When Is It Time?

[papacheese]

This was inspired by a post by hp4l in the LODD thread....specifically regarding a 66 year old firefighter succumbing to a heart attack. The question is more than rhetorical: when it it time to hang up the helmet? Should a 66 year old man or woman be subjected to the rigorous demands of firefighting?

While calling it quits is very much a personal decision, should there be any kind of benchmark you feel is fair that can be used to gauge someone's ability to continue? I'm sure there are people out there older than me in far better shape, so it's difficult to associate a number.

[chief3102]

Common sense tells us that we should know when it is time all by our selves. Having said that and knowing that this will not occur, I believe that every department should have mandatory physicals after a certain age. Not a form that you hand to a FF and tell them to have their own doctor fill out. But a physical performed by an occupational doctor that is familiar with the stresses of the job. To open a large can of worms, I personally believe that some sort of physical test be given to replicate what we do (i.e. Combat Challenge) with set benchmarks for performance. Don't pass ? Don't ride the BRT.

[hp4l]

My personal opinion is that age is just a number. If you can pass your department's physical and/or mandatory training, then why not still run. There are plenty of "older" members that are in better shape than the younger guys and girls that are getting on the trucks.

Maybe the question is this: What training and/or physicals does your department require? Is there an SCBA test where you have to don and doff it? Walk through a course on air? Doctor's physical? As long as you have something in place that is fair and even across the board for all members, then anyone that passes should be eligible to run regardless of age.

[papacheese]

I wholeheartedly agree with 02 and hp4l's comments....but realize that the single most obstructive action is a member burying their head in the sand when it comes to realistically assessing themselves.

Which of course poses the question: Can anyone be that totally honest with themselves?

In dealing with this issue on a frequent basis, I encounter this syndrome all the time: "So what if my finger/hand/leg/nose is broken/amputated/numb.... I can still do stuff!"

I like to think we have a decent and fair physical exam program in place here, but harbor few illusions regarding it's overall effectiveness, depending of course on what your objective is.

There is no silver bullet program out there (that I'm aware of) which can regularly and reliably provide a firm answer on a person's medical ability to do the job, unless you want to invest in extensive cardiovascular testing...ie, stress tests.

[ENG27SQ]

papacheese said:

There is no silver bullet program out there (that I'm aware of) which can regularly and reliably provide a firm answer on a person's medical ability to do the job, unless you want to invest in extensive cardiovascular testing...ie, stress tests.

With the treadmill, wires coming out of you and one screaming "where's the nurse?!"

LOL, sorry I had to.

[chief3102]

papacheese said:

Which of course poses the question: Can anyone be that totally honest with themselves?

That was part of the point I was trying to make.......How honest are we ?? I have had this discussion with several people who complained about being sidelined from active firefighting. The first question I asked each of them is "would you want someone else to get hurt trying to pull you out of a fire if something happened to you??" The look on their faces as they pondered their response was one of confusion which quickly turned to realization that no, they could not justify putting their brothers in danger for their own ego.

[voyager9]

I think this topic hits across two very strong traits that are common:
1) I put firefighters in a very similar class as professional athletes. We tend to be very Type-A, ignore-pain, play-through-everything, type of individuals. Very rarely do we allow ourselves to think "I can't do that".
2) Everyone, as life goes on, gets to the age where they no longer function the way they used to. It is a fact of life and a very hard one to face.. especially given the "It aint gonna get better"-factor. Coming to grips with that is tough for everyone. talk to anyone who has had to put their parents/family in nursing homes or forced them to stop driving..

1 + 2 == A aging group of people who is used to thinking they can do anything and don't want to come to admit that time is catching up with them.

One thing that would help is to remove the emotion from the decision making. Have standards, physicals and other measurable criteria that must be met. Then it isn't a "Sorry Bill, you're too old", but a "Sorry Bill, you didn't finish quickly enough" or whatever.

Side question: Would "Age Discrimination" become a factor/hindrance?

[shader101]

66 is but one number ,age, don't tell much about his lifestyle, shape he was in ect...i would say know your limits and your strengths whatever your age is be realistic with yourself, if your the 300lb./5'5", 20 or 55+ you don't belong in a airpac or on the roof ect

[papacheese]

The medical standards (ie: NFPA) do not mention anything about age, because it would be discriminatory. Instead, they (like voyager mentioned) recommend a standard that everyone must meet, regardless of age, both medically as well as physically. You must be able to do this within that amount of time as well as not have a disqualifying medical condition such as a prior heart attack or history of serious cardio-pulmonary issues. If you can meet these standards, then you're OK.

Like 02, I'm primarily concerned about other firefighters...we all make personal decisions based on our own perspectives and needs, yet too often fail to take into account how it will affect others. We ARE typical Type A athletes...who wants to face the end of something we love?

[voyager9]

papacheese said:

We ARE typical Type A athletes...who wants to face the end of something we love?

This is the way the world will end. Not with a bang but a whimper.

