2-2026-2027 Fire Dept Medical Fitness Evaluations RFP - 05-22-2026.docx

JOLIET FIRE DEPARTMENT

FIREFIGHTER PHYSICAL EXAMINATION SPECIFICATIONS

JOLIET FIRE DEPARTMENT

FIREFIGHTER PHYSICAL EXAMINATION SPECIFICATIONS

JOLIET FIRE DEPARTMENT

FIREFIGHTER PHYSICAL EXAMINATION SPECIFICATIONS

JOLIET FIRE DEPARTMENT

FIREFIGHTER PHYSICAL EXAMINATION SPECIFICATIONS

JOLIET FIRE DEPARTMENT

FIREFIGHTER PHYSICAL EXAMINATION SPECIFICATIONS

CITY OF

JOLIET, IL.

FIRE

DEPARTMENT

MEDICAL AND FITNESS EVALUATIONS

PROGRAM 2026-2027

RFP 2991-0726

Thursday, July 2, 2026, at 10:00 a.m.

Proposal Submission Deadline must be submitted in Euna Procurement Bonfire by:

Bids will be opened and read at:

City of Joliet Conference Room 1 150 W. Jefferson St.

Joliet, Illinois 60432-4158

All questions shall be submitted exclusively through Euna Procurement (Bonfire). Questions submitted via email or phone will not be answered. Only inquiries made through the Euna Procurement (Bonfire) platform will receive a response.

The deadline for submitting questions is Thursday, June 25th, 2026, at 4:00 p.m.

No questions will be answered or acknowledged after that date.

IMPORTANT: Due to the need to send on-duty personnel for these medical evaluations, all tests and exams for providers must be located within the City of Joliet corporate limits. No exceptions.

Please read carefully.

Please complete and return the following packet.

Joliet Fire Department Physical Specifications.

The following is the proposal for the per-member cost. This must be completed and returned by the completion date. The description of each part of the exam is detailed throughout the rest of this document. Please note – These prices may vary from year to year depending on new hires and/or retirements. Therefore, unit costs multiplied by the actual number of tests taken will be the overall determining factor for the yearly invoices, not the proposal total on this page.

Please list the proposal price for the medical exam as follows:

Yearly Extension

Apolipoprotein B (>40)

TOTAL:

2026 Proposal Total $______________________________________

2027 Proposal Total $______________________________________

Yearly Extensions Proposal Total $______________________________________

Company Name ______________________________________

Signature of Responsible Party ___________________________________

SUPPLEMENTAL UNIT PRICES – THESE TESTS WILL BE DONE ON AN “AS NEEDED” BASIS SHOULD THEY BE REQUIRED AS A RESULT OF THE PHYSICAL EXAMS ABOVE.

2026 UNIT PRICE 2027 UNIT PRICE EXT. UNIT PRICE

Hepatitis A booster (if needed)

Tetanus booster (if needed)

X-Ray (if needed)

Blood Type & RH (if needed)

List the physical location of all exams and tests (due to sending on-duty personnel, this must be within the corporate limits of the City of Joliet - no exceptions)

Company ____________________________________________________

Lead Physician ________________________________________________

Address: _____________________________________________________

Contact Person _____________________ Phone Number ______________

E-mail address ________________________________________________

Signature of Responsible Party ___________________________________

Print Name ____________________Title ___________________________

Date ___________________________________________________________________

Please attach any exceptions or explanations to this form or list them below.

OTHER QUESTIONS REGARDING FIRE DEPARTMENT PHYSICALS

1. What other Fire Departments have your business conducted annual physicals for? Please include the Fire Department and contact details for three (3) other departments.

2. Please give any additional information about the MD experience examining with Fire Department Physicals and NFPA 1582.

3. Please give any additional information about the examining MD experience with IAFF-IFCA Wellness Fitness Initiative

Introduction

To provide the Joliet Fire Department with the best firefighters capable of performing the many tasks required of them, the Joliet Fire Department has developed the following medical evaluation process for all members of the department. The following Joliet Fire Department standard is based on the National Fire Protection Association (NFPA) Standard 1582, OSHA and the needs of the fire department. This medical evaluation is offered to the members of the Joliet Fire Department at no charge. The Physician will be responsible for guiding, directing, and advising the members regarding their health, fitness, and suitability for duty. Also, for the purpose of conducting medical evaluations, the fire department physician shall understand the physiological and psychological demands placed on members and shall understand the environmental conditions under which members must perform.

