NFPA_1582_2007_Edition_TIG.pdf

Technical Implementation Guide 1582-07

For

NFPA 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments, 2007 Edition

Date Published: 9 January 2008

Preface

This Technical Implementation Guide (TIG) provides standard determinations, interpretations, equivalencies and deviations to implement National Fire Protection Association 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments (2007 Edition) within the Air Force.

This TIG remains in effect until rescinded or one year following publication of a revised NFPA 1582. This TIG includes 4 attachments:

NFPA 1582 TIG Correlation Document1.

Fire Fighter Health History2.

Air Force Fire Fighter Physical Exam Schedule3.

Air Force Policy on Implementing NFPA Standards4.

//Signed// //Signed//

DONALD W. WARNER LAURA TORRES-REYES

Chief, Air Force Fire Emergency Services COLONEL, USAF, MC, FS HQ Air Force Civil Engineer Support Agency Chief, Occupational Medicine Air Force Medical Operations Agency

I have approved the deviations from NFPA Standard 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments, 2007 Edition, contained in this TIG.

DEL EULBERG, Major General, USAF The Civil Engineer DCS/Installations & Logistics

NFPA 1582 MAIN GUIDE (Attachment 1) NFPA 1582, Standard on Comprehensive Occupational Medical Program for Fire Emergency Services , 2007 Edition

Air Force Implementation Guidance.

CHAPTER 1 - Administration

1.1 Scope.

This standard contains descriptive requirements for a comprehensive occupational medical program for Fire Emergency Services.

Implement as written.

1.1.1* The medical requirements in this standard are applicable to fire department candidates and members whose job descriptions as defined by the authority having jurisdiction (AHJ) are outlined in NFPA1001, Standard for Fire Fighter Professional Qualifications; NFPA 1002, Standard for Fire Apparatus Driver/Operator Professional Qualifications; NFPA 1003, Standard for Airport Fire Fighter Professional Qualifications; NFPA 1006, Standard for Rescue Technician Professional Qualifications; NFPA 1021, Standard for Fire Officer Professional Qualifications; and NFPA 1051, Standard for Wildland Fire Fighter Professional Qualifications.

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 fire fighting and are not required to wear personal protective ensembles and use SCBA). Medical requirements should reflect essential job tasks, and all might not be specifically addressed in this standard.

This standard shall apply to individuals involved in emergency response operations as defined in DoDI 6055.6, DoD Fire and Emergency Services (F&ES) program.

1.1.2 This standard provides information for

physicians and other health care providers responsible for fire department occupational medical programs.

Implement as written.

1.1.3 These requirements are applicable to public, governmental, military, private, and industrial fire department organizations providing rescue, fire suppression, emergency medical services, hazardous materials mitigation, special operations, and other emergency services.

Waiver request, see paragraph 6.22.1.1.

1.1.4 This standard shall not apply to industrial fire

brigades that also can be known as emergency brigades, emergency response teams, fire teams, plant emergency organizations, or mine emergency response teams.

Implement as written.

1.2 Purpose.

The purpose of this standard is to outline an occupational medical program that, when implemented in a fire department, will reduce the risk and burden of fire service occupational morbidity and mortality while improving the health, and thus the safety and effectiveness, of firefighters operating to protect civilian life and property.

Implement as written.

1.2.1 Accordingly, the standard specifies the

following information:

(1) Minimal medical requirements for candidates as delineated in Chapter 6

(2) Occupational medical and fitness evaluations for members as delineated in Chapters 7 and 8

(3) Information regarding fire department activities and essential job tasks that assist the department physician in providing proper medical support for members

(4) Methods and types of data that must be collected to sustain comprehensive occupational medical programs for Fire Emergency Services

Implement as written.

1.2.2* The implementation of the medical requirements outlined in this standard ensures that candidates and current members are medically capable of performing their required duties and will reduce the risk of occupational injuries and illnesses.

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 non-emergency. Members perform a variety of emergency operations including fire fighting, emergency medical care, hazardous materials mitigation, driving/operating fire apparatus, and special operations. Non-emergency 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.