[windtunnel]

i too agree with most of you on this subject... we often times let our pride get in the way of the correct decision... when faced with plucking a senior members gear because of age the situation can often times become really sensitive because although the man or womans body is worn and weathered, his/her psychological being may still be youthful and ready to take on the world. let us not think of age as the determining factor or our own spirits when it comes to whether or not we can do the job yet the determining factor should be a feat of physiological being. lets face it although a 70 year old may be in the best shape of his/her life they have still stressed their heart for the past 70 years thus damaging the muscular tissue and becoming more prone to injury and or endangering others due to their condition....the most important part: WE ARE HUMANS NOT ROBOTS!

[papacheese]

windtunnel said:

i too agree with most of you on this subject... we often times let our pride get in the way of the correct decision... when faced with plucking a senior members gear because of age the situation can often times become really sensitive because although the man or womans body is worn and weathered, his/her psychological being may still be youthful and ready to take on the world. let us not think of age as the determining factor or our own spirits when it comes to whether or not we can do the job yet the determining factor should be a feat of physiological being. lets face it although a 70 year old may be in the best shape of his/her life they have still stressed their heart for the past 70 years thus damaging the muscular tissue and becoming more prone to injury and or endangering others due to their condition....the most important part: WE ARE HUMANS NOT ROBOTS!

WHEW!

[thecutman]

I say follow the NFPA standards for physical testing. Alot of people might fail due to the stringent policy. That is the price you pay for being unfit or unable to continue your service. While some people feel that this is unfair, I personally feel that this will drop the deaths of heart attacks in the fire service. But the big question is are we willing to take the chance to lose our job for not being fit for duty wether career or volunteer? I would but I know most would not.

Take a poll and see who would take an NFPA full blown physical. There are quite a few fireman, career and volunteer that would no longer be pack certified. For career guys this could be detrimental to their job. For volunteers this could be detrimental as well but not to the extent of the career guys who depend on this as a living. There is alot to be said about this subject.

[thecutman]

NFPA 1582 Chapter 6

Trust me read this over. Alot and I mean Alot of guys running would be taken off the front lines. Be careful what you wish for because this could affect alot of people. Read it thoroughly to understand its meaning. young guys take a look and pay attention to what we are putting into our bodies. This is why we need to work out.
Chapter 6 Medical Evaluations of Candidates

6.1 Medical Evaluation.

A medical evaluation of a candidate shall be conducted prior to the candidate being placed in training programs or fire department emergency response activities.

6.1.1* The medical evaluation of a candidate shall include a medical history, examination, and any laboratory tests required to detect physical or medical condition(s) that could adversely affect his/her ability to safely perform the essential job tasks outlined in 5.1.1.

6.1.2 If a candidate presents with a condition that temporarily interferes with his/her ability to safely perform essential job tasks, the pre-placement medical evaluation shall be postponed until the candidate has recovered from that condition.

6.2 Medical Conditions Affecting Ability to Safely Perform Essential Job Tasks.

6.2.1 Medical conditions that can affect a candidate's ability to safely perform essential job tasks shall be designated either Category A or Category B.

6.2.2 Candidates with Category A medical conditions shall not be certified as meeting the medical requirements of this standard.

6.2.3 Candidates with Category B medical conditions shall be certified as meeting the medical requirements of this standard only if they can perform the essential job tasks without posing a significant safety and health risk to themselves, members, or civilians.

6.3 Head and Neck.

6.3.1 Head.

6.3.1.1 Category A medical conditions shall include the following:

(1) Defect of skull preventing helmet use or leaving underlying brain unprotected from trauma

(2) Any skull or facial deformity that would not allow for a successful respiratory facepiece fit test

(3) Any head condition that results in the candidate not being able to safely perform one or more of the essential job tasks

6.3.1.2 Category B medical conditions shall include the following:

(1)* Deformities of the skull such as depressions or exostoses

(2)* Deformities of the skull associated with evidence of disease of the brain, spinal cord, or peripheral nerves

(3)* Loss or congenital absence of the bony substance of the skull

6.3.2 Neck.

6.3.2.1 Category A medical conditions shall include any neck condition that results in the candidate not being able to safely perform one or more of the essential job tasks.

6.3.2.2 Category B medical conditions shall include the following:

(1)* Thoracic outlet syndrome

(2)* Congenital cysts, chronic draining fistulas, or similar lesions

(3)* Contraction of neck muscles

6.4 Eyes and Vision.

6.4.1 Category A medical conditions shall include the following:

(1)* Far visual acuity less than 20/40 binocular, corrected with contact lenses or spectacles, or far visual acuity less than 20/100 binocular for wearers of hard contacts or spectacles, uncorrected

(2)* Color perception — monochromatic vision resulting in inability to use imaging devices such as thermal imaging cameras

(3)* Monocular vision

(4) Any eye condition that results in the candidate not being able to safely perform one or more of the essential job tasks

6.4.2 Category B medical conditions shall include the following:

(1)* Diseases of the eye such as retinal detachment, progressive retinopathy, or optic neuritis

(2)* Ophthalmological procedures such as radial keratotomy, Lasik procedure, or repair of retinal detachment

(3) Peripheral vision in the horizontal meridian of less than 110 degrees in the better eye or any condition that significantly affects peripheral vision in both eyes

6.5* Ears and Hearing.

