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.
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.
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.
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.
2. Gordon Graham, JD