Implement as written.

1.2.3 Nothing herein is intended to restrict any

jurisdiction from exceeding these minimum requirements.

Implement as written.

1.3 Implementation

1.3.1 For candidates, the medical requirements of

this standard shall be implemented when this standard is adopted by an AHJ on an effective date specified by the AHJ.

Implement as written.

AHJ for deviations = HQ USAF/ILE.

AHJ for equivalency & interpretations = HQ AFCESA/CEXF.

1.3.2* When this standard is adopted by a jurisdiction, date(s) shall be set for members to achieve compliance by establishing a phase-in schedule for compliance with specific requirements, if needed.

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 having regulatory authority over a fire department, such as federal, state, or local government or political subdivision, this body is responsible for making those determinations as the authority having jurisdiction. The compliance program should take into account the services the fire department is required to provide, the financial resources available to the fire department, the availability of personnel, the availability of trainers, and such other factors as will affect the fire department’s ability to achieve compliance.

1.3.3* The fire department risk management plan as described in NFPA 1500, Standard on Fire Department Occupational Safety and Health Program, shall include implementation of a comprehensive occupational medical program that is compliant with this standard.

A.1.3.3 The most vital resource of any fire department is its members. This standard is to be implemented in a process aimed at improving member health and wellness. Due to the hazardous nature of the occupation, methods to reduce the risk of occupational injury, illness, and exposures 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 fire fighters 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 fire fighters 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 the welfare of fire fighters. By implementing the medical requirements of this standard, a fire department commits to a process that evaluates and enhances the health and fitness for duty of members.

CHAPTER 2- Referenced publications All referenced publications can be found in the basic NFPA 1582, Standard on Comprehensive Occupational Medical Program for Fire Emergency Services, 2007 Edition.

CHAPTER 3- Definitions All referenced definitions can be found in the basic NFPA 1582, Standard on Comprehensive Occupational Medical Program for Fire Emergency Services, 2007 Edition.

Authority Having Jurisdiction In accordance with policy letter issued by HQ USAF/ILE, the AHJ for waivers is HQ USAF/ILE.

The AHJ for determinations, equivalencies, and interpretations is HQ AFCESA/CEXF. The authority for medical determination at the installation level is the Fire Chief in coordination with Fire Department Physician.

CHAPTER 4 – Roles and Responsibilities Implement as written.

4.1 Fire Department Responsibilities.

4.1.1 The fire department shall establish a

comprehensive occupational medical program that includes medical evaluations for candidates and members.

Implement as written.

4.1.2 The medical evaluations and any additional

medical tests ordered by the fire department physician shall be provided at no cost to the members.

Implement as written.

4.1.2.1* This obligation shall not extend to medical tests beyond the basic medical evaluation for candidates.

A.4.1.2.1 Fire Emergency Services can require candidates to provide some form of medical clearance for candidate participation in pre-employment physical strength and agility tests.

When there is such a requirement, the medical clearance forms should enumerate the tasks that the candidate will be asked to safely perform during the test.

Implement as written.

4.1.3 The fire department shall have an officially

designated physician who shall be responsible for guiding, directing, and advising the members with regard to their health, fitness, and suitability for duty as required by NFPA 1500, Standard on Fire Department Occupational Safety and Health Program.

Implement as written.

4.1.4* The fire department shall ensure that the fire department physician is a licensed doctor of medicine or osteopathy who has completed residency training in an accredited medical training program and/or is American Boards of Medical Specialties (ABMS) or American Osteopathic Association (AOA) board certified or international equivalent.

A.4.1.4 This physician should also have experience with running an occupational medicine program for

Exception: Air Force physicians who have completed Air Force specific courses in occupational medicine meet the intent of this section. The Occupational Health Installation Consultant will approve physician candidates before appointment as FD physician.

Occupational Health Installation Consultant is POC for these matters. All exams may not necessarily accomplished by this person.

public safety workers, preferably fire fighters.

4.1.5 The fire department shall provide the fire

department physician with a fire service overview, current job descriptions, and the essential job tasks required for all fire department positions and ranks.

