC with data (a) Sit and reach on which to base individual exercise prescription. (b) Modified sit and reach (c) Trunk extension
C.1.1.2 The fitness assessment shall be conducted at least (d) Shoulder elevation annually.
C.2 Annual Fitness Evaluation. The copyrighted material in C.1.2 Fitness Assessment. this section is reprinted with permission from the International C.1.2.1 All members shall be cleared for participation in the Association of Fire Fighters (IAFF) Fire Service Joint Labor- fitness assessment by the fire department physician. Management Wellness-Fitness Initiative.
C.1.2.2 If a member has an acute medical problem or a newly A C.2.1 Fitness Evaluation Protocols for Members. The follow- acquired chronic medical condition, fitness assessment ing mandatory fitness protocols should be used to determine shall be postponed until that person has recovered from this the member's baseline level of fitness and to evaluate progress condition and presents to the fire department for review. from year to year. Fitness evaluations should be under the auspices of the fire department physician. The actual evalua- C.1.3 Pre-Assessment Questionnaire. The HFC shall adminis- tions are permitted to be conducted by the fire department's ter to all members a pre-assessment questionnaire that seeks to fitness personnel. All data collected by the evaluator is to be identify contraindications for participation in the fitness assess- held confidential and maintained in the member's confidential ment and department exercise training program. medical file. The evaluator can provide exercise programs to encourage the members to maintain or improve their level of C.1.4 Fitness Assessment Components. The annual fitness fitness. assessments shall consist of the following components:
There are many protocols currently available to measure the (1) Aerobic capacity
(2) Body composition sub-maximal VO, levels of apparently healthy individuals.
Muscular strength These protocols differ in evaluation equipment (i.e., treadmill, (3)
(4) Muscular endurance stepmill, and stationary bike), rate of increasing work output, (5) Flexibility degree of increasing work output, and final result. To increase the consistency of VO, measurements, as well as the accuracy of C.1.4.1 Sample Assessment Protocols for the Health-Related the data collected between members within and between Components of Fitness. The following examples of assessment participating fire departments, one of the two following sub- protocols for health-related components of fitness vary in terms maximal protocols is to be used to predict maximum aerobic of ease of administration, safety, cost, and predictive value: capacity. The WFI Treadmill Protocol and WFI Stepmill Proto col were specifically developed and validated to evaluate the (1) Aerobic capacity
sub-maximal aerobic capacity of members.
(a) 1-mile walk
(b) 1.5-mile run/walk After continued evaluation and research by the IAFF/IAFC (c) 12-minute run Wellness-Fitness Initiative's technical experts, it was determined (d) Step test (various) that significant errors were occurring when past protocols were (e) Stairclimbing machine applied to a population that has different characteristics from (f) Cycle ergometer (various) those for which the evaluation was developed. For this reason, (g) Treadmill (various) the Bruce and Balke Treadmill Protocols were removed as eval- (2) Percentage of body fat uation protocols and as a means to collect data. Both were specifically tailored for less-fit populations to determine cardio (a) Skinfold (various) vascular pathology and thus proved to be less accurate proto- (b) Circumference (various) cols for the
general members population.
(c) Bioimpedance (BIA) Stationary Bike Test Protocol was also removed since it consis- (d) Hydrostatic weighing tently and grossly underestimated VO, for above average body Shaded text = Revisions. A = Text deletions and figure/table revisions. • = Section deletions. N = New material. 2018 Edition Copyrign: 2019 National Fire Protection Ascociation MEPA. Ucensed by agreement, for indivisual se and download on: 07/08/2019 to Billy Alcon for designated user Willien Swan No oner reproduction or transmiss-on in a ty done penited without isritten parmesion deNED, Forinaules orto report unauthenzed use contact bersing ripe org This NECES Al Acess subscapion exotes on December 19 2018 1582-70 COMPREHENSIVE OCCUPATIONAL MEDICAL PROGRAM FOR FIRE DEPARTMENTS size (i.e., most members). The Canadian Step Test was also shoes. All members must refrain from eating, drinking. removed since it relies on a single-stage exercise that was found smoking, and any physical activity prior to the evaluation to underestimate measurement of member's VO,. The Gerkin to ensure accurate heart rate and blood pressure meas- protocol was removed because it was found to provide values that were somewhat variable Obtain a resting heart rate and blood pressure prior to proven measures of cardiovascular fitness. aerobic capacity evaluation. If resting heart rate exceeds 110 beats per minute and/or resting blood pressure
A maximal cardiopulmonary evaluation with an electrocar- exceeds 160/100 mm Hg, ask the individual to relax in a diogram (ECG) should be permitted to be used to obtain VOg quiet place for 5 minutes and re-test. If the heart rate measurements. This medical evaluation should only be conduc- and/or blood pressure remain at these levels, cancel the ted in a medical facility with proper monitoring by a physician fitness evaluation and refer the individual to the fire and available resuscitation equipment. department physician. If the retest indicates a reduction The muscular endurance evaluations were also modified. In in heart rate and blood pressure, the evaluation can be order to improve the accuracy of the evaluation and the data given. The aerobic capacity protocols also require that collection, the sit-and-hold evaluation was eliminated. The sit- age and weight in kilograms be obtained prior to the eval- up and curl-up protocols were changed to the static plank eval- uation in order to ensure the safety of the participant and to Review health status with the individual being evaluated improve the specificity of the evaluation. The push-up evalua- Contraindications for evaluations must be reviewed, tion was modified to now include the option of the alternate addressing any changes in the individual's health status grip push-up evaluation, to ensure participant safety and since their last medical evaluation that would warrant uniformity in data collection. The alternate grip push-up was deferring the evaluation, including the following:
added for individuals with a history of hand, wrist or shoulder (a) Chest pain during or absence of physical activity injuries. (b) Loss of consciousness
(c) Loss of balance due to dizziness (ataxia)
The flexibility evaluation was modified to address the differ- ence in limb length and/or differences in proportion between (d) Recent injury resulting in bone, joint, or muscle problem
an individual's arm and legs.
(e) Current prescribed drug that inhibits physical activ- The IAFF/IAFC Wellness-Fitness Initiative's technical experts ity have evaluated all equipment utilized in these fitness protocols. (f) Chronic infectious disease (e.g., hepatitis) The technical experts found either accuracy, maintenance, or (g) Pregnancy availability problems with some evaluation equipment. Manu- (h) Any recent disorders that can be exacerbated by facturer's information and product names are included in each exercise protocol. Unless indicated, this equipment must not be substi- (i) Any other reason why the individual believes that he tuted with other equipment. All equipment must be main- or she should not be physically evaluated and properly calibrated in accordance with
A C.2.1.1 Aerobic Capacity. | Treadmill. Submaximal treadmill manufacturer's instructions.
evaluations shall use the WFI Treadmill Protocol. The treadmill Members must be fully recovered from the previous evalua- should be a commercial treadmill capable of obtaining a tion before proceeding to the next evaluation. The evaluation 15 percent grade and 10 mph. A heart rate monitor or equiva- events can be sequenced to minimize the effects of previous lent shall be used for heart rate measurements and a stopwatch evaluations on subsequent evaluation performance. If evalua- used for timing. tions for body composition, aerobic capacity, muscular
strength, muscle endurance, and flexibility are to be evaluated Stepmill. Submaximal stepmill evaluations shall use the WFI in one evaluation battery, the following sequence should be Stepmill Protocol. The stepmill shall be a Stairmaster Stepmill used after completing mandatory pre-evaluation procedures: SM-916 or 7000 PT. A heart rate monitor shall be used for heart rate measurements and a stopwatch used for timing.
(1) Body composition
(2) Aerobic capacity
(3) Muscular strength/power
(4) Muscle endurance
(5) Flexibility
treadmill shall be a commercial treadmill capable of obtaining The following is a mandatory pre-evaluation procedure. It a 25-percent grade. should be conducted for all members prior to conducting the fitness evaluations: All aerobic capacity evaluation results must be recorded in milliliters (ml) of oxygen per kilogram (kg) of body weight per (1) Review and confirm individual's current medical status. It minute (VO,max).
is required that all members are medically cleared
through this standard's medical evaluation within 12 (+3) (I) Choose the aerobic capacity protocol and worksheet. months prior to any fitness evaluation. Inform the fire fighter of all evaluation components. (2) Notify members in advance of the scheduled time and Ensure that the individual is in proper clothing and foot- place of physical fitness evaluations. The individual wear, is comfortable, and understands all facets of the should understand the protocol and what is expected evaluation. etore, during, and after the evaluation, including star Review all indicators for stopping the evaluation with the id stop procedures. The individual will be required , individual wear comfortable clothes and either sneakers or athletic 2018 Edition Shaded text = Revisions. 4 = Text deletions and figure/table revisions. • = Section deletions. N = New material.
Copyright 2018 National Fire Protection Association (FPA Licensed by agreement, for endividual use and download on 07/08/2019 to Bily Alcom for Ces anated user Willien Swan No other reproduction or Inensmission in any fore permitted whout outter permission of NEPAD, Foringuiries orto report unethented use, contact lee engenips org This NFCSS All /cosss subscrigion capires on Decomber 19. 2019.
ANNEX C 1582-71
(5) Place and secure heart rate monitor transmitter around (8) Determine 85 percent of the fire fighter's estimated individual's chest, in accordance with the manufacturer': maximum heart rate, which will be the target exercise heart instructions; evaluator shall hold or wear the heart rate rate (see Table C.2.1.1(b)), using the following equation:
Measure the fire fighter's resting heart rate and resting Target exercise heart rate = (208 - (0.7 x age)] × 0.85 lood pressure and record on the protocol workshee Example: The target exercise heart rate of a 40-year-old indi- 7) Obtain and record weight and age for both protocol vidual is:
Determine the participants body mass index (BMI). Refer to Target exercise heart rate = [208 - (0.7 × 40)] × 0.85 = 153 Table C.2.I.I (a).
If instead, maximum heart rate (MHR) had been previously measured on this individual, then 85% predicted MHR on
[C.2.1.la] future occasions would be more accurately calculated as:
Weight (kg)
BMI = Height (m) Target exercise heart rate = .85 (MHR - [age when MHR determined - current age])
US: (9) Record the target exercise heart rate on the protocol worksheet
[C.2.1.1b]
Weight (lb)
BMI = 703 x
Height (in.)*
Table C.2.1.1 (a) Body Mass Index (BMI)
BMI 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 Height Body Weight (pounds)
58" (4'10") 96 100 105 110 115 119 124 129 134 138 143 148 153 158 2[1 62 167 172 17 11 1 191 196 201 205 210 215 220 224 229 234 289 59" (411") 99 104 109 114 119 124 128 133 138 143 148 153 158 163 168 173 178 183 188 193 198 203 208 212 217 222 227 232 237 242 247 60" (5) 102 107 112 I18 123 128 133 138 143 148 153 158 163 168 174 179 184 189 194 199 204 209 215 220 225 230 235 240 245 250 255 61" (5'1") 106 Ill 116 122 127 132 137 143 148 153 158 164 169 174 180 185 190 195 201 206 211 217 222 227 232 238 243 248 254 259 264 62" (5/2") 109 115 120 126 131 136 142 147฿ 153 158 164 169 175 180 186 191 196 202 207 213 218 224 229 235 240 246 251 256 262 267 273 63" (5'3") 113 118 124 130 135 141 146 152 158 163 169 175 180 186 191 197 203 208 214 220 225 231 237 242 248 254 259 265 270 278 282 64" (5/4) 116 122 128 134 140 145 151 157 163 169 174 180 186 192 197 204 209 215 221 227 232 238 244 250 256 262 267 273 279 285 291 65" (5'5") 120 126 132 138 144 150 156 162 168 174 180 186 192 198 204 210 216 222 228 234 240 246 252 258 264 270 276 282 288 294 300 66" (5'6") 124 130 136 142 148 155 161 167 173 179 186 192 198 204 210 216 223 229 235 241 247 253 260 266 272 278 284 291 297 303 309 67" (5'7") 127 134 140 146 153 159 166 172 178 185 191 198 204 211 217 223 230 236 242 249 255 261 268 274 280 287 293 299 306 312 319 68" (5'8") 131 138 144 151 158 164 171 177 184 190 197 203 210 216 223 230 236 243 249 256262 269 276 282 289 295 302 308 315 322 328 69" (5'9") 135 142 149 155 162 169 176 182 189 196 203 209 216 223 230 236 243 250 257 263 270 277 284 291 297 304 311 318 324 331 338 70" (5/10"') 139 146 153 160 167 174 181 188 195 202 209 216 222 229 236 243 250 257 264 271 278 285 292 299 306 313 320 327 334 341 348 71" (5'11") 143 150 157 165 172 179 186 193 200 208 215 222 229 236 243 250 257 265 272 279 286 293 301 308 315 322 329 338 343 351 358 72" (6) 147 154 162 169 177 184 191 199 206 213 221 228 235 242 250 258 265 272 279 287฿ 294฿ 302 309 816 324 831 338 346 353 361 368 78" (6'1") 151 159 166 174฿ 182 189 197 204 212 219 227 235 242 250 257 265 272 280 288 295 302 310 318 325 333 340 348 355 363 $71 378 74" (6'2") 155 163 171 179 186 194 202 210 218 225 233 241฿ 249 256264 272 280 287 295 303 311 319 326 334 342 350 358 365373 381 389 75" (6'3") 160 168 176 184 192 200 208 216 224 232 240 248 256 264 272279 287 295 303 311 319 327 335 343 351 359 367 375 383 391 399 76" (6'4") 164 172 180 189 197 205 213 221 230 238 246 254 263 271 279 287 295 304 312 320 328 336 344 353 361 369 377 385 394 402 410 BMI 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 16 47 48 19 50 4 Table C.2.1.1(b) Target Heart Rate (THR) for Respective Age Age THR Age THR Age THR Age THR
(yrs) (BPM) (yrs) (BPM) (yTs) (BPM) (yTs) (BPM)
18 166 29 160 40 153 51 146
19 165 30 159 42 152 52 146
20 165 31 158 42 152 53 145
21 164 32 158 43 151 54 145
22 164 33 157 44 151 55 144
23 163 34 157 45 150 56 143
24 163 35 156 46 149 57 143
25 162 36 155 47 149 58 142
26 161 37 155 48 148 59 142
27 161 38 154 49 148 60 141
28 160 39 154 50 147 61 140
THR Formula: [208 - (0.7 × 40)] × 85
Note: THR is used as endpoint in submaximal aerobic capacity protocols.
Shaded text = Revisions. A = Text deletions and figure/table revisions. • = Section deletions. N= New material. 2018 Edition Copyrent 2019 Natical Fire Prefection Association (FPAS tensed, by agreement. for individual use and ownined on: 07/06/2019 to Bly Arcom for designated user Willar Swan No oner recroduction er Irensmission in any fore permitted wilheut witten permission of NEPADForinguines orto report unauthensed use, comest cersing hope org TiNg NECES AACCASS BuDscOton sapires on December 19 2019. 1582-72 COMPREHENSIVE OCCUPATIONAL MEDICAL PROGRAM FOR FIRE DEPARTMENTS C.2.1.2 Body Composition. then calculate the average of all three measurements [e.g., (1) 6 mm, (2) 9 mm, (3) 12 mm the average of all three measure- Conduct pre-evaluation procedures. Obtain the participant's ments is 9 mm]. If the three measurements are not equal age. Note the gender-specific skinfold sites. Men are measured distance apart, then calculate the average of the two closest at the triceps, subscapular and pectoral sites; women are meas- measurements |e.g., (1) 7 mm, (2) 4 mm, (3) 5 mm the aver- ured at the triceps, abdominal and suprailiac sites. All measure- age is calculated for measurement #2 and #3 only. The average ments should be made on the right side of the body, with the of the two measurements is 4.5 mm]. Once the skinfolds are subject standing upright. Use the tape measure to mark the site collected for all three sites, calculate the sum of the average to be measured with a water-soluble marker. Place calipers skinfold measurement for each site. (Note: Sites are specific to directly on the skin surface, 1 cm away from the thumb and gender.) To determine body fat percentage, cross-reference the finger; perpendicular to the skinfold; and halfway between the sum of skin folds with the subject's age on the appropriate crest and base of the fold. Maintain pinch while reading the chart provided in this section [males, Table C.2.1.2(a); females, caliper. Wait 1-2 seconds (not longer) before reading caliper. Table C.2.1.2(b)].
