The IAFC’s Safety, Health and Survival (SHS) section has been a driving force for many important initiatives in the past 10-plus years, including its groundbreaking Rules of Engagement for Structural Firefighting.
The champions who form the roots of this section are a “who’s who” of this nation’s fire service, with names like Alan Brunacini, Bruce Varner, Gary Morris, Rich Marinucci, Dennis Rubin, Gordon Routley and others. These stalwarts of the fire service have been pushing the agenda of firefighter safety for decades, well before it was popular to do so. We are all in debt to these men for their vision and courage. However, change does not come easily in the fire service, and there are any number of interests and obstacles to overcome when initiating a new direction. The safety of firefighters should transcend all of those obstacles. The bottom line is that a healthy, well-trained, properly equipped and competently led firefighter is the only real solution to systemically decreasing line-of-duty deaths (LODDs) and line-of-duty injuries (LODIs).
Focus on health
Four years ago, the SHS did a comprehensive review of its strategic plan. At that meeting, the board took on the task of identifying the future direction of our growing influence. Inevitably, the discussion came around to how the section could truly affect the number of LODDs and LODIs in a more global way. We had been pushing out many great projects, programs and initiatives in the areas of fireground safety and survival, and were enjoying a great boost in awareness of these issues as a result. But the “health” part of our name was clearly our Achilles heel, and we knew that if we truly wanted to make a difference, we had to put more emphasis on this foundational element.
We were invested in many health-related issues, including spearheading the IAFC’s 2012 official position statement on Health and Fitness. Under the leadership of then-Section Chair Chief Matt Tobia, we resolved to take on the elephant in the room—annual comprehensive physicals for every firefighter. The statistics supported our proposition; historically, over half of all firefighter deaths have been cardiac- and stroke-related. The medical community has been steadfast in its assertion that early detection of the underlying causal aspects and risk factors of heart disease and high blood pressure can generally be identified and treated before an event occurs but only if the patient has an annual routine medical evaluation. The same holds true for most cancer incidents as well.
Having acknowledged the elephant, our initial discussions focused on identifying the pitfalls of pushing this difficult agenda as a national discussion. Several questions came up:
- What impact would this have on union members’ job security?
- How would this impact the volunteer communities’ ability to recruit and retain members?
- Is this a mandatory or voluntary program?
- How will the cities and towns pay for it?
- How could the legislative process be used to support the initiative?
- What state or federal agency has jurisdiction?
- Will this become another unfunded mandate?
These questions and the pending obstacles were daunting, and in fact, many have not yet been fully answered. The facts are still the facts. To have an effective wellness plan, to ensure that every firefighter is fit for duty, it must all start with a baseline medical evaluation. The section made the bold decision to reshape our three-year strategic plan to focus on one overriding goal—to take a national leadership role in moving the agenda of ensuring an occupationally relevant annual medical evaluation for EVERY firefighter.
First summit
The section immediately seized upon a valuable opportunity. Our long-time partner, the National Fallen Firefighters Foundation (NFFF) was holding its Tampa 2 summit in March 2014. With all the significant stakeholders already in one place, the SHS piggybacked the NFFF event and held its first Firefighter Physicals Summit on site the following day.
The impetus behind this first meeting was to build coalitions and to identify a viable path forward. Nearly every major fire service organization supplied representation to this summit, and the results were a tremendous boost to the mission of pushing this debate forward. The discourse was honest and hard-hitting regarding the global importance of this initiative and the obstacles that would need to be overcome. Each member voiced their organization’s support that a job-specific medical examination was an unequivocal and fundamental responsibility that every community must provide to its members. Each organization also identified the various ancillary issues that were anticipated vis-à-vis funding, job security, presumptions, etc. The group identified the central strategic issues that would need to be answered to advance the cause, none more relevant and difficult to answer than:
- What is the proper medical evaluation to utilize?
- Who will pay for the service?
- What happens if a member fails the examination?
Who pays?
The most common question that comes up in this debate is, “Who is going to pay for it?” The answer is at the very heart of the issue itself. Municipal department members will look directly to the communities to shoulder the cost. Volunteer and call departments don’t necessarily have similar fiscal revenue streams, and may need an alternate means of funding.
Fundamentally, a firefighter physical is not a luxury; it is a necessity. An annual budget item for the cost of firefighter medical evaluations is no less vital than any recurring budget item. In fact, the overall costs will oftentimes be more than offset by the savings realized when an injury or long-term illness is prevented. The costs associated with members’ long-term care when they are struck down by a preventable disability are astronomical in comparison to the cost of an annual evaluation. The nominal cost of a cancer screening or EKG or echo stress test is a fraction of the cost of chemotherapy and radiation, of cardiac catheterization or ablation or, God forbid, the cost of state and federal survivor benefits for a widow. We realize that money is a driving force behind any discussion about firefighter medical evaluations; however, hundreds of departments, large and small, career and volunteer, are already making the commitment. If they can do it, so can we.
NFPA 1582
The standard most identified with this issue is, of course, NFPA 1582: Standard on Comprehensive Occupational Medical Programs for Fire Departments (2013). This standard, like all NFPA standards, is a consensus minimum. Many departments are already meeting or exceeding the 1582 standard; others see it as an unreachable criterion. Whichever side you view the standard, there is no doubt that it represents the absolute direction that we need to push the fire service to reach our ultimate goal to reduce LODIs and LODDs.
NFPA 1582 is currently under review, and the committee members are committed to reviewing all aspects of the standard, including perhaps identifying job-specific criteria for various fire service positions, which may help departments to better build consensus and implementation.
Further, the SHS, with Firefighter Safety Through Advanced Research (FSTAR), have secured an AFG grant to develop and distribute a physician’s guide related to 1582 medical evaluations, so firefighters can educate our occupational health doctors and primary care physicians on our specific exposures and needs.
Second summit
In 2015, the SHS held its second Firefighter Physicals Summit in conjunction with Fire-Rescue International (FRI). This time the group included several medical practitioners and research scientists to help guide the process forward. Having the medical community present lent great insight into the feasibility and practicality of the initiative. The discussions centered on the concept of a scalable examination depending on the member’s job requirements, age, overall health and standard medical practices in those areas. Essentially, one-size medical evaluation does not (and should not) fit all throughout the course of a 30-plus-year career. The day also included an emotionally charged presentation from Dr. Michael Hamrock of the Boston Fire Department on the department’s outstanding efforts to raise the bar on cancer awareness among the nation’s fire service.
Attend the third summit
This year’s summit will again coincide with FRI, held at the convention center in San Antonio on Aug. 17 at 0800 hrs. Anyone who wants to attend and listen in is welcome. There will be opportunities for everyone to be a part of this pressing health and safety issue. We will be getting an update from the FSTAR Wellness initiative as well as from the OSHA’s National Advisory Committee on Occupational Safety and Health, which is also working the issue at the federal level.
The first summit was a call to unite; the second summit was a call for realistic assessment; the third summit is a call to sustained action. Many fire service organizations are picking up the ball in their respective areas and carrying the torch forward. We are all stronger when united together, and the issue of an annual firefighter medical evaluation for EVERY firefighter is one that we can and should all support. There are no administrative issues more important than our membership’s health and wellness. There are no excuses relevant enough to deny this fundamental responsibility that we owe to our members and our communities!