02-PWS for Firefighters Physicals.pdf

Performance Work Statement for Civilian Firefighter/Emergency Management/Bio-Engineering

Pre- Employment and Annual Examinations

Westover Air Reserve Base, MA

1January 2022

1. SCOPE: The contractor shall furnish all personnel, equipment, materials, and facilities necessary to perform up to 75 health examinations for civilian employees at Westover ARB, MA to include but not limited to: Pre-employment, annual, termination, and fitness-for-duty examinations. The frequency, scope, and applicability of occupational health examinations is determined by the Westover ARB Aeromedical Council, OPM standards, and DOD/AF regulations. Exams are to be documented on one of the following forms:

AF Form 2766 Clinical Occupational Health Requirements SF 88 Report of Medical Examination SF 513 Medical Consultation Sheet SF93 Report of Medical History AF Form 895 Annual Medical Certification SF78/OF178 Certificate of Medical Examination SF600 Chronological Record of Medical Care

2. EXPLAINATION OF TERMS:

2.1. Physician – A licensed doctor of medicine (M.D.) or osteopathy (D.O.) who has been designated by the agency to provide professional expertise in the areas of occupational safety and health as they relate to emergency services.

2.2. Medical Classifications:

2.2.1. Category A Medical Conditions – A medical condition that would preclude a person from performing as a member in a training or emergency operational environment by presenting a significant risk to the safety and health of the person or others.

2.2.2. Category B Medical Conditions – A medical condition that, based on its severity or degree, could preclude a person from performing as a member in a training or emergency operational environment by presenting a significant risk to the safety and health of the person or others.

2.3. Medical Evaluation – The analysis of information for the purpose of making a determination of medical certification. Medical evaluation includes a medical examination.Medical Examination – An examination performed or directed by the Fire Department Physician.

2.4. Medically Certified – A determination by the Fire Department Physician that the candidate or current member meets the medical requirements of NFPA 1582.

2.5. Functional Capacity Evaluation – An assessment of the correlation between the individual’s capabilities and the essential job tasks.

2.6. Firefighter Essential Job Tasks:

2.6.1. While wearing personal protective ensembles and self-contained breathing apparatus (SCBA), performing fire-fighting tasks (e.g., hose line operations, extensive crawling, lifting and carrying heavy objects, ventilating roofs or walls using power or hand tools, forcible entry), rescue operations, and other emergency response actions under stressful conditions including working in extremely hot or cold environments for prolonged time periods

2.6.2. Wearing an SCBA, which includes a demand valve–type positive-pressure face piece or HEPA filter masks, which requires the ability to tolerate increased respiratory workloads

2.6.3. Exposure to toxic fumes, irritants, particulates, biological (infectious) and non-biological hazards, and/or heated gases, despite the use of personal protective ensembles and SCBA

2.6.4. Depending on the local jurisdiction, climbing six or more flights of stairs while wearing a fire protective ensemble, including SCBA, weighing at least 50 lb.(22.6 kg) or more and carrying equipment/tools weighing an additional 20 to 40 lb. (9 to 18 kg)

2.6.5. Wearing a fire protective ensemble, including SCBA, that is encapsulating and insulated, which will result in significant fluid loss that frequently progresses to clinical dehydration and can elevate core temperature to levels exceeding102.2°F (39°C)

2.6.6. While wearing personal protective ensembles and SCBA, searching, finding, and rescue-dragging or carrying victims ranging from newborns to adults weighing over 200 lb (90 kg) to safety despite hazardous conditions and low visibility

2.6.7. While wearing personal protective ensembles and SCBA, advancing water-filled hose lines up to 2 1/2 in. (65 mm) in diameter from fire apparatus to occupancy [approximately 150 ft. (50 m)], which can involve negotiating multiple flights of stairs, ladders, and other obstacles

2.6.8. While wearing personal protective ensembles and SCBA, climbing ladders, operating from heights, walking or crawling in the dark along narrow and uneven surfaces that might be wet or icy, and operating in proximity to electrical power lines or other hazards

2.6.9. Unpredictable emergency requirements for prolonged periods of extreme physical exertion without benefit of warm-up, scheduled rest periods, meals, access to medication(s), or hydrationOperating fire apparatus or other vehicles in an emergency mode with emergency lights and sirens

2.6.10. Critical, time-sensitive, complex problem solving during physical exertion in stressful, hazardous environments, including hot, dark, tightly enclosed spaces, that is further aggravated by fatigue, flashing lights, sirens, and other distractions

2.6.11. Ability to communicate (give and comprehend verbal orders) while wearing personal protective ensembles and SCBA under conditions of high background noise, poor visibility, and drenching from hose lines and/or fixed protection systems(sprinklers)

2.6.12. Functioning as an integral component of a team, where sudden incapacitation of a member can result in mission failure or in risk of injury or death to civilians or other team members

3. FIREFIGHTER/EM/BIO REQUIREMENTS:

3.1. Contractor shall provide a licensed physician to complete Physical exams as per requirements published in NFPA 1582 and further clarified in Air Force Technical Implementation Guide 1582-13 (or subsequent versions) for approximately 75 Air Force Civilian Firefighters/EM/Bio personnel.