6.5.1 Category A medical conditions shall include the following:

(1) Chronic vertigo or impaired balance as demonstrated by the inability to tandem gait walk

(2) On audiometric testing, average hearing loss in the unaided better ear greater than 40 decibels (dB) at 500 Hz, 1000 Hz, 2000 Hz, and 3000 Hz when the audiometric device is calibrated to ANSI Z24.5, Audiometric Device Testing

(3) Any ear condition (or hearing impairment) that results in the candidate not being able to safely perform one or more of the essential job tasks

6.5.2 Category B medical conditions shall include the following:

(1)* Unequal hearing loss

(2) Average uncorrected hearing deficit at the test frequencies 500 Hz, 1000 Hz, 2000 Hz, and 3000 Hz greater than 40 dB in either ear

(3) Atresia, stenosis, or tumor of the auditory canal

(4)* External otitis

(5)* Agenesis or traumatic deformity of the auricle

(6)* Mastoiditis or surgical deformity of the mastoid

(7)* Ménière's syndrome, labyrinthitis, or tinnitus

(8)* Otitis media

6.6 Dental.

6.6.1 Category A medical conditions shall include any dental condition that results in inability to safely perform one or more of the essential job tasks.

6.6.2 Category B medical conditions shall include the following:

(1)* Diseases of the jaws or associated tissues

(2)* Orthodontic appliances

(3)* Oral tissues, extensive loss

(4)* Relationship between the mandible and maxilla that interferes with satisfactory postorthodontic replacement or ability to use protective equipment

6.7 Nose, Oropharynx, Trachea, Esophagus, and Larynx.

6.7.1 Category A medical conditions shall include the following:

(1)* Tracheostomy

(2)* Aphonia

(3) Any nasal, oropharyngeal, tracheal, esophageal, or laryngeal condition that results in inability to safely perform one or more of the essential job tasks including fit testing for respirators such as N-95 for medical response, P-100 for particulates and certain vapors, and SCBA for fire and hazmat operations

6.7.2 Category B medical conditions shall include the following:

(1)* Congenital or acquired deformity

(2)* Allergic rhinitis

(3) Epistaxis, recurrent

(4)* Sinusitis, recurrent

(5)* Dysphonia

(6) Anosmia

(7) Tracheal stenosis

(8) Nasopharyngeal polyposis

6.8 Lungs and Chest Wall.

6.8.1 Category A medical conditions shall include the following:

(1) Active hemoptysis

(2) Current empyema

(3) Pulmonary hypertension

(4) Active tuberculosis

(5) An FVC or FEV1 less than 70 percent predicted independent of disease as it prevents the safe use of SCBA due to increased minute ventilation requirements leading to the earlier than expected depletion of air in the SCBA cylinder

(6)* Obstructive lung diseases (e.g., emphysema, chronic bronchitis, asthma) with an FEV1/FVC less than 0.75, with both FEV1 and FVC below normal (less than 0.80) as defined by the American Thoracic Society (see references in Annex D)

(7)* Hypoxemia — oxygen saturation less than 90 percent at rest or exercise desaturation by 4 percent or to less than 90 percent (exercise testing indicated when resting oxygen is less than 94 percent but greater than 90 percent)

(8)* Asthma — reactive airways disease requiring bronchodilator or corticosteroid therapy for 2 or more consecutive months in the previous 2 years, unless the candidate can meet the requirement in 6.8.1.1

(9) Any pulmonary condition that results in the candidate not being able to safely perform one or more of the essential job tasks

6.8.1.1* A candidate who has in the past required bronchodilator, corticosteroid, or anti-inflammatory therapy for asthma but who does not believe he/she has asthma shall be evaluated by a pulmonologist or other expert in asthmatic lung diseases such as an allergist to determine the following:

(1) Asthma has resolved without symptoms off medications for 2 years.

(2) If allergic, allergen avoidance or desensitization has been successful.

(3) Spirometry demonstrates adequate reserve (FVC and FEV1 greater than or equal to 90 percent) and no bronchodilator response measured off all bronchodilators on the day of testing.

(4) Normal or negative response (less than 20 percent decline in FEV1) to provocative challenge using cold air, exercise (12 METS), or methacholine. (PC20 greater than 8 is considered normal, as response at dose greater than 8 mg might not be clinically significant.)

6.8.1.1.1 Challenge testing shall be performed off all anti-inflammatory medications for 4 weeks preceding the test and off all bronchodilators on the day of testing.

