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Item C23
IL44 DO 9 DAV V ICK Meeting Date: September 17, 2014 Division: Employee Services Bulk Item: X No Department: Human Resources Staff Contact /Phone #: Pam Pumar X4459 AGENDA ITEM WORDING: Approval to Amend contract with New Truman Medical to provide testing for Nicotine products. ITEM BACKGROUND: On May 1, 2014, the BOCC approved to implement a no hire tobacco user policy for those hired on or after January 1, 2015, in addition to a non -tobacco use policy for Health Plan participants who are newly enrolled on or after January 1, 2015. PREVIOUS RELEVANT BOCC ACTION: The BOCC approved the original contract on March 19, 2014. CONTRACT/AGREEMENT CHANGES: Amend to include testing for nicotine products and to correct facility address that is reflected in Scope of Services. 1-32twelal-0- III, I I I -------------- 200 . INDIRECTCOST: BUDGETED: Yes X No 113 1 W 01 of I., 1 *2 t"_ t2 to x COST TO COUNTY:— N/A SOURCE OF FUNDS: Ad Valorem jj!��Ipjiii 112,11115111•1 1 Qi:1ffWff,%kTj mek, APPROVED BY: County Atty /&B/Pu kcasing _ Risk Management DOCUMENTATION: Included X Not Required DISPOSITION: AGENDA ITEM if�' Revised 7/09 CONTRACT SUMMARY Contract # Contract with: New Truman Medical Effective Date: September 17, 2014 Expiration Date: Contract Purpose/Description: Contract amendment to include Nicotine Testing and correct physician facility testing address. Contract Manager: Pam Pumar 4459 Human Resources (Name) (Ext.) (Department) for BOCC meeting on §SpL=17.20 14 Agenda Deadline: Sept 2, 2014 CONTRACT COSTS Total Dollar Value of Contract: Approx $700 yr Current Year Portion: $0 Budgeted? Yes X No Account Codes: 001-06500-510-316- Grant: $ County Match: $ ADDITIONAL COSTS Estimated Ongoing Costs: $__jyr For: (Not included in dollar value above) (eg. maintenance, utilities, jan't2rial, salaries, etc.) 'WHITICTIM1.11MI ... ... ... ... . Changes Date Out Date In Needed Reviewer Division Director 46RU2 Yes[:]Noo Risk Management i Yeso N& O.M.B./Purchasing Yes[:] NoEil -00 County Attorney "Lq Yes[:] Comments: L)Adb corm t(evisea q/ i iig-*) mup #2 This is an amendment ("Amendment") dated — is entered into by and between Monroe County ("County") and New Truman Medical. ("Contractor"). County WHEREAS, the • Contractor entered into _ Contract for • • Physical Services ("Agreement") on March 19, 2014, whereby New Truman Medical agreed to furnish employment physical services; and i WHEREAS, the incorrect facility address is reflected in Section 1. Scope of Services of - currentcontract;and WHEREAS, it is now necessary to amend the contract to include testing for nicotine • • NOW THEREFORE, in consideration of the mutual covenants contained herein the parties agree to amend the Agreement as follows: 1. Section 1. Scope of Services of the agreement is revised to reflect that the employee will be tested at the physician's facility located at 540 Truman Ave., Key West, FL 33040. 2. Section One, ••' of Services, of -- • to include ees for testing of nicotine as follows: SERVICE FEE Urine Testing for When requested, a $40.00 per test Nicotine nicotine test will be performed by the physician and will be either scheduled or done on a walk-in basis. 3. All other terms and conditions of the Agreement remain in full force and effect. IN WITNESS WHEREOF, the parties hereto have caused this Amendment to be executed the day and year first above written. (SEAL) Attest: Amy Heavilin, Clerk ?379W 7-#T-Trm� �A) Attest: M Print Name Title Mayor/Chairman New Truman Medical AGREEMENT EMPLOYMENT PHYSICAL SERVICES SECTION ONE - Scope of Services SECTION TWO - County Forms and Insurance Forms ATTACHMENTS: A. POst-offer and Fit for Duty Physical Forms (4 pages) B. DOT Physical (9 pages) C. Respirator Physical "Part I " (4 pages) Respirator Physical "Part 111, (5 pages) Respirator Policy,,111,, (12 pages) D. NFPA Guidelines 2000 Edition — Firefighter Physical (49 page.1 MONROE COUNTY CONTRACTIFOR EMPLOYMENT PHYSICAL SERVICEI • • � !• .rr 1 = 1 t' • •R shall •• • s • • professional • proper • - described - Scope of One -• hereto anI •' r. • agreement. 7 • The employee will be tested at the physician's facility located at 1446 Kennedy Drive, Key West. H. Appointments will be seen by the contractor in a reasonable and timely y I The Contractor will provide the County with at least a 24 — 48 hour turnaround time for the receipt of any drug and/or physical results. J. The Medical Review Officer will be available for contact by the Monroe County BOCC or its employees to answer questions about the effect of prescribed drugs. Part of the requirements set forth by the State of Florida drug free workplace policy, which Monroe County has adopted, and the Department of Transportation, the County must have a qualified Medical Review Officer "MRO° perform drug screening services. The MRO receives lab reports from the laboratory (as governed by regulations); Reviews lab reports for integrity, authenticity, false negatives, and false positives; interprets lab results, including verification of lab positives; reports lab reports to the employer (as defined by rules and regulations). K. The personnel shall not be employees of or have any contractual relationship With the County. To the extent that Contractor uses subcontractors or independent contractors, this Agreement specifically requires that subcontractors and independent contractors shall not be an employee of or have any contractual relationship with County. L. All personnel engaged in performing services under this Agreement shall b qualified, and, if required, to be authorized or permitted under State and local lawfully to perform such services. Section 2. QUALIFICATIONS NECESSARY OF CONTRACTOR The CONTRACTOR must certify at least annually that all staff members, independent contractors, subcontracted work, if any, all service providers it uses, engages or ma comply with Health Insurance Portability and Accountability Act HIPA security rules. Wages, f A) privacy and Physical examinations will be conducted by, or under the direct supervision of physician or medical doctor currently licensed and practicing a State of Florida. The examining9 general medicine in the trained, as necessary, to perforpabora laboratory tests anmay d/or ooy rass stun properly licensed and examination. all phases of the Section 3. COUNTY'S RESPONSIBILITIES 3.1 Provide all best available information as to the COUNTY'S requirements f Scope of Services described in Section One to this Agreement. or the 3.2 Designate in writing a person with authority to act on the COUNTY°S behalf concerning said services. on all matters Section 4. TERM OF AGREEMENT 4.1 The term of this contract will be for one automatically renew for successive one year terms unless and until either art year beginning March 19, 2014 and shall 1 other notice of cancellations in accordance with the terms set forth in Section 7 gives the Sectioni Compensation to CONTRACTOR is outlined in the Scope of Services — Section One. • CONTRACTOR _ on 6. PAYMENT 6.1 Payment will be made according to the Florida Local Government Prompt Payment Act. be form satisfactory to Any request for payment must the Clerk of Courts for Monroe County (Clerk). The request must describe in detail the services performed and the payment amount requested. The CONTRACTORf •ices to the appropriate offices markedHuman Resources. on the request and forward it to the Clerk for payment. Administrator of Human Resources, who will review the request, note his/her approval County Board of County commissioners. Section T. CONTRACT TERMINATION obligations under the Agreement. Either• . rty may terminate this Agreement without cause upon sixty (60) days' notice to other party• • . nce with Section 9 of this Agreement. The County shall pay CONTRACTOR for all work performed •I • • _ oftermination. Section •' •ACCEPTANCE OF • • NS A. CONTRACTOR hereby agrees that he has carefully examined the RFP, his response, and this Agreement and has made a determination that he/she has the personnel, equipment, and other requirements suitable to perform this work and assumes full responsibility therefore. The provisions of the Agreement shall control any inconsistent provisions contained in the specifications. All specifications have been read and carefully considered by CONTRACTOR, who understands the same and agrees to their sufficiency for the work tbeto bmoredone. stronglyUnder construed against circumstances, contions, or COUNTY than ituaons against shall this Agreement CONTRACTOR, B. Any ambiguity or uncertainty in the specifications shall be interpreted and construed by COUNTY, and its decision shall be final and binding upon all parties. C. The passing, approval, and/or acceptance by COUNTY of any of the services furnished by CONTRACTOR shall not operate as a waiver by COUNTY of strict compliance with the terms of this Agreement, and specifications covering the services. D. CONTRACTOR agrees that County Administrator or his designated representatives may visit CONTRACTOR'S facility (ies) periodically to conduct random evaluations of services during CONTRACTOR'S normal business hours. E. CONTRACTOR has, and shall maintain throughout the term of this Agreement, appropriate licenses and approvals required to conduct its business, and that it will at all times conduct its business activities in a reputable manner. Proof of such licenses and approvals shall be submitted to COUNTY upon request. F. Pursuant to Florida Statute §119.0701, Contractor and its subcontractors shall comply with all public records laws of the State of Florida, specifically to i. Keep and maintain public records that ordinarily and necessarily would be required by Monroe County in the performance of this Agreement. ii ii. Provide the public with access to public records Countyconditions that Monroe • • Provide nd at a cost • • . .-• . that does not exceed the or as otherwise Provided by law. Ill. Ensure that public records that are mpt •, a Statutes, Chapter 119 • ' • • = - requirementsrecords disclosure authorized by law. to Monroe iv. Meet all requirements for :i • • • • and transfer, at n co t, recordsCounty all Public Possession termination of this Agreement and destroyduplicate Public records that are exempt or confidential and • - exempt •' • s'recordsdisclosure electronically. All records stored Monroe County in a format that is be provided t• compatible technology systems of • •: County. ResourcesTo the COUNTY: Human • _ 1100 Simonton Key West, Florida 33040 To the CONTRACTOR: New Truman Medical 540 Truman Avenue Key West, FL 33040 Section 10. RECORDS CONTRACTOR shall maintain all books, records, and documents direct) performance under this Agreement in accordance with generally accepted accounting principles consistently applied, Each a Y Pertinent tc party to this Agreement or their authorized representaties shall have reasonable and timely access to such records of each other party to this A public records purposes during the term of the agreement and for four years following Agreement for termination of this Agreement. If an auditor employed by the COUNTY or Clerk determines the monies paid to CONTRACTOR pursuant to this Agreement were spent far purposes that authorized by this Agreement, the CONTRACTOR shall repay the monies together pwposes not calculated pursuant to Section 55.03 of the Florida Statutes, running from the date t with Interest were paid to CONTRACTOR. he monies Section 11. EMPLOYEES SUBJECT TO COUNTY ORDINANCE NOS. 010 AND 0 . 20 1990 The CONTRACTOR warrants that it has not employed, retained or otherwise had act on its behalf any former County officer or employee subject to the prohibition of Section 2 of W of Sectionof Ordinancenty officer or employee in vioiation Cou or No. i 0• • • provision discretion.Ordinance No. 020-1990. For breach and may also, in its discretion, deduct from terminate this agreementcommission, _ *ver the ull amountof percentage,the agreement or purchase price, or otherwise r, CONVICTEDSection 12. • '' A person or affiliate who has been placed on • d vendor list following a conviction for • - submite may not • • •an Agreement with a public entity • public building r public work,rform work as a public CONTRACTOR,construction or repair of a supplier, subcontractor, • CONTRACTORexc•' the _ lamount public entity in transactentity, and may not of Florida Statutes,• r the Category Two for a period of 39- months from the provided in Section 287-017 date •. being placed on Zection 13. GOVERNING LAW, VENUE, INTERPRETATION, COSTS AND FEES ad. by aand construed in accordance with the laws of the State of • - ; 3 • • instituteda ea Florida applicable to Agreements ma e a dministrative proceeding is for actionIn the event that any cause of it • CONTRACTORagree • • - • • •Areementadministrative the body in Monroe County,enforcement venue shall lie in the appropriate court or before the appropriate r. Section 14. SEVERABILITY If any term, covenant, condition or provision of this Agreement (or the application thereof to any circumstance or person) shall be declared invalid or unenforceable conditions any tentproviy a cof rths Of competent jurisdiction, the remaining terms, covenants, Agreement, shall not be affected thereby; and each remaining able to the fullest covenant, condition nd provision of this Agreement shall be valid and shall be enforceableand by law unless the enforcement of the remaining terms, covenants intent ditions of this s Agreement provisions of this Agreement would prevent the accomplishment o the original The COUNTY and CONTRACTOR agree to reform the Agreementreplace stricken strp ®v siorovision with a valid provision that comes as close as possible to the intent of theSection 15. ATTORNEY'S FEES AND COSTS The COUNTY and CONTRACTOR agree that in the tave Loathe enforcemencause of 1on or t or interpretation ,ve of proceeding is initiated or defended by any party relative and court this Agreement, the prevailing party shall be entitled to r ason bin attor edingees, and and costs, as an award against the non -prevailing party. conducted pursuant to this Agreement shall be u in accordance required by with the theFlorida Court r'Rules of Monroe Procedure and usual and customary procedures req County. The terms, Covenants, •c _ • • • • r • -- ment shall bind and inure to - successors,legal representatives, r COUNTY and CONTRACTOR . respective Each party represents and warrants to the other that the execution, delivery and performance this Agreement have been duly authorized by all necessary County and corporate action, of required by law. on, as Section 18. ADJUDICATION OF DISPUTES OR DISAGREEMENTS COUNTY and CONTRACTOR agree that all disputes and disagreements shall be attempted be resolved by meet and confer sessions between representatives of each of the Parties. t to issue or issues are still not resolved to the satisfaction of the parties, then any a shall the right to seek such relief or remedy as may be provided by this Agreement p If the This Agreement shall not be subject to arbitration. p I have 9 ment or by Florida law. Section 19. COOPERATION In the event any administrative or legal proceeding is instituted against either party relating to the formation, execution, performance, or breach of this Agreement, COUNTY CONTRACTOR agree to participate, to the extent required by the other a and proceedings, hearings, processes, meetings, and other activities related to the substance oin al f thisl Agreement or provision of the services under this Agreement. COUNTY and CONTRAC specifically agree that no party to this Agreement shall be required to enter into an arbitration proceedings related to this Agreement. Y ron Section 20. • - • COUNTY and CONTRACTOR agree that there will be no discrimination against an and it is expressly understood that upon a determination by a court of competent jurisdiction discrimination has occurred, this Agreement automatically terminates without an Y person, tion on the part of an that Y party, effective the date of the court order. The parties agree to complyCwith all Federal and Florida statutes, and all local ordinances, as applicable, relating nondiscrimination. These include but are not limited to: 1) Title V!I of the Civil Rights Ac 1964 (PL 88-352) which prohibits discrimination in employment on the basis to national origin; 2) Title iX of the Education Amendment of 1972, as amended g t of 1683, and 1685-1686), which prohibits discrimination on the basis srs of race, color, Rehabilitation Act of 1973, as amended (20 USC S. 794 which(20 USC ss. 1681- of sex; di Section 504 of the basis of handicaps: 4) The Age Discrimination Act of 1975, as amended (42 USC ss. on the 6107) which prohibits discrimination on the basis of age; 5) The Drugs 6101- Treatment Act of 1972 (PL 29-255), as amended, relating to nondiscrimination on the drug abuse; 6) The Comprehensive Alcohol Abuse and Alcoholism Abuse Office and Rehabilitation Act of 1970 (PL 91-616), as amended, relating to nondiscri • basis of rsm Prevention, Treatment and of alcohol abuse or alcoholism; 7) The Public Health Service Act of 1912, ss. 523 an USC ss. 690dd-3 and 290ee-3) as amended, relating to confidentiality nondiscrimination on the basis abuse patient records; 8) Title Vill of the Civil Rights Act of 1968 42 US d 527 (42 dentiality of alcohol and drug amended, relating to nondiscrimination in the sale, rental or financing of housin • g Americans with Disabilities Act of 1990 42 USC ( C ss. 3601 et seq.), as time, relating to nondiscrimination on the basis of disability; 10) Monroebe Co amended from time to r County Code Chapter 7 13, Article VI, which prohibits discrimination on the basis of race, color, sex, religion, national 11) gender •- or expression,or _.eand origin, ancestry, sexual orientation, any other nondiscrimination provisions in any Federal or state statutes which may apply to the parties to, or the subject matterof, Agreement. COUNTY and CONTRACTOR covenant that neither presenOy has any interest, and shall not acquire any interest, which would conflict in any manner or degree with its performance under this Agreement, and that only interest of each is to perform and receive benefits as recited in this • eement. Section 22. CODEOF officersCOUNTY agrees that s employees of ' COUNTY recognizeand will be required to comply with the standards of conduct for public officers and employees as delineated in Section 112.313, Florida Statutes, regarding, but not limited to, solicitation or acceptance of gifts; doing business with one's agency; unauthorized compensation; misuse of public position, • • Sectionemployment or contractual relationship; and disclosure or use of certain information. O• • '; • The COUNTY and CONTRACTOR warrant that, in respect to itself, it has neither employed nor retained any pany bona fide employee working solely for it, to solicit Agreement • - • .. that it has • •.'.d• or f ed to •.anyperson,company, or secure this corporation, individual, or firm, other than a bona fide employee working solely for it, any fee, commission, percentage, gift, or otherconsideration contingent upon or resulting from the award or making of this Agreement. For the breach or violation of the provision, the CONTRACTOR agrees ll its discretion, to offset from ht to terminate this Agreement without liability and, at •I — • _• •I • _ recover, _ll amountcommission, percentage, gift, or consideration. COUNTYandCONTRACTORshall allowand permit reasonable•andinspection The of, all documents, papers, letters or other materials in its possession or under its control subject to the provisions of Chapter 119, Florida Statutes, and made or received by the COUNTY and CONTRACTOR conjunction Agreement; and COUNTYshallright to unilaterally cancel this Agreement upon violation of this provision by CONTRACTOR. Notwithstanding the provisions of Sec. 768.28. Florida Statutes, the participation of the COUNTY and the CONTRACTOR in this Agreement and the acquisition of any commercial liability insurance coverage, self-insurance coverage, or local government liability insurance pool coverage shall not be deemed a waiver of immunity to the extent of liability coverage, nor shall any Agreement entered into by the COUNTY be required to contain any provision for waiver. All of the privileges and immunities from liability, exemptions from laws, ordinances, and rules and pensions and relief, disability, workers, compensation, and other bens activity of officers, agents, or employees of an when performing their respective functions under this Agreement benefits which apply to the y public agents n employees of the COUNTY, the COUNTY shall apply to the same degree and extent to the performance ctions and duties of such officers, agents, volunteers ®r g Bement within the territorial limits of COUNTY. employees Outside he territorial limitsofthe Section 27. LEGAL OBLIGATIONS AND RESPONSIBILITIES Non -Delegation of Constitutional or Statutory ry Duties. This Agreement is not intended to, nor shall it be construed as, relievin imposed upon the entity by law except to the extent of actual and timely Y participating entity from any obligation or responsibility any participating entity, in which case the performance may be offered in obligation or responsibility. Further, this Agreement is no performance thereof by as, authorizing the delegation of the constitutional or statutorydutiessatisfaction of the the extent permitted el the Florida constitution t intendedto, of the COUNTY, except to to, nor shall it be construed state statute, and case law. Section 28. NON -RELIANCE BY NON-PARTIES No person or entity shall be entitled to rely upon the terms, or any of the enforce or attempt to enforce any third -party Program contemplated hereunder, and the COUNTY and the CO m, of this Agreement to p rty claim or entitlement to or benefit of any service or the COUNTY nor the CONTRACTOR or any agent, officer, or employee authority to inform, counsel, or otherwise indicate that CONTRACTOR agree that neither individuals, entity or entities, have entitlements or benefits underof either shall have the a inferior tit or superior to the entitlements in any particular individual or group tof o part, this Agreement separate and this Agreement.community general or for the purposes contemplated in Section 29. ATTESTATIONS CONTRACTOR agrees to execute such documents as the COUNTY including, but not being limited to, a Public Entity Crime Statement a Drug -Free Workplace Statement, Lobbying and Conflict of Interest may reasonably require, Agreement. n Ethics Statement, and a t Clause, and Non -Collusion Section 30. NO PERSONAL LIABILITY No covenant or agreement contained herein shall be deemed to be any member, officer, agent or employee of Monroe County in his or her individual no member, officer, agent or employee of Monroe Count shall a Covenant or agreement of Agreement or be subject to an capacity, and this Agreement. Y personal liability or accountability lbyeea ®In oft he execution of of Section 31. EXECUTION IN COUNTERPARTS This Agreement may be executed in any number of counterparts, regarded as an original, all of which taken together shall constitute one and the same instrument and any of the parties hereto may execute this Agreement each of which shall be Section 32. SECTION HEADINGS by sagrnng any such counterpart. Section headings have been inserted in this Agreement as a matter of convenience of reference only, and it is agreed that such section headings are not a part of this Agreement and will not be 9 nrovision this Agreement. • Certificate of Insurance or • A Certified copy of the actual insurance policy. The County, at its sole option, has the right to request a certified copy of any or all insurance policies required by this contract. All insurance policies must specify that they are not subject to cancellation, non -renewal, material change, or reduction in coverage unless a minimum of thirty (30) days prior notification is given to the County by the insurer. The acceptance and/or approval of the Contractor's insurance shall not be construed as relieving the Contractor from any liability or obligation assumed under this contract or imposed by law. The Monroe County Board of County Commissioners, its employees and officials will be included as "Additional Insured" on general liability policies. 33.2 General Liability Insurance Requirements For Contract Between County And Contractor IN Prior to the commencement of work governed by this contract, the CONTRACTOR shall obtain General Liability Insurance. Coverage shall be maintained throughout the life of the contract and include, as a minimum: Premises Operations Bodily Injury Liability Expanded Definition of Property Damage The minimum limits acceptable shall be: 11 111 . • - • • s If split limits are provided, the minimum limits acceptable shall be: 11 111 per or 11 1!1 per Occurrence An Occurrence Form policy is preferred. If coverage is provided on a Claims Made policy, its Provisions should include coverage for claims filed on or after the effective date of this contract. In addition, the period for which claims may be reported should extend for a minimum of twelve (12) months following the acceptance of work by the County. The Monroe County Board of County Commissioners shall be named as Additional Insured on all policies issued to satisfy the above requirements. Workers,33.3 Prior to commencement of work governed by this contract, the CONTRACTOR shall obtain Workers' Compensation Insurance with limits sufficient to respond to the applicable state statutes. In addition, the CONTRACTOR shall obtain Employers' Liability Insurance with limits of not less than: 11 0Ir Bodily Injury by Accident 10ter Bodily by Disease, policy $100,000 Bodily Injury by Disease, each employee Coverage shall be maintained throughout the entire term of the contract. Coverage shall be provided by a company or companies authorized to transact business in the state of Florida. 0.4 ProfessionalLiability Recognizing that the work governed by this contract involves the furnishing of advice or services of a professional nature, the Contractor shall purchase and maintain, throughout the life of the contract, Professional Liability Insurance which will respond to damages resulting from any claim arising out of the performance of professional services or any error or omission of the Contractor arising out of work governed by this contract. The minimum limits of liabilitybe: 1 /11 • • _ f i1i aggregate Section 34. INDEMNIFICATION ree to indemnify and hold harmless the The CONTRACTOR daes hereby consent andss oners appo n ed 6Boards and Comm ssions, COUNTY, its Mayor, the Board of County Comm Officers, and the Employees, and any other agents, attordividually ney°s fees nor liability ofyany kind, larising suits, claims, demands, actions, costs, obligations, out of the sole negligent actions of the CONTRACTORTOR and shall be solely responsible r substantial and unnecessary and caused by the willful nonperformancay e of the CO erty arising out of its answerable for any and all accidents or injuries to personsf 9 surance propcovea requ. ments set performance of this contract. The amount and type limiting the scope of indemnity forth hereunder shall in no way be construed as to defend and pay all legaloststattendant to forth in this paragraph. Further the CONTRACTOR agree acts attributable to the sole negligent act of the CONTRACTOR. At all times and for all purposes hereunder, the CONTRACTOR is an independent contractor and not an employee of the Board of County Commissioners. No statement contained in this agreement shall be construed so as to findhCONTRACTOR had ofrCaunty Commiss onany of his/her lers for contractors, servants or agents to beemployees Monroe County. As an independent contractor the ®®TdCI®®al statutes,lodinances, rules is professional judgment and comply with all federal, and regulations applicable to the services to be provided. its The CONTRACTOR shall be responsible forthe or competeness iled ed underdiits obligation for for this rproject, supporting data, and other documents prepaybe and shall correct at its expense all significant errcorrect ®hose errors ralttrib t bleor missions teen whichmtoY he disclosed. The cost of the work necessary CONTRACTOR and any damage incurred bhetCON®RA CONTRACTOR. This provision shas a result of eaill not apply caused by such errors shall be chargeable to any maps, official records, contracts, or other data that may be provided by the COUNTY or other public or semi-public agencies. it The CONTRACTOR agrees that no charges or claims for durings shall be madthe progress of any for any delays or hindrances attributable to the Cm portion of the services specified in this contract. Such hindrancesdelays or reasonable period for , if any, shall be compensated for by the COUNTY by an extension of time for a the CONTRACTOR to complete the work schedule. Such an agreement shall be made between the parties. 12 IN WITNESS WHEREOF, the parties hereto have caused these presents to be executed on I t of A-- - r day of 7 2PLq. (CORPORATE SEAL) ATTEST: Print name I I by OrIChairm I's JprApMlk • STATE Q.Tr COUN'rF` OF 71N3 Copy is True CapyLftNe 0 n 01r. m Wit-mls rly head 4,avl 73etL is Y rI kMY 'IFXIIUN 13 I The scope of services to be provided on an as needed basis by the Provider may include, but not be limited to, the following. The forms to be reviewed and completed by the Contractor are attached to this agreement (Attachments A - E). All results will include: • Written interpretation of test results in common terms and written explanation of the significance of each abnormality or written explanation of those results which are outside the normal range. • Examining physician's written recommendation concerning future action on any condition considered outside the normal range. • Written recommendation of specific reasonable accommodations in accordance with the ADA. SERVICE FEE DRUG SCREEN: When requested, a drug screen will (Collection, Lab, MRO be performed by the physician and review) 10 panel State will be either scheduled or done on a $60.00 Requirement walk-in basis. After hours drug testing for post $25.00 accident, random, and reasonable per test suspicion drug screening. DRUG SCREEN: en requested, a drug screen will requested, (Collection, Lab, MRO l2ep-e orm6dby the physician and review) 5 panel v ill be either scheduled or done on a $40.00 Department of �alk-in basis. Transportation Requirement After hours drug testing for a $25.00 moving violation or an accident per test where a fatality occurs. Medical Review Officer The MRO receives lab reports from Included (MRO) REVIEW the laboratory (as governed by regulations); Reviews lab reports for integrity, authenticity, false negatives, and false positives; interprets lab results, including verification of lab positives; reports lab reports to the employer (as defined by rules and regulations). BLOOD ALCOHOL When requested, Blood Alcohol (Collection, Lab, MRO Screens will be per -formed by the review) h sician and will be either S30.00 14 smaimmm DOT PHYS_JCkL: (SEE ATTACHMENT to be completed by =13 VaMq%P1TFr uone on a walk-in basis. After ho Urs testing fir —Post acci—dent, random and reasonable suspicion alcohol screen. MEMO post accident, random, and reasonable suspicion alcohol screening. If breath alcohol screen is Positive, a blood screen will be Performed at the rate designated b a' ove. When requested a Hepatitis A inoculation will be scheduled and performed by the physician during the facility's normal business hours. e requested, a Hepat_iiis_B� inoculation(s) will be scheduled and performed by the physician during the facilit 'Un—ormal bysiness hours. When requis_&W, - phod noculation a Tyii f will be scheduled and per ormed by the physician during the facilitys normal business hours. anus inoculation will be scheduled and performed by the physician during the facility's normal business hours -requested, a 671—ph—t-6n�a inoculation will be scheduled and performed by the Physician during the facility's normal business hours. 1� When requested, a DOT physic - a will be scheduled and performed by the physician during the facility's normal business hours. Includes exam and physician review of employee health history and job description. The DOT physical is initially performed on'unction with a-POst-offer i M, W (Series of 2 total) $110.00 each (Series of 3 total) N/A M R POST -OFFER PHYSICAL: (SEE ATTACHMENT "A" to be completed by employee and physician) FITNESS FOR DUTY PHYSICAL (SEE ATTACHMENT "A" to be completed by employee and physician) RESPIRATOR PHYSICAL (SEE ATTACHMENTS "C', PART I & it to be completed by employee and physician) CHEST X RAY SPIROMETRY physical. Thereafter, only a DOT physical is performed by the physician. Physician may also perform a urine drug screen if requested separately by Monroe Co nty BOCC. When requested, a post -offer physical will be scheduled and performed by the physician during the facility's normal business hours. Includes exam and physician review of employee health history and job description. Physician may also perform a urine drug screen if requested separately by Monroe County BOCC. When requested, a Fitness for Duty Physical may be requested at any time by the employer in the employee's respective area of work. The exam will be scheduled during the facility's normal business hours. Includes physician review of employee health history, exam, review of job duties and medical records if necessary. Physician may also perform a urine drug screen if requested separately by Monroe County BOCC. When requested, a Respirator physical will be scheduled and performed -by the physician during the facility's normal business hours. Includes exam and physician review of employee health history and job description. Physician may also perform a urine drug screen if requested separately by Monroe County BOCC. Also required: Chest X-ray and HEARING/AUDIOGRAM $65.00 $65.00 Chest X Ray is normally done in conjunction with the Respirator physical if there is an issue with the spirometry results. Normally done in conjunction with the Respirator physical. All employees who use a respirator will have a Spimmetry when hired. Normally done in conjunction with the appropriate physical. May be requested %enarately by Monroe County BOCC. Ss5.00 $45.00 $45.00 S30.00 16 CHEMICAL PANELU/C Tests Glucose (sugar), liver (I $25.00 CBC tube of blood drawn). ...... ... ......... .... .... . ... .. :1 . ....... Test to see. I F,,,'�Wernic* i �1, , , any infections $25.00 within the body; if dehydrated (test LIPIDS from I of the tubes of blood drawn . (CHOLESTEROL) Tests good cholesterol and bad $35.00 cholesterol ( one of the tubes of blood drawn UA DIP Normally done in conjunction with the $10.00 DOT 1, .. t UA WITH MICRO $35.00 The Contractor shall retain all records pertaining to this contract for a period of four (4) years after the termination of this contract. • The County, the Clerk, the State Auditor General, and agents thereof shall have access to Contractor's books, records, and documents required by this contract for the purposes of inspection or audit during normal business hours, at the Contractor's place(s) of business. 