3.2. Individuals will be scheduled annually by the Fire Department Health and Safety representative in conjunction with 439 Aeromedical Squadron. Medical documents/forms will be faxed or hand carried by the patient on the day of exam and will remain in the custody of the contractor until faxed or picked up by 439 Medical Squadron personnel authorized by the 439 AMDS.

3.3. Exams must meet requirements defined in NFPA 1582 and Air Force Technical Implementation Guide 1582-13. Examination requirements will be delineated on COHER form (Comprehensive Occupational Health Examination Requirements, AF Form 2766) or other appropriate forms and will include:

a. Medical History:

i. A medical history questionnaire shall be completed by each member to provide baseline information with which to compare future medical concerns.

ii. An annual medical history questionnaire, which includes changes in health status and known occupational exposures since the previous annual evaluation, shall be completed by each member to provide follow-up information.

iii. Information on the questionnaire and interval concerns shall be reviewed with each member by the fire department physician or designated medical evaluator.

b. Physical Examination: The annual physical examination shall include each of the following components:

i. Vital signs [temperature, pulse, and respiratory rate, and blood pressure (BP)BP shall be measured according to the recommendations of the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7)

ii. Head, eyes, ears, nose, and throat (HEENT)

iii. Neck

iv. Cardiovascular

v. PulmonaryBreast

vi. Genitourinary Gastrointestinal with digital rectal exam as clinically indicated

vii. Hernia

viii. Lymph nodes

ix. Neurological

x. Musculoskeletal

xi. Skin includes screening for cancers

xii. Vision - Far visual acuity is at least 20/30 binocular, corrected with contact lenses or spectacles. Far visual acuity uncorrected is at least 20/40 binocular for wearers of hard contacts or spectacles. (Color Vision testing is not required)

c. Blood Tests: Blood tests shall be performed annually and must be drawn during the examination time. Testing shall include the following:

PART 1:

i. CBC with differential, RBC indices and morphology, and platelet count

ii. Electrolytes (Na, K, Cl, HCO3, or CO2)

iii. Renal function (BUN, creatinine)

iv. Glucose

v. Liver function tests (ALT,AST, direct and indirect bilirubin, alkaline phosphatase)

vi. Total cholesterol, HDL, LDL, clinically useful lipid ratios (e.g., percent

LDL), and triglycerides

vii. Prostate Specific Antigen(PSA)

PART 2:

Blood testing for DOD firefighters to determine exposure to Per- and Poly-fluoroalkyl substances. Testing shall include the following:

i. Perfluorobutanesulfonic acid (PFBS)

ii. Perfluoroheptanoic acid (PFHpA)

iii. Perfluorohexanesulfonic acid (PFHxS)

iv. Perfluoronanoic acid (PFNA)

v. Perfluorooctane sulfonate (PFOS)

vi. Perfluorooctanoic acid (PFOA)

The contractor will provide the blood test results to each tested DoD firefighter no later than one (1) business day for tests under Part 1 and no later than twenty (20) business days for tests under Part 2. The contractor will also inform the fire fighter that they may decline the PFAS blood testing. The blood testing results are to be recorded in each tested firefighters individual health record. The results will be retained for the duration of employment plus 30 years, or for as long as the official personnel folder is maintained whichever is longer.

d. Urine Laboratory Tests: The urine laboratory tests required shall include the following:

i. Dipstick analysis for glucose, ketones, leukocyte esterase, protein, blood, and bilirubin

ii. Microscopic analysis for RBC, WBC, casts, and crystals if indicated by results of dipstick analysis

iii. Analysis for occupational chemical exposure if indicated

e. Spirometry: Pulmonary function testing (spirometry) shall be conducted annually to measure the member’s forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and the absolute FEV1/FVC ratio.

f. Electrocardiograms (ECGs): A resting ECG shall be performed as part of the baseline medical evaluation and shall be performed annually thereafter.

g. Colon Cancer Screening: Stool-based blood testing risks and benefits shall be discussed with all members above the age of 40, or earlier if clinically indicated. Visual exams (e.g., colonoscopy, CT colonoscopy, or flexible sigmoidoscopy) or stool-based testing shall be recommended to all members ages 45 to 75, or earlier if clinically indicated and repeated at regular intervals.