Implement as written.

4.1.6 The fire department shall provide the fire

department physician with the department’s organizational statement that outlines types and levels of services provided by the department, in accordance with NFPA 1500.

Implement as written.

4.1.7* The types and levels of services provided by the fire department shall dictate for candidates and members the essential job tasks that pertain to its members and shall therefore be correlated to the medical requirements outlined in this standard.

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 Emergency Services 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

NFPA1001, NFPA1002, NFPA1003, NFPA1006,

NFPA1021, and NFPA 1051 is provided in 5.1.1 and Section 9.1. An effective way to transmit this information to the physician is to use the list with checkboxes in front of 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 particular essential job task shall therefore be correlated to the medical requirements outlined in this standard.

Implement as written.

4.1.8 For the purpose of conducting medical

evaluations, the fire department shall assist the fire department physician to understand the physiological and psychological demands placed on members as well as the environmental conditions under which they must perform and the personal protective equipment (PPE) they must wear during various types of emergency operations.

Implement as written.

4.1.9 The fire department shall ensure member

access to evaluation by medical specialists, medical and/or surgical treatment, rehabilitation, and any other intervention prescribed by a medical provider, in consultation with the fire department physician, following an injury or illness resulting from a member’s participation in fire department functions.

Implement as written.

4.1.10 The fire department shall require that the fire

department health and safety officer and the health and fitness coordinator maintain a liaison relationship with the fire department physician to ensure that all aspects of the comprehensive occupational medical program are actively engaged.

4.1.11 The fire department shall ensure employee

privacy and confidentiality regarding medical conditions identified during the medical evaluation except as required by law.

Implement as written.

4.1.12 Where possible, the fire department shall

provide alternate duty position for members when the fire department physician recommends temporary work restrictions.

Implement as written.

4.1.13 Medical Record Keeping.

4.1.13.1* The fire department comprehensive occupational medical program shall include collection and maintenance of a confidential medical and health information system for members.

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

Implement as written, see Attachment 3.

A.4.1.13.1. These are not requirements, but suggestions. Specific data points will be determined by the base Occupational Health Working Group

(OHWG).

(b) ICD9 codes are not required.

(d) If indicated, BMI can be calculated from height and weight.

(l) Cancer screening not indicated in routine surveillance.

(n) Aerobic capacity not required.

(o) Muscle strength testing not required.

(p) Muscle endurance testing not required.

(q) Flexibility testing not required.

4.1.13.2 All medical record keeping shall comply

with the requirements of 29 CFR 1910.1020, “Access to employee exposure and medical records,” and other applicable regulations and laws.

4.1.14 The provisions of 4.1.13 shall apply to all

health and medical records regarding individual members and to all methods of communicating or transferring the information contained in these records, including written, oral, electronic, and any other means of communication.

Implement as written.

4.2 Fire Department Physician Responsibilities.

4.2.1 The fire department physician shall fulfill the

following responsibilities:

(1) Understand the physiological, psychological, and environmental demands placed on fire fighters

(2) Evaluate fire department candidates and members to identify medical conditions that could affect their ability to safely respond to and participate in emergency operations

(3) Utilize the essential job task descriptions supplied by the fire department to determine a candidate’s or a member’s medical certification

(4) Identify and report the presence of Category A or disqualifying Category B medical conditions if present in candidates

(5) Inform the fire chief or his/her designee whether or not the candidate or current member is medically certified to safely perform the essential job tasks

(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

(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

(8) Review results of the annual occupational fitness evaluation as described in Chapter 8

(9) Provide or arrange for a prescriptive rehabilitation and/or fitness program when indicated to aid a member’s recovery from illness or injury and enhance his/her ability to safely perform essential job tasks

Implement as written.

4.2.2 When medical evaluations are conducted by a

physician or medical provider other than the fire department physician, the evaluation shall be reviewed and approved by the fire department physician.

Implement as written.

4.2.3 The fire department physician shall review

individual medical evaluations and aggregate data from member evaluations in order to detect evidence of occupational exposure(s) or clusters of occupational disease.

