RFP 25084 Attachment 2 NFPA 1582.pdf

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NFPA® 1582

Standard on

Comprehensive Occupational Medical Program for Fire Departments

2022 Edition

This edition of NFPA 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments, was prepared by the Technical Committee on Fire Service Occupational Safety. It was issued by the Standards Council on March 18, 2021, with an effective date of April 8, 2021, and supersedes all previous editions.

This edition ofNFPA 1582 was approved as an American National Standard on April 8, 2021.

Origin and Development of NFPA 1582

The initial mandatory medical requirements for candidat es for firefighter were in the 1 4 edition of NFPA 1001, Standard on Professional Qualifications for Fire Fighter. When the first edition of NFPA 1500, Standard on Fire Department Occupational Safety and Health Program, was issued in 1987, it required all members engaged in emergency operation to be examined by a physician at least annually and suggested the medical examination be developed and administered by the fire department physician in recognition of the specific requirements of the members' activities.

In the late 1980s, members of the Technical Committee on Fire Fighter Professional Qualifications (responsible for NFPA 1001 ) and members of the Technical Committee on Fire Service Occupational Safety and Health (responsible for NFPA 1500) formed a working group to develop a new standard on medical requirements for firefighters.

The first edition of NFPA 1582 was titled Standard on Medical Requirements for Fire Fighters and was issued in 1992 under the responsibility of the Fire Service Occupational Safety and Health Committee. A subsequent edition was issued in 1997. The 2000 edition was titled Standard on Medical Requirements for Fire Fighters and Information for Fire Department Physicians, in recognition of the increasing amount of guidance being provided in the document to persons serving as fire department physicians.

The title of the 2003 edition was changed to Standard on Comprehensive Occupational Medical Program for Fire Departments to reflect a comprehensive occupational medical program. The document included references to the IAFC-IAFF Fire Service Joint Labor-Management Wellness-Fitness Initiative, and to NFPA 1583, Standard on Health-Related Fitness Programs for Fire Fighters. These two documents outline a health-related fitness program that is medically validated against NFPA 1582.

The 2003 edition delineated between medical issues of a candidate seeking to become a fire fighter, and those of incumbents currently performing the tasks of firefighting. The intent with incumbents with a medical condition is to rehabilitate them and only restrict them from performing those essential job tasks where their injury or illness would affect the safety of themselves or others on their crew.

In the 2007 edition, new requirements were added to both the chapter on medical evaluation for candidates and the chapter on specific evaluation of medical conditions in incumbents to allow persons with diabetes to enter the fire service or continue performing essential job tasks associated with firefighting if they meet defined criteria. All the medical conditions that govern whether a person can become a firefighter and the specific medical conditions of incumbents that affect their ability to perform certain essential job tasks were reviewed and updated, if appropriate, based on current medical research and knowledge.

For the 2013 edition, the committee, with the assistance of several task groups and subject matter experts in specialty areas with regard to medical conditions, updated many of the medical requirements to reflect current practices. Some of the areas that were addressed were that of diabetes, metabolic synd rome, prosthetic adjuncts, hearing aids, and cochlear implants, as well as

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Attachment 2 pregnancy and reproductive system concerns. Also developed for the 2013 edition was a new annex designed to assist the end user with the subject of pregnancy. The committee, with the assistance of the International Association of Fire Fighters, provided an updated Annex C, which contains the protocols for the evaluation of fitness for members. The committee also updated some of the medical requirements relating to hypertension, anticoagulants, TB testing, and screening for cancer.

For the 2018 edition, the committee, with the assistance of several task groups and subject matter experts in specialty areas with regard to medical conditions, updated many of the medical requirements to reflect current practices. Some of the areas that were addressed were lung function, spinal injuries / conditions, and seizure disorders. A new section was added to the annual fitness evaluation regarding lung function performance. The committee updated all of the annex material in order to provide the best guidance and references for physicians and fire departments.

The 2022 edition includes expanded and revised material on psychiatric, psychological, and behavioral health , updated essential job tasks (Sections 5.1 and 9.1), and improved alignment of the medical evaluation criteria in Chapters 6 and 9. In addition, updated guidance on cancer screening has been added. The annex on "Protocols for Evaluation of Fitness of Members" was eliminated and replaced with a reference to the Fire Service joint Labor Management Wellness-Fitness Initiative (VYH) in Chapter 8. The annex on "Maternal and Child Health Considerations" was updated in accordance with the latest research and information.

2022 Edition

COMMITIEE PERSONNEL 1582-3

Technical Committee on Fire Service Occupational Safety

Randy J. Krause, Chair Port of Seattle Fire Department, WA [El

Christina M. Baxter, Emergency Response Tips, LLC, FL [SE] David T. Bernzweig, Columbus (OH) Division of Fire, OH [L]

Rep. Columbus Firefighters Union Sandy Bogucki, Yale University Emergency Medicine, CT [SE] Dennis R. Childress, Orange County Fire Authority, CA [UJ

Rep. California State Firefighters Association Donald Lee Cox, Volunteer Fireman's Insurance Service, Inc.

