Medical clearance exams have taken center stage in a number of discussions lately nationally, regionally and within individuals departments.
On the face of it, it seems like an easy issue — what department wouldn’t want their firefighters to be medically cleared to perform their job? Unfortunately, what seems like a simple questions isn’t as clear once we start looking at applications at the department level.
The question posed repeatedly is why more departments aren’t providing medical physicals to their firefighters. I have to wonder why more firefighters aren’t demanding them.
Fire and emergency services work has several inherent risks that are unavoidable. There are exposures to chemicals that can increase the risk for specific cancers, the physiologic strain of the fireground that increases risk for cardiac events, the interruption of circadian rhythms from middle of the night calls and risk of injury from physical exertion.
The list is long and growing based on recent research.
It only seems logical that if a community expects their fire and EMS personnel to risk their health for the sake of the community, they also owe it to those personnel to provide every protection they can against those risks.
Basic logic
I have been asked whether firefighters should be cleared by a doctor to participate in physical fitness training given the risks of putting your body under that much physical stress. My answer is, without a doubt, yes. We require medical clearance for middle school athletes, why wouldn’t we require it for personnel whose liability the department assumes?
There is a bigger question. If it is logical that medical clearance be required to let someone get on a treadmill at the fire station, how it is not logical to require a more stringent clearance before allowing them to go into a burning building loaded with more than 40 pound of gear, on air, in heat, with adrenaline rushing through their body?
So what are the barriers?
Some are very obvious — like cost. Medical exams are expensive and not every community can afford them. For some, this is more an issue of priority than it is funding.
For others, it truly is a lack of overall funding for the department. For these departments, there are options such as federal funding for physicals — FEMA’s Assistance to Firefighters Grant program for one funds annual medical exams.
For others, costs can be cut by partnering with other local departments or working with clinics that provide mobile services as a way to cut back on costs and the time required to travel to and from exams. Other departments have developed a plan for tiered exams with those highest at risk receiving their exams first and then phasing in exams for other firefighters as funding allows.
The right provider
There also is the challenge of finding providers who know what they are doing related to medical exams. Obviously, everyone’s first choice is an occupational medicine physician who is well versed in the risks of firefighting and is intimately familiar with the ins and outs of NFPA 1582.
Realistically, that is not an option for many departments that have to go with what they have in their community or the lowest bid they receive. Others rely on personal physicians who often are unaware of the unique physical demands of firefighting.
Not all departments know what they are looking for when it comes to finding a physician. The International Association of Fire Chiefs is one of the groups working toward developing resources for physicians who work with firefighters through a grant from FEMA’s Fire Prevention and Safety mechanism.
They also have developed a resource guide they will be updating for departments working toward relevant resources for medical clearance exams. Stay tuned for more progress on this front in the next year from IAFC and other organizations.
A bigger issue that is less popular in discussion is the fear that firefighters face in getting an exam. So many say they are afraid of being pulled off the line or having a health problem identified — typically one they would rather not know about so they don’t have to manage it.
My job is primarily sitting behind a desk writing or out in the field collecting data. If I have a medical issue that causes me a heart attack, aside from being heartbroken at my pain, my colleagues’ biggest risk is tripping as they grab their cell phones to call 911 (which hopefully they would do).
Shared risk
I would argue that agreeing to be a firefighter also means giving up some freedom to take personal health risks. When I first started research in firefighter health, a firefighter named Steve Mast was discussing the importance of health research with me.
“I get it,” he said. “It’s important because when we hit the fireground, your risk factors become my risk.”
Most jobs don’t include shared risk factors. You can make your own health choices and they arguable affect primarily you — and, by extension, your family. But it does not increase risk in the lives of the people who depend on you.
Medical exams don’t just protect the firefighter; they protect the entire crew. Firefighters should expect them for themselves and for the people they have to depend on in life-threatening situations.
The bottom line is that relevant medical exams are effective. They provide a way to monitor health across time, can catch diseases before they progress, and can be the perfect teachable moment for prevention.
In our studies, we found that most physicians do not intervene with firefighters on their weight, but when they did, firefighters were significantly more likely to change their behaviors and improve their health.
Ultimately, medical exams should not be something departments force on their firefighters. Firefighters should expect them as a minimum service from their departments.