Rotate through all three sites or allow time for skin to regain normal texture and thickness. Take two measurements at each C.2.1.2.1 Male Skinfold Sites. site. If the values are less than 1 mm of each other then calcu- Triceps — located at the midpoint between the acromioclavic- late the average of the two measurements. If the difference ular (AC) joint and the olecranon process (center of the between the two measurements is greater than or equal to elbow) on the posterior aspect of the upper arm. (See Figure 1 mm, then a third measurement must be taken. If the differ- ences between the three skinfold measurements are equal, C. 2.1.2.1(a) and Figure C.2.1.2.1(b).J A Table C.2.1.2(a) Percentage of Body Fat Estimate for Men Based on the Sum of Triceps, Subscapular, and Pectoral Skinfolds Skinfelds Age up to Last Complete Year
Sum (mm) Under 22 23-27 28-32 33-37 38-42 43-17 48-52 53-57 Over 57 8-10 1.5 2.5 3.1 3.6 4.1 4.6 5.1 5.6
2100 5.6 6.1 6.6 7.1
11-13 3 4.5 5.1
14-16 4.5 5 5.5 6 6.5 7 7.6 8.1 8.6
17-19 5.9 6.4 6.9 7.4 8 8.5 9 9.5 10
20-22 7.3 7.8 8.3 8.8 9.4 9.9 10.4 10.9 11.4
8.6 9.2 9.7 10.2 10.7 11.2 11.8 12.3 12.8
26-28 10 10.5 11 11.5 12.1 12.6 13.1 13.6 14.2
29-31 11.2 11.8 12.3 12.8 13.4 13.9 14.4 11.9 15.5
32-34 12.5 13 13.5 14.1 14.6 15.1 15.7 16.2 16.7
35-37 13.7 14.2 11.8 15.3 15.8 16.4 16.9 17.4 18
38-40 14.9 15.4 15.9 16.5 17 17.6 18.1 18.6 19.2
41-43 16 16.6 17.1 17.6 18.2 18.7 19.3 19.8 20.3
41-46 17.1 17.7 18.2 18.7 19.3 19.8 20.4 20.9 21.5
47-49 18.2 18.7 19.3 19.8 20.4 20.9 21.4 22 22.5
50-52 19.2 19.7 20.3 20.8 21.4 21.9 22.5 23 23.6
53-55 20.2 20.7 21.3 21.8 22.4 22.9 23.5 24 24.6
56-58 21.1 21.7 22.2 22.8 23.3 23.9 24.4 25 25.5
59-61 22 22.6 23.1 23.7 24.2 24.8 25.3 25.9 26.5
62-64 22.9 23.4 24 24.5 25.1 25.7 26.2 26.8 27.3
64-67 23.7 24.3 24.8 25.4 25.9 26.5 27.1 27.6 28.2
68-70 24.5 25 25.6 26.2 26.7 27.3 27.8 28.4 29
71-73 25.2 25.8 26.3 26.9 27.5 28 28.6 29.1 29.7
74-76 25.9 26.5 27 27.6 28.2 28.7 29.3 29.9 30.4
77-79 26.6 27.1 27.7 28.2 28.8 29.4 29.9 30.5 31.1
80-82 27.2 27.7 28.3 28.9 29.4 30 30.6 31.1 31.7
83-85 27.7 28.3 28.8 29.4 30 30.5 31.1 31.7 32.3
86-88 28.2 28.8 29.4 29.9 30.5 31.1 31.6 32.2 32.8
89-91 28.7 29.3 29.8 30.4 31 31.5 32.1 32.7 33.3
92-91 29.1 29.7 30.3 30.8 31.4 32 32.6 33.1 33.4
95-97 29.5 30.1 30.6 31.2 31.8 32.4 32.9 33.5 34.1
98-100 29.8 30.4 31 31.6 32.1 32.7 33.3 33.9 34.4
101-103 30.1 30.7 31.3 31.8 32.4 33 33.6 34.1 34.7
104-106 30.4 30.9 31.5 32.1 32.7 33.2 33.8 34.4 35
107-109 30.6 31.1 31.7 32.3 32.9 33.4 34 34.6 35.2
110-112 30.7 31.3 31.9 32.4 33 33.6 34.2 34.7 35.3
113-115 30.8 31.4 32 32.5 33.1 33.7 34.3 34.9 35.4
116-118 30.9 31.5 32 32.6 33.2 33.8 34.3 34.9 35.5
2018 Edition Shaded text = Revisions. A = Text deletions and figure/table revisions. • = Section deletions. IN = New material.
Copyright 2019 Natone: Fine Prolection Association NFP Woelsed. by agreement for incividual use and downicad on: C1/06/2019 to Billy Alcom for designated user Willam Swan No other raproduction or transmissien in any peare permitted whout watter permission of FPA. Foringures erforeport unauthonzed use. contact [email protected] This NECSS All Access subsenpion: expires on December 19, 2019.
ANNEX C 1582-73
A Table C.2.1.2(b) Percentage of Body Fat Estimates for Women Based on the Sum of Triceps, Abdominal, and Suprailiac Skinfolds Skinfolds Age up to Last Complete Year
Sum (mm) 18-22 23-27 28-32 33-37 38-42 43-47 48-52 53-57 Over 57 8-12 8.8 9 9.2 9.4 9.5 9.7 9.9 10.1 10.3
13-37 10.8 10.9 11 11.3 11.5 11.7 11.8 12 12.2
18-22 12.6 12.8 13 13.2 13.4 13.5 13.7 13.9 14.1
23-27 14.5 14.6 14.8 15 15.2 15.4 15.6 15.7 15.9
28-32 16.2 16.4 16.8 17 17.1 17.3 17.5 17.7
33-37 17.9 18.1 18.5 18.7 18.9 19 19.2 19.4
38-12 19.6 19.8 20 20.2 20.3 20.5 20.7 20.9 21.1
43-47 21.2 21.4 21.6 21.8 21.9 22.1 22.3 22.5 22.7
48-52 22.8 22.9 23.1 23.3 23.5 23.7 23.8 24 24.2
53-57 24.2 24.4 24.6 24.8 25 25.2 25.3 25.5 25.7
58-62 25.7 25.9 26 26.2 26.4 26.6 26.8 27 27.1
63-67 27.1 27.2 27.4 27.6 27.8 28 28.2 28.3 28.5
68-72 28.4 28.6 28.7 28.9 29.1 29.3 29.5 29.7 29.8
73-77 29.6 29.8 30 30.2 30.4 30.6 30.7 30.9 31.1
78-82 30.9 31 31.2 31.4 31.6 31.8 31.9 32.1 32.3
83-87 32 32.2 32.4 32.6 32.7 32.9 33.1 33.3 33.5
88-92 33.1 33.3 33.5 33.7 33.8 34 34.2 34.4 34.6
93-97 34.1 34.3 31.5 34.7 34.9 35.1 35.2 35.4 35.6
98-102 35.1 35.3 35.5 35.7 35.9 36 36.2 36.4 36.6
103-107 36.1 36.2 36.4 36.6 36.8 37 37.2 37.3 37.5
108-112 36.9 37.1 37.3 37.5 37.7 37.9 38 38.2 38.4
113-117 37.8 37.9 38.1 38.3 39.2 39.4 39.6 39.8 39.2
118-122 38.5 38.7 38.9 39.1 39.4 39.6 39.8 40 40
123-127 39.2 39.4 39.6 39.8 40 40.1 40.3 40.5 40.7
128-132 39.9 40.1 40.2 40.4 40.6 40.8 41 41.2 41.3
133-137 40.5 10.7 40.8 41 41.2 41.4 41.6 41.7 41.9
138-142 41 41.2 11.4 41.6 41.7 41.9 12.1 12.3 42.5
143-147 41.5 41.7 41.9 42 42.2 42.4 42.6 42.8 43
148-152 41.9 42.1 42.3 42.8 42.6 42.8 43 43.2 43.4
153-157 13.3 12.5 42.6 42.8 43 43.2 43.4 43.6 43.7
158-162 42.6 42.8 43 43.1 43.3 43.5 43.7 43.9 44.1
163-167 42.9 43 43.2 43.4 43.6 43.8 44 44.1 41.3
168-172 43.1 43.2 43.4 43.6 43.8 44 44.2 44.3 44.5
173-177 13.2 43.4 43.6 43.8 43.9 11.1 44.3 44.5 14.7
178-182 43.3 43.5 43.7 43.8 44 14.2 14.4 44.6 44.8
Subscapular — located on the same diagonal line as the infe- A C.2.1.3 Submaximal Graded Treadmill Evaluation (WFI Tread- rior border of the scapula, 2 cm beyond the inferior angle. /See mill Protocol).
Figure C. 2.1.2.1(c) and Figure C. 2. 1.2. 1(d). J (1) Conduct pre-evaluation procedures.
Pectoral — Located on a diagonal line, midway between the The individual being evaluated is instructed to straddle axillary fold and the right nipple. [See Figure C.2.1.2. 1(e) and the treadmill belt until it begins to move. At approxi- Figure C.2.1.2.1(D.J mately 1 mph, the individual is instructed to step onto the belt and the belt speed is increased to 3 mph at 0 percent C.2.1.2.2 Female Skinfold Sites. grade. The individual warms up at 3 mph at 0 percent Triceps - located at the midpoint between the acromioclavic- grade for 3 minutes. During the warm up, the individual is informed that the evaluation is submaximal and will
ular (AC) joint and the olecranon process (center of the terminate once their monitored heart rate exceeds the
elbow) on the posterior aspect of the upper arm. (See Figure C. 2.1.2.2(a) and Figure C. 2. 1.2.2(b). J target exercise heart rate for 15 seconds. The individual is informed that the target exercise heart rate is 85 percent Abdominal — located at the right of the umbilicus, on a verti- of their predicted maximal heart rate. The individual is cal fold, 2 cm from the right lateral border. (See Figure advised that the evaluation is a series of I-minute exercise C. 2. 1.2.2(c) and Figure C. 2.1.2.2(d). J stages, alternating between percent grade and speed (i.e., first minute percent grade is increased, second minute
Suprailiac — located on a diagonal line, 1-2 cm anterior to speed is increased, etc.). Inform the individual that if at the crest of the pelvis (ASIS). Grasp a diagonal skinfold just any time during the evaluation they experience chest above and slightly forward of the crest of the ilium. (See Figure light-headedness, ataxia, confusion, nausea, pain, or
C.2.1.2.2(e) and Figure C.2.1.2.2(f).] clamminess, they should ask the evaluator to terminate the evaluation.
Shaded text = Revisions. A = Text deletions and figure/table revisions. • = Section deletions. N= New material. 2018 Edition Copyright 2019 National Fire Prolecton Association:NFPA, Licensed by egreement, for noividual use and downinad on 07/06/2019 to Billy Attor for designated user Willen wen, No omer represhion of hensmission in any em pamited without witten permission of NEPA Forloures orto report unahonzed use. [email protected] This NECSS All Aconus aubscheten expires on Decent 19, 2013 1582-74 COMPREHENSIVE OCCUPATIONAL MEDICAL PROGRAM FOR FIRE DEPARTMENTS +
FIGURE C.2.1.2.1(a) [Site of Male Skinfold Measurement FIGURE C.2.1.2.1 (c) [Site of Male Skinfold Measurement - Triceps.] - Subscapular.]
FIGURE C.2.1.2.1(d) [Subscapular Measurement - Male.]
15 seconds. Do not make any changes to the assessment speed FIGURE C.2.1.2.1(b) [Triceps Measurement — Male.] or grade during this time. If the participant's heart rate remains above the THR for the full 15 seconds, then stop the assessment and proceed to the cool-down phase. Record the Start the stopwatch when the treadmill reaches 3 mph at 0% grade. Continue with this speed and grade for 3 minutes total time, including the 3-minute warm-up, at which point the (steady state). After completing the 3-minute steady state inter- participant exceeds the THR. If the participant's heart rate the participant that the speed exceeds the target, but then drops back to the THR or below
4.5 mph. Advise the participant that the assessment is a series within 15 seconds, then the assessment should continue. The of 1- minute intervals, alternating between speed and percent assessment is not complete until the participant's heart rate exceeds the THR for 15 seconds. If this does not occur within grade. All subsequent speed increases occur at 0.5 mph. At 4:01 minutes, increase the grade from 0% to 2%. At this time, 18 minutes, then terminate the assessment and record the the participant that all subsequent grade increases time. Once the assessment is completed, the time is recorded occur at 2% intervals. The assessment will continue until the The participant should perform a cool-down for a minimum of participant's heart rate exceeds the THR rate for 15 seconds, or 3 minutes at 3 mph, 0% grade. Continue to monitor the heart the subject exhibits the medical criteria for early termination. rate during the cool-down. Record the recovery heart rate at Once the heart rate exceeds the Target Heart Rate (THR), Iminute of cool-down. note the time and continue the assessment for an additional 2018 Edition Shaded text = Revisions. A = Text deletions and figure/table revisions. • = Section deletions. N= New material.
Copenht 2018 Nationa Fire Pretection Asscoation NFpage Licensed. 2y agreement for indyidual use and downicad on 071062018 to Bily Alcon for designated user Willlam Swan. No are: reproduction or transmission in any fore permitted withe written permission of NFP4, Fornquines or to report unauthorted use. contact licensing@nipa 0rg. This NECSS All Accass sunschpuon expires on December 19, 2019 ANNEX C 1582-75
+
FIGURE C.2.1.2.1(e) [Site of Male Skinfold Measurement
- Pectoral.]
FIGURE C.2.1.2.2(a) [Site of Female Skinfold Measurement - Triceps.]
FIGURE C.2.1.2.1 (f) [Pectoral Measurement - Male.]
Record the reason for terminating the assessment and the initial time the THR was exceeded (if applicable). Record time in minutes and convert second (s) into decimal.
See Treadmill Formula and Table C. 2.1.3 below. Use the test time (TT) the participant completed the assessment (i.e. excee- ded the THR) along with the treadmill conversion formula [VO, max = 56.981 + (1.242 × TT) - (0.805 x BMI] to estimate VO, max. Record the VO, max.
A C.2.1.4 Submaximal Stepmill Evaluation (WFI Stepmill Proto- (1) Conduct pre-evaluation procedures. Obtain and record individual's age in years and weight in kilograms.
(2) The individual being evaluated is instructed to assume a starting position about two-thirds of the way up the stairs.
The individual is instructed to temporarily grasp the
handrails to reduce the possibility of losing balance when the stairs begin to move. The individual is also informed that holding or leaning on the handrails is not allowed FIGURE C.2.1.2.2(b) [Triceps Measurement - Female.] Shaded text = Revisions. A = Text deletions and figure/table revisions. • = Section deletions. N= New material. 2018 Edition Copyright 2019 Nationa: Fire Protection Association (NFPA), Licensed, by egreement, for individual use and dewninad on 07/06/2010 to Billy Alcony for designated user Willian: Swan No other reproduction er transmiss on in any for permitted shout walter permission of NEPAD. Foringuries orto report unauthonzed use. contact keensing@enipeorg. ThIs NOSS All Aross sunspipt an exotes on Secember 19. 2019 1582-76 COMPRETENSIVE OCCUPATIONAL MEDICAL PROGRAM FOR FIRE DEPARTMENTS rate remains above the THR for the full 15 seconds, then the participant has completed the assessment. Stop the
assessment and record the time at which the participant exceeded the THR. The total Test Time (TT) begins from
the time the participant starts on the Stepmill, to
point at which the participant exceeds their THR. It does not include the final 15 second monitoring period that
the heart rate was above the THR. The assessment is
complete once the participant's heart rate exceeds the
target for 15 seconds. If the participant's heart rate
exceeds the target, but then drops down to the THR or
below within 15 seconds, then the assessment should
continue. Once the assessment is completed, the partici- pant will cool down for a minimum of 2 minutes at level
3. Continue to monitor the heart rate during the cool-
down. Record the recovery heart rate at one minute of
cool-down. The participant may grasp the handrails
during the cool-down phase. Upon completion of the
cool-down, instruct the participant to grasp the handrails.
Stop the stepmill and assist the participant off the appara-
TERMINATE THE ASSESSMENT IF ANY OF THE
FOLLOWING OCCURS:
The participant's heart rate exceeds THR for 15 seconds.
The THR has not been met after 16 minutes.
FIGURE C.2.1.2.2(c) [Site of Female Skinfold Measurement The participant asks to terminate the exercise. - Abdominals.] The equipment malfunctions.
once the evaluation begins since this will cause false over- estimations of aerobic capacity.
(3) The assessment starts at level 4 for 2 minutes, then level 5 for 1 minute (warm-up period). Start the stopwatch once the Stepmill begins. Inform the participant that the evalu- ation is a series of 1-minute intervals with increasing work loads on each subsequent minute. Once the assessment
commences, do not allow the participant to hold or lean on the handrails; this will result in overestimation of aero- bic capacity. At the completion of the 3 minute-warm-up, proceed to level 7 for 1 minute. *Note: This is marked by increasing the workload from level 5 to level 7. Once the heart rate exceeds the Target Heart Rate (THR), note the time and continue the assessment for an additional
15 seconds. Do not make any changes to the assessment
intensity level during this time. If the participant's heart FIGURE C.2.1.2.2(e) [Site of Female Skinfold Measurement - Suprailiac.]
FIGURE C.2.1.2.2(d) [Abdominal Measurement - Female.]
2018 Edition Shaded text = Revisions. 4 = Text deletions and figure/table revisions. • = Section deletions. N = New material.
Copyrighl 2010 Natienal Fire Proteston Association (NEPA) Licensed by agreement, for indivisual us and downined on 07/06/2019 to Billy Alcom for designated user William Swan No otner reproduction or hansmission in any form permitted whout walter permiasion eNDA foringuines orto report unsuthanged use, contact icersing @nipa org This NECES All Access Bunchpuon expires on Decembe: 19, 2018 ANNEX C 1582-77
A Table C.2.1.3 Treadmill Assessment
Time Speed mph % grade
0:00 - 1:00 3 0
1:01 - 2:00 3 0
2:01 - 3:00 3 0
3:01 - 4:00 4.5 0
4:01 - 5:00 4.5 2
5:01 - 6:00 5 2
6:01 - 7:00 5 4
7:01 - 8:00 5.5 4
8:01 - 9:00 5.5
9:01 - 10:00 6
10:01 - 11:00 6 8
11:01 - 12:00 6.5 8
12:01 - 13:00 6.5 10
13:01 - 14:00 7 10
14:01 - 15:00 12
15:01 - 16:00 7.5 12
16:01 - 17:00 7.5 14
17:01 - 18:00 8 14
Recovery Phase
0:00 - 1:00 3
1:01 - 2:00 3
2:01 - 3:00 3
A Table C.2.1.4 Decimal Equivalents for Seconds
Time Decimal Decimal Time Decimal
Equivalent (seconds) Equivalent
0.02 21 0.35 0.68
2 0.03 22 0.37 0.7
0.05 23 0.38 43 0.72
0.07 24 0.4 44 0.73
0.08 25 0.42 45 0.75
FIGURE C.2.1.2.2(f) [Suprailiac Measurement — Female.] 0.1 26 0.43 46 0.77
0.12 27 0.45 47 0.78
0.13 28 0.47 48 0.8
Medical conditions arise that prohibit completing the assess- 0.15 29 0.48 49 0.82 ment. Record the reason for terminating the assessment and 10 0.17 30 0.5 50 0.83 the initial time the heart rate had been exceeded (if applica- 0.18 31 0.52 51 0.85 ble). Record time in minutes and convert second (s) into deci- 12 0.2 32 0.53 52 0.87 mal (see Table C.2.1.4). Insert the test time (TT) at which the 13 0.22 33 0.55 53 0.88 14 0.23 34 0.57 54 0.9
15 0.25 35 0.58 55 0.92
onversion tormula to estimate VO
16 0.27 36 0.6 56 0.93
17 0.28 37 0.62 57 0.95
was exceeded 18 0.3 38 0.63 58 0.97
VO, Prediction Formula. 19 0.32 39 0.65 59
20 0.33 40 0.67 60
[VO_max = 57.774 + (1.757 × TT) - (0.904 x BMI)]
C.2.1.5 Muscular Strength/Power. Hand grip strength evalua- tions shall use the following protocol. The hand grip dvna- mometer shall be a Jamar Hydraulic Hand dynamometer. (See Figure C. 2.1.5.]