(VFIS), FL (I]

Fabrice Czarnecki, DHS, VA [SE]

Rep. American College of Occupational and Environmental Medicine (ACOEM) Bradley Roy Davidson, Firefighter Cancer Consultants, LLC, Canada [CJ

Rep. Last Call Foundation David W. Dodson, Response Solution s LLC, CO [SE]

Rep. Fire Department Safety Officers Association Scott William Dollman, United State Army, SC [UJ Christopher A. Garrett, City of Owasso, OK [M]

Rep. International Fire Service Training Association Stanley Haimes, UCF College of Medicine, FL (SE] Kepra Jack, Heartfit for Duty, AZ [U] Scott D. Kerwood, Hutto Fire Rescue, TX [El

Rep. International Association of Fire Chiefs James Roger Lackore, REV Fire Group, WI [M]

Rep. Fire Apparatus Manufacturers Association Murrey E. Loflin, National Institut e for Occupational Safety & Health, WV [RT] Tamara DiAnda Lopes, American Iron Gym, NV [U]

Gregg Avery, Los Angeles Fire Depar tment, CA [U) (Alt. to Ronnie Villanueva)

Kurt Becker, Clayton, Missouri Fire Department, MO [L] (Alt. to John R. Niemiec)

Brian Carlson, University Of Cincinna ti, OH [SE] (Voting Alt.)

Wesley D. Chestnut, Spartan Motors, Inc., MI (M] (Alt. to James Roger Lackore)

Bradd K. Clark, Ocala Fire Rescue, FL [M] (Alt. to Christopher A. Garrett)

Kenneth Desmond, Bath, ME [U] (Alt. to Philip C. Stittleburg)

Edward I. Galaid, Roper St. Francis Occupational Medicine, SC

[SE]

(Alt. to Stanley Haimes) Edward M. Hawthorne, DFW Dynamics, TX [M]

(Alt. to Robert D. Neamy)

William R. Hamilton, US Department of Labor, DC [El

Joseph McHugh, Fire Department City of New York, NY (U]

Rep. Fire Department of New York Steven M. Moffatt, Public Safety Medical, IN [SE] Paul J. Napoli, Association of Fire Districts of tl1e Stace of New York, NY[UJ

Rep. Association of Fire Districts/ State of New York Robert D. Neamy, Gardnerville, NV (M]

Rep. National Incident Management System Consortium JohnR. Niemiec, International Association of Fire Fighters (IAFF), DC [L]

Rep. International Association of Fire Fighters CharlesJ. Popp, III, Boston Fire Department, MA [UJ DavidJ. Prezant, Fire Department City of New York, NY [E]

Rep. Fire Department of New York Mario D. Rueda, San Marino Fire Department, CA [El Daniel G. Samo, Northwestern Medical Group, IL [SE] Andrew G. Schwartz, LION Group, Inc., OH [M] Denise L. Smith, Skidmore College, NY [SE] Donald F. Stewart, Medocracy Inc./Fairfax County Fire & Rescue, VA(E]

Philip C. Stittleburg, La Farge Fire Department, WI [UJ

Rep. National Volunteer Fire Council Susan Tamme, Tampa Fire Rescue Department, FL [L]

Rep. International Association of Women in Fire & Emergency Services Fred C. Terryn, US Department of the Air Force, FL [UJ John Tippett, National Fallen Firefighters Foundation, MD [CJ Ronnie Villanueva, Los Angeles Fire Department, CA [UJ

Alternates

John A. Kottmyer, Volunteer Fireman's Insurance Service, Inc.

(VFIS), PA [I]

(Alt. to Donald Lee Cox) Paul Parrish, Austin Fire Wellness, TX [SE]

(Alt. to Sandy Bogucki ) Joanne R. Rund, Baltimore County Fire Department, MD [El

(Alt. to Scott D. Kerwood) Kevin Douglas Schulz, Lion Total Care, IL [Ml

(Alt. to Andrew G. Schwartz) Jay L. Tarley, National Institute for Occupational Safety & Healtl1, WV[RT]

(Alt. to Murrey E. Loflin ) Brian Dean Thompson, United States Air Force, FL [U]

(Ale. to Fred C. Terryn) Eric Valliere, Scottsdale Fire Department, AZ [SE]

(Alt. to David W. Dodson)

Nonvoting

Andrew Levinson, US Department of Labor, DC [El Rep. Occupational Safety & Health Administration

Barry D. Chase, NFPA Sta.ff Liaison

This list represents the membership at the time the Committee was balloted on the final text of this edition.

Since that time, changes in the membership may have occurred. A key to classifications is found at lhe back of the document.

1582-4 COMPREHENSIVE OCCUPATIONAL MEDICAL PROGRAM FORFlRE DEPARTMENTS

NOTE: Membership on a committee shall not in and of itself constitute an endorsement of the Association or any document developed by the committee on which the member serves.

Committee Scope: This Committee shall have piimary responsibility for documents on occupational safety and incident command in the working environment of the fire service, not including hazardous materials or cross functional events. The committee shall also have responsibility for documents related to medical requirements for firefighters, and the professional qualifications for fire department safety officer. It shall coordinate its work with NFPA technical committees dealing with emergenc y responder safety and wellness.

