NFPA 1582 Medical Evaluation.pdf

NFPA 1582 Medical Evaluation Highlights

To comply with 1582, a healthcare professional needs to perform an annual comprehensive medical evaluation that includes the following components:

1. Medical History: A thorough review of the firefighter’s medical history, including any past illnesses, surgeries, and current medications completed through a medical history questionnaire. Document known occupational exposures since the previous annual evaluation.

2. Physical Examination: A complete physical examination to assess overall health and fitness for duty. The annual physical examination shall include each of the following components:

a. Vital signs [temperature, pulse, and respiratory rate, and blood pressure (BP)]

(1) A BP shall be measured according to the recommendations of the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7).

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

c. Neck

d. Cardiovascular

e. Pulmonary

f. Breast

g. Gastrointestinal with digital rectal exam as clinically indicated

h. Hernia

i. Lymph nodes

j. Neurological

k. Musculoskeletal

l. * Skin (includes screening for cancers)

m. Vision

3. Ancillary Tests & Consults:

a. Blood Analysis: Tests to check for various health indicators, such as cholesterol levels, blood sugar, and other relevant markers. Blood tests shall be performed for firefighters, at minimum, every three years for those under the age of 40, and every year for those over the age of 40, and shall include the following:

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

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

iii. Renal Function (BUN, creatine)

iv. Glucose

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

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

vii. PSA screening for males 50 years old and older.

b. Urine Laboratory Tests: To detect any underlying health issues, such as kidney problems or infections. The urine laboratory tests required shall include the following:

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

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

iii. Analysis for occupational chemical exposure if indicated

c. Audiology: Hearing thresholds shall be assessed annually in each ear at each of the following frequencies

i. 500 Hz

ii. 1000 Hz

iii. 2000 Hz

iv. 3000 Hz

v. 4000 Hz

vi. 6000 Hz

vii. 8000 Hz

d. Pulmonary Function Test/Spirometry: Shall be conducted annually to measure the member’s forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and the absolute FEV1/FVC ratio.

e. Chest X-Ray: Required every five years to check for any abnormalities in the lungs and chest area.

f. Electrocardiogram (EKG): A resting 12-lead ECG shall be performed as part of the baseline medical evaluation and shall be performed annually after age 40 or as clinically indicated.

g. Risk Stratification: Asymptomatic firefighters 40 years of age or older with no known atherosclerotic cardiovascular disease (ASCVD) shall be assessed annually for their 2-year or 10-year risks of ASCVD, defined as coronary death, nonfatal myocardial infarction, or fatal or nonfatal stroke.

h. Sleep Disturbance Screening

i. Screening for sleep disorders using a validated questionnaire, such as the

Berlin Questionnaire or Epworth Sleepiness Scale, shall be provided annually.

ii. For firefighters with a high index of suspicion for a sleep disorder based on questionnaires or biometric data, the physician shall discuss the risks and benefits of testing and treatment.

i. Cancer and Cardiovascular Disease Risk Reduction

i. The fire department physician shall annually inform members of the heightened risks of cardiovascular disease and various types of cancer associated with firefighting.

ii. In addition to medical screening for these entities as outlined in this standard, the member shall be apprised of occupational routes of hazardous exposures related to firefighting, as well as common signs, symptoms, and preventive measures for both cardiovascular disease and cancers.

j. Occupational Stress Awareness Consultation

i. The fire department physician shall, during the annual physical, inform the member of, and assess for the heightened risks of, stress associated with occupational exposures related to firefighting.

ii. The fire department physician shall make the member aware of common adverse signs and symptoms of occupational stress, inform the member of practices that might limit the damaging effects of occupational stress, and provide the member with referral to licensed behavioral health specialists trained to recognize and treat stress-related disorders in first responders as indicated.

k. Hormone Imbalance Awareness Consultation

i. During the annual physical, the fire department physician shall inform the member of the heightened risks of certain hormone therapy that can have adverse effects on a member’s health.

l. Behavioral Health Screening

i. The fire department physician or qualified healthcare provider shall, in advance of or during the annual physical, provide behavioral health screening for posttraumatic stress disorder (PTSD), major depressive disorder, active suicidality, and substance-use disorder.

ii. Prior to conducting screening, the fire department physician or qualified healthcare provider shall provide the member a written explanation of the purpose of behavioral health screening.

iii. The behavioral health screening explanation shall state behavioral health screening is not intended to provide a diagnosis but to identify symptoms that might indicate a behavioral health risk and warrant further evaluation.

iv. The behavioral health screening explanation shall state that screening results will be kept strictly confidential.

v. Behavioral health screening results and shall not be used to remove a member from duty, unless the member displays an imminent threat to the physical safety of self or others.

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

vii. Self-Screening

1. An incumbent firefighter shall be provided with the selected screening instruments in self-administered format, where applicable, to complete prior to entering their annual physical exam.

2. Screening results shall be reviewed and interpreted by the department physician or qualified healthcare provider prior to or during the annual physical exam.

viii. Referrals

1. An incumbent firefighter who screens positively for PTSD, major depressive disorder, or substance-use disorder shall receive a referral to a qualified behavioral health care provider.