The liaison between the Joliet Fire Department and the Physician responsible for the medical evaluations (Lead Physician) will be the EMS Coordinator or the EMS Battalion Chief for the Joliet Fire Department. The Shift Battalion Chief or a designee will be responsible for the scheduling of medical evaluations for all members that are eligible to receive the evaluations. The schedules will be organized with a named individual of the responsible medical group. The number of Joliet Fire Department members that will be scheduled in a single day will be dependent on workload for that day. The period of waiting to start the physical should be kept to a minimum to enable the employee to return to work as soon as possible. Time should be allotted, however, for a full and complete evaluation and time for the physicians to advise the Joliet Fire Department members of their medical evaluations. Licensed physicians [(physician’s assistant (PA) or nurse practitioner (NP)] shall be allowed to conduct the physical examinations: i.e., hernia check, digital prostate exam, chart/history/12 Lead review. The lead physician can authorize other qualified medical personnel to perform certain diagnostic tasks (blood draw, vitals, spirometry), but the actual patient exam must be conducted by a licensed medical physician (MD, DO, PA, NP). Failure for this to occur is grounds for cancellation of this contract.

The providers must have a thorough understanding of the positions in the fire department, including:

· Essential job tasks

· Physical demands

· Psychosocial stressors

· Chemical, biological, and physical exposures

· The effects of medical conditions on essential job tasks.

It is important that the physician understand and participate as a member of a multidisciplinary WFI Team. The physician is a vital advisor/consultant to both labor and management on all medical issues.

Physicians must maintain complete adherence to medical confidentiality. Specific information regarding the medical examination, evaluation, laboratory results and medical diagnosis shall not be released unless written permission is obtained from the individual. Employees need to feel assured that the information provided to the physician will not be shared unless consent is granted.

Finally, the fire department physician must have knowledge of local, state, provincial, and federal laws related to health and safety.

Physicians play a central role in all medical aspects of the WFI. The following parameters should be considered in selecting a physician for this program. Ensure that the provider:

1. He has experience in occupational medicine including wellness and fitness health components related to firefighting.

2. Is board eligible or certified in a relevant specialty such as emergency, family, internal, or occupational medicine.

3. It has experience coordinating referrals to a variety of medical specialties for care of occupational injuries, cardiac and pulmonary issues, cancer, behavioral and other health issues affecting firefighters.

4. Is familiar with data collection, risk management and environmental conditions relevant to Labor/Management Wellness Fitness Initiatives.

The Fitness Assessments are optional and non-punitive. The intent is to provide participants with feedback on various fitness components. By having a broad view of different fitness components, the members will be offered areas to improve their physical fitness levels.

The EKG Stress Test shall be scheduled by the individual Joliet Fire Department members qualifying for the test and the Physician responsible for the medical evaluations. This test is to be scheduled and completed no greater than 30 days from the start of the first department physical. The scheduling of this test shall not overlap with or interfere with the regular daily physical. Members who are eligible for the EKG Stress Test shall have the option to have the “Cardiac Calcium Scoring Test” performed in lieu of the EKG Stress Test. Members will decide which test they wish to take, if any.

The lead physician shall be a licensed Doctor of Medicine or osteopathy. He/She shall also review and approve all evaluations conducted by other physicians within his group. The physician’s role is to evaluate the person to ascertain the presence of any medical conditions listed in this standard or NFPA 1582.

The current member shall be certified according to the following schedule:

· Under 29 years of age - every three years

· Ages 30 to 39 - every other year

· Over 40 years of age - every year (annually)

· Needs of the fire department This medical evaluation shall meet the medical requirements of other applicable standards, such as OSHA standards, 29CFR 1910.120, “Hazardous Waste Operations and Emergency Response,” 29 CFR 1910.134, “Respiratory Protection,” 29 CFR 1910.95,” Occupational Noise Exposure,” and 29 CFR 1910.1030, “Bloodborne Pathogens.”

The following shall be part of the medical evaluation.

· An interval of medical history

· An interval medical history, including significant exposures

· Height and Weight

· Blood Pressure

· Heart Rate and Rhythm

· Vital Signs

· Dermatological System

· Ears, Eyes, Nose, Mouth, Throat

· Cardiovascular

· Respiratory

· Gastrointestinal

· Genitourinary system

· Endocrine and Metabolic Systems

· Musculoskeletal Systems

· Neurological System

· Audiometry

· Prostrate

· Visual Acuity and Peripheral Vision Testing

· Pulmonary Function testing

· Laboratory Testing, if indicated

· Diagnostic testing, if indicated

· Electrocardiography, if indicated

Medical evaluation for the Physician

(Please check all boxes of services that you can supply)

All individuals will either be qualified to work without limitations or placed in category A or B.

Category A: 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.

Category B: 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.

Medical and Occupational History

· Should cover the members’ health problems, such as major illnesses, surgeries, medication use, allergies, and so forth. Symptom review is also important for detecting early signs of illness. In addition, a comprehensive medical history should include a personal health history, a family health history, a health habit history, an immunization history, and a reproductive history. An occupational history should also be obtained to document the member's past occupational and environmental exposures.