CONTENTS 1582-5

Contents

1582-24

6.15 Infectious Diseases

6.16 Skin

6.17 Blood and Blood-Forming Organs

6.18 Heat Stress and Illness

6.19 Tumors and Malignant Diseases

6.20 Psychiatric Conditio ns and Psychological

Disorders

1582- 17

1582- 17

1582- 18

1582-18

Administrators

Annex C Maternal and Child Health Considerations

Annex D Sample Physician Evaluation Form for Firefighters with Diabetes

1582- 70

1582- 71

1582- 76

Chapter 7 Occupational Medical Evaluation of Members

7.1 General

7.2 Member Education Regarding Occupational

Medical Evaluation Program

1582- 19

Annex E

Annex F

Index

Behavioral Health

Informational References

1582- 83

1582- 84

1582- 90

Chapter 1 Administration .......... .............................. . 1582- 6 7.3 Timing of the Annual Occupational Medical

1.1 Scope. ................................................................ 1582- 6 Evaluation of Members. ................................... 1582- 19

1.2 Purpose. ............................................................ 1582- 6 7.4 Componen ts of the Annual Occupational

1.3 Implementation. .............................................. 1582- 6 Medical Evaluation of Members. ..................... 1582- 20

7.5 Medical History. ............................................... 1582- 20 Chapter 2 Referenced Publications ......................... 1582- 6 7.6 Physical Examination. ...................................... 1582- 20

2.1 General. ............................................................ 1582- 6 7.7 Ancillary Tests. .................................................. 1582- 20

2.2 NFPA Publications. ........................................... 1582- 6

2.3 Other Publications. .......................................... 1582- 7 Chapter 8 Annual Occupational Fitness Evaluation

2.4 References for Extracts in Mandatory of Members ...... ........ ...................... .......... 1582- 23

Sections. ............................................................ 1582- 7 8.1 Weight and Body Composition. ...................... 1582- 23

8.2 Annual Fitness Evaluation. .............................. 1582- 23 Chapter 3 Definitions ............................................... 1582- 7

3.1 General. ............................................................ 1582- 7 Chapter 9 Essential Job Tasks - Specific

3.2 NFPA Official Definitions................................ 1582- 7 Evaluation of Medical Conditions in

3.3 General Definitio ns. ................ ......................... 1582- 7 Members .................................................. 1582- 23

Chapter 4 Roles and Responsibilities ...................... 1582- 8

9.1 Essential Job Tasks

9.2 Fire Department Physician Roles

1582- 23

4.1 Fire Department Responsibilities. ................... 1582- 8 9.3 Medical Conditions Involving Head, Eyes,

4.2 Fire Department Physician Responsibilities... 1582- 9 Ears, Nose, Neck, or Throat. ........................... 1582- 24

4.3 Candidate and Member Responsibilities. ....... 1582-9 9.4 Lung, Chest Wall, and Respiratory

4.4 Confiden tiality of Medical Information. ........ 1582- 9 Disorders . .......................................................... 1582- 25

Chapter 5 EssentialJob Tasks .......................... ........ 1582- 9 9.5 Cardiovascular Disorders. ................................ 1582- 28

5.1 EssentialJob Tasks and Descriptions. ............. 1582-9 9.6 Endocrine and Metabolic Disorders. .............. 1582- 32

5.2 Essential Job Tasks for Specialized Teams. ..... 1582- 10 9.7 Disorders Involving the Gastrointestinal Tract and Abdominal Viscera. ................................... 1582- 34 Chapter 6 Medical Evaluations of Candidates

6.1 Medical Evaluation

1582- 10 1582- 10

9.8 9.9

Spine Disorders Orthopedic Disorders

1582- 34 1582- 35

6.2 Medical Conditions Affec ting Ability to 9.10 Neurologic Disorders. ...................................... 1582- 37 Perform Essential Job Tasks............................. 1582- 10 9.11 Medications. ..................................................... 1582- 38

6.3 Head and Neck. ................................................ 1582- 11 9.12 Pregnancy and Reproductive Health. ............. 1582- 39

6.4 Lungs and Chest Wall. ..................................... 1582- 12 9.13 Chronic Systemic Diseases and Miscellaneous

6.5 Heart and Vascular Syste m 1582-12 Conditions. ....................................................... 1582- 40

6.6 Endocrine and Metabolic Disorders . .............. 1582- 13 9.14 Urinary Disease. (Reserved) ............................ 1582- 40

6.7 Abdominal Organs and Gastrointestinal 9.15 Infectiou s Diseases. .......................................... 1582- 40

System. .............................................................. 1582-14 9.16 Chronic Skin Conditions. ................................ 1582- 40

6.8 Spine and Axial Skeleton. ................................ 1582- 14 9.17 Hematologic Disorders . ................................... 1582- 41

6.9 Extremities. ....................................................... 1582- 15 9.18 Heat and Stress Illness. .................................... 1582- 41

