Firefighting, Health & Safety

Mandatory Firefighter Medical Examinations

By John K. Murphy 

You’re working a fully involved structure fire, hauling hose up a staircase, wearing full personal protective equipment. You are straining and pushing, pushing and pulling, encouraging the crew, working hard, and the heat is unbearable. Your chest discomfort–a nagging problem over the past few weeks but dismissed as some stomach upset and “no big deal”–is getting worse. With increased exertion while pushing and pulling hose and equipment to the third floor, your chest discomfort becomes a crushing pain mid-chest, radiating to your arms and neck. Your breathing becomes labored and you feel like you’re dying and are going to pass out. You Mayday, “I’m having a heart attack.” That’s the last thing you remember.
Could this be you during those times of heavy exertion at a working fire or complex rescue? Could this be you denying your “stomach upset” or jaw discomfort? Are you on a river in Egypt –called “de-Nile?”
 
Statistics from 2010 for firefighter line-of-duty deaths caused by cardiac arrest indicate these deaths accounted for 56.4 percent of all deaths, and there is a 44 percent average from cardiac arrest and heart disease over the past 10 years. Firefighters are dying from preventable diseases. What about our retired brethren? Although there are no comprehensive studies, I would surmise they die early from all kinds of preventable diseases like heart disease, diabetes, cancer, and high blood pressure. Not much of a retirement.
 
Did you have a comprehensive medical evaluation that followed National Fire Protection Association (NFPA) 1582, Standard on Comprehensive Occupational Medical Programs for Fire Departments, Chapter 6, Medical Evaluations of Candidates, when you were hired by your fire department? This initial medical evaluation will establish the baseline for your continued medical evaluations if your physician finds a change in heart, lung, vision, hearing, lab work, or other vital functions. Corrective processes can be implemented to prevent the furthering of potential fatal disease or illness. As we age and beat our bodies down doing our job, it is inevitable that we will have some medical condition that requires early detection, intervention, and treatment. If no entry medical evaluation was performed, how do we know what is happing to us medically over time?
 
Here is the hard question, if a problem is found–is it preexisting or newly acquired on the job? Many states have presumptive legislation for heart, lung, and, in some states, cancer and infectious diseases. What about the rest of you? How can you prove that your disease was acquired on the job?
 
Are employers responsible for starting and maintaining a comprehensive medical testing for their firefighters under the Occupational Safety and Health Administration (OSHA)?1 Although these standards apply to fire brigades, as a best practice, they should also apply to you.
 
Would we knowingly enter a fully involved unsafe structure fire? Enter into a complex confined space rescue without a lot of training and planning? Certainly not! So why do we bounce through our careers, blind to the possibility that we may have a potentially catastrophic medical condition existing inside our own bodies? Wouldn’t it be better to know, understand, and treat these conditions? There is a saying in our world, “Predictable is preventable,2” and certainly heart disease, cancer, diabetes, high cholesterol and hypertension are predictable AND preventable. Knowing those factors and the fact that more than 50 percent of firefighter deaths are caused from preventable diseases, I believe that it is time for MANDATORY FIREFIGHTER MEDICAL EXAMINATIONS for all of our firefighters on a regularly scheduled basis. Not ignoring the labor/management and financial issues this may present, I believe the health and welfare of the firefighter is the most important issue, and this article will not approach those labor issues.
 
Now this may scare you for many reasons, but research and the literature have demonstrated extensive coronary artery disease in firefighters stems from a combination of personal and workplace factors. The personal factors are well known: age, gender, family history, diabetes mellitus, hypertension, smoking, high blood cholesterol, obesity, and lack of exercise. Not as widely known, however, is that firefighters have exposures to workplace factors that are associated with adverse cardiovascular outcomes, such as exposure to fire smoke (notably carbon monoxide, hydrogen cyanide, and particulates), heat stress, noise, and shift work.3
 
How do we address the subsequent medical evaluations in those departments already having such programs? A greater question: if you do not have a current program, how do you start one?
 
For ongoing programs, a comprehensive physical evaluation performed by a qualified health care practitioner4 consists of the items found in NFPA 1582 Section 6 as a guideline for ongoing evaluations and should consist, at a minimum, of these items: vital signs (blood pressure, pulse, height and weight); head; ears; eyes; nose and throat; heart; peripheral vessels; lungs; abdomen; back; extremities; joints for flexibility; lymph nodes; skeletal and muscular tone and condition; evaluation of your nervous system; examination of your skin, nails, and hair; and, for men, a prostate examination. These evaluations can detect early cancers, heart disease, hypertension, and high cholesterol. 

This evaluation should also encompass additional testing, including an audiogram to benchmark hearing loss; vision, including depth perception and peripheral and color vision); height and weight, to see if you are gaining or losing weight; a chest X-ray to detect any disease like chronic obstructive pulmonary diseases (COPD) or tuberculosis; and a pulmonary function test. For cardiac health, a stress treadmill electrocardiogram must be performed on the initial firefighter entry exam and included as a periodic examination at least every five years. Laboratory studies should include a comprehensive blood test to include blood chemistries for liver enzymes, kidney function, cholesterol, and any heavy metals if the firefighter is a hazmat responder.

There are disqualifying medical findings that may arise from the periodic medical evaluations; I suggest that you refer to NFPA 1582 and those disqualifying medical finings. It has been found that, for most firefighters who develop diseases, their treatment comprises a confidential relationship between the firefighter and his physician; the information is not necessarily shared with the department. Obviously, if there is severe heart disease and you require a four-way bypass, your department will need to be informed of the impending surgery. With these medical conditions, if proper medical care is provided, there is no reason the firefighter should not be able to return to work. 

For departments that do not have an existing program, I suggest you establish a relationship with your local health care professional and ask them to be your “department physician.” They can read the NFPA guidelines and standards and implement a comprehensive medical evaluation program following your department’s guidelines, Many states also have vertical medical standards in place that address initial and ongoing medical assessment programs. 

Many of you may not agree that this is the right way to go, since it may cause an early end to your career; but personally, I get tired of reading of my brother and sister firefighter deaths, and I’ve been to too many firefighter funerals. Together, we can actually do something to prevent unnecessary firefighter deaths. So what are we waiting for?

JOHN K. MURPHY, JD, MS, PA-C, EFO, retired as a deputy fire chief after 32 years of career service; is a practicing attorney and physician assistant, and is a frequent speaker on legal and medical issues at local, state, and national fire service conferences. He is a contributing author to Fire Engineering and a fireengineering.com podcast host. 

REFERENCES 

1. 1910.156(b)(2) Personnel. The employer shall assure that employees who are expected to do interior structural fire fighting are physically capable of performing duties which may be assigned to them during emergencies. The employer shall not permit employees with known heart disease, epilepsy, or emphysema, to participate in fire brigade emergency activities unless a physician’s certificate of the employees’ fitness to participate in such activities is provided.

4. Physician, physician assistant, or nurse practitioner