17 SECTION TWO: COUNTY FORMS AND INSURANCE FORMS SWORN 9TATE-111-01;1 MONROE FLORIDA ETHICS CLAUSE r (Company) ru...warrants that he/it has not employed, etained otherwise .. act on his/her behaf any former County officer or employee in violation of • of Ordinance No. r i "1 or County officer or employee in violation of Section 3 of Ordinance No. 010-1990. For breach or discretion, -Agreement without violation of this provision the County may, in its liability • may also, in its discretion, deduct from formerotherwise the full amount of any fee, commission, percentage, gift, or consideration County officer or employee." paid to the (Signatu Date:�� -- STATE OF: _ Flori�g --- COUNTY OF: AA �I�rr� � 27ly (date) by P o !+<t "� •4� (name of affiant). He/She is personally known to me or has produced 2f-taf c -- My Commission Expires: �0. % Notary Pubk State of FlorWa Garret Cabrera My Commie.ion EE129165 18 or ro Expires 09/1112015 my •. _ + aCCOrding to la , 1. l am d ce lcQ. of Proposal for the projectdescribed in bidder the firm in } the Request for Proposals ordder making the �` h. J/If proposal with full authority to do so; rvl 'F J. l and that 1 executed the said 2• The prices in this bid have been arrived at independently without consultation, communication or agreement for the purpose of restricting competition, as to any matter relating to such prices with Collusion, any competitor; th any other bidder or with 3. Unless otherwise required by law, the prices which have been have not been knowingly disclosed by the bidder and will not knowingly disclosed by the bidder prior to bid opening, directlyor i • quoted in this bid bidder or to any competitor; and indirectly, to any other 4• No attempt has been made or will be made by the bidder to induce person, partnership or corporation to submit, or not to submit, a bid for the eur Of restricting competitions and 5• The statements contained in this affidavit are true p p®se knowledge that Monroe County relies upon the truth of the s a,tements de with full contained in this affidavit in awarding contracts for said project. (Signature) Date: STATE OF: COUNTY OF: M"•.-a e Subscribed and sworn to (or affirmed) before me on A (date) by personally known to me or has produced (name of want). He/She is (type of identification) as identification. n +.cec ;;dale 0t FPO►M® '=3hera NOTARY PUBLIC :0mm y�s,00 EE 129165 cP+e7 49; 1'12015 ` My Commission Expires: 19 �,�++* Nosy Pubec Star. ar Fiohda DGarrel Cabrera Mr cOn,maa ee,ae�ea N FYDBfwa f100e a.aw.. undersignedThe •Section- e. that: NEW TRU AN MEDICAL of f ion, 1. Publishes a statement notifying employees that the unlaw ul manufacture, distributi dispensing, possession, or use of a controlled substance is prohibited in the workplace and specifying the actions that will be taken against employees for violations of such prohibition. 2. Informs employees about the dangers of drug abuse in the workplace, the business' policy ofmaintaining drug -free • •'. 1 drugcounseling, • •. and employee assistance programs, and the penalties that may be imposed upon employees for drug abuse violations. 3. Gives each employee engaged in providing the commodities or contractual services that are under bid a copy of the statement specified in subsection (1). 4. In the statement specified in subsection (1), notifies the employees that, as a condition of working on the commodities or contractual services that are under bid, the employee will abide by the terms of the statement and will notify the employer of any conviction of, or plea of guilty or nolo contendere to, any violation of Chapter 893 (Florida Statutes) or of any controlled substance law of the United States or any state, for a violation occurringin the workplacenolater than fivedays after• •.. 5. imposes a sanction on, or require the satisfactory participation in a drug abuse assistance or rehabilitation program if such is available in the employee's community, or any employee ois so convicted. 6. Makes a good faith effort to continue to friaintain a drug -free workplace through implementation ofthis section. As the person authorized to sign the statement, I certify that this..riirm complies fully with the above requirements. (Signatu Date: STATE OF: F(ur;C: COUNTY OF: P^^r,t Subscribed and sworn to (or affirmed) before me on A •,-b Y , .Jfj __(date) by r`; M, Fh• t1, yct (name of affiant). He/She is personally known to me or has produced _ CrPvk L- t (type of identification) as identification. NOTARY PUBLIC My Commission Ex ires° 'r lam, eery Publk State of Florida i' Garret Cabrera My Commie•1®n EE129165 i ® ►� n ExpirN 0911112015 • "A person or affiliate !hasbeen placed •. _ f • • • • • • • • • •• I have read the above and state that neither NEW TRUMAN M DICAL (Contractor's 2ny Affiliate has been placed on the convicted vendor list within the last 36 months. I STATE OF: F)-ridge COUNTY OF: Subscribed and sworn to (or affirmed) before me on M �rC.l, goJCf (date) by T,,r,�F�C, i�r..c-re,, (name of affiant). He/She is personally known to me or has produced__.I,er,L.,_, (type of identification) as identification. My Commission Expires: 7/09 Notary Public state of Florida d� Garret Cabrera My C""'i"ion EE 129195 "o* N Expires 09/11/2015 21 MONROE COUNTYt FLORIDA RISK MANAGEMENT POLICY AND PROCEDURES CONTRACT ADMINISTRATION MANUAI. Indemnification and Hold Harmless For The Contractor covenants and agrees to indemnify and hold harmless Monroe County Board of County Commissioners from any and all claims for bodily injury (including death), personal injury, and property damage (including property owned by Monroe County) and any other losses, damages, and expenses (including attorney's fees) which arise out of, in connection with, or by reason of services provided by the Contractor or any of its Subcontractor(s) in any tier, occasioned by negligence, errors, or other wrongful act of omission of the Contractor or its Subcontractors in any tier, their employees, or agents. In the event the completion of the project (to include the work of others) is delayed or the Contractor shall indemnify the County from any and all increased expenses resulting from such delay. The first ten dollars ($10.00) of remuneration paid to the Contractor is for the indemnification provided for above. i��surancernvuirements contained elsewhere within this agreement. 22 •' COMPENSATION INSURANCE REQUIREMENTS •'' EMPLOYMENT P.-wX4AT*1ARr IAV-94W BETWEEN MONROE • FLORIDA AND NEW TRUMAN MEDICAL Prior to the commencement of work governed by this contract, the Contractor shall obtain Workers' Compensation Insurance with limits sufficient to respond to the applicable state statutes. In addition, the Contractor shall obtain Employers' Liabty Insurance with limits of • less than. - I # M Coverage shall be maintained throughout the entire term of the contract. Coverage shall be provided by a company or companies authorized to transact business in the state of Florida. nce i-rogil If the Contractor participates in a self-insurance fund, a Certificate of Insurance will be required. In addition, the Contractor may be required to submit updated financial statements from the fund upon request from the County. 23 GENERAL LIABILITY INSURANCE REQU IREMENTS FOR EMPLOYMENT PHYSICAL SERVICES BETWEEN MONROE COUNTY, FLORIDA AND NEW TRUMAN MEDICAL Prior to the commencement of work governed by this contract, the Contractor shall obtain General Liability Insurance. Coverage shall be maintained throughout the life of the contract and include, as a minimum: • Premises Operations rations • Products and Completed Ope • Blanket Contractual Liability • Personal Injury Liability • Professional Liability • Expanded Definition of property Damage The minimum limits acceptable shall be: a � If split limits are provided, the minimum limits acceptable shall be: 20() 10o _ per Person $ per occurrence 00o Property Damage An occurrence Form policy is preferred. if coverage is provided on a Claims Made policy, its provisions should include coverage for claims riled on or after the effective date of this contract. In addition, the period for which claims may be reported should extend for a minimum of twelve (12) months following the acceptance of work by the County. The Monroe County Board of County Commissioners shall be named as Additional Insured on all policies issued to satisfy the above requirements. 24 Worker's Compensation $-10-0-j.0_00 Bodily Injury by Acc. �--5-002,0-0_0 Bodily Inj. by Disease, policy limi $-100--0.60Bodlly Ini. by Disease, each eml General Liability, including $-300A0.00 combined Single Limit Premises Operation Products and Completed Operations Blanket Contractual Liability Personal Injury Liability Expanded Definition Of Property Damage Professional Liability $250,000 peO r•ccurrence and including errors and Omissions $750,000 Aggregate The Monroe County Board Of Coun , C insured.n-f ty Omm1ss1O-neTs-shalIA3&--E--kuc-e 25 qew Truman Medical • i 2014 Attachment "N {r . 61 a � . s n arms on Is for offlcial and madicaily-confidential use only and will not be released to unauthorized persons OF PATIENT (Last, first, or RFD., Citv or and — ,, 7. STATEMENT OF PATIENT'S PRESENT HEALTH AND MEDICATIONS CURRENTLY USED (Use additional pages if necessary) a. PRESENT HEALTH b. CURRENT MEDICATION REGULAR OR INTERM. c. ALLERGIES (Include insect bites/sdiegs and common foods) Is.WEIGHr- 8. PATIENT'S OCCUPATION 9. ARE YOU fCheCkores RIGHT HANDED LJ LEFT HANDED 10. PAST/CURRENT MEDICAL HISTORY CHECK EACH ITEM YES NO DON'T KNOW CHECK EACH ITEM YES NO DON'T KNOW CHECK EACH ITEM YES NO DON'T KNOW Household contact with anyone with tuberculosis Shortness of breath Bone, joint or other deformity Pain or pressure in chest Loss of finger or toe Tuberculosis or positive TS test Chronic cough Painful or "trick" shoulder or elbow Blood in sputum or when coughing Palpitation or pounding heart Heart trouble Recurrent back pain or any back injury Excessive bleeding after injury or dental work High or low blood pressure Cramps in your legs "Trick" or locked knee Suicide attempt or plans Frequent Indigestion Foot trouble Sleepwalking Stomach, liver or intestinal trouble Nerve Injury Wear corrective lenses Gall bladder trouble or gallstones Paralysis (including infantile) Eye surgery to correct vision Epilepsy or seizure Lack vision in either eye Jaundice or hepatitis Car, train, sea or air sickness Wear a hearing aid Broken bones Frequent trouble sleeping Stutter or stammer Adverse reaction to medication Depression or excessive worry Wear a brace or back support Skin diseases Loss of memory or amnesia Scarlet fever Tumor, growth, cyst, canner Nervous trouble of any sort Fheumatic fever Hernia Periods of unconsciousness Swollen or painful joints Hemorrhoids or rectal disease Parent/sibling with diabetes. cancer, stroke or heart disease Frequent or severe headaches Frequent or painful urination Dizziness or tainting spells Bed wetting since age 12 X-ray or other radiation therapy Eye trouble Kidney stone or blood in urine Chemotherapy Hearing lose Sugar or albumin in urine Asbestos or toxic chemical exposure Recurrent ear nfections Sexually transmitted diseases Chronic or frequent colds Recent gain or loss of weight Plate, pin or rnd in any bone Severe tooth or gum trouble Eating disorder (anorexia bulimia. etc ) Easy fatigability 9uw.:ais Been told to cut down or criticized for alcohol use Hay fever or allergic rl•;ndis Arthritis, Rheumatism, or Bursitis JHead njury Used illegal substances Asthma Thyroid trnuble or goiter Used tobacco ,1 7540 00 181 a368 STANDARD FORM 93 (REV 6 96) Previous edition not usable Prescribed by ICMR/GSA F1Rfv1R (41 CFR) 201 9 202 1 MEDICAL RECORD 1. LAST NAME - FIRST NAME . A 8. DATE OF 8 10. PLACE OF 12e. AGENCY REPORT OF MEDICAL EXAMINATION 2. IDENTIFICATION NUMBER P C1 S. EMERGENCY CONTACT (Name 7. AGE 8. SEX B. RELATIONSHIP OF CONTACT FEMALE MALE 11, RACE WHITE BLACK AMERICLASKA N INDINATryEAW 92b. ORGANIZATION UNIT Position m 13. TOTAL YEARS GOVERNMENT SERVICE Q. MILITARY b. CIVILIAN - IS. RATING OR SPECIALTY OF EXAMINER 18. PURPOSE OF EXAMINATION 17. CLINICAL EVALUATION MAL (Check each item /a eporuprlere column. enter iVE" /fnof evaiueterl) MAL r AL !Check each A. HEAD, FACE, NECK AND SCALP Mfem In appmpriateoofuunn, enter"NE'ifnot evaluated) rAAI O. PROSTATE (Ovar40 ordinkelly(-dc W) B. EAR5 -GENERAL (INTERNAL CANALS) (Audory acuity underftema 39 and 40) P• TESTICULAR C. DRUMS (Perforalbn) D. NOSE R. ENDOCRINE SYSTEM E. SINUSES S. G-U SYSTEM F. MOUTH AND THROAT T. UPPER EXTREMITIES (Strength, uanged rflof(on) G. EYES - GENERAL (Visual "n" end U. FEET ry redFecO'vrr ands deep 2e, 20 and JO) hl. OPTHALMOSCOPIC V. LOWER EXTREMITIES (Except feel) (Sherigth, range of motba) I. PUPILS (EquaW and rwUan) W. SPINE, OTHER MUSCULOSKELETAL J. OCULAR MOTILITY (Assoc/ated parailei movmnents nystagmus) X. IDENTIFYING BODY MARKS, SCARS, TATTOOS K. LUNGS AND CHEST Y. SKIN, LYMPHATICS L. HEART (Thrust, she, rhythm, sounds) Z. NEUROLOGIC (EquiNbdum testa underitem 41) M. VASCULAR SYSTEM (Varkosities, eta) AA. PSYCHIATRIC (SpeCWyanypersoneplydeviatlon) N ABDOMEN AND VISCERA flnOude hamia) NOTES: (De9Crtbe ®very ebnorma/!ly/n data!!. Enter pertinent Nam number before each comment. Conflnue /n item 42 afrd use addif/onal sheetslf necessary) 18. DENTAL (Piave ap111 1 71 ;:;:;7 M examples, uboveorbefownumberofu -�1...g ttestorawa r �`1on- x -�- a11d �r jr I��') REMARKS AND ADDITION s1 •'� Truth restorable 1 _2 Missing ' 2 , Replaced a f1 1 Teeth 3� Teeth by 1 2 rtaB DEFECTS AND DISEASES X X X X Dsnhrroe R Dentures I 1 2 3 4 5 8 7 8 9 G I® 11 12 13 14 1E T H 32 31 30 29 28 27 28 5 18 25 24 23 22 21 20 19 18 17 F T 19. TEST RESULTS (Copies of results are preferred as attachments} A. URINALYSIS: (1)SPECIFIC GRAVITY (2) URINE ALBUMIN B CHEST X-RAY OR PPD (Place, date, Nim number and resuN) (4) MICROSCOPIC (J) URINE SUGAR C. SYPHILIS SEROLOGY (Spacdy fast Used D. EKG E. BLOOD TYPE AND RH and results) F OTHER TESTS FACTOR NSN 7540-00-634-4038 88.12e 'r A;ned a {' �nri 9 edrm p•o..^MNDIOR STANDARD FORM 88 (Rev. 10.94) (EG) Proscribed by GSAIICMR FIRMR r41 CFR) 201-9 202-1 11. FEMALES ONLY DON'T DATE OF LAST MENSTRUAL DATE OF LAST PAP SMEAR JOATE OF LAST MAMMO- CHECK EACH ITEM YES I NO I KNOW I PERIOD I 1GRAM Treated for a female disorder IV Change in menstrual pattern N/ CHECK EACH ITEM. IF YE.a EXPLAIN IN BLANK ITEM I YES NC 12. Have you been refused employment or been unable to hold a job or,. stay in school because of: a. Sensitivity to chemicals, dust, sunlight, atc. b.Inability to perform certain motions. c.Inability to assume certain positions. d.Other medical reasons (if yes, give reasons.) 13. Have you ever been treated for a mental condition? (if Yes, specify when, where, and give details.) 14, Have you ever been denied life inawance? (if yes, state reason and give details.) I S. Have you had, or have you been advised to have, any operation. (if yes, describe and give age at which occurred.) Have you ever can a patient in any type o oa to (I yes, specify when, where, why, and mama of doctor and complete address of hospital.) 17. Have you consulted or been treated by clinics, physicians, healers, or other practhloners within the past 5 years for other than minor Illnesses? (if yes, give complete address of doctor, hospital, clinic, and details.) Have you ever been reject or military service because o physical, mental, or other reasons? (if Yes, give Beta and reason for rejection.) ri 19. Have you ever been discharged from milhery service because of physical, mental, or other reasons? (if yes, give date, reason, and type of discharge; whether honorable, other than honorable, for unfitness or unsuitability.) 20. Have you ever received. Is them pending, or have you ever applied for pension or compensation for existing disability? Of yes, specify what kind, granted by whom, and whet amount, when, whyd 22. Have you ever been diagnosed with a learning disability? Of yes, give type, where, and how diagnosed.) N/A . i N/A I N/A RIGHT. LIST EXPLANATION BY certr y that eve reviews the oregomg n ormation supp y me an t a4 et s true an compete tots est o my now a ge. out or ae any o the doctors, oeprta s, or clinics mentioned above to furnish the Government a complete transcript of my, medical record for purposes of processing my application for this employment or service. I understand that falsification of information on Govemment forms is punishable by Pine and/or imprisonment. 24a. TYPED OR PRINTED NAME OF EXAMINEE 24b. SIGNATURE 24c. DATE NOTE: HAND TO THE DOCTOR OR NURSE, OR IF MAILED MARK ENVELOPE "TO BE OPENED BY MEDICAL OFFICER UNLY'-. 25. PHYSICIAN'S SUMMARY AND ELABORATION OF ALL PERTINENT DATA (Physician shall comment on all positive answers in items 7 through l F. Physician may develop by interview any additional medical history deemed important, and record any significienr findings here.) _6a STANDARD FORM 93 (REV 6.96) BALK A 20. HEIGHT 21. WEIGHT ' MEASUREMENTS AND OTHER FINUNGg NO.OFSHEETS ATTACF 22, COLOR HAIR 23. COLOR E`IE8 24. BUILD 28. BLOOD PRESSURE (gM of,,serf leaW) SLENDER A. SYS. B. MEDIUM HEAVY 25. TEMPERATURE SITTING Dlgg RECUM• SY3, BENT DI AS STANDING SYB. A SITTING B. TANDI.) RECUMBENT OBESE 27.PULSE (Ann ethgW19wo 28. DISTANT VISION ®IAS (3 mina) D° AFTER EXERCISE E. 2 MINS AFTER RIGNT 201 CORR. TO 201 29, REFRACTION LEFT 20( CORK. TO 201 31. HETEROPHORIA (SPOC&Ld4 BY S• By CX S. 30. NEAR VISION CORR. TO ) ESO EXO CX BY CORR. TO R.H. H L.H. PRISM DIV. BY 32. ACCOMMODATION RIGHT 33. COLOR VISION (Tea(Laedandoesuq) PRISM CONV, CT PC PO LEFT T 35. FIELD OF VISION RIGHT 38. NIGHT VISION (Testusedartdsgare) (Test Used and ) UNCORRECTED LEFT CORRECTED 37. RED LENS TEST 39, HEARING 38. INTRAOCULAR TENSION RIGHT W/V /ISSV /15 40, AUDIOMETER 250 500 1 258 3000 RIGHT LEFT 41. PSYCHOLOGICAL AND PSYCHOMOTOR Testa ( 512 10024 2048 4000 6000 80p0 2SW 4096 6144 us ed and score) LEFT WN 1155V RIG 8192 /15 42. NOTES (Conl/na LEFT �) AND SIGNIFICANT OR INTERVAf Lorna®.. 43. SUMMARY OF DEFECTS AND DIAGNOSES (Wd (u�aedlltla°°el shee/s iPnecessaryj �9nosea with IMm numbers) 44 RECOMMENDATIONS -FURTHER SPECIALIST EXAMINATIONS INDICATED (SpW r r) 45A. PHYSICAL PROFILE 16. EXAMINEE (Check) P U L H A- ® IS QUFIED FOR E ALIS S. IS NOT QUALIFIED FOR In accordance With attached job 47. IF NOTQUALIFIED LIST DISOUALIFYINO DEFECTS BS ITEM N,tMBER I on 458. PHYSICAL CATEGORY 48 TYPED OR PRINTED NAME OF PHYSICIANA B C E 49 TYPED OR P SIGNATURE RINTED NAME OF PHYSICIAN 50. T'IPEO OR PRINTED tL1h1E OFCENTIST OR PHYSICIAN (lndicytewhich) SIGNATURE SIGNATURE 51. 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'cyp' n'i roffio 3g9 ,a a c -<2a-- ` 5 3 rpo ? 0' w w n� m� ® 5019 mao T3 o o IZ p ''b m n'3' m m n`< O cr n � m a► m g �r ®ro amo wed �cmn �0 o.� c�a� ?� ®3 m qy 5�� ®r ro'� y+®.• "' cg u'.c �Q c� g es 03 w �� cn� o N Q�H°c 02 3`�D)0 n' wi_i� aa� S. o (yp ca y ° 9 - a ems• e 0 fD m ,yams; Uf °'C 3 m �(pp � (p^ w V8 w �w ` Eo � G• � t19 to ro• 7 N Of t�O[7i®Se_'Q tu CD 6 33 �.Q ; jCL J5 ��=2 n� 9 fiCD t_ ? ir 3m'm m g `gCOm® cCL 2 rN CO ca F�'- g gam_ 3w a--�®® yRI��gy$ 3 n�3�- �Z,,3__.W 8 ®M®w M. 7 7 w 6 T Ll a �DeOD'ya 3•e 3 7 A� 3 C M to 0 iD o CD 5 ? M ® a y OD F Vl z a a a vt z` 7 N D I w K rn m m m m R Z••4d• uY•'• V1/W •Nao• •M W,M cuaerAlyhAve any of the following symptonns of PuIMAMM7 or larrg IIlnese? 4L po you ............. Wes 0 No a. Sho of breaths.»•._.........».».».......,..»«•..•..«.•«.«..,»«»..........•••••......... ................... ........... » h, shortness of breath when walking fast on level ground or walking up it slight hill or indinte ..»...... _13 Ycs3 ®No Shortness of breath when walking with other people at an 001indry pace on level groumh .......«».»,..,0 Yes 0 No `. �!. Hrve to stop for breath when walking at your own pace on level 6roundt»... »..».».».»..... ».................. »D Yes 0 No breath washing or dressing »«..»....... »..»...... »............ ®Yes ® No e• shortness of when yo.»....»»••.,..,«»..,..,»...... f. shortnins of breath that inte6res with your jobs ................... ».......... •....... »..... »............ ........................ 0 Yes 0 No (thick sputum »..... .'........... »»... »..».».»....... ....•«....«.»...»«❑ Yes 0 No g• Coughing that produces phlegm. ................. IL Cougjvmg that wakes you early in the mornings ...»»......». ........ »»........... »... »... ».......... .......................... 0 Yes 0 No LCoughing that occurs mostly when you are lying dowm..... »....... »............... »........ »•».... ..................... ...a Yes O No j. Coughing up blood in the lust month »«»»...... »... ......... »..».........»».»»»».»»...«..».......«.««..».«..»»•«,...»0 Yes 0 No k. Wheezinip............».....»..»...»«..........».»«........... »......,......... «»».... ........ .... ».«...««..««»....«....»...«.»....«..«® Yes 0 No 1. vvheezjng that interfim with yore jobs .... »..»........»..».•.•.....«.»,....»».».».».•.«....«.........«»«....»».......,»....»0 Yes. O No u,.Chest pain when you breathe deeplys.... ........ ....... .•,».»................ Yes O No n Any other symptoms then you think may be related to lung problems: ... ........ ........ ......... .... ..•....,«».»...0 Yes O No S. Have you ever had any of the following cardiovascular or heart problem? Heart attack•....._......»....»......».».........«»»«..».............«.»..»».........»»..».«......»....»......».«.....,....»»..«.»».»••0 Yes 0 No a. b. stroke ..»..,....»»_.»».....««....»_.......».............»».......»...»....»..»...«.«...................»....«..».«.,...»...........».....»»®Yes ONo c. Ar gina:«««_......»:.««..«..»»»».....»......_.««...».»........»..».»......,».».....»...«.,....»».»....«».».«...«««.».»».«..».«»® Yes 0 No d. Meart failure:..«».«».»»...........»...».»«.»..»...».......»»..»«»«.......»«....»...».»«..».«..»...«....».....,...«.«..»»»..«..® Yes O No e. Swelling in your lep or feet (not caused by w &.»....«......«,.»»......»...«,....».«......«»».......,.»..«».»»..0 Yes Q No f. Heart aahytbwja (heart beating frregulaziyk... ••,©Yes- Q No g. High blood . ..... .................................... .»«««......«.««..«.»»....»....««.».»«.......... ««......«._.«.»..»»».,D Yes O No h• Any other heart problem, that you°ve been told about: ........ ... ................................................... »,«•0 Yes 0 No Have you ever had my of the following caidin arbeartsymptoms? r b. PWn or ti0kneSS In Your during r .' . .ractivity, r— Pain or tighkruns in your chest that WU&M with YOWJ'Dtr- 13 Yes 0 No d. In the past two yew!A, have you nodced your heart skipping or mkising a beat: . .. . ........... . ...... —._..(3 Yes ONO e. Heartburn or indigestion that is not related to Yes ONo E. Any other symptams that you think may be related to head or diculation problewx ........... Yes C3 NO 7. Do you cunvady take =tdIcRfl0nfollowing .r lung problems:- troubleb. Heart ■' Yes ■ f Yes ■ respirator8. if yateve wed a respirator, have you ever had any of the followtrig problems? o to question ■ Yes ■ 'a a. Eye irritation: ■ Yes ■ •` yes ■ d. General weakness or fatigue: `IC ® hV4. w!U Ddr 11VIL{t1 `A- ``'uulcl you like to talk to the health.:Am pmfesq,111.d who will nrviesY this •lue�til)naz.uiRatwut youe .1uLw` OM to this yuestionnaiRr................................ Nit 'titu)ns 11) tit 13 below must 141,111„Vert-d 17 e. a mpluvtr' �` hu 1t•�'i hr®�tt tie'll!1 tl°I� tl) u.51! 1°lthl'r ' v'c N 1 ° °�,°If�:e9nt.a►n1°cl bmJthinl,,lpl yratus f5C8�). Fail°n;ph))�,y� h'I,<) hav,� blwn w' s full-lae a q'11. MIS tltl•w! `Iuewtn;9L16 l°8 `olua)tJry. kr trcl to usa° I,th1°r ty ey 19f n°s FrJG; �ptrstur 11 p ^� •a1�w1'rir t0 flaveYou everlustvisionineithereye(tam Oran! or • p ' y pe entlyjs ................ IL Do you currently have Any of the folluwinS vision probleoup J. `Ve°are'untkt 11°lrie's:............... h. %Vv it gLws................................................................................................................................... c°. Color blind:...............................................,...,..................,............................,........ ] Yly ..0! Nu 11. Cther ............................................................................................ ............................7 Yts{ ] Nu eye or vision pruhlem:......................................................... ..................... ...!7 YID 0 Flo '-1 Y,I 0 Nu LHave you ever had .......................................................... injury to your ear, hwludinS a broken ear drum 13. Do. you curenttly have a 7 of the tolto�r fi,adAi ........................................................ ........_ .....,.,,...e................°°•0 Yey t] No J. Diffk�ulty heurinIF .............................................. h'6 b. We!ar a g Jid:...,........................................................,.................................................... ....................... .......0 Yew 7 No C. Any other hij%U in ................................ g 1>r car prablcan....................................................................p] Ye,s ® No ............................................,.....................................0 YI' ................... Have you ever hid IAa � NO injutr.......................................................................................................... ..O Ye! O No ............... tS. Do youcunfritly have any of t!u foUowin .a. TrV1! S o.'kektrl ptesblemst w any of your Arm* b. ®................................ ........„...... fe�p, ®r.............°...........................,..°.........................................0 Yen O No C. by fully moving your AnM And leggy ......... J. Pain or stif ntm when you lean forw................................................................................................0 Yes O No arc! uT - and at ••••••••••••O Yew O No eg. D)ffieulty fully moving your he°ad u o the waft ...........................................................❑ YeJI O No f. D p r eluwrr.......................................... ®af kWty fully moving your head side to side.... ............... ...............0 Yes O No kneex h. Diffieul y s�luatting to tUhe................................................................................................. ............®Yc°s rJ No i. Climbing a Flight uf.stailra ugr a Udder ................................................................................................................0 Yes 0 No carrying more than 25 lbe�:...............................................................• O Yes 1] No j. r11„y other muscle or skerletvl problem that interferes w ®Yest O No 1th usin g a rL'sl?irJtUr' ..........................................0 Ycy O Nu Paart B Any of the following yurytiorts and other clul'tiuets not [istecl, may be JJcleel to the qu�°stiunn.lite At the J e Jre pn)f1'%M1)ru! %vho wlll review the yuestionnaint. a" retiun of the health I- In yoUX pent jub, are you working at high altitudes over S than no j ,t)00 fart) or in J playa that has lore+er L aataounb of ouysen........... y mptl)ms w lien ou rt! �vurking un y 111°r th1�s1! I un111tlult ......... '] Y� ................................. ............................7 Yes ] vu 2- .\t work or at home, have you ever been etp®4ed to h.tz.udous sulvenb, haz.Wo,1s aitboane e, ie•& yuaes, fumes, urdust), of have you come into skin contaet with h�+arlous :hemicAls:........ I ... heaurab r MONROE COUNTY SAFETY POLICIES AND PROCEDURES MANUAL 7. Use only safety type lathe dogs or those with flush set screws. g. DO NOT HOLD emery cloth in your hand while polishing revolving work. Use a wood block or jig for this purpose. Only use files with handles. g. When machine rods or bars that project beyond s pthe erted an stock, sutable enclose the projecting portion in a stationary pipe stand. 10. The machining of irregularly shaped ta ttwth'the work durcrankshaftsing the similar objects where the tool is not in co entire revolution of the chuck, IS EXTREMELY THE ALERT to avoid ®o d being caught operator MUST BE CONSTANTLY O or struck by the work. ips off the tool or lean over the lathe to inspect the 11. Do not knock ch work while it is running. 10.17 PERSONAL PROTECTIVE EQUIPMENT A. Gloves: On operations where gloves are necessary, wear the proper type specified by your Supervisor. t your head B. Hard Hats: Hard hats are provided by theflyngCountyobjects, troe from electrical against the danger of head injury from falling or flying shock and burns. Be sure your hat is in gnocked off.`on and has a if an area s designated as There is no protection if the hard hat is k "HARD HAT AREA" all persons entering these areas shall be required to wear a hard hat. C. Respirators i. POLICY it is the policy of •- County to protectrecognition;yees from hazardous atmprehensive program of evaluation; ive and work practice • • - t • controls; • d personal protective engineering, administratextent feasible,hazard equipment, including res k practicecontrols engineering elimination and • control employee exposure to within allowable e der development, these measures are not feasible or fully effective or are un • • appropriate Monroe County shall under thisprogram.• •..... County _rtaining - •. • - - • • federalry regulations • applicable protection. POLICIESMONROE COUNTY SAFETY PROCEDURES PURPOSE2. The Purpose of this program is to Protect the health of Monroe County employees who may -be exposed to hazardou t - • ! f • • - • • respiratorThis Program applies to all • • - County employees who need to wear a r• - •• - _ • • Examples • • r'r- i ons that • - •involve _ • 1 Asbestos - Facilities Maintenance Dust — Facilities Maintenance Spray w ♦ Roads ♦ Bridges - •' • Immediate Danger to Life & Health r Airborne/Bloodborne Pathogens — Fire Rescue Herbicides — Roads & Bridges, Airport Maintenance Household Waste• ♦Waste 4. ROLES D RESPONSIBILITIES resourcesGeneral Manager — Employee Services Director - Supports the Respiratory Protection Program and and • Administrator with responsibility Respirator Administrator — Safety Officer - Has overall responsibility for the Respirator Protection Progr m including monitoring respiratory hazards, and conducting Program eva a Has knowledge about respiratory protection and main ar Approves training • •• ram for employees, r, r • M11111171 yi• .. • • Approves fit test procedures for • • - - Approves respirator makes and models for use. hazardous atmosphere and whenever work conditions change that may affect employee exposure. Performs employee exposure monitoring in accordance with Federal an't State OSHA regulations acceptedUses generally accepted sampling techniques and analytical methods, including generally quality•control Reports all findings to the supervisor within five days of receipt of analytical results from -laboratory, Upon request,performs- •makes recommendations hazard control. Complete initial respirator trairefresher training and training maintain records. In addition, complete any recommended respirator manufacturer prior to servicing respirators and their components. Perform and document semi-annual inspections of each air purifying respirator and monthly inspections of each supplied air respirator issued by the employer or maintained in its inventory. Ensure that compressed breathing air cylinders• • _ sted on • Remove from service and tagout any defective respirator parts. Perform maintenance and repairs for respiratory protection equipment in accordance _manufacturer'sinstructions. inventoryMaintain an of - • s 1associated parts and -+ r in a clean, secure area. Issue respirators when so directed in writing, inspecting to confirm that the respirator or • • of •e specified in the respirator 1 lan or • •♦ Issue spectacle kits to employees who require corrective their respirators. Perform tests for compressed air quality and inspect breathing air compressors periodically 10-61 MONROE COUNTY SAFETY POLICIES AND PROCEDURES Supervisors ProtectionInitiate and approve a written Respiratory Program involvesoperation that • • supervisionComplete the initial and respirator refresher training of the type attended by employees under their Initiate safety briefings on respiratory protection issues at the start of each new project or task that involves 1'i under their respiratory supervision Ensure that any use of respirators by is in accordance with this employees un• - Programr their supervision • • • • _ n Respiratory Protection nd Worksite-Specific been •approved • Respiratory Protection is - •.. Plan that has y the Supervisor and the Respirator designee • or relatedRecord any complaints to respirator usage, act promptly to correctinvestigate the complaints, assistance, when indicated. Report first -:..• •. medical treatment in accordance with Monroe County Procedures. Report every respirator related incident to the Respirator Administrator before the end of the work shift Ensure that their employees mclearances before authorizing them to weara'ny respirators edical have the requisitetraining, Prohibit any employee with lapsed or incomplete respirator clearances to work in hazardous atmospheres. Enforce any restrictions imposed by the Occupational physician on individual employees, corrective lenses Physically check each respirator prior to its assignment to their employees to be sure that it is of - f- specified affectedInform each employee of within one day of receiving such results and assure inclusion of all exposure reports in the County's recordkeeping system Monitor• • yee compliance with the respirator •' program Employees Use respiratory Protection in accordance With training Provide -instructions Immediately report any defects in the respiratory protection equipment and whenever there is a respirator malfunction, immediately evacuate to a safe area and report the malfunction MONROE COUNTYPOLICIES AND PROCEDURES Promptly report to the supervisor any symptoms of illness that may be related to respirator usage or exposure to hazardous atmospheres Report any health concerns related to respirator use or changes in health status to -• •.'