h. Prostate Cancer: Due to increased prostate cancer risk, the fire department physician shall discuss the risks and benefits of prostate cancer screening, including prostate-specific antigen (PSA) testing, with all male firefighters beginning at age 50 and annually thereafter. For firefighters who are at a higher risk for prostate cancer (e.g., African-Americans or where one or more first-degree relatives have been diagnosed with prostate cancer at an early age), the physician shall discuss the risks and benefits of prostate cancer screening, including PSA testing, beginning at age 40 and annually thereafter

i. Lung Cancer Screening: Low-dose computed tomography (LDCT) shall be performed annually on firefighters ages 50–74 who have at least a 20-pack-per-year smoking history and currently smoke or have quit within the past 15 years. Screening shall be discontinued once a firefighter has not smoked cigarettes for 15 years or is too ill to benefit

j. Cervical Cancer Screening: Female firefighters shall be screened for cervical cancer with cytology (i.e., Pap smear) every 3 years from ages 21 to 65 or, for firefighters who want to lengthen the screening interval, with high-risk human papillomavirus (HPV) testing with or without cytology every 5 years

k. Bladder Cancer Screening: Urine shall be evaluated for blood (hematuria) A positive dipstick for hematuria shall require a follow-up and referral which could involve upper tract imaging, cystoscopy, and/or urine cytology

l. Oral Cancer Screening: The entire mouth shall be examined for signs of oral and oropharyngeal cancers

m. Thyroid Cancer Screening: Physical exam for palpable nodules shall be part of the annual physical examination

n. Skin Cancer Screening: Physical exam of a member’s skin shall be conducted annually for evidence of cancer

o. Sleep Disturbance Screening: Screening for sleep disorders using a validated questionnaire, such as the Berlin Questionnaire or Epworth Sleepiness Scale, shall be provided annually. For firefighters with a high index of suspicion for a sleep disorder based on questionnaires or biometric data, the physician shall discuss the risks and benefits of testing and treatment

p. Cancer and Cardiovascular Disease Risk Reduction: The fire department physician shall annually inform members of the heightened risks of cardiovascular disease and various types of cancer associated with firefighting.

In addition to medical screening for these entities as outlined in this standard, the member shall be apprised of occupational routes of hazardous exposures related to firefighting, as well as common signs, symptoms, and preventive measures for both cardiovascular disease and cancers. The fire department physician shall, during the annual physical, inform the member of, and assess for the heightened risks of, stress associated with occupational exposures related to firefighting. The fire department physician shall make the member aware of common adverse signs and symptoms of occupational stress, inform the member of practices that might limit the damaging effects of occupational stress, and provide the member with referral to licensed behavioral health specialists trained to recognize and treat stress-related disorders in first responders as indicated.

q. Hormone Imbalance Awareness Consultation: During the annual physical, the fire department physician shall inform the member of the heightened risks of certain hormone therapy, such as testosterone therapy in male members, that can have adverse effects on a member’s health

r. Behavioral Health Screening: The fire department physician or qualified healthcare provider shall, in advance of or during the annual physical, provide behavioral health screening for posttraumatic stress disorder (PTSD), major depressive disorder, active suicidality, and substance-use disorder. Prior to conducting screening, the fire department physician or qualified healthcare provider shall provide the member a written explanation of the purpose of behavioral health screening. The behavioral health screening explanation shall state behavioral health screening is not intended to provide a diagnosis but to identify symptoms that might indicate a behavioral health risk and warrant further evaluation. The behavioral health screening explanation shall state that screening results will be kept strictly confidential. Behavioral health screening results and shall not be used to remove a member from duty, unless the member displays an imminent threat to the physical safety of self or others.

The fire department physician or qualified healthcare provider shall use a validated screening instrument to screen for PTSD, major depressive disorder, active suicidality, and substance-use disorder.

3.4. Weight and Body Composition: Body weight shall be measured and recorded annually. A body composition evaluation including the following shall be conducted on personnel solely for the purpose of departmental health surveillance.

i) Circumferential measurements

ii) Hydrostatic weighing or Bod-Pod

iii) Skinfold measurements

iv) Bio impedance analysis

NOTE: Any test not required per COHER or other appropriate documents will not be performed without coordination and approval from 439 AMDS/SGP.

3.5. At the end of the scheduled physical, the physician shall make a determination of “Fit for Duty”. The contractor shall notify the patient of abnormal lab results within one (1) business day and notify the 439 Aeromedical Squadron POC that the firefighter needs to follow up with private physician. Contract the Westover Fire Chief 413-557-3818 for POC information.