6.8.2 Category B medical conditions shall include the following:

(1)* Pulmonary resectional surgery, chest wall surgery, and pneumothorax

(2) Pleural effusion

(3)* Fibrothorax, chest wall deformity, and diaphragm abnormalities

(4)* Interstitial lung diseases

(5)* Pulmonary vascular diseases or history of pulmonary embolism

(6)* Bronchiectasis

(7) Infectious diseases of the lung or pleural space

(8) Cystic fibrosis

(9) Central or obstructive apnea

6.9 Heart and Vascular System.

6.9.1 Heart.

6.9.1.1 Category A medical conditions shall include the following:

(1)* Coronary artery disease, including history of myocardial infarction, angina pectoris, coronary artery bypass surgery, coronary angioplasty, and similar procedures

(2)* Cardiomyopathy or congestive heart failure, including signs or symptoms of compromised left or right ventricular function, including dyspnea, S3 gallop, peripheral edema, enlarged ventricle, abnormal ejection fraction, and/or inability to increase cardiac output with exercise

(3)* Acute pericarditis, endocarditis, or myocarditis

(4)* Syncope, recurrent

(5)* A medical condition requiring an automatic implantable cardiac defibrillator or history of ventricular tachycardia or ventricular fibrillation due to ischemic or valvular heart disease, or cardiomyopathy

(6) Third-degree atrioventricular block

(7)* Cardiac pacemaker

(8) Idiopathic hypertrophic subaortic stenosis

(9) Any cardiac condition that results in the candidate not being able to safely perform one or more of the essential job tasks

6.9.1.2 Category B medical conditions shall include the following:

(1)* Valvular lesions of the heart, including prosthetic valves

(2)* Recurrent supraventricular or atrial tachycardia, flutter, or fibrillation

(3)* Left bundle branch block

(4) Second-degree atrioventricular block in the absence of structural heart disease

(5) Sinus pause more than 3 seconds

(6)* Ventricular arrhythmia (history or presence of multifocal PVCs or nonsustained ventricular tachycardia on resting EKG with or without symptoms; history or presence of sustained ventricular tachycardia with or without symptoms)

(7)* Cardiac hypertrophy or hypertrophic cardiomyopathy

(8)* History of a congenital abnormality

(9)* Chronic pericarditis, endocarditis, or myocarditis

6.9.2 Vascular System.

6.9.2.1 Category A medical conditions shall include the following:

(1)* Hypertension with evidence of end organ damage or not controlled by approved medications

(2)* Thoracic or abdominal aortic aneurysm

(3) Carotid artery stenosis or obstruction resulting in greater than or equal to 50 percent reduction in blood flow

(4)* Peripheral vascular disease resulting in symptomatic claudication

(5) Any other vascular condition that results in inability to safely perform one or more of the essential job tasks

6.9.2.2 Category B medical conditions shall include the following:

(1) Vasospastic phenomena such as Raynaud's phenomenon

(2)* Thrombophlebitis and varicosities

(3)* Chronic lymphedema due to lymphadenopathy or venous valvular incompetency

(4)* Congenital or acquired lesions of the aorta or major vessels

(5)* Circulatory instability as indicated by orthostatic hypotension, persistent tachycardia, and peripheral vasomotor disturbances

(6) History of surgical repair of aneurysm of the heart or major vessel

6.10 Abdominal Organs and Gastrointestinal System.

6.10.1 Category A medical conditions shall include the following:

(1) Presence of uncorrected inguinal/femoral hernia regardless of symptoms

(2) Any gastrointestinal condition that results in the candidate not being able to safely perform one or more of the essential job tasks

6.10.2 Category B medical conditions shall include the following:

(1)* Cholecystitis

(2)* Gastritis

(3)* GI bleeding

(4)* Acute hepatitis

(5) Hernia including the following:

(a) Uncorrected umbilical, ventral, or incisional hernia if significant risk exists for infection or strangulation

(b) Significant symptomatic hiatal hernia if associated with asthma, recurrent pneumonia, chronic pain, or chronic ulcers

(c)* Surgically corrected hernia more than 3 months after surgical correction

(6)* Inflammatory bowel disease or irritable bowel syndrome

(7)* Intestinal obstruction

(8)* Pancreatitis

(9) Diverticulitis

(10)* History of gastrointestinal surgery

(11)* Peptic or duodenal ulcer or Zollinger-Ellison syndrome

(12)* Asplenia

(13)* Cirrhosis, hepatic or biliary

(14)* Chronic active hepatitis

6.11 Reproductive System.

See B.1.2.1.

6.11.1 Category A medical conditions shall include any genital condition that results in inability to safely perform one or more of the essential job tasks.

6.11.2 Category B medical conditions shall include the following:

(1) Pregnancy, for its duration

(2) Dysmenorrhea

(3) Endometriosis, ovarian cysts, or other gynecologic conditions

(4) Testicular or epididymal mass

6.12 Urinary System.

6.12.1 Category A medical conditions shall include the following:

(1) Renal failure or insufficiency requiring continuous ambulatory peritoneal dialysis (CAPD) or hemodialysis

(2) Any urinary condition that results in the candidate not being able to safely perform one or more of the essential job tasks

6.12.2 Category B medical conditions shall include the following:

(1) Diseases of the kidney

(2) Diseases of the ureter, bladder, or prostate

6.13 Spine and Axial Skeleton.

6.13.1 Category A medical conditions shall include the following:

(1) Scoliosis of thoracic or lumbar spine with angle greater than or equal to 40 degrees

(2) History of spinal surgery involving fusion of two or more vertebrae, or rods that are still in place