(1) Conduct pre-evaluation procedures.
(2) The individual being evaluated is instructed to towel hands to ensure they are dry. The individual is instructed to place dynamometer in the hand to be evaluated; the evaluator adjusts, ensuring that the bottom of the handle clip is adjusted to fit snug in the first proximal interphalangeal joint. The red Shaded text = Revisions. A = Text deletions and figure/table revisions. • = Section deletions. N= New material. 2018 Edition Copyrigh: 2019 Nationa: Fire Protection Association (NFPA) Licensed by agreement, for individual use and downined on 07/06:2019 to Billy Alcom for designated user William Swen. No other reproduction of transmission in any tom permitted sethout arten permission of PAC Forumes orte report enauthonged ase. comtact licensing@peorg Tres NEGES A Access substrpion expires on December 10 2013. 1582-78 COMPREHENSIVE OCCUPATIONAL MEDICAL PROGRAM FOR FIRE DEPARTMENTS elbows (keeping their elbows to their sides) 90 degrees. Indi- vidual must stand erect without arching back.
neutral position. (4) The instructor verifies that the arm/elbow joint angle is 90 degrees and adjusts the chain so that it is taut in this posi- (4) The individual is instructed to squeeze with maximum strength 2 to 3 seconds while exhaling and then slowly release grip. The peak-hold needle will automatically record the high- (5) The individual shall be instructed not to shrug should- ers, bend back, or perform any other motion other than to est force exerted.
contract arms and attempt to move the handlebar in a vertical (5) Measure both hands alternatively allowing three evalua- direction. tions per hand. Reset the peak-hold needle to zero before (6) Instruct the individual to flex arms for a total of obtaining new readings. List the scores for each hand to the nearest kilogram. 3 seconds.
(6) Record the highest score. (7) After 3 seconds, instruct the individual to slowly relax arms and to remain at standing rest for 30 seconds.
C.2.1.6 Leg strength evaluations shall use the Wellness-Fitness Initiative Protocol for Leg Strength. The leg dynamometer (8) Once the individual has completed the 30-second recov- shall be the Jackson Strength Evaluation System or a commer- ery period begin the second evaluation. Repeat evaluation for cial dynamometer system that is digital, incorporates dead load the third time using the same procedure. cells, and includes an adjustable chain, handlebar, and test plat- (9) List all scores. Note: Digital readout will display the form. The fire department must verify that the dynamometer is actual force, the highest peak force, and the average force equivalent to the Jackson Strength Evaluation System. A V-grip achieved during the threc evaluations. handlebar (chinning triangle) is required. [See Figure C.2.1.6.] (10) Record the highest of the three trials to the nearest (1) Conduct pre-evaluation procedures. kilogram.
(2) The individual being evaluated is instructed to towel C.2.1.7 Arm strength evaluations shall use the following proto- hands to ensure they are dry. The individual is advised that the col. The arm dynamometer shall be the Jackson Strength Eval- evaluation is a series of three measurements. The individual is uation System or a commercial dynamometer system that is informed that the isometric arm contraction required during digital, incorporates dead load cells, and includes an adjustable this evaluation must be eased into and then released slowly, chain, handlebar, and test platform. The fire department must without swinging arm, pumping arm, or jerking hands. Inform verify that the dynamometer is equivalent to the Jackson Strength Evaluation System. A straight-grip handlebar
experience back pain, chest pain, light-headedness, ataxia, required. (See Figure C. 2. 1.7.) evaluation. (1) Conduct pre-evaluation procedures.
(3) The individual is instructed to stand upon the dynamom- (2) The individual being evaluated is instructed to towel eter base plate, which has been placed on a level and secure hands to ensure they are dry. The individual is advised that the surface, with fect spread shoulder width apart. The individual evaluation is a series of three measurements. The individual is is instructed to hold the bar with a wide grip and bend their informed that the isometric leg extension required during this evaluation must be eased into and then released slowly, without bending back, swinging arm, pumping or bending arm, or jerk- ing hand. Inform the individual that if at anytime during the evaluation they experience back pain, chest pain, light- headedness, ataxia, confusion, nausea, or clamminess, they should terminate the evaluation.
(3) The individual is instructed to stand upon the dynamom- eter base plate, which has been placed on a level and secure surface, with feet spread shoulder width apart. The individual is instructed to stand erect. The chain is then adjusted so the upper (inside) edge of the bottom cross member of the V-grip handlebar is at the top of the individual's kneecap. The evalua- tor verifies this position, ensuring the chain is taut. (4) The individual is then instructed to hold the bar, look straight with head in the neutral position, fully extend arms, and maintain a straight back. The evaluator shall verify this position and ensure that the individual's hips are directly over their feet, with trunk and knees slightly bent.
(5) Instruct the individual to lift using their legs for a total of 3 seconds.
(6) After 3 seconds, instruct the individual to slowly relax arms and legs and to remain at standing rest for 30 seconds.
FIGURE C.2.1.5 [Hand Grip Dynamometer.]
2018 Edition Shaded text = Revisions. A = Text deletions and figure/table revisions. • = Section deletions. N = New material.
Copvrich: 2019 National Fire Protection Association (NFDA) Lucersed by egreement for individual use and download on: O7/06/2019 in Bly Aicom for designated user Willem Swen No other reproduction or transmission in any ince permined without witten permission ofFPAS Foringenes ontoropert treatherzed use contact [email protected] This N° CES All Access Buespion excires on Decembe: 19, 2019 ANNEX C 1582-79
(7) Once the individual has completed the 30-second recov- weight and record in kilograms (# Ibs ÷ 2.2 = kg). Conduct pre- ery period begin the second evaluation. Repeat the evaluation evaluation procedures. Place the jumping mat on a level for the third time using the same procedure. surface. Connect the cord attached to the jumping mat to the handheld computer port. With the participant off the mat, (8) List all scores. Note: Digital readout will display the turn the computer on. Choose "One Jump" actual force, the highest peak force, and the average force menu. The display should read "Step on Mat." Have the partici- achieved during the three evaluations. pant squat to a position where the knees are at a 90° angle and (9) Record the highest of the three trials to the nearest kilo- the hands by the sides (momentary pause at 90° [see Figure C.2. 1.8(a)]. Instruct the participant to jump straight up as high gram.
as he/she can, reaching toward the ceiling or a target object, C.2.1.8 WFI Vertical Jump - Optional Assessment. LEG without tucking the legs, and land with both feet on the mat POWER ASSESSMENT [see Figure C.2.1.8(b)]. When the participant has completed the jump, the display will read the hang time and vertical jump in Equipment: inches. The vertical jump mode resets automatically. Have the (I) Pressure Mat — "Just Jump" Probotics participant perform a series of 3 jumps and record the highest Safety Tape - or any object that can be suspended above the mat to act as a target
(3) Calculator
Assessment:
The purpose of this assessment is to estimate peak power produced in the lower body. Collect the participant's body FIGURE C.2.1.6 [Leg Dynamometer.] FIGURE C.2.1.7 [Arm Dynamometer.] A = Text deletions and figure/table revisions. • = Section deletions. N. = New material. 2018 Edition Shaded text = Revisions.
Copyright 2010 Natone Fire Protecton Association (N-PA) Licenses. By egreement. for individual use and downsad on 0/6/2019 to Mily Alcomfor designated user When Swan No other reproducon or transmission in any for parmated whout watten permiasion of NEPAC. Foringures orto repeat unaulioneed use comest icensingenipe org This NECS At Accass supsaction expires on December 19, 2019. 1582-80 COMPREHENSIVE OCCUPATIONAL MEDICAL PROGRAM FOR FIRE DEPARTMENTS Convert the highest jump achieved in inches to centimeters C.2.1.10 Optional Assessment: WFI Alternate Grip Push-Up (# inches × 2.54 = cm). Use the power formula provided below Test. Equipment:
with the jump height (cm) and body weight (kg) to estimate Push-up handles leg power.
Metronome
Any deviations from the above techniques cannot be coun ted, and the participant must repeat the trial. The following are Stopwatch examples of situations that require a reevaluation: The partici- pant fails to land with both feet on the mat. The participant Prop - 5", plus the height of the handles tucks the legs instead of extending them while jumping. Note:
Administrators can minimize the tendency of participants to tuck the legs by suspending a target object above the mat for The purpose of this assessment is to evaluate muscular the participant to attempt to touch. endurance of the upper body. The alternate grip push-up (with stands) is an optional assessment for participants who experi- Power formula: ence muscular/skeletal discomfort in the performance of the Leg Power (watts) = [(60.7 x jump height (cm)) + (45.3 x standard WFI push-up. Conduct the pre-evaluation procedures. body weight (kg))] - 2055 Advise the participant that the evaluation is a series of push-ups performed in a 2-minute time period to complete a maximum Use the following conversions: of 80 push-ups. The evaluation is initiated from the "up" posi- tion (hands are shoulder width apart, back is straight, and head Height in inches to centimeters (# inches × 2.54 = cm)
is in neutral position). [See Figure C.2.1.10(a).J Advise the partic- Body weight in pounds to kilograms (# Ibs ÷ 2.2 = kg) ipant of the following: It is not permitted to prop feet against a C.2.1.9 Push-up muscle endurance evaluations shall use the Wellness-Fitness Initiative Protocol for Push-ups. Equipment used for this evaluation includes a 5 in. prop (i.e., cup, sponge), a metronome, and a stopwatch.
(1) Conduct pre-evaluation procedures.
(2) The individual is advised that the evaluation is a series of push-ups performed in a 2-minute time period. The individual is advised that the evaluation is initiated from the "up" position neutral position). The individual is informed that they are not must be straight at all times and they must push up to a straight arm position. The individual is instructed to continue perform- ing push-ups in time with the cadence of the metronome, one beat up and one beat down. Inform the individual that if at any time during the evaluation they experience chest pain, light- headedness, ataxia, confusion, nausea, or clamminess, they should terminate the evaluation.
(3) The evaluator places the 5-in. prop on the ground
beneath the individual's chin and the individual must lower their body to the floor until the chin touches this object. (See Figure C.2.1.9(a) and Figure C. 2.1.9(b)./
(4) The metronome should be set at a speed of 80, allowing for 10 push-ups per minute.
(5) The individual has a 2-minute time limit to complete a maximum of 80 push-ups
(6) The administrator shall stop the evaluation when the individual:
(a) Reaches 80 push-ups
(b) Performs three consecutive incorrect push-ups
(c) Does not maintain continuous motion with the metro- nome cadence
(7) Record the highest number of successfully completed push-ups.
FIGURE C.2.1.8(a) [Preparation for Leg Power
Assessment.]
2018 Edition Shaded text = Revisions. A = Text deletions and figure/table revisions. • = Section deletions. N= New material.
Copyngll 2019 Natonal Fire Prolection Association (NA Liensed. by agreement. for individual use and demicad on 07/06/2090 Bily Alcome for designato user Willem Swan. No other reproduction or transnession in any ben pummuted without enter permission of NEPAL Forindunes orto teport ungulhenged use contest loesng@nips org This NOSS All Access subsenpron expires o December 10 2019.
ANNEX C 1582-81
wall or other stationary object. Back must be straight at all times (neutral position). Arms must be fully extended during the up-phase. Cadence with the metronome must be main-
tained, (one beat up and one beat down). Instruct the partici- pant to grasp the push up stands, and assume the "up"
position. (Caution: hex dumbbells may roll.)
Place the modified prop so that the chin of the participant will contact the prop during the lowering phase. (Prop height = 5" plus the height of stands). [See Figure C.2.1.10(b)./ Set the metronome at a speed of 80 bpm, allowing for 40 push-ups per minute for 2 minutes. The assessor shall terminate the evalua- tion when the participant: Reaches 80 push-ups; Performs consecutive incorrect push-ups; or Fails to maintain
continuous motion with the metronome cadence. Once the
assessment is complete, record the highest number of success- fully completed push-ups.
FIGURE C.2.1.9(a) ["Up" Position for Push-Up.]
FIGURE C.2.1.9(b) I"Down" Position for Push-Up.]
FIGURE C.2.1.8(b) [Vertical Jump.]
FIGURE C.2.1.10(a) ["Up" Position for Alternate Grip
Push-Up.J
Shaded text = Revisions. A = Text deletions and figure/table revisions. • = Section deletions. N= New material. 2018 Edition Copyright 2042 National Sure Profecton Association (NPA) Loansed By agreement, for incidual use and download on 07/642016 to Billy Aion for designated user Willer Swan, No other reproduction or transmission in any fore permited ithout waiter permission of NEW. Forinquires orto report unaulimaged use contact censingthpa arg To NEGES All Ardess aubsorpion expires on December 19. 2019. 1582-82 COMPREHENSIVE OCCUPATIONAL MEDICAL PROGRAM FOR FIRE DEPARTMENTS A C.2.1.11 WFI Prone Static Plank - Core Stabilization Assess- is informed that the flexion required during this evaluation ment. must be smooth and slow, as the individual advances the slide on the box to the most distal position possible. Inform the indi- Equipment: vidual that if at anytime during the evaluation they experience Stopwatch back pain, chest pain, light-headedness, ataxia, confusion, nausea, or clamminess, they should terminate the evaluation.
Exercise Mat
(3) The individual is instructed to sit on the floor ensuring Assessment: the head, upper back, and lower back are in contact with the The purpose of this assessment is to evaluate the muscular wall. The individual is instructed to place legs together, fully endurance of the core stabilizer muscles of the trunk. Conduct extended. The sit and reach box with the sliding measurement the pre-evaluation procedures. Instruct the participant to lay guide is placed with the box flat against the feet. (See Figure prone, keeping upper body elevated and supported by the elbows. Raise hips and legs off the floor, supporting the body (4) While maintaining head and upper/lower back contact on forcarms and tocs. Position elbows directly under the with the wall, the individual is instructed to extend arms fully in shoulders. Maintain straight body alignment from shoulder front of their body with the right hand overlaying the left hand, through hip, knee and ankle. The ankles should maintain a with middle finger of each hand directly over each other. The 90° angle, the scapulae should remain stabilized with elbows at rule is set to 0.0 in. at the tips of the middle fingers. The indi- 90°. The spine should remain in a neutral position throughout vidual is then instructed to exhale slowly while stretching slowly the assessment. Once the feet are in position, the participant forward, bending at the waist, and pushing the measuring (See Figure device with the middle fingers. During the stretch, legs are to C. 2.1.11.) Start the stopwatch at this time. Instruct the partici- remain together and fully extended and hands are to remain pant to contract the abdominals so that the back will remain overlaid. [See Figure C. 2.1.12(b).] The stretch is held momentar- flat in the neutral position for the duration of the assessment. ily and the distance obtained. If the individual bounces, flexes Any deviations from the above posture will warrant 2 verbal knee, or uses momentum to increase distance, the evaluation is warnings. If a 3rd infraction occurs stop the watch and termi- nate the assessment. The assessor shall terminate the evalua- tion when the participant reaches 4 minutes or is unable to (5) Instruct the individual to relax for 30 seconds. Once the maintain proper form after the 2nd warning. Once the assess- individual has completed the 30-second recovery period begin ment termination criteria are met, stop the watch and record the second evaluation. Repeat evaluation for the third time using the same procedure.
A C.2.1.12 Sit-and-reach flexibility evaluations shall use the (6) Record the furthest distance from the three trials (roun- Wellness-Fitness Initiative Sit and Reach Protocol. Equipment ded to the nearest ¼ in.) as the final score. used for this evaluation shall be a Novel Acuflex I or equivalent C.2.1.13 Jackson Strength Evaluation System Lafayette Instru- trunk flexibility tester that compensates for variable arm and ment Company Phone: 800-428-7545 or 765-423-1505 Website:
Icg lengths. www.licmef.com
(1) Conduct pre-valuation procedures.
JAMAR Hydraulic Hand Dynamometer Lafayette Instrument
(2) The individual is advised that the evaluation is a series of Company Phone: 800-428-7545 or 765-423-1505 Website:
three measurements that will evaluate the flexibility of the www.licmef.com lower back, hamstring muscles, and shoulders. The individual Novel Acuflex II Trunk Flexibility Tester Novel Products, Inc.
Phone: 800-323-5143 E-mail: [email protected]
StairMaster StepMill StairMaster Phone:
888-678-2476 Website: www.stairmaster.com
Probotics "Just Jump" Mat Probotics, Inc. Phone:
256-489-9153 Website: www.probotics.org 19
(1) LifeFitness 9100HR Treadmill: for information and local distributor contact, LifeFitness, 10601 West Belmont
Avenue, Franklin Park, IL 60131, Phone (847) 288-3300,
fax (847) 288-3791, Website www.lifefitness.com.
FIGURE C.2.1.10(b) ["Down" Position for Alternate Grip (2) Jackson Strength Evaluation System with V-Grip Handle- Push-Up.] bar (chinning triangle): for information and local distrib- utor contact, Lafayette Instrument, 3700 Sagamore
Parkway North, P.O. Box 5729, Lafayette, IN 47903,
Phone (765) 423-1505 or (800) 428-7545, fax (765)
423-4111, Website www.licmef.com (Note: The Jackson
Strength Evaluation System includes a Jamar Hydraulic
Hand Dynamometer).
FIGURE C.2.1.11 [Core Stabilization Assessment.1
2018 Edition Shaded text = Revisions. A = Text deletions and figure/table revisions. • = Section deletions. IN = New material.
Copynah: 2019 Nationa: Fire Protection Association. INFPA Licensed. 2y agreemen!. for indenduai use and downtead on 0/8:2018 to Bly Atom or designated user Willem: Swen No other meproduction: or trensmission in any lore permitted willout water permission of NED Foringumes orto report smashonged use. [email protected] The NFOSS All Accoss subscription expires on December 19 2019 ANNEX D 1582-83
Annex D Pregnancy Issues
This annex is not a part of the requirements of this NFPA document but is included for informational purposes only:
D.1 Introduction.