/ physician Wash their assigned reusable respirators at the end of each work shift when used and disinfect assigned respirators at least weekly Store respirators in accordance with instructions received Observe any restrictions placed on work activities by the occupational fr Be clean Allow no headpieces, Band-Aids or other items beneath a respirator seal or head -strap assembly. Inspect the respirator immediately before each use, in accordance with training provided. Perform a user seal, negative and positive respirator fit check each time respiratordonned in accordancewith training provided. 5. PERMISSIBLE PRACTICE Any respirator worn by a Monroe County employee on the job. shall be issued by Monroe County• ' program. allowableRespirators shall be issued by Monroe County and worn by exposed employees whenever airborne contamination levels are not otherwise reduced to within the voluntaryA written Respiratory Protection Program and Worksite-Specific Respiratory Protection Plan shall be prepared and approved by the Supervisor and the Respirator Administrator prior to any employee respirator use, including r • - or f. ' use. This •... shall identify• • and identify• quantitative the air contaminantsor oxygen deficiency, specify p• • • •.respirator,f specifylimitations, monitoring, respirator cartridge change out frequency, etc. Each operation involving respirator use must have a signed and approved written plan. Upon an employee's request, an appropriate respirator shall be issued for • •ry use when exposure to contaminant- it above •^ of allowable f i • or exposed • nuisance dusts, moids, pollen, etc. Reasonable efforts should be made to reduce such exposures. 10 - 63 MONROE COUNTY SAFETY POLICIES AND PROCEDURES Supervisorreturned to the returnedannually. A log shall be maintained of these periodic inspections. s purifying respirators shall be for The Supervisor is responsible to ensure that each • • /c f respirator - • _ certifications.rrently approved for respirator use, including medical, fit testing and training certifications shall not be • • voluntarilyyees with expired - work hazaril.. ar a r • until their • • ' - f 1. lapsed requirements Each respirator Must be inspected by its wearer immediately prior to each use, according to instructions provided in the resPlrat r training. Any defects shall be reported 1i seal check shall be performed by the wearer immediately prior to entering the • _ hazardous hazardous atmosphere. Monroe County will provide an appropriate spectacle wearer who requires corrective lenses and will pay for prescription safety lenses for the kit initially and as needed. Contact lenses shall be permitted if the employee's ophthalmologist or Optometrist authorizes their use by the in hazardous atmospheres with -r. • ! Monroeessure and Positive pressure respirators in a written communication to issued a respirator are responsible for its maintenance, daily fstorage while the unit is in their o inspecti! :.: •. t . FIT TESTING RespiratorEach respirator wearerbe - -1 testing, using protocols approved by the Administrator. Frequency the Federal Code of Regulations for specific substances or if shall be Performed contours change, such as - wearer's facial by • gain or loss,suOn the n of each fit test, arrayrge of - i_._ employees choose - • irator from an ces from different manufacturers and sizes approved by the Respirator Administrator. Fit test certifications shall be Prepared _-il. - •irator nd signed by the Person performing the fit test and must -• •1• make, resfit tested; and the result of the fit test. A copy shall be provided : • the Monroe County required fit tests, • • reasonable employee time and travel costs, shall be paid for by Monroe County. A medical evaluation as described in Section 10. 17. C. 11 must be performed before an employee is fit tested. 11. MEDICAL APPROVAL FOR RESPIRATOR MONROE COUNTY SAFETY POLICIES AND PROCEDURES MANUAL Monroe County approved respirator training shall be conducted by or paid f] by Monroe County including the employee's reasonable gtime and travel to Tarticipate in such trainin, Air purifying respirator (APR) — a type Of respirator that removes specific contaminants from air by use of filters pg cartridges or canisters by passing ambient air through the urifyin•element. APR's do not supply oxygen. Allowable limit — the maximum by reguconcentration of a substance in air that is permitted lation or voluntary standards to Protect employee health. These concentrations may be expressed in terms of an 8-hour time-weihd g te• averae, a 15-minute short- term averag• g e or as an instantaneous upper ceilinlimit. An example is the OSHA pegrmissible exposure limits (PEL). Assigned protection factor — the level Of respiratory Protection expected to be Provided by a given class Of respirators to a Properly fitted and trained user. This factor is assigned by OSHA in substance specc dardstandards and by ANSI in the voluntary national stan, Z88.2. Atmosphere-suPPlying resp birator — a type of respirator that supplies the user with reathing air from a Source independent of the ambient atmosphere, and includes supplied -air respirators (SARs) and self-contained breathing apparatus (SCBA) units. Canister or cartridge — a container with a filter, sorbent or catalyst, or combination of these items, which removes specific ocontaminants from the air passed through the cntainer. Demand respirator — an atmosphere-suPplying respirator that admits breathing air to the face piece only when a negative Pressure is created •inside the face piece by inhalation. Dust mask — see filtering face piece. Emergency situation — any occurrence such as, but not limited to, equipment failure, rupture Of containers, or failure Of control equipment that may or does result in an uncontrolled significant release of an airborne contaminant. Employee exposure — exposure to a concentration of an airborne contaminant that Would occur if the employee were not using respiratory Protection. End -of -service -life indicator (ESLI) — a system that warns the respirator user of the approach of the end of adequate respiratory protection, for example, that the sorbent is approaching saturation or is no longer effective Escape -only respirator — a respirator intended to be used only for emergency exit. Filter or air -purifying element — a Component used in respirators to remove solid or liquid aerosols from the inspired air. 10-68 10-69 MONROE COUNTY SAFETY POLICIES AND PROCEDURES MANUAL p P Powered air -purifying uri respirator irator PAPR — an uses a blower to force the ambient air through air -purifying if in elements for that covering, fY 9 elements to the inlet Pressure demand • Pressure atmosphere -supplying is reduced inside the face piece pressul by inhalation. Protection factor — a _ ratio -• by ntration concoutside a respirator by - conce •.. ntration uantitative fit test. inside•' • r. This is measured in aQualitative fit test w •. _ st to assess the adequacy of respirator fit that relies on the • • response to the amount test agent. Quantitative fit test (QNFT) — an assessment of the adequacy of respirator fil by numerically measuring the of - ,;;- into the respirator. Respiratory Inlet covering — that portion of clamp.Protective barrier between the users respiratory tract and an air -purifying device or breathing air source or both. It may be a face piece, helmet hood, su or a mouthpiece respirator with nose Self-contained breathing apparatus a a breathingrespirator for which the air s • urce is designed to be carried by the 1 Service life — the period Of time that a respirator, filter or sorbent or other respiratory equipment Provides adequate protection •• to respirator the wearer. or supplying respirator for which the source of breathing air is not designed to be carried by the user. Tightfitting face piece — a respiratory inlet covering that forms a seal with h the actionUser seal check — an -. • • •. - f •determine the •the face D. ,• , Toe ProtectionThe appropriate foot _q heavy objects that may be dropped on the feet, electrical Protection, piercing Protection, chemical designated_ ' • tection and working in areas that are s high hazard areas •rolling lifts • ' require •► Protection • • f' 10-70 Vew Truman Medical Agreement 2014 Attachment u ®n ?yright ® 2000 NFPA. All Rights Reserved NFPA 1582 Standard on Medical Requirements for Fire Fighters and Information for Fire Department Physicians 2000 Edition This edition of NFPA 1582. Standard on Aledical Rtquirem n 4 forFim Fighters and Information jorFimDepartmeniPhysician.4 was prepared by the Technical Committee on Fire Service Occu- pational Medical and Health, and acted on by the National Fire Protection Association, Inc., at its November Mewing held November 14-17, 1999, in New Orleans, LA. It was issued by the Standards Council on January 14. 2000. with an effective date of February 11, 2000, and supersedes all previous editions. This edition of NFPA 1582 was approved as an American National Standard on February 11. 2000. Origin and Development of NFPA 1582 A joint task force of members representing both the Technical Committees on Fire Service Occupational Safety and Health and Fire Fighter Professional Qualifications began address- ing medical requirements for fire fighters in March 1988. A standing subcommittee on Med- ical/ Physical Requirements for Fire Fighters was created under the Fire Service Occupational Safety and Health Committee in 1990 and was responsible for the development of NFPA 1582. This new document covered the medical requirements necessary for persons who perform fire -fighting tasks. Medical requirements that were previously contained in Section 2-2 of NFPA 1001, Standard for Fie Fighter Professional Quatifrcado"A applied only to the entry level. They were deleted from NFPA 1001. Legal opinion and federal laws show that requirements set for a position must apply to anyone who would be or is in that position. These medical requirements are therefore intended to apply to candidates as well as to current fire fighters. Two categories of medical conditions were created, Categories A and B. Category A repre- sented conditions that, if they exist in the candidate or current fire fighter, would not allow this person to perform fire -fighting operations. Category B conditions must be evaluated on a cam -by -case basis so that the fire department physician can determine if the medical condi- tion in a particular candidate or current fire fighter would prevent that person from perform- ing fire -fighting operations. Medical evaluations, medical examinations, record keeping, and confidentiality were addressed in Chapter 2. Chapter S contained the actual medical conditions that comprise the requirements. Extensive advisory and informational material was developed in the appendixes to aid fire department administrators and fire department physicians. The committee completed its work in january 1992, and the first edition was presented to the Association membership at the 1992 Annual Meeting in New Orleans, Louisiana. The second edition of this standard reflected the numerous changes in medical technol- ogy that have impacted structural fire fighters. The technical committee was assisted by phy- sicians whose expertise covered the arras of emergency medicine; vision; haring; and cardiac. pulmonary, neurological, and metabolic conditions. The technical committee endeavored to update six critical areas and moved some of the previous Category A text to Category B. They then enhanced some of the Category A material that would prohibit an individual from being hired or to continue as a fire fighter. The com- mittee also added additional appendix text in the areas of ADA requirements, explanatory material for both fire department administrators and fire department physicians, and sample physician checklist forms. Additional explanatory material was added or enhanced to provide the user with addi- tional information regarding medical conditions whose categories were changed. These included a number of cardiac conditions, diabetic conditions, seizure disorders, asthma, and therapeutic anticoagulation. 1582-1 1582-2 MEDIC'iL REQUIRUIENTS FOR FIRE nC HTERS AND NF01LN1J`T1ON FOR FIRv nmi n,raer%— The 2000 edition of this standard reflects (1) the technical committee's recognition that medical technology is continually changing and (2) the committee's effort to incorporate those medical technology changes within the standard jarsc as the committee recognizes med- ics! technology advances, it is incumbent on the re dea fi department physician changes in the essential lunch®ns rit to communicate with the fire { Conversely, the fire department physician must keep the fire dhe fire department performs. est changes in the medical field. Partrrtenc updated on the lac - Fire department physicians are the that allowing the fire de Primary users °f . iFPA 158:. Committee members feel abili to pent Physician more latitude in determination of a member's n' Perform essential functions will assist users in enforcing the standard. Therefore, the committee has changed the tide of the standard to [vFPA 158'� Stan menu commior ttee Ftgieters and 11(mmotfon%r Fmr Department p4rirrara,c lord on Afidfur! Rsquira� {. The topic of incident scene rehabilitation and accountability are included in this edition, since the fire department physician may provide guidance or assistance at the rehabilitation unit. In addition. specific areas concerning the following conditions were clarified or expanded: cardiac, vision, hearing, neurological, and metabolic. those of 29 An appendix was added to this edition comparing the requirements of this standard with of both docume1910.134, ttsl and this appen�� clarifies the companion a regulation. There are many users areas of each. 5 20O0 EdNlon .�. CO`IMITTEE PERSONNEL Technical Committee on Fire Service Occupational Medical and Health MurM L LaMar Chair Virginia Beach Fire DepL, VA [U] Rep. NFPA Fire Service Section David J. Barillo, U.S. Army Inst. of Surgical Research, TX (SE] Kimberly S. Bevbw BicrCara. MI (SE] Paul "Shan' Blake, City of Baytown Fire & Rescue Services. TX (E) Rep. Industrial Emergency Response Working Group Slaty S. Bogudd, Yale University. CI [SE] Anthony L CLarit, Kenton County Airport Board, OH [U] 'Thomas J. Cuff. Jr., Firemens Assn. of the State of New York. NY (U] Tammy DiAnda, Reno Fire Dept., NV (U] John F. Folan, Northside Medical Assoc., NY (SEJ Richard D. Gerkio, Jr., Good Samaritan Hospital/Phoeni.< Fire Dept., AZ (E] Juan Gonsalea, Medfiem The Exercise Science Inst., TX (RT] W. Limy Kenney, Penn State University, PA CRT] Rep. Landy Jacobs & Assoc. Sandra Kirkwood, Las Vegas Fire Dept., NV (U] Frank P. Mina New York City Fire Dept., NY [U] Gary L Neilson, Truckee Meadows Fire Protection District. NV (U] Rep. Fire Dept. Safety Officers Assn. David W. Dodson, Loveland Fire Dept. CO (U] (AIL to G. L Neilson) Michael S. Gray, Virginia Beach Fire Dept, VA (U] (Alt to M. E. Lotlin) Stephen N. Foley, NFPA Staff Liaison 1582_8 Deborah L Pritchett, Lawrence Township Fire Dept., IN (L] Rep. Indianapolis Metropolitan Professional Fire Fighters Union Gordon H. Sachs, IOCAD Emergency Services Group. Pk (SEJ Rep. Fairfield Community Fire Co., Inc. Daniel G. Sarno, EN H • OMEGA. IL (SE] James Sewell, Seattle Fire Dept., WA (L] Rep. Int'i Assn. of Fire Chieh Philip C. Stittleburg, LaFarge Fire Dept.. WI (L] Rep. Nat'l Volunteer Fire Council RobertM. Straanan, West Metro Fire Protection District, CO CRT] Rep. Metropolitan State College of Denver Andy C. Teeter, Tulsa Fire Dept., OK (U] Rap. Int'I Fire Service Training Assn. KathyTlnios, Cooperative Personnel Services. CA (SE] Teresa Waon, Santa Ana College. CA (SE) Don N. Whittaker, Lockheed -Martin Idaho Technologies Co.. ID (E) Decker Williams, Phoenix Fire Dept.. AZ (E] 11arnas R, Luby, New York City Fire Dept., NY (U] (AIL to F. P. Mineo) Brian V. Moore, Phoenix Fire Dept, AZ (E] (AIL to D. Williams) This fist rep►eserts Ihs membership at d a time the Committer was baBored on de final leW of tits edition. Sinea that time, changes in the membership may have occmod. A key to clatrifcatiorts it found at the back of the datsiment NOTE. Membership on a committee shall not in and of itself consdtute an endorsement of the Association or any document developed by the committee on which the member serves. Committee Scope: This Committee shall have primary responsibility for documents on occupational medi- cine and health in the working environment of the fire service. 2000 Edition 1582--4 `IEDIC,iI, REQUIREMENTS FOR Fin FiGHTE(tg AaVD INFORMATION FOR FIRE DEPART ENT !MS1C"%4S Contents Chapter 1 Administration . 1-1 Scope .......... , ' ' ................ 1582-5 ............°..... 3-18 Tumors 1.2 Purpose.. 1582- 5 .............. . ...... I582- g 1-3 Implementation 3.19 and b[alignant Diseases..,.......158 Psychiatric Conditions........... 2-10 . 14 Definitions......... ' 1582- 5 1582-11 20 Chemicals, Drugs, and 4fedications.. 1582- 5 1582-I1 Chapter 2 Medical process Chapter 4 Infectious Disease program 2-1 Medical Evaluation Process 1582- 6 . ........ . 4" Infection Control Program ,1582-11 2.2 Fire De 1582- 6 Department Roles. .. 4-2 Exposure Incidents ' ' , • • • 1582-11 2-3 Preplacrment Medical Eunice ' . ' ' ' ' i582- 6 . .... � � ` . ' . ' ` ` ° ° ' . 1582-11 `I-3 Tuberculosis. 2-1 Periodic Medical E tion........ 1582- 6 Evaluation , 4-4 Immunizations ' ° ......* . . ° ' ' ..... 1582-11 lions. , 2-5 Return -to -Duty Medical Evaluation . ' ' • 1582- 7 , . ....... • ..... 1582-11 ....... I M2- 7 2'6 Medical Evaluationds,R Retards, Results, Chapter p 5 Incident Scene Rehabilitation Reporting, and Confidentiality �' and and Medical Treatment ° I532- 7 Chapter 54 ° ° ` ' ° 1582-11 Scene Rehabilitation 3 Category ,� and Category B , , , . 5.2 Incident Scene Safe ....... 1582-11 `fedical Condition ... 3-1 Medical Conditions 1582- 8 Wecdng 5.3 ry and Health ...... , , 1582-11 Evaluation and Triage of , Ability to P erform., Member Injuries ... . 3-2 Head and Neck....... ° . . • . • � , • ' ` ' . ' ' • 1582- 8 5-} In ...•....••... ••••1582-11 incident Scene Rehabilitation 3-3 ' ' ' ° ° • • • • • • • • • .. 1582- 8 Eyes and Vision.. Tactical Level Management Component. 3-4 Ears and Hearin ........... ' ..... 1582- 8 , ............... 1582-11 3-5 Dental ..... 8 1582- 8 Chapter 6 Referenced Publication.. ' 1582- 8 3-8 No,c, OrOand Trachea, . ........ . . 1582-12 Pharynx, Esophagus, Appeodix.l Explanatoryy Material ' ....... 1582- 8 3-7 Lungs and Chest Wall. 1582-12 , . . . Hean and Vascular System , , ' ° ' ' • 1582- 9 Appendix B Information for Fire De . . 3-9 Abdominal Or 1582- 9 Bps and Castrointesdnal Pbysiq� .... Patent System ... 1582-21 �. 3-10 Genitourinary...................... 1582- ...... ......... 3-11 a Appendix C un� nsStrvetnryi FireaFFlghtiag Spine, Scapulae,�tem . . 1582- 9 Ribs, and Sacroiliac Joints . 1582-26 . 3-12 Extremities . • ........ ` . ' ' ' ' ` ' • • • 1582-10 Appendix D Guide for Fire DePnent . 3-13 Neurological Disorders1582-10 as . 3-14 Skin.. .,.... 1582-10 ...................1582-26 3-15 Blood and Blood•Fo • • ° ' ' " ° 1582-10 rmlic Organs Appendix E Sample Forms 3-�b Endocrine 'rid Metabolic D' ...... 1582-10 . , ... .... • ....... . 1582-33 3-17 Systemic DiseasesDisorders .. , . , 1582-10 and �lucelianeaua Appendix F Referenced Publications , Conditions.......,. 1582-33 .................. 1582-10 index ......•.,... .......1582-48 6 4 2000 Ed"an AmitNls-myrION L582-5 NFPA 1582 Standard on Medical Requirements for Fire Fighters and Information for Fire Department Physicians 2000 Edition NOTICE: An asterisk (`) following the number or letter des ignating a paragnph indicates that explanatory material on the paragraph can be found in Appendix.AL Information on referenced publications can be found in Chapter 6 and Appendix F. Chapter 1 Administration 1-1 Scope. WA This standard shall contain medical requirements for members, including full-time or part-time employees and paid or unpaid volunteers. It also shall provide information forphv- sicians regarding other areas of fire department medicine, including infection control and fireground rehabilitation. 1-1.2 'These requirements are applicable to public, govemmen- tal, military, private, and industrial fire department organizations providing rescue, fire suppression, emergency medid services. hazardous materials mitigation, special operations, and other emergency services. 14.3 This standard shall not: apply to industrial fire brigades that also can be known as emergency brigades, emergency response teams, fire teams, plant emergency organizations, or mine emergency response teams. 1-2 Purpose. 1-2.1 The purpose of this standard shall be to specify mini- mum medical requirements for candidates and current mem- bers. it also shall provide other information regarding fire department activities that assist the department physician in providing proper medical support for members. 1-2.2* The implementation of the medical requirements out- lined in this standard shall help ensure that candidates and current members are medically capable of performing their required duties and shall help to reduce the risk of occupa- tional injuries and illnesses. 1-2.3 Nothing herein shall be intended to restrict any jurisdic- tion from exceeding these minimum requirements. L-3 implementation. 1-3A For candidates, the medical requirements of this stan. dard shall be implemented when this standard is adopted by an authority having jurisdiction, on an effective date specified by the authority having jurisdiction. 1.3.2* When this standard is adopted by a jurisdiction, the authority havingjurisdiction shall set a date or dates for cur- rent members to achieve compliance with the requirements of this standard and shall be permitted to establish a phase - in schedule for compliance with specific requirements of this standard in order to minimize personal and departmental disruption. 14 Derutitions. 14.P Approved. Acceptable to the authority having juris- diction. 14.2* Authority Having jurisdiction. The organization, office. or individual responsible for approving equipment, materials, an installation. or a procedure. 1-4.3* Candidate, A person who has made application to commence performance as a member. 14.4 Category A Medical Condition. A medic -at condition that would preclude a person from performing as a member in a training or emergency operational environment by presenting a significant risk to the safety and health of the person or others. 14.5 Category 8 Medical Condition. A medical condition that. based on its severity or degree, could preclude a person from performing as a member in a training or emergency operational environment by presenting a significant risk to the safety and health of the person or others. 14.6 Drug. Any substance, chemical, over-the-counter medi- cation, or prescribed medication that could affect the perfor- mance of the member. 14.7 Essential Job Function. Task or assigned duty that is critical to successful performance of the job. 14.8 Evaluation. See Lledical Evaluation. 1-4.9 Ecposure Incident. A specific eye, mouth, or other mucous membrane, non -intact skin, or parenteral contact with blood, body fluids, or other potentially infectious materi- als, or inhalation of airborne pathogens, ingestion of food - borne pathogens or toxins. 14.10 Fire Department physician. The licensed doctor of medicine or osteopathy who has been designated by the fire department to provide professional expertise in the areas of occupational safety and health as they relate to emergency services. 14.11 Functional Capacity Evaluation. An assessment of the correlation between that individual's capabilities and the essential job functions. 14.12 Health and Ftnesr Coordinator. The person who, under the supervision of the fire department physician. has been desig- nated by the department to coordinate and be responsible for the health and fitness programs of the department. 14.13 Health and Safety Officer. The member of the fire department assigned and authorized by the fire chief as the manager of the safety and health program and who performs the duties and responsibilities specified in this standard. This individual can be the incident safety officer or that can also be a separate function. 14.14 Wection Control officer. The person or persons within the fire department who'ace responsible for managing the department infection control program and for coordinat- ing efforts surrounding the investigation of an exposure. 1-4.15 Infection Control Program. The fire departments for- mal program relating to the control of infectious and commc a nicable disease hazards where employees, patients, or general public could be exposed to blood, body fluids. or other potentially infectious materials in the fire department work environment. This program includes, but is not limited to, implementation of written policies and standard operating procedures regarding exposure follow up measures, immuni- sations, members' health screening programs, and educa- tional programs. 20M Etthon 158`:-ti `iEDiCAL REQtItRE`IE, VTS FOR FiRE FIGHTEMA.Vi7 INF oR`aertoly F 1-•[.16 Medical Evaluation. The the purpose of makin a Bete analysis of information, for lion. ,�Iedieal evaluation can Inrtninaeion of medical eertifip- 1-1.17 Medical de medical estamination. directed b taaO11' An examination performed or 14.18 y the fire department physician. "ellicalSer4 mint--sueh as farst aid, Eamerge"Y- The provision of treat. lifesu art ads d° cardiopulmonary resuscitation, PP advanced life support, and other pre -hospital pro, basic eedurp including ambulance transportation --to patients_ 1-4.19 &1edically Cer�ed meet physician that the A determination by the fire depart. medical r candidate or current member meets the require of this standard. 1-4.20• Member. and responsibilities Of afireide tied in Performing the duties of the organization. ,� fire department rtment, under the auspices time or Part-time employee Pavement member can be a fult- occupy any Position ploryee r a paid or unpaid volunteer, can can engage in emergency within the fire department, and 1-f<.20.! h[ena 3enty operations. bee and whose Cwrett, A person who is already a me hose duties require the performance of m• fire -fighting functions, essential 1-4.21 Shall. Indicates a mandatory requirement, 1- -22 Should. Indicates a recommendation or that which is 1-4'23 Standard- A document, the main text of which con- rains only mandatory pr®visions using the word "shall" to i cate requirements and which is in a form generally mandatory referencendt- coon into w. L*4onmandat®®�erstandardorcodeorforadoor appendix, footnote, or finery Provisions shall be located in an sidered a part of the requirement note and are not to be con OR FiRE DEP.IR'RIENT PH'tSICLlti5 2.2 Fire Department Roles 2-2.1 The fare department shall have an officially designated Physician who shall be responsible for riding, advising the members � directing suitability for du with regard to their health, film ' and s. D.p.,Y„� t?ccu P tya ral equired by tYFPA 1300, Stand", o and 2.2.2' Safety and Heald, Program on The fire department physician shall be a licensed for of medicine or osteopathy, doc- 2-2.3' For the purpose of conducting the fire department Physician shall understand evaluations to ieal and Psychological rand the physiolag understand t}t al demands placed on members and shall mem- bers must a environmental conditions under which Perform. The fire department shall dmem_ d�pa«cnr physician with acurrentjobdescriptionfortall fire Positions and ranks. 2.2.4 The fire department shall require that the fire de ment health and safety officer and the health dinator main pare Lain a liaison with the fire departmentand ft physician coon_ to ensure that the Health maintenance prcess for th department is maintained. P ysician e fire 2-2.5 Fire Department Physic Roles. 2.2.5.1 The fee de son to ascertain the department physician shall evaluate the pec- in this standard any medical conditions listed 2-2.3.2 when medical evaluations are conducted bays physician other than the fire department physician, the evaluation' hall be reviewed and approved b "is of a s Y the fire department physician. 1-4.24 Tacdeal Level ►y�ge standard. � 2-3' PreplacemeAt Midi management unit iden .an a theinctdent management al Evaluation. Po®ent (7TI MC). A 2-3.1 The candidate shall be certified b sem common( "division," " oar as meeting Y Y kn®tam as g mint sys_ Physician the Fire department gr p." or "sector." of this standard g the °medics! requireme Chapter 2 Medical process 2-1 Medical Evahradon Prone, , 2-1.1 * The fire department shall establish and implement a medical evaluation process for candidates and current members, P mint 2 1.2 The medical evaluation process shall include mane medical evaluations, per!®die medical return -to -duty preplace- ry medical evaluations. evaluations, and 2-1.3 The fire department shall ensure that the medical eval- uation process and all medical evaluations meet all of the requirements Of Section 2.1, 2.1.4 Each candidate or current membershalt coo hall r and comply with the medical evaluationProcess shall provide complete and accurate info pirate, par. department physician. rmadoto tand e fire 2-1.5• Each candidate or current member shall re time( basis, to department medical condition that could interfere Port' on a Physician any exposure or individual to perform as a Member.ere with the ability of the 2-1.6 The medical evaluation shall be at no cost to the candi. date. current member, or other member. 2000 Ediffen prior to entering nes of Chapter 3 performing become a member or nng into a training Program to tional environment as a orming in an emergent, ®Peat• member. 2.3.2 The candidate shall be ical requirements of Chapter 3 fat°d according to the mid_ forma of medical conditions on th this standard to assess the a candidate's ability to per- form as a member. 2.3,3 Acandidate shall not be certified as meeting the medi. cal requirements of this standard if the fire departmen t physi- cian determines that the candidate has an medical that as specified in Chapter 3 a this standard. Category A 2-3.4' A candidate shall not be certified as theme ical requirements of this standard if the fire depart the med- sician determines that the can department phy. medical condition as specified in Chapter 9 of this standard that is of sufficient severity to prevent the candidate from Performing, withor of a or with essential functioout reasonable accommodation. the risk to member without Posing a significant the safety and health of the candidate or others. 2-3.4,1 The determination of cv modation shall be made b heeher a reasonable aceom- conjunction with the fire the authority havingjurisdiction in Partment physician, -3.5 If the candidate presents with an acute medical problem or newly acquired chronic medical condition that interferes with the candidates ability to perform the functions ofa mem- ber, medical certification shall be postponed until that person `lED!(.lL PRUt;EaS 133;!m7 has recovered from this condition and presents to the fire department for review. 240 Periodic Medical Evaluation. 24.1 The current member shall be certified annually, or at the request of either the fire department or die member, by the fire department physician as meeting the medical require. ments of Chapter 3 of this standard in order to determine that member's medical ability to continue participating in a train- ing or eme ,envy operational environment as a member. Any applicable OSH.3 standards, such as '29 CFR 1910.111). "Haz- ardous Waste Operations and Emergency Response."''29 CFR 1910.134. "Respiratory Protection," 29 CPR 1910.95. "Occupa- tional Noise Exposure,- and 29 CFR 1910.1030, "Bloodborne Pathogens," shall be followed. 24.1.1 The components of the annual medical evaluation as specified in 24.1.2 shall be permitted to be performed by qualified personnel as authorized by the tire department physician. When other qualified personnel are used. the fire department physician shall review the data gathered daring the evaluation. 24.1 2 The annual medical evaluation shall consist of the fol- lowing: (1) An interval medical history (2) An interval occupational history, including significant exposures (3) Height and weight (4) Blood pressure (5) Heart rate and rhythm 24.1.30 In addition to the annual medical evaluation, the fire department shall include a medical examination according to the following schedule: (1) Ages 29 and under — at least every 3 years (2) Ages 30 to 39 — at least every 2 years (3) Ages 40 and above — every year 24.1.40 The medical examination shall include examination of the following components: (1) Vital signs — namely, pulse, respiration, blood pressure, and, if indicated, temperature (2) Dermatological system (3) Ears, eyes, nose, mouth, throat (4) Cardiovascular system - (5) Respiratory system (6) Gastrointestinal system (7) Genitourinary system (3) Endocrine and metabolic systems (9) Musculeskeletal system (W) Neurological system (11) Audiometry (12) Visual acuity and peripheral vision testing (13) Pulmonary function testing (14) Laboratory testing, if indicated (13) Diagnostic imaging, if indicated (16) Electrocardiography, if indicated 24.2 A current member shall not be certified as meeting the medical requirements of this standard if the fire department physician determines that the member has any Category A medical condition specified in Chapter 3 of this standard. '2-4.3v A current member shall not be cerufred as meeting the medical requirements of this standard if the fire department physician determines that the member hats a Category B con- dition specified in Chapter 3 of this standard that is of sufii. cient severity to prevent the member from performing, with or without reasonable accommodation, the essential functions of a member without posing a significant risk to the safety and health of the member or others. 