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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The purpose of fire physicals is to help reduce firefighter deaths due to heart attacks. One statistic says it all. Every year, almost half of firefighter line-of-duty deaths are caused by heart attacks. The typical fire physical is inadequate to reduce the number of deaths. Current physicals do not routinely include screening for cardiac risk factors in a structured format. Screening for cardiac risk factors identifies people who have a high risk of heart attack. This allows them to change some aspects of their risk profile such as smoking, diet and exercise to reduce their risk of having a heart attack.

Risk factors for cardiovascular disease should be part of every health screen done for every firefighter during every medical exam. The medical officer must review the OSHA respiratory questionnaire for symptoms of existing heart disease and also offer a separate questionnaire that would identify cardiac risk factors. If firefighters do not know their cholesterol levels, either the department's exam should provide this test or the department's policy should direct the members to return to their own doctors for the test.

The OSHA questionnaire asks the firefighter to report symptoms such as chest discomfort or shortness of breath. If the firefighter is not sure if what he or she is experiencing is chest discomfort, the questionnaire is an opportunity to ask about it. Usually, the examiner will request those answering yes to those symptoms to come in for an exam. This is how we would identify firefighters needing further evaluation. Perhaps the next step would be to refer the members back to their own doctors or to suggest that active firefighting be postponed pending the follow up with their doctors.

All firefighters should have medical exams. Some districts offer fire physicals only to interior qualified firefighters based on their use of respiratory protection or active firefighters such as drivers. Should we offer it to fire police, veteran firefighters with many years of service, and should it include the electrocardiogram and lung function testing?

Every Firefighter Deserves the Best

My opinion is yes. I believe that every firefighter who responds to an alarm needs and deserves to receive a medical exam. One might view the medical exam as a valuable benefit being offered to firefighters in return for their service to the community or an opportunity to access a check-up for those unable to afford medical care. I believe that it can and should be viewed as the gift of life for members. It must be presented as a "how can we keep you fit to fight fires with us" type of physical. Too often, it is presented to members as a negative threat to weed out firefighters if they have a medical problem. We could and should use firefighter physicals as a recruiting and retention tool, not a hammer to drive members away. We need to start a "fit to fight" mentality to replace the "sacrifice ourselves" mentality.

Fire districts have an opportunity to reduce their potential liability if all firefighters are examined for heart disease. The fire service should want every firefighter on the fireground to be screened because there is significant risk to personnel every time we respond to an alarm. The adrenaline of responding can trigger a heart attack. So can directing traffic or doing a fire investigation. Look at the case histories. Fatalities are not only occurring to interior firefighters!

It is also common for interior qualified firefighters to migrate over the years to less strenuous (less physically demanding) assignments such as drivers, fire police or chief officers. While the first expectation is that this may reduce the likelihood of a job-related heart attack, the converse is actually true. The probability of cardiovascular disease increases with age making any fire-related activity more dangerous with time. These assignments come with additional emotional stresses that are every bit as significant as physical stress. Heart attacks account for a higher proportion of deaths among older firefighters, as might be expected. For example, two-thirds of the firefighters over age 50 who died in 2003 died of heart attacks. The youngest heart attack victim was 35 years old.

Fire commissioners must ask themselves why firefighters should want the medical exams. Some do, while others, especially the younger members, regard it as another administrative burden. At least for those under 30, it is required by NFPA every third year. The frequency of the exam is every other year for firefighters 30 to 40 and every year for personnel over 40.