Fire Commissioner's Complete Guide to Medical Examinations - Part 1

Raymond Basri, MD, outlines how to create a cost-effective health and wellness program for firefighters.


As a physician and as a firefighter, I am keenly aware of the risks common to all who serve in the fire service. Fire commissioners are uniquely responsible for creating the policy for the health and wellness of their firefighters, selecting the medical services that are part of examination...


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As a physician and as a firefighter, I am keenly aware of the risks common to all who serve in the fire service. Fire commissioners are uniquely responsible for creating the policy for the health and wellness of their firefighters, selecting the medical services that are part of examination, choosing the physicians providing the services, enforcing compliance with the program, monitoring the program and budgeting the funds to support the program. A tough assignment.

Fire commissioners are required to take training to serve as commissioners, but nowhere in the curriculum do they teach the medical issues. How do you create a cost-effective health and wellness program or choose what constitutes a good medical exam? A weak medical program misses opportunities to find disease before it strikes. A good program saves lives.

The most important part of the process is to have a workable policy in place that fulfills the legal and regulatory requirements while at the same time clearly defining the nuts-and-bolts issues to the membership in simple language. It is this policy that allows the firefighters to understand the objectives of the program without intimidation or coercion. The health and wellness policy defines the schedule of examinations, job assignments with their medical classifications level, and how the process gets done.

  • OSHA Respiratory Standard — Fire physicals were not a homegrown idea by firefighters to help our own. First, the federal government issued a statutory requirement to protect firefighters using respiratory protection called the Occupational Safety and Health Administration (OSHA) 1910.134 respiratory standard. It states that before employees may use any type of respiratory protection, they must have a medical evaluation using a medical questionnaire or an initial medical examination that obtains the same information as the questionnaire.

    The OSHA respiratory questionnaire is used by many districts for firefighters to self report any symptoms, conditions or new medical history once yearly. This is an excellent tool to conveniently monitor the health of our members between the medical exams. It does depend on firefighters honestly answering the questionnaire if they truly feel symptoms.

  • NFPA 1582 Standard — This is only one part of the applicable standards for the medical examinations for the fire service. The fire service mandated physical exams for firefighters as part of the National Fire Protection Association (NFPA) 1582 standard in 1992. It calls for the fire service to fund and implement medical exams consisting of a health history, physical exam by a doctor, physician assistant or licensed nurse practitioner, and include an electrocardiogram and lung-function test. It set the frequency of exam based on each firefighter's age and recommended vaccination for Hepatitis B.

Recently, this standard was adopted by the Department of Homeland Security (DHS)/U.S. Fire Administration (USFA) for all 50 states. Previously, there was a patchwork of compliance with the standards on a state level with some states doing little more than reviewing a screening health questionnaire.

Commissioners must understand that just because a firefighter had a physical does not reduce his or her chance of having a heart attack. Current exams may catalog pre-existing illnesses and find dangerous new conditions such as high blood pressure. We need to set a standard for the physical exams that will assess the cardiac risk factors. Thus far, we have not demanded that the medical team do this as they perform the physical exams on our firefighters. The fire service pays for medical exams, but does not require appropriate screening tools to detect firefighters at risk for heart attacks.

Heart Attacks Are Preventable

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