24.3.1 The determination of reasonable accommodation shall be made by the authority haling jurisdiction in conjunc. tion with the fare department physician. 24.4 If the current member presents with an acute illness or recently acquired chronic medical condition, the evalua. tion shall be deferred until the member has recovered from the condition :and presents to the fire department to return to duty. 2-5 Return -to -Duty Medical Evaluation. 2.5.1 " A current member who has been absent from duty for a medical condition of a nature or duration that could affect performance as a member shall be evaluated by the fire department physician before returning to duty. 2.5.2 The fire department physician shall not medically cer. tify the current member for return to duty if any Category A medical condition specified in Chapter 3 of this standard is present. 2-5.30 The fire departement physician shall not medically cer- tify the current member for return to duty if any Category B medical condition specified in Chapter 3 of this standard is present that is determined to be severe enough to affect the member's performance as a member. The fire department physician, in conjunction with the authority having jurisdic- tion, shall take into account the member's current duty assign- ment and alternative duty assignments or other programs that would allow a member to gradually return to full duty. 2-3.40 The department shall provide guidance, opportunity. and encouragement to the member so as to expedite his safe return to full duty. 2-6 Medical Evaluation Records, Results, Reporting, and Coufrdentiallty. 2.6.1 All medical information collected as part of a medical evaluation shall be considered confidential medical informa- tion and shall be released by the fire department physician only with the specific written consent of the candidate or cur- rent member. 2.6.2 The fire department physician shall report the results of Elie medical evaluation to the candidate or current member, including any medical conditions) disclosed during the med- ical evaluation, and the recommendation as to whether the candidate or current member is medically certified to perform as a member. 2.6.3 The fire department physician shall inform the lire department fire chief or designee only as to whether or not the candidate or current member is medically certified to per- form as a member. The specific written consent of the candi- date or current member shall be required in order to release confidential medical information regarding this condition to the fire department 2-6.4 All medical record keeping shall comply with the requirements of 29 CFR 1910.20, "Medical Recordkeeping." Z000 Edition 1582-$ 6tEDlGaL REQUiRE`tEYrS FOR FIRE FI CRMRS A.tiD 1NFOR ATION FOR FTR v nv® a a°r% Chapter 3 Category A and Category B Medical Conditions 34 Medical Coodidans Affecting Ability to Perform. gory A and Category B Caee• medical conditions shall help the examiner understand the type of condition that could result in rejection or acceptance. The medical conditions listed are organized by organ sv with the lstem. In the corresponding Appendix A explanatory material, a diagnostic example is often included ist in addition, the rationale for the rejection is pre• sensed in terms of the effect of the medical condition on the capability of the person to perform as a member. 3.2 Head and Neck 3-2.1 Head. 3-2.1.1 There shall be no Category A medical conditions. 3-2.1.20 Category 8 medical conditions shall include the fol. lowing: (1) Deformities of the skull such as depressions or exostoses (2) Deformities of the skull associated with evidence of dis. ease of the brain, spinal cord, or peripheral nerves ' (3) Loss or congenital absence of the bony substance of the skull (4) Any other head condition that results in a person not being able to perform as a member 3.2.2 Neck. 3-2.2.1 There shall be no Category A medical conditions. 3-2.2.2+ Category B medical conditions shag include the fol. lowing. (1) Thoracic oudetsyndrorne (2) Congenital cysts, chronic draining fistulas, or similar lesions (3) Contraction of neck muscles (4) Any other neck condition that results in a person not being able to perform as a member 3-3 Eyes and Vision. Category ry A medical conditions shall include the fol. lowing:g (a) Far visual acuity. Far visual acuity shall beat least 20/30 binocular, corrected with contact lenses or spectacles. Far visual acuity uncorrected shall be at least 20/ 100 binocular for wearers of hard contacts or spectacles. (b) PMphrral t'iria.. Visual field performance without cor. recrion shall be 140 degrees in the horizontal each eye. meridian in 3.3.20 Category B medical conditions shall include the fol. lowing: (l) Diseases of the eye such as retinal detachment, progres- sive retinopathy, or optic neurids (2) Ophthalmological procedures such as radial keratotomy or repair of retinal detachment (3) Anvother eye condition that results in a person not being able to perform as a member 2000 Edition .—.•e ci7 SaLl-"N5 3'4 Ears and Hearing, 3-4.1 There shall be no Category A medical conditions. 3'4.2+ Category B medical conditions shall include the fol. lowing: (a) Hang deficit in the pure tone thresholds in the unaided worst ear that Is (1) Greater than 25 dB in three of the four frequencies a. 500 Hz b. 1000 Hz c. 2000 Hz d. 3000 Hz OR (2) Greater than 30 dB in anyone of the three frequencies a. 500 Hz b. 1000 Hz c. 2000 Hz AUND (3) In addition averages greater than 30 dB for the four fre. quencies a. 500 Hz b. 1000 Hz C. 2000 Hz d. 3000 Hz (b) Unequal hearing loss (c) Atresia, severe stenosis, or tumor of the auditory canal (d) Severe external otitis (e) Severe agenesis or traumatic deformity of the auricle (f) Severe mastoiditis or surgical deformity of the mastoid (g) Meniere's syndrome or labyrinthitis (h) Otitis media (i) Any other ear condition that results in a person not being able to perform as a member and results in a person being unable to pass a job -specific functional hearing task test or a hearing in noise test. 3.5 DentaL 3-5.1 There shall be no Category medical conditions. 3-5.2+ Category B medical conditions shall include the fol. lowing (1) Diseases of the jaws or associated tissues (2) Orthodontic appliances (3) Oral tissues, extensive loss (4) Relationship between the mandible and maxilla that pre- cludes satisfactory postorthodontic replacement or abil- ity to use protective equipment (5) Any other dental condition that results in a person not being able to perform as a member 3-6 Nose. OroPW"Xv+ Trachea . EloPbagu+, and Larynx, 3.6•1+ Category medical conditions shall inclu de ude the fol- (1) Tracheostomy (2) Aphonia 3-6'2` Category B medical conditions shall include the fol- lowing: (1) Congenital or acquired deformity (2) Allergic respiratory disorder a GkTEGORYAAND WEGORYB MEDICALCONDITIONS 1582-9 (3) Sinusitis, recurrent (4) Dysphonia (3) Anosmia (6) Any other nose, oropharynx, trachm esophagus, or lar- ynx condition that results in a person not being able to perform as a member or to communicate effectively 34 burgs and Chest Wall. 3.7.10 Category A medical conditions shall include the fol- lowing: (1) Active hemoptysis (2) Empyema (3) Pulmonary hypertension (4) Active tuberculosis 3.7.21, Category B medical conditions shall include the fol- lowing (1) Pulmonary resectional surgery, chest wall surgery, pneu- mothorax (2) Bronchial asthma or reactive airways disease (3) Fbrothomt. chest wail deformity, diaphragm abnormalities (4) Chronic obstructive airways disease (5) Hypoxemic disorders (6) Interstitial lung diseases (7) Pulmonary vascular diseases, pulmonary embolism (8) Bronchiectasis (9) Infectious diseases of the lung or pleural space (10) Any other pulmonary condition that results in a person not being able to perform as a member 3-8 Heart and Vascular System. 38.1 Heart. 3-8.1.1* Category A medical conditions shall include the fol- lowing. (1) Angina pectoris, current (2) Heart failure, current (3) Acute pericarditis, endocarditis, or myocarditis (4) Syncope, recurrent (5) Automatic implantable cardiac defibrillator 318.1.2* Category B medical condidons shall include the fol- lowing: (1) Significant valvular lesions of the heart, including pros- thetic valves (2) Coronary artery disease, including history of myocardial infarction, coronary artery bypass surgery, or coronary angioplasty, and similar procedures (3) Atrial tachycardia, flutter, or fibrillation (4) Left bundle branch block, second- and ehirddegree atri- oventricular block (5) Ventricular tachycardia (6) Hypertrophy of the heart (7) Recurrent paroxysmal tachycardia (8) History of a congenital abnormality (9) Chronic pericarditis, endocarditiss, or myocardids (10) Cardiac pacemaker (11) Coronary artery vasospasm (12) Any other cardiac condition that results in a person not being able to perform as a member 3-8.2 Vascular System. 3-8.2.1 There shall be no Category A medical conditions. 34.2.20 Category B medical conditions shall include the fol- lowing- (1) Hypertension (2) Peripheral vascular disease such as Raynaud's phenome- non (3) Recurrent thrombophlebitis (4) Chronic lymphedema due to lymphadenopathy or severe venous valvular incompetency (5) Congenital or acquired lesions of the aorta or major ves. sels (6) Marked circulatory instability as indicated by orthostatic hypotension, persistent tachycardia, and severe periph. eral vasomotor disturbances (7) Aneurysm of the heart or major vessel (8) Any other vascular condition that results in a person not being able to perform as a member 3-9 Abdominal Organs and Gastrointestinal System. 3-9.1 There shall be no Category A conditions. 3-9.2* Category B medical conditions shall include the fol- lowing- (1) Cholecystitis (2) Gastritis (3) GI bleeding (4) Acute hepatitis (5) Hernia (6) Inflammatory bowel disease (7) Intestinal obstruction (8) Pancreatitis (9) Resection, bowel (10) Ulcer, gastrointestinal (11) Cirrhosis. hepatic or biliary (12) Chronic active hepatitis (13) Any other gastrointestinal condition that results in a per- son not being able to perform the duties of member 3-10 Genitourinary System. 3.10.1 Reproductive. 3-10.1.1 There shall be no CategoryA medical conditions. 3-10.1.20 Category B medical conditions shall include the fol- lowing- (1) Pregnancy, for its duration (2) Dysmenorrhea (3) Endometriosis, ovarian cysts, or other gynecologic con- ditions (4) Testicular or epididymal ma33 (5) Any other genital condition that results in a person not being able to perform as a member 3-10.2 Urinary System. 3.10.2.1 There shall be no Category A medical conditions. 3-10.2.2* Category B medical conditions shall include the fol- lowing: (1) Diseases of the kidney (2) Diseases of the ureter, bladder, or prostate (3) Any other urinary condition that results in a person not being able to perform as a member 20M Editlon 1382—IU i1EDIC.sII v REQUtREtitEa TS FOR FIRE FIGHTERS AY,D 1NF4 R. LATIOr4 FO 3-1 l S R FIRE DEPART`IENT PMSiC pine, Scapulae, Ribsand G0.NS Sacroilia�Jointr. 3-11.1 There shall be no , Category A medical conditions 3" 1.2* Category B medical conditions shall include the fol- lowing: (1) Arthritis (2) Structural abnormality, fracture. or dislocation (3) Nucleus pulp°sw. herniation of, or history oflaminec- torny, dlseeeeomy or fusion (4) Ankylwig n s ond ($) Any ochersp spinal cotndition that results in a e being able to perform as a member p Cron not 3-12 Extremities. 3.12.1 There shall be no o CateS 3-12t.2m tY A medical conditions. Category B medical conditions shall include lowing: the fol. (1) Limitation of motion of a joint (2) Amputation or deformity Dies )Dine °r limb (3) Dislocation of a joint (1) Point reconstruction, ligamentous instability, or replacement (5) Chronic osteoa joint (6) lnilammato rthrid3 or traumatic arthritis (7) Any Other e.xtremity being able to perform that results in a person not Q rnt as a member 3.13 Neurological Disorders. 3-13.1• Category, A medical lowing: conditions shall include the fol- (2) Cerebral®f heredo.degeneradve type episodes of neurolo rosin as evidenced by documented (3) Multiple sclerosis wig'CW'mPmirntent within previous threth e years activity or evidence of progression ('1) Progressive muscular dystrophy or atrophy (,) All epileptic conditions to include simple partial, complex other t generalized, and psych®motor seizure disorders than those with complete control during previous five Yeas, normal neurological examination ` tive statement from qualified near ar c ` and defini- 3.13.2 If an epileptic Bl specialist Free irate P put member experiences a five-year seizure- rval resulting from a than that individual shall not be cleared for re in eturn medical - duty until he or she h regimen, on the new re completed five ea" w without regimen. Y without a seizure 3-13.30 Category B medical conditions shall include the fol- lowing; (1) Congenital (2) Migraine malformations (3) Clinical disorders with paresis, paralysis, dyscoordina- tion, deformity, abnormal sensation, or complaint motor activity, abnormality of (4) Sub Plaint of pain arachnoid or intracerebral hemorrhage (a) Abnormajities from recent head injury such as severe cerebral contusion or concussion (6) Any other neurological condition Chat results in a e not being able to perform as a member p Cron 2Gpo Edition 3-14 Skin, 3.14.1 There shall be no Category A medical conditions. 3"1'1.2' Category B medical conditions shall include the fol- lowing.. (1) Acne or inflammatory skin disease (2) Eczema (3) AnYotherdennatologic condition that results in the per- son not being able to perform as a member 3.15 Blood and Blood-Fornteng ®ram 3"5.1• Category A medical ical conditio ns shall include the fo!- (1) Hemorrhagic states requiring replacement therapy (2) Sickle cell disease (homozygous) 3.15-2' Category B medical conditions shall include lowing the fol- e (1) Anemia (2) Leukopenia (3) Polvcythemis very (4) SplenomegaiY (`) History of thromboembolic disease (6) Any other hee able condition that results in a per- son not being beperform as a member 3.16 Endocrine and Metabolic Disor Diabetes mellitus, which is treated with Oral hypoglycemic agent and where an individual th ultra or an ry of one or more episodes of incapacitatingh a history be a Category medical condition. yPoglycemia, shall 3-16.20 Category B medical conditions shall include the fal- lowing (1) Diseases of the adrenal 1 roid gland, or thyroidgland, pituitary glandifi, parathy (2j Nutritional deficiency disease orand of Lme metnical abolic disorder (3) Diabetes melfitw requiring treatment with insulin or oral hypoglycemia Imic agent without a history of incapacitating (`I) Arty other endocrine or metabolic condition that results in a person not being able to perform as a member 3.17 Systemic Disease and M+sCellaneoua Conditions. 3-17.1 There shall be no Category A medical conditions. 3-17.2' Category B medical conditions shall include the fol- lowing; (1) Connective tissue disease, erythematosw such as dermatomyositis, lupus (�) Residuals from scleroderma, and rheumatoid arthritis (3) Residuals Past thermal injury with recurrent episodes or revidence Of a esulting sultinto heat stress (4) `ray other systemic condition that B ul� inaI injury being able to perform as a member person not 3.18 Tumors and Malignant Diseases. 3-18.1 There shall he no Category medical conditions. 3.18.2• Category B medical lowing; conditions shall include the fol- (1) Malignant disease that is newly diagnosed, untreated, or currently being treated. INCIDENT SCENE REMUIL1T.LTION AN0 4tEDIGOL.IREAT`IENT 1582-1 1 a. Candidates shall be subject to the provisions of 2.3.3 of this standard. b. Current members shall be subject to the provisions of 24.4 of this standard. (2) Treated malignant disease that is evaluated on the basis of an individual's current physical condition and on the likelihood of the disease to recur or progress. (3) Any other tumor orsimilar condition chat results in a per- son not being able to perform as a member. 3-19 Psychiatric Conditions. 3-19.1 There shall be no Category A medical conditions. 3-19.20 Category B medical conditions shall include the fol- lowing (1) A history of psychiatric condition or substance abuse problem ("_) Any other psychiatric condition chat results in a person not being able to perform as a member 3-19.3 Candidates and current members shall be evaluated based on the individual's current condition. 3.20 Chemicals, Drip, and Medication& 3.20.1 There shall be no Category A medical conditions. 3.20.20 Category B medical conditions shall include the use of the following, (1) Anticoagulant agents (2) Cardiovascular agents (3) Narcotics (4) Sedative-hypnotics (5) Stimulants (6) Psychoactive agents (7) Steroids (8) Any other chemical, drug, or medication that results in a person not being able to perform as a member Chapter 4 Infectious Disease Program 4-1 Infection Control Program. 4-4.1 The fire department shall maintain infection control programs as delineated in IVFPA 1581, Standard on Fire Depart- ment Infection Control Pmgram 4.1.2 The fire department physician shall maintain a liaison with the infection control officer specified in NFPA 1581. 4-2 Exposure incidents. 4-2.10 All blood and/or body fluid exposures shall be reported immediately, and medical assessment shall be pro- vided within 2 hours of exposure. N(edical assessment shall conform to current CDC guidelines. 4-2.24 All other exposure incidents shall be reported and assessment provided within 24 hours of exposure. 4-3 Tuberculosis. 4-3.10 The fire department shall provide a tuberculosis mon- itoring program that wall test members at least annually and as indicated by CDC guidelines. Tuberculosis (TB) testing inter - vats shall conform to current CDC guidelines. 4-3.20 All members shall be evaluated according to current CDC guidelines following any tuberculosis exposure. These results shall be communicated to and reviewed by the fire department physician. 4-V Immunizations. All members shall be immunized against infectinus diseases as required by the authority haying jurisdiction and by 29 CFR 1910.1030 "Bloodborne Patho- gens." The fire department physician shall ensure that all members are offered currently recommended immunizations. Chapter 5 Incident Scene Rehabilitation and Nfedical Treatment 5-1 Incident Scene Rehabilitation. 5-1.1" The fire department shall develop standard operating procedures that outline a systematic approach for the rehabil- itation of members operating at incidents. Provisions addressed in these procedures shall include medical evalua- tion and treatment, food and fluid replenishment, crew rota- tion, and relief from extreme climatic conditions. 5.1.21 The incident commander shall consider the circum- stances of each incident and initiate rest and rehabilitation of members in accordance with the fire departments standard operating procedures and with NFPA 1561. Standard an Emer- gency Seruica Incident Management System. 5.2 incident Scene Safety and Health 5.2.1 The incident safety officer shall ensure that the incident commander establishes an incident scene rehabilitation tacti- cal level management component during emergency opera - Lions as required by NFPA 1521, Standard for Fire Department Safety Officer: 5.2.211 Transport capable emergency medical services (EMS) shall be available in the incident scene rehabilitation tactical level management component for evaluation and treatment of members. Basic life support (BLS) shall be the minimum level of available care. Advanced life support (ALS) care is preferable where it is available. 5-3 Evaluation and Triage of Member Injuries. 1 In the event of an injury to a member during emergency operations, ENiS personnel shall assess and treat the injury based on local EMS protocol and fire department standard operating procedures. 5.3.2' Protocols and procedures guiding ENIS providers car- ing for ill or injured members during emergency operations shall be developed by the ENIS medical director in collabom- tion with the fire department physician and chief. 54 Incident Scene Rehabilitation Tactical Level `ianagement Component. 5.4.1 The rehabilitation tactical level management compo- nent shall be designated per department standard operat- ing procedures, such as large-scale incidents, long -duration incidents, or chose associated with significant temperature extremes. 5-1.2 The rehabilitation tactical level management compo- nent shall be established in a safe environment away from the hatardous area of the incident. 2cao Edition t1EDfe;lL ItL•c`t_°lREil@NTS FOR FIRE F(Gi•ffER5.t;ap INI:OKbLiTtr,N FOR FiRE DEP ORTtIE 54,3° The resources needed at the rehabilitation cacti level management component shall include an en v►ronmt to limit atrextrrss, medicalstaff. medical equipment, and adequ; 5-4•4` Members shall be_assigned to rehabilitation as p scribed by departmental standard operating procedur Unusual urcurrtstear such as Bong -duration incidents, see lions requiring heavy exertion. or severe weather eetrem Shall require an alteration in procedures. 5�-4.3• Members arrivi/ig at rehabilitation shall be brief questioned heat s r' medical state about any symptoms of dehyd lion, heat stress, cold •►tress, physical exlraitstion and/or ca diopulmonary abnormalities. Any member leaving signitica symptoms shall be moved to an area where assessment b advance lift support personnel can be Performed. -5 4•6 Members assigned to rehabilitation shall be to add/ remove clothing to regain normal body empetrature drink fluids (water, electrolvte replacement drinks), and rest. 54.7 No member shall be reassigned to return to dun• until medical evaluation and hydration has occurred for at least 10 minutes in rehabilitation and after being cleared by medical staff. 5 4-S All members entering and leaving rehabilitation shall be properly assigned by the incident management system and be cracked through the personnel accountability system. Chapter 6 Referenced Publicadons 6-1 The following doctunents or portions thereof are refer- enced within this standard as mandatory requirements and shall be considered part of the requirements of this standard The edition indicated for each referenced mandatory docu. ment is the current edition as of the date of the NFP.k issuance of this standard. Some of these mandatory documents might also be referenced in this standard for specific informational Purposes and, therefore, are also listed in Appendix F. ti-I.1 Napa publications, National Fire Protection Allocia- 101 I Baeterymatch Park, P.O. Box 9101, Quincy, tVLA 02_vgt9- 9101. tiFP.i pm , Standard on Fire Department Oeeuprrdlunal.Safety and Krrtlth 1'rograrrr, 1997 edition. NFP.k 1521, Standardf r Fier Department ,Safety pffheer [997 edition. NFPA 1. 20 .Standard on Emrrg ney Servieer lnc"'nt Ala nage. rrtesreSyrtem, 2000rdttton, rrrsm FPik 1581, .S14nd,,rd on Fin D,partment lnfecttun Control PYo- 000 edition. 6-1.2 U. S. Covern meet Publications, L.S. Gnrmmrnt Print ing Office, Washington, DC 20-Ipl, Title 29, Cuele ofFederal Rr! tlattunr, Part 1910.120, "H zard- ous Waste Operations and Emergency Response," 1986. Title 29, Code of Federal 1>!ettattinr, Part 19 10. 1S 4 "Respira- tory Protection," 1998. Title 29, Cuv4ofFiderd'uGrlirmt, Part 1910,95, "Occupa- tional ;Noise Exposure,' 1980. Title 29, Cotle of Federral Rit;�ttbtetuns, Pare 1910.20, 'Medical Recordkeeping,"1980. Title 29, Cov4 of Federal Re9rGrtiont, Part 19IO.10Jt), -Blood. Pathogens," 1�•y)5• 2Qoo Edlhon • VT P!•ifYSfGI.I.VJ APPend4 A Explanatory Material Appendix ,{ u rtnt rs part of lire re7uln'ments of chit :LFp,; . merit but er inclue4rl for infnrrnralmnal purpaset only. Thit.r re- cnntains rxpbtnatmy matarrnl numberrrl to comes and es. rab4 pp`n'iax ua-=tragrrrphr. p u+itlt the ai- rs A-1-2.2 There is a direct relationship between the medical requirements and the job description of members. The job description should include all essential job functions of mot_ iy bees, both emergency °�" a variety e emergency ' cY and nonemergency, Members erf r- operations including fire fighting emergency medical care, hazardous materials mid , do nt special o era n, and v P eons. tNonemergency ditties can include , and are not limited to, training, station and vehicle maintenance, and physical fitness. Each fire department needs to identify and d develop a written job description for members. Appendix C. Essential Fire -Fighting Functions, provides an e..cample of essential job functions for members. A 1-3.2 The specific determination of the authorihavin jurisdiction depends on the mechanism under h chrythis stag lard is adopted and enforced. Where this standard is adopted voluntarily by a Particular fire de its own U;se, the authority having jurisdiction should bentheofire chief or the Political entity that is responsible for the operation of the fire department. Where this standard is legally adopted and enforced by a body having regulatory authority over a fire department, such as federal, state, or local government or Political subdivision, this body is responsible for making those determinations as the authority having jurisdiction. The com- pliance program should take into account the services the fire department is required to provide, the financial resources available to the fire department. the availability of personnel, the availability of trainers, and such other factors as will affect the fire department's ability to achieve compliance. A'" ' 1 Approved, The National Fire Protection Association does ot approve, inspect, or certify any installations, proce- dures, equipment, or materials; nor does it approve or evalu- ate testing laboratories. In determining the acceptability of installations, procedures, equipment, ormaterials, theauthor- tn' having jurisdiction may base acceptance on compliance with NFPA or other appropriate standards. In the absence of such standards, said authority may require evidence of proper installation, procedure, or cue. The authority lion may also refer to the listings or labeling practi es of n organization that is concerned with product evaluations and is thus in a position to determine compliance with appropriate standards for the current production of listed items. A-14.2 Authority HavingJurisdicdon. The phrase "authority having jurisdiction' is used in NFPA documents in a broad manner, since jurisdictions and approval agencies vary, as do their responsibilities. Where public safety is primary, the authority havingjttrisdicrion may he a federal, state, local, or other regional department or individual such as a fire chief; fire marshal; chief of a fire prevention bureau, labor depart- ment, or health department; building official; electrical inspector, or others having statutory authority. For insurance Purposes, an insurance inspection department, rating bureau, or other insurance company representative may be the author- ity having jurisdiction. In many circumstances, the property owner or his or her designated agent assumes the role of the authority havingjurisdicuon; at government installations, the APPENDIX A 1582-13 commanding officer or departmental otPtcial may be the authority having jurisdictiun. A 1-4.3 Candidate. In an employment context, the Ameri- cans with Disabilities Act (discussed in further detail in Appen- . dix D) requires that any medical examination to be conducted take place after an offer of employment is made and prior to the commencement of duties. Therefore, in the employment context, the definition of the term candidatsshould be applied so as to be consistent with that requirement. Volunteer members have been deemed to be employees in some states or jurisdictions. Volunteer fire departments should seek legal counsel as to their legal responsibilities in these matters. A-14.20 Member. See Appendix C. Essential Structural Fire - Fighting Functions. A-2-1.1 See Appendix D. Guide for Fire Department Adminis- trator. A-2-1.5 Exposures and medical conditions that should be reported if they can interfere with the ability of the individual to perform as a member include, but are not limited to, the following- (1) Exposures to hazardous materials or toxic substances (2) Exposure to infectious or contagious diseases (3) Illness or injury (4) Use of prescription or nonprescription drugs (5) Pregnancy A-2-2.2 See Appendix D. Section D-2, Choosing a Fire Depart- ment Physician. A 2-2.3 See Appendix B. Information for Fire Department Physicians. Appendix C, Essential Structural Fire -Fighting Functions provides a generic description of job tasks per- formed by members. A fire department needs to provide the fire department physician with a job description of all posi- tions and ranks so that the fire department physician can understand the physical and mental demands placed upon all members regardless of position or rank. Appendix D, Guide for Fire Department Administrators, also provides guidance for ensuring that the fire department physician is provided with this information. A-2-3 See Appendix B, Section B-3, Guidance for Medical Evaluations. A-23.4 See Appendix D. Section D-1, Legal Considerations in Applying the Standard. A-24 See Appendix B, Section B-3, Guidance for Medical Evaluations. A-24.1.3 At the discretion of the fire department physician, an examination can be performed sooner than would be expected from the schedule given in 24.1.3. Current medical conditions and coronary risk factors could mandate more fre- quent medical examinauons. A-24.1.4 See Appendix B, Guide for Fire Department Phy- sicians. A-24.3 See Appendix D, Section D-1, Legal Considerations in Applying the Standard. A-2-5.1 A department should set protocols regarding length of time absent from duty and/or medical conditions that require the department physician to evaluate a member. A-2-5.3 See Appendix D. Section D-I, Legal Considerations in Applying the Standard. A-2-5.4 Physical therapy, strength training, work hardening, functional capacity evaluations, and alternate duty are all activ- ities that can be helpful. A► 3.2.1.2 Category B medical conditions of the head include the following: (1) Deformities of the skull. such as depressions or exos. toses, of a degree that interferes with the use of protec. tive equipment. Deformities of the skull can result in the member's inability to property wear protective equipment. (2) Deformities of the skull associated with evidence of dis. ease of the brain, spinal cord, or peripheral nerves. These deformities can result in the potential for sudden inca. pacitation, the inability to properly wear protective equipment, and the inability to communicate effectively due to oropharyngeal dysfunction. (3) Loss of or congenital absence of the bony substance of the skull (if associated with disease interfering with perfor mane or if appropriate protection cannot be provided for the area without interfering with protective equipment and vision). Loss of or congenital absence of the bony sub. stance of the skull can result in the inability to properly wear protective equipment and the inability to communi- cate effectively due to oropharyngeal dysfunction. (4) Any other head condition that results in a person not being able to perform as a member. X3-2.2.2 Category B medical conditions of the neck include the following- (1) Thoracic outlet syndrome (symptomatic). Thoracic out- let syndrome can result in frequent episodes of pain or inability to perform work. (2) Congenital cysts, chronic draining fistulas, or similar lesions (if lesions or underlying disease interferes with performance). Congenital cysts, chronic draining fistu- las, or similar lesions can result in the inability to properly wear protective equipment, and the inability to commu- nicate effectively due to oropharyngeal dysfunction. (3) Contraction of neck muscles (if it interferes with wearing of protective equipment or ability to perform duties). The contraction of neck muscles can result in the inabil- icy to properly wear protective equipment, and the inabil- ity to perform functions as a member due to limitation of flexibility. (4) Any other neck condition that results in a person not being able to perform as a member. A-3-3.1 Category A medical conditions of the eyes and vision include the following- (1) Far visual acuity. Far visual acuity is at least 20/30 binocu- lar, corrected with contact lenses or spectacles. Far visual acuity uncorrected is at least 20/100 binocular for wear- ers of hard contacts or spectacles. Successful long-term soft contact lens wearers (that is, sir months without a problem) are not subject to the uncorrected standard. Inadequate far visual acuity can result in the failure to be able to read placards and street signs or to see and respond to imminently hazardous situations. (2) Peripheral vision. Visual field performance without correc- tion is 140 degrees in the horizontal meridian in each eye. (`(embers, cannot have just monocular vision.) 2ro0 Edition 1.582—I 4 trCptt;V. RL•'QUtREdtCVTS FOR EI Rl: Fi1.,1lTER5.4,\D Iti}()R6L\ fIt},y FOR FIRE DC('.