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The medical services provided to professional firefighters at large municipal departments vary widely throughout the United States. Typically, these services focus on identifying injuries and illnesses that can affect the ability of the firefighter to do his or her job. It is exciting to report that a growing number of fire departments are embracing and promoting comprehensive wellness programs in support of their firefighters’ long-term health, wellness and fitness. This is a huge benefit to those firefighters who have the opportunity to participate in this type of wellness initiative. It is certainly vital to know that a firefighter’s individual health is sufficient to partake in some of the most strenuous activity known to mankind. But providing a value-added wellness component that addresses the long-term health of that firefighter and his or her family is an opportunity that is worthy of our appreciation.
Many fire departments use traditional healthcare delivery options, such as hospitals, clinics and physician offices, to provide a varied menu of services. Large municipal fire departments may have their own medical departments and staff of physicians to provide a range of needed healthcare services, including pre-employment examinations, fitness-for-duty determinations and return-to-duty evaluations. In addition, these medical departments may monitor the health and wellness of employees, perform routine examinations, treat injuries and refer patients to specialists. They may also perform surveillance programs for occupational illness. These medical departments also serve to protect the interests of the municipality against legal action stemming from firefighter claims that they were injured on the job, but not provided medical care or that they were not medically able to perform their duties.
Mobile testing systems
There are alternatives to the traditional healthcare delivery options available to fire departments. One such alternative is Professional Health Services (PHS) of Havertown, PA. PHS uses mobile health testing systems, bringing its services to customers’ work sites. The mobile units are customized tractor-trailers that incorporate state-of-the-art medical equipment and computer technologies, and can travel anywhere in the country to provide health screenings and wellness programs. Typically, these examinations include hearing testing, vision screening, blood and urine profiles, pulmonary-function evaluations, electrocardiograms and chest X-rays.
Early in its history, PHS began developing a computerized medical information and record-keeping system. Today, all medical information is electronically stored in a secure HIPAA-compliant database. PHS has the capability to access all medical records dating back almost 40 years. This creates an invaluable repository of medical data that someday could be used to track diseases such as cancer.
The value of such programs to the fire service is immense. There is a growing awareness and focus on the high rates of cancers and other occupational illnesses now being associated with fire service activities. In this respect, many states have adopted laws providing a presumption of causality for many cancers and occupational illnesses in firefighters. Many of us in the fire service strongly believe this should be a national standard and uniformly applied to all firefighters. Such large data repositories are among the strongest tools available to recognize the close association between the incidence of cancer and other occupational illnesses in the fire service.
Two PHS programs of note are those administered for the Baltimore City, MD, and City of Memphis, TN, fire departments. Both programs were designed as wellness initiatives, not fitness-for-duty evaluations, and were funded primarily through Federal Emergency Management Agency (FEMA) grants. Departments opened their wellness initiatives to more than 1,700 of their respective city’s firefighters. On-site teams of healthcare professionals included a physician, three exercise physiologists and several medical technicians and support staff. In both programs, participation was voluntary.
The distinction between a wellness initiative and a fitness-for-duty examination is significant. Usually when we think of medical exams for the fire service, we think of certifying firefighters for the strenuous physical demands of the job (fitness for duty). A wellness program is different in that it provides each participant the opportunity to gain a broad view of his or her overall health through the completion of a health-risk appraisal questionnaire and participation in a comprehensive medical and physical examination process.
The Baltimore City and Memphis programs included general health screening, submaximal stress testing and physical fitness assessments with personalized exercise prescriptions for each participant. The desired outcome of both programs was to help firefighters identify health and general wellness issues that may not otherwise be obvious on a routine examination, to identify potential health issues years before they become a significant medical issue and to provide recommendations to each firefighter on how to make healthier lifestyle choices to improve their general health and well being. Each participant receives a comprehensive report that provides personalized recommendations on how to improve individual health and wellness. Provided “help information” focuses on diet, exercise and stress reduction. Another key element of the wellness program is a cardiovascular risk assessment and targeting of specific issues such as smoking cessation, nutrition and cholesterol reduction to cut an individual’s risk of a heart attack or stroke.
Participants in the Baltimore City program have expressed positive feedback regarding the comprehensiveness of both the evaluations and the post-testing reports. The program is continuing in 2012.
In the Memphis program, firefighters were given supplemental wellness evaluations to complement their medical examinations. The program identified many health issues that the firefighters addressed through primary-care physicians, enabling them to become healthier and avert potentially more significant issues later on.
Facing hazards on the job
Firefighting is physically demanding and offers a unique challenge to healthcare-delivery systems. The highly stressful job brings with it psychological risk, the potential for catastrophic injury and the concern of contracting occupational illnesses, including cancers triggered by exposure to toxic smoke and fumes.
As such, it is strongly advocated that those in the fire service participate in routine medical evaluations to improve their health, rather than face the additional risk of being a firefighter without a clue. A good place to start is with a wellness evaluation to review one’s current state of health and make specific recommendations focused on the individual firefighter’s needs. n