This directive gave the fire service until Sept. 15, 1990 to be fully in compliance. As early as 1980, OSHA recognized the fire service as one of the most dangerous professions in the United States. With this recognized, OSHA acknowledged that sudden cardiac death was the leading cause of death in the fire service.
There have been over 50 deaths per year for the last 10 years in the fire service. Those deaths did not confine themselves to any specific age group or to any specific cardiovascular problem whether it is artery disease or other electrical activity problems. NFPA has recognized this also with their recommendation 1582 where they have dropped all health screening age recommendations.
The fire service spends (plus or minus) $250,000 for a fire truck and over $8000 per firefighter for air packs, turnout gear and communication, but is reticent to spend the necessary funds to health screen the firefighter even though there is a specific OSHA regulation requiring the physician’s certificate. If the firefighter is not physically capable, all of this equipment is not going to save him from a coronary event. It has been 28 years since OSHA 1910.156 came in being as a directive, not a recommendation.
A financially feasible medical screening program designed not according to age, firefighter history or a family history should be designed according to a firefighter’s job description. Taken into consideration is the fact a firefighter puts on 60-plus pounds of gear to go into a fire situation. Every firefighter should be screened for coronary artery disease as well as other coronary arrhythmias. An EKG and blood pressure monitored graded exercise test should be a standard screening tool until such time as a more comprehensive economically feasible test is found.
Credentialing of the technicians performing the tests becomes mandatory and protocol during testing must be absolutely maintained. Even with the most exact standards, test results are not 100 percent accurate. The very best that can be obtained with non-invasive testing is approximately 80 percent accuracy. With the cardiovascular testing that is available to us today, testing the heart muscle under load, the graded exercise EKG monitored test is the only non-invasive, financially feasible test available.
Will there be better and more accurate tests in the future? Absolutely! But, we have to use the tests that are available with individuals that are credentialed and trained to perform those tests. These individuals must understand the structural fire service and its job descriptions.
With the above in mind, a health-screening program must possess the following components to identify those firefighters who have been exposed and those to be referred for further work up.
The following program has been shown to be an effective health screening program:
- Health history questionnaire for the individual and family
- A 25-item blood panel, which includes thyroid levels, liver and kidney levels with all cholesterols. This blood work must be used for possible chemical exposure
- Body Composition measurements with body fat percentages
- Resting 12-lead electrocardiogram with resting blood pressure
- A 12-lead graded exercise test, blood pressure monitored with aerobic capacity results
- Visual acuity, color and peripheral vision tests
- At least a tuning fork hearing screening or a hearing booth audiogram
- A complete results packet for each participant and a review of each participants’ test results
This program would be a minimum program to which other health screening items could be added. By no means is this the only acceptable health enhancement program, but the above listed should be included in all health screening programs.
In conclusion, OSHA has dictated to the structural fire service that each firefighter be physically capable of performing duties assigned in emergency activities. A health screening program is mandatory to meet the requirements under 1910.156, 1910.134 and 1910.120. Monies must be made available for health screening just as monies are made available for turn out gear and fire trucks.
The fire service must provide for the health of its firefighters.
Charles F. Turner, R.N. is President/Director and founder of North Greenville Fitness and Cardiac Rehabilitation Clinic. He’s a graduate of Furman University with a B.S. in Business Administration. He received is RN certification at Greenville Technical College, Cardiac Certification from Colorado State University and the Medical University of South Carolina. Since 1979 he has performed over 120,000 Stress Tests and Health Screenings. He can be reached at 888-348-8911.