(3) Any spinal or skeletal condition producing sensory or motor deficit(s) or pain due to radiculopathy or nerve root compression

(4) Any spinal or skeletal condition causing pain that frequently or recurrently requires narcotic analgesic medication

(5) Cervical vertebral fractures with multiple vertebral body compression greater than 25 percent; evidence of posterior element involvement, nerve root damage, disc involvement, dislocation (partial, moderate, severe), abnormal exam, ligament instability, symptomatic, and/or less than 6 months post injury or less than 1 year since surgery

(6) Thoracic vertebral fractures with vertebral body compression greater than 50 percent; evidence of posterior element involvement, nerve root damage, disc involvement, dislocation (severe — with or without surgery), abnormal exam, ligament instability, symptomatic, and/or less than 6 months post injury or less than 1 year since surgery

(7) Lumbosacral vertebral fractures with vertebral body compression greater than 50 percent; evidence of posterior element involvement, nerve root damage, disc involvement, dislocation (partial, moderate, severe), fragmentation, abnormal exam, ligament instability, symptomatic, and/or less than 6 months post injury or less than 1 year since surgery

(8) Any spinal or skeletal condition that results in the candidate not being able to safely perform one or more of the essential job tasks

6.13.2 Category B medical conditions shall include the following:

(1) Congenital or developmental malformations of the back, particularly those that can cause instability, neurological deficits, pain, or limit flexibility

(2) Scoliosis with angle less than 40 degrees

(3) Arthritis of the cervical, thoracic, or lumbosacral spine

(4) Facet atrophism, high lumbosacral angle, hyperlordosis, Schmorl's nodes, Scheuermann's disease, spina bifida occulta, spondylolisthesis, spondylolysis, or transitional vertebrae

(5) History of infections or infarcts in the spinal cord, epidural space, vertebrae, or axial skeletal joints

(6) History of diskectomy or laminectomy or vertebral fractures

6.14 Extremities.

6.14.1 Category A medical conditions shall include the following:

(1) Bone hardware such as metal plates or rods supporting bone during healing

(2) History of total joint replacement

(3) Amputation or congenital absence of upper-extremity limb (hand or higher)

(4) Amputation of either thumb proximal to the mid-proximal phalanx

(5) Amputation or congenital absence of lower-extremity limb (foot or above)

(6) Chronic non-healing or recent bone grafts

(7) History of more than one dislocation of shoulder without surgical repair or with history of recurrent shoulder disorders within the last 5 years with pain or loss of motion, and with or without radiographic deviations from normal

(8) Any extremity condition that results in the candidate not being able to safely perform one or more of the essential job tasks

6.14.2 Category B medical conditions shall include the following:

(1)* History of shoulder dislocation with surgical repair

(2) Significant limitation of function of shoulder, elbow, wrist, hand, or finger due to weakness, reduced range of motion, atrophy, unequal length, absence, or partial amputation

(3) Significant lack of full function of hip, knee, ankle, foot, or toes due to weakness, reduced range of motion, atrophy, unequal length, absence, or partial amputation

(4)* History of meniscectomy or ligamentous repair of knee

(5)* History of intra-articular, malunited, or nonunion of upper or lower extremity fracture

(6)* History of osteomyelitis, septic, or rheumatoid arthritis

6.15 Neurological Disorders.

6.15.1 Category A medical conditions shall include the following:

(1) Ataxias of heredo-degenerative type

(2) Cerebral arteriosclerosis as evidenced by a history of transient ischemic attack, reversible ischemic neurological deficit, or ischemic stroke

(3) Hemiparalysis or paralysis of a limb

(4)* Multiple sclerosis with activity or evidence of progression within previous 3 years

(5)* Myasthenia gravis with activity or evidence of progression within previous 3 years

(6) Progressive muscular dystrophy or atrophy

(7) Uncorrected cerebral aneurysm

(8) All epileptic conditions including simple partial, complex partial, generalized, and psychomotor seizure disorders other than as allowed in 6.15.1.1

(9) Dementia (Alzheimer's and other neurodegenerative diseases) with symptomatic loss of function or cognitive impairment (e.g., less than or equal to 28 on Mini-Mental Status Exam)

(10) Parkinson's disease and other movement disorders resulting in uncontrolled movements, bradykinesia, or cognitive impairment (e.g., less than or equal to 28 on Mini-Mental Status Exam)

(11) Any neurological condition that results in the candidate not being able to safely perform one or more of the essential job tasks

6.15.1.1 A candidate with epileptic conditions shall have had complete control during the previous 5 years.

6.15.1.2 To be medically qualified a candidate shall meet all of the following:

(1) No seizures for 1 year off all anti-epileptic medication or 5 years seizure free on a stable medical regimen

(2) Neurologic examination is normal

(3) Imaging (CAT or MRI scan) studies are normal

(4) Awake and asleep EEG studies with photic stimulation and hyperventilation are normal

(5) A definitive statement from a qualified neurological specialist that the candidate meets the criteria specified in 6.15.1.2(1) through 6.15.1.2(4) and that the candidate is neurologically cleared for fire-fighting training and the performance of a fire fighter's essential job tasks

