This administrative checklist was written to aid fire chiefs and organizations in identifying pertinent administrative processes prior to an on-duty or on-duty related event occurring. Often, without prior identification and planning, the lack of a standardized approach can present myriad roadblocks and can be a significant source of stress for both the employee and the organization.

The benefits to being proactive and putting in place thoughtful guiding documents (processes, policies, and procedures) are often tangible. All members of the organization will know the "rules of game," it will reduce stress throughout the process for all involved, it can and often will improve morale, and most importantly: members are more likely to speak up when experiencing an event or know some who is.

Below you will find a checklist which outlines pertinent points to identify, research, and potentially implement into your guiding documents related to the handling of cardiac events experienced by on-duty members.

Administrative Guidance and Process Checklist:

• Establish whether cardiac events are covered by presumptive legislation within your state/province.
• Discuss the handling of acute on-duty medical events with your organization’s Human Resources Department (if applicable) and/or your Bureau of Workers’ Compensation (BWC) Representative (if applicable).
  • Identify best-practices and recommended procedures throughout the region and state when handling these types of events.
  • Special focus should be made on identifying whether these types of events will be covered indefinitely by a member’s BWC claim, if the coverage is circumstantial, or if there is an exclusion on coverage for these types of events.
• Identify whether similar language is written, or similar events are covered in municipal handbooks/manuals and/or collective bargaining agreements (CBA).
  • If available, these documents should be incorporated into any guiding documents written by the department, and appropriately referenced.
• When writing your guiding documents, you want to plainly outline each step of the process and how it will be handled by the supervisors. The goal is to remain general enough to encompass many circumstances, while being specific enough as to not cause confusion. The organization, the supervisors, and the members should know what to do and what to expect from start to finish.
  • Outline the handling of an on-duty cardiac event from the time that a member begins experiencing the event all the way until they have a release decision by the treating physician.
• Things to consider when writing the procedure for handling a cardiac event are:
  • What notifications are to be made? (e.g. on-duty supervisor, transport agency, Fire Chief)
  • What treatments are to be rendered immediately? During transport?
  • Are you permitted by the law, your organization, and/or BWC to mandate a member experiencing signs and symptoms of an acute cardiac event to receive treatment and transport?
  • What type of leave status will the member be put on? Paid or unpaid?
  • What steps of the process will be covered by the organization and will the member have any fiduciary responsibility?
  • What approvals will be required for the member to return to duty?
  • If the member is unable to return immediately, or at all, to duty, does your organization allow and provide light-duty/restricted duty assignments?
  • Note: These are just some of the items that should be researched when developing and approving guiding documents. However, it is important to remember to only write documents that can be supported indefinitely by the organization and are not subject to change during the handling of an event.

Additional Items to Consider:

• If your organization does not perform BLS/ALS treatment and transport:
  • You must train your members to recognize the common signs and symptoms of an acute cardiac event.
  • You should identify the closest, most appropriate agency who will render care and transport in the instance a member of your organization experiences a cardiac event.
• Ensure that whatever guiding documents your organization put in place adhere to the law, BWC guidelines (if applicable), pertinent municipal and department manuals, and CBAs prior to implementation.
• Establish a culture change where if you don’t feel well or know a co-worker that does not feel well, your members feel empowered to say something immediately.
• Identify preventative measures to implement proactively into other departmental processes, policies, and procedures (e.g. mandatory fitness, NFPA 1582 compliant annual physicals, 1582 compliant physical fitness program, etc.).
• Ensure your organization has or institutes an NFPA 1584 - Standard on the Rehabilitation Process for Members During Emergency Operations and Training Exercises compliant rehabilitation process for after training exercises and incidents. This will ensure your member’s physiological vital signs are being monitored for the purposes of identifying or anticipating a cardiac event. 
• Encourage your members to research their family health history to help identify if they are at a higher risk for cardiovascular disease and/or sudden cardiac arrest.