Medical Examination

· Vital signs, such as pulse, respiration, blood pressure, and, if indicated, temperature.

· Height and Weight

· Dermatological System

· Ears, Eyes, Nose, Mouth, Throat

· Cardiovascular

· Respiratory

· Gastrointestinal

· Genitourinary system

· Endocrine and Metabolic Systems

· Musculoskeletal Systems

· Neurological System

· Audiometry

· Visual Acuity and Peripheral Vision Testing

· Pulmonary Function Testing

· Laboratory Testing, if indicated

· Diagnostic testing, if indicated

· Electrocardiography, if indicated

· Hernia check

· Digital Prostate exam for males over 40 yearly

Laboratory Tests

· CBC

· Biochemical Test Battery

· Urinalysis

· Glucose

· BUN

· Creatinine

· Liver Function

· Lipid Profile

· PSA

· LEAD and ZPP

Vision

· Vision Test (Snellen)

Category A medical conditions shall include the following:

1) Far visual acuity. Far visual acuity shall be at least 20/30 binocular, corrected with contact lenses or spectacles. Far visual acuity uncorrected shall be at least 20/100 binocular for wearers of hard contacts or spectacles.

2) Peripheral vision. Visual field performance without correction shall be 140 degrees in the horizontal meridian in each eye.

Category B medical conditions should include the following:

1) Diseases of the eye, such as retinal detachment, progressive retinopathy, or optic neuritis

2) Ophthalmological procedures such as radial keratotomy or repair of retinal detachment

3) Any other eye condition that results in a person not being able to perform as a member

Pulmonary Function Test (must be administered by an experienced individual)

· Baseline test

· The Spirogram must be technically acceptable and demonstrate the members' best effort. Should use FVC and FEV1 to calculate

Lungs and Chest Wall

· Chest X-Rays

· Only for members with a history of respiratory health problems or symptoms.

Category A medical conditions shall include the following:

1) Active hemoptysis

2) Emphysema

3) Pulmonary hypertension

4) Active tuberculosis

Category B medical conditions should include the following:

1) Pulmonary re-sectional surgery, chest wall surgery, pneumothorax

2) Bronchial asthma or reactive airways disease

3) Fibrothorax, chest wall deformity, diaphragm abnormalities

4) Chronic obstructive airways disease

5) Hypoxemic disorders

6) Interstitial lung diseases

7) Pulmonary vascular diseases, pulmonary embolism

8) Bronchiectasis

9) Infectious diseases of the lung or pleural space

10) Any other pulmonary condition that results in a person not being able to perform as a member

Audiometry (every three years over 40 or at the discretion of The Joliet Fire Dept)

· Must be performed in an ANSI-approved soundproof booth with equipment calibrated to meet ANSI standards.

· If a booth is unavailable, then the test room sound pressure should not exceed those specified in the federal OSHA noise regulations (29 CFR 1910.95)

Category A medical condition:

NONE

Category B medical conditions should include the following:

1) Hearing deficit in the pure tone thresholds in the unaided worst ear that is

OR

AND

2) Unequal hearing loss

3) Atresia, severe stenosis, or tumor of the auditory canal

4) Severe external otitis

5) Severe agenesis or traumatic deformity of the auricle

6) Severe mastoiditis or surgical deformity of mastoid

7) Meniere’s syndrome or labyrinthitis

8) Otitis media

9) Any other ear condition that results in a person not being able to perform as a member and results in a person being unable to pass a job-specific functional hearing task test or a hearing in noise test.

Electrocardiography (should be administered at site of physicals …. If different than site of physicals, please list site here… ___________________________________________)

· Stress EKG should be given

· Method (mark all that apply)

· Treadmill

· Bicycle

· Stair climber

· Other _________________________________ Gradual increase in workload metabolic equivalent of resting energy expenditure (METS) is the protocol to use. A submaximal test, with the endpoint being the attainment of 85% of predicted maximal heart rate (PMHR), may be performed.

All members will start this test at the age of 50 unless other tests or medical histories suggest coronary artery disease. Testing will be done annually beginning at age 50. This may change as needed by the fire department and the members. The Joliet Fire Department will supply this schedule. (During stress test, appropriate medical equipment should be readily available. i.e. AED)

Category A conditions

1) Angina Pectoris, current

2) Heart Failure, current

3) Acute pericarditis, endocarditis, or myocarditis

4) Syncope, recurrent

5) Automatic implantable cardiac defibrillator

Category B conditions

1) Significant valvular lesions of the heart, including prosthetic valves

2) Coronary artery disease, including history of MI, coronary artery bypass surgery, or coronary angioplasty, and similar procedures.