6.10 Neurological Disorders. ................................... 1582- 15 9.19 Tumors-Malignant or Benign. .................... 1582- 41

6.11 Chemicals, Drugs, and Medications. ............... 1582- 16 9.20 Psychi atric Conditions and Psychological

6.12 Reproductive System. .................... ................... 1582- 16 Disorders. .......................................................... 1582- 42

6.13 Systemic Diseases and Miscellaneous

Conditions. ....................................................... Annex A Explanatory Material ........................................ 1582-44

6.14 Urinary System. ................................................ 1582- 17 Annex B Guide for Fire Department

1582-6 COMPREHENSIVE OCCUPATIONAL !VIEDICAL PROGRAM FOR FIRE DEPARTMENTS

2022 Edition Shaded text= Revisions . =Text deletions and figure/table revisions. • = Sec tion deletions. N = New material.

NFPA 1582

Standard on

ComprehensiveOccupational Medical Program for Fire Departments

IMPORTANT NOTE: 'This NFPA document is made available for use subject to important notices and legal disclaimers. These notices

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.

1.2 Purpose. The purpose of this standard is to outline an

occupational medical program that, when implemented i 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 members oft he _ public's life and property.

1.2.1 The standard specifies the following information:

and disclaimers appear in all publications containing this document and may be found under the heading "Important Notices and Disclaimers Concerning NFPA Standards." They can also be viewed at www.nJPa.org/ disclaimers or obtained on request from NFPA.

UPDATES, ALERTS, AND FUTURE EDITIONS: New editions of NFPA codes, standards, recommended practices, and guides (i.e., NFPA Standards) are released on scheduled revision cycles. This edition may be superseded by a later one, or it may be amended outside of its scheduled revision cycle through the issuance of Tenta,.

tive Interim Amendments (TIAs). An official NFPA Standard at any point in time consists of the current edition of the document, together with all TIAs and Errata in effect. To verify that this document is the current edition or to determine if it has been amended by TIAs or

(1)

(2)

(3)*

(4)

Minimal medical requirements for candidates as delinea-ted in Chapter 6 Occupational medical, behavioral health, and physical fitness evaluations for members as delineated in Chapters 7and8 Information regarding fire department activities and essential job tasks that assist the department physician in providing proper medical, behavioral health, and physical fitness support for members Methods and types of data that must be collected to sustain comprehensive occupational medical programs for fire departments

Errata, please consult the National Fire Codes® Subscription Service or the "List of NFPA Codes & Standards" at www.njpa.org/docinfo.

In addition to TIAs and Errata, the document information pages also include the option to sign up for alerts for individual documents and to be involved in the development of the next edition.

NOTICE: An asterisk (*) following the number or letter designating a paragraph indicates that explanatory material on the paragraph can be found in Annex A.

A reference in brackets [ ] following a section or paragraph indicates material that has been extracted from another NFPA document. Extracted text may be edited for consistency and style and may include the revision of internal paragraph refer-ences and other references as appropriate. Requests for inter-pretations or revisions of extracted text shall be sent to the technical committee responsible for the source document.

Information on referenced and extracted publications can be found in Chapter 2 and Annex F.

Chapter I Administration

1.1 Scope. This standard contains descriptive requirements

for a comprehensive occupational medical program for fire departments.

1.1.1 * The medical requirements in this standard are applica-ble to fire department candidates and members whose job descriptions as defined by the authority having jurisdiction (AHJ) are outlined in NFPA 1001; NFPA 1002; NFPA 1003;

NFPA 1006; NFPA 1021; and NFPA 1051.

1.1.2 This standard provides information and guidance for

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

1.1.3 * The requirements in this standard are applicable to public, governmental, miHtary, private, and industrial fire department organizations providing rescue, fire suppression, hazardous materials mitigation, special operations, and other emergency services.

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.

1.2.3 Nothing herein is intended to restrict any jurisdiction from exceeding these minimum requirements.

1.3 Implementation.

1.3.1 For candidates, the medical requirements of this stand -ard shall be implemented when this standard is adopted by an AHJ on an effective date specified by the AHJ.

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.

1.3.3 * The fire department risk management plan as descri- bed in NFPA 1500 shall include implementation of a compre- hensive occupational medical program that is compliant with this standard.

Chapter 2 Referenced Publications

2.1 General. The documents or portions thereof listed in this chapter are referenced within this standard and shall be considered part of the requirements of this document.

2.2 NFPA Publications. National Fire Protection Association, 1 Batterymarch Park, Quincy, MA 02169-7471.

NFPA 1001, Standard for Fire Fighter Professional Qualifications, 2019 edition.

NFPA 1002, Standard for Fire Apparatus Driver/Operator Profes-sional Qualifications, 2017 edition .

NFPA 1003, Standard for Airport Fire Fighter Professional Qualifi-cations, 2019 edition.

Shaded text= Revisions. = Text deletions and figure/ table revisions. • = Section deletions. N = New material. 2022 Edition

1582 -7 DEFINITIONS

NFPA 1006, Standard for Technical Rescue Personnel Professional

Qualifications, 2021 edition.