6.15.2 Category B medical conditions shall include the following:

(1) Congenital malformations

(2)* Migraine

(3) Clinical disorders with paresis, dyscoordination, deformity, abnormal motor activity, abnormality of sensation, or complaint of pain

(4) History of subarachnoid or intraparenchymal hemorrhage

(5) Abnormalities from recent head injury such as severe cerebral contusion or concussion

6.16 Skin.

6.16.1 Category A medical conditions shall include the following:

(1) Metastatic or locally extensive basal or squamous cell carcinoma or melanoma

(2) Any dermatologic condition that would not allow for a successful respiratory facepiece fit test

(3) Any dermatologic condition that results in the candidate not being able to safely perform one or more of the essential job tasks

6.16.2 Category B medical conditions shall include the following:

(1)* Skin conditions of a chronic or recurrent nature (eczema, cystic acne, psoriasis) that cause skin openings or inflammation or irritation of the skin surface

(2)* Surgery or skin grafting

(3)* Mycosis fungoides

(4)* Cutaneous lupus erythematosus

(5)* Raynaud's phenomenon

(6)* Scleroderma (skin)

(7)* Vasculitic skin lesions

(8)* Atopic dermatitis/eczema

(9)* Contact or seborrheic dermatitis

(10)* Stasis dermatitis

(11)* Albinism, Dariers disease, ichthyosis, Marfan syndrome, neurofibromatosis, and other genetic conditions

(12)* Folliculitis, pseudo-folliculitis, miliaria, keloid folliculitis

(13)* Hidradenitis suppurativa, furuncles, carbuncles, or Grade IV acne (cystic)

(14)* Mechano-bullous disorders (epidermolysis bullosa, Hailey pemphigus, porphyria, pemphigoid)

(15)* Urticaria or angioedema

6.17 Blood and Blood-Forming Organs.

6.17.1 Category A medical conditions shall include the following:

(1) Hemorrhagic states requiring replacement therapy

(2) Sickle cell disease (homozygous)

(3) Clotting disorders

(4) Any hematological condition that results in inability to safely perform one or more of the essential job tasks

6.17.2 Category B medical conditions shall include the following:

(1) Anemia

(2) Leukopenia

(3) Polycythemia vera

(4) Splenomegaly

(5) History of thromboembolic disease

(6) Any other hematological condition that results in inability to safely perform essential job tasks

6.18 Endocrine and Metabolic Disorders.

6.18.1 Category A medical conditions shall include the following:

(1)* Type 1 diabetes mellitus, unless a candidate meets all of the following criteria:

[thecutman]

NFPA 1582 Chapter 6 cont.
(a) Is maintained by a physician knowledgeable in current management of diabetes mellitus on a basal/bolus (can include subcutaneous insulin infusion pump) regimen using insulin analogs.

(b) Has demonstrated over a period of at least 1 year the motivation and understanding required to closely monitor and control capillary blood glucose levels through nutritional therapy and insulin administration. Assessment of this shall take into consideration the erratic meal schedules, sleep disruption, and high aerobic and anaerobic workloads intrinsic to fire fighting.

(c) Has a dilated retinal exam by a qualified ophthalmologist or optometrist that shows no higher grade of diabetic retinopathy than microaneurysms, as indicated on the International Clinical Diabetic Retinopathy Disease Severity Scale.

(d) Has normal renal function based on a calculated creatinine clearance greater than 60 mL/min and absence of proteinuria. (Creatinine clearance can be calculated by use of the Cockroft-Gault or similar formula. Proteinuria is defined as 24-hour urine excretion of greater than or equal to 300 mg protein or greater than or equal to 300 mg of albumin per gram of creatinine in a random sample.)

(e) Has no autonomic or peripheral neuropathy. (Peripheral neuropathy is determined by diminished ability to feel the vibration of a 128 cps tuning fork or the light touch of a 10-gram monofilament on the dorsum of the great toe proximal to the nail. Autonomic neuropathy might be determined by evidence of gastroparesis, postural hypotension, or abnormal tests of heart rate variability.)

(f) Has normal cardiac function without evidence of myocardial ischemia on cardiac stress testing (to at least 12 METS) by ECG and cardiac imaging.

(g) Has a signed statement from an endocrinologist knowledgeable in management of diabetes mellitus as well as the essential job tasks and hazards of fire fighting as described in 5.1.1 that the candidate meets the following criteria:

i. Is being successfully maintained on a regimen consistent with 6.18.1(1)(a) and 6.18.1(1)(b).

ii. Has achieved stable control of blood glucose as evidenced by Hemoglobin A1C consistently less than 8 when monitored at least twice yearly. This shall include evidence of a set schedule for blood glucose monitoring and a thorough review of data from such monitoring.

iii. Does not have an increased risk of hypoglycemia due to alcohol use or other predisposing factors.

iv.* Has had no episodes of severe hypoglycemia (defined as requiring assistance of another) in the preceding 1 year, with no more than one episode of severe hypoglycemia in the preceding 5 years.

v. Is certified not to have a medical contraindication to fire-fighting training and operations.