D.l.1 Due to the legal issues associated with pregnancy and employment (see Section D.2), this annex is intended to serve as guidance for the fire department physician in advising the pregnant fire fighter of the risks associated with performing essential job functions and enabling her in decision-making This has been summarized in an informational handout devel- oped by the Task Group for the pregnant fire fighter (see D.1.2 The majority of pregnant fire fighters will be able to continue to work throughout pregnancy, with some accommo FIGURE C.2.1.12(a) [Sit and Reach Flexibility Evaluation - dations. A point will likely come during the pregnancy when Initial Position.] the physical changes to the body of the pregnant fire fighter will impair her ability to perform some of the essential job tasks, and appropriate restrictions will need to be offered D.2 Legal Framework.
D.2.1 This document does not constitute legal advice. Before developing a pregnancy policy or before restricting or suspend- ing a pregnant fire fighter against her will, fire physicians and the AHJ should seek competent legal advice.
D.2.2 The Pregnancy Discrimination Act of 1978 states that discrimination on the basis of pregnancy or childbirth consti- tutes unlawful sex discrimination under Title VIl of the Civil Rights Act of 1964 [1]. Women who are pregnant or have rela- ted conditions must be treated in the same manner as other applicants or employees with similar abilities or limitations. An employer may not force a pregnant employee to take disability leave if she is able to work and cannot remove her from her duty assignment if she is able and willing to perform it. The FIGURE C.2.1.12(b) [Sit-and-Reach Flexibility Evaluation - Pregnancy Discrimination Act applies to most employers that Forward Position.] have 15 or more employees.
D.2.3 The U.S. Supreme Court ruled in 1991 that
employer may not exclude pregnant women from hazardous
jobs (2]. Therefore, assuming the pregnant fire fighter is will- (3) Jamar Hydraulic Hand Dynamometer: for information ing and able to perform her essential job tasks, fire agencies should give options to pregnant fire fighters, but ultimately it is up to the individual fire fighters to decide, after consultation 323-5547 (Note: The Tackson Strength Evaluation System with their personal physicians, whether to accept a light duty includes a Jamar Hydraulic Hand Dynamometer). assignment or other reasonable changes in their job assign- Novel Acuflex II Trunk Flexibility Tester: for information ments. (4)
and local distributor contact, Novel Products Incorpora- D.3 The pregnant fire fighter can be exposed to the following ted, Post Office Box 408, Rockton, IL 61072-0408, Phone hazards associated with adverse outcomes to the pregnancy or 323-5143, fax (815)624-4866, E-mail damage to the fetus:
[email protected].
Polar Heart Rate Monitor: for information and local (1) Physical hazards, including heat, trauma, radiation, and (5)
noise.
distributor contact, Polar Electro Inc., 370 Crossways Park Drive, Woodbury, NY 11797, Phone (800) 227-1314; (2) Chemical hazards, including exposure to carbon monox- Canada (888) 918-5043, fax (516) 364-5454, Website other products of combustion cyanide, acrolein, formaldehyde, benzene, acetaldehyde, www.polarus.com.
StairMaster StepMill SM-916 or 7000 PT: for information formic acid), heavy metals, and organic solvents. (6) Biological hazards. As first responders, fire fighters are at and local distributor contact, StairMaster Sports/Medical Products, L.P., 12421 Willows Road, NE, Suite 100, Kirk- a higher risk of exposure to infectious agents. Pregnancy land, WA 98034, Phone (425) 823-1825, ext. 7605, fax by itself does not increase that risk. However, with some (425) 821-3794, Website www.stairmaster.com. agents (e.g., novel HINI influenza), the risk of complica- tions is higher during pregnancy. Pregnant fire fighters should be aware of these risks and follow good hygiene
principles.
Shaded text = Revisions. A = Text deletions and figure/table revisions. • = Section deletions. N= New material. 2018 Edition Copyngh: 2012 Natiena: Fire Prolection Association (FPARLicensed Py spreement, fer indivice use and downied on 07706/2016 to Billy Alcom for designated user Wiliam Swan No ether reproducien ur hansmssion in any fore permited windhi witten parmission ef NEPAIR Foringunies orto report unauthenged vee, contact licensing @ripe org This NESS All Access subserpton expires on Decumber 10, 2013 1582-84 COMPREHENSIVE OCCUPATIONAL MEDICAL PROGRAM FOR FIRE DEPARTMENTS D.4 Physical Hazards. limited, and adequate hydration should be maintained with physical activity.
D.4.1 Trauma.
D.4.5 Physical Activity. Prolonged working hours, heavy lift- D.4.1.1 The uterus extends out of the protection of the pelvis ing, prolonged standing, and heavy physical workload have after 13 weeks and is therefore more susceptible to direct been associated with preterm birth, lower birth weight, and trauma (to the uterus or the fetus) after that gestational point pre-eclampsia [14,28]. (See D.11.3.) [3].
D.4.6 Radiation. Fire fighters assigned to patient transport via D.4.1.2 Fetal mortality due to nonuterine trauma is increased aircraft or other high-altitude aviation may encounter radiation during the first. 23 weeks, possibly due to higher susceptibility exposure of significance to a fetus [35,36]. (See D.11.4.) to maternal hypotension during the first and second trimesters (4,5]. D.5 Chemical Hazards.
D.4.1.3 With blunt trauma, the leading causes of fetal death D.5.1 Carbon Monoxide. Carbon monoxide exposure during are maternal shock, abruption, and uterine rupture [3]. Direct pregnancy is associated with miscarriage, malformations, fetal injury from blunt trauma is rare [5]. mental retardation, and low birth weight [32,38,39].
D.4.1.4 Fetal mortality rates due to maternal trauma [3]: D.5.2 Products of Combustion. Other chemicals toxic to the fetus that are found in products of combustion include
(1) Overall with major trauma: 10 percent to 65 percent benzene, acrolein, formaldehyde, hydrogen cyanide, acetalde- [4,5,6] hyde, chloroform, and formic acid [32,38,39]. Both fire (2) Overall with minor trauma: 1 percent to 5 percent [3,5] In case of maternal pelvic fracture: 25 percent to suppression and overhaul phases can expose firefighters to (3) toxic chemicals [40].
35 percent [5,7]
(4) Gunshot wound to abdomen: 30 percent to 50 percent D.5.3 Exposure to Lead and Other Metals. Lead exposure during pregnancy is associated with serious materno-fetal complications, including miscarriage, premature rupture of D.4.1.5 Long-term outcomes after trauma, besides fetal loss, membranes, pre-eclampsia, hypertension, and neurobehavioral clude less preter labor and birth eight e effects in infants and children [41,42,43]. Even at low levels, found to be nearly double in a series of patients discharged lead exposure has been associated with preterm delivery; congenital abnormalities [44]; and decreased birth weight, from a trauma center (8].
length, and head circumference [45]. Current research
suggests that there is no safe lead exposure threshold to chil- dren, infants, and fetuses [43,46,47]. (See D.11.5.)
harness between the breasts); improper placement can result D.5.4 Exposure to Organic Solvents. Some organic solvents, like xylene, might be harmful to the fetus [18].
fetal mortality (fivefold reduction) in a series of cases of preg- D.5.5 Other Chemicals. Clandestine drug laboratories and nant patients injured in motor vehicle accidents 19]. hazardous-material scenes should be avoided. Clandestine drug D.4.1.7 Standard personal protective quipment is not laboratories can expose fire fighters to a variety of toxic chemi- cals, some of which are potentially injurious to the fetus (49]. designed to protect the fetus. The personal protective equip- Extensive exposure to exhaust fumes might be dangerous ment fitted pre-pregnancy might not offer the same level of because of exposure to carbon monoxide, benzene, and other protection during pregnancy. organic solvents from motor vehicles. In the United States, gas D.4.2 Noise. Noise exposure during pregnancy has been asso- used for regular road traffic does not contain benzene. In ciated. in human studies, with several developing countries that use leaded gasoline, lead exposure including miscarriage (10,ll], intrauterine growth retardation can be significant problem for fire fighters exposed to exhaust [11,12,13], preterm delivery (11,14], hearing loss in babies and fumes [52]. children [15,16], and hypertension in pregnancy [11]. In a review of 10 studies on pregnancy and noise, most studies did D.6 Medical Issues. The American College of Obstetricians not achieve statistical significance in showing negative effect of and Gynecologists has published a list of medical contra- noise [17]. The safe threshold of noise exposure during preg- indications to exercise during pregnancy[53] [Exercise during nancy is unknown [18]. (See D.11.1.) pregnancy and the postpartum period. ACOG Committee.
Opinion No. 267. http://mail.nyacog.org/website/SMIPod- D.4.3 Shift Work. Alternating shift work and night work have cast/Exercise.pdf]. That list could be used to recommend work been associated with preterm birth [24,25], miscarriage (26] accommodation to pregnant fire fighters who are suffering and lower birth weight (25,27]. Existing research is controver- from specific complications. sial. (See D. 11.2.)
D.7 Risks by Trimesters. Table D.7 lists risks by trimester and D.4.4 Heat. In animal studies, increase in maternal core during lactation. temperature over 1.5°C has been shown to be teratogenic [30]. D.8 Recommended Activity Modifications During Pregnancy.
Core temperature has been shown to be up to 39°C in training [31,32]. Hyperthermia creates the highest risk during the first ).8.1 The following activities are not recommended durin two months of pregnancy [33,34]. Sports Medicine Australia he entire pregnancy recommends a pregnant woman "to avoid exercise in hot
conditions" [33]. Exercising in a warm environment should be (1) Exposure to excessive heat 2018 Edition Shaded text = Revisions. A = Text deletions and figure/table revisions. • = Section deletions. N= New material.
Copynch: 2019 National Fire Protection Assocation (NfP: Licensed, by agreement, for individual use and downicad on 07/062019 to Billy Alcom for designated user William Swan No omer reproduction or transmission in any tere petritten without watten germission of NEPA Forinquiries ore report unauthenced use, comact tensingdenipe cea InS NEOSE Ail Access subscrotion expires on December 19. 2019.
ANNEX D 1582-85
(2) Hazmat assignment, exposure to products of combustion D.9.2 Once the fire fighter requests to return to full duty with or toxic chemicals the consent of her treating health care provider, all restrictions (3) Use of encapsulating protective gear for patrol duty and training should be lifted, unless other medi- (4) Exposure to ionizing radiation [18,35] cal issues are present. (5) Exposure to prolonged vehicular exhaust or high-volume vehicular traffic (see D.8.1.1) D.9.3 The physician should consider various issues such as the (6) Aviation (including helicopter) unit assignment following [55]:
[18,35,36,37] (1) Delivery trauma and mode of delivery
C-section healing (See D.11.7.)
D.8.1.1 Recommendations by Trimester. Physical deconditioning, fatigue, and lack of sleep (1) First trimester: Musculoskeletal conditions (e.g., back pain, carpal tunnel (a) Modified, nonhazardous duty only if requested by syndrome, tendonitis) the fire fighter in consultation with her personal Pregnancy-related issues (treating) physician. (a) Hypertension
(b) The fire physician should ensure that the fire (b) Eclampsia fighter and her treating physician are aware of risks (c) Gestational diabetes created by the job assignment. (d) Post-partum depression (c) All recommendations stated in D.8.1 (e) Post-partum thyroiditis (2) Second trimester: (f) Deep venous thrombosis
(g) Anemia
(a) An accommodation for maternity uniform may be
needed (h) Other complications
(b) The following are not recommended: D.10 Post-Delivery: Lactation. i. Assignments with alternating shift work
ii. Heavy lifting and prolonged standing D.10.1 Fire fighters who are breastfeeding should avoid unprotected exposure to toxic levels of heavy metals and other All recommendations stated in D.8.1
chemicals.
(3) Third trimester:
(a) The fire fighter may have to be taken off hazardous D.11 Notes. duties if she is unable to perform the required job D.ll.I Intrauterine measurements showed that the fetus was functions due to issues with balance, speed, or agil- not significantly protected against loud noises [19]. One study ity. She should be given a modified duty assignment. in human volunteers found a maximal intrauterine noise (b) An accommodation for maternity uniform may be attenuation of 10 dB at 4000 Hz (20]. In a study of ewes, the needed.
noise attenuation was 20 dB at 4000 Hz, but low-frequency (c) The following are not recommended: sounds less than 250 Hz were 2 to 5 greater inside the uterus [21]. The sound of a siren can reach up to 110 dB inside the cab of an emergency vehicle [22,23]. The Navy and Marine (d) All recommendations stated in D.8.1 Corps Public Health Center makes the following recommenda- tions:
D.9 Post-Delivery: Return to Work.
"1. The ACGIH (American Conference of Governmental
D.9.1 Because of different types of deliveries and associated Industrial Hygienists] 115 dBC TWA [time weighted average] complications, return-to-work decisions should be based upon and peak 155 dBC noise notations should be observed as exclu- an individualized evaluation of the fire fighter's current status sion criteria starting at 20 weeks gestation. Excluding pregnant and the requirements of her work assignment. (See D.11.6.) women from discharging firearms after 20 weeks would be consistent with those criteria.
A Table D.7 Risks by Trimester and During Lactation
First Trimester Second Trimester Third Trimester Lactation Trauma The risk of direct fetal The risk of direct fetal The risk of direct fetal No additional risk. trauma is mitigated trauma is increased auma is increase lue to the location of due to the intra- le to the intr iterus, which is a abdominal position ibdominal position elvic organ in th after 13 weeks. ufter 13 weeks
rst trimeste
Chemicals Avoid exposure to heavy Avoid exposure 1o Avoid exposure 10 Avoid exposure to metals, hydrocarbons, heavy metal: leavy metal heavy metals, carbon monoxide lydrocarbons ydrocarbons hydrocarbons,
carbon monoxide. carbon monoxide. carbon monoxide.
Other risks Heat, noise, radiation, leat, noise, radiation Leat, noise, radiation No additional risk. shift work, infections. hift work, infection: shift work, infections Shaded text = Revisions. A = Text deletions and figure/table revisions. • = Section deletions. N= New material. 2018 Edition Copyright 2010 National Fire Protection Aseociation (UFPA Licensed By agreement. for indivisual use and download on 07/00/2019 to Billy Alcort for designated user Willem Swan No other reorduction or transmission in any faint permited without waten permiasion of NEPAD, Forinquines onto report unauthorzed use. contact consing@nipa org Enis NECES Al Access subsception soires on December 19 2019 1582-86 COMPREHENSIVE OCCUPATIONAL, MEDICAL PROGRAM FOR FIRE DEPARTMENTS
2. Pregnant workers should be vigilant in wearing hearing (5) Mattox KL, Goetzl L. Trauma in pregnancy. Crit Care Med protectors whenever environmental noise exceeds 84 dBA, to 2005;33(10): S385-9. minimize potentially unhealthy maternal cardiovascular and (6) Ali J, Yeo A, Gana T, McLellan BA. Predictors of fetal endocrine effects on the growing fetus. mortality in pregnant trauma patients. J Trauma. 1997;42(5):782-5
3. Extended exposures (more than 12 minutes) above 104 (7) Leggon RE, Wood GC, Indeck MC: Pelvic fractures in dBA should be avoided after 20 weeks gestation, even with the factors influencing maternat and fetal pregnancy:
use of maternal hearing protection. outcomes. / Trauma 2002;53(4): 796.804.
4. Impact/impulse noise exposure sufficient to require Sperry JL, Casey BM, McIntire DD, et al. Long-term fetal personal hearing protection should be avoided" [18]. outcomes in pregnant trauma patients. Am J Surg. 2006;192(6):715-21.
D.11.2 In a review of studies on pregnancy and shift work, 8 (9) Luley T, Brown HL, Fitzpatrick FB, Hocker M. Trauma out of 12 studies showed a significant (but usually small) during pregnancy: restraint use and perinatal outcome adverse effect of alternating shift work on pregnancy [17]. In a after motor vehicle accidents. Obstel Gynecol 2008;111:IS. meta-analysis of 17 studies of shift work during pregnancy, the (10) Zhang J, Cai WW, Lee DJ. Occupational hazards and authors found a significant but small (relative risk 1.2) effect of pregnancy outcomes. Am / Ind Med 1992;21 (3):397-408. shift work on preterm delivery; but no association between shift (11) Zhan C, Lu Y, Li C, Wu Z, Long Y, Zhou L, et al. A study work and birth weight [28]. In a meta-analysis of 4 studies of of textile noise influence on maternal function and pregnancy among nurses, shift work was significantly associated embryo-growth. Hua Xi Yi Ke Da Xue Xue Bao. with a slightly increased risk of miscarriage (29]. 1991;22(4):394-8.
D.11.3 In a meta-analysis of 53 studies of occupational expo- (12) Hruba D, Kukla L, Tyrlik M. Occupational risks for sures (prolonged working hours, shift work, lifting, standing human reproduction: ELSPAC Study. European Longitu- dinal Study of Pregnancy and Childhood. Cent Eur J
and heavy physical workload) during pregnancy, the authors found a significant but small effect of long working hours Public Health 1999;7(4):210-5.
Hartikainen AL, et al. Effect of occupational noise on
(beyond 40 hours a week) on preterm birth; and a significant the course and outcome of pregnancy. Scand J Work Envi- but small effect of prolonged standing (more than 3 hours day) ron Health 1994;20(6): 444-50.
on preterm birth. The influence of these occupational expo- Luke B, Mamelle N, Keith L, et al. The association
sures on pre-eclampsia is less clear [28]. preterm birth:
between occupational factors
D.11.4 Aviation-related (including helicopters) potential United States nurses' study. Research Committee of the hazards for the fetus include vibration, noise, jet fuel, and alti- Association of Women's Health, Obstetric, and Neonatal tude (18,37]. Nurses. Am / Obstet Gynecol 1995;173(3 Pt 1):849-62.