NFPA 1021 , Standard for Fire Officer Professional Qualifications, 2020 edition.

NFPA 1051, Standard for Wildland Firefighting Personnel Profes-sional Qualifications, 2020 edition.

NFPA 15oon 1, Standard on Fire Department Occupational Safety, Health, and Wellness Program, 2021 edition .

NFPA 1561, Standard on Emergency Services Incident Manage-ment System, 2020 edition.

NFPA 1581, Standard on Fire Department Infection Control

Program, 2022 edition.

NFPA 1583 , Standard on Health-Related Fitness Programs for Fire

Department Members, 2022 edition.

NFPA 1584, Standard on the Rehabilitation Process for Members

During Emergency operations and Training Exercises, 2022 edition.

2.3 Other Publications.

2.3.1 ASA Publications. Acoustical Society of America, 35

Pinelawn Road, Suite 114 E, Melville, NY 11747-3177.

ANSI/ ASA S3.6, Specification for Audiometers, 2018.

.i:l 2.3.2 CDC Publications. Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333 .

"Poliomyelitis Prevention in the United States: Updated Recommendations of the Advisory Committee on Immuniza-tion Practices (ACIP) ," Morbidity and Mortality Weekly Report, 49(No. RR-5):1-22, May 19, 2000.

N 2.3.3 IAFF/ !AFC Publications. International Association of Fire Fighters, 1750 New York Avenue, Suite 300, NW, Washing-ton, DC 20006-5395; International Association of Fire Chiefs, 4025 Fair Ridge Drive, Suite 300, Fairfax, VA 22033-2868.

http:/ / www.iafc.org

The Fire Service Joint Labor Management Wellness-FitnessInitia-tive, 4th edition, 2018.

2.3.4 US Government Publications. US Government Publish-

ing Office, 732 North Capitol Street, NW, Washington, DC 20401-0001.

Title 29, Code of Federal Regulations, Part 1910.95, "Occu-pational noise exposure," 1996.

Title 29, Code of Federal Regulations, Part 1910.120, "Hazardous waste operations and emergency response," 2002.

Title 29, Code of Federal Regulations , Part 1910.134, "Respi-ratory protection," 1998.

Title 29, Code of Federal Regulations, Part 1910.1020, "Access to employee exposure and medical records." 1996.

Title 29, Code of Federal Regulations, Part 1910.1030, "Bloodborne pathogens," 2001.

US Dept . of Health & Human Services, National Heart, Lung and Blood Institute, Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation , and Treatment of High Blood Pressure QNC 8) , 2014.

2.3.5 Other Publications.

American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, https:/ / www.psychiatry.org/ psychia-trists/ practice/ dsm.

International Council of Ophthalmology, "International Clinical Diabetic Retinopathy Disease Severity Scale," San Fran-cisco, CA, October 2002, http:/ / www.icoph.org/ standards/ pdrdetail.html.

Merriam-Webster's Collegiate Dictionary, 11th edition, Merriam- Webster, Inc., Springfield, MA, 2003.

2.4 References for Extracts in Mandatory Sections.

NFPA 1002, Standard for Fire Apparatus Driver/Operator Profes-sional Qualifications, 2017 edition.

NFPA 1500™, Standard on Fire Department Occupational Safety, Health, and Wellness Program, 2021 edition.

Chapter 3 Definitions

3.1 General. The de fin itions contained in this chapter shall apply to the terms used in this standard. Where terms are not defined in this chapter or within another chapter, they shall be defined using their ordinarily accepted meanings within the context in which they are used. Merriam-Websters Collegiate Dictionary, 11th edition, shall be the source for the ordin arily accept ed meaning.

3.2 NFPA Official Definitions.

3.2.1 * Approved. Acceptable to the authority having jurisdic-tion.

3.2.2 * Authority Having Jurisdiction (AHJ). An organization , office, or individual responsible for enforcing the requirements of a code or standard, or for approving equipment, materials, an installation, or a procedure .

3.2.3 Shall. Indicates a mandatory requirement.

3.2.4 Should. Indicates a recommendation or that which 1s

advised but not required.

3.3 General Definitions.

3.3.1 Candidate. A person who has submitted an application

to become a member of the fire department. [1500, 2021]

3.3.2 Category A Medical Condition. See 3.3.14.1.

3.3.3 Category B Medical Condition. See 3.3.14.2.

3.3.4 Emergency Medical Services. The provision of treat-

ment, such as first aid, cardiopulmonary resuscitation, basic life support, advanced life support, and other pre-hospital proce-dures including ambulance transporta tion , to patients. [1500, 2021]

3.3.5 Essential Job Task. Task or assigned duty that is critical to successful performance of the job. (See Chapter 5 and Section 9.1.)

3.3.6 Evaluation. See 3.3.15, Medical Evaluation.

3.3.7 * Fire Department. An organization providing rescue, fire suppression, and related activities, including any public, governmental, private, industrial, or military organization engaging in this type of activity. [1002, 2017]

3.3.8 Fire Department Physician. A licensed doctor of medi-

cine or osteopathy who has been designated by the fire depart-ment to provide professional expertise in the areas of occupational safety and health as they relate to emergency serv-ices.