(2) Insulin-requiring Type 2 diabetes mellitus, unless a candidate meets all of the following criteria:

(a) Is maintained by a physician knowledgeable in current management of diabetes mellitus.

(b) Has demonstrated over a period of at least 3 months the motivation and understanding required to closely monitor and control capillary blood glucose levels through nutritional therapy and insulin administration. Assessment of this shall take into consideration the erratic meal schedules, sleep disruption, and high aerobic and anaerobic workloads intrinsic to fire fighting.

(c) Has a dilated retinal exam by a qualified ophthalmologist or optometrist that shows no higher grade of diabetic retinopathy than microaneurysms, as indicated on the International Clinical Diabetic Retinopathy Disease Severity Scale.

(d) Has normal renal function based on a calculated creatinine clearance greater than 60 mL/min and absence of proteinuria. (Creatinine clearance can be calculated by use of the Cockroft-Gault or similar formula. Proteinuria is defined as 24-hour urine excretion of greater than or equal to 300 mg protein or greater than or equal to 300 mg of albumin per gram of creatinine in a random sample.)

(e) Has no autonomic or peripheral neuropathy. (Peripheral neuropathy is determined by diminished ability to feel the vibration of a 128 cps tuning fork or the light touch of a 10-gram monofilament on the dorsum of the great toe proximal to the nail. Autonomic neuropathy can be determined by evidence of gastroparesis, postural hypotension, or abnormal tests of heart rate variability.)

(f) Has normal cardiac function without evidence of myocardial ischemia on cardiac stress testing (to at least 12 METS) by ECG and cardiac imaging.

(g) Has a signed statement from an endocrinologist knowledgeable in management of diabetes mellitus as well as the essential job tasks and hazards of fire fighting as described in 5.1.1 that the candidate meets the following criteria:

i. Is maintained on a stable insulin regimen and has demonstrated over a period of at least 3 months the motivation and understanding required to closely monitor and control capillary blood glucose levels despite varied activity schedules through nutritional therapy and insulin administration

ii. Has achieved stable control of blood glucose as evidenced by Hemoglobin A1C less than 8 when monitored at least twice yearly, which must include evidence of a set schedule for blood glucose monitoring and a thorough review of data from such monitoring

iii. Does not have an increased risk of hypoglycemia due to alcohol use or other predisposing factors

iv.* Has had no episodes of severe hypoglycemia (defined as requiring assistance of another) in the preceding 1 year, with no more than one episode of severe hypoglycemia in the preceding 5 years

v. Is certified not to have a medical contraindication to fire-fighting training and operations

(3) Any endocrine or metabolic condition that results in the candidate not being able to safely perform one or more of the essential job tasks

6.18.2 Category B medical conditions shall include the following:

(1)* Diseases of the adrenal gland, pituitary gland, parathyroid gland, or thyroid gland of clinical significance

(2) Nutritional deficiency diseases or other metabolic disorder

(3) Diabetes mellitus, not on insulin therapy, but controlled by diet, exercise, and/or oral hypoglycemic agents unless all of the following are met:

(a) Has achieved a stable blood glucose as evidenced by Hemoglobin A1C level less than 8 during the prior 3-month period.

(b) If on oral hypoglycemic agents, has had no episodes of severe hypoglycemia (defined as requiring assistance of another) in the preceding year.

(c) Has a dilated retinal exam by a qualified ophthalmologist or optometrist that shows no higher grade of diabetic retinopathy than microaneurysms, as indicated on the International Clinical Diabetic Retinopathy Disease Severity Scale.

(d) Has normal renal function based on a calculated creatinine clearance greater than 60 mL/min and absence of proteinuria. (Creatinine clearance can be calculated by use of the Cockroft-Gault or similar formula. Proteinuria is defined as 24-hour urine excretion of greater than or equal to 300 mg protein or greater than or equal to 300 mg of albumin per gram of creatinine in a random sample.)

(e) Has no autonomic or peripheral neuropathy. (Peripheral neuropathy is determined by diminished ability to feel the vibration of a 128 cps tuning fork or the light touch of a 10-gram monofilament on the dorsum of the great toe proximal to the nail. Autonomic neuropathy can be determined by evidence of gastroparesis, postural hypotension, or abnormal tests of heart rate variability.)

(f) Normal cardiac function without evidence of myocardial ischemia on cardiac stress testing (to at least 12 METS) by ECG and cardiac imaging.

6.19 Systemic Diseases and Miscellaneous Conditions.

6.19.1 Category A medical conditions shall include any systemic condition that results in the candidate not being able to safely perform one or more of the essential job tasks.