Pierson LL. Hazards of noise exposure on fetal hearing
D.11.5 Inorganic lead is absorbed by inhalation and ingestion. Semin Perinatol 1996:20(1):21-9 Blood absorption of inhaled lead is 30-40%, and blood absorp- Lalande NM, Hétu R, Lambert J. Is occupational noise tion of ingested lead is 5-15%. Lead is then mostly stored in exposure during pregnancy a risk factor of damage to bones. The half-life of lead is 1 to 3 months in blood and soft the auditory system of the fetus? Am JInd Med tissues and 10 to 25 years in bones. Lead crosses the placenta 1986;10(4):427-35. and is transmitted from the mother to the fetus. Lead is excre- Nurminen T. Female noise exposure, shift work, and ted mainly through the kidneys and gastrointestinal tract. Lead reproduction. | Occup Environ Med 1995;37 (8):945-50. is also excreted in breast milk [42,43,48]. Navy and Marine Corps Public Health Center. Reproduc- D.11.6 Sports Medicine Australia recommends waiting for up tive and Developmental Hazards: A Guide for Occupa- to 6 weeks after delivery before performing intense physical tional Health Professionals. Portsmouth, VA; April 2010. exercises [54]. www.nehc.med.navv.mil/downloads/occmed/ Repro2010d2.pdf
D.11.7 In a series of 100 patients with complications after a C- Gerhardt KJ, Abrams RM, Huang X, Griffiths SK, Peters section, the most common complications were endomyometri- AJ. Intra-abdominal sound pressure levels patients), wound infection (32 patients), wound impulse noise exposure in sheep. Mil Med 2000;165(2):
hematoma (22 patients) and postpartum hemorrhage (12
patients). Wound dehiscence was seen in 4 patients. All compli- Richards DS, Frentzen B, Gerhardt KJ, McCann ME, cations were seen within 10 days of the surgery [56]. Sports Abrams RM. Sound levels in the human uterus. Obstet Medicine Australia recommends waiting for 6 weeks after C- Gynecol. 1992;80(2): 186-90. section to resume exercising [54). Gerhardt KJ, Abrams RM, Oliver CC. Sound environ- D.12 Pregnancy References. ment of the fetal sheep. Am J Obstet Gynecol 1990;162(1):
(1) Pregnancy Discrimination Act, 42 USC §2000e(k) (22) Johnson DW, Hammond RJ, Sherman RE. Hearing in an (2) Automobile Workers v. Johnson Controls. 499 US 187 ambulance paramedic population. Ann Emerg Med (1991). 1980;9(11):557-61.
(3) Hill CC. Trauma in the obstetrical patient. Women's (23) Pepe PE, Jerger J, Miller RH, et al. Accelerated hearing 2009;5 (3):269-83. loss in urban emergency medical services firefighters. www.medscape.org/viewarticle/701797 Ann Emerg Med 1985;1 4(5):438-42.
Theodorou DA, Velmahos GC, Souter I, et al. Fetal (24) Bodin L, Axelsson G, Ahiborg Jr G. The association of pregnancy. Am Surg shift work and nitrous oxide exposure in pregnancy with 2000;66:809-12. birth weight and gestational age. Epidemiology 1999;10(4):429-36.
2018 Edition Shaded text = Revisions. A = Text deletions and figure/table revisions. • = Section deletions. N = New material.
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(25) Xu X, Ding M, Li B, et al. Association of rotating shift- (43) Agency for Toxic Substances and Disease Registry. Toxi- work with preterm births and low birth weight among cological Profile for Lead. U.S. Department of Health never smoking women textile workers in China. Occup and Human Services, Public Health Service. Atlanta, GA:
Environ Med 1994:51:470-4. 2007. www.atsdr.cdc.gov/toxprofiles/tp13.pdf Axelsson G, Lutz C, Rylander R. Exposure to solvents (44) O'Halloran K, Spickett JT. The interaction of lead expo- and outcome of pregnancy in university laboratory sure and pregnancy. Asia Pac J Public Health. 1992;6(2):
employees. Br J Ind Med 1984;41:305-12. 35-9.
Zhu JL, Hjollund NH, Olsen J. Shift work, duration of (45) Osman K, Akesson A, Berglund M, et al. Toxic and pregnancy, and birth weight: the National Birth Cohort essential elements in placentas of Swedish women. Clin in Denmark. Am J Obstet Gynecol 2004;191(1):285-91. Biochem 2000;33(2): 131-8 Bonzini M, Coggon D, Palmer KT. Risk of prematurity, (46) Lanphear BP, Hornung R, Khoury J, et al. Low-level envi- low birthweight and pre-eclampsia in relation to working ronmental lead exposure and children's intellectual hours and physical activities: a systematic review. ccup function: an international pooled analysis. Environ Health Environ Med 2007;64(4): 228-43. Perspect 2005;113(7):8949 Quansah R, Jaakkola JJ. Occupational exposures and (47) Centers for Disease Control and Prevention. Preventing adverse pregnancy outcomes among nurses: a systematic Lead Poisoning in Young Children. Atlanta, GA.; 2005. review and meta-analysis. J Women's Health (Larchmt). www.cdc.gov/nceh/lead/publications/PrevLeadPoison- 2010;19(10):1851-62. ing.pdf
(30) Artal R, O'Toole M. Guidelines of the American College (48) Saryan LA, Zenz C. Lead and its compounds. In: Zenz C, of Obstetricians and Gynecologists for exercise during Dickerson OB, Horvath EP, eds. Occup Med 3rd ed. St. pregnancy and the postpartum period. Br / Sports Med Louis, Mo: Mosby; 1994:506-41. 2003;37(1):6-12. http://bjsm.bmj.com/content/ (49) Czarnecki F. Chemical hazards in law enforcement. Clin 37/1/6.full Оссир Environ Med 2003;3(3): 443-456
(31) Agnew J, McDiarmid MA, Lees PS, et al. Reproductive (50) Yorifuji T, Naruse H, Ohki S, et al. Residential proximity hazards of fire fighting. I. Non-chemical hazards. Am / to major roads and preterm births. Epidemiology Ind Med 1991;19(4): 433-45. 2011;22(1):74-80.
(32) vanoff BA. Rosenstock L. Reproductive hazards in th Tomei F, Ghittori S, Imbriani M, et al. Environmental orkplace: a case study of women hrenighters. Am In and biological monitoring of traffic wardens from the Med 1986;9(6):503-15. city of Rome. Occup Med (Lond). 2001;51 (3):198-203. (33) Sport Medicine Australia. SMA statement: The benefits Kamal AA, Eldamaty SE, Faris R. Blood lead level of and risks of exercise during pregnancy. J Sci Med Sport policemen. 2002;5 (1):11-9. 1991;105:165-70.
(34) Hale RW, Milne L. The elite athlete and exercise in Exercise during pregnancy and the postpartum period. pregnancy. Semin Perinatol 1996;20:277-84. ACOG Committee. Opinion No. 267. American College (35) Nicholas JS, Copeland K, Duke FE, Friedberg W. Galac- of Obstetricians and Gynecologists. Obstet Gynecol tic cosmic radiation exposure of pregnant aircrew 2002,99:171-3 http://mail.ny.acog.org/website/ members II. Federal Aviation Administration Report
DOT/FAA/AM-00/33. Washington, DC; October 2000. Sports Medicine Australia. Exercise in Pregnancy. www.faa.gov/library/reports/medical/oamtechreports/ Women in Sport - Fact Sheet. Mitchell, Australia. 2000s/media/00_33.pdf http://sma.org.au/wp-content/uploads/2009/10/WIS Federal Aviation Administration Advisory Circular No
120-61A. In-Flight Radiation Exposure. U.S. DOT, July 6, (55) McGovern P, Dowd B, Gjerdingen D. Mothers' health www.airweb.faa.gov/Regulatory_and_ and work-related factors at 1l weeks postpartum. Ann ance_Library/rgAdvisoryCircular.nsf/ Fam Med 2007; 5(6): 519-27. 0/0e9f4e29ad41d6ce86257la7005a8288/$FILE/AC (56) Hadar E, Melamed N, Tzadikevitch-Geffen K, et al. %20120-61A.pdf Timing and risk factors of maternal complications of Van Dyke P. A literature review of air medical work 13541. peci01o Mar necol Obste 2011 Apr:283(4). hazards and pregnancy. Air Med 12010:29(1):40-7.
(38) McDiarmid MA, Agnew J. Reproductive hazards and fire- ighters. Occup Med 1995 Oct-Dec;10(4):829-41.
(39) McDiarmid MA, Lees PS, Agnew J, et al. Reproductive Annex E Sample Physician Evaluation Form for Fire Fighters hazards of fire fighting. II. Chemical hazards. Am J Ino with Diabetes Med 1991;19(4):447-72. This annex is not a part of the requirements of this NFPA documen (40) Bolstad-Johnson DM, Burgess JL, Crutchfield CD, et al. but is included for informational purposes only Characterization of firefighter exposures during fire
overhaul. AIHA/ 2000 Sep-Oct;61 (5):636-41.
(41) Winder C. Lead, reproduction and development. Neuro- afely perform the essential job functions of a fire fighte toxicology 1993;14(2-3):303-17.
(42) Gardella C. Lead exposure in pregnancy: a review of the literature and argument for routine prenatal screening.
Obstet Gynecol Surv 2001;56(4):231-8.
Shaded text = Revisions. A = Text deletions and figure/table revisions. • = Section deletions. N = New material. 2018 Edition Copynch: 2019 Natone: Fire Protection Association (FPA6). Licensed By egreement, for individual ase and downina on 0706201010 Bill Alcom for designated user When Swan No other reproduction or transmission in any lora permitted without witten connission eNER, Foringunes orto report unauthonged uce contact keensmgenipe oro Tre NECES AlACeS subsopron exotes on Documbr 19 2019 1582-88 COMPREJENSIVE OCCUPATIONAL, MEDICAL PROGRAM FOR FIRE DEPARTMENIS
PHYSICIAN EVALUATION FORM
FOR FIRE FIGHTERS WITH DIABETES MELLITUS
You are being asked to evaluate an individual for a position as a fire fighter (FF). It is essential that the FF undergo the individual meets these guidelines.
I. Introduction
The educated and motivated FF or FF applicant with well-managed diabetes mellitus can be capable of safe and effective job performance. An individualized assessment of the FF's or FF applicant's diabetes should be performed, including an assessment of the following:
• History of blood glucose control
• Current stability of blood glucose
• Risk for significant hypoglycemia or hyperglycemia
• Presence of diabetic complications
• Knowledge of diabetes and its management
Risk of hypoglycemia remains the major concern in regard to those with diabetes being or becoming a FF.
This risk occurs primarily in those taking insulin, particularly those with type 1 diabetes, although it may also occur in those with type 2 diabetes who take insulin and/or sulfonylureas and other secretagogues. ire fighting entails a unique set of conditions that need to be considered in regard to those with diabete nd the risks of either hypo or hyperglycemia. These may include (depending upon the duties of the particula FF position):
• unpredictable periods of maximal physical exertion (e.g., climbing stairs with over 50 pounds of PPE and 20 to 40 pounds of equipment);
• use of encapsulating and insulated personal protective equipment (PPE) that can result in significant fluid loss and dehydration;
• exposure to extreme environmental temperatures;
• during emergency responses with limited access to food, water, and medications for prolonged periods of time;
• emergency response driving with the responsibility for others in the vehicle; • critical, time-sensitive complex problem solving in hazardous environments; : unpredictable meal schedules;
control of one's emotions under stress;
• functioning as a team where sudden incapacitation can result in mission failure or risk of injury or death to civilians or other team members.
© 2017 National Fire Protection Association NFPA 1582 (p. 1 of 6) A FIGURE E.1 Physician Evaluation Form.
2018 Edition Shaded text = Revisions. A = Text deletions and figure/table revisions. • = Section deletions. N = New material.
Copyngh: 2019 Nationa: Fire Protecton Asociation (FPA) scensed, by agreement. for indivichase and download on C7/06/2015 to Billy acon: to designated user Willian Swan No orner reproducien or transmission in any form permitted without watten pommission of NEPE Foringuines orto report unauthonzed wee. contacticensing @rip2.ore This NFOSS All Access sunserpuon expres on December 10. 2013 ANNEX E 1582-89
Il. Assessment
1. FF has been under the care of an endocrinologist or other physician knowledgeable about diabetes management. Outpatient and in-patient medical record(s) of the last three years or since date of iagnosis (whichever is shorter) should be reviewed by the treating physician and provided to the fir epartment physicia
My credentials as a physician knowledgeable about diabetes management are as follows (or attach CV):
This person has type 1 diabetes O type 2 diabetes
Date of diagnosis:
Attach records for prior 3 years or since onset of diabetes whichever is shorter for O out-patient treatment Oin-patient treatment
2. TEx 8) morahs per has beaunt on a a bolus regimen or an insulin pump using analogue insulins for the Current insulin regimen:
Insulin pump brand and model:
Pump settings:
Start Time
Basal Rate
Start Time
Basal Rate
Usual Bolus doses:
Breakfast
Lunch
Supper
Other
Correction factor:
Multiple dose insulin (specify regimen)
Basal:
Bolus:_
Starting date on current regimen: /
© 2017 National Fire Protection Association NFPA 1582 (p. 2 of 6) A FIGURE E.I Continued
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3. If type 2 diabetes on insulin, has been on a stable medication regimen for the three (3) months prior to evaluation: IF on oral agents alone, should be on a stable medication regimen for one month prior to Current medication regimen:
oral agents insulin
Starting date on current regimen:
4. Has documentation of ongoing self-monitoring of blood glucose. This must be done with a glucose meter that stores every reading, records date and time of reading and from which data can be downloaded.
Tonitoring records must be available covering the time periods (1, 3, or 6 months), as described i ections 2 and 3, following a schedule acceptable to the fire department physician The individual has been asked to test glucose times a day, and • IS adhering to my recommended schedule for testing.
O is NOT adhering to my recommended schedule for testing.
Glucose logs
• are attached for review
• are not attached for review (please explain)
5. Has been educated in diabetes and its management and thoroughly informed of and understands the procedures that must be followed to monitor and manage his/her diabetes and what procedures should be followed if complications arise.®
The individual has completed the following diabetes education (include year of completion):
6. If an insulin pump user, documents
• proper understanding and education in the use of the insulin pump start date for the use of the pump
• history of insulin site infections
• history of pump cessation and pump malfunction
backup plan for pump malfunction, including use of injectable insulin • frequency of infusion set changes
The indie jdua coppetited the following education in the use of a continuous insulin infusion pump © 2017 National Fire Protection Association NFPA 1582 (p. 3 of 6) A FIGURE E.I Continued
2018 Edition Shaded rext = Revisions. A = Text deletions and figure/table revisions. • = Section deletions. N.= New material.
ANNEX E 1582-91
The individual routinely carries appropriate supplies to compensate for pump malfunction, including syringes and insulin vials or insulin pens.
• Yes • No - please explain
The individual has had more than one pump site infection that caused him / her to miss work or usual daily activities in the preceding six months.
• Yes - please explain • No
7. Has had hemoglobin A1C measured at least four times (intervals of two to three months) over the 12 months prior to evaluation if diagnosis has been present over a year.7,8 Date HbAIC
8. If the individual's A1C was found to be 8% or above on one or more occasions, has the validity of that level been confirmed by a second determination?
• Yes • No (please explain)
9. If the second determination specified above was done, is there reason to suspect that the original A1C levels) overestimates average blood glucose?
• Yes • No
10. Incapacitating events — Has not had any within the past one (1) year and no more that two (2) episodes in the past three (3) years, or since diagnosis of diabetes (whichever is shorter) of a. severe hypoglycemia (loss of consciousness, seizures or coma, requiring the assistance of others or needing urgent treatment (glucose injection or IV glucose]) or b. a blood sugar < 60 mg/dl with unawareness demonstrated in current glucose logs.
Has this individual had an episode of hypoglycemia as described above? • Yes ° No
If the individual has had such episode(s), please describe episodes and provide dates or episodes
11. Has had a complete eye exam by a qualified ophthalmologist or optometrist, including a dilated retinal exam, demonstrating no more than mild background diabetic retinopathy."° Copy of ophthalmology or optometry report is attached
0 Yes • No (please explain)
© 2017 National Fire Protection Association NFPA 1582 (p. 4 of 6) A FIGURE E.1 Continued
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2. Has normal vibratory testing with 128 Hz tuning fork, has normal testing with 10 gram Semmes-Weinsteil monofilament" and normal orthostatic blood pressure and pulse testing.' Vibration sensation:
Monofilament:
BP supine: Pulse supine: _
BP standing: Pulse standing:
13. Has normal cardiac physical exam and normal cardiac stress testing to at least 12 METS. Annual cardiac stress testing 1 should begin when any of the following criteria are met:
• age greater that 35 years
• Type 1 DM greater than 15 years duration
• Type 2 DM greater than 10 years duration
• signs of target organ damage (eyes, kidney, autonomic, cardiac) any other coronary artery disease risk factors
Copy of stress test report performed within the last 12 months is attached:
• Yes • No (please explain)
14. Has normal renal function based on albumin/creatinine ratio ≤ 30:1, and measured or calculated creatinine clearance > 60 ml/min.!
Serum Creatinine:
Calculated creatinine clearance (Specify method):
B Cockcroft Gault or
• MDRD
Urine microalbumin /creatinine ratio:
III. Treating Physician Statement
The above-named individual meets all of the criteria provided on this form:
See agent aid has at te dave or d indies ali eleduce and wel sae anded in die go perfor- nance as a fire fighter
have reached this opinion after careful review of the above criteria 3 No — not recommended for position
• No, but IS recommended for position (letter of explanation attached) Signature of Physician Date
Printer or Typed Name of Physician Phone Number
@ 2017 National Fire Protection Association NFPA 1582 (p. 5 of 6) A FIGURE E.1 Continued
2018 Edition Shaded text = Revisions. A - Text deletions and figure/table revisions. • = Section deletions. N = New material.
Copyright 2012 Nationa: Fre Protection Association INFRIO. scense. by apreent, or tal we and cosmoad on Drate to Bly Alcern for designated user William Swan No ether reproduction or transmission in any tea permited wiped widen permission of NEPA For incines onto repor: unauthonzes w. contactlcensng@@nippa.org This NECES All Access subsonghon expires on Dacember 19. 2013.