\ItT.LICYT t+►ns.,....... Monocular vision can result in sudden incapacitation when debris is lodged in one rye. Inadequate or compro. mired Peripheral vision can result in the following a. Failure to perform job duties and maintain visual con- tact with a partner b. Inability to maintain safety near moving objects C. Poor balance on uneven surfaces d- Unsuccessful performance in environments where visual cues are critical to personal safety A 3.3.2 Category B medical conditions of the include the following eyes and vision (1) Diseases of the eve such as retinal detachment, progres. sive recinopathv, or optic neuritis (severe orprogres These diseases of the eye can result isiee). h placards and street signs n the failure es or to see and respond to immi- nendy hazardous situations. (2) Ophthalmological procedures such as radial keratot- omv and repair of retinal detachment. With retinal detachment, sufficient time (1-2 weeks for radial kera- tonomy and Lasilt-type surgeries, three months for reti- nal detachment) must have passed to allow stabilization Of visual acuity and to ensure that there are no postsitr. gical complications. These dophthalmological proce- 3iures may result the faild failure to be able to re Placards and street signs or to see and respond to im a nently hazardous situations. (3) Any other eye condi don that results in a person not being able to perform as a member. Persons with severe color vision loss will likely fail the acuity requirement Formerly, color vision deficiency was listed as a Cate- gory B medical condition. However, it is felt that Withinmost cases this condition will not affect the ability of a member to perform the'essential functions of his or her job. The fire service physician should consider the color vision deFteiency of the individual and consider the color vision requirements of the member's job and reach an individual determination. A-3-#.2 There are currently no hearing tests that will fire department physician to aallow the allow predict whether the fire fighter will adequately be able duties.Job'specito Perform essential job fic hearing testa should be individualized for each department and its specific job functions. The following list of g protocols. tasks can assist to direct development of hearing protocols. (1) Understanding spoken commands, both over the radio and while wearing SCBA (=') Hearing alarm si;nals, including building evacuation, JOIN air signal on the SCBA, and PASS alarms (3) Heating and locating the source of calls for assistance from victims or other fire Fighter All of the above tasks will need to be performed with rea- sonabtysimtllatedincldentscenebackgroundnoise and SCBA y y^aish voice from background noise can noise. The inability to hear sounds of low intensity or to distin• lead to failure to respond to imminently hazardous situations. (SeeaGn 84.5.) Gitegon+ 6 medical conditions of hearing include the fol. (ruing: (a) Unequal hearing can result in the inability to localize sounds, leading to failure in the ability to perform search and rescue and other localization tasks. 2CCO Edition (b) Severe external odds, that is, recurrent fuss of hearing can resttic in the inability to hear sounds of low intensity or to distingeish voice from background noise, leading to failtere to respond to imminently hazardous situations. (c) Severe agrnesis or traumatic deformity of the auricle can result in the inability to properly wear protective equip mint and the inability to hear sounds of low intensity or to dis. tinguish voice from background noise, leading to failure to respond to imminently hazardous situations. (d) Severe mastoidid or surgical deformity of the trrastoid can result in the inability to properly evear protective egtoid ment and the inability to hear sounds of low intensitvor to dis. anguish voice from background noise, leading to failure to respond to imminently hazardous situations. (e) `feniere's syndrome or severe labyrinthitis may result in the potential for sudden incapacitadon and the inability to perform job functions due to limitations of balance. M Otitis media (chronic) can result in frequent episodes of pain or the inability to perform work and the inability to hear sounds of low intensity or to distinguish voice from back- ground noise, leading to failure to respond to imminently has. ardous situations. (9) Any other ear condition that results in a person not being able to perform as a member can be classified as a Cat egory B medical condition of hearing. A-3-5.2 Category B dental medical conditions include the fol- lowing: (1) Diseases of the jaws or associated tissues (those that are equipment)napng or Preclude ability to use protective Diseases of the jaws or associated tissues can result in the inability to properly wear protective equipment. (2) Orthodontic appliances (those that preclude the ability to use protective equipment). The wearing of orthodon- tic appliances can result is the inability to properly wear Protective equipment. (3) Oral tissues, extensive loss ( that which precludes satisfac- tOHY Postorthodontic replacement or ability to use pro. recdve equipment). Extensive loss of oral tissues may result in the inability to properly wear protective equip- ment and the inability to communicate effectively due to oropharyngeal dysfunction. (4) Relationship between the mandible and maxilla that pre- cludes satisfactory Postorthodondc replacement or abil. ity to use protective equipment. This condition can result in the inability to properly wear protective equipment and the inability to communicate effectively due to oropharyngeal dysfunction. (3) Any other dental condition that results in a person not being able to perform as a member, A•3.6.1 CategoryA medical conditions of the nose, orophar- nx, trachea, esophagus, and larynx include the following; t) Orac eOmwear tracheostomy can result in the inability properly p otective equipment, the inability to perform job Functions due to limitations of endurance, and the inability to communicate effectively due to orophatyngeal dysfunction. -') Aphonia, regardless of cause. Aphonia can result in the inability to communicate elTectively due to oropharyn. Beal dysfunction. APPENDIX A A-3-6.2 Category B medical conditions of the nose, orophar- yn , trachea, esophagus. and larynx include the following- (1) Congenital or acquired deformity that interferes with the ability to use protective equipment. A congenital or acquired deformity can result in the inability to properly wear protective equipment. (2) Allergic respiratory disorder (unconerolled). Allergic res- piratory disorder can result in frequent episodes of pain, the inability to perform work, and the inability to perform functions as a member due to limitations of endurance. (3) Sinusitis, recurrent (severe, requiring repeated hospital- izations or causing impairment). Recurrent sinusitis can result in frequent episodes of pain and the inability to perform work. (4) Dvsphonia (severe). Severe dvsphonia can result in the inability to communicate effectively due to oropharyn- geal dysfunction. (5) Any other nose, oropharynx, trachea, esophagus. or lar- ynx condition that results in a person not being able to perform as a member or to communicate effectively. A-3-7.1 CategoryA. medical conditions of the lungs and chest wall include active hemoprysis, empyema, pulmonary hyper- tension, and active tuberculosis. These conditions can result in the inability to perform functions as a member due to limi- tations of endurance. A-3-7.2 Category B medical conditions of the lungs and chest wall include the following- (1) Pulmonary resectional surgery, chest wall surgery, pneu- mothorax (that is, history of recurrent spontaneous pneumothorair). These conditions can result in the inability to perform functions as a member due to liimita. tions of strength or endurance and may result in the potential for sudden incapacitation. (2) Bronchial asthma or reactive airways disease (frequent medication use or symptoms caused by exposures to exer- tion, heat and cold, or products of combustion and other irritant inhalation). Bronchial asthma or reactive airways disease can result in frequent episodes of pain or the inability to perform work, the potential for sudden inca- pacitation, and the inability to perform functions as a member due to limitations of endurance. (3) Fbrothorax, chest wall deformity, diaphragm abnormali- ties. Fibrothorax, chest wall deformity, and diaphragm abnormalities can result in the inability to perform func- tions as a member due to limitations of endurance. (4) Chronic obstructive airways disease. Chronic obstructive airways disease can result in the inability to perform func- tions as a member due to limitations of endurance. (5) Hypoxemic disorders. Hypoxemic disorders can result in the inability to perform functions as a member due to limimtions of endurance. (6) Interstitial lung diseases. Interstitial lung diseases can result in the inability to perform functions as a member date to limitations of endurance. k 7) Pulmonary vascular diseases, pulmonary embolism. Pul- monary vascular diseases and pulmonary embolism can result in frequent episodes of pain and the inability to perform functions as a member due to limitations of endurance. (3) Bronchiecta.sis with significant residual impairment of pulmonary function or requiring frequent therapy. Bron- chiectasis can result in the inability to perform functions as a member due to limitations of endurance. 1582-15 (9) Infectious diseases of the lung or pleural space. (10) Any other pulmonary condition that results in a person not being able to perform as a member. A-34LI-1 Category A medical conditions of the heart and vas. cular system include the following- (1) Angina pectoris, current. Angina pectoris can result in frequent episodes of pain or inability to perform work, progressive illness leading to functional impairment, and the potential for sudden incapacitation. (2) Heart failure, current. Heart failure can result in fre. quent episodes of pain or inability to perform work, pro- gressive illness leading to functional impairment, and the potential for sudden incapacitation. (3) Acute pericarditis, endocarditis, or mvocarditis. These conditions can result In frequent episodes of pain or the inability to perform work. (4) Syncope, recurrent. Recurrent syncope can result in the potential for sudden incapacitation. (5) Automatic implantable cardiac defibrillator. An auto- matic implantable cardiac defibrillator can result in the potential for sudden incapacitation. A 3-5.1.2 Category B medical conditions of the heart and vas- cular system include the following- (1) Significant valvular lesions of the heart, including pros- thetic valves. Specific recommendations include the fol- lowing- a. Mitral stenasis. Mitral stenosis is acceptable if in sinus rhythm and stenosis is mild, that is, valve area> 1.3 cm2 or pulmonary artery systolic pressure < 35 mm Hg. b. Afitral insuffixienc7. Mitral insufficiency is acceptable if in sinus rhythm with normal left ventricular size and function. c. Aortic stmosis Aortic stenosis is acceptable if stenosis is mild, that is, mean aortic valvular pressure gradi- ent c 20 mm Hg. d. Aanic regurgitation Aortic regurgitation Is acceptable if left ventricular size is normal or slightly increased and systolic function is normal. e. Prosthetic valves. Prosthetic valves are acceptable unless full anticoagulation is in effect. (2) Coronary artery disease, including history of myocardial infarction, coronary artery bypass surgery, coronary angioplasty, and similar procedures. Persons at mildly increased risk for sudden incapacitation are acceptable for fire fighting. Mildly increased risk is defined by the presence of each of the following - a. Normal left ventricular ejection fraction b. Normal exercise tolerance, > 10 metabolic equivalents (NETS) c. .Absence of exercise-induceduchemia by exercise testing d. Absence of exercise -induced complex ventricular arrhythmias e. Absence of hemodynamically significant stenosis on all major coronary arteries (>_50 percent lumen diameter narrowing), or successful myocardial revascularizition (3) Atrial tachycardia, flutter, or fibrillation (4) Left bundle branch, second- and third-degree atrioven- tricular block. These blocks will result in disqualification unless exercise can be performed with an adequate heart rate response. They can result in frequent episodes of pain. the inability to perform work, and have the poten- tial for sudden incapacitation. M EdidGM 1582-16 `tEUtG1L REr)t [REtIEN 75 FOR FiRE FiCtITERS AND iNFOR-NUT10N FOR FiRE (3) Ventricular tachycardia. Ventricular tachveat•dia can result in the potential for sudden incapacitation and the inability to perform job functions due to limitations of strength or endurance. (6) Hypertrophy of the heart Hypertrophy of the heart can result in the potential for sudden incapacitation and the inability to perform job functions due to limi endutations of rance. (7) Recurrent paroxysmal tachycardia. Recurrent parr'xvs. mal tachycardia can result in the potential for sudden incapacitation and the inability to perform job functions due to limitations of strength or endurance. (3) History ofa congenital abnormality that has been bysurgery but with residual treated complications or that has not been treated by surgery; leaving residuals or complica- dons. A congenital abnormality can result in frequent episodes of pain or inability to perform work and the Potential for sudden incapacitation. (9) Chronic pericarditis, enducardids, or myocarditis. These conditions can result in the inability to perform job funs. dons due to limitations of endurance. (10) Cardiac pacemaker. If the person is pacemaker-deperr, dent, then the risk for sudden failure due to trauma is not acceptable. Those with cardiac pacemakers can have the potential for sudden incapacitation. (11) Coronary artery vasospasm. Those with cardiac artery vasospasm can have the potential for sudden Incapaci- tation. (12) Any other cardiac condition that results in a person not being able to perform as a member. Category tem include the 61lowin�ical conditions of the vascular sys- (1) Hypertension that is uncontrolled, poorly controlled, or requires medication likely to interfere with the perfor- mance of duties. Acceptable hypertension is a blood pres. sure less than 180/100 and no target organ damage Hypertension is a progressive illness leading to functional impairment with the potential for sudden incapacitation. (2) Peripheral vascular disease, such as Raynaud's phenome- non, that interferes with performance of duties or makes the individual likely to have significant risk of severe injury. Peripheral vascular disease can result in frequent episodes of pain or the inability to perform work and the inability to perform functions as a member due to Jimi tions of endurance. ta- (3) Recurrent thrombophlebitis. Recurrent thrombophlebi- tis can result in frequent episodes of pain or the inability to perform work and the inability to perform functions as a member due to limitations of endurance, NY Chronic Iymphedema due to Iymphopathy or severe venous valvular incompetency. Chronic lymphedema can result in the inability to perform functions as a member due to limitations of endurance. (5) Congenital or acquired lesions of the aorta or major ves- sels, forexample, syphilitic aortitis, demonstrable athero. sclerosis that interferes with circulation, and congenital acquired dilatation of the aorta. Congenital or acquired lesions of the aorta or major vessels can result in the Potential for sudden incapacitation and the inability to perform joh functions due to timitadons of endurance. (ti) Marked circulatory instahiliry as indicated by orthostatic hypotension, persistent tachycardia, and severe periph- eral vasomotor disturbances. Marked circulatory instabil- i ry can result in the inability to perfurin job functions due 2000 Edition to limitations of endurance and the inability to perform job functions due to limitations of balance, (7) Aneurysm of the heart or major vessel, congenital or acquired. An aneurysm of the heart or major vessel can result in frequent episodes of pain, the inability to per- form work, and the potential for sudden incapacitation. (s) Anv other vascular condition that results in a person not being able to perform as a member. A-3-9.2 Category B medical conditions of the abdominal organs and gastrointestinal system include the following; i 1) Cholecystitis ( that which causes frequent pain due to stones or infection). Cholecysdtis can result in frequent episodes of pain or the inability to perform work, (') G.tstritis (that which causes recurrent pain and impair- ment). Castritis can result in frequent episodes of pain or the inability to perform work (3) GI bleeding can cause fatigue, and or hemodynamie mnstability resulting in inability to perform work. (4) Acute hepatitis (until resolution of acute hepatitis as determined by clinical examination and appropriate lab. oratory testing). Acute hepatitis can result in frequent episodes of pain or the inability to perform work. (5) Hernia (unrepaired inguinal or abdominal hernia that could obstruct during duty), A hernia can resale in the Potential for sudden incapacitation. (6) Inflammatory bowel disease (that which causes disabling Pain or diarrhea)Inflammatory , bowel disease can result in frequent episodes of pain or the inability to perform work. It is a progressive illness leading to functional impairment. g (7) Intestinal obstruction (that is, recent obstruction with impairment). An Intestinal obstruction can result in fre. quent episodes of pain, the inability to perform work, and the potential for sudden incapacitation. (9) Pancreatitis (that is, chronic or recurrent with impair- ment). Pancreadtis can result in frequent episodes of pain or the inability to perform work. (9) Resection, bowel (if frequent diarrhea precludes perfor- mance of duty). A bowel resection can result in frequent episodes of pain or the inability to perform work. (10) Ulcer, gastrointestinal (where symptoms are trolled by drugs or surgery)uncon- . A gastrointestinal ulcer can form work result in frequent episodes of pain or the inability to per- G 1) Cirrhosis, hepatic or biliary (that which is symptomatic or in danger of bleeding). Cirrhosis can result in frequent episodes of pain or the inability to perform work { 12) Chronic active hepatitis. Chronic, active hepatitis can result in frequent episodes of pain or the inability to per- form work. (13) Any other gistrointesdnal condition that results in a per- son not being able to perform as a member. A-3.10.I.2 Category 8 medical conditions of the reproductive organs include the following: (1) Pregnancy. Pregnancy can result in frequent episodes of pain or the inability to perform work; progressive inabil- ity to perform work due to limitations of endurance, elex- ibiliq, or strength; and the inability to properly wear Protective equipment. (SeeB-4.4, Reproluelivr.) 2) Dysmenorrhea that leads to recurrent incapacitation. Dysmenorrhea can result in frequent episodes of pain or the inability to perform work. APPENDIX (3) Endometriosis. ovarian cysts, or other gynecologic condi- tions (.severe, leading to recurrent incapacitation). Endometriosis, ovarian cysts, and other gynecologic con- ditions can result in frequent episodes of pain or the inability to perform work. (4) Testicular or epididymal mass (that which requires medi- cal evaluation). A testicular or epididymal mass can result in frequent episodes of pain or the inability to perform work. This is a progressive illness leading to functional impairment. (5) Any other genital condition that results in a person not being able to perform as a member. A 3.10.2.2 Category B medical conditions of die urinary s'tis- tem include the following: (1) Diseases of the kidney requiring dialysis. Diseases of the kidney can result in frequent episodes of pain or the inability to perform work. Kidney disease is a progressive illness leading to functional impairment. (2) Diseases of the ureter, bladder, or prostate that require frequent or prolonged treatment. These diseases can result in frequent episodes of pain or the inability to per- form work. (3) Any other urinary condition that results in a person not being able to perform as a member. A13.11.2 Category B medical conditions of the spine, scapu- lae, ribs, and sacroiliac joints include the following: (1) Arthritis that results in progressive impairment or limiter tion of movement. Arthritis is a progressive illness that leads to functional impairment. Arthritis can result in the inability to perform functions as a member due to limita- tions of endurance or flexibility. (2) Structural abnormality, fracture, or dislocation that is a progressive or recurrent impairment. These conditions are progressive illnesses leading to functional impair- ment. These illnesses can result in the inability to per- form functions as a member due to limitations of strength or flexibility. (3) Nucleus pulposus, herniation of, or history of laminec- tomy, discectomy, or fusion. These conditions are pro- gressive illnesses leading to functional impairment and the inability to properly wear protective equipment. (4) Ankylosing spondylitis. This condition can result in the inability to perform functions as a member due to limita- tions of endurance or flexibility. (5) Any other spinal condition that results in a person not being able to perform as a member. A3.12.2 Category B medical conditions of the extremities include the following: (1) Limitation of motion of a joint of a degree to interfere with successful and safe performance of fire -fighting duties. The limitation of motion of a joint can result in the inability to perform functions as a member due to limitation of flexibility. (2) Amputation or deformity of a joint or limb of a degree to interfere with successful and safe performance of fire- fighting duties. The amputation or deformity of a joint or limb can result in the inability to perform functions as a member due to limitations of strength and/or balance. (3) Dislocation of ajoint. Recurrent dislocation of a joint or dislocation with residual limitation of motion of a degree to interfere with successful and safe performance of fire- fighting duties; successful surgery for recurrent shoulder 158'2-17 disincation, if range of motion is intact. would not exclude a person. Dislocation of a joint can result in the inability to perform functions m a member due to limita- tions of strength or flexibility. (4) joint reconstruction. Ifirtmentous instability, or joint replacement. In cases where recurrent or with residual limitation of motion of a degree to interfere with success- ful and safe performance of fire -fighting duties, surgery for a corn anterior cruciate lip. meet could disqualify if quadrieep strength is not normal or if the knee is lax or develops pain or swelling when stressed. These condi- tions of the joint can result in the inability to perform functions as a member due to limitations of strength or flexibility (3) Chronic osteourthritis or traumatic arthritis (in cases where recurrent exacerbations leads to impairment). Chronic osteoarthritis or traumatic arthritis can result in frequent episodes of pain, the inability to perform work, and the inability to perform functions as a member due to limitations of strength, endurance, or flexibility. (6) Inflammatory arthritis (in gases where it is severely recur- rent fir a progressive illness or with deformity or limita- tion of range of motion of a degree to interfere with successful and safe performance of fire -fighting duties). Inflammatory arthritis can result in frequent episodes of pain, the inability to perform work, and the inability to perform functions as a member due to limitations of strength, endurance, or flexibility. (7) Any other extremity condition that results in a person not being able to perform as a member. A-3-13.1 Category A medical conditions of a neurological nature include the following: (a) Ataxias of the heredo-degenerative type. Ataxias of the heredo-degenerative e)-pe can result in the inability to perform functions as a member due to limitations of balance. (b) Cerebral arteriosclerosis as evidenced by documented episodes of neurological impairment. Cerebral arteriosclero- sis can result in the inability to perform functions as a member due to limitations of strength and/or balance. (c) Progressive multiple sclerosis or multiple sclerosis with evidence of progression within previous three years. Multiple sclerosis can result in the inability to perform functions as a member dire to limitations of strength or flexibility. (d) Progressive muscular dystrophy or atrophy. This condi- tion can result in the inability to perform functions as a mem- ber due to limitations of strength and/or balance. (e) Epileptic conditions. After a provoked seizure, with the precipitant identified and alleviated, with subsequent normal CT or MR1 scan, normal EEG, normal neurological exam, free of recurrence without medication for one year, and %nth dedn- ittve statement from a qualified neurological specialist. a mem- ber can be cleared to return to duty. A-3-13.3 Category B medical conditions of a neurological nature include the following: (a) Congenital malformations (that is, severe vascular mal- formations that interfere with the ability to wear protective equipment). Congenital malformations can result in the inability to properly wear protective equipment- (b) Migraine (that is, recurrent, with impairment uncon- trolEed). Lligmines can result in frequent eptsodes of pain or the inability to perform work. 2Wa Edition 153:'-18 vtEDtGtLItE 1U((tL•J(EY TS Fr)R FIRC F1GttTERS .0`U IVFtpRyl.®TIUN Fr)R FiaF nvrr t net,.- _ (c) Clinical disorders with a daralysis, dvscoordin� on, deformity, abnormal mocoracctivity, abnormality ofsensi don, or complaint of pain (progressive or severe). The, disorders are progressive illnesses leading to funcdons Impairment. They can result in the inability to perform funs dons as a member due to limitations of strength, flexibility, o balance. (d) Subarachnoid or intracerebral hemorrhage. verifier either clinically or by laboratory, studies except for those ear rested with verification by laboratory studies and report of treating physician. Subartachnoid or intracerebral hemor- rhage is a progressive illness lead- to functional impair meat. ibis illness incapacitation. can result in the potential for sudden (e) Abnormalities from recent head injury, such as severe cerebral contusion or concussion. The abnormalities can result in the potential for sudden incapacitation. M Any other neurological condition that results in a per- son not being able to perform as a member. A-3-14.2 Ca1egory B medical conditions of the skin include the following: (a) Acne or inflammatory skin disease (if condition cludes good fit of protective equipment, such as SCpre- lon face piece, or prevents shaving). Acne or inflammatory skin disease can result in the inability to properly Wear protective equipment. (b) Eczema (if broken skin results in impairment from infections or pain or interferes with seal between skin and per- sonal proteci•e equipment). Eczema can result in frequent episodes of pain or the inability to perform work. (c) Any other dennatologic condition that results in the Person not being able to perform as a member. A•3.15.1 Category A medical conditions of blood and blood - forming organs includes the following: (a) Hemorrhagic states requiring replacement therapy (for example, von Willebaand`s disease, thrombocytopenia, hemophilia). These hemorrhagic states can result in frequent episodes of pain or the inability to perform work, (b) Sickle cell disease (homozygous). Sickle cell disease can result in frequent episodes of pain or the inability to per. form work and the potential for sudden incapacitation. A-3-15.2 Category B medical conditions of blood and blood - forming organs include the Following- (a) Anemia (in cues that require regular transfusions). Anemia can result in frequent episodes of pain or the inability to perform work. Anemia is a progressive illness leading to functional impairment, (b) Leukopenia (where chronic and indicative of serious illness). Leukopenia is a progressive illness leading to func- tional impairment. (c) PolYcythemia sera (where severe, requiring treat- ment) Polycvthemia vera can result in frequent episodes of pain or the inability to perform work and the potential for sud- rlen incapacitation. (d) Splenomegaly (where the spleen is susceptible to nap- ture from blunt trauma). Splenomegaly can result in the poren dal for sudden incapaci Ea don. (e) History of thromboembolic disease (that is, more than one episode or an underlying condition), A history of thrombnembolic disease can result in the potential for sud- den incapacitation. 2000 Eason ��•�� t-rrratc:LiNS M Any other hematological condition that results in a person not being able to perform as a member, A-3-16.1 Category A medical conditions of endocrine and metabolic disorders include diabetes mellitus that is treated with insulin or an oral hypoglycemic history of one or more eisodes of incapacitatingent and thv includes a mia. Diabetes mellitus can result in the potential forpsudden incapacitation. A3-16.2 Grtegnry B medical conditions of endocrine and membolic disorders includes the following: (a) Diseases of the adrenal gland, pituitary gland. paradav- roid gland, or thyroid gland of clinical significance (that is. sympcomaic and poorly controlled). These diseases can result in frequent episodes of pain, the inability to perform work, and the potential for sudden incapacitation. (b) Nutritional deficiency disease or metabolic disorder (where clinically significant and not correctable by replace. ment therapy or ocher medication). Nutritional deficiency dis. ease or metabolic disorder can result in frequent episodes of pain or the inability to perform work. (c) Diabetes mellitus requiring treatment with insulin or oral hypoglycemic agent. Diabetes mellitus can result sodes of pain or inability to per work. It i illness leading to functional a progressive ons! Impaiin epi- rment and can result In the Potential for sudden incapacitation, (d) Any other endocrine or metabolic condition that results in a person not being able to perform as a member. A-3.17.2 Category B medical conditions of systemic diseases and miscellaneous conditions include the following: (a) Connective lupus tissue disease, such as dermatomyositis, C1Ythematosus, scleroderma, and rheumatoid arthri- tis (where manifested by systemic impairment or limitations Of motion). These connective tissue diseases are progressive illnesses leading to functional impairment and the inability to function as a member due to limitations of strength or flexibility. (b) Residuals from past thermal injury (for example, frost- bite resulting in significant symptomatic discomfort). Residu- als from past thermal injury, may result in the inability to perform functions as a member due to limitations of strength, endurance, or flexibility. (c) Documented evidence of a predisposition to heat stress with recurrent episodes or resulting residual injury. A predisposition to heat stress can result in the potential for sud- den incapacitation and the inability to perform functions as a member due to limitations of endurance. (d) Any other systemic condition that results in a person not being able to perform as a member. A-3-18.2 Category B medical conditions of tumors and malig- nant diseases can include the following - (a) The medical evaluation of any person with malignant disease that is newly diagnosed, untreated, or currently being treated will be deferred. Any person with treated malignant disease should be evalu- ated based on that person's current physical condition and on the likelihood of that persons disease to recur or progress. (b) Any other tumor or similar condition that results in a person not being able to perform as a member. APPENDIX A Ac3.19.2 Category B medical conditions of a psychiatric nature include the following: (a) Any person with a history of a psychiatric condition or substance abuse problem should be evaluated based on that person's current condition. Psychiatric conditions and sub• stance abuse problems can result in frequent episodes of pain or the inability to perform work and the potential for sudden incapacitation. These conditions are progressive illnesses lead. ing to functional itnpairmenL (b) Any other psychiatric condition that results in a person not being able to perform as a member. A 3-20.2 Category B medical conditions concerning chemi- cals, drugs, and medications include the following (a) Anticoagulant agents such as coumad°in can be permit- ted if the anticoagulated state is controlled such that the pro - thrombin time or INR has been in the therapeutic range on a stable medical regimen for at least one month and that no other coexisting conditions would either contribute to a bleeding diathesis or by themselves preclude certification for full duty. Anticoagulant agents can result in frequent episodes of pain or the inability to perform work, as well as the potential for sudden incapacitation. (b) Cardiovascular agents (for example, antihypertensives) can result in frequent episodes of pain or the inability to per- form work, as well as the potential for sudden incapacitation. (c) The use of narcotics can result in frequent episodes of pain or the inability to perform work, as well as the potential for sudden incapacitation. (d) The use of sedative-hypnotics can result in frequent episodes of pain or the inability to perform work, as well as the potential for sudden incapacitation, (e) The use of stimulants can result in frequent episodes of pain or the inability to perform work, as well as the potential for sudden incapacitation. (f) The use of psychoactive agents can result in frequent episodes of pain or the inability to perform work, as well as the potential for sudden incapacitation. (g) The use of steroids can result in frequent episodes of pain or the. inability to perform work. (h) Any other chemical, drug, or medication that results in a person not being able to perform as a member is included in this group. A-1.2.1 Physicians who cue for members need to be familiar and keep up-to-date with the most current recommendations for post -exposure prophylaxis (PEP) for bloodbome patho- gen (BBP) exposures. Also there should be a written protocol for dealing with members who present with BBP exposures. This should be based on the following elements: (1) Fact sheet that explains in lay language the risks of infec- tion, the various prophylactic and therapeutic options, the testing and follow-up that will be needed and recom- mendations for personal behavior (i.e.. safe sex, blood donation, and so forth) following an exposure. (2) Classification table to determine the exposure type and recommendation for prophylaxis. Current recommenda- tions of U.S. Department of Health and Human Services. Centers for Disease Control and Prevention, and Public Health Services. (3) Listing of testing to be done on exposed member, includ- ing the following: 1582-19 a. HN b. Hepatitis B surface Antibody (HBsAb), if not previ. ously known to be positive c. Hepatitis B surface Antigen (H"), if not previously known to be positive HBsAb d. Hepatitis C Antibody (HCAb) e. If HIV prophylaxis is to be given, the following tests should be done: 1. CBC 2. Glucose, renal and hepatic chemical function 3. Pregnancy test for females (4) Listing of testing to be done on source patient. including the following: a. HIV b. HBsAg c. HCAb (5) If source is available, interview for HIV. HepB, and HepC risk/stanrs. (6) Determination of risk and need for PEP (7) Idlember counseling regarding PEP medication(s) and side effects of treatment. A printed fact sheet should be available for the member to review. (8) If PEP prophylaxis is to be given, It should be done as soon as possible after the incident, preferably within 2 hours. (9) Nlembers on prophylaxis need to be followed (preferably by an M specialist) for the duration of their treatment (10) Assessment of tetanus status and administration of dT booster, if appropriate (11) :bless HepB status a. If previously immunized with a positive post -immuni- zation titer, no further treatment is needed. b. If previously immunized, titer was negative, and source is HBsAg positive or high risk, give Hepatitis B Immune Globulin (HBIG) as soon as possible — pref- erably within 24 hours — and a dose of Hepatitis B vaccine. c. if previously immunized and titer is unknown, draw titer. 