3) Atrial Tachycardia, flutter, or fibrillation

4) Left bundle branch block, second-and third-degree atrioventricular block

5) V-tach

6) Hypertrophy of the heart

7) Recurrent paroxysmal tachycardia

8) History of a congenital abnormality

9) Chronic pericarditis, endocarditis, or myocarditis

10) Cardiac pacemaker

11) Coronary artery vasospasm

12) Any other cardiac condition that results in a person not being able to perform as a member

Fitness Evaluation (should be administered at site of physicals …. If different than site of physicals, please list the site here… ___________________________________________)

· Evaluation of Aerobic Capacity Accurate estimates of VO2 max are needed to educate personnel about their current fitness relative to the demands of their job. This information can be used to assist in designing an appropriate exercise program and will help the exercise specialist, PFT, and member gauge its effectiveness. The WFI Treadmill Protocol and the WFI StepMill Protocol were adopted as submaximal field tests for fire service personnel. Details pertaining to both assessment protocols are outlined in Appendix A.

Submaximal versus Maximal Aerobic capacity can be assessed with submaximal or maximal protocols. Well-validated submaximal tests have been shown to accurately estimate aerobic capacity. These tests can be less expensive and easier to administer than maximal tests and can be performed in a fitness setting by a qualified exercise specialist.

The submaximal aerobic assessments developed for the WFI (i.e. StepMill and Treadmill protocol) are based on the heart rate response to graded exercise. It is important to note that all submaximal tests use regression equations to estimate aerobic capacity and are, therefore, subject to error. Potential sources of error include:

· Age-predicted estimation of maximal heart rate.

· Resulting test termination heart rate, and

· Potential idiosyncratic heart rate responses due to dehydration, anxiety, and certain medications.

The magnitude and frequency of these prediction errors are reduced by using a well-validated sub-maximal test and appropriate medical prescreening.

Programs that have an on-site physician and ECG monitoring may choose to use a maximal aerobic capacity test; this will produce a more accurate estimate of VO2 max. The WFI Treadmill or StepMill protocol can be extended to maximum effort. The test terminates at maximum volitional fatigue, which is consistent with the effort put forth in an arduous emergency situation or a competitive athletic event, rather than at a percentage of the age-predicted maximal heart rate.

Maximal testing must be conducted under medical supervision with ECG monitoring, and resuscitation and defibrillation equipment on site.

· Evaluation of Muscular Strength and Endurance Evaluation of Muscular Strength and Endurance: Although strength is sometimes evaluated using single-repetition tests, in which an attempt is made to lift the heaviest load possible (i.e., 1RM), these single maximal-effort tests carry an inherent risk of injury. Further, many essential emergency service tasks, including lifting and carrying equipment, packaging and moving patients, holding and operating hose lines, raising extension ladders, and removing victims, require firefighters to exhibit submaximal strength over extended periods (strength and endurance). For this reason, three assessments are recommended to assess muscular strength and endurance.

The push-up assessment can be used to evaluate upper body pushing strength, endurance, and coordination, and control of the trunk. The alternate grip push-up is an alternative assessment that may be better suited for individuals with a history of hand, wrist, or shoulder injuries. Please refer to Appendix A for the push-up protocol.

The horizontal pull-up assessment can be used to evaluate upper-body pulling strength and endurance (including grip strength), as well as coordination and control of the trunk and hips. Please refer to Appendix A for the horizontal pull-up protocol.

A static side plank assessment can be used to evaluate firefighters’ trunk muscle strength and endurance, including the ability to resist lateral flexion and spinal rotation. Both right- and left-side assessments are performed to address potential asymmetries through exercise interventions. Please refer to Appendix A for the static side plank protocol.

· Evaluation of Mobility and Flexibility Mobility and flexibility of the hips and shoulders will be evaluated using active straight-leg raise and shoulder flexion and extension assessments, respectively. Each assessment protocol is described in Appendix A.

Reporting Results

· All medical evaluation information is considered confidential and is subject to customary patient-physician confidentiality restrictions and HIPAA. Under most circumstances, results and recommendations arising from the evaluation should be expressed in general terms without specific diagnostic information. In cases where more specific information is needed to determine the member's status, a consent form authorizing the release of that information should be obtained from the member.

· Example of a statement

· Based on the results of the medical evaluation of (date), (name) is/or is NOT medically certified to engage in training and emergency operations for the Joliet Fire Department. He has been advised of the medical reasons for this recommendation and of the policies and procedures available to him if he disagrees with the results of the medical evaluation.

· The Joliet Fire Department EMS Coordinator or Battalion Chief of EMS and Safety, Health and Wellness Committee will be supplied with the following information (The appropriate release information must be obtained by the medical facility)

· HEP. B results (not part of physical)

· HEP. Results (only given to Dive Team Members)

· Blood Type (only members as required by Joliet Fire Department)

· Any other issues related to infection Control and Bloodborne pathogens. (To be placed into the members' secured infection control files)

· A General Health of Department Report will be submitted after completing the physical. The items listed in the report shall be:

· Percentage of age groups tested (20-29, 30-39, 40-49, 50-59, and over 60)

· Percentage of Smokers

· Percentage of departments overweight

· How many pounds are overweight?