ANNEX E 1582-93
References
1 Times cited for durations of stable treatment regimen or stability of management are in reference to the date of current evaluation for a fire fighter position.
* Dareso yes when pa or ase of ora medication. A sea orel agen regimen is fridas as maintaining the same types t insulin (long acting, intermediate acting, short or rapid acting). Changes in insulin amount are part of the appropriat elf-management of diabetes and do not disqualify an applicant or incumbent under this section * Changes in dose within the evaluation period will be allowed but addition of a new class of medications or insulin should result in a new period of observation:
• one month for addition of a sulfonylurea or metformin • two months for addition of a thiazolidinedione to insulin or a sulfonylurea • three months for the addition of insulin.
• Testing schedules are individual. What follows is a common pattern. Individual patterns may differ.
Therapeutic Regimen Glucose Testing Schedule
Diet alone Once or twice a week
Metformin, Thiazolidinediones, or Alpha Glucosidase Once or twice a week inhibitors alone or in combination
hypoladen Are at super, wich any suspected
Insulin — one shot in combination with orals
Insulin — two or more shots, Insulin pump
6Seehttp://care.diabetesjournals.org/cgi/content/full/28/suppl 1/s72 See http://care.diabetesjournals.org/cgi/content/full/27/suppl 1/s91 • If Hemoglobin A1C > 8% this may signal a problem with diabetes management that warrants further assessment. • See http://care.diabetesiournals.org/cgi/content/full/28/suppl1/s61 1 Noon than 4 odot, blot, or flame-shaped hemorrhages or microaneurym in all four fundus quadrants. ta//wice..
See www.med.umich.edw/mdrtc/textonly/educmats/MNSI howto.doc Orthostatic hypotension is a physical finding defined by the American Autonomic Society and the American Academ (Ner, within see milotes of sane in pw at 20842005126/2391 hood pressure decrease of at leas See Gibbons, et al. [20021. ACC/AHA 2002 guideline update for exercise testing: a report of the American College rdiology/American Heart Association Task Force or Practice Guidelines. Circulation 106(14): 1883-189 1See See calculator: www.nephron.com/mdrd/default.html
© 2017 National Fire Protection Association NFPA 1582 (p. 6 of6) A FIGURE E.I Continued
Shaded text = Revisions. A = Text deletions and figure/table revisions. • = Section deletions. N = New material. 2018 Edition Copyright 2010 National Fire Protection association (NFP Licensed By greenent. for ind vida use and cosmicad on: Drms/2019 to Billy Arcond for designated user Willien. Swan. No omar repreduct on or transmission in any fom perritted whou! witten parmision of NEP? foregoes orto reper unbutor zed 2ee contect censegripeorg This NOSE All Mccess sunserplion gapires on Decent 19, 2013 1582-94 COMPREHENSIVE OCCUPATIONAL MEDICAL PROGRAM FOR FIRE DEPARIMENTS Annex F Informational References Title 29, Code of Federal Regulations, Part 1910.95, "Occu- pational noise exposure," 1996.
F.1 Referenced Publications. The documents or portions
chereof listed in this annex are referenced within the informa F.1.2.4 Additional Publications. tional sections of this standard and are not part of the require American Thoracic Society Guidelines Journal of Occupational and ments of this document unless also listed in Chapter 2 for Environmental Medicine, 2000. other reasons.
Fire Service Joint Labor-Management Wellness-Fitness Initiative, F.1.1 NFPA Publications. National Fire Protection Associa- International Association of Fire Fighters, 1750 New York tion, 1 Batterymarch Park, Quincy, MA 02169-7471. Avenue, NW, Washington, DC 20006; International Association NFPA 1001, Standard for Fire Fighter Professional Qualifications, of Fire Chiefs, 4025 Fair Ridge Drive, Suite 300, Fairfax, VA 2013 edition. 22033, 1999.
NFPA 1002, Standard for Fire Apparatus Driver/Operator Profes- Journal of the American College of Cardiology; October 1994. sional Qualifications, 2017 edition. F.2 Informational References. The following documents or NFPA 1003, Standard for Airport Fire Fighter Professional Qualifi- portions thereof are listed here as informational resources cations, 2015 edition. only. They are not a part of the requirements of this document.
NFPA 1006, Standard for Technical Rescuer Professional Qualifica- F.2.1 Testing Protocols. tions, 2017 edition.
American College of Sports Medicine. 1995. Guidelines for NFPA 1021, Standard for Fire Officer Professional Qualifications, Exercise Testing and Prescription. Baltimore, MD: Williams 2014 edition.
NFPA 1051, Standard for Wildland Fire Fighter Professional Quali- American Industrial Hygiene Association. 1971. Ergonomic fications, 2016 edition. guide to assessment of metabolic and cardiac costs of physical work. Am J Ind Hyg Assoc 32:560-564.
NFPA 1500, Standard on Fire Department Occupational Safety, Health, and Wellness Program, 2018 edition. Bilzon, J. E. J., E. G. Scarpello, D. V. Smith, N. A. Ravenhill, et al. 2001. "Characterization of the metabolic demands of NFPA 1561, Standard on Emergency Services Incident Manage- simulated shipboard Royal Navy fire-fighting tasks." Ergonomics ment System, 2014 edition. 44:766-780.
NFPA 1583, Standard on Health-Related Fitness Programs for Fire Gibbons, R. J., G. J. Balady, J. W. Beasley, et al. 1997.
Department Members, 2008 edition. "ACC/AHA guidelines for exercise testing: a report of the NFPA 1584, Standard on the Rehabilitation Process for Members American College of Cardiology/American Heart Association During Emergency Operations and Training Exercises, 2015 edition. Task Force on Practice Guidelines (Committee on Exercise Testing) "J Am Coll Cardiol 30:260-311.
F.1.2 Other Publications.
Glenhill N, Janitz V 1992. Characteristics of the physical F.1.2.1 ANSI Publication. American National Standards Insti- demands of firefighting. Can J. Spt Scr 17 (3): 2017-213. tute, Inc., 25 West 43rd Street, 4th Floor, New York, NY 10036.
Lemon, P. W., and R. T. Hermiston. 1977. "The human
ANSI S3.6, Specification for Audiometers, 1996. energy cost of fire fighting." J Occup Med 19:558-562.
F.1.2.2 IAFF Publications. International Association of Fire Malley, K. S., A. M. Goldstein, T. K. Aldrich, K. J. Kelly, M.
Fighters, 4025 Fair Ridge Drive, Fairfax, VA 22033. Weiden, N. Coplan, M. L. Karwa, and D. J. Prezant. 1999 "Effects of fire fighting uniform (modern, modified modern The Fire Service Joint Labor Management Wellness-Fitness Initia- and traditional) design changes on exercise duration in New tive, 3rd edition. Available at http://www.iafc.org/files/health- York City firefighters." J Occup Med 41:1104-1115. well_wfi3rdedition.pdf.pdf.
F.1.2.3 U.S. Government Publications. Manning J. E., and T. R. Griggs. 1983. "Heart rate in fire U.S. Government fighters using light and heavy breathing equipment: simulated Publishing Office, Washington, DC 20402.
near maximal exertion in response to multiple work load National Diabetes Information Clearinghouse, National conditions." / Occup Med. 25:215-218.
Institute of Diabetes and Digestive and • Kidney Diseases, National Institute of Health (NIH), Sickle Cell Trait and Other O'Connell, E. R., P. C. Thomas, D. Lee, L. D. Cady, et al. 1986. "Energy costs of simulated stair climbing as a job-related Hemoglobinopathies and Diabetes. Important Information for task in fire fighting." J Occup Med 28:282-285.
Physicians, http//diabetes.niddk.nih.gov/dm/pubs/hemovari- Sothmann, M. S., K. Saupe, D. Jasenof, and J. Blaney. 1992.
Title 21, Code of Federal Regulations, Part 801.420, "Hear- "Heart rate responses of firefighters to actual emergencies." J ing aid devices; professional and patient labeling," 1999. Occup Med 34:797-800.
U.S. Preventive Services Task Force. 1996. Guide to Clinical Title 29, Code of Federal Regulations, Part 1630.2(n) (3), Prevention Services, 2nd edition. Baltimore, MD: Williams & "Regulations to Implement the equal employment provisions Wilkins, 3-14. of the Americans with Disabilities Act," 2003.
2018 Edition
Shaded text - Revisions. A = Text deletions and figure/table revisions. • = Section deletions. N = New material.
Copyrigh: 2012 National Fire Pectection Association NFPA Licensed, Py agreement. for individal use ano downiead or 0708208 to Ply Acon for designated use: Willem Swen. No emer mercue on o* lensmission in any fem parmated without water permission of NEP&D foringuines onto report uneuthonzed use contest leers for Tis NECES Altactess subscroson expires on December 19. 2013.
ANNEX F 1582-95
F.2.2 Spinal Fusion and Its Impact on Adjacent Vertebral Level. Soteriades ES, Kales SN, Liarokapis D, Christiani DC (2003].
Prospective surveillance of hypertension in firefighters. J Clin Eck, J. C., S. C. Humphreys, and S. D. Hodges. 1999. Hypertens 5:315-320. "Adjacent-segment degeneration after lumbar fusion: a review of clinical biomechanical and radiologic studies." Am J Orthope- F.2.4 Asthma and Chronic Obstructive Pulmonary Diseases. dics 1999; 28(6):336-310. Bousquet, J., P. K. Jeffery, W. W. Bussc, and M. Johnson, A.
Lee, C. K. 1988. "Accelerated degeneration of the segment M. Vignola. 2000. "Asthma from bronchoconstriction to airways adjacent to a lumbar fusion." Spine 13(3):375-377. inflammation and remodeling." Am J Respir Crit Care Med 161(5):1720-1745.
A F2.3 Cardiology.
Nadel, J. A., and W. W. Busse. 1998. "Asthma." Am ] Respir Alfred, E. N., E. R. Bleecker, B. R. Chairman, T. E. Dahms, S. Crit Care Med 157(4 Pt. 2):S130-138.
O. Gottlieb, J. D. Hackney, M. Pagano, R. H. Selvester, W. M.
Walden, and J. Warren. 1989. "Short-term effects of carbon Postma, D. S., and H. A. Kerstjens. 1998. "Characteristics of monoxide exposure on the exercise performance of subjects airway hyperresponsiveness in asthma and chronic obstructive with coronary artery disease." N Engl J Med 321(21):1426-1432. pulmonary diseases." Am J Respir Crit Care Med 158 (5 Pt. 2): S187-192.
American Diabetes Association. Standards of Medical Care in Diabetes - 2010. Diabetes Care 33: supplement 1, S11-S61, Prezant, D. J., M. Weiden, G. I. Banauch, G. McGuinness, W. 2010. N. Rom, I. K. Aldrich, and K. J. Kelly. 2002. "Cough and bron- chial responsiveness in firefighters at the World Trade Center Chobanian AV, Bakris GL, Black HR, Cushman WC, Green site." N Engl J Med 347:806-815.
LA, Izzo JL Jr, Jones DW, Materson BJ, Oparil S, Wright JT Jr, Roccella EJ; the National High Blood Pressure Education Senior R. M., and N. R. Anthonisen. 1998. "Chronic obstruc- Program Coordinating Committee [2003]. The seventh report tive pulmonary diseases (COPD)." Am J Respir Crit Care Med of the Joint National Committee [JNC-7] on Prevention, Detec- 157(4 Pt. 2):S139-147. tion, Evaluation, and Treatment of High Blood Pressure. JAMA Sherman, C. B., S. Barnhart, M. F. Miller, M. R. Segal, M. 289:2560-2571. Aitken, R. Schoene, W. Daniell, and L. Rosentsock. 1989. "Fire- Gibbons RJ, Balady GJ. Bricker JT, Chaitman BR, Fletcher fighting acutely increases airway hyperreactivity." Am Reu Resp GF, Froelicher VF, Mark DB, McCallister BD, Mooss AN, Dis 40(1):185-190.
O'Reilly MG, Winters WL Jr. [2002]. ACC/AHA 2002 guideline F.2.5 Pulmonary Function Testing: Challenge Testing and Exer- update for exercise testing: summary article: a report of the cise Testing.
ACC/AHA Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing guidelines). J Am Coll Cardiol American College of Sports Medicine. 1995. Guidelines for 40:1531-1540. Exercise Testing and Prescription. Baltimore, MD: Williams Wilkins.
Greenland, et al. 2007. ACCE/AHA 2007 Clinical Expert.
Consensus Document on Coronary Artery Calcium Scoring By American Thoracic Society, Medical Society of the American Computed Tomography in Global Cardiovascular Risk Assess- Lung Association. 1993. "Guidelines for the evaluation ment and in Evaluation of Patients With Chest Pain: A Report impairment/disability in patients with asthma." Am Reu Resp Dis of the American College of Cardiology Foundation Clinical 147(4):1056-1061.
Expert Consensus Task Force (ACCF/AHA Writing Committee 10 Update the 2000 Expert Consensus Document on Electron Crapo R. O., R. Casaburi, A. L.. Coates, Enright P. L., J. L Beam Computed Tomography). J Am Coll Cardiol 49:378-402. Hankinson, C. G. Irvin, N. R. MacIntyre, R. T. McKay, J. S Wanger, S. D. Anderson, D. W. Cockcroft, J. E. Fish, and P. J.
Jouven, X., M. Zureik, M. Desmos, D. Courbon, and P. Duci- Sterk. 2000. "Guidelines for methacholine and exercise chal- netiere. 2000. "Longterm outcome in asymptomatic men witr lenge testing - 1999." This official statement of the American xercise-induced premature ventricular depolarizations." A Thoracic Society (ATS) was adopted by the ATS Board of Direc- Engl J Med 343(12):826-833. tors July 1999. Am ] Respir Crit Care Med 161(1):309-329.
Kales SN, Tsismenakis AJ, Zhang C, Soteriades ES [2009]. Hankinson, J. I.., J. R. Odencrantz, and K. B. Fredan. 199 Blood pressure in fire fighters, police officers, and other emer Spirometric reference values from a sample of the U. ency responders. Am / Hypertens 22:11-20 general population." Am J Respir Crit Care Med 1999; 159:179- "Premature ventricular depolarizations and exercise" (edito ial comment on E.N. Alfred reference). 2000 N Engl I Mea Miller, M. R., Hankinson J., Brusasco V., et al. ATS/ERS Task 343(12):879-880. Force. "Standardization of spirometry." Eur Respir J 2005 26:319-338.
Schlant RC, Adolph RJ, DiMarco JP, Dreifus LS, Dunn MI, Fisch C, Garson A Jr, Haywood LJ, Levine HJ, Murray JA, Noble Tierney MT, Lenar D, Stanforth PR, Craig JN, Fannar RP 010. Prediction of aerobic capacity in firefighters usin ubmaximal treadmill and stairmill protocols. J Strength Cona tion Res 24 (3): 757-764.
peutic Cardiovascular Procedures (Committee on Electrocar- • = Section deletions. N = New material. 2018 Edition
Shaded text = Revisions. A = Text deletions and figure/table revisions.
Coperal 2010 National Fire Protection Association (NFPA). Licensed by agreement, for individ use and downtend on 07/06 2019Bily Acomfor deigned user Millar Seen No arser reprod chion or transnussion in airy lore permitted without witten parmason of NED? fre madries orto report argumented use. contact acensing@@nipe.ora This NECES All Acceas sunscapron expires on Cecember 19. 2019 1582-96 COMPREHENSIVE OCCUPATIONAL MEDICAL PROGRAM FOR FIRE DEPARTMENTS Townsend, M. C., and the Occupational and Environmental Thoracic Society (ATS) was adopted by the ATS Board of Direc- Lung Disorder Committee. 2000. "American College of Occu- tors July 1999. This is a joint statement of the ATS and the pational and Environmental Medicine Position Statement on Centers for Disease Control and Prevention (CDC). This statc- Occupational Spirometry in the Occupational Setting." J Occup ment was endorsed by the Council of the Infectious Diseases Environ Med 42:228-245. Society of America (IDSA), Sept. 1999.
F.2.6 Tuberculosis. F.2.7 Cancer Screening.
American Thoracic Society, Centers for Disease Control and Smith R. A., C. J. Mettlin, K. J. Davis, and H. Eyre. 2000.
Prevention (CDC), and Infectious Diseases Society of America. "American Cancer Society guidelines for the early detection of Treatment tuberculosis, Mortal Morbid Weekly Reu cancer." CAJ Clin 50(1):34-49. 2003;52 (No. RR-11):1-74.
F.2.8 Other Publications.
Centers for Disease Control and Prevention (CDC). Guide- lines for using the QuantiFERON-TB Gold test for detecting U.S. Department of Defense, Department of the Army Regu- Mycobacterium tuberculosis infection, United States. Mortal lation 40-501 Medical Services Standards of Medical Fitness.
Morbid Weekly Rep. 54:48-55, 2005. Headquarters Department of the Army, Washington, DC, 27 February 1998.
ATS and CDC. "Diagnostic standards and classification of tuberculosis in adults and children." 2000. Am ] Respir Crit Care F.3 References for Extracts in Informational Sections.
Med 161(4): 1376-1395. This official statement of the American NFPA 1002, Standard for Fire Apparatus Driver/Operator Profes- sional Qualifications, 2017 edition.
NFPA 1500, Standard on Fire Department Occupational Safety, Health, and Wellness Program, 2018 edition.
TS and CDC. "Targeted tuberculin testing and treatment ol NFPA 1583, Standard on Health-Related Fitness Programs for Fire atent tuberculosis infection." 2000. Am | Respir Crit Care Mec Department Members, 2015 edition. 161(4):S221-247. This official statement of the American 2018 Edition Shaded text = Revisions.
A = Text deletions and figure/ table revisions. • = Section deletions. N = New material.