1582-8 COMPREHENSIVE OCCUPATIONAL MEDICAL PROGRAM FOR FIRE DEPARTMENTS

2022 Edition Shaded text= Revisions. A = Text deletions and figure/ table revisions. • = Sec tion deletions. N = New material.

3.3.9 Functional Capacity Evaluation. An assessment of the

correlation between that individual's capabilities and the essen-tial job tasks.

3.3.10 Health and Fitness Coordinator. A person who, under

the supervision of the fire department physician, has been designated by the department to coordinate and be responsible for the health and fitness programs of the department.

3.3.11 Health and Safety Committee. A representative group

of individuals who serve along with the fire department physi-cian and health and fitness coordinator, and is chaired by the fire department health and safety officer, who oversee the implementation of the fire department occupational safety and health program.

3.3.12 Health and Safety Officer. The member of the fire

department assigned and authorized by the fire chief as the manager of the safety, health, and wellness program. [1500, 2021)

3.3.13 Infection Control Program. The fire department's

formal policy and implementation of procedures relating to the control of infectious and communicable disease hazards where employees, patients, or the general public could be exposed to blood, body fluids, or other potentially infectious materials in the fire department work environment. [1500, 2021)

3.3.14 Medical Condition Classifications.

3.3.14.1 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.

3.3.14.2 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 emer-gency operational environment by presenting a significant risk to the safety and health of the person or others.

3.3.15 Medical Evaluation. The analysis of information for the purpose of making a determination of medical certification.

Medical evaluation includes a medical examination.

3.3.16 Medical Examination. An examination performed or

directed by the fire department physician.

3.3.17 Medically Certified. A determination by the fire

department physician that the candidate or current member meets the medical requirements of this standard.

3.3.18 * Member. A person involved in performing the duties and responsibilities of a fire department, under the auspices of the organization. [1500, 2021)

N 3.3.19* Mental Health Professional. A board-certified psychiatrist, a psychiatric nurse practitioner, clinical psycholo-gist, clinical professional counselor, or clinical social worker that is independently licensed to evaluate, diagnose, and treat mental health disorders in their state of practice and is in good standing with their state licensure board.

3.3.20 Occupational Safety and Health Program. An occupa-

tion specific program, implemented to reduce the risks associ-ated with the occupation, that outlines the components of a program and the roles and responsibilities of the fire depart-ment and its members.

Chapter 4 Roles and Responsibilities

4.1 Fire Department Responsibilities.

4.1.1 The fire department shall establish a comprehensive

occupational medical program that includes medical evalua-tions for candidates and members. (See Annex B.)

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.

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

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.

4.1.4 * The fire department shall ensure that the fire depart- ment 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.

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 posi-tions and ranks.

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 depart-ment, in accordance with NFPA 1500.

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 there-fore be correlated to the medical requirements outlined in this standard.

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 emer-gency operations.

4.1.9 The fire department shall ensure member access to eval-uation by medical specialists, medical and/or surgical treat-ment, 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.

4.1.10 The fire department shall require that the fire depart-ment health and safety officer and the health and fitness coor-dinator maintain a liaison relationship with the fire department physician to ensure that all aspects of the comprehensive occu-pational 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.

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ESSENTIAL JOB TASKS 1582-9

4.1.12 Where possible, the fire department shall provide alter-nate duty position for members when the fire department physician recommends temporary work restrictions.

4.1.13 Medical Record Keeping.

4.1.13.1* The fire department comprehensive occupational medical program shall include collection and maintenance of a

4.2.3 The fire departme nt physician sha ll review individual medical evaluat ion and aggregate data from member evalua-tions in order to detect evidence of occ upational exposure(s) or clusters of occupa tio nal disease.

4.2.4 The fire depan ment physician shall be a member o the

Fire Departmen t Occupation al Safety and Health Cor_nrn1ttee chaired bv the health and safeL-y o fficer as reqmred by confidential medical and health information system for members. l\TFPA 1

J

500.

4.1.13.2 All medical record keeping shall comply with the

requirements of 29 CFR 1910.1020, "Access to employee e:'po-sure 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 meth-ods of communicating or transferring the information contained in these records, including written, oral, electron ic, and any other means of communication.