To include evaluations from other epidemiologic centers and other sources for indicators of a need for additional medical monitoring.

4.2.4 The fire department physician shall be a

member of the Fire Department Occupational Safety and Health Committee chaired by the health and safety officer as required by NFPA1500.

4.2.5 The fire department physician shall provide

medical supervision for the fire department fitness, return-to-duty rehabilitation, and physical conditioning programs as required by NFPA 1583, Standard on Health-Related Fitness Programs for Fire Fighters.

Implement as written.

4.2.6* The fire department physician shall ensure adequate on-scene medical support at the incident scene rehabilitation sector for members during emergency operations as required by NFPA 1500 and NFPA 1561, Standard on Emergency Services Incident Management System.

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, NFPA 1561, 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 at the scene and should include criteria for transportation to a medical facility for additional evaluation and treatment. Fire Emergency Services can develop specific standard operating procedures establishing conditions under which fire department physician(s) are dispatched to emergency incidents.

Clarification: Base Level Fire Chief shall oversee development of a local Standard Operating Procedure in coordination with the of Fire Department Physician.

4.2.7 The fire department physician shall provide

supervision for the fire department infection control program as required by NFPA 1581, Standard on Fire Department Infection Control Program.

Implement as written.

4.3 Candidate and Member Responsibilities. Each

candidate or member shall adhere to the following requirements:

(1) Cooperate, participate, and comply with the medical evaluation process

(2) Provide complete and accurate information to the fire department physician and other authorized medical care provider(s)

(3) Report any occupational exposure such as exposure to hazardous materials or toxic substances and exposure to infectious or contagious diseases

(4) Report to the fire department physician any medical condition that could interfere with the ability of the individual to safely perform essential job tasks, such as illness or injury, use of prescription or nonprescription drugs, and pregnancy

4.4 Confidentiality of Medical Information.

4.4.1* Specific information concerning medical diagnosis shall be released by the fire department physician only with written permission from the candidate or member.

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 physician will not be inappropriately shared.

Implement as written.

4.4.2 No fire department supervisor or manager

shall have access to medical records without the express written consent of the member.

Implement as written.

4.4.3 When specific medical information is needed

by a fire department manager to make a decision about placement, return to work, and so forth, written consent shall be obtained from the member to release the specific medical information necessary for that decision.

Implement as written.

CHAPTER 5- Essential job tasks

5.1 Essential Job Tasks and Descriptions.

5.1.1 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:

1)*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 while wearing personal protective ensembles and self-contained breathing apparatus (SCBA), including working in extremely hot or cold environments for prolonged time periods.

(2) Wearing an SCBA, which includes a demand valve– type positive-pressure facepiece or HEPA filter masks, which requires the ability to tolerate increased respiratory workloads

(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 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 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 lb (90 kg) to safety despite hazardous conditions and low visibility

(7) Advancing water-filled hoselines up to 21⁄2 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

(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 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 is 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 hoselines 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.

Implement as written.

5.1.3 Medical requirements for candidates and

members shall be correlated with the essential job tasks as determined by 5.1.1.

Implement as written. The Fire chief using the core position description develops essential job tasks.

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.

Implement as written.

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 the list of essential job tasks specific to each specialized team.

Implement as written.

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

Implement as written.

CHAPTER 6 -Medical evaluations and clearances

6.1 Medical Evaluation. A medical evaluation of a

candidate shall be conducted prior to the candidate being placed in training programs or fire department emergency response activities.

AF military firefighters will receive the candidate physical evaluation prior to attending the Apprentice Fire & Emergency Services Course at the DoD Fire Academy and before arriving at their first permanent duty location.

6.1.1* The medical evaluation of a candidate shall include a medical history, examination, and any laboratory tests required to detect physical or medical condition(s) that could adversely affect his/her ability to safely perform the essential job tasks outlined in 5.1.1.

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

A6.1.1. See Attachment 3 for implementation guidance. Tests that are not recommended for implementation due to lack of correlation to required job tasks include:

(6) - (8) Delete breast exam, rectal exam, pap smear, testicular exam and prostate exam as these are not pertinent to qualification for work.

(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 test for glucose, ketones, leukocyte esterase, protein, blood, and bilirubin.

(3) Audiology. Hearing 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 done with no exposure to industrial noise for 14 hours.

(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) Tuberculosis screen (PPD)

(b) Hepatitis C virus screen (baseline)

(c) Hepatitis B virus vaccinations

(d) Tetanus/diphtheria vaccine (booster every 10 years)

(e) Measles, mumps, rubella (MMR) vaccine

(f) Polio vaccine given to uniformed personnel if

(a) Only CBC indicated for baseline. RBC indices and morphology, and platelet count not indicated.

(b) Electrolytes not indicated.

(c) Renal function testing not indicated.

(d) Fasting blood glucose not indicated. Dipstick urine for glucose only.

(e) Only ALT indicated for baseline.

(2) Only Dipstick test for glucose. For Diabetics, urinary microalbumin and hemoglobin A1C indicated.

(3) 8000 Hz testing not indicated.

(a) Firefighters are not considered high risk for TB.

IPPD is not recommended routinely.

(b) CDC does not recommend Hepatitis C screening.

(c) Baseline Hepatitis B vaccine/titre recommended.

(e) Should be done by candidate’s own provider.

(f) Should be done by candidate’s own provider.

vaccination or disease is not documented

(g) Hepatitis A vaccine, offered to high-risk (hazmat, USAR, and SCUBA) and other personnel with frequent or expected frequent contaminated water exposures

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

(i) Influenza vaccine, offered to all personnel

(g) As indicated by Fire Department Physician.

(h) Should be done by candidate’s own provider.

(i) Should be done by candidate’s own provider.

6.1.2 If a candidate presents with a condition that

temporarily interferes with his/her ability to safely perform essential job tasks, the pre-placement medical evaluation shall be postponed until the candidate has recovered from that condition.

Implement as written.

6.2 Medical Conditions Affecting Ability to Safely

Perform Essential Job Tasks.

6.2.1 Medical conditions that can affect a

candidate’s ability to safely perform essential job tasks shall be designated either Category A or Category B.

Implement as written.

6.2.2 Candidates with Category A medical

conditions shall not be certified as meeting the medical requirements of this standard.

FD Physician shall determine the ability of a member returning from an illness or injury to perform duties.

6.2.3 Candidates with Category B medical

conditions shall be certified as meeting the medical requirements of this standard only if they can perform the essential job tasks without posing a significant safety and health risk to themselves, members, or civilians.

Implement as written.

6.3 Head and Neck.

6.3.1 Head.

6.3.1.1 Category A medical conditions shall include

the following:

(1) Defect of skull preventing helmet use or leaving underlying brain unprotected from trauma

(2) Any skull or facial deformity that would not allow for a successful respiratory facepiece fit test

(3) Any head condition that results in the candidate not being able to safely perform one or more of the essential job tasks

Implement as written.

6.3.1.2 Category B medical conditions shall include

the following:

(1)*Deformities of the skull such as depressions or exostoses

A.6.3.1.2 (1) Deformities of the skull can result in the member’s inability to properly wear protective equipment.

(2)*Deformities of the skull associated with evidence of disease of the brain, spinal cord, or peripheral nerves

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.

(3)*Loss or congenital absence of the bony substance of the skull

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

6.3.2 Neck.

6.3.2.1 Category A medical conditions shall include

any neck condition that results in the candidate not being able to safely perform one or more of the essential job tasks.

6.3.2.2 Category B medical conditions shall include

the following:

(1)*Thoracic outlet syndrome

A.6.3.2.2 (1) Thoracic outlet syndrome can result in frequent episodes of pain or inability to safely perform work.

(2)*Congenital cysts, chronic draining fistulas, or similar lesions

A.6.3.2.2(2) Congenital cysts, chronic draining fistulas, or similar lesions can result in the inability to properly wear protective equipment and the inability to communicate effectively due to oropharyngeal dysfunction.

(3)*Contraction of neck muscles

A.6.3.2.2(3) The contraction of neck muscles can result in the inability to properly wear protective equipment and the inability to safely perform functions as a member due to limitation of flexibility.

6.4 Eyes and Vision.

6.4.1 Category A medical conditions shall include

the following:

(1)*Far visual acuity less than 20/40 binocular, corrected with contact lenses or spectacles, or far visual acuity less than 20/100 binocular for wearers of hard contacts or spectacles, uncorrected A.6.4.1 (1) 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. Successful long-term soft contact lens wearers (that is, 6 months without a problem) are not subject to the uncorrected standard. Inadequate far visual acuity can result in the failure to be able to read placards and street signs or to see and respond to imminently hazardous situations.

(2)*Color perception—monochromatic vision resulting in inability to use imaging devices such as thermal imaging cameras

A.6.4.1 (2) This does not refer to abnormal color perception such as red/green color blindness.

Persons with severe color vision loss will likely fail the acuity requirement. Formerly, color vision deficiency was listed as a Category B medical condition. However, it is felt that within most cases this condition will not affect the ability of a member to safely perform the essential functions of his or her job. The fire service physician should consider the color vision deficiency of the individual and consider the color vision requirements of the member’s job and reach an individual determination.

(3)*Monocular vision

A.6.4.1 (3) Candidates with monocular vision are not allowed to drive per DOT/CDL regulations.

(4) Any eye condition that results in the candidate not being able to safely perform one or more of the essential job tasks

6.4.2 Category B medical conditions shall include

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

A.6.4.2 (1) These diseases of the eye can result in the failure to read placards and street signs or to see and respond to imminently hazardous situations.

(2)*Ophthalmological procedures such as radial keratotomy, Lasik procedure, or repair of retinal detachment

A.6.4.2 (2) Sufficient time (approximately 2 weeks for radial keratotomy and Lasik-type surgeries, and 3 months for retinal detachment) must have passed to allow stabilization of visual acuity and to ensure that there are no post-surgical complications. These ophthalmologic procedures can result in the failure to be able to read placards and street signs or to see and respond to imminently hazardous situations.

(3) Peripheral vision in the horizontal meridian of less than 110 degrees in the better eye or any condition that significantly affects peripheral vision in both eyes

6.5* Ears and Hearing.

A.6.5 Currently, no hearing tests will allow the fire department physician to accurately predict whether the fire fighter will adequately be able to safely perform essential job duties. Job-specific hearing tests should be individualized for each department and its specific job functions. The following list of hearing-specific tasks can assist to direct development of hearing protocols:

(1) Understanding spoken commands, both over the radio and while wearing SCBA

(2) Hearing alarm signals, including building evacuation, low air alarm on the SCBA, and PASS alarms

(3) Hearing and locating the source of calls for assistance from victims or other fire fighters All of these tasks will need to be performed with reasonably simulated incident scene background noise and SCBA noise. The inability to hear sounds of low intensity or to distinguish voice from background noise can lead to failure to respond to imminently hazardous situations.

6.5.1 Category A medical conditions shall include

the following:

(1) Chronic vertigo or impaired balance as demonstrated by the inability to tandem gait walk

(2) On audiometric testing, average hearing loss in the unaided better ear greater than 40 decibels (dB) at 500 Hz, 1000 Hz, 2000 Hz, and 3000 Hz when the audiometric device is calibrated to ANSI Z24.5, Audiometric Device Testing

(3) Any ear condition (or hearing impairment) that results in the candidate not being able to safely perform one or more of the essential job tasks

6.5.2 Category B medical conditions shall include

(1)*Unequal hearing loss

A.6.5.2 (1) Unequal hearing can result in the inability to localize sounds, leading to failure in the ability to safely perform search and rescue and other localization tasks.

(2) Average uncorrected hearing deficit at the test frequencies 500 Hz, 1000 Hz, 2000 Hz, and 3000 Hz greater than 40 dB in either ear

(3) Atresia, stenosis, or tumor of the auditory canal (4)*External otitis A.6.5.2 (4) Severe external otitis — that is, recurrent loss of hearing — can result in the inability to hear sounds of low intensity or to distinguish voice from background noise, leading to failure to respond to imminently hazardous situations.

(5)*Agenesis or traumatic deformity of the auricle

A.6.5.2 (5) Severe agenesis or traumatic deformity of the auricle can result in the inability to properly wear protective equipment and the inability to hear sounds of low intensity or to distinguish voice from background noise, leading to failure to respond to imminently hazardous situations.

(6)*Mastoiditis or surgical deformity of the mastoid

A.6.5.2 (6) Severe mastoiditis or surgical deformity of the mastoid can result in the inability to properly wear protective equipment and the inability to hear sounds of low intensity or to distinguish voice from background noise, leading to failure to respond to imminently hazardous situations.

(7)*Ménière’s syndrome, labyrinthitis, or tinnitus

A.6.5.2 (7) Ménière’s syndrome or severe labyrinthitis can result in the potential for sudden incapacitation and the inability to safely perform job functions due to limitations of balance.

(8)*Otitis media

A.6.5.2(8) Otitis media (chronic) can result in frequent episodes of pain and the inability to hear sounds of low intensity or to distinguish voice from background noise, leading to failure to respond to imminently hazardous situations.

6.6 Dental.

6.6.1 Category A medical conditions shall include

any dental condition that results in inability to safely perform one or more of the essential job tasks.

Implement as written.

6.6.2 Category B medical conditions shall include

the following:

(1)*Diseases of the jaws or associated tissues

A.6.6.2 (1) Diseases of the jaws or associated tissues can result in the inability to communicate effectively and/or to properly wear protective equipment.

(2)*Orthodontic appliances

A.6.6.2 (2) The wearing of orthodontic appliances can result in the inability to communicate effectively and/or to properly wear protective equipment.

(3)*Oral tissues, extensive loss

A.6.6.2(3) Extensive loss of oral tissues can result in the inability to properly wear protective equipment and the inability to communicate effectively due to oropharyngeal dysfunction.

(4)*Relationship between the mandible and maxilla that interferes with satisfactory post orthodontic replacement or ability to use protective equipment

A.6.6.2 (4) This condition can result in the inability to properly wear protective equipment and the inability to communicate effectively due to oropharyngeal dysfunction.

6.7 Nose, Oropharynx, Trachea, Esophagus, and

Larynx.

6.7.1 Category A medical conditions shall include

the following:

(1)*Tracheostomy

A.6.7.1 (1) A tracheostomy can result in the inability to properly wear protective equipment, the inability to safely perform job functions due to limitations of endurance, and the inability to communicate effectively due to oropharyngeal dysfunction.

(2)*Aphonia

A.6.7.1 (2) Aphonia can result in the inability to communicate effectively due to oropharyngeal dysfunction.

(3) Any nasal, oropharyngeal, tracheal, esophageal, or laryngeal condition that results in inability to safely perform one or more of the essential job tasks including fit testing for respirators such as N-95 for medical response, P-100 for particulates and certain vapors, and SCBA for fire and hazmat operations

Implement as written.

6.7.2 Category B medical conditions shall include

the following:

(1)*Congenital or acquired deformity

A.6.7.2 (1) A congenital or acquired deformity can result in the inability to properly wear protective equipment.

(2)*Allergic rhinitis

A.6.7.2 (2) Allergic rhinitis can result in frequent episodes of pain, the inability to safely perform work, and the inability to safely perform essential job tasks due to limitations of endurance.

(3) Epistaxis (nose bleed), recurrent (4)*Sinusitis, recurrent

A.6.7.2 (4) Recurrent sinusitis can result in frequent episodes of pain and the inability to safely perform essential job tasks due to limitations of endurance.

(5)*Dysphonia

A.6.7.2 (5) Severe dysphonia can result in the inability to communicate effectively due to

(6) Anosmia

(7) Tracheal stenosis

(8) Nasopharyngeal polyposis

6.8 Lungs and Chest Wall.

6.8.1 Category A medical conditions shall include

the following:

(1) Active hemoptysis

(2) Current empyema

(3) Pulmonary hypertension

(4) Active tuberculosis

(5) An FVC or FEV1 less than 70 percent predicted independent of disease as it prevents the safe use of SCBA due to increased minute ventilation requirements leading to the earlier than expected depletion of air in the SCBA cylinder (6)*Obstructive lung diseases (e.g., emphysema, chronic bronchitis, asthma) with an FEV1/FVC less than 0.75, with both FEV1 and FVC below normal (less than 0.80) as defined by the American Thoracic Society

A.6.8.1 (6) Chronic obstructive airways disease can result in the inability to safely perform essential job tasks due to limitations of endurance.

(7)*Hypoxemia — oxygen saturation less than 90 percent at rest or exercise desaturation by 4 percent or to less than 90 percent (exercise testing indicated when resting oxygen is less than 94 percent but greater than 90 percent)

A.6.8.1 (7) Hypoxemic disorders can result in the inability to safely perform essential job tasks due to limitations of endurance.

(8)*Asthma—reactive airways disease requiring bronchodilator or corticosteroid therapy for 2 or more consecutive months in the previous 2 years, unless the candidate can meet the requirement in 6.8.1.1

A.6.8.1 (8) The term asthma, or reactive airways dysfunction syndrome, is not meant to include acute, nonrecurring bronchitis treated with bronchodilators for only days to weeks. Recurrent or persistent allergic, irritant, exertional, or other forms of asthma are included. Bronchial asthma or reactive airways disease can result in frequent unpredictable episodes of shortness of breath and the potential for sudden incapacitation, leading to the inability to safely perform essential job tasks due to limitations of endurance. Acute hyperactivity in the fire or hazardous materials environment can induce immediate or progressive clinical asthma

(bronchospasm and wheeze) that can lead to sudden incapacitation from status asthmaticus and/or cardiac ischemia. True asthma is a chronic condition with a clinical history of recurrent reversible bronchospasm or longstanding, persistent reversible bronchospasm. Based on the pathophysiology of this disease, it is reasonable that exposure to smoke or other irritants on the fire ground or hazardous materials environment can lead not only to acute exacerbations but can also worsen the progression of their underlying obstructive inflammatory disease. If this occurs in an environment that is immediately dangerous to life and

(9) Any pulmonary condition that results in the candidate not being able to safely perform one or more of the essential job tasks 6.8.1.1* A candidate who has in the past required bronchodilator,corticosteroid, or anti-inflammatory therapy for asthma but who does not believe he/she has asthma shall be evaluated by a pulmonologist or other expert in asthmatic lung diseases such as an allergist to determine the following:

(1) Asthma has resolved without symptoms off medications for 2 years.

(2) If allergic, allergen avoidance or desensitization has been successful.

(3) Spirometry demonstrates adequate reserve (FVC and FEV1 greater than or equal to 90 percent) and no bronchodilator response measured off all bronchodilators on the day of testing.

(4) Normal or negative response (less than 20 percent decline in FEV1) to provocative challenge using cold air, exercise (12 METS), or methacholine. (PC20 greater than 8 is considered normal, as response at dose greater than 8 mg might not be clinically significant.)

A.6.8.1.1 Because the clinical definition of asthma is reversible bronchospasm, spirometry, or pulmonary function, testing performed in the absence of a clinical attack is expected to be normal and might not even show a bronchodilator response.

Only if performed during an attack will spirometry or other pulmonary function tests show obstructive airway flow limitations. Therefore, in candidates who report that their bronchospasm was temporary and has resolved, spirometry should show adequate reserve (FVC and FEV1 greater than or equal to 90 percent predicted) without significant bronchodilator response (less than 12 percent change and less than 200 ml increase) when performed off bronchodilators on the day of testing.

For population studies, pulmonary function is considered normal when greater than or equal to 80

Implement as written.

Required testing should be done by candidate’s own provider.

percent predicted, but for an individual with a history of asthmatic bronchospasm who is being considered for job…