Copynaht 2018 National Fire Prefection Association (FPA Linensed py apreement. furindividualse and download on 07/06/2019 to Ely Alcom for designated use Willem 3wan No other reproduction: or iransmission in any tom permited without witen permission iNPA For induenes or to report unauthoned use. comtact [email protected] This NEOSS AR Access subscription expires on December 10, 2019 INDEX 1582-97
Index
Copyright © 2017 National Fire Protection Association. All Rights Reserved.
The copyright in this index is separate and distinct from the copyright in the document that it indexes. The licensing provi- sions set forth for the document are not applicable to this index. This index may not be reproduced in whole or in part. by any means without the express written permission of NFPA.
-A- Physician Evaluation, 9.4.4.1
Physician Guidance, 9.1.4.2
Administration, Chap. 1
Implementation, 1.3 Coronary Artery Disease, 9.4.3
Physician Evaluation, 9.4.3.1, A.9.4.3.1
Purpose, 1.2
Scope, 1.1 Physician Guidance, 9.4.3.2
Annual Occupational Fitness Evaluation of Members, Chap. 8 Heart Transplant, 9.4.24 Physician Evaluation, 9.4.24.1
Annual Fitness Evaluation, 8.2
Physician Guidance, 9.4.24.2
Weight and Body Composition, 8.1
Approved Hypertension, 9.4.20
Stage 1 Hypertension, 9.4.20.1
Definition, 3.2.1, A.3.2.1
Physician Evaluation, 9.4.20.1.1, A.9.4.20.1.1
Authority Having Jurisdiction (AHI)
Definition, 3.2.2, A.3.2.2 Stage 2 Hypertension, 9.4.20.2 Physician Evaluation, 9.4.20.2.1
-C- Hypertrophic Obstructive Cardiomyopathy, 9.4.8
Candidate Physician Evaluation, 9.4.8.1
Definition, 3.3.1 Physician Guidance, 9.4.8.2
Category A Medical Condition Metabolic Syndrome, 9.4.21 Mitral Valve Insufficiency, 9.4.12
Definition, 3.3.2
Category B Medical Condition Physician Evaluation, 9.4.12.1 Definition, 3.3.3 Physician Guidance, 9.4.12.2
Mitral Valve Stenosis, 9.4.11
-E- Physician Evaluation, 9.4.11.1
Emergency Medical Services Other Supraventricular Arrhythmias, Atrial Fibrillation, or Atrial Flutter, 9.4.17
Definition, 3.3.4
Physician Evaluation, 9.4.17.1, A.9.4.17.1
Essential Job Task
Physician Guidance, 9.4.17.2
Definition, 3.3.5
Pacemaker or Automatic Implantable Defibrillator, 9.4.10 Essential Job Tasks, Chap. 5
Essential Job Tasks and Descriptions, 5.1 Physician Evaluation, 9.4.I0.1, A.9.4.10.1 Prosthetic Cardiac Valves, 9.4.15
Essential Job Tasks for Specialized Teams, 5.2
Physician Evaluation, 9.4.15.1
Essential Job Tasks — Specific Evaluation of Medical Conditions in Members, Chap. 9 Recurrent Syncope, 9.4.9
Cardiovascular Disorders, 9.4, A.9.4 Physician Evaluation, 9.4.9.1, A.9.4.9.1 Acute Pericarditis, Acute Endocarditis, and Acute Restrictive Cardiomyopathy and Constrictive Myocarditis, 9.4.6 Pericarditis, 9.4.5
Physician Evaluation, 9.4.6.1 Physician Evaluation, 9.4.5.1 Aortic Valve Insufficiency, 9.4.14 Ventricular Arrhythmias and Ectopy, 9.4.18 Physician Evaluation, 9.4.14.1 Physician Evaluation, 9.4.18.1 Aortic Valve Stenosis, 9.4.13 Physician Guidance, 9.4.18.2 Physician Evaluation, 9.4.13.1 Wolff-Parkinson-White (WPW) Syndrome, 9.4.16 Atrioventricular Block, 9.4.19 Physician Evaluation, 9.4.16.1, A.9.4.16.1 Physician Evaluation, 9.4.19.1 Disorders Involving the Gastrointestinal Tract and Abdominal Viscera, 9.11
Cardiac Congenital Abnormality, 9.4.22
Renal Disease, 9.11.4
Physician Evaluation, 9.4.22.1
Endocrine and Metabolic Disorders, 9.6, A.9.6
Cardiac Hypertrophy, 9.4.23 Diabetes Mellitus That Does Not Require Insulin Physician Evaluation, 9.4.23.1 Therapy, 9.6.5
Physician Guidance, 9.4.23.2, A.9.4.23.2
Physician Evaluation, 9.6.5.1
Chronic Pericarditis, Endocarditis, or Myocarditis, 9.4.7 Diseases of the Adrenal Gland, Pituitary Gland, Parathyroid Physician Evaluation, 9.4.7.1 Gland, or Thyroid Gland, 9.6.7 Physician Guidance, 9.4.7.2 Physician Evaluation, 9.6.7.1 Congestive Heart Failure, 9.4.4 Physician Guidance, 9.6.7.2 2018 Edition
Cops 12019 Natione Fire Protection AssodelingPA Licensed. Py agreement, for individual use and dominad on 07/612018 Ply Alcom for designated user Willar Swan No other readstion cransmussionin any toms penited without watter permission of NEPNE. Foringenes onto report anauthonzed use comactlicensng@rapd:040 This NECES All Access subscription expires on December 18, 2019. 1582-98 COMPREHENSIVE OCCUPATIONAL MEDICAL PROGRAM FOR FIRE DEPARTMENTS Nutritional Deficiencies, 9.6.6 Physician Guidance, 9.7.15.2 Physician Evaluation, 9.6.6.J Hypercapnic Disorders, 9.7.10 Physician Guidance, 9.6.6.2 Physician Evaluation, 9.7.10.1 Type 1 Diabetes Mellitus That Requires Treatment with Physician Guidance, 9.7.10.2 Insulin, 9.6.3 Hypoxemic Disorders, 9.7.9
Physician Evaluation, 9.6.3.1, A.9.6.3.1 Physician Evaluation, 9.7.9.1 Physician Guidance, 9.6.3.2 Physician Guidance, 9.7.9.2 Type 2 Diabetes Mellitus That Requires Treatment with Interstitial Lung Diseases, 9.7.18 Insulin, 9.6.4
Physician Evaluation, 9.7.18.1
Physician Evaluation, 9.6.4.1, A.9.6.4.]
Physician Guidance, 9.7.18.2
Physician Guidance, 9.6.4.2
Lung Cancer, 9.7.21
Essential Job Tasks, 9.1
Fire Departnent Physician Roles, 9.3 Lung Transplant, 9.7.25 Physician Evaluation, 9.7.25.1
Infectious Diseases, 9.8
Pleural Effusions, 9.7.16, A.9.7.16
Active Pulmonary Tuberculosis, 9.8.10, A.9.8.10
Physician Evaluation, 9.7.16.1
Physician Evaluation, 9.8.10.1
Pulmonary Embolism, 9.7.20
Ear Infections, 9.8.6
Physician Evaluation, 9.7.20.1
Physician Evaluation, 9.8.6.1
Pulmonary Hypertension, 9.7.11
Gastrointestinal Infections, 9.8.7
Physician Evaluation, 9.7.11.1
Physician Evaluation, 9.8.7.1
Pulmonary Resection Surgery, Chest Wall Surgery, or
Hepatitis, 9.8.11, A.9.8.11 Traumatic Pneumothorax, 9.7.13 Physician Evaluation, 9.8.11.1 Physician Evaluation, 9.7.13.1 Physician Guidance, 9.8.11.2 Physician Guidance, 9.7.13.2 Human Immunodeficiency Virus (HIV) Infection, 9.8.12, Sarcoidosis, 9.7.19 A.9.8.12
Physician Evaluation, 9.7.19.1
Physician Evaluation, 9.8.12.1
Physician Guidance, 9.7.19.2
Infection That Results in Dizziness, Weakness, Significant Weight Loss, or Pain, 9.8.9, A.9.8.9 Spontaneous Pneumothorax, 9.7.14, A.9.7.14 Physician Evaluation, 9.8.9.1 Physician Evaluation, 9.7.J4.1 Kidney or Urinary Infections, 9.8.8 Physician Guidance, 9.7.14.2 Physician Evaluation, 9.8.8.1 Tracheal Stenosis, 9.7.12 Skin Infections and Draining Ulcers or Cysts, 9.8.4 Physician Evaluation, 9.7.12.1 Physician Evaluation, 9.8.4.1 Tracheostomy, 9.7.4
Upper or Lower Respiratory Infections, 9.8.5 Physician Evaluation, 9.7.4.1 Physician Evaluation, 9.8.5.1 Physician Guidance, 9.7.4.2 Lung, Chest Wall, and Respiratory Disorders, 9.7, A.9.7 Tuberculosis, 9.7.23 Allergic Lower Respiratory Disorders, 9.7.7, A.9.7.7 Medical Conditions Involving Head, Eyes, Ears, Nose, Neck, or Throat, 9.12
Physician Evaluation, 9.7.7.1
Abnormal Hearing, 9.12.4
Physician Guidance, 9.7.7.2
Minimum Hearing Standard, 9.12.4.2, A.9.12.4.2
Asthma, 9.7.6, A.9.7.6
Physician Evaluation, 9.12.4.1, A.9.124.1
Physician Evaluation, 9.7.6.1
Physician Guidance, 9.12.4.3
Physician Guidance, 9.7.6.2
Disorders of the Eyes or Vision, 9.12.3
Bronchiectasis and/or Bronchiolitis Obliterans, 9.7.17
Physician Evaluation, 9.12.3.1, A.9.12.3.1
Physician Evaluation, 9.7.17.1
Physician Guidance, 9.12.3.2
Physician Guidance, 9.7.17.2
Nose, Nasopharynx, Oropharynx, or Dental
Chronic Cough, 9.7.5 Structures, 9.12.6
Physician Evaluation, 9.7.5.1
Physician Evaluation, 9.12.6.1, A.9.12.6.1
Physician Guidance, 9.7.5.2 Physician Guidance, 9.12.6.2, A.9.12.6.2 Chronic Obstructive Airways Diseases, 9.7.8, A.9.7.8 Physician Evaluation, 9.12.1, A.9.12.1 Physician Evaluation, 9.7.8.1 Physician Guidance, 9.12.2 Cystic Lung Diseases, 9.7.22 Vertigo, Ataxia, or Disturbance of Gait and Balance. 9.12.5 Physician Evaluation, 9.7.22.1 Physician Evaluation, 9.12.5.1, A.9.12.5.1 Disorders of Respiratory Regulation, 9.7.21 Medications, 9.16 Physician Evaluation, 9.7.21.1
Anabolic Steroids, 9.16.11
Physician Guidance. 9.7,21.2
Physician Evaluation, 9.16.11.1
Fibrothorax, Chest Wall Deformity, and/or Diaphragm
Anti-Hypertensive Agents, 9.16.9
Abnormalities, 9.7.15
Physician Evaluation, 9.7.15.1 Physician Evaluation, 9.16.9.1 Physician Guidance, 9.16.9.2
2018 Edition
Copyrch: 2019 Nationa Fire Protection Ascociation (NA Licenser Cy agrsemert, to ndividual use and downined on 07/002010 to Ply Alcome for demonaled user Willem Ban. No other reproductien or transmission in any fum permitted without witten permiscion of NEPAl. For quines orto report unputhented wee comest icersignpa erg Inis NECES All Aces subsorotion expires on Decumber 19. 2010.
INDEX 1582-99
Anticoagulation, 9.16.4 Bone Grafts, 9.10.16
Physician Evaluation, 9.16.4.1 Physician Evaluation, 9.10.16.1 High-Dose Corticosteroids, 9.16.10 Physician Guidance, 9.10.16.2 Physician Evaluation, 9.16.10.1 Chronic Osteoarthritis or Traumatic Arthritis, 9.10.17 Physician Guidance, 9.16.10.2 Physician Evaluation, 9.10.17.1 Muscle Relaxants, 9.16.6 Complex Regional Pain Syndrome, 9.10.19 Physician Evaluation, 9.16.6.1 Physician Evaluation, 9.10.19.1 Narcotics, 9.16.5 Dislocation of a Joint, 9.10.8
Physician Evaluation, 9.16.5.1 Physician Evaluation, 9.10.8.1 Other Medications, 9.16.12 Physician Guidance, 9.10.8.2 Physician Evaluation, 9.16.12.1 Fractures, 9.10.14
Physician Guidance, 9.16.12.2 Physician Evaluation, 9.10.14.1 Psychiatric Medications, 9.16.8 Physician Guidance, 9.10.14.2 Physician Evaluation, 9.16.8.1 Inflammatory Arthritis, 9.10.18 Sedatives and Hypnotics, 9.16.7 Physician Evaluation, 9.10.18.1 Physician Evaluation, 9.16.7.1 Joint Reconstruction, 9.10.13 Neurologic Disorders, 9.13, A.9.13 Physician Evaluation, 9.10.13.1 Ataxias, 9.13.3 Physician Guidance, 9.10.13.2
Physician Evaluation, 9.13.3.1 Joint Replacements or Artificial Joints, 9.10.11 Cerebrovascular Disease, 9.13.4 Physician Evaluation, 9.10.11.1 Physician Evaluation, 9.13.4.1, A.9.13.4.1 Physician Guidance, 9.10.11.2 CNS Tumors, 9.13.9 Ligament and/or Meniscus Knee Disease, 9.10.10 Physician Evaluation, 9.13.9.1 Physician Evaluation, 9.10.10.1 Physician Guidance, 9.13.9.2 Physician Guidance, 9.10.10.2 Head Trauma, 9.13.8 Limitation of Joint Motion, 9.10.12 Physician Evaluation, 9.13.8.1, A.9.13.8.1 Physician Evaluation, 9.10.12.1 Physician Guidance, 9.13.8.2 Osteomyelitis or Septic Arthritis, 9.10.20 History of Cerebral Vascular Bleeding, 9.13.7 Physician Evaluation, 9.10.20.1 Physician Evaluation, 9.13.7.1, A.9.13.7.1 Recurrent Joint Dislocation of a Major Joint, 9.10.9 Narcolepsy, 9.13.12 Physician Evaluation, 9.10.9.1
Neuromuscular, Demyelinating, and Other Progressive Physician Guidance, 9.10.9.2 Neurologic Diseases, 9.13.5 Pregnancy and Reproductive Health, 9.18 Physician Evaluation, 9.13.5.1, A.9.13.5.1 Psychiatric and Psychologic Disorders, 9.14, A.9.14 Physician Guidance, 9.13.5.2 Specific Psychiatric Disorders, 9.14.2 Parkinson's and Other Diseases with Tremor, 9.13.10 Special Teams, 9.2 Physician Evaluation, 9.13.10.1 Spine Disorders, 9.9, A.9.9 Physician Guidance, 9.13.10.2 Ankylosing Spondylitis, 9.9.5 Progressive Dementia, 9.13.11 Physician Evaluation, 9.9.5.1 Physician Evaluation, 9.13.11.1 Herniation of Nucleus Pulposus, 9.9.9 Single Unprovoked Seizure and Epileptic Conditions, 9.13.6 Physician Evaluation, 9.9.9.1 Physician Evaluation, 9.13.6.1, A.9.13.6.1 Spinal Condition with Significant Radiculopathy, 9.9.6 Orthopedic Disorders, 9.10, A.9.10 Physician Evaluation, 9.9.6.1 Amputation of Arm, Hand, or Thumb, 9.10.4 Spinal Fusion, 9.9.4 Physician Evaluation, 9.10.4.1 Physician Evaluation, 9.9.4.1 Physician Guidance, 9.10.4.2 Spine Structural Abnormalicy, Fracture, or Dislocation, 9.9.8 Amputation of Fingers) Other than Thumb, 9.10.6 Physician Evaluation, 9.9.8.1 Physician Evaluation, 9.10.6.1 Physician Guidance, 9.9.8.2 Physician Guidance, 9.10.6.2 Use of Narcotics or Muscle Relaxants, 9.9.7 Amputation of Leg, 9.10.5 Physician Evaluation, 9.9.7.1 Physician Evaluation, 9.10.5.1 Physician Guidance, 9.9.7.2 Physician Guidance, 9.10.5.2 Substance Abuse, 9.15, A.9.15 Amputation of Partial Foot or Toe(s), 9.10.7 DSM 5 Criteria, 9.15.3 Physician Evaluation, 9.10.7.1 Physician Evaluation, 9.15.3.1 Physician Guidance, 9.10.7.2 Physician Guidance, 9.15.3.2 Appliances, 9.10.15 Methadone Maintenance, 9.15.4
Physician Evaluation, 9.10.15.1 Physician Evaluation, 9.15.4.1 Physician Guidance, 9.10.15.2 Tumors -- Malignant or Benign, 9.17 2018 Edition
Cheyngh 2018 Natue: Fire Protection Associaton FA Licensed By agreement for india use end comicad on 07052010o Bly Alcom for designated user Millar Swan No omar repreduction or trensmission in any om permalee waout witten parmasion of NEPA For mouries co report unauthonged use. comact licensing @nips.or This NEOSS ARACtesS subscripton epires on December 19, 2013. 1582-100 COMPREHENSIVE OCCUPATIONAL MEDICAL PROGRAM FOR FIRE DEPARTMENTS Acute Illness Related to Malignancy or Its Treatment, 9.17.5 -G- Physician Evaluation, 9.17.5.1 Guide for Fire Department Administrators, Annex B Physician Guidance, 9.17.5.2 Choosing a Fire Department Physician, B.3 Benign Tumors, 9.17.4 Confidentiality, B.5
Physician Evaluation, 9.17.4.1 Coordinating the Medical Evaluation Program, B.4 Physician Guidance, 9.17.4.2 Determining Essential Job Tasks, B.2 Central Nervous System Tumors, 9.17.6 Legal Considerations in Applying the Standard, B.1 Physician Evaluation, 9.17.6.1 Legal Protections for Individuals Who Are Members of Physician Guidance, 9.17.6.2 Protected Classes (Race, Sex, Color, Religion, or Gastrointestinal Malignancies, 9.17.9 National Origin), B.1.2 Physician Guidance, 9.17.9.2 Pregnancy and Reproduction, B.1.2.1 Genitourinary Malignancies, 9.17.10 Legal Protections for Individuals with Handicaps or Physician Evaluation, 9.17.10.1 Disabilities, B.1.1
Physician Guidance, 9.17.10.2
-H-
Head and Neck Malignancies, 9.17.7
Health and Fitness Coordinator
Physician Evaluation, 9.17.7.1
Physician Guidance, 9.17.7.2 Definition, 3.3.10
Hematologic or Lymphatic Malignancies, 9.17.11 Health and Safety Committee Physician Evaluation, 9.17.11.1 Definition, 3.3.11
Physician Guidance, 9.17.11.2 Health and Safety Officer Definition, 3.3.12
Lung Cancer, 9.17.8
Physician Evaluation, 9.17.8.1
-I-
Physician Guidance, 9.17.8.2
Infection Control Program
Skin Cancer, 9.17.12
Definition, 3.3.13
Physician Evaluation, 9.17.12.1
Informational References, Annex F
Physician Guidance, 9.17.12.2
-M.