4.2 Fire Department Physician Responsibilities.

4.2.1 The fire department physician shall fulfill the following responsibilities:

(1) nderstand 1.he phy siological, psychological, a n d emi-ronme ntal demands placed on fi refig hters

(2) Evaluate fire departmen t candidates and memb ers to identify med ical condition r:.hat could affect thei r abilir:y to afely re pond to and parr.icipate in eme rgency opera-tions

(3) til ize tile ess ntiaJ job task description upp lied by the fire departm en t to determine a candida r:e 's or a rn mber's medical certificati on

(4) Iden tify and repon the presence of Category A or disqua li l)·ing Car:egory B medical conditions if pre sem in cand idates

(5) Inform th fire chief or his/ her designee wh e th er or not the candidate or currenr member i medi cally cen ified to safely ¥>erform the e sentialjob tasks

(6) Report the results of th e.,medical evaluation to the cancli-dac or curren memb c::r , i eluding any med ical co ndi-tion ( ) ident i fi d uring the med ical evaluation, a:nd the recom mendadon as to wh ether the cand idate or current Q1ember i med ic all} certified to safely perform the essenr:ia l job tasks

(7) Forward pie of any abno rmal resul along wiLh patien in truction regardi ng primary care follow-up to cand idates or curreJJt members who wer instructed to see k (a appropriate) m clical follow-up to addres any medical conditio ns, or lab abnorma lities, identified durin g the nedical e\aluat ion

(8) Re\·ie ll' re ul of {he annu al o cupar:ionaJ fitness evalua-tion as de cribed in Chapter 8

(9) Pro\·idr or arrang e.. for a prescriptive. rehabilitation and / or firne rogram when indicated rn aid a me 1 l er' recovr ry from illness or irtjury and enhance hi ;/h r abilit y to afely pe-rform es ential job taSk

(10) Pan.icipaw in irtjury preve ntion and health promotion program s for fire fig hters

4.2.2 vVhe n med ical evalu atjons are conduet<"d by , ph r ician or me dical provide o r.h er than the fire department physician , the evaluatio n shall be reviewed and approved by th e fire d par tmen t physician .

4.2.5 The fire departmen t physician shall p rovide medical

supen ision for the fire depart me nt fitness, retum-to-du y reha-bilitation, and physical con ditio ning programs as requ1recl b y

NFPA 1583.

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; NFPA 1561; and NFPA 1584.

4.2.7 The fire department physician shall provide supervi ion for the fire department infection control program as reqmred by NFPA 1581.

4.3 Candidate and Member Responsibilities. Each candidate

or member shall adhere to the following requirements :

(1) Cooperate, participate, and comply with the medical eval-uation 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 indi- vidual 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 conce rning me i al diagn sis hall be released by the fire departmen t phys1c1an o nly wit h written perm is ion from the cand idate or membe r, and/ or as required by law.

4.4.2 , ' o fire departrn t p r onne l. ther tha n rhe fir depart.mem physici, n or app ropriate me dical staff, sha ll have acce o another member 's medic al records without the express written consem of that membe r.

Chapter 5 Essential Job Tasks

5.1 Essential Job Tasks and Descriptions.

A 5.1.1 The fire department shall evaluate the following 14 essential job tasks against the types and levels of emergen cy services provided to the local community by the fire depart -ment, the types of structures and occupancies in the commun-ity, and the configuration of the fire department to determin which tasks apply to their department members and candi-dates:

( l )* Wearing personal protective equipment (PPE) and self-contained breathing apparatus (SCBA) while perform-ing firefighting tasks (e.g., hose line opera ons, extensive crawling, lifting and carrying heavy objects, 2022 Edition Shaded text= Revisions. A = Text deletions and figure/ table revisions. • = Sec tion deletions. N = New material.

COMPREHENSIVE OCCUPATIONAL MEDICAL PROGRAM FOR FIRE DEPARTMENTS 1582-10

ventilating roofs or walls using power or hand tools, forcible entry), rescue operations, and other emergency response actions under stressful conditions, including working in extremely hot or cold environments for prolonged time periods

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

(3) Exposure to toxic fumes, irritants, particulates, biologi-cal (i.e., infectious) and nonbiological hazards, or heated gases, despite the use of PPE and SCBA

(4) Climbing at least six flights of stairs or walking a similarly strenuous distance and incline in jurisdictions without tall buildings while wearing PPE and SCBA, commonly weighing 40-"50 lb (18- 23. kg) and carrying equipment/ tools weighing an additional 20-40 lb (9-18 kg)

(5) Wearing PPE and SCBA that is encapsulating and insula-ted, 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) Working alone while wearing PPE and SCBA, searching, finding, and rescue-dragging or carrying victims ranging from newborns to adults weighing over 165 lb (75 kg) to safety despite hazardous conditions and low visibility

(7) vVhile wearing PPE and SCBA, advancing water-filled hose lines up to l % in. (45 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) While wearing PPE and SCBA, climbing ladders, operat-ing from heights, walking or crawling in the dark along narrow and uneven surfaces that might be wet or icy, and operating in proximity to electrical power lines or other hazards

(9) Unpredictable, prolonged periods of extreme physical exertion as required by emergency operations without benefit of a warm-up period. , scheduled rest periods, meals, access to medication(s), or hydration

(10) Operating fire apparatus or other vehicles in an emer-gency 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 (i.e., give and comprehend verbal orders) while wearing PPE and SCBA under conditions of high background noise, poor visibility, and drenching from hose lines or fixed protection systems (e.g., 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 members of the public or other team members

(14) Working in shifts, including during nighttime, that can extend beyond 12 hours

5.1.2 The fire department shall provide the fire department

physician with the list of essential job tasks, as developed per 5.1.1, to be used in the medical evaluation of members and candidates.

