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...


To access the remainder of this piece of premium content, you must be registered with Firehouse. Already have an account? Login

Register in seconds by connecting with your preferred Social Network.

OR

Complete the registration form.

Required
Required
Required
Required
Required
Required
Required
Required
Required
Required

Some firefighters, especially career firefighters, view the medical exam as a potentially career-ending exam if they are found to have a disqualifying condition. There is never a time that a firefighter would not want to know if something is wrong. The truth is that everyone wants to be healthy and find a potentially serious condition before it leads to an early death. This is what medical screening exams want to accomplish. No one wants to disqualify anyone from serving unless it is a question of safety. All people want to be assured that if something is wrong, it will be addressed and they will be helped back to their previous activities.

Fire commissioners have a responsibility to ensure that members do not present a threat to other members of the department, the public we serve or themselves. For example, a firefighter who is struck down suddenly by a disabling heart attack must be rescued by other firefighters during the interior fire attack or search operation. This scenario will stop the fire attack, which may be protecting search teams, and place a huge burden on firefighters engaged in the suppression operation. An alternate scenario assigns a rapid intervention team with rescue and removal of the downed firefighter.

Anyone who has been on the scene of a "firefighter down" call knows how hectic it can be. The entire operation may focus on the firefighter and not the civilians or property we were trying to save. If the firefighter is a driver, sudden illness or death could result in a motor vehicle accident with a fire apparatus with injury to members and the public.

No single medical exam can address every possible medical issue or condition for every firefighter. If any firefighters have eye conditions that are out of my field, I must ask them to get notes from their eye doctors clearing them for duty. I can't do this without the help of their eye doctors. It is the responsibility of the firefighter, if they want to serve, to produce the documentation. If this is a volunteer firefighter, the cost of the eye exam is their responsibility, not the fire district. The fire service cannot and should not be asked to pay for the specialist's care for anyone wanting to volunteer. This is not part of the basic medical exam offered by the fire service, but rather a clearance from a specialist the firefighter needs to bring to the department in order to complete its review. Almost all career firefighters are provided health insurance through their employment and the issue of the cost of medical is removed.

The district's physician protects its interests. Occasionally, firefighters ask that their own physicians do the physical exams or that their jobs' exams be substituted for the department's exam. I do not recommend this since there may be a tendency for one's own doctor to underestimate the rigors for firefighting or to base their opinion on less data than used for the standard OSHA exam.

While that is the simple explanation, fire commissioners need to take a more rigorous look at the reasons. There are three reasons for having all the medical exams done by the department's physician. First, you increase your potential liability since any other doctor does not work for your district. That doctor is not loyal to you, but to the firefighter who is the patient. If that doctor misses something obvious or your firefighter intentionally does not provide accurate symptoms such as having chest pain, your district is stuck with responsibility. Second, will the doctor know what is involved with firefighting? National Institute for Occupational Safety and Health (NIOSH) fatality reports say repeatedly that physician lack of familiarity with firefighting contributes to line-of-duty deaths. Third, will the doctor ask if there is a history of back pain or prior injuries? Your district will be responsible for a new compensation claim when that firefighter files a claim for a new back injury while humping hose. Also, will the firefighter give you access to his or her entire medical record from a personal doctor if you need to review it to find out? I doubt it.

So that is my reasoning. You should ask your fire district's attorney as well. These are relatively new issues, so what we say here will set the standard, but I am sure you should not allow medical exams to be done by anyone other than your own district's physician. I have seen many instances of doctors finding critical health issues when a patient is examined one additional time. Ultimately, it is the fire district and its medical team that takes responsibility for the health and safety of its firefighters.

Next: Setting Policy