Addressing the Need for Annual Occupational Medical Exams and Fitness Evaluations for All Firefighters 

The International Association of Fire Chiefs (IAFC) adopts a position of support for the implementation of annual medical examinations and fitness evaluations for all firefighters.

 Problem Statement
It is a significant historical fact that annually, nearly half of all firefighter fatalities occur as a result of medical emergencies. The United States Fire Administration’s report, Firefighter Fatalities in the United States in 2010, released in September 2011 analyzes eighty-seven firefighter fatalities for that calendar year. Fifty-five, or 63.2 percent, of those fatalities are categorized as “stress or overexertion.” Fifty occurred as a result of heart attacks and five resulted from cerebrovascular accidents (CVA) or strokes. The severe physical nature of our work and the harsh environmental conditions under which firefighters must perform their duties dramatically increases our susceptibility to stress and overexertion.

Many of these deaths have the substantial potential to be avoided through early detection of underlying medical conditions by participation in an annual routine medical examination which includes commonplace non-invasive medical testing. According to the Mayo Clinic, even for the general population that does not work under our conditions, “ideally, your doctor should screen you during regular physical exams for risk factors that can lead to a heart attack.”

The National Fire Protection Association (NFPA) 1582, Standard on Occupational Medical Programs for Fire Departments, 2007 edition § 7.1.2 states “Occupational medical evaluations shall be conducted as a baseline for surveillance and annually thereafter.”

The NFPA standard lists eight purposes for the annual medical evaluation:

1. Identifying conditions that interfere with a member’s physical or mental ability to safely perform essential job tasks without undue risk or harm to self or others.
2. Monitoring the effects of exposure to specific biological, physical and chemical agents on individual members.
3. Detecting changes in a member’s health that can be related to harmful working conditions.
4. Detecting patterns of disease or injury occurrences in the workforce that could indicate underlying work-related problems.
5. Providing members with information about their current health, promoting wellness, and referring them for appropriate further evaluation and treatment.
6. Providing members with information and education about occupational hazards.
7. Providing a cost-effective investment in work-related disease prevention, early detection, and health promotion for members.
8. Complying with federal, state, provincial, local and/or other jurisdictional requirements.

Therefore, in order to directly impact preventable line of duty deaths and injuries, it is the position of the IAFC that every individual who responds to emergency calls for service must receive an annual medical examination at no cost to the individual, which is in compliance with NFPA 1582.

Further, each organization establish, and each individual who responds to emergency calls for service undergo, a non-punitive fitness evaluation as a complimentary program to the medical examination initiative under the guidance and for the purposes as stated in NFPA 1582 to ensure the ongoing health and wellness of all members. This also shall be at no cost to the individual.

Desired Actions
To create a national legislative or regulatory initiative requiring all fire departments to retain proof of an annual medical examination (as defined in NFPA 1582) for all individuals who respond to emergency calls for service. Further, that such proof of examinations be retained at the local level as they can be subject to investigation in the event of a significant line-of-duty injury or line-of-duty death.

To create action and policy through the Federal Emergency Management Agency (FEMA) to add language into the review and grading criteria for Assistance to Firefighters grants awarding bonus points to organizations who can demonstrate compliance with the proposed annual medical examination (as defined in NFPA 1582) requirement. Departments that are unable to demonstrate compliance shall be provided with guidance to receive a grant to establish an NFPA 1582-compliant medical examination program through FEMA.

Finally, all fire departments develop and maintain an associated non-punitive annual fitness evaluation program to complement the medical exam initiative. This shall be at no cost to the individual.

Impact
The impact of this initiative is to substantially reduce the number of preventable line-of-duty injuries and deaths within the fire service as a result of medical emergencies, and to provide an annual fitness evaluation as a complementary tool to ensure firefighter health and safety. This initiative will have the combined critical effect of enhancing public safety, improving emergency responder safety, and reduce the devastating impact of a line-of-duty death or permanent disabling injury on the families of emergency responders.

Coordination
This initiative will require support and coordination from all levels of government: federal, state, local, provincial, tribal and others. Further, coordination and cooperation will be needed from all major national fire service organizations such as the IAFC, IAFF, NVFC, CFSI, and others to ensure success. Given the primacy of ensuring the safety of emergency responders, we are confident that federal political leaders will support this initiative with the necessary funding to produce the intended results.

This position statement supports the National Fallen Firefighters Foundation’s Life Safety Initiative #6, mutually developed and agreed upon by all North American fire service organizations and associations. 

SUBMITTED BY: IAFC Safety, Health and Survival Section
ADOPTED BY: IAFC Board of Directors on July 31, 2012