· Hearing loss report

· Cholesterol Report

· Overall General Health Report

· Any other reports the physician believes will help the department in promoting a healthy lifestyle

This report should be provided electronically in Microsoft-based programs within 30 days of payment.

SPECIFIC MEDICAL CONDITIONS

· Diabetes Mellitus

· The major concern for diabetic members is the risk of becoming hypoglycemic during fire ground operations or other emergency responses. The most reliable predictor is the history of diabetes. Each case will be closely monitored, and in the absence of a history of incapacitating hypoglycemic episodes, there is probably no reason to exclude members who are taking hypoglycemic agents, and if they have stable weight, diet, and renal function.

· Asthma and Reactive Airway Disease

· Persistence of airway obstruction between attacks

· Need and frequency of steroid and bronchodilator use

· Usual type of triggers for the member

· History of hospitalization, emergency room, or urgent treatment

· Length of time between attacks

· Nocturnal symptoms and other estimates of airway instability

· Moderate Asthma or worse could disqualify an individual for duties.

· Seizures and Epilepsy

· If a member has a single seizure, a clear precipitant not associated with the central nervous system damage is identified and eliminated, and the individual has no recurrence after the ensuing year, then he or she is probably not more likely to have another seizure.

· A qualified neurologist should verify that an individual with a history of seizures does not, in fact, have epilepsy.

Medical evaluations will be done according to the following process.

1) All spirometry testing and blood draws will be completed at four fire stations over the course of three days. These stations currently are:

a. Station one 101 E Clinton Joliet, IL.

b. Station six 2049 Oneida St. Joliet, IL.

c. Station eight 2293 Essington Rd. Joliet IL.

d. Station ten 1599 John D. Paige Dr. Plainfield, IL.

2) The dates and times of the drawings will be decided upon by the Joliet Fire Department and typically will be as follows: (consideration must be given for emergency calls, etc.)

a. 0800 hours at stations one, six, and eight.

b. 1000 hours station 10

3) Blood draws should be completed early enough (usually two weeks before meeting with the physician) to obtain all the laboratory results for a consultation by the physician and the results of the entire medical evaluation.

4) Medical Evaluations will be completed at a rate of approximately 10 per day to allow ample time for consultation and the exam.

5) Mutually agreed-upon Saturdays must be available for exams as well.

Definitions:

Candidate. A person who has made an application to commence performance as a member.

Category A Medical Condition. 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.

Category B Medical Condition. 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.

Evaluation. See Medical Evaluation.

Fire Department Physician. A licensed Doctor of Medicine or osteopathy who has been designated by the fire department to provide professional expertise in the areas of occupational safety and health as they relate to emergency services.

Health and Safety Officer. The member of the fire department assigned and authorized by the fire chief as the manager of the safety and health program.

Infection Control Officer. The person or persons within the fire department responsible for managing the department's infection control program and coordinating efforts related to the investigation of an exposure.

Infection Control Program. The fire department's formal policy and implementation of procedures relating to the control of infectious and communicable disease hazards were that employees, patients, or the public could be exposed to blood, body fluids, or other potentially infectious materials in the fire department work environment.

Lead Physician. Physician in charge of physicals and assumes role as fire department physician.

Medical Evaluation. The analysis of information for the purpose of deciding of medical certification. Medical evaluation includes a medical examination.

Medical Examination. An examination performed by a licensed medical physician (MD or DO), the fire department physician, as listed above.

Medical Services, Emergency. The provision of treatments such as first aid, cardiopulmonary resuscitation, basic life support, advanced life support, and other pre-hospital procedures, including ambulance transportation to patients.

Medically Certified. A determination by the fire department physician that the candidate or current member meets the medical requirements of this standard.

Member. A person involved in performing the duties and responsibilities of a fire department, under the auspices of the organization. A fire department member can occupy any position or rank within the fire department and can engage in emergency operations.

Member, Current. A person who is already a member and whose duties require the performance of essential fire-fighting functions.

Shall. Indicates a mandatory requirement.

Should. Indicates a recommendation or that which is advised but not required.

Standard. A document, the main text of which contains only mandatory provisions using the word “shall” to indicate requirements, and which is in a form generally suitable for mandatory reference by another standard or code or for adoption into law. Nonmandatory provisions shall be in an appendix, footnote, or fine-print note and are not to be considered a part of the requirements of a standard.

Included in this specification sheet for your convenience is the following excerpts from NFPA 1582. (Essential Structural Fire-Fighting Functions, Explanatory Material, Information for Fire Department Physicians). Although these are not actual parts of the NFPA requirement, they are included for informational purposes.