1. If titer is positive, no further treatment is needed. 2. If titer is negative and source is HBsAg positive or high risk, then give Hepatitis B Immune Globulin (HBIG) as soon as possible — preferably within 24 hours — and a dose of Hepatitis B vaccine. d. If previously immunized with negative titer and revao- cinated with a negative titer, give HBIG immediately and a second dose 1 month later. e. If never immunized, give HBIG and begin Hepatitis B vaccine series. (12) Follow-up instructions should include the following a. Adverse events and side effects of PEP b. Signs and symptoms of retroviral illness (fever, aden- opathy, rash) c. Appointments for follow-up blood work, including the following- 1. HIV at 6 weeks, 3 months, and 6 months 2. HBsAb and/or HCAb at 6 weeks, 3 months, and 6 months, if source is HepB and/or HepC positive 3. Every other week CBC, renal and liver function, if receiving PEP :!Coo Edition 1582-20 :iIED►GV. REQLBRE.%BE.\TS FOR FIR E FIGHTERS.;ND BNFOR,` mON FOR FtttF nFPA12rvc.-..... A-4'2.2 Past<xposure prophylaxis may also be indicated for the following diseases; (1) Diphtheria (2) Hepatitis: (3) Meningitis (4) Pernssis (5) Rabies (6) Varicella Zoster A-4-3.1 An annual TB Program should include the following; (1) Docu(PPD) of two-step purified protein derivative (PPD) prior to this PPD or a 0-mm PPD within the past 1 year. (2) Placement of PPD and reading by a trained, designated rs reader within •18 hours to 72 houof placement. Nfem- bets with a history Ofposidve PPD should fill out a ques- tionnaire. (3) PPD results should be documented in millimeters (mm). A test with no skin reaction should be recorded as 0 mm. (4) A PPD skin test will be considered positive if the followin conditions are present g a. Greater than 5 item in someone who is immunostip- pressed b. Greater than 10 mm in someone with a n immune system who is at risk for conversion duormal e to an exposure c. Greater than 10 mm increase from previous reading (5) ffPPD is positive (conversion), the followingstepsshould be taken: a. Fill out questionnaire b. Obtain chest x-ray c. Evaluate for active disease d. Evaluate for preventative therapy (6) If active disease is diagnosed the member has to be removed from any duty until she/he has been deter- mined to be noninfectious. This will occur when ade- quate therapy has been instituted. the cough has resolved, and 3 consecutive sputum smears for acid -fast bacillus (AFB) on different days are negative. A-43.2 In the event of an exposure to TB, should be taken: the following steps (1)-, Member should receive a PPD within 14 days of expo- sure. Members with a history of positive PPD should till out a TB questionnaire. (2) Repeat PPD or questionnaire should be done 6 weeks to 12 weeks after the first (3) If PPD is proceed Positive(conversion)or questionnaire is posi- dve, (5) and (6) ofA-1-3.1. A44 29 CFR 1910.1030 requires that members be offered Hey. atius B immunization at no cost to the member. Members who choose to decline the offer of this immunization are required to sign a written declination. The declination becomes part of a member's confidential health data base as specified in Section znd H-Uh pm �, Jtcrndard rm Fire DrVa"Lpa+fmrrtI Orcupalianal Safety and receive off d immunization re stlowed to recant at any time A-5-1.1 Haying a preplanned rehabilitation prom that is applicable to most incident tvpes is essential for the health and safety of members. This program should outline an ongoing t rehabilitation for simple or short -duration incidents as well as a process to transition into the rehabilitation needs ofa large 1COO Edmon . • . � cac�.d.yw5 or long -duration incident. Medical evaluation and treatment 1n the on -scene rehabilitation area should be conducted according to emergency medical service (ENIS) protocols developed by the fire department in consultation with the fiat department physician and the ENIS medical director. If advanced fife support (ALS) personnel are available, this level of ENIS care is preferred. A 5-1.2 Weather Factors during emergency incidents can impact severely on the safety and health of members, who are operating during extremes of heat or cold. Where these fac- tors combine with long -duration incidents or situations that require heavy exertion, the risks to members increase ea The tire department should develop procedures. in consulta- tion with the fire department physician, to provide relief from adverse climatic conditions. The following are typical rehabilitation considerations for operations during hot weather extremes: (1) Nloving fatigued or unassigned members away from the hazardous area of the incident (2) Removing personal protective equipment (3) Ensuring that personnel are out of direct sunlight (4) Ensuring that there is adequate air movement over per- sonnel, either naturally or mechanically (5) Providing members with fluid replenishment, especially water (6) Providing medical evaluation for personnel showing signs or symptoms of heat exhaustion or heat stroke The following are typical rehabilitation consideradorw for Operations during cold weather extremes: (1) Moving fatigued or unassigned members away from the hazardous area of the incident (2) Providing shelter from wind and temperature extremes (3) Providing members with fluid replenishment, especially water (4) Providing rosymptoms din ®medical evaluation for members showing signs Ymp ms of frostbite, hypothermia, or other cold - related Injury A-5-2.2 The assignment of an ambulance or other support crew to the rehabilitation function is essential during long - duration or heavy -exertion incident operations. This crew can assist with rehabilitation functions as well as be available to provide immediate basic life support needs for members. Advanced life support (paramedic) level of evaluation and treatment has to be available quickly, however, to ensure the proper level of care. The medical staff has to have an assigned medical director. This can be an on -scene physician such as a fire department physician, a remote physician at a base hospital, or a central medical direction facility. A5.3.2 For major incidents or escalating incidents, medical control can be established by the fire department physician or medical director at the incident scene. Bum Injury. When a member suffers a bum injury, he or she should be evaluated as to the extent of injury. First -degree bums can be treated on scene, and the member may continue duty. Second-degree bums should be evaluated by a physician familiar with bums, such as an emergency department physi- cian, a member of a bum unit, or a fire department physician. Second-degree bums and higher are conditions that demand hat the member be removed from emergency response duty. After the burns have healed to the extent that there is minimal risk for entry into the member's body of body fluids and chem- APPENDIX B 1582—•21 icals encountered during regular duties, he or she can return to full dory. The American Bum Association has criteria for referral to a bum center. They are second- and third-degree bums with characteristics as follows: (1) Exceeding 20 percent body surface area (BSA) (9) Exceeding 10 percent BSA for age under 10 or over 50 (3) Any third-degree burn over 5 percent BSA (4) Involving hands, feet, face, perineum, genitalia, or major joints (5) Circumferential involving extremities or chest (6) Caused by contact with chemicals, electricity, or lightning (7) Coupled with smoke inhalation injury (9) Associated with multiple trauma (9) Involving patients with preexisting significant medical illness ,Huseuloskeleud Sprains. Strains and sprains are among the most common member injuries. When they occur during peri- ods when circulating catecholamines are high, such as on the fireground, the injured member might underestimate the severity of the injury. Under such conditions. he or she might continue working and worsen the injury. Evaluation of these type of injuries on the fireground'can be difficulL The injury might worsen with time due to swelling, muscle spasm, and increased pain perception after the emer- gency call is over. Any acute injury that leads to swelling or results in more than a trivial limitation of motion should prob- ably be evaluated by a physician. Smake lnhaktfon. Smoke inhalation is fortunately becoming less common, due to the use of self-contained breathing appa- ratus. A member with smoke inhalation should be treated with 100 percent oxygen and transported to an emergency depart ment. Burns involving greater than 15 percent of body surface area, facial burns, singed hair,, and airway soot are associated with more severe airway burns. Lower airway Injury can be associated with carbonaceous sputum, wheezing, rates, rhon- chi, and chest pain, Pulmonary function tests can reveal a decrease in forced expiratory volume in one second (FEV1). A chest radiograph may disclose infiltrates or atelectasis. Hypoxemia may be seen on arterial blood gas analysis. A nor- mal chest radiograph and normal arterial blood gas results do not, however, rule out significant smoke inhalation injury. Endotracheal intubation should be performed if there is central nervous system, stridor, hypoxemia (PO. less than 60), hyperctrbia (PCO, greater than 50), full -thickness burns of the face or neck, airway or pulmonary edema, or inability to handle secretions. Positive end -.expiratory pressure (PEEP) should be used if hypoxemia persists despite intubation and administration of 100 percent oxygen. Inhaled beta-a►;onists and anticholinergics can be used for bronchospasm. Systemic corticosteroids are not recommended for pneumonitis or pul- monary edema. Antibiotics may be needed if sputum gram stain and culture with fever and leukorytosis suggest the pres- ence of a bacterial pneumonia. Dmn Member. Cerminly the scenario involving the discovery of an unconscious member is one that is difficult to manage tven the psychological responses of all involved. Of course, the first priority is the safe removal of the victim from the haz- ardous area. Then the Airway, Bleeding, Cardiac (ABCs) are carried out and a secondary survey performed. Transport to a hospital should be expedited. Any unconscious member should be treated with 100 per- cent oxygen, since carbon monoxide poisoning is common and cyanide poisoning possible as secondary effects of smoke inhalation. At the emergency department, the victim shot►Id have an arterial carboxyhemoglobin determined and should be evaluated for possible cyanide toxicity, if cyanide poisoning is suspected, treatment with a cyanide antidote kit should he initiated. Since inducing methemoglobinemia in a patient with an elevated carboxyhemoglobin level may further impair oxygen delivery, only sodium thiosulfate should be given ini- tially. If treatment with hyperbaric oxygen is ,carted. nitrite, may he used. A-54.3 Items that can assist in limiting temperature stress in cold environments include heat, blankets. and protection from the wind For hot weather, items should include adequate shade, fans, air-conditioning, and misting systems. Food and hydration needs include water and oral fluids, food. broth, and fruit. Also, for hydration, a 50i 50 mixture of water and an electrolyte replacement drink can be provided. Medical equipment should include blood pressure cuffs, stethoscopes. oxygen, cardiac monitors, thermometers, and intravenous fluid and supplies. A-54.4 The incident commander should consider the cir. cumstances of each incident and make suitable provisions for rest and rehabilitation of members operating at the incident scene. For example, when members consume air from two SCBA air cylinders (two -cylinder rule), they should be =signed to rehab. r15-4.5 The measurement of the pulse rate has been used by some fire departments in assessing members during rehabilim- tion. A persistently elevated pulse could be a sign of excessive stress on the body due to dehydration, heat stress, exhaustion, or cardiopulmonary disease. The use of a pulse rate has not been studied in a manner that allows strict medical protocol to be recommended. The pulse rate combined with the remain- der of the clinical evaluation of the member may be used to determine if the member can return to operations. Appendix B Infonnation for Fire Department Physicians This appendix is not a pant of the requirements of this iti RA doc- ument but is included for informational purposm only. B-1 Occupational Safety and Health Problems for Members. B-l.l General. Fire fighting and emergency response are very difficultjobs. People in these jobs perform functions that are physically and psychologically very demanding. These functions are often performed under very difficult conditions. (.See Appendix G) B-1.2 Physical Load. Studies have shown that frre-fighting functions require working at near. maximal heart rates for pro- longed periods of time. Heavy prbcective equipment (includ- ing respirators) and the heat from the fire contribute to this physical load. B-1.3 Toxic Substances. Members and emergency response personnel also are exposed to many toxic substances during their work. Carbon monoxide is the most common contami- nant: studies have shown individual exposures that are as high as 5000 ppm during actual Fires. Other significant exposures common during fires include cyanide, acrolcin, hydrogen chloride, nitrogen dioxide, and benzene. The burning of plas- tics and other synthetic materials can expose members to other toxic materials, such as isocyanates and nitrosamines. Hazardous materials incidents can involve exposures to many Z000 Edition 1582--1—'3 `HEDIGI(, REt,?UIREifENTS FOR FIR E FIGHTERSA;ND IVF()R%LXrl()N FOR Fein° nrnour„c..... other toxic materials. Although the use ofrespirawrs helps to reduce exposures. mechanical, environmental, and behav- ioral factors can limit their We during all phases of lire. The available health data on members are limited. %hile the protection for members has improved over the last several years, exposures might be changing due to the introduction of snore svrtdmeric materials. Given the delay between exposure and onset, (that is, latency) of many occupational illnesses, current or past health studies of members might not reflect future health risks. These limitations should be recognized %vhrn reviewing the available studies. B-1.4 Increased Risk of Injury and Disease. Available data indicate that members have increased risk for injuries, pul- monary disease, cardiovascular disease, cancer, and noise - induced hearing loss. The increased risk for injuries is expected. ,oven the demands and circumstances of this tvork. Fatalities and serious injuries from burns or other fire -scene hazards can occur. The risk for respiratory disease occurs due to the respira- tory damage caused by many of the components of fire smoke (for example, particulate, acrolein, nitrogen oxides, and 'so on.) Acute reductions in pulmonary function and even hspox. emia are not uncommon after fires, even in asatnptomatic members. Permanent damage from smoke Inhalation has also been reported. Studies of chronic pulmonary changes from fire fighting have not had consistent results. Some follow-up studies have shown a greater rate of decline in pulmonary function among members over time, while others have not been able to detect this change. Increased use of protective equipment and job selection factors (ill members transferring to other duties) could account for these inconsistent findings. The strenuous work demands of fire fighting combined with exposures to carbon monoxide and other toxic sub- stances can increase the risk for cardiovascular disease among members. Acute respiratory changes also can stress the cardiovascular system. This increased cardiovascular dis- ease risk has been documented even in some mortality stud. ies. despite the job selection factors that tend to mask any increase when compared to the general population. Other studies have not detected this risk. Certainly, the combina- tiori of the physical stress of fire fighting and exposures for a person with preexisting coronary heart disease would be expected to increase the risk of a myocardial infarction or usher acute event. However, acute risk and the degree of this whether fire figheingalso contributes to the development of coronary heart disease is uncertain. Increased cancer risk for members has been found in sev- ersl recent studies. While not totally consistent, these studies generally show an increased risk of brain cancer, (gastrointes- tinal cancers) colon cancer, prostate cancer, lymphoma, and leukemia among members in many different parts of she world. Increased incidence of other cancer sites has also been shown in some studies. Several studies are currently under way to further evaluate this risk noise -induced hearing loss has now been documented in several studies of members. Members might also be at ribk from other specific exposures including infectious diseases and liver, kidney, or neurological damage fr specific chemicals. om exposure to 2Crio Edition - • . c IT-11LL%N.1j B-2 Guidance for ��iedical Evaluations, B-2.1 Preplacement and Baseline Vfedical Evaluations. Preplaeement medical evaluations assess an irediviclual's health status before assignment to a position. The purp(mse of tits evaluation is to ascertain whether the indbidual has anv health condition that prevents him or her from performingtltr job. including the ability to wear protective equipment required for time job. The evaluation should also identify any health problems that could be substantially aggratiated by the physical demands and working conditions. Baseline medical information concerning the applicant's health status can then be compared to subsequent esaluation results for the pine of detrrtni.ing whether the individual has any significant health trends that can be occupationally related. ' Two apes of information are essential for a medical pre. cement evaluation of those member duties, performinsf First, the physician must understand the working conditions and physicsl demands of this occupation. Appendix C pro - `°ides a list of the environmental factors encountered in fire fighting, and emergency response. The physician also should obtain additional information from the fire department regarding specifrcjob dudes and task lists (if the fire depart- ment has conducted a validation study or job analysis) and should be familiar with the organization of the fire depart- ment. For the evaluation of some medical conditions, the phy- jsician will need to obtain further information about specific ob dudes in order to make a determination. This might require on -site inspections and consultation with fire depart. ment personnel. Second, the physician needs to have accurate information about the Person's disease or medical condition, the func- tional limitations associated with that condition, and an understanding of how physical demands and working condi- tions would impact on that condition. An accurate diagnosis is often the key factor in determining the Person's capability. For example, different skin diseases can have similar clinical appearances but can markedly differ in their response to envi- ronmental exposures. The physician should also recognize that indiyidual variability+ can exist between persons with the same clinical condition." Upon completion of the examination, the physician should inform the authority havingjurisdicdon whether the applicant is medically qualified to perform as a member. B-2.2 Periodic bfedical Evaluations. The periodic medical evaluation is designed to evaluate the Person's continued abil- ity to Perform his or her duties and to detect any other signif- icant changes in the condition of his or her health. The latter includes possible job -related changes or abnormalities. Everyyear, each member will be medically evaluated by the fire department physician. This rdedieal evaluation includes an update on the member's medical historyincluding any sig- nificant changes, a brief review of svmp, toms, and a report on any significant job -related exposures experienced during the past year. Height, weight, visual acuity, and blood pressure are measured and recorded. The extent of the medical evaluation and additional testing will depend on the member's medical condition. A more thorough evaluation, including a medical examina- tion, is conducted on a periodic basis. For individuals less than 30 years of age, the medical evaluation and examination is conducted at least every three ,years, for those 30 to 39 yean of age, at least every two years, and for those 40 years of age or over, every year. This evaluation should include an updated APPF.NUIK e medical and interval history. complete physical examination. vision testing. audiometry, pulmonary function testing, and a CBC, urinalysis, glucose. BUN, creatinine, liver function tests. and lipid profile. The use of chest x-rays in surveillance activities in the absence of significant exposures, symptoms, or medical find- ings has not been shown to reduce respiratory or other health impairment. Therefore, only preplacement chest x-rays are recommended No firm guidelines for stress electrocardiography in asvmp- ■ somatic individuals have been developed. There have been problems with false -positive results from this testing, especially in younger age groups and in women. In those with one or more risk factors for coronary artery disease, there is probably justification for performing the tesdng.:As well, stress tests are more important in those whose work deals with public safety. '� Stress tests can be performed using a treadmill, bicycle, or stair climber, as long as the protocol being used gradually increases in workload metabolic equivalent of resting energy expenditure (LIETS). A submaximal test, with the endpoint being the attainment of 85 percent of predicted maximal heart rate (PVIHR), may be performed. Additional informa- tion gained by performing a maximal symptom -limited test might not be worth the additional time, effort, cost, and risk. A reasonable approach is to start periodic treadmill testing on members at age 40. In those with one or more coronary artery disease risk factors (premature family history (less than age 55), hypertension, diabetes mellitus, cigarette smoking, and hypercholesterolemia (total cholesterol greater than 240 or HDL cholesterol less than 35) ), testing should be started by age 35. The frequency of testing should increase with age, but at the minimum the test should be done at least every two years. Testing can also be done as indicated for those with symptoms suggestive of coronary artery disease, as reported in their yearly medical histories or interim reports. Conversely, it is known that even maximal stress testing fre- quently misses cardiac abnormalities seen during actual fire- fighting duties. � B-2.3 Content of the Medical Evaluation. B-2.3.1 Medical and Occupational History. The medical his. tory should cover the person's known health problems, such as major illnesses, surgeries, medication use, allergies, and so forth. Symptom review is also important for detecting early signs of illness. In addition, a comprehensive medical history should include a personal health history, a family health his- tory, a health habit history, an immunization history, and a reproductive history. An occupational history should also be obtained to collect information about the person's past occu- pational and environmental exposures. B-2.3.2 Medical Examination. The medical examination includes the following organ systems and tests: (1) Vital signs, such as pulse, respiration, blood pressure, and. if indicated. temperature (2) Dermatological (3) Ears, eyes, nose, mouth, throat (4) Cardiovascular (5) Respiratory (fs) Gastrointestinal (7) Genitourinary (8) Endocrine and metabolic �9) %lusculaskeletal (10) Neurological (1I) Audiometry (12) Visual acuity and peripheral vision testing (13) Pulmonary function testing (14) Laboratory testing, if indicated (13) Diagnostic imaging, if indicated (16) Electrocardiography, if indicated 1582-23 B-2.3.2.1 Laboratory Tests. CBC. biochemical test battery, urinalysis, glucose. BUN, creatinine, liver function tests, and lipid profile, should be conducted for detecting specific ill. nesses as well as developing a baseline for later comparison. B-2.3 2.2 X rain. A baseline chest x-ray can be helpful for individuals with a history of respiratory health problems or symptoms. For others, it can be useful for later comparison. B-2.3.2.3 Pulmonary Function Testing. Pulmonary function testing can be helpful for individuals with a history of respira- tory health problems and as a baseline for later comparison. A baseline test should be administered by an experienced per- son. Only a spirogram that is technically acceptable and dem- onstrates the best efforts by an individual should be used to calculate the forced vital capacity (FVC) and forced expiratory volume in one second (FEVI). B-2.3.2.4 Audiometry. Audiogram , should be performed in an ANSI -approved soundproof booth (,%ANSI S3.1, .Ilaadmum Permissible Ambient Noise Levee's for Audiometric Test Rooms) with equipment calibrated to ANSI standards ( ANSI S3.6, Spedfrca- Lion for Audiometers). If a booth is unavailable, the test room sound pressure levels should not exceed those specified in the federal OSHA noise regulations (29 CFR 1910.95). B-2.3.2.5 IIectrocardiogmphy. Baseline electrocardiography should be conducted. (Periodic resting electrocardiograms have not been shown to be useful, but may be reasonable as a member's age increases.) B-2.4 Reporting the Results of the Medical Evaluation. All individuals participating in a medical evaluation should be informed ahead of time about the purpose of the medical evaluation and the content of the exam. The results of any medical evaluation are considered to be confidential medi- cal information, subject to customary patient -physician con- fidentiality restrictions. Under most circumstances, results and recommendations arising from the evaluation should be expressed in general terms without specific diagnostic infor- mation. In cases where more specific information is needed in order to make a decision on the status of a candidate or member, a specific consent form releasing that information should be obtained from the candidate or member. Blanket or general "release of medical information- forms should not be used. in most cases, a simple statement like one of the following will suffice: (a) Based on the results of the preplacement medical eval- uation of December 10, 1996, Jane Doe is (or is NOT) medi- cally terrified to engage in training and emergency operations for Anytown Fire Department. (b) Based on the results of the preplacement medical eval- uation of December 10, 1996, John Doe is NOT medically cer- tified to engage in training and emergency operations for Anytown Fire Department. He has been advised of the medical reasons for this recommendation and of the policies and pro- cedures available to him if he disagrees with the results of the mcdical evaluation. 2CM Editlan 1382-24 MEDIC:tt. RE QU IREMENTs FOR, FiRE FIGHTERS ND 1NF0RX%T1()N FOR FiRE nFP t n•rtn B-2.5 Second Opinions. Fire department policies and proce- dures should allow for a medical second opinion when a candi. date or member disagrees with the results or recommendations of a medical examination the by the fire department physician or when the fire department physician is uncertain about the limit tiolhs or prognosis of the individual's condition. Often other physicians will not be Familiar with the duties and demands of tire' fighting and emergency response. When ble, the fire department physiciapossi- n should help When the other physician about Nosy the individual's condition could affect or be affected by fire fighting If there is still disagreement about the condition or placement recommendation, a third Physician (acceptable to both the fire department and the can- didate) can be consulted B-2.6 ifusculoskeletal Syste Icros encountered in thim. Some of the injuries or prob- s system will need functional capacity evaluation to determine fitness for duty. physical therapy pro- viders often design tests for emplovers to determine ability to Perform tasks similar to those required as part of their essen. tial job functions. These tests should be based on direct mea- surements of the actual job functions. These functional capacity evaluations can be has been cleared for full duespecially useful when a member ty by a physician who is not familiar with the essential job functions of a member. B-3 Specific Medical Condition& B-3.1 Diabetes Nlelatu.,. The major concern for diabetic members is the risk of becoming hypoglycemic during fire. ground operations or other emergency responses. Both ex enous insulin and oral hypoglycemic ageog: nts can be associated with episodes of hypoglycemia that can rapidly progress from impaired judgment to unconsciousness. The most reliable predictor of hypoglycemia is a history of it. In one study of insulin -dependent adolescents conducted at the Joslin Clinic (Bhada and Wolfsdorf 1991), All 196 pedants experienced hypoglycemia at least once during the two-year observation period. Of these, 15 percent were classified as severe, based on loss of consciousness, seizure, or the clinical need for them. peutic glucagon or intravenous glucose. It was particularly concerning that 24 percent of hypoglycemic episodes detected by blood glucose monitoring were inapparent epio the patients. The probablecauses of hypoglycemia were identified in 71 percent of cases, and the most common were strenuous exercise and skipped meals or snacks. Both of these precipi- tants are likely to occur in emergency responders, especially fire service personnel. In addition to accelerating glucose ud. Wss r strenuous exercise (aincreases insulin sensitivity (Wasserman and Sinman 1994). With the tighter glycemic control that is now known to decrease and delay onset of dia- betic complications, there is a concomitantly increased likeli- hood of exercise -induced hypOglycemia (Wasserman and Sinman 1994). insulin is clearly associated with a much higher risk of symptomatic hypoglycemia than are oral agents. In the absence of a history of incapacitating hypoglycemic episodes, and with close medical monitoring, there is probably no rea- son to exclude members who are taking oral hypoglycemic agents, as long as they have stable weights, diets, and renal funeeion. alt}tough stable with Disabilities Act (Public Law 101.336 1990) does not appear to require each diabetic patient to be evaluated for fitness for duty individually, there is some case law that disallowed blanket exclusion of insulin. dependent diabetics from public safety positions (Fire & Police Personnel Reporter 1994). The Federal Aviation loco Edition ° , d I rael,r: N5 Administration (14 CFR 67.1316 1995) does not grant medical certificates to diabetics treated with insulin and severely limits thost on oral hypoglycemic agents. B-3.8 Asduna and Reactive Airways Disease. The din gnosis Of asthma and related airway hvperactivity disorders is often confounded by definitional issues, For the purposes en member eereilication, a variety of airway disorders thaof t Meet the following criteria can be included. Asthma is a chronic inflammatory disorder of the airways. Insuscepti- ble individuals, this inflammation causes symptoms that usually associated with widespread but e e hat are obstruction that is often reversible, either spontaneously or with treatment, and causes an associated increase in airway responsiveness to a variety of stimuli. Since asthma is a highly prevalent disease, a number of member applicants will requlre special evaluadon. Combus. dun products, exercise, and cold air are all potent provokers of an asthma attack. Some of these exposures are unavoidable, even with SCBA use. If a candidate has a diagnosis or symp. toms consistent with an astihma4ike disease, many factors will need to be considered. An asthma attack during a suppre�on activity could harm the member, his fellow members, or a member of the public. The following factors can be used to help in certification; (1) Persistence of airway obstruction between attacks (as measured by spirometry) (2) Need and frequency of steroid and bronchodilator use (frequent bronchodilator use suggests persistent airway hyperactivity) (3) Usual type of triggers in the applicant (allergic, infer. uous, exercise -induced, etc.) (4) History of hospitalization, emergency room, or urgent treatment (5) Length of time between attacks (6) Nocturnal symptoms and other estimates of airway insta- biliry tiloderate asthma or worse could disqualify an individual for member duties. Unknown factors such as the suppression Of airway hyperscdvity with anti-inflammatory medications to reduce the possibility of a sudden or severe attack are under investigation and could modify current suggestions. B.3.3 Heart Disease. The medical conditions relating to the cardiovascular system have been reviewed since the previous edition (1997) 'of this document- The task forces at the Bethesda Conference published recommendations for ath- letes competing with cardiovascular disease in the fournal ofdW Amerkan C®Urgs of Cardiology, in October 1994. The analysis used by the task force has relevance to the evaluation of mem. bers with cardiovascular disease. Fire -fighting activities have a high static component (i.e., inducing predominantly an increase in blood pressure) and a moderate to high dynamic component (i.e.. inducing predominantly an increase in heart rate). Sports with a similar set of demands include wrestling, body building, and boxing Recommendations made by the task force with respect to athletic activities that have these physical demands (high static, moderate dynamic) have been followed in this document. B-3.4 Reproductive. Exposures in the firefighting environ- ment can cause adverse reproductive effects for both males and females. Medical evidence exists to indicate that chemical exposure, heat, noise, and physical exertion can affect various endpoints of reproductive health including fertility, feral loss, Ai,I,ENDIX 3 l53'2-Z and growth parameters of the offspring. All candidates mid members should be educated about these risks and abut the need w take appropriate steps to limit their exposures. Also, there could be some situations where a male or female member is attempting to conceive a child and is having difficulty. In these situations. where a complete medical evalii- adon has not identified another cause for this infertilim. tem- porary assignment on a voluntary basis to alternative citicy or a leave of :absence should be considered. Medical evidence exists that certain toxic substances or con- ditions that are present in the fire -fighting environment are dangerous to the safety and well-being of the fetus. Therefore, it is important to educate all members about these risks and the reasons for recommending that pregnant members restrict their fire -suppression activities. For example. there is good evi- dence that the fetus is especially sensitive to carbon monoxide. a• known significant component of fire smoke. Although the we of SCBA is assumed to be protective, sometimes such equipment is not used throughout a fire suppression or haz- ardous materials incident. The use of such equipment also increases other fetal stressors, such as exertion and heat. Other concerns are those involving physical work. Prolonged stand- ing, heavy lifting. and exposures to temperature extremes.and humidity have been related to an increase of preterm and loco birth weight infants. Because the fetus should be protected from these exposures at the earliest possible time, the member who might be pregnant should obtain early pregnancy testing. Recognizing potential risks to the fetus from the fire -fighting environment is a relatively recent event. and many members might not be aware of these risks. Based on a recent U.S. Supreme Court decision (Intema- tional Union et al. v. Johnson Controls, Inc., 59 U.