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

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 the additional essential job tasks and specialized personal protective equipment (PPE) 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 also provide the fire depart-ment physician with the list of additional essential job tasks and specialized PPE specific to each specialized team.

5.2.3 When performing the medical evaluation of members of

a specialized team, the fire department physician shall also 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 members of having to wear or utilize specialized PPE that can increase weig ht, environmental isolation, sensory deprivation, and/or dehydration poten-tial above levels experienced with standard fire suppres-sion PPE

Chapter 6 Medical Evaluations of Candidates

6.1 Medical Evaluation. An individualized medical evaluation

of a candidate shall be conducted prior to the candidate being placed in training programs or fire department emergenc y response activities.

A 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 or her ability to perform the essential job tasks outlined in 5.1.l.

A 6.1.2* This standard shall provide specific requirements for candidates based on medical conditions that can affect a candi-date's ability to perform the essential job tasks of a firefight e r.

A 6.2 Medical Conditions Affecting Ability to Perform Essential Job Tasks.

A 6.2.1 Medical conditions that can affect a candidate's ability to perform essential job tasks shall be designated either Category A or Category B.

6.2.2 Candidates with Category A medical conditions shall not be certified as meeting the medical requirements of this stand-ard.

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 the public.

MEDICAL EVALUATIONS OF CANDIDATES 1582-11

Shaded text= Revisions. .a. = Text deletions and figure / table revisions. • = Sec tion deletions. N = New ma terial . 2022 Edition

6.3 Head and Neck.

6.3.1 Head.

A 6.3.1.1 Category A medical conditions shall include the following:

(1) Defect of skull preventing helmet use or leaving unde rly-ing brain unprotected from trauma

(2) Any skull or facial deformity that would not allow for a successful fit test for respirators used by that department

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

6.3.1.2 Category B medical conditions shall include the follow-ing:

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

(2) * Deformities of the skull associated with evidence of disease of the brain, spinal cord, or peripheral nerves (3)* Loss or congenital absence of the bony substance of the skull

6.3.2 Neck.

(3) Peripheral vision in the horizontal meridian of less than

110 degrees in the better eye or any condition that affects peripheral vision in both eyes

(4) ) Amblyopia

6.3.4* Ears and Hearing.

A 6.3.4.1 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 audio metric testing, without the aid of a hearing assis-tance device, average n earin g loss in the una ided better ear worse than 40 decibels (dB) at 500 Hz, 1000 Hz, 2000 Hz, and 3000 Hz. wh en the audiometric device is cali brated to ANSI/ASA 3.6, Specijicati on forlhuliom ters

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

6.3.4.2 CaLegoTyB med ical conditions shall include the follow-ing:

(l)* Unequal hearing loss

A 6.3.2.1 Category A medical conditions shall include any neck condition that results in the candidate not being able to perform one or more of the essential job tasks.

6.3.2.2 Category B medi cal conditions shall include the follow-

(2)

(3) (4)*

Average uncorrected hearing deficit at the test frequen -cies 500 Hz, 1000 Hz, 2000 Hz, and 3000 Hz wor se than 40 dB in either ear Atresia, stenosis, or tumor of the auditory canal External otitis, recurrent ing:

(1)* Thoracic outlet syndrome

(2) * Congenital cysts, chronic draining fistulas, or similar lesions (3)* Contraction of neck muscles

6.3.3 Eyes and Vision.

.ll 6.3.3.1 Category A medical conditions shall include the following:

(l)* Far visual acuicy worse r.hao 20/ 40 binocular, corrected with contacL lenses or pecta cles, or far ,isual acuity worse than 20/ 100 binocular for w arers of hard cootans or spectacl , or newcSoft contact Jens wearers, wicorr ted

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

(3) Ear visual acuity worse than 20/100 in the worse eye, corrected or uncorrecte d

(4)* Monocular vision, stereopsis without fusional capacity, night blindness, or loss of peripheral vision (i.e., horizon-tal field of vision less than llO degrees in each eye)

(5) Peripheral vision in the horizontal meridian of less than 110 degrees in the better eye or any condition that signifi-cantly affects peripheral vision in both eyes

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

(7) Near visual acuity Jes than 20/40 binocular, uncorrected or correeted

A 6.3.3.2 Category B medical conditions shall include the follow-ing:

(1)* Diseases of the eye, such as retinal detachment, progres-sive retinopathy, or optic neuritis (2)* Ophthalmological procedures, such as radial keratotomy, Lasik procedure, or repair of retinal detachment

(5)* Agenesis or traumatic deformity of the auricle (6)* Mastoiditis or surgical deformity of the mastoid (7)* Meniere's disease, labyrinthitis, or tinnitus (8)* Otitis media, recurrent

(9) Surgical procedu res to correct or improve hearing or other conditions of the ear

6.3.5 Dental.

a 6.3.5.1 Category A medical conditions shall include any dental condition that results in inability to perform one or more of the essential job tasks.

6.3.5.2 Category B medical conditions shall include the follow-ing:

( l )* Diseases of the jaws or associated tissues…