Again, we prove to be our own worst enemy. We know what kills us! Stress, particularly to the cardiovascular system, is the number one killer of firefighters. Let’s suppose you are on one of those mundane EMS runs in your community. You respond to a 48-year-old male who is not feeling well after cutting the grass on a very hot, humid day. He is diaphoretic, is flushed, has slightly labored breathing, and answers “I’m just a little tired” when you ask how he feels. Probably you would grab the oxygen and the blood pressure cuff and look a little further into what’s going on. You’d insist on it!
Now think of you or your fellow firefighter coming out of a fire in full bunker gear after knocking down a room-and-contents fire on the second floor of an occupied home on a hot and humid summer afternoon. How many of you would look at your “friend” and insist on taking the firefighter’s blood pressure?
National Fire Protection Association (NFPA) 1500, Standard on Fire Department Occupational Safety and Health Program, addresses medical screening and tracking of firefighters. That’s the good news. The bad news is the following:
- It’s only a “standard.” With how many “standards” does your department comply? Have you adopted 1500? Have you adopted, and do you follow, NFPA 1710, Standard for the Organization and Deployment of Fire Suppression Operations, Emergency Medical Operations, and Special Operations to the Public by Career Fire Departments?
- The standard costs money to implement-lots of money.
- Most unions have “concerns” with screening and tracking firefighters. What happens to firefighters who are chronically at a high risk of cardiovascular disease or an accident? Unions are partially there to protect their members, and the weeding out of members because of cardiovascular stress flies in the face of that protection. This is not to say that unions are not concerned with the health and safety of their members, but most are reluctant to apply screening standards concerning health and fitness.
There is a fine line here. We know what kills us, and yet we generally take on this “Don’t do as I do/Do as I say” attitude.
–John “Skip” Coleman, deputy chief of training and fire prevention, Toledo (OH) Department of Fire and Rescue, is the author of Incident Management for the Street-Smart Fire Officer (Fire Engineering, 1997) and Managing Major Fires (Fire Engineering, 2000), a technical editor of Fire Engineering, and a member of the FDIC Executive Advisory Board.
Question: The NFPA 1500 standard was developed in 1984, yet two years ago the 16 National Fallen Fire Fighter Initiatives echoed the need for routine medical screening and tracking. Where is your department in relation to NFPA 1500 with respect to medical screening and tracking?
Ron Hiraki, assistant chief,Gig Harbor (WA) Fire & Medic One
Response: We conduct the Respiratory Clearance Exam (to wear an SCBA respirator) as required by state law. Additionally, we offer on a voluntary basis a complete physical exam and treadmill test to each member. The frequency of the exams/test vary according to the person’s age. Younger members are seen every three years; older members are seen annually. Many members participate.
We have a strong voluntary wellness program. We have a good selection of flexibility, strengthening, and cardio equipment in each of our stations, staffed by career firefighters. Our members report for duty at 0800 hours and immediately perform apparatus and equipment checks. Following that, physical training (PT) is scheduled throughout the fire department each day. We have one member on each shift trained as a peer fitness trainer, who can give instruction or advice to members who want to improve their fitness level. Members may receive a physical fitness evaluation from a local exercise physiologist. Additionally, we invite local experts in the areas of back injury prevention and nutrition to speak to our members.
Jeffrey Schwering, lieutenant,Crestwood (MO) Department of Fire Services
Response: We have been proactive on the issues of medical screening and tracking our members for 30-plus years. Medicine has greatly improved over the past 30 years; so has our screening and tracking policy. Annual routine physicals apply to all members. Our department doctor offers additional services above and beyond the routine examination. Every five years, all members undergo a mandatory full physical, including blood work, EKG, chest X-ray, and so on.
Although our policy of medical screening and tracking of members has been in place for some time, many of our members are screening themselves. Some have a family history that could require additional attention. Our members are stepping forward to ensure their own health and well-being. The department believes that by being proactive, we will be better able to take care of our biggest asset, our members.
John O’Neal, chief, Manassas Park, (VA) Fire Department
Response: The department requires and provides a pre-employment medical physical based on NFPA 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments guidelines and Occupational Safety and Health Administration respiratory protection requirements. The contract vendor performing the medical physical provides the department with a fire brigade fit-for-duty clearance and respirator clearance for each individual passing the physical. Appropriate vaccinations are also provided on hire as needed.
The department requires and provides an annual medical physical regardless of age for all employees with suppression duties. The contract vendor performing the medical physical provides a fire brigade fit-for-duty clearance and respirator clearance for each individual annually. The program includes the following evaluations: physician exam, comprehensive lipid panel, pulmonary function test, resting and sub-max bike stress test with 12-lead EKG, hearing and vision test, height and weight measurements, Hep-B titer, PPD screening, prostate specific antigen screening for males over the age of 40, and ovarian cancer screening for females.
Personnel are provided with a copy of all their results and recommendations on fitness and nutrition. This program, coupled with a physical fitness policy and the availability of exercise equipment, promotes a high level of wellness and fitness.
Thomas Dunne, deputy chief,
Fire Department of New York
Response: FDNY schedules annual medical exams for all of its personnel. Units are placed out of service to allow time for a thorough evaluation of firefighters by department doctors. The exam results are reviewed with each individual, along with any recommendations for improving their health. In addition, there has been increased baseline testing and medical tracking because of concerns about unusual hazardous materials exposures resulting from 9/11 working conditions.
Even “routine” firefighting is brutally demanding on firefighters. The physical stresses lead to heart attacks and half of our line-of-duty deaths. It is, therefore, incumbent on any department to protect its personnel by providing regular medical exams and preventive care.
However, no fire department has total control over an individual’s lifestyle. It is also the responsibility of firefighters to protect themselves as best they can. This means proper use of personnel protective equipment and continually addressing health concerns. By improving nutrition, discontinuing smoking, and engaging in regular exercise, a firefighter can greatly improve chances for achieving a long, healthful retirement.
There are some health hazards the fire service can’t control. But annual medical exams, health education, and individual firefighter efforts are excellent steps toward improving our safety and well-being.
Craig H. Shelley, EFO, CFO, MIFireE,
fire protection advisor,
Advanced Fire Training Center,
Saudi Aramaco Fire Protection
Response: Our department is very cognizant of the fact that firefighting is a hazardous and stressful occupation that requires a medically fit firefighting force. To this end, company and department policy requires that all operational firefighting forces, including the company’s Plant Emergency Response Teams, have medical examinations biannually up to age 40 and annually thereafter. Company physicians administer the examinations; a record of pass/fail is sent to the fire department.
Employees who fail the examination are sent for follow-up to the occupational medical department, where they are further evaluated for their ability to perform duties associated with firefighting. The medical program is monitored by an audit team to ensure full compliance with the established guidelines. Division heads are held accountable for any noncompliance with procedures.
In addition to the medical program, our department conducted an audit, including testing of a sample population, to determine the effectiveness of our health and fitness program. Unfortunately, the results indicated that although the employees were medically fit, they may not be physically fit in all cases. Improvements have been made to the program, and a department health and fitness coordinator has been appointed.
In addition, each division has a health and fitness coordinator, each unit will have a health and fitness advisor, and each shift will have instructors to assist shift members with the established program. Our fitness program is mandatory with individual progress monitored and documented. The results of the progress will be included in performance appraisal indicators. Only with full management concern, direction, and support will these programs be effective. I can report that our department’s management has driven the program and cares about members’ health, fitness, and safety.