6.19.2 Category B medical conditions shall include the following:

(1) Connective tissue disease, such as dermatomyositis, systemic lupus erythematosus, scleroderma, and rheumatoid arthritis

(2)* History of thermal, chemical, or electrical burn injury with residual functional deficit

(3) Documented evidence of a predisposition to heat stress with recurrent episodes or resulting residual injury

6.20 Tumors and Malignant Diseases.

6.20.1 Category A medical conditions shall include the following:

(1) Malignant disease that is newly diagnosed, untreated, or currently being treated, or under active surveillance due to the increased risk for reoccurrence

(2) Any tumor or similar condition that results in the candidate not being able to safely perform one or more of the essential job tasks

6.20.2 Category B medical conditions shall be evaluated on the basis of an individual's current physical condition and on the staging and prognosis of the malignancy (i.e., likelihood that the disease will recur or progress), and include the following:

(1)* Benign tumors

(2)* History of CNS tumor or malignancy

(3)* History of head and neck malignancy

(4)* History of lung cancer

(5)* History of GI or GU malignancy

(6)* History of bone or soft tissue tumors or malignancies

(7)* History of hematological malignancy

6.21 Psychiatric Conditions.

6.21.1 Category A medical conditions shall include any psychiatric condition that results in the candidate not being able to safely perform one or more of the essential job tasks.

6.21.2 Category B medical conditions shall include the following:

(1) A history of psychiatric condition or substance abuse problem

(2) Requirement for medications that increase an individual's risk of heat stress, or other interference with the ability to safely perform essential job tasks

6.22 Chemicals, Drugs, and Medications.

6.22.1 Category A medical conditions shall include those that require chronic or frequent treatment with any of the following medications or classes of medications:

(1) Narcotics, including methadone

(2) Sedative-hypnotics

(3) Drugs that prolong prothrombin time, partial thromboplastin time, or international normalized ratio (INR)

(4) Beta-adrenergic blocking agents, high-dose diuretics, or central acting antihypertensive agents (e.g., clonidine)

(5) Respiratory medications: inhaled bronchodilators, inhaled corticosteroids, systemic corticosteroids, theophylline, and leukotriene receptor blockers/antagonists

(6) High-dose corticosteroids for chronic disease

(7) Anabolic steroids

(8) Any chemical, drug, or medication that results in the candidate not being able to safely perform one or more of the essential job tasks

6.22.1.1 Tobacco use shall be a Category A medical condition (where state law allows).

6.22.1.2 Evidence of illegal drug use detected through testing, conducted in accordance with Substance Abuse and Mental Health Service Administration (SAMHSA), shall be a Category A medical condition.

6.22.1.3 Evidence of clinical intoxication or a measured blood alcohol level that exceeds the legal definition of intoxication according to the AHJ at the time of medical evaluation shall be a Category A medical condition.

6.22.2* Category B medical conditions shall include the use of the following:

(1) Cardiovascular agents

(2) Stimulants

(3) Psychiatric medications

(4) Other than high-dose systemic corticosteroids

(5) Antihistamines

(6) Muscle relaxants

NEXT CHAPTER

[thecutman]

NFPA 1582 Chapter 8

8.2 Annual Fitness Evaluation.

8.2.1* A mandatory fitness evaluation that is not punitive or competitive shall be conducted annually as part of an individualized program.

8.2.1.1 All component results of the mandatory fitness evaluation shall be used to establish an individual's baseline or measured against the individual's previous assessments and not against any standard or norm.

8.2.2 The mandatory fitness evaluation shall include a mandatory pre-evaluation procedure and the components in 8.2.2.1 through 8.2.2.4. (For additional information, see Annex C.)

8.2.2.1 An evaluation of aerobic capacity shall be conducted using either a stairmill or a treadmill protocol. (See C.2.1.1.1 for the protocol.)

8.2.2.2 An evaluation of muscular strength shall be conducted using each of the following protocols:

(1) Grip strength evaluation (See C.2.1.1.2 for the protocol.)

(2) Leg strength evaluation (See C.2.1.1.3 for the protocol.)

(3) Arm strength evaluation (See C.2.1.1.4 for the protocol.)

8.2.2.3 An evaluation of muscular endurance shall be conducted using each of the following protocols:

(1) Push-up evaluation (See C.2.1.1.5 for the protocol.)

(2) Curl-up evaluation (See C.2.1.1.6 for the protocol.)

8.2.2.4 An evaluation of flexibility shall be conducted using the sit-and-reach protocol. (See C.2.1.1.7 for the protocol.)

[papacheese]

It should be pointed out that 1582 has TWO protocols...one being for the "candidate" (which is less forgiving), and another for an existing member, which focuses on rehabilitation and return to duty (depending of course on the severity of the condition).

[chief3102]

Again, I will say that until your fire district is ready and willing to spend the bucks necessary, we hand the candidate a physical form and they take it to their doctor who pretty much rubber stamps the damn thing. I know Pappa Cheese and his dept have a protocol where they send their candidates and existing to an occupational doctor, but too many Commission's/Fire Districts can't or won't find the dollars to do the same.

[rp42]

Like people have stated before in this, age is just a number. There are "older" guys that run circles around us younger guys. I think that if you pass a physical (which includes a stress test), pass a SCBA Confidence course, and feel that you can still preform, then yes you can stick around. I know some departments have an age limit of 65 to get out. I know I'll be retired 25 yrs by then, but if you can still perform 100% then you should have the option to stick around. If you don't meet the requirements, you can still stick around and pass "all the ticks of the trades" that you have learned to the new guys.