Aortic Aneurysm, 9.5.3
Medical Condition Classifications
Physician Evaluation, 9.5.3.1
Category A Medical Condition
Physician Guidance, 9.5.3.2
Definition, 3.3.14.1
Carotid Artery Disease, 9.5.4
Category B Medical Condition
Physician Evaluation, 9.5.4.1
Definition, 3.3.14.2
Circulatory Instability, 9.5.8
Definition, 3.3.14
Physician Evaluation, 9.5.8.1
Medical Evaluation
Lesions of Aorta or Major Vessels, 9.5.11
Definition, 3.3.15
Physician Evaluation, 9.5.11.1
Medical Evaluations of Candidates, Chap. 6
Lymphedema, 9.5.10
Abdominal Organs and Gastrointestinal System, 6.11
Physician Evaluation, 9.5.10.1
Aerobic Capacity, 6.9
Peripheral Vascular Disease, 9.5.6
Blood and Blood-Forming Organs, 6.19
Physician Evaluation, 9.5.6.1
Chemicals, Drugs, and Medications, 6.24
Peripheral Vascular Disease, 9.5.9
Physician Evaluation, 9.5.9.1 Dental, 6.6
Ears and Hearing, 6.5, A.6.5
Thoracic Outlet Syndrome, 9.5.5
Endocrine and Metabolic Disorders, 6.20
Physician Evaluation, 9.5.5.1
Extremities, 6.16
Thrombophlebitis, 9.5.7
Eyes and Vision, 6.4
Physician Evaluation, 9.5.7.1
Head and Neck, 6.3
Evaluation
Head, 6.3.1
Definition, 3.3.6
Neck, 6.3.2
Explanatory Material, Annex A
Heart and Vascular System, 6.10
-F- Heart, 6.10.1
Fire Department Vascular System, 6.10.2
Definition, 3.3.7, A.3.3.7 Lungs and Chest Wall, 6.8
Fire Department Physician Medical Conditions Affecting Ability to Safely Perform Essential Job Tasks, 6.2
Definition, 3.3.8
Medical Evaluation, 6.1
Functional Capacity Evaluation Metabolic Syndrome, 6.12 Definition, 3.3.9
Neurological Disorders, 6.17
2018 Edition
Copyngh: 2010 National Fire Protection Association NFPA Licensed. By spreement. for individal use and Contad on 07708/2016 to Bily Alcon for designated user Milliam Swan No emer reproduction c: transmission in any tom permitted without witten permission of NFPA. Forinduires orto report unauthonzed use. comtect icensing @nipo.org This NECES dIAcosss sunscupon expires on December 19, 2019 INDEX 1582-101
Nose, Oropharynx, Trachea, Esophagus, and Larynx, 6.7 Exposure to Lead and Other Metals, D.5.3 Psychiatric Conditions, 6.23
Reproductive System, 6.13
Skin, 6.18
Spine and Axial Skeleton, 6.15
Systemic Diseases and Miscellaneous Conditions, 6.21
Tumors and Malignant Diseases, 6.22
Urinary System, 6.14
Medical Examination
Definition, 3.3.16
Medically Certified
Definition, 3.3.17
Member
Definition, 3.3.18, A.3.3.18
-0- Post-Delivery: Lactation, D.10
Occupational Medical Evaluation of Members, Chap. 7 Post-Delivery: Return to Work, D.9 Ancillary Tests, 7.7 Pregnancy References, D.12
Audiology, 7.7.3, A.7.7.3 Recommended Activity Modifications During Pregnancy, D.8 Bladder Cancer Screening, 7.7.18 Risks by Trimesters, D.7 Blood Tests, 7.7.1, A.7.7.1 Protocols for Evaluation of Fitness of Members, Annex C Cancer and Cardiovascular Disease Risk Reduction, 7.7.22, Annual Fitness Evaluation, C.1
4.7.7.22 Fitness Assessment, C.1.2
Cervical Cancer Screening, 7.7.16 Fitness Assessment Components, G.1.4 Chest Radiographs, 7.7.5 Sample Assessment Protocols for the Health-Related Colon Cancer Screening, 7.7.13 Components of Fitness, C.1.4.1 Electrocardiograms (ECGs), 7.7.6 General, C.1.1
Heavy Metal Evaluation, 7.7.12 Pre-Assessment Questionnaire, C.1.3 HIV Testing, 7.7.11 Annual Fitness Evaluation, C.2
Immunizations and Infectious Disease Screening, 7.7.9 Fitness Evaluation Protocols for Members, C.2.1 Lung Cancer Screening, 7.7.15 Aerobic Capacity, C.2.1.1 Mammography, 7.7.8 Muscular Strength/Power, C.2.1.5
Occupational Stress Awareness Consultation, 7.7.23 Optional Assessment: WFI Alternate Grip Push-Up Oral Cancer Screening, 7.7.19 Test, C.2.1.10
Post-Exposure Bloodborne Pathogen Testing, 7.7.10 Submaximal Graded Treadmill Evaluation (WFI Treadmill Protocol), C.2.1.3
Prostate Cancer, 7.7.14, A.7.7.14
Submaximal Stepmill Evaluation (WFI Stepmill
Risk Stratification, 7.7.7 Protocol), C.2.1.4
Sleep Disturbance Screening, 7.7.21 WFI Vertical Jump — Optional Assessment, C.2.1.8 Spirometry, 7.7.4
Testicular Cancer Screening, 7.7.17 -R-
Thyroid Cancer Screening, 7.7.20 Referenced Publications, Chap. 2 Urine Laboratory Tests, 7.7.2 Roles and Responsibilities, Chap. 4 Components of the Annual Occupational Medical Evaluation of Candidate and Member Responsibilities, 4.9 Members, 7.4
Confidentiality of Medical Information, 4.1
General, 7.1
Fire Department Physician Responsibilities, 4.2
Medical History, 7.5 Fire Department Responsibilities, 4.1 Member Education Regarding Occupational Medical Evaluation Program, 7.2 Medical Record Keeping, 4.1.13
Physical Examination, 7.6
Timing of the Annual Occupational Medical Evaluation of Sample Physician Evaluation Form for Fire Fighters with Members, 7.3
Diabetes, Annex E
Occupational Safety and Health Program
Shall
Definition, 3.3.19
Definition, 3.23
-P- Should
Definition, 3.2.4
Pregnancy Issues, Annex D
Chemical Hazards, D.5
Carbon Monoxide, D.5.1
2018 Edition
Conner 2018 Natiena: Sire Prolecion Assoma on INFP, Licensed Dy agreement. for indidual use and gownicad on 07/08/201916 Bily Acom for designated user William Swan No ome reproductien or hensnussion in any four permitted without atten permission cNEPRE, Foringuines erto rapert unauthonzed use contact hensing@ nipa cra This NECES Al Access subschpson epires on Decenter 10, 2019 Sequence of Events for the Standards Committee Membership Development Process Classifications,2,3,4
Once the current edition is priblished, a Standard is opened for The following classifications apply to Committee members Public Input. and represent their principal interest in the activity of the Step 1 - Input Stage Committee.
• Input accepted from the public or other committees for 1. M Manufacturer: A representative of a maker or mar- consideration to develop the First Draft keter of a product, assembly, or system, or portion • Technical Committee holds First Draft Meeting to revise thereof, that is affected by the standard.
Standard (23 weeks); Technical Committee(s) with Cor- 2. U User: A representative of an entity that is subject to relating Committee (10 weeks) the provisions of the standard or that voluntarily • Technical Committee ballots on First Draft (12 weeks); uses the standard.
Technical Committee (s) with Correlating Committee 3. IM Installer/Maintainer: A representative of an entity that (11 weeks) is in the business of installing or maintaining a prod- • Correlating Committee First Draft Meeting (9 weeks) uct, assembly, or system affected by the standard. • Correlating Committee ballots on First Draft (5 weeks) 4. L Labor: A labor representative or employee concerned • First Draft Report posted on the document information with safety in the workplace. page 5. RT Applied Research/Testing Laboratory: A representative Step 2 - Comment Stage of an independent testing laboratory or indepen- dent applied research organization that promulgates
• Public Comments accepted on First Draft (10 weeks) fol- and/or enforces standards. lowing posting of First Draft Report 6. E Enforcing Authority: A representative of an agency or • If Standard does not receive Public Comments and the
an organization that promulgates and/or enforces
Technical Committee chooses not to hold a Second Draft standards. meeting, the Standard becomes a Consent Standard and 7. I Insurance: A representative of an insurance company, is sent directly to the Standards Council for issuance (see broker, agent, bureau, or inspection agency.
Step 4) or 8. C Consumer: A person who is or represents the ultimate • Technical Committee holds Second Draft Meeting
purchaser of a product, system, or service affected by
(21 weeks); Technical Committee(s) with Correlating the standard, but who is not included in (2).
Committee (7 wecks)
• Technical Committee ballots on Second Draft (11 weeks); 9. SE Special Expert: A person not representing (1) through (8) and who has special expertise in the scope of the
Technical Committee(s) with Correlating Committee standard or portion thereof. (10 weeks)
• Correlating Committee Second Draft Meeting (9 weeks)
• Correlating Committee ballots on Second Draft NOTE 1: "Standard" connotes code, standard, recom- (8 weeks) mended practice, or guide.
• Second Draft Report posted on the document informa- NOTE 2: A representative includes an employee. tion page NOTE 3: While these classifications will be used by the Step 3 - NFPA Technical Meeting Standards Council to achieve a balance for Technical Com- mittees, the Standards Council may determine that new
• Notice of Intent to Make a Motion (NITMAM) accepted classifications of member or unique interests need repre- (5 weeks) following the posting of Second Draft Report sentation in order to foster the best possible Committee • NITMAMs are reviewed and valid motions are certified
deliberations on any project. In this connection, the Stan- by the Motions Committee for presentation at the NFPA dards Council may make such appointments as it deems Technical Meeting appropriate in the public interest, such as the classification • NFPA membership meets each June at the NFPA Techni- of "Utilities" in the National Electrical Code Committee. cal Meeting to act on Standards with "Certified Amend-
ing Motions" (certified NITMAMs)
• Committee (s) vote on any successful amendments to the Technical Committee Reports made by the NFPA mem-
bership at the NFPA Technical Meeting
Step 4 - Council Appeals and Issuance of Standard
• Notification of intent to file an appeal to the Standards Council on Technical Meeting action must be filed within 20 days of the NFPA Technical Meeting
• Standards Council decides, based on all evidence,
whether to issue the standard or to take other action
Notes:
1. Time periods are approximate; refer to published sched- ules for actual dates.
6/16-A
Copynght 2010 National Fire Protection Association INFP. Licensed. pyapreement, for indirdual seen downied on 07/06:200to Bily Alromfordesignated user Willem Swan, No omer reproduction er transmission in any Submitting Public Input / Public Comment Through the Online Submission System Soon after the current edition is published, a Standard is open for Public Input.
Before accessing the Online Submission System, you must first sign in at www.nfpa.org. Note: You will be asked to sign-in or create a free online account with NEPA before using this system:
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tocument phase and closing date, are stand males an anatory introdes use i torna on omen tube t Contents, and icons at the top you can click for Help when using the site. The Help icons and navigation panel will be visible except when you are actually in the process of creating a Public Input.
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For further information on submitting public input and public comments, go to: http:// www.nfpa.org/ publicinput.
Other Resources Available on the Document Information Pages About tab: View general document and subject-related information.
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Copyright 2019 Narional Fire Protecton Association iNFDAN Licensed, By agreeme:t, for noidual use and download on 07/06/201$10 BiliAron for designated use Wilhen: Swan No ciner reproducion or transmission in any some permitted without waten permssion of Da for inques o0 report unauthonzed use. contact losing@nipa org This NECES All Acoses aubecnoton expires on Gecember 10, 2019) Information on the NFPA Standards Development Process
I. Applicable Regulations. The primary rules governing the processing of NFPA standards (codes, standards, recommended practices, and guides) are the NFPA Regulations Governing the Development of NFPA Standards (Regs). Other applicable rules include NFPA Bylaws, NFPA Technical Meeting Convention Rules, NFPA Guide for the Conduct of Participants in the NFPA Standards Development Process, and the NFPA Regulations Governing Petitions to the Board of Directors from Decisions of the Standards Council. Most of these rules and regulations are contained in the NFPA Standards Directory: For copies of the Directory, contact Codes and Standards Administration at NFPA Headquarters; all these documents are also available on the NFPA website at "www.nfpa.org."
The following is general information on the NFPA process. All participants, however, should refer to the actual rules and regulations for a full understanding of this process and for the criteria that govern participation.
II. Technical Committee Report. The Technical Committee Report is defined as "the Report of the responsible Committee(s), in accordance with the Regulations, in preparation of a new or revised NFPA Standard." The Technical Committee Report is in two parts and consists of the First Draft Report and the Second Draft Report. (See Regs at III. Step 1: First Draft Report. The First Draft Report is defined as "Part one of the Technical Committee Report, which documents the Input Stage." The First Draft Report consists of the First Draft, Public Input, Committee Input, Committee and Correlating Committee Statements, Correlating Notes, and Ballot Statements. (See Regs at 4.2.5.2 and Section 4.3.) Any objection to an action in the First Draft Report must be raised through the filing of an appropriate Comment for consideracion in the Second Draft Report or the objection will be considered resolved. [See Regs at 4.3.1 (b).] IV. Step 2: Second Draft Report. The Second Draft Report is defined as "Part two of the Technical Committee Report, which documents the Comment Stage." The Second Draft Report consists of the Second Draft, Public Comments with corresponding Committee Actions and Committee Statements, Correlating Notes and their respective Committee Statements, Committee Comments, Correlating Revisions, and Ballot Statements. (See Regs at 4.2.5.2 and Section 4.4.) The First Draft Report and the Second Draft Report together constitute the Technical Committee Report. Any outstanding objection following the Second Draft Report must be raised through an appropriate Amending Motion at the NFPA Technical Meeting or the objection will be considered resolved. [See Regs at 4.4.1 (b).] V. Step 3a: Action at NFPA Technical Meeting. Following the publication of the Second Draft Report, there is a period during which those wishing to make proper Amending Motions on the Technical Committee Reports must signal their intention by submitting a Notice of Intent to Make a Motion (NITMAM). (See Regs at 4.5.2.) Standards that receive notice of proper Amending Motions (Certified Amending Motions) will be presented for action at the annual June NFPA Technical Meeting. At the meeting, the NFPA membership can consider and act on these Certified Amending Motions as well as Follow-up Amending Motions, that is, motions that become necessary as a result of a previous successful Amending Motion. (See 4.5.3.2 through 4.5.3.6 and Table 1, Columns 1-3 of Regs for a summary of the available Amending Motions and who may make them.) Any outstanding objection following action at an NFPA Technical Meeting (and any further Technical Committee consideration following successful Amending Motions, see Regs at 4.5.3.7 through 4.6.5.3) must be raised through an appeal to the Standards Council or it will be considered to be resolved.
VI. Step 3b: Documents Forwarded Directly to the Council. Where no NITMAM is received and certified in accordance with the Technical Meeting Convention Rules, the standard is forwarded directly to the Standards Council for action on issuance. Objections are deemed to be resolved for these documents. (See Regs at 4.5.2.5.) VII. Step 4a: Council Appeals. Anyone can appeal to the Standards Council concerning procedural or substantive matters related to the development, content, or issuance of any document of the NFPA or on matters within the purview of the authority of the Council, as established by the Bylaws and as determined by the Board of Directors. Such appeals must be in written form and filed with the Secretary of the Standards Council (see Regs at Section 1.6). Time constraints for filing an appeal must be in accordance with 1.6.2 of the Regs. Objections are deemed to be resolved if not pursued at this level.
VIII. Step 4b: Document Issuance. The Standards Council is the issuer of all documents (see Article 8 of Bylaws). The Council acts on the issuance of a document presented for action at an NFPA Technical Meeting within 75 days from the date of the recommendation from the NFPA Technical Meeting, unless this period is extended by the Council (see Regs at
4.7.2). For documents forwarded directly to the Standards Council, the Council acts on the issuance of the document at its next scheduled meeting, or at such other meeting as the Council may determine (see Regs at 4.5.2.5 and 4.7.4).
IX. Petitions to the Board of Directors. The Standards Council has been delegated the responsibility for the administration of the codes and standards development process and the issuance of documents. However, where extraordinary circumstances requiring the intervention of the Board of Directors exist, the Board of Directors may take any action necessary to fulfill its obligations to preserve the integrity of the codes and standards development process and to protect the interests of the NFPA. The rules for petitioning the Board of Directors can be found in the Regulations Governing Petitions to the Board of Directors from Decisions of the Standards Council and in Section 1.7 of the Regs.
X. For More Information. The program for the NFPA Technical Meeting (as well as the NFPA website as information becomes available) should be consulted for the date on which each report scheduled for consideration at the meeting will be presented. To view the First Draft Report and Second Draft Report as well as information on NFPA rules and for up-to- date information on schedules and deadlines for processing NFPA documents, check the NFPA website (www.nfpa.org/ docinfo) or contact NFPA Codes & Standards Administration at (617) 984-7246. 6/16-C
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