&L.W. 4209. March 20, 1991). the ability' to perform as a member is to be the basis for the medical certification without consideration of health risks to the fetus. However, the pregnant member should be counseled on the potential risks to her fetus due to her exposures during Fire -fighting duties. Any member who becomes pregnant should be offered the opportunity at any time during the pregnancy to be voluntar- ily removed from fire -fighting duties and from other duties involving the hazards or physical stress that might endanger the fetus. If practical, the membershould be offered voluntary reassignment to an alternative position. At such time as the pregnant member can no longer be medically certified as being capable of performing fire -fighting duties, the member should be reassigned to other duties. At such time as the mem- ber is no longer pregnant, the member should be reinstated to the position held prior to being pregnant. Nursing mem- bers should also be advised about the potential exposures to their infants. &3.5 Noise -induced Hearing Loss. This category can pose difYiculues because a high percentage of current members have noise -induced hearing loss due to their exposures as members. Implementation of hearing conservation programs and programs to reduce noise exposures should lead to a decrease in the prevalence of this condition in the future. B-3.6 Seizures and Epilepsy. It is important to distinguish berween a history of seizures and epilepsy. As much is 10 per - Lent of the population will experience at least one seizure in a lifetime, whereas less than l percent of the population qualifies for a diagnosis of epilepsy (Hauser and HesdortTer 1990). `Zany conditions producing seizures in the pediatric age group are known to remit prior to adulthood, and many adults sustain a reactive seizun: that c.ut he attributed to a reversible. underiv- ing precipitant. These circumstances da not u`^cr.'ssarily reprLy lent an ongoing risk ofsildden, unpredictable incapacitation of a member. if a member loss a sinde seizure, a clear precipitant not assaxiatcd with central nervous system damage is identified and eliminated. and the individual has no recurrence over the ensuing year. then he or ilie is probably not more likely w have another "iziire than die rest of the general population (Spen- cer 1995). Most fire department phevieians Will want a qualified. neurologbit to verify that an individual with a history of seizures does not, in fact. have epilepsy. Epilepsy is diamosed by the presence of `unprovoked. recurrent seizures -- paroxysmal disordery of the central ner- vous svmem characterized by an abnormal cerebral neuronal ciischarme with or without loss of cortseiotisness' (Cascino 1131--34). Treatment of patients with epilepsv is only variably suc- cessful. with roughly 40 percent of patients attaining remismott on anti-convulsant therapy (Hauser and Hesdorffer 1990; Spencer 1995). Remissiun is defined as five years without recurrence of seizure activity (Annegers, Hauser, and Elve- back 1979). Farther complicating the fitness-forduty issue is the fact that only 50 percent of patients who achieve remission do so without toxic side effects of the anti-convulsant drug (Cascino 1994). Partial, simple epilepsv, or recurrent seizures that do not impair consciousness, are felt to be a disqualifying condition because of the uncertainty regarding how much of the brain might be involved, and the risk of propagation to other regions of the brain, particularly in the highly epileptogenic environment of the ftreground (Spencer 1995). This standard is somewhat more liberal than that promul- gated by the Federal Aviation Administration of the U.S. Department of Transportation for aircraft pilots (14 CFR 67.1316 1995). All epileptics, regardless of therapeutic success are denied first-, second-, or third-class medical certificates, except under the provisions of 14 CFR 67.19. 'Special Issue of Medical Certificates." B-4 References. Annegers, J. F., W. A. Hauser, and L R. Elveback. 1979. 'Remission of Seizures and Relapse in Patients with Epilepsy," Epilepsia M 7 -9. Bhatia, V., and J. I. Wolfsdorf. 1991. "Severe Hvpoglycemia in Youth with Insulin -Dependent Diabetes Mellitus: Fre- quency and Causative Factors," Pediatrics, 88:1137. Brunacini, Alan. Firegmund Command National Fire Protec- tion Association, 1985. Cascino, G. D. 1994. Epilepsy: Contemporary Perspectives o'tr Evaluation and Treatment. Mayo Clinic Proceedings 69:1199. "Emergency Incident Rehabilitation," United States Fire Administration (FAkl12). Fire & Police Personnel Reporier,.November 1994, p. 169. Hauser, W. A., and D. C. HesdortTer. 1990. "Epilepsy: Fre- quenty. Causes and Consequences." New York: Demos. National Fire Incident Reporting System (NFiRS) data base. NZ FPA 1521, Standard for Fin Department Safety Offers, 1997 edition. Public Law 101-336. 1990, Title I — Employment. Spencer, S., Personal Communication, 1995. (Spencer is professor of neurology and director of the Clinical Epilepsy and Electrophysiologic Monitoring Services at Yale University School of Medicine.) Title 14. Code for Federal Regulations. Part 1910.1000, Sub' parts 13-16, "Air Contaminants." 2GG9 Edition 13S`r :'fi e1EDlr_kL PEt`UREMENTS FOR F1RE FICFITERI.k,VD flFryR` LMON FOR FIRE DEPARTMENTPl1vnrrr t%:c auxic smoke inhalation: Cyanide poisoning in fire `ic- :317, lones19S7., J. et al., .imeriean fourrral of Lrmer9M,ry A&,Ucine 3:3I e, l98;. Wasserman, D. K. and 8. Sinman. viduals with I1991- "E tercise in indi- DD�[," Mimic Carr, 17:9^4. Appendix C Essential Structural Fire -Fighting Functions Thu appendix it not a PfIrt Of umeni but it in't"1141 for informationaltr � of t 'V�Pi �fue- u p pares onlx C-I The medical requirements in this standard were based on in-depth consideration of essential structural tire -fighting functions. These essential functions are what ral are ex- pected to perform at emergency incidents and are derived from the performance objectives star danted in NFP; I001, ,Stan. for Fire Fgherr professional Quatrfrr ed i Essential functions are performed in and affected by the u. following environmental factors: (1) Operating both as a member of a team and indepen- dently at incidents of uncertain duration (2) Spending extensive time outside exposed to the elements (3) Tolerating extreme fluctuations in temperature while per- forming dudes; fire fighters are required to perform phvs. ically demanding or in hoc (up to E00°�, humid (up to 100 percent) atinospheres while wearing equipment that significantly impairs body -cooling mechanisms. (4) Experiencing frequent trrnsition from hot to cold and from humid to dry atmospheres (5) Working in wet, icy, or muddy areas (6) Performing a variety, of tasks on slippery; hazardous Mr. faces such as on rooftops or from ladders (7) Working in areas where sustaining traumatic or thermal injuries is possible (g) Facing exposure to carcinogenic dusts such as asbestos, toxic substances such as hydrogen cyanide, acids, carbon monoxide, or organic solvents, either through inhalation or skin contact N) Facing exposure to infectious agents such as Hepatitis B or HIV (W) Wearing personal Protective approximately 50 lb hile performing fi etfr that weighs (! 1 ) Performing physically demanding work while wearin Pos idve-pressure breathing equipment with 1.5 in. of water column resistance CO exhalation at a flow of 40 L/min (12) Performing complex tasks during life -threatening emergencies (13) Working for long periods of time, requiring sustained physical activity and intense concentration (1 }) Facing life -or -death decisions during emergency conditions (15) Being exposed to grotesque sights and smells associated with major trauma and burn victims (16) Ntaking rapid transitions from rest to near-ma,<imal exer- tion without yvarm.up periods (17) Operating in environments of high noise, poor visibility, limited mobility; at heights; and in enclosed or confined spaces (18) Ltsingmanual and power tools in the performance of dudes (19) Relying on senses of sight, hearing, smell, and touch to help determine the nature of the emergency, to maintain personal safety, and to make critical decisions in a con- s fused, chaotic, and potentially life -threatening environ- ment throughout the duration of the operation 2000 EJsf*n Appendix D Guide for Fire Depar�ent, Thir appendix is not a part of the ►equirrmmts of this .V77?{ doe r,rtlost it inc "'W for i frsmationat purfimsrs only. D-I Legal Considerations in Applying the Standard, [}1C con- sideration Of an application or continued empla lord'Ment T com- ber based on medical or physical petfonnance evaluations involves a determination that is nut without le;al Implications To this nyd rior making adverse emplo wnent decision based on the foregoing, d the authority with.jurisdicdon might wish to consult with counsel. D-1.1 individuals with Handicaps or Disabilities, The Reha- bilitation Act of 1973, as amended, 29 U-S.C. 791 et seq., and implementing regulations, prohibit discrimination against those with handicaps or disabilities under any Program receiv- ing financial assistance from the federal government. The Americans with Disabili des Act of 1990, •Fin U.S.C. § 1n101, et seq-, also prohibits employment discrimination by certain pri_ ,,ate emplovers against individuals with disabilities. In addition, manystates have enacted legislation prohibiting discrimination against those with handicaps or disabilities the exclusion, denial of benefits, refusal to hire or ese prom®�e®r other discriminatory conduct against an individual based on a handicap or disability, where the individual involved can, with or without reasonable accommodation, perform the essendal functions of the job without creating undue hardship on the employer or program involved. Application of this standard should be undertaken with these issues in mind. The medical requirements of the 1997 edition of this stan- dard were initially developed and found to be job -related by a subcommittee comprised of medical doctors, physiological specialists, and fire service professionals, as processed through the NFPA consensus standards -making system. Changes for the current edition have been proposed by a task group com- prised of similar expertise. The standard provides, to the extent feasible, that decisions concerning candidates and cur- rent members with medical ailments, handicaps, ordisabiliLies be made after case -by -case medical evaluations. Thus, most medical conditions have been assigned to Category B. The medical requirements in this edition of the standard were revised based on the essential functions contained in Appendix C. It is recognized that some fire -fighting functions and tasks can vary from location to location due to differences in department size, functional and organizational differences, geography, level of urbanization, equipment utilized, and otherfactors. Therefore, it is the responsibilityofeach individ- ual fire department to document, through job analysis, that the essential functions performed in the localjurisdicdon are substantially similar to those contained in Appendix C. There are a wide variety of job apalyaic techniques available to document the essential functions of the job of a member. However, at a minimum, any method utilized should be cur. rent, in writing, and meet the provisions of the Americans with Disabilities -Act (29 CFR 1630.2 (n) (3) I. Job descriptions should focus on critical and important work behaviors and specific Wks and functions. The frequency and/orduradon of task per- formance, and the consequences of failure to perform the task should be specified The working conditions and environmen- tal hazards in which the work is performed should be described. The job description should be made available to the fire ervice physician for use during the preplacement medical examination for the individual determination of the medical uitability of applicants for member. APPF-NDIX D L582-'27 D-1.2 Anti -Discrimination Laws. Finally, users of this stan- dard should be aware that, while courts are likely to give con- siderable weight to the existence of a nationally recognized standard such as NFPA 1582, Standard on Medical Requissments for Fin Fighkn and information for Fire Department Physicians (e.g., dbliller v. Sioux Gateway Fin Department, 497a N.W.2d $38 (1993)1. reliance on the standard alone could be insufficient to withstand a challenge under the antidiscrimination laws. Even in the case of Category A medical conditions, courts can still require additional expert evidence concerning an individ- ual candidate's or member's inability to perform the essential functions of the job. Until the courts provide further guidance in this developing area of law, some uncertainty as to the degree and nature of the evidence required to establish com- pliance with the anti -discrimination laws will remain. D=1.3 Individuals Who Are Members of Protected Classes (Race, Sex, Color, Religion, or National Origin). Title VII of the Civil Rights Act of 1964, as amended, 42 U.S.C. 2000e, and implementing regulations by the Equal Employment Opportu- nity Commission (EEOC) prohibit discrimination in employ- ment on the basis of race, sex, color, religion, or national origin (i.e., protected classes). Under Tide VTI, an "employer" is defined, generally, to mean a person with `15 or more employ- ees for each working day in each of 20 or more calendar weeks in the current or preceding calendar year." (42 U.S.C. 2000e) Several federal jurisdictions have held that unpaid volunteers are not considered to be "employees" under Tide VR. Additionally, many states, cities, and localities have adopted similar legislation. Cenerally, physical performance or other requirements that result in "adverse impact" on mem- bers of a protected class (e.g.. on the basis of gender) are required to be validated through a study in accordance with EEOC guidelines, if such requirements are to be relied on in making employment decisions. Under EEOC guidelines, a study validating employment standards in one jurisdiction can be transportable to another jurisdiction (and therefore used in lieu of conducting a separate study). However, specific pre- conditions must be met in this regard, and the authority hav- ing jurisdiction should seek the advice of counsel before relying on a transported validation study. D-1.4 Pregnancy and Reproductive. Fcderal regulations, as well as many court decisions, including the U.S. Supreme Courts decision in International Union, et al. v. Johnson Controls, Ire. (499 U.S. 187. 111 S.CL 1196 (1991A. have interpreted the requirements of Tide VII with respect to pregnancy and reproduction. The authority having jurisdiction should seek the advice of counsel in resolving specific questions concern- ing these requirements as well as other requirements that can be imposed by state or local laws. D-2 Choosing a Fire Department Physician. Several factors should be considered in choosing a fire department physician. There are relatively few physicians with formal residency tmin- ing and certification in occupational medicine. The fire depart- ment physician needs to be qualified to provide professional expertise in the areas of occupational safety and health as these areas relate to emergency services. For the purpose of conduct- ing medical evaluations, the fire department physician needs to understand the physiological and psychological demands placed on members and needs to understand the environmen- tal conditions under which members have to perform. Therefore. physicians with specialties other than occupa- tional need to be considered, as well as the physician's back- ground and experience. Knowledge of occupational medicine and experience with occupational health programs, obviously, would be helpful. The physician has to be committed to meeting the require- ments of the program. including appropriate record keeping. His or her willingness to work with the department to contin- ually improve the program is also important. Finally, his or her concern and interest in the program and in the individuals in the department is vital. There are many options for obtaining physician services. (a) Physicians could be paid on a service basis or through a contractual arrangement. (b) For volunteer departments, local physicians could be willing to volunteer their services for the program. with addi- tional member arrangements for payment of laboratory test- ing, x-rays. and so forth. (c) Some departments could utilize a local health care facility for medical care. However. in that case, the department should be sure to have one individual physician responsible for the program, record keeping, and so forth. (d) In some cases, it could be possible to have the medical examination by the fire department physician, while some of the associated costs could be defrayed by the member's own health insurance. For example, the health insurance provider could allow the member to have a yearly physical, normally performed by the member's personal physician. The health care insurance provider could allow that physical to be per- formed by the fire department physician with some degree of reimbursement. D-3 Coordinating the Medici! Evaluation Program. An indi- vidual from within the department should be assigned the responsibility for managing the health and fitness program, including the coordination and scheduling of evaluations and examinations. This person should also act as liaison between the department and the physician to make sure that each has the information necessary for decisions about placement, scheduling appointments, and so forth. Confidentiality of all medical data is critical to the success of the program. Members need to feel assured that the infor- mation provided to the physician will not be inappropriately shared. No fire department supervisor or manager should have access to medical records without the express written consent of the member. There are occasions, however, when specific medical information is needed to make a decision about placement, return to work, and so forth, and a fire department manager must have more medical information for decision making. In that situation, written medical consent should be obtained from the individual to release the specific information necessary for that decision. Budgetary constraints can affect the medical program. Therefore, it is important that components of the program be prioritized such that essential elements are not lost. With addi- tional funding, other programs or testing can be added to enhance the program. D4 Table D-1 represents a comparison between VFPA 1582 and OSHA 29 CFR 1910.134. 1582-28 tIED(G\L KE(`UIRL• MEN-M F Ott EHRE F(CtHTElL1e\.ND INFOR.ti(,\Ttt)iV fOK Ftar. nvn..»•r..ca�... _ - ----•—••• rnxaeG44V5 Table D4 Comparison of OSHA 29 CFRParts 1910Regemf"Jo- Fur Fglerand Infonnationf.131, "Medical Reuiremenb" rFuD and NFP.� 1582, Stadard ®n ,Maris!ePent an; 2000 Edition NFPA 1582 OSHA 1910.13.4 2-1 Strdical Evaluation Process. -1.1 • The fire department p The employer must establish and implement p ttment shall establish and implement a medical rvalua• those elements of the written respiratory pro• son process for candidates and current members. rmpployee using �pissary r volunta�I�t med ically able to use that respirator, and that the respirator is cleaned, stored, and maintained $o that its use does not present a hazard to the user. wpm = D 3 Coordinating the Medical Evaluation Program, An individual from within the department should be assigned the responsibility For man- 9 the health and fitness program, inciudi�ng scheduling of evaluations and examinations, T}gy the coordination and liaison between the de athe is person should also act as ake has the information necemaary for decisiopns abo t Placician to ementsure that each , scheduling appointments, and so forth. Confidentiality of all medical data Members must feel assured that the information provito the cde�d ®® th the ro will not be inappropriately shared No Pere department supe�or physician man. seer should have access to medical records without the express written con - is sent of the member. There are occasions when specific medical info is needed to make a decision about placement, return to work, and so forth, and a fire de information that situation, written �ent manager must have more medical information. In sat to release the sP tdFic nformationcal consent ne necessary forth t decision. - tained from the tndrvtd- Bupdgetary constraints can affect the medical program. Therefore, it is �i el menu are not t that components With additional funding, o program be prioritized such that essen- ing can be added to enhance the prom a Cher programs or test- 2-1-2 The , Periodic evaluation evaluatiossperioprocess shall include preplacement medical anions. dic medical evaluations, and return-to-dury medical evalu- MCt] Edition Exception: Employers are not required to include in a written respiratory protection pro. g ram those employees whose only use of respi- rators involves the voluntary use of faltering face pieces (dust masks). (3) The employer shalt designate a program administrator who is qualified by appropriate training or experience that is commensurate With the complexity of the program to admin- ister or oversee the respiratory protection pro• gram and conduct the required evaluations of the program effectiveness. (1) General, The employer shall provide a medical evaluation to determine the employee's ability to use a respirator, before the employee is fit tested or required to use the respirator in the workplace. The employer may discontinue an employee's medical evalu• ations when the emplovee is no longer required CO use a respirator. (sheet t of J) 1582-29 ,VPE:YDtx 0 Table D-4 Comparison of OSHA 29 CF& Parse 1910.134,arb"` t ph) l � 2000 Edition iremente d(Condm�cd) on ,Vdedaca! IUInwemsnts for Fire Fghtan and Infvrmaiion jor Fare Deparhnent hysi OSHA 1910.134 NFPA 1582 24.3 The fire department shall ensure that the medical evaluation process and all medical evaluations meet all of the requirements of Section 2-1. (3) Follow-up medical examination. W The employer shall ensure that a follow-up medical examination is provided for an employee who gives a Positive response to any question among questions 1 through 8 in Sec i- tion Part A of Appendix C or whose initial medical examination demonstrates the need for follow-up medical examinations. (ii) The follow-up medical examination shall include any medical tests, consultations. or diagnostic procedures that the physician or licensed health care professional ! PLHCP) deems necessary to make a final determina- tion. ate, and 7,1 Lional cal At a 2-1.4 Each ��candidate ine or current fire ®n process hall cooperate shall provide complete and mum�the employer s shall provide additional mini medical evaluations that comply with the accurate information to the fire department physician. requirements of this section iF 2.1.5" Each candidate or current fire fighter shall, on a timely basis. report to the fire department ph sician any exposure or medical condition that (i) employee reports medical signs or p could interfere with the ability of the individual to perform as a fire fighter rsympmwtQ that are related to ability to use a 24.1.1 The components of the annual medical evaluation specified in 24.1 h of this section shall be permitted to be performed by qualified per- sonnel as authori2ed by the fire department physician. When other quali- fied personnel are used, the fare department physician shall review the data gathered during the evaluation. (ii) A pLHCP, supervisor, or the respirator pro grate administrator informs the employer that an employee needs to be re-evaluated; (iii) information from the respiratory protec- tion program , including observations made during fie testing and program evaluation, indicates a need for employee re-evaluation; or (iv) A change occurs in workplace conditions physical work effort, protective clothing, temperature) that may result in a substantial increase in the physiological burden placed on an employee. (Shag 2 of 3) 20M Edi4aA 1582-30 `1EDlCAI. REQUIREabtEIgTS FOR FIRE FIGHTER AND INFORNLMON FOR FIRE DEPARTMENT PMsICGINS Table D4 Comparison of OSHA 29 C79 Parts 1910.1 "bledid Requirrmenlr for Fim FrgJttns and I on/5r Fns Requirements" and NFPA 1582, Standard on Medical 2000 Edition (Cantermd) NFPA 1582 2-2 Fire Department Roles. 2.2. I The fire department shall have an officially designated physician who shall be responsible for guiding, directing, and advising the members with regard to their health, fitness, and suitability for duty as required by NFPA 1500, Standanl on Far Department Occupational Safety and Mealth ftram. 2.2.2 The fire department physician shall be a licensed doctor of medicine or osteopathy. D-2 Choosing Fire Department Physician. Several factors should be consid Bred in choosing a fire department physician. There are relatively few physi cians with formal residency training and certification in occupational medicine. The fire department physician shall be qualified to provide pro- fessional expertise in the areas of occupational safety and health as they relate to emergency services. For the purpose of conducting medical evalua lions, the fire department physician shall understand the physiological and psychological demands placed on fire fighters and shall understand the environmental conditions under which fire fighters must perform. Therefore, physicians with other specialties need to be considered. The background and experience of the physician should be considered. Knowl- edge of occupational medicine and experience with occupational health programs obviously would be helpful. The physician must be committed to meeting the requirements of the pro- gram including appropriate record keeping. His/her willingness to work with the department to continually improve the program is also important. Finally, his/her concern and interest in the program and in the individuals in the department is vital. There are many options for obtaining physician services. They could be paid on a service basis or through a contractual arrangement For volunteer departments, local physicians might be willing to volunteer their services for the program with additional arrangements to pay for laboratory testing, x- rays, and so forth. Some departments might want to utilize a local health care facility for their care. However, in that case, the department should be surp to have one individual physician responsible for the program, record keeping, and so forth. In some cases it could be possible to have the medical examination by the fire department physician, while some of the associated costs could be defrayed by the fire fighter's own health insurance. For exam- ple, the health insurance provider might allow the fire fighter to have a yearly physical, normally performed by the fire fighter's personal physician. The health care insurance provider can allow that physical to be performed by the fire department physician with some degree of reimbursement. 20M Edition OSHA 1910.134 (2) Medical evaluation procedures. (i) The employer shall identify a physician or other licensed health care professional (PLHCP) to perform medical questionnaire or an initial medical examination that obtains the same information as the medical question- naire. (ii) The medical evaluation shall obtain the information requested by the questionnaire in Sections I and 2. Part A of Appendix C of this section. (Shed 3 of 3) .Ir APPENDIX D Table D-k Comparison of OSHA 29 CFR, Parts 1910.134, "Medical Requirements" and NFPA 1582, Shmdard on Medicd Reo for Fuca FsghUrs and I fa' Firs Dep Phyrie+anr, 2000 Edition M d) NFYA 1582 2-2.39 For the purpose of conducting medical evaluations. the fire depart- ment physician shall understand the physiological and psychological demands placed on members and shall understand the environmental con- ditions under which members must perform. The fire department shall pro- vide the fire department physician with a current job description for all fire department positions and ranks. B-1 Occupational Safety and Health Problems for Fire Fighters. Fire fighting and emergency response are very difficult jobs. People in these jobs per- form functions that are physically and psychologically very demanding. These functions are often performed under very difficult conditions. (See Appendix C.) Studies have shown that fire -fighting functions require work- ing at near maximal heart rates for prolonged periods of time. Heavy pro- tective equipment (including respirators) and the heat from the fire contribute to this physical load. Fire fighters and emergency response personnel also are exposed to many toxic substances during their work. Carbon monoxide is the most common contaminant; studies have shown individual exposures as high as 5000 ppm in actual fires. Other significant exposures common in fires include cya- nide. acrolein. hvdrogen chloride, nitrogen dioxide, and benzene. The burning of plastics and other synthetic materials can expose fire fighters to other toxic materials such as isocyanates and nitrosamines. Hazardous mac riab incidents can involve exposures to many other toxic materials. While the use of respirators helps to reduce exposures, mechanical, environmen- tal, and behavioral factors can limit their use during all phases of a fire. OSHA 1910.134 (e) Medical evaluation. Using a respirator may place a physiological burden on employees that vanes with the type of respirator worn, the 'ob and the workplace conditions in which the respirator is used. and the medical status of the employee. Accordingly, this paragraph specifies the minimum requirements for medi- cal evaluation that employers must implement to determine the employees ability to use a respirator. (5) Supplemental information for the PLHCP. (i) The following information must be pro- vided to the PLHCP before the PLHCP makes a recommendation concerning an employee's ability to use a respirator. (A) The type and weight of the respirator to be used by the employee; use (including use foe duration r frequency and escaof pe) for a (C) The expected physical work effort; (D) Additional protective clothing and equip- ment to be worn; and (E) Temperature and humidity extremes that be encountered. (ii) Any supplemental information provided previously to the PLHCP re5ardingan employee need not be provided for subse- quent medical evaluation if the information and the PLHCP remain the same. (M) The employer shall provide the PLHCP with a copy of the written respiratory protec- tion program and a copy of this section. Note to paragraph (e)(5)(iii): When the employer replaces a PLHCP, the employer must ensure that the new PLHCP obtains this information, either by providing the docu- ments directly to the PLHCP or having the documents transferred from the former PLHCP to the new PLHCP. However, OSHA does not expect emplgyers to have employees medically re-evaluated solely because a new PLHCP has been selected. (Shut i of 3) 20M Edison 1582-3: `HEDHGIL, REIQUIRE.MEIM FOR FIRE FIGHTERS AND INFORb AMN FOR FIRt: nru ru-m riark— _ Table D4 C.ompuison of OSHA 2g CFP Amdsefi�a for Fan Frg►,terY o td I Parts 1910.134, 'btedical Requirements" and �+ah®n�iir Frrr 2000 Edition (cor�itsaeeu158 itd)' opt iVtedied NTPA 1582 OSHA 191o.134 24.1 The current member shall be certified annually, or at the request of richer the fire current member or the member, by the fire de physician Medical as meeting the medical requirements of Chapter 3 of this standard in order employer shall:determination. In determining department h sician the employee's ability to use a respirator, the to determine that member's medical ability to continue participating in a training or emergency operational environment as a member. Any applica- ble (i) Obtain a written recommendation re�srd_ OSHA standards, such as :9 CFR 1910. [20, *Hazardous Waste O ia- g dons and F_rriergenry Response,' 29 19 0,12.13H 'RespiratoryProtection P in the empplovee's ability to use the respirator 9 CFR 1910.95, "p Noise p protection," from the PLHCP. t }1t recommendation shall "Bloodborne Pathogens.'" be followedsure," and 29 CFR I910.1030, provide only the following information: (A) Any limitations on respirator use related to the medical condition of the employee, or relating to the workplace conditions in which the respirator will be used, including whether or not the employee is medically able to use the respirator.; (B) The need, if any, for follow•up medical evaluations; and thetatement that the msployee with a copy of the PEjiCas provided t. ten recommendation. (ii) if the respirator is negative a pressure res- pirator and the PLHCP finds a medical condi- tion that may place the employee's health at increased risk if the respirator is used, the employer shall provide a PAPR if the PLHCP's medical evaluation finds that the employee can use such a respirator; if a subsequent med- ical evaluation Bnds that the employee is med- ically able to use a negative pressure respirator; then the empployer is no longer required to provide a AM. ('l) Administration of the medical question- naire and examinations. (i) The medical questionnaire and examina. dons shall be administered confidentially dur- ing the employee's normal working hours orat a time and place convenient to the employee. The medical questionnaire shall be adminis- tered in a manner that ensures that the employee understands its content. (ii) The employer shall provide the employee with an opportunity to discuss the question. naire and the examination results with the PLHCP. !Shed 1 of Sl 2000 Edition APPENDIX F Appendix E Sample Forms Viis appendix is not a part of the requirements of this NTRA doc- ument but it included for informational "am only. E-1 pltysiarl Exam Summary. The fire department physician can report results of the periodic medical evaluation, which is designed to evaluate a member's continued ability to perform his or her duties and to detect any significant changes in the condition of his or her health, on a form fake the Physical &tam Summary. (See Figure E-1.) E-2 Medical Examination Report. The fire department ph}si- clan can record information from the medicat examination on a form like the Medical Examination Report. (See FigumE-2) 1582-33 Appendix F Referenced Publications F-1 The following documents or portions thereof are refer- enced within this standard for informational purposes only and are thus not considered part of the requirements of this standard unless also listed in Chapter 6. The edition indicated here for each reference is the current edition as of the date of the NFPA issuance of this standard. F 1.1 NFPA Publications. National Fire Protection Associa- don. l Batterymarch Park, P.O. Box 9 10 1. Quincy. IM 02269. 