Essential Structural Fire-Fighting Job Tasks

This appendix of Essential Job Tasks and Descriptions is included for informational purposes only.

The fire department shall evaluate the following 13 essential job tasks against the types and levels of emergency services provided to the local community by the fire department, the types of structures and occupancies comprising the community, and the configuration of the fire department to determine the essential job tasks of fire department members and candidates:

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

(4) Depending on the local jurisdiction, climbing six or more flights of stairs while wearing a fire protective ensemble 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)

(5) Wearing a fire protective ensemble 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 exceeding 102.2°F (39°C)

(6) Searching, finding, and rescue-dragging or carrying victims ranging from newborns up to adults weighing over 200 lbs. (90 kg) to safety despite hazardous conditions and low visibility

(7) Advancing water-filled hose lines up to 2 ½ 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

(8) Climbing ladders, operating from heights, walking or crawling in the dark along narrow and uneven surfaces, and operating in proximity to electrical power lines and/or other hazards

(9) Unpredictable emergency requirements for prolonged periods of extreme physical exertion without the benefit of warm-up, scheduled rest periods, meals, access to medication(s), or hydration

(10) Operating fire apparatus or other vehicles in an emergency mode with emergency lights and sirens

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

(12) 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)

(13) 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

5.1.2 The fire department physician shall consider the physical, physiological, intellectual, and psychological demands of the occupation when evaluating the candidate's or member's ability to perform the essential job tasks.

5.1.3 Medical requirements for candidates and members shall be correlated with the essential job tasks as determined by 5.1.1.

5.1.4 The fire department shall provide the fire department physician with the list of essential job tasks to be used in the medical evaluation of members and candidates.

5.2 Essential Job Tasks for Specialized Teams.

5.2.1 If the fire department operates specialized teams such as hazardous materials units, self-contained underwater breathing apparatus (SCUBA) teams, technical rescue teams, emergency medical services (EMS) teams, or units supporting tactical law enforcement operations, the fire department shall identify for each team it operates additional essential job tasks not specified in 5.1.1(1) through 5.1.1(13) that would apply to the members of that team.

5.2.2 The fire department shall provide the fire department physician with a list of essential job tasks specific to each specialized team.

5.2.3 When performing the medical evaluation of members of a specialized team, the fire department physician shall consider the following:

(1) Additional medical and/or physical requirements that are related to the job tasks being performed by the team that are not enumerated in this standard

(2) The impact on the member of having to wear or utilize specialized personal protective equipment (PPE) that can increase weight, environmental isolation, sensory deprivation, and/or dehydration potential above levels experienced with standard fire suppression PPE

Explanatory Material Annex A is not a part of the requirements of this NFPA document but is included for informational purposes only. This annex contains explanatory material, numbered to correspond with the applicable text paragraphs.

A.1.1.1 Some of the medical requirements in this standard are not applicable to candidates and members whose essential job tasks within the fire department are not described in NFPA 1001, NFPA 1002, NFPA 1003, NFPA 1006, NFPA 1021, and NFPA 1051. However, particular attention must be paid to the essential job tasks of individual candidates or members when applying this standard (for example, administrative staff personnel, some EMS personnel, fire/police, and others who do not have responsibility for structural firefighting and are not required to wear personal protective ensembles and use SCBA). Medical requirements should reflect essential job tasks, and not all may be specifically addressed in this standard. (See also Chapter 5 and Chapter 9.)

A.1.2.2 A direct relationship exists between the medical requirements and the job description of members. The job description should include all essential job functions of members, both emergency and nonemergency. Members perform a variety of emergency operations, including firefighting, emergency medical care, hazardous materials mitigation, driving/operating fire apparatus, and special operations. Nonemergency duties can include, but are not limited to, training, station and vehicle maintenance, and physical fitness. Each fire department needs to identify and develop a written job description for members.

A.1.3.2 The specific determination of the authority having jurisdiction depends on the mechanism under which this standard is adopted and enforced. Where this standard is adopted voluntarily by a particular fire department for its own use, the authority having jurisdiction should be the fire chief or the political entity that is responsible for the operation of the fire department. Where this standard is legally adopted and enforced by a body with regulatory authority over a fire department, such as a federal, state, or local government or political subdivision, that body is responsible for making those determinations as the authority having jurisdiction. The compliance program should consider the services the fire department is required to provide, the financial resources available to the fire department, the availability of personnel and trainers, and such other factors as will affect the fire department's ability to achieve compliance.