3.6. The contractor shall verify physical examination findings through verification of the original tests or additional testing as prescribed by the attending contract physician, after telephone coordination with the 439th AMDS/POC in the annual physicals, or the Civilian Personnel Office, in the case of pre-employment or fitness-for-duty physical. Contract the Westover Fire Chief 413-557-3818 for POC information. The case shall be pursued until it can be conclusively determined as an individual is/is not at an increased risk of health impairment from occupational exposure or is/is not physically able to perform their job.

3.7. An individual may be recommended for temporary removal from his/her work area or recommended limitations from specific working conditions or exposures until the specific nature of their medical condition can be determined through verification or additional testing.

The contractor shall verbally notify the employee’s supervisor via the phone number provided on the check in form, but no later than one workday after the determination that limiting condition exists or that removal from the work area is recommended. Written notification will be provided via an approved form provided by the contractor or SF 513, in the case of a fitness-for-duty physical.

3.8. The contractor shall be able to provide additional specialized testing when required as in

3.6 to facilitate continuity of care and the most expedient definitive determination of members’ fitness for duty.

3.9. Liability – It is expressly agreed that the services rendered by the contractor and its employees are rendered in the capacity of an independent contractor. The government will evaluate the quality of both professional and administrative services for purposes of contract inspection and acceptance. It retains no control over the services rendered, including, but not limited to:

professional judgments, diagnosis, or specific treatments. The contractor shall be solely responsible for any and all liability caused by the acts or commissions of its agents or employees

3.10. The contractor expressly agrees to indemnity, hold harmless, and defend the government of the United States and all of its employees and agents acting officially or otherwise, from any and all liability, claims, demands, actions, debts, and attorney fees arising out of, claimed on account of, or in any manner predicated on loss or damage to the property of the injuries to, or death of any person whatsoever, which may occur as a result of or in connection with the services being provided under this contract.

4. PHYSICIAN

4.1. The contactor shall provide a Physician who has the following responsibilities 4.1.1.Understand the physiological, psychological, and environmental demands placed on firefighters

4.1.2. Evaluate the fire department candidates and members to identify medical conditions that could affect their ability to safely respond to and participate in emergency operations

4.1.3. Utilize the essential job task descriptions supplied by the fire department to determine a candidate’s or a members medical certification

4.1.4. Identify and report the presence of Category A or disqualifying Category B medical conditions if present in firefighters.

4.1.5. Inform the Fire Chief or his/her designee whether or not the candidate or member is medically certified to safely perform the essential job tasks.

4.1.6. Report the results of the medical evaluation to the candidate or current member, including any medical condition (s) identified during the medical evaluation, and the recommendation as to whether the candidate or current member is medically certified to safely perform the essential job tasks.

4.1.7. Forward copies of any abnormal results along with patient instructions regarding primary care follow-up to candidates or current members who were instructed to seek (as appropriate) medical follow-up to address any medical conditions, or lab abnormalities, identified during the medical evaluation. *All physical examination results that medically disqualify employees and/or abnormal laboratory results must be telephoned to the Fire Chief at 413-557-3818 immediately after receipt.* Telephone notification is not normally necessary for normal examination results; however, it must be provided via secure email or fax if requested by the AMDS/POC and/or the Westover Civilian Personnel Office. Contract the Westover Fire Chief 413-557-3818 to confirm POC information.

4.1.8. Review and approve medical evaluations conducted by another physician or medical provider within the same work center.

5 Billing Invoicing will be made utilizing the Government’s Wide Area Workflow (WAWF) website. Invoices shall reflect the total amount of physicals completed for that month.

TECHNICAL EXHIBIT 1

SS# Performance Objective

PWS

Section

Performance Threshold

Rating Criteria Remedy

Quality 1 The Contractor shall provide scheduled appointments for examinations

3.2 2 per day (Monday-

Friday)

Satisfactory: 2 Unsatisfactory: < 2

Provide appointment(s) within 72 hours

2 The Contractor shall complete scheduled examinations.

3.1 2 per day (Monday-

Friday)

Satisfactory: 2 Unsatisfactory: < 2

Complete examination(s) within 72 hours

3 The Contractor shall complete all examinations requirements.

3.3 100% of required items

Satisfactory: 100% Unsatisfactory: < 100%

Complete requirement(s) within 72 hours

REMEDIES

If the Performance Objectives are not met, the vendor has 72 hours to make the necessary corrective actions to become compliant with sections 1-3 of Technical Exhibit 1. Failure to do so, will result in rejection of invoices.