By Tom Warren
The recently released National Fire Protection Association (NFPA) firefighter fatality report is a must read for every fire chief and all those in leadership positions in the fire service. The findings in the 2011 installment of the annual report (CLICK HERE) demonstrate that 54 percent of firefighter deaths were caused by overexertion/stress and that 49 percent of firefighter deaths by nature of injury were sudden cardiac events. The report clearly points to sudden cardiac events as the leading cause of death facing today’s firefighters. These cardiac events are not always fatal, but in most cases it is a career-ending injury. The fire service has the ability to lower these statistics through physical exams and physical conditioning, and it is incumbent upon every fire service leader to protect their firefighters and their families through the NFPA Standard 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments.
The fire service has done a great job in recent years of improving our equipment and practices, from the development of high-tech personal protective equipment to apparatus crash technologies. Our tools and equipment continue to be improved year after year. Our fireground operations now take on the look of a battle plan developed at the Pentagon, with sectors and divisions all operating within a single command structure. The system allows for aggressive firefighting operations but maintains a measurable level of safety for the firefighters working in an unforgiving environment. Despite all the improvements in our emergency operations, this single health issue remains unresolved. The tools to resolve this single health issue are to a large extent addressed in NFPA 1582. This annual medical exam provides a baseline for every firefighter and allows for detection of any change in the firefighter’s health during his career. Adoption of this standard by local fire departments will improve the lives of every firefighter and their families.
NFPA 1582 sets forth a comprehensive medical evaluation that matches the workloads of firefighters and the ability of a firefighter to medically and safely perform those duties. The standard was introduced in 1992 and has undergone several revisions; the latest revision was in 2007. The standard addresses risk factors such as high cholesterol, smoking, hypertension, and pulmonary issues, among others. The components of the medical exam include the following:
- Medical profile
- Blood testing*
- PPD screening (Tuberculosis)
- Vision testing
- Pulmonary function testing
- Physician consultation
- Chest X-ray
- Physical exam*
- Urine testing*
* Tests for illegal drugs shall not be performed as part of the NFPA 1582 medical exam.
The medical profile will address certain family histories and possible health risks the firefighter may have. Blood testing is extensive, including CBC, electrolytes, renal function, glucose, live functions, cholesterol, and PSA. The physical exam contains 14 components and is conducted by a physician who is familiar with the duties and workload of firefighters. Firefighters will receive a confidential report of their physical exam, and the department will receive only a one-page report from the physician, indicating whether the firefighter is medically certified to perform the duties of a firefighter based on the standard. This report will become part of the firefighter’s medical file and will be treated as a confidential medical record (this report is not included in the firefighter’s personnel file).
Starting an NFPA1582 physical program can be difficult. Several considerations must be addressed before any physical program can be successful.
The first consideration is determining how the program will be funded. The individual physical can cost upwards of $400 each, plus an additional $100 for a hazmat-level physical. This cost will be the responsibility of the local fire department or jurisdiction. Some departments will arrange for funding directly from operating budgets, whereas some will incorporate the program’s cost into the cost of medical insurance from the department’s health care provider. Grant funding may also be available, but continued reliance on grant funding is not advisable. In some instances, departments have paid for the costs of the physicals from the “Injured On Duty” line item in their budgets while expecting to see a reduction is this operating cost. The department must be certain that mechanisms are in place prior to the start of the physicals program to prevent firefighters from receiving medical bills generated by the program.
A second consideration is acceptance by the members of your department. Many firefighters will resist any physical program based on fear of the unknown. Many firefighters do not have personal physicians, have not had a physical in many years, and are concerned about what may be found during the physical. It is important to engage the firefighters early individually or through their local labor organization and to explain every detail of the physical program. The International Association of Fire Chiefs/ International Association of Fire Fighters Fire Service Joint Labor and Management Wellness-Fitness Initiative has endorsed medical evaluations. This is an effort that all sides agree is important for the individual firefighters and their families. Participating firefighters need to understand that all medical information is held in the strictest confidence (Federal HIPAA Privacy Rule) and that the only information the department receives is whether a firefighter is fit for duty or not. The department is required to keep this one-page report in each firefighter’s secured medical file. The program is best administered while the firefighters are on duty, giving them a detailed schedule prior to the start of the program, which enables them to prepare for the testing.
The third consideration is physician/staff familiarization with the firefighters and their duties. Many successful programs include a period where the physicians and medical staff participate in ride-alongs with on-duty firefighters. This ride-along accomplishes two very important goals. The first is it enables the physicians/staff to see firsthand what it is like to respond to emergencies and observe firefighters performing the necessary tasks under pressure. This ride-along is often an eye-opening experience for physicians/staff and helps them put into perspective the physical and emotional demands placed on firefighters. The second benefit of a ride-along is the development of personal relationships with the health-care professionals that will quickly erode any fears firefighters may have.
The fourth issue that must be resolved prior to initiating a physicals program is making it clear to members that any illness or medical condition found will be corrected and will not affect the firefighter’s employment. If the illness or medical condition is covered under a collective-bargaining agreement, then the firefighter will be placed on injury leave until the condition is corrected. When an illness or medical condition is found that falls outside of the collective bargaining agreement, the department must relieve the firefighter from duty and make every effort to assist that firefighter in his recovery. The department must allow for light duty if requested, extension of sick leave if needed, or time off for medical and rehabilitative therapy until the firefighter is once again fit for duty. The department can in no way implement any punitive measures when an illness or a medical condition is uncovered. It cannot be overstated that testing for illegal drugs shall not be performed as part of the NFPA1582 medical exam.
Many departments across the country have already implemented an NFPA1582 physical program, but far too many have not. The benefits of this program are clear and go beyond financial considerations; the standard demonstrates a genuine concern and respect for a department’s firefighters. Through this program, firefighters will have a clear picture of their personal health throughout their careers and what they need to do to stay healthy. Perhaps most importantly, the families of these firefighters can take comfort in knowing that their loved one is healthy enough to effectively perform the physically demanding work of firefighting.
THOMAS N. WARREN has more than 40 years of experience in the fire service in both career and volunteer departments. He recently retired as assistant chief of department of the Providence (RI) Fire Department after 33 years of service. He holds a bachelor’s degree in fire science from Providence College, an associate degree in business administration from the Community College of Rhode Island, and a certificate in occupational safety and health from Roger Williams University.