9101. NFPA 1001. Standard for Fire Fighter Pmfeuionnl Qualifrca. bons. 1997 edition. F l.2 ANSI Publications. American National Standards Insti- tute, Inc.. it West 42nd Street, 13th floor, New York, NY 10036r ANSI SM. Maximum Parmissible Ambient eVoiw Levels for.i udi- omeiric Tat Room. 1991 edition. ANSI 53.6, Specification for Audiometers, 1996 edition. ZCop Edition 1582-34 `tEDIGV. REQUIRE`IE.Yrs FOR FIRE FIGHTERS AND LVFOPWATION FOR FIRE DEPARTIIE.VT PMSIC V LL S FIGURE 1r1 Form for fire depnrtM,,t P�+aaa,s r+tport. Physical Exam Summary Employer. Employee's Name: Position Title: Date of Exam: Components Within Normal Performed Limits ❑ Physical exam O Audiogram ❑ Pulmonary function ❑ Treadmill stress ❑ EKG-12 lead ❑ Chest x-ray ❑ btammogram ❑ Pelvic/Pap ❑ Laboratory tests ® Other Explanation of Abnormal Results/Significant Changes: ❑ Medically cleared to perform job tasks ❑ Denied medical clearance for current job tasks 2000 Edition i Examining Physician: Abnormal, Abnormal, Able to Perform Unable to Perform Significant Changes Job Tasks Job Tasks Noted from Precious Exam (if applicable) MFVA ®hya E,.m Summary tt Of gl APPENDIX F 1582-35 FIGURE Eel (t;0"a eue-1 H of P.I.; htrJMs. is a ® vo• Fire Fighter Police Officer with the department. The purpose of this annual physical is to establish fitness for the continuation of those dudes. He/she has enjoyed good health. MrJMrs. voiced the following questions; Medical History Surgical History Medications ® D.M. ® Orthopedic ® HTN — ENT CVD — Optho ® Asthma r Other Allergies Social History ROS Smoke G1 ® .� PPD ® Hematochezia ® Quit ® Stool caliber ® PkYr ® Bowel habits Exercise y Alcohol G.U. Stones ® Amount Hematuria ® Frequency cv Chest pain SOB Resp ® Cough Wheezes SOB FM Physical Audio ® DM Insert physical here ---- HP'H' ® HTN ^ Speech gage CVD Vision EKG1TMT Blood Neat ® HR H/H Far — Target WBC Corrected ® Interp Glu ® ® Stage achieved Choi Stool OB HDL f Positive Pulm Ratip e ® Negative FVC Risk `To Pred LFTs UA FEW SGOT�. Blood ® % Pred SGPT Protein _ GGT Glucose Other NFPA Phys9sat ZUM SummM (2 o111 2000 Edttlon l592-3t3 M1(EDIC,1d, REQU[RE`dEVM FOR FIREF(CFd'TERS,#,VD tNFORh,tATIOtY FOR FIRE DEP.'lRT1(ENT PIiY3dCL4V3 FIGURE E•2 Medial exarninadoa report form. 1. NAINE (Last) Medical Examination (First)(Middle) 2 SE.�C d. PLANT OR DIVISION 3. DATE OF EXA.�tIIYATION 5. SOC. SEC. OR EMPLOYEE NO. 6' ��ATION ?. DATE CAST E KAMINATION 8. REASON FOR PRESENT EXAA'IINATTON ❑ PRE-PLAMlENT ❑ D.O.T. 9. TEMP !0. PULSE ❑ SURVE'LLANCE ❑ � GRATTON 1 L BLOOD PRESSURE ❑ F.LT ►2. HEIGHT' l3. WEIGHT FT 14. TTT'��IUS SNELLIIYG 11- VISION IN. U+vCORRECTED DISTANT CORRECTED RE Z0a BOTH l6. COLOR VISION . '►. LE 20/ RE 20d BOTH NEAR RE 20/ (Use Code)* LE 20l BOTH LE 20/ RE 20/ BOTH LE 20/ 17. PERjpHERAL Area Examined Clinical Evaluation ® Use Code Renurlts 18. Head and neck (Describe all 9!Code IS In detail) 19. Thyroid -------------- LYMPh nodes _____________ 20• Eyes Fund! _-_-_ 21. Fan 22 Nose and sinuses 23e Iblauth and throat 24. Teeth 25• Chest and lungs Breast -------------------------- 26 Heart e 27. Abdomen 2R Inguinal, e.g.. hernia 2�• Genitalia Code: 0 ®within normal limits 1 --- SlgtuFcantlY abnormal X Not examined NFPA Medley! Esaenln®tlon Fam ti or 12) 20W Eftan APPENDIX T 1582-37 38, Emotional status 39. Other 40. Urine dip: Glucose: Albumin: Home- Leukocyte -Esterase: 41. Flex 142. Step test 143. Body fat 144. PFT 46. Chest x-ray (use 0. 1, or X) 47. EKG (use 0. 1. or X) and specify test used 49. Back eval. 50. Tetanus 51. Pit) 52. Stress test • Code: 0 — Within normal limits I — Significantly abnormal X — Not exan-dned b.U.: Other. 45. Audio 48. Hemocult NFPA MedfeW ElminatMe Fwm (2 at 12) ZCM EdIdGM I582-39 14tEDCC,1i ' REO,t11RE,`(EFOR f 1RE FiCHTERS AND 1NF01MpnON FOR FIRE rtr®.inr%, FIGURE E-2 (t o ) 53.Other x-ray or laboratory findings ..----• • rcteJtL:L�dYS 6 54. Physician't a.. (include code numbers for diagnoRS and diagnoses, ' �ons � d)B �®mmendations made to patient 55. Recommendations /Restn13 56. R.N. signature S7. Physician's signature 58. Patient's signature A Work qualification: 60. Contact person: 61. Dace: ' Code: 0 Within normal limits I —Significant! abnormal y X — Not examined m 62. Initial: NFVA Aftdleati exWM-Um Form (3 of 13) i 2000 Edition . _ APPENDIX F 1582-39 FIGURE E-2 (C ) Health History Yes No it "Yes," Give Details. HaveYou Had Any Surgeriesloperations: On your back arm, leg, or knee? ❑ ❑ To treat a hernia? ❑ ❑ Varicose veins? ❑ ❑ Other operations? ❑ ❑ Have you ever been hospitalized? ❑ ❑ Allergy — Have You Ever Had or Do You Currently Have' Serious allergy? ❑ ❑ Bad reaction to any medication? ❑ ❑ Advised not to take any medication (e.g., aspirin)? ® ®-' Skin — Have You Ever Had or Do You Currently Have: Hives/eczema or rash? ❑ ❑ Chronic skin problems (e.g.. cuts slow to ❑ ❑ heal)? Excessive skin dryness? ❑ ❑ Problems with "easy bruising"? ❑ ❑ -- Chemical or jewelry rasWsensitiviry? ❑ ❑ Neuro -- Have You Ever Had or Do You Currently Have: A psychiatric or emotional problem? ❑ ❑ Numbness/weakness/pa-alysis? ❑ ❑ 'Dizziness or fainting spells? ❑ ❑ Severelfrequent or migraine headaches? ❑ ❑ Head injury, concussion, or skull fracture? ❑ ❑ t4curological disorders? ❑ Cl Seizures or blackouts? ❑ ❑ Stroke? ❑ ❑ Eyes/Ears — Have You Ever Had or Do You Currently Have: Hearing loss? ❑ ❑ Frequent ear infections? ❑ ❑ NFPA Ysd" 8naminsdon Form (4 of 121 1 2000 EdWon 1582-40 titEDtGu, REQUgRE.rtE. TS FOR FIRE FiCFITERSA, 0 f.VFOR141Tt®ly FOR FIRE DEprlltTStEVT p({tStCwVS FIGURE >E<2 (Conliiured, Hearth nging in ears? Hrstory Yes No If '°Yes,°° Give Details. Ri Other ear problems? ❑ ❑ Glaucoma or cataracts? ❑ ❑ Red eyes? ❑ ❑ Eye injury/vision loss? ❑ ❑ Other eye problems s.❑ ❑ ( $., Strain froth Val' u�,v ® ❑ Glasses/contacts? Date of last vision screen? ❑ ❑ ❑ ❑ �+ Head/Neck -- Have You Ever Had or Oo You Currently Have: Date of last dental exam: Recent problems with teedVdentures? ❑ ❑ Frequent mouth ulcersrnf�tions7 ❑ ❑ Sinus or hay fever? ❑ ❑ Frequent sore dtroats? ❑ ❑ Frequent nose bleeds? ❑ ❑ Trouble with thyroid (e,g.. ❑ ❑ medication)? n thyroid ❑ ❑ Problem requiring radiation treatment to the neck area? ❑ ❑ Lungs ® Have You Ever Had or Oo You Currently Have: Asthma or wheezing? Coughed up any blood? ❑ ❑ Shortness of breach without apparent reason? TB or a positive skin test for TB? Pneumonia or pleurisy? ❑ ❑ Do you cough every (:by, especially ❑ ❑ the morning? y in ❑ ❑ Pain or tightness in chest? °41orn than three episodes Of bronchitis in ® ❑ one year? .Ever smoked tobacco in any form? Had a chest x-ray? ❑ ❑ How long: Yrs. Packs ® Per may' when quit: ❑ Last time: 2000 EdiMon HP PA M.d►cW Ee.Aarw.uon Form (! ar t� APPENDIX F 1582-41 rrr_trRr.V.2 (Continued) Health History Yes No It "Yes," Give Details. Heart — Have You Ever Had or Do You Currently Have: Rheumatic fever or heart murmur? ❑ ❑ Heart disease? ❑ ❑ Treated for heart condition? ❑ ❑ Unusually cold or bluish -colored hands ❑ ❑ or feet? High blood pressure. If "Yes.' how is it U Medicine U Diet 0 Exercise -treated? Do you have a history of elevated cholesterol? ❑ ❑ Anemia or any blood disease? ❑ ❑ Phlebitis, varicose veins. or blood clots! ❑ El poor circulation? Chest pain with activity? ❑ ❑ Gi — Have You Ever Had or Do You Currently Have: Ulcers? ❑ ❑ Hiatal hernia? ❑ ❑ Indigestion, pain, or unusual burning in stomach? Vomiting of blood? Bloody/tarry bowel movements? Colitis or nervous stomach? Yellow jaundice or hepatitis? Problems with your pancreas? Gallbladder disease? Kidneys — Have You Ever Had or Do You Currently Have: Bladder or kidney infections? ❑ ❑ Kidney stones? Burning or discomfort on urination, or frequent urination? Hernia? ❑ ❑ Blood in urine? NFPA Lt"cal Exarninalkm Foes (4 Of 12) 20M Edition 1582-42 MEDICAL REQtJiRE'%tE,VM FOR FIRE F7CIiTERS AND INFOPA'W 'nON FOR FIRE DEFARTtiCENT r"ICIAN9 FIGURE 1�2 (C 1 Health History Yes NO It "Ye'." Give Details Miscellaneous — Have you Ever Had or Do You Currently Have: Diabetes or sugar in your blood or urine? Cancer of any kind? Muscle -Skeletal — Have You Ever Had or Da You Currently Have: Anhdds' rheumatism, back injury or disease? k' bk• or neck Beta treated for a back problem? ❑ ❑ El 0 Recurrent stiffness or back pain? ❑ ❑ Bursitis. tendonitis? Recurrent pulled muscles or sprains? El F1 Hand or wrist injury or problem? Cl ❑ Flip or knee injury or Problem? ❑ Ankle or foot injury or problem? Frostbite? Job requuio heavY sitting for long lining standing; or g Penods of time? Any broken bones? ® : ® P For Females Only — Have You Ever Had or Do You Currently Have: Menstrual irregularities? ❑ ❑ Recurrent problems of the female organs? ® ❑ Breast masses or lumps? a ❑ Do you practice monthly breast self -exam? Have you ever had a m aaunogram? ❑ ❑ Date of last pap smear ❑ ❑ For Males Only — Have You Ever Had or Do You Currant IY Have: Prostate or testicular problems? ❑ ❑ Breast tenderness. swelling, or lumps? Do you practice Monthlytesuctrtarself-exam? ® ❑ NFPA Mwtear t?aaiMnatloy tam, (r of 17) 2000 Edition APPENDIX F 1582-43 FIGURE E-2 (Continued.) Health History General Lifestyle 1. (Check the answer that bad describes yom) General health 0 Poor 0 Fair 0 Good 0 Excellent % Seatbelt use 00-24% 025-49% 0 50-74% 0 75-100% Daily stress 0 Low 0 moderate 0 High Average hours sleep 0 6 hours or less 0 74 hours 0 8 hours or mom Average meals daily 0 1 meal 0 2 meals 0 3 or more -Number of eggs per week a 0-1 0 2 0 3 or more Average number red meat meals per week a 0-1 0 2-3 0 3 or more Average number of alcoholic beveragestbeers 0 0-5 0 6-14 0 15 or more per week ' Yes Nor- If "Yes," Give Details. Do you exercise dm times per week? Cl C1 3040 minutes each time? Identify types of exercise. Are you more than 30% above your ideal 11 0 weight? Have you received a tetanus booster in the last 10 years? 0 11 Have you been immunized against hepatitis B? C] C] Year immunized: Do you take any prescription medication? 0 0 Do you take nonprescription medication (or drug) basis? 0 0 over-the-counter on a regular General Lifestyle 11. Do you participate in a workplace wellness/ Cl 11 help promotion program? Which of the following would you like to see offered and would you participate in? Cholesterol screen Blood pressure screen C] C] Weight loss Cl El Nutrition program 0 0 Stress management 0 11 Smoking cessation El ❑ Cl El CPR NFPA MMSCOI 9X&I"I"OdOR FOM (6 of 12) 2000 EddOn 1582-14 `IEi)[C,iL REQUIRE,6tENlg FOR FIRE FtCk{T ,VYD 1, FOp. kTl®ty FOR FIRE DEPARTMENT P"IC64YS FIGURE E-2 (C 1 Health History Yes No If "Yes,'° Give Detaila. Blooddrive° ❑ Health risk appraisal ❑ Self -directed exercise ❑ Health education program ❑ Women's health Work History L Have you ever. Been restricted in your work or given "tight duty" because of your health or injury? Left a job because of health problems? ® Been injured on the job and treated by a doctor? ❑ Received compensation for an industrial injury or illness? ® ❑ Are you receiving any health ❑ care treatment® (e-g., physical therapy, chiropractic, acupuncture, medical, etc.)? Been hos i P taHzed in the last five years? ® Cl you had any illness or injury that we have not asked you about? Work History il: Do you have hobbies, such as furniture nefrn. is idfngainting. hunting, shooting, or model Do you moonlight or have a second job? ,. ❑ ❑ ❑ ❑ Work History il(. Exposures ® Have You Ever Worked Around the Following; Chemical plant? Coke oven? Construction? ❑ ® ,, Cotton, flax, or hemp mill? ® ❑ Electronics plant? ❑ ❑ Farm? ❑ ❑ Foundry? ❑ ❑ NFPA WWieW Examinatlon Roam (9 of 12) 2000 Edi lon ° APPE4NDIX F 1582-45 FIGURE E-1 (Continued) Health History Yes No ' If "Yes," Give Details. Hazardous waste industry? ❑ ❑ Hospital? ❑ ❑ Lumber mill? ❑ ❑ Metal production? ❑ ❑ Mine? ❑ ❑ Nuclear industry? ❑ ❑ Paper mill? ❑ ❑ Pharmaceutical? ❑ ❑ Plastic production? Pottery mill? Refinery? ❑ ❑ Rubber processing plant? ❑ ❑ Sand pit or quarry? ❑ ❑ Service station? ❑ 11 Shipyard? ❑ ❑ Smelter? ❑ ❑ Have You Ever Worked With or Been Exposed To:. Aldrin? ❑ ❑ Arsenic? ❑ ❑ Asbestos? ❑ ❑ .Benzene? ❑ ❑ Benzidine? ❑ ❑ Beryllium? ❑ 11 BIS chlormethyl ether? ❑ 11 Cadmium? Carbon disulfide? Carbon tetrachloride? Chlorine? Chlorodane? Chloroform? NfVA ModkW 9xamine0an Form 110 of 12) -000 ECOO" I582-46 `tEDtCAL REQUIREMENTS FOR FIRE FIG RS+WO INFOR,vW'ryON FICtME £r2 FOR FIRE DEPARTMENT PFtySICL-1M (Covjimr�d) Health History Yes No if "Yes," Give Details. Chlomprene? ❑ ❑ Chromates? Chromic acid mist? ® ❑ Cutting oils? DDT? ❑ ❑ Dieldrin? ❑ ❑ Dioxin? ® ❑ Dust, coal? ❑ ❑ Dust, sandblasting? ❑ ❑ Dusk other? ❑ ❑ Ethyl dibroriide? ❑ Ethylene oxide? ❑ Extreme heat or cold? ❑ ❑ Heptachlor? ❑ ❑ Hexachlorobenzene? ® ❑ DOCyannces (TDI, MDq? ❑ ❑ Laud or continuous noise? ❑ ❑ Mercury? ❑ ❑ Methylene chloride? ❑ ❑ Microwaves, lasers? ❑ Nickel? ,�yyA ® ❑ BS? ❑ ❑ Pesticides, herbicides? Phenois? Phosgene? ® ❑ Plastics? ❑ ❑ Radioactive materials? ❑ ❑ Roofing materials? ® ❑ Rubber? ® ❑ Silica? ❑ ❑ NFPA Uqdtea esamMrdon F.. gt t of 12) 20M Edit" W APPENDIX F I582-47 FIGURE E-2 (ConfimstO Health History Yes No 1f "Yes," Give Details. Solvents/degreasers? ❑ ❑ Soots and tars? ❑ Spray painting? ❑ ❑ TR11PER chlotoethylene? ❑ Vinyl chloride? ❑ ❑ List any toxins/chemicals/biological hazards you might currently be exposed to: Worst History IV. Jobs — Start with the Most Recent: Date (Year to Year) company Position Any work Hazards I certify that the above information is taste and complete to the best of my knowledge. I hereby give permission to release work -related information to the proper authorities of my employer or the company for which I alas a job applicant. Date: Examiner. Signature: NFPA Marled Eeuminsdoe Paine (12 of 12) 1 "k,,, 1582-48 WEDICAL REQUIRB.`1F_N73 FOR FIRE FIGti7ERSA,VO INFOR.ti(,;t•ION FOR FIRE D EpAMtitENT pl•DSICIAN3 Index The copyright in this index is x 02000 National Fire protection Association. doc.rment separate and distinct from the co All Rights Rnerved. qre not applicable to this index- This index may not copyright in the document that It indexes. minion of the National Fire protection AnOciation. Inc. The licensin Peed in whole or in pare by any means without the exs r rovision 3ot �� for the P written per. Abdominal organs, .. 3.9. A 3.9.2 AdwinistaWM guide for fire depart.... Advaneed life support ............. .............. D A" tin. laws .. 5.2.2. A•5.1.1. A-5••2.2 Approved (definition) .................................. D-1.2 Athmta, •�e..................................1-'4.1. A•8.3.2 &2.3.2.4 Authority SJu*l+dledo. {definition) ....... 14.2, A-1.4.2 Basic 9fe su -B- PP� (BLS) Blood and blood.forsaimg organs ......... 5-2.2, A-5-2 2 Blood exposures ...... 3.13. &3.15 Bloodborne pathogen expo .... 4-2.1, A•4-2.1 ProPbllfor ...... Body fluid exposures ...... .............. . Burn mjnry............... ...................... 4-2.1, A-4.2.1 .............. ..•A•5-3.2 Cancer risk ..................C• Candidates.............,......... 8-1.4 Definition ....... De niti . .................. evaluation ° ....1-4.3, X1.4 3 ..... Category A medical condition 2'1, 2-3, A-2-1. d, A.2.1.5. M2.3 Category B medicalco.dido.. sa�tiledical conditions Cbemlcrds ..... ... • • • • ... aerMedical conditions Chest wall ....... ......... .. ' .............. 3.20. A•3.20.2 " ...................3.7• A 3.7 ConBdendan% medical e+'aluuio . .. ................. 2-6 Dental .............. Diabetes mellinn ... , $.5, A-3$.2 Do" member �......................... ' ......... 0.1.1 Drugs ........... .. A-&3.2 Definition ................ 3•90,A-3.20.2 1.4.6 •g. Elecaocardiog-pby ....... ...... .............. 34, A-3-4.2 Emergency medial services (E41g).. &2.2, &2.3.2.5 ,- 5-2.2, A-5.3.2 5.2.2, 5.3, A-5-1.1 Definition ..... Endocrine disorders.. 1-4.18 Epilepsy ...............'.........................3.16,A 3.16 Esophagus......... &3.6 Essential job fimcdons (strrrctrrral ........ "' 36, A-34 fir..Rgbtmg) Definition ........... o ........... App. C Evaluations . ...... ............ 1-4.7 Medical evaluations ' ' Functional zes Functional Capacity evaluation, Exposure incident ..... . Definition ............ ........... . ..............4 2. A-4-2 Ext emiti.s ........ .......... . ............ 14.9 Eyes ............ . ............................ 3.12, A-3.12.2 3.3. A-&3 2000 Edition Fire department .F. Guide for administrators... . Members.... App, Q Fire department physician . .......... as Members Choosing . °.''.2.2.M2.2;.am alo.Mdcaevaluations ...............Definition 2-2.2. A-z2.2. 0.2 Immunizations, responsibility far .................. 1.410 Incident scene treaunent, role in......... , • , 4-i A-5.3.2 5-3.2, "I.I to A•5.1.2 Infection disease control. role in . information for ...... 4.1.2. A-4-21 Record keeping and reports of ............. ... App, B Functional apaci ...... . waluadom ° ...... 24 DefinitionI.,Ljj 4. .G. Gastrointestinal systems Genitour _ary gxasms....... . . . . . . .. . ..... . • .....3-9. A-3A.2 A-3.10, B-3.4, D-1.4 H Head...... Healtb and fitnea coocdln ..or .......... • ...... ' ° .3-2.1, A-3.2.1.2 Definition....... ..........................2-2.4 ....1-4.12 `.. Heel* Definition ty safeofficer....... . on......... 2-2.4 Heating..............................................1-4.13 esrL ..... 3 8.1, .1 , B-13.4, A 3.4.2, 5-1.4. 8-2.3.2.4, B•3.5 .Y, &1.4, g 21 to &2 2, B-Y.l.2 5. &!.! Hepatitis 3 immunizations Implementation of sandsrd.....I .... ........ 4-4- A44 iaeidemt commander... .........1-3. A-1-3.2 Incident safety officer.. ........... . . 5-1.2, 5.2.d, A-5-4.4 Incident nem M`tMtion and medical tres.eat.s...Chap. 5. A.5 Weed* co Definition..... .. , .... , , 4.1.2 Infection cl pr9d.fecti ab1 1-4.14 diseaontose controgr+m (l). Oi4f an c able Definition ........................ ............ Chap.4,A4 14.15 °L- Laboratory tests.. . larynx ........... ................. 8-2.3.2.1 Legal Consideration . ' 3 6, A-! 6 Lungs .... t ..........................17, A-3.7, D-I &21.2.3. & Malignant disease,. Medial conditions ......3-18, A 3-18.2 Category A ........... Chap. 3. A-3; conditions ra- lto specific body parts Definition... • , , , I i' INDEX 1582-49 Category B...................Chap 3. A-3; sae ahir specific body pate and conditions Definition........................................ 14.3 Specific ............................................. B3 Medical evaluations Contentof.......................................... &2.3 Coordination of program ............................... D-3 Definition.........................................1-4.16 Guidancefor ......................................... &2 Incident scene .................................. 5.3,A4-3.2 OSHA 1910.134 compared ........................ Table D-4 Periodic .............................. 2.1.2. 2.4, A-24, &2.2 Preplacement and base line .............. 2.12, 2-3. r12-3, &2.1 Process ................................. 2-1, a4 2-1.1. A-2-1.5 Records, results, reporting. and confidentiality .........26, &2.4 Sample forms, medical examinations ................ App. E Return -to -duty .............. 2-1.2. 2-5, A-2-5.1, A-2-5.3 to A-2.5.4 Tactical level management component (TL..VIC) ........... 5-4.5 5.4.7. A,-54.5 Medical examinations ................ err oko Medical evaluations Componentsof .................................... B&2.3.2 Definition ......................................... 1-4.17 Sampleforms ..................................... App. E Medical history ...................................... 3.2.3.1 Medical process .................................. Chap. 2, A-2 Medicalsartices, emergency................ aceEmergency medical ser"Re(EMS) Medically card8ed Definition.........................................1-4.19 Periodic medical evaluation .........................2.4. A-2-4 Preplacement medical evaluation ....................2-3. A 2-3 Reports ......................................26.2 to 26.3 Renam-toduty medial evaluation ......... 24.2 to 2 5.3. A 2-b.3 Medications .................................... 3-20, A-3.20.2 Members Current Definition ...................................... 1-4.20,1 Medial evaluations ............2-1, 24, A-2-1.1, A 2-1.5, A 2d Definition .................................. 1-4.20.A-1-4.20 Doom ............................................ A-5.3.2 " Incident scene rehabilitation and medical treatment ....................... Chap. 5. A-5 Infection control program ....................... Chap. 4, A-4 Occupational safety and health problems .......... &I, Table D-4 Metabolic disorders ............................... 3-I6. A 3-16 .%fusculoskeletal system ........................... A-5-3.2. &2.6 .N. Neck ......................................... 3.2.2. A3-2.2.2 Neurological disorders .............................3.13, A 3.13 Nose..............................................36.A 36 -O- Occapational history ................................. B-2.3.1 Occupational Safety and Health Admin° trados (OSHA) 1910.134 comparison ............... Table D-4 Occupational safety and health problems ............ &1, Table D-4 Oropbarynx........................................36. 41-36 .P. Personnel accountability system...........................5-4.8 Physical toad, of fire -fighting functions .................... B-1.2 Pbyslci; an ....................... sae Fire department physician pos6expessere pro ....................A-4.2.1 to A-4.2.2 Pregnancy ..................................... 8-3.4. D-1.4 Protected classes ...................................... D-i.3 psychilaoic conditions ........................... 3.19. A-3-19.2 Pulmonary function testing ........................... &2.3.2.3 "me of standard .............................. 1.2. A 1-2.2 -R- Reactive airways disease ................................ 8-3.2 Rote. cod publications .................... Chap. 6. B-4. App. F Reports and records Exposure incidents ................... 4-2.4.3.2. A-4-2. A-4-3.2 Immunization records ................................ A4 4 Medical evaluations .................................... 2-6 Sample forms, medical examinations ................... App. E Reproductive system ............... 3-10.1. A-3.10.1 8-3.4. 0-1.4 Respiratory disease risk .................... &1.4. B-2.3.2.3, &3.2 Ribs .......................................... 3-11.2t • 3.11.2 Rlak,increased........................................ &1.4 S- Sacroiliu joints ................................ Sample forms ........................................ App. E Sanulas...................................... 3.11. A 3-11.2 Scopeof standard.......................................1-1 Second opinions ....................................... 8-2.5 Seisuras.............................................. 114.6 Shall (definition) .....................................1-4.21 Should(defisidon)....................................1-L22 Skin .......................................... 3.14. A-3-14.2 Smoke Inhalation ..................................... A-5.3.2 Spine ......................................... 3-i i, A 3.11.2 Standard (definition) ...................................114.23 Stresstesting . ................................ ..... 8-2.2 Systemic diseases ............................... 3-I6. A-3.17.2 -T Tactical level management component (TLC Q ............... 5.4 A 5-4.3 to A-5.4.5 Definition..........................................1.4.24 Toxic substances ............................ B-1.3, 8-1.4. 8-3.4 Trachea........................................... 16.Ar36 Triage, incident scene ............................ 3-3, A-5.3.2 Tuberculosis ....................................... 4.3. A-4-3 Tumors .................................... 1. 1 3.18, A-3-18.2 .U. Urinary system .............................. 3.10.2, r13-10.2.2 11 -Y- `lascular system ......................... 3-8.2. A.M. &1.4. &3.3 Y°sios............................................ 3-3.A-34 -X- X-rays....................................... &2.2. 8-2.3.2.2 Cou/W 2000 Edition IIINANCE . IS ISSUED lI A MATTER OF INFORNtgTION ONLY AND CONFERS NO RIGHTS UPON TH CERT IF ®ATE I3/26/1 YyyYl 1 CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONS ®3/Z6/14 REPRESENTATIVE OR PRODUCE EX7 END OR ALTER THE COVE iCATE HOLDER, THIS R AND THE CERTIFICATE HOLDER. A CONTRACT BETWEEN THE SUING INSURERROED S THE POLICIES IMPORTANT: If the OR holder Is an ADDITIONAL IIVSUREb the { 1s AUTHORIZED C91 terms and conditions of the policy, cartadn policies may require an endo (raemer1 LA statement on this cardAeats does cerUlteate holder in lieu of such end may endorsed.be If SUBROpgTiON IS WAIVED, aubleet to PRopu .ER not confer rights to the Advanced Professional Services coNTACT 240 Lock Road Prlonle Jo�� 090. CPIq, CPII, PIAM Daerftld s112 F Beach, 2 33442 Isantt LA&h!Rt (972"11554) PhOrae 954 725-8112 �°an�edpr�essional.cam------.-_® INSURED Fax (954 725-6115 INI Gilbert Shapiro, MD INSURER A: Lancet 540 Truman Ave. rNSURER e : INSURER C : Key West, FL 33040 INSURER D : COVERAGES (305) 296-9145 INSURERE: -_ THIS IS TO CERTIFY THAT CERTIFICATE NUMBER: INSURER F: THE POLICIES OF NSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY INDICATED, NOTWRHSTgNDING ANY REpUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUME CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED - REVISI®N NUMBER EXCLUSIONS gNp 9r®NDITIONS�OF SUCH p0_LICIES. LIMBTS SHOWN MAY HAVE BEEN REDUCED BY_Pgip CLAIIytS pERiOD R — ENT WITH RESPECT TO WHICH THIS TYPE OF INSURANCE A UBR ..� REPN IS SUBJECT TO ALL THE TERMS, ®= LIABtLrry POLICY NUMBER POLICY EFF' MM OO/Yyyy 1 MNDEXP COMMERCIAL GENERAL LUIBBUTY e UMI1S� L__J CLAIMS -MADE I EACH OCCURRENCE s r OCCUR DAMAGE TORE r -, PREMISE Ea oaurronee $ L_.-i v MED EXP IAny one person S GEN'L AGGREGATE LIMIT APPLIES PER` - I PERSONAL A ADV INJURY S I I __ r-1 ____ _ AUTOMOEIR E LIABIUTV RI MANAGEM NIT PRODUCTS - COMP/OP AGG s Ie�tt ANYAuao BY s :J AUTOS NED L— AUTOS ULED Ee �slp�D SINGLE LIMIT HIRED AUTOS r-- 110111OWNEO I ®A AUTOS (, BODILY INJURY (Per Perini S I ....r UMBRELLA LIAR - - "-'--------.- BODILY INJURY W Y (Per ealdaM yE�®' POPE:R DAM-®qGE g er •ca .,_ OCCUR ` EXCESS LIAR enlr 71. d CLAIMS -MADE OE®,_,', J.,RETENTrONt _._..w, WORKERS S EACH OCCURRENCE w COMPENSATION J AND EMPLOYERS* LIABILITY AGGREGATE ANY PROPRIETORIP Y I N I OFFICER/MEMBER EXCLUDEDvECUTIVE — N I A i I IMandarory In NHIae UI C!"I TON _OFPERNSbelow -__1QRK Md�1_N- EACHACCIDEESCRIPtD ---C - -T_—I S ' A Medical Professional Llability E L. DISEASE - EA -' EMPLOYE S — - m`~ - E L I L1091289001415 DISEASE -POLICY LIMIT DEscRIPnoN of oPERAnONs / LOCAnoNs I VEHICLES (Aaacb AcoRo tot, Addluon,l R•m,ra Schedule, u®moro®• 3�®07J012014 P $250,000 Each/ $750.000 Aggregate Specialty; Family Practice. No Surgery -___.-�--- •-�-'-�'-""--••-�-- Endorsement: Stephanie A. Gallaher, ARNP I®Aaulltiel - -- - -'— CERTIF .CANCELLATION Monroe County Board of County COMIniSSioners 500 UVhitehead St. Key West. FL 33040- ACORD 25 (2010/051 CIF SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORI ZED REPRESENTATIVE n 1988-2010 ACORD CORPORATION. All rights reserved, The ACORD name and logo are registered marks of ACORD 1 e' 1!' 1 • r holder-inIMPORTANT: If the cartificato holder Is an ADDITioml iksukmj�& poucypes) must be endorsed. IIISUBROGATIONISWAIVIED,subloetto the terms and conditions of the policy, certain policies may require an endorsemorrL A statement on this certificate does not confer rights to the car tificate of such endorsement[s). Advanced Professional Services 240 Lock Road Deerfield 0 AFFORDING -. . _. Indemnity RRG INSURED 1� Elias J. Gerth, MD �rm Truman Ave. Key West, FL 33040 INSURER 0: _540 ' P-M • %%lYr�;7_L�i� N�a11yfN_1s�itah51:1� :t�9K11•liS2lsl„I=1� THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _ IN9�R TYPE Of INSURANCE A UB POLICY NUMBER ILDICY EPP POLICY EXP LIMITS - GENERAL LIABkJ1Y EACH OCCURRENCE S 250,000.00 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTEDE PREMI Ee occunrencalS MED EXP (Any one Person S ` f LCLAIMS-MADE u OCCUR i LRO91212001354 PERSONAL a ADV INJURY S A —_) Medical Professional 05/01/2013 05/01t2014 GENERAL AGGREGATE S 750,000.00 ~' Liability insurance GEN'L AGGREGATE LIMIT APPLIES PER' PRODUCTS - COMP/OP AGO S S i__ POLICY n PRO- C LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT a aed ent BODILY INJURY (Per Person) s ANY AUTO QMEW f-� AALLLL OWNED :1 AUTOS DULED _j ,-1 NON -OWNED `. D �� BODILY INJURY (Per accident SOS P�PERTYnDAMAGE _ 3 HIRED AUTOS j AUTOS AUTOS ._. f-' BY + I---� -.. UMBREu.A LIAR f OCCUR _ DA EACH OCCURRENCE $ _ (r EXCESS LIAB 1 CLAIMS -MADE WAIVER YE9 AGGREGATE s S I DED RETENTION WORKERS COMPENSATION I AND EMPLOYERS' LIABILITY YIN I ANY PROPRIETORIPARTNER/EXECUTIVE OFFICERIMEMBEREXCLUDED? (Mandatory In NH) J NIA -- NC ST�ATU- _ TORY. EL EACH ACCIDENT EL DISEASE • EA EMPLOYE S S 1 :f as, !®scribe under D6CRIPTION OF OPERATIONS below — - - �..r__ E L. DISEASE - POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES lAdach ACORD 101, Additional Remark® Schedule, if more space to required) Specialty: Internal Medicine - No Surgery CERTIFICATE HOLDER Monroe County Board of County Commissioners 500 Whitehead St. Key West, FL 33040- ACORD 25 (2010106) CIF �— CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. (-AUTHORIZED REPRESENTATIVE 1 ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LI j CERTIFICATE �MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTg UPON-THE`� ®ATa IM® DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND E03/26/14 BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE REPRESENTA o AND OR ALTER CERTIFICATE HOLDER, THf3 T1Vt: OR PRODUCER, AND THE CERTIFICATE HOLDER A CONTRACT BE THE COVERAGE AFFORDED By THE POLICIES IMPORTANT: Ilthe ceeiificate holder Is an AD TWEEN THE ISSUING INSURER($}, AUTHORIZED the temts and conditions of thepolicy,DRIONAL INSURED, the Poltcypes) mast be endorsed, If sUBROGATiON IS WAIVED subject to CertIficate holder in lieu of such nor own POltolse may require an endorsement A s��mem on Dols certlticate d PRODUCER orsemerlgsl• oes not confer rights to the Advanced Rrofess(onal Services TA 240 Ludt Road �� E Joseph Seretlago, CPIA, CPIs, PIAM kf € " (954 725-6112 ) 72 2 5-61 f 2 112 jsand aC o ° 954 725 6115 Pho►'� 954pn)fesaional.ram 11 OUREa Fax 954 72"115 INI INSURER A : Lane! TimDthy W. Mackey, Do INSURER B : 540 Truman Ave. INSURER C ; Key West. FL 33040 LINSURER D : OEO - i RETENTION g - WORKERS COMEN PSATION AND EMPLOYERS' LIAeILny DESCRIPTION OF OPERATIONS r LOCAT10Ns r VEHICLES (Atree CAh 0 OR tet, Addalonel Rertnelp Sehadub, Ir gpro Specialty: Urgent Care 'L"---- wa 12 required) CERTIFICATE Monroe County Board Of County Commissioners SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CAN -- THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN ®BEFORE `? 500 Whitehead St. ACCORDANCE WITH THE POLICY PROVISIONS. Key West, FL 33040. AUTHORLZED REPRESENTAT --- ACORD 25 (2010/05) qF I O 1988-2010 ACORD CORPORATION. All right ree®rved The ACORD name and logo are reg(st®rlsd marks of ACORD