A.1.3.3 The most vital resource of any fire department is its members. This standard is to be implemented as part of a process aimed at improving members' health and wellness. Given the hazardous nature of the occupation, measures to reduce the risk of occupational injury, illness, and exposure to communicable diseases are warranted. Annual reports repeatedly indicate over 100 line-of-duty deaths and 100,000 occupational injuries and illnesses among career and volunteer fire fighters. Another concern is the firefighters who experience disabling injuries or develop occupational diseases and conditions, which often have debilitating or fatal results, forcing them to leave their fire service activities. There is an increased risk of respiratory and heart disease in firefighters and strong evidence of a link to some cancers and other conditions related to occupational exposures to carcinogens, toxic products of combustion, and hazardous materials.

Safety and health are two of the many components of the risk management process. The intent of this standard is to reduce the risk and burden of fire service occupational morbidity and mortality while improving firefighters' welfare. By implementing the medical requirements of this standard, a fire department commits to a process for evaluating and enhancing members' health and fitness for duty.

A.3.2.1 Approved. The National Fire Protection Association does not approve, inspect, or certify any installations, procedures, equipment, or materials; nor does it approve or evaluate testing laboratories. In determining the acceptability of installations, procedures, equipment, or materials, the authority having jurisdiction may base acceptance on compliance with NFPA or other appropriate standards. In the absence of such standards, said authority may require evidence of proper installation, procedure, or use. The authority having jurisdiction may also refer to the listings or labeling practices of an organization responsible for product evaluations to determine compliance with appropriate standards for the current production of listed items.

A.3.2.2 Authority Having Jurisdiction (AHJ). The phrase “authority having jurisdiction,” or its acronym AHJ, is used broadly in NFPA documents, since jurisdictions and approval agencies vary, as do their responsibilities. Where public safety is primary, the authority having jurisdiction may be a federal, state, local, or other regional department or individual, such as a fire chief, fire marshal, chief of a fire prevention bureau, labor department, health department, building official, electrical inspector, or others having statutory authority. For insurance purposes, an insurance inspection department, rating bureau, or other insurance company representative may be the authority having jurisdiction. In many circumstances, the property owner or his or her designated agent assumes the role of the authority having jurisdiction; at government installations, the commanding officer or a departmental official may serve in that role.

A.3.3.1 Candidate. Volunteer members are considered employees in some states or jurisdictions. Volunteer fire departments should seek legal counsel regarding their responsibilities in these matters.

A.3.3.17 Member. A fire department member can be a full-time or part-time employee or a paid or unpaid volunteer, can occupy any position or rank within the fire department, and can engage in emergency operations. [1500, 2007] A.4.1.2.1 Fire departments can require candidates to provide some form of medical clearance for candidate participation in pre-employment physical strength and agility tests. When such a requirement exists, the medical clearance forms should list the tasks the candidate will be asked to safely perform during the test.

A.4.1.4 This physician should also have experience with running an occupational medicine program for public safety workers, preferably firefighters.

A.4.1.7 The fire department should provide the fire department physician with a representative list of essential job tasks for members of fire departments who wear personal protective ensembles and SCBA to conduct interior structural fire-fighting operations. The tasks on this list should be verified by the fire department to be essential to the job under consideration for each individual candidate or member. A sample list based on NFPA 1001, NFPA 1002, NFPA 1003, NFPA 1006, NFPA 1021, and NFPA 1051 is provided in 5.1.1 and Section 9.1.1. An effective way to convey this information to the physician is to use a list with checkboxes next to each essential job task. This list is taken by a candidate or member to the medical provider at the time of medical evaluation. A check in the box indicates that there is no medical reason why an individual cannot safely perform that essential job task.

A.4.1.13.1 Suggested fields (data points) include but are not necessarily limited to the following:

(1) Medical history, including the following:

(a) Date of exam

(b) Medical history

(c) Smoking history

(d) Tobacco (smokeless) use

(e) Smoking in the past year

(f) Tobacco cessation program participation

(g) Alcohol use

(h) Family history of heart disease or cancer

(i) Personal history of past disease, disorders, or cancer

(j) Exercise history

(2) Current medical and fitness results, including the following:

(a) Blood pressure and heart rate

(b) ICD9 codes for physician assessment

(c) Height and weight

(d) Body composition (local recording only)

(e) Blood analysis results

(f) Urinalysis results

(g) Vision

(h) Hearing

(i) Spirometry

(j) Chest x-ray

(k) Resting electrocardiogram

(l) Cancer screening results

(m) Immunizations

(n) Aerobic capacity results

(o) Muscle strength results

(p) Muscle endurance results

(q) Flexibility results A.4.2.6 Incident scene rehabilitation is an important component of incident scene management that protects the health and safety of fire department members. NFPA 1500, Standard on Fire Department Occupational Safety and Health Program, and NFPA 1561, Standard on Emergency Services Incident Management System, require the establishment of “rehab” during incident scene operations. A significant component of member rehabilitation is ongoing medical evaluation. The standard does not require the fire department physician to be at every incident, but does require that the physician coordinate with the EMS medical director to provide protocols for medical evaluation and management of members in emergency incident rehab. This medical planning process ensures optimal medical support for members of the scene and should include criteria for transportation to a medical facility for additional evaluation and treatment. Fire departments can develop specific standard operating procedures establishing conditions under which fire department physicians(s) are dispatched to emergency incidents. (See NFPA 1584, Recommended Practice on the Rehabilitation of Members Operating at Incident Scene Operations and Training Exercises.)

A.4.4.1 Confidentiality of all medical data is critical to the success of the program. Members need to feel assured that the information provided to the physicians will not be inappropriately shared.

A.5.1.1(1) A member, while wearing full protective clothing (turnout coat and pants, helmet, boots, and gloves) and SCBA, is required to safely perform a variety of firefighting tasks that require upper-body strength and aerobic capacity. For those not familiar with fire suppression, the following specific details inherent to the activities in essential task 1 are offered:

(3) Performing forcible entries while utilizing tools and equipment (e.g., axe, Halligan tool, chain saw, circular saw, or rabbet tool) that require chopping, pulling, or operating these items to open doors, windows, or other barriers to gain access to victims or possible victims or to initiate fire-fighting operations.

(4) Performing ventilation (horizontal or vertical) utilizing tools and equipment (e.g., axe, circular saw, chain saw, pike pole) while operating on a flat or pitched roof or operating off a ground or aerial ladder. This task requires the firefighter to chop or push tools through roofs, walls, or windows.

Other tasks that could be performed include search-and-rescue operations and other emergency response actions under stressful conditions, such as working in extremely hot and cold environments for prolonged periods.

A.6.1.1 The medical history should include the candidate's known health problems, such as major illnesses, surgeries, medication use, and allergies. Symptom review is also important for detecting early signs of illness. A medical history should also include a personal health history, a family health history, a health habit history, an immunization history, and a reproductive history.

An occupational history should also be obtained to collect information about the person's past occupational and environmental exposures.

Physical examination should include the following:

(1) Vital signs

(2) Head, eyes, ears, nose, and throat (HEENT)

(3) Neck

(4) Cardiovascular

(5) Pulmonary

(6) Breast

(7) Gastrointestinal (includes rectal exam for mass, occult blood)

(8) Genitourinary (includes pap smear, testicular exam, rectal exam for prostate mass)

(9) Hernia

(10) Lymph nodes

(11) Neurological

(12) Musculoskeletal

(13) Skin (includes screening for cancers)

(14) Vision testing Laboratory tests on candidates should include the following:

(1) Blood tests, including the following:

(a) CBC with differential, RBC indices and morphology, and platelet count

(b) Electrolytes (Na, K, Cl, HCO3, or CO2)

(c) Renal function (BUN, creatinine)

(d) Glucose

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

(f) Total cholesterol, HDL, LDL, clinically useful lipid ratios (e.g., percent LDL), and triglycerides

(2) Urinalysis. Dipstick tests for glucose, ketones, leukocyte esterase, protein, blood, and bilirubin.

(3) Audiology. Hearing was assessed in each ear at each of the following frequencies: 500 Hz, 1000 Hz, 2000 Hz, 3000 Hz, 4000 Hz, 6000 Hz, and 8000 Hz. Results should be corrected for age as permitted by OSHA. Baseline audiometry is performed in accordance with 29 CFR 1910.95, “Occupational noise exposure.” The basics of this standard include the following:

(a) The first audiogram done (for members, this will probably be done during their pre-placement exam) becomes the baseline audiogram.

(b) If subsequent audiograms are better than the baseline, then the best one becomes the baseline. All audiograms should be performed after 14 hours of no exposure to industrial noise.

(4) Spirometry. Pulmonary function testing (spirometry) is conducted to measure the member's forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and the FEV1/FVC ratio. Data is corrected within American Thoracic Society Guidelines and normative equations (Knudson et al., 1983, and ACOEM 2000).

(5) Chest radiography. Chest x-ray, posterior-anterior and lateral views.

(6) Electrocardiograms (EKG). A resting 12-lead EKG.

(7) Immunizations and infectious disease screening. The following infectious disease immunizations or infectious disease screenings are to be provided, as indicated:

(a) Hepatitis C virus screen (baseline)

(c) Hepatitis B virus vaccinations

(h) Varicella vaccine, offered to all non-immune personnel

(i) Influenza vaccine, offered to all personnel A.6.3.1.2(1) Deformities of the skull can result in the member's inability to properly wear protective equipment.

A.6.3.1.2(2) These deformities can result in the potential for sudden incapacitation, the inability to properly wear protective equipment, and the inability to communicate effectively due to oropharyngeal dysfunction.

A.6.3.1.2(3) Loss of or congenital absence of the bony substance of the skull can result in the inability to properly wear protective equipment and the inability to communicate effectively due to…