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Item C20 BOARD OF COUNTY COMMISSIONERS AGENDA ITEM SUMMARY Meeting Date: March 19, 2014 Division: Employee Services Bulk Item: Yes X No _ Department: Human Resources Staff Contact Person/Phone#: Pam Pumar X4459 AGENDA ITEM WORDING: Approval to amend contract with Michael D. Burton, D.O. to provide employment physical services. ITEM BACKGROUND: On April 20, 2014, this contract will expire. Michael D. Burton has agreed to continue to provide the services as in the current contract with an increase in fees. PREVIOUS RELEVANT BOCC ACTION: The BOCC approved the original contract on April 20, 2011. CONTRACT/AGREEMENT CHANGES: Section 1: The amendment includes a slight increase in fees for physicals, from $35 to $45 for safety-sensitive(DOT)positions, and from$35 to $40 for all other positions. Section 4: The contract is amended to provide that the term of the contract will be automatically renewed unless one party terminates the agreement. Section 7: The contract is amended to provide that either party can terminate without cause, on sixty(60)days' notice to the other party. Section 8: The contract is amended to include new language required by Florida Statutes section 119.0801(2)regarding public records. STAFF RECOMMENDATIONS: Approval TOTAL COST: approx. $3,50031 INDIRECT COST: BUDGETED: Yes X No DIFFERENTIAL OF LOCAL PREFERENCE: COST TO COUNTY: approx. $3,500 3r SOURCE OF FUNDS: Ad Valorem REVENUE PRODUCING: Yes_ No X AMOUNT PER MONTH Year APPROVED BY: County Atty 410 M(jk/Purc asing Risk Management DOCUMENTATION: Included X Not Required DISPOSITION: AGENDA ITEM# Revised 7/09 MONROE COUNTY BOARD OF COUNTY COMMISSIONERS CONTRACT SUMMARY Contract# Contract with: Michael D. Burton, D.O. Effective Date: March 19, 2014 Expiration Date: Contract Purpose/Description: First Amendment to renew contract,• increase fees,• and add Florida Statute requirement regarding public records Contract Manager:Pam Pumar 4459 Human Resources (Name) (Ext.) (Department) for BOCC meeting on March 19, 2014 Agenda Deadline: March 4, 2014 CONTRACT COSTS Total Dollar Value of Contract: Approx$3,500 Current Year Portion: $1 590 yr Budgeted?Yes X No Account Codes: 001-06500-510-316- Grant: $ — County Match: $ ADDITIONAL COSTS Estimated Ongoing