In my passion for law and medicine as a practitioner of both professions, I often see individuals injured on the job arriving in my medical clinic for a return to work evaluation, most notably firefighters. Many times they are accompanied with the instructions from the department to use NFPA 1582 as the medical standard for the injured firefighters return to work. I will tell you in my humble opinion, this is not the standard to use for the reasons to follow.
NFPA 1582 is an entry level standard for use by medical professionals to screen your new firefighter candidates if adopted by your jurisdiction as the standard. For entry level candidates there are numerous medical conditions that will prevent their hiring in your department ranging from heart disease, endocrine problems, respiratory compromise and similar medical conditions. A department and their medical providers, need to become well versed (almost at an expert level) as to the medical conditions that will preclude a candidate from the hiring process.
Possible discrimination - As our firefighter’s age, they will develop numerous medical conditions that may inhibit their performance on the fire ground and possibly create health and safety problems for them and their partner firefighters. Using the NFPA 1582 standard to judge their medical fitness can be interpreted as a form of discrimination against the affected firefighter. A quick explanation for this is found under the American With Disabilities Act of 1990 (ADA) prohibiting discrimination and ensures equal opportunity for persons with disabilities in employment, State and local government services, public accommodations, commercial facilities, and transportation including your fire department. An example is a firefighter with a heart condition, causing chest pain goes to the hospital. While in the cardiac cath lab, they finds a blockage in a coronary artery necessitating the placement of a stent. After rehabilitation and clearance from her cardiologist, returns to work whereas she is terminated from employment as the Chief is using the NFPA 1582 standard (6.9 Heart and Vascular System. 6.9.1 Heart. 18.104.22.168 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) as the return to work standard. There are hundreds of similar cases in all of the employment world where some similar reasoning preventing healthy individuals from returning to work under a pretext of their health conditions. A better return to work standard is to use the department’s current job description, job analysis (JA) and essential elements of the job as a guideline for a successful return to work evaluating what you actually do while on the job and not using an entry level standard.
Existing Firefighters - This is where the Shift Officer or Training Division becomes an important dynamic in determining the first observations of a firefighter’s health based on performance. It is my learned opinion that the Shift Officer and Training Division evaluates, teaching and trains firefighters more than other officers in your department. You observe their ability to work at high levels of performance and can determine if a firefighter is poorly conditioned, de-conditioned or in general, is a hazard to himself/herself and others. These are the ones that should be identified as high risk and sent for medical evaluations (for medical and not punitive reasons) using your departments specific Job Analysis. Remember, as we age your existing long term firefighters show signs of a critical medical condition that may be life threatening at some point in their career. In addressing this issue, I highly recommend that your department have an annual or bi-annual medical/physical examination program in place for all firefighters and possibly a for-cause medical testing for firefighters showing signs of a condition preventing them from working at 100% of capacity, understanding that almost 50% of firefighter deaths are caused by a preventable disease such as heart disease, cardiac arrest and increasingly cancers. Using your department’s job description, job analysis and essential elements of the job is the foundation for continuing medical evaluations and abilities testing. There are defined processes available to determine the fitness of your established firefighters using a medical physical and a physical capacities test based on your work environment.
For those firefighters with a possible critical medical condition (hypertension, high cholesterol, coronary artery disease or diabetes to name a few) discovered in the physical, the department must have a policy and program to allow the firefighter to find a medical solution to the discovered medical issue. You have invested thousands of dollars in their training and experience over many years of service to the department, and it is incumbent on the department to evaluate their firefighter’s current medical status in order for them to remain as productive members of your department.
At a minimum, a periodic medical standard should include: basic questions about current health history, current immunizations with the addition of specific blood work to include liver function, cholesterol, blood glucose level, a CBC (complete blood count), your immunity to Hepatitis B, chest x-ray or PPD, hearing testing, pulmonary function testing, mask fit testing and other testing as determined by your health care provider based on your job description or job analysis. For male firefighters a PSA to detect possible prostate cancer. There are a number of blood tests to detect certain cancers however those tests have some false positive results. They should be used judiciously by your health care provider during the physical examination. It is developing technology that will make our firefighters healthier. For those of you on the Haz/Mat team, include baseline testing for the most common heavy metals to include lead, mercury, arsenic, cadmium, copper and zinc. All firefighters should be examined for developing skin or throat cancers. These tests are closely correlated with your job description, job analysis and essential functions of the job. What is very important, is the resting EKG and stress treadmill testing to ensure cardiovascular health and the results evaluated by a cardiologist.
Injured Firefighters – Return to work independent medical examinations (IME) - As stated in the opening of this article, using the NFPA 1582 as a return-to-work standard is the wrong standard to utilize when returning an injured or disabled firefighter to work. The NFPA 1582 guidelines have been designed as an entry level standard for firefighters and there are certain medical elements contained within that document that would disqualify an injured firefighter (or some existing firefighter if tested) seeking to return to work. My suggestion is to have an IME predicated on the actual functions of the job performed by a qualified physician. For example a firefighter out with a rotator cuff repair, an orthopedist should perform the IME using the essential functions of the job and a job analysis. There are a number of firefighters successfully returning to work after a heart attack, rotator cuff repair, spinal disk repair, hip or knee replacement surgery and other medical conditions.
Finally - As an attorney and health care practitioner, I have toss in this little nugget - you may have to make reasonable accommodations under the ADA rules and regulation for firefighters that cannot pass the medical/physical or physical ability test. Under the law (eeoc.gov), Title I of the ADA requires an employer to provide reasonable accommodation to qualified individuals with disabilities who are employees or applicants for employment, except when such accommodation would cause an undue hardship on the employer. As this is a complex issue, I suggest employers look at the EEOC website and discuss this issue with your HR director and the department’s attorney for guidance.
John K. Murphy JD, MS. PA-C, EFO, Deputy Fire Chief (Ret), has been a member of the career fire service since 1974, beginning his career as a firefighter & paramedic and retiring in 2007 as a deputy fire chief and chief training officer. He is a licensed attorney in Washington State since 2002 and in New York since 2011 and active as a Physicians Assistant with an Occupational Health center in Seattle. He serves as an expert witness involving fire department litigation and has been involved in numerous cases across the country. He is a frequent Legal contributor to Fire Engineering Magazine, participant in Fire Service Court Blog Radio and a national speaker on fire service legal issues. He is a contributing author to Fire Engineering and serves as legal counsel for ISFSI.