2. A fire department shall provide the fire department physician or qualified healthcare provider conducting the annual screening a referral list of three preferred behavioral health providers that was updated in the last six months.

3. An incumbent firefighter who displays a threat to their physical safety or the safety of others at the time of their annual examination shall be referred to a qualified behavioral health care provider or facility for an emergency psychiatric evaluation.

4. Mammography: Shall consult with each female member regarding the need which could be performed bi-annually for those over the age of 40 and annually for those over the age 50 or as clinically indicated.

5. Infectious Disease Screening: The following infectious disease immunizations or infectious disease screenings shall be provided, as indicated:

a. Tuberculosis (TB) screening—baseline, by either tuberculin skin testing using the tuberculin purified protein derivative (PPD) or the tuberculin blood test (i.e., interferon gamma release assay); subsequent tuberculosis screening to be performed annually or at a frequency according to CDC guidelines unless the member has history of a positive tuberculin screening test, in which case CDC guidelines for management and subsequent chest radiographic surveillance apply.

b. Hepatitis C virus screening—baseline, following occupational exposure, and if requested by the fire department physician or member.

c. Hepatitis B virus vaccinations and titers cost—as specified in CDC guidelines;

laboratory confirmation of immunity to be tested 1–2 months after completion of the vaccination 3 dose series.

d. Tetanus/diphtheria (Td) or Tetanus/diphtheria/pertussis (Tdap) vaccine—Tdap vaccine should be given once to replace the one Td booster which is given every 10 years or the 5-year wound management Td dose.

e. Measles, mumps, rubella vaccine (MMR)—in absence of documented immunity, two doses of MMR to be administered according to current immunization guidelines

f. Polio vaccine—a single booster of IPV for members traveling to endemic areas in the line of duty, or as outlined in the Morbidity and Mortality Weekly Report article, “Poliomyelitis Prevention in the United States: Updated Recommendations of the Advisory Committee on Immunization Practices (ACIP).”

g. Hepatitis A vaccine cost for high-risk personnel [HAZMAT, USAR, and SCUBA] and other personnel with frequent exposure to contaminated water.

h. Varicella vaccine—cost to all non-immune personnel.

i. Influenza vaccine — cost annually unless required by state or local regulations.

j. HIV screening—baseline, following occupational exposure, and if requested by the fire department physician or member.

k. Bloodborne Pathogens

i. Immunizations shall be offered to all members against infectious disease as required by AHJ.

ii. Physicians who or members shall follow current CDC recommendations for post-exposure prophylaxis (PEP) for bloodborne pathogen (BBP) exposures.

iii. There shall be written protocol for members who present with BBP exposures.

l. Heavy Metal Evaluation

i. Baseline testing for heavy metals shall be required when indicated by known exposure or substantial risk.

ii. Evaluations shall be performed following known exposures, for recurrent exposures, or where required under federal, state, or provincial regulations.

6. Cancer Screening: Depending on age and risk factors, screenings for various types of cancer may be necessary.

a. Colon Cancer Screening

i. Stool-based blood testing risks and benefits shall be discussed with all members above the age of 40, or earlier if clinically indicated.

ii. Visual exams (e.g., colonoscopy, CT colonoscopy, or flexible sigmoidoscopy) or stool-based testing shall be recommended to all members ages 45 to 75, or earlier if clinically indicated and repeated at regular intervals.

b. Prostate Cancer

i. Due to increased prostate cancer risk, the fire department physician shall discuss the risks and benefits of prostate cancer screening, including prostate-specific antigen (PSA) testing, with all male firefighters beginning at age 50 and annually thereafter.

ii. For firefighters who are at a higher risk for prostate cancer (e.g., African Americans or where one or more first-degree relatives have been diagnosed with prostate cancer at an early age), the physician shall discuss the risks and benefits of prostate cancer screening, including PSA testing, beginning at age 40 and annually thereafter.

c. Lung Cancer Screening

i. Low-dose computed tomography (LDCT) shall be performed annually on firefighters ages 50–74 who have at least a 20-pack-per-year smoking history and currently smoke or have quit within the past 15 years.

ii. Screening shall be discontinued once a firefighter has not smoked cigarettes for 15 years or is too ill to benefit.

d. Cervical Cancer Screening

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

e. Testicular Cancer Screening

i. A baseline examination shall be performed by a health care provider.

f. Bladder Cancer Screening

i. Urine shall be evaluated for blood (hematuria).

ii. A positive dipstick for hematuria shall require a follow-up and referral which could involve upper tract imaging, cystoscopy, and/or urine cytology.

g. Oral Cancer Screening

i. The entire mouth shall be examined for signs of oral and oropharyngeal cancers.

h. Thyroid Cancer Screening

i. Physical exam for palpable nodules shall be part of the annual physical examination.

i. Skin Cancer Screening

i. Physical exam of a member’s skin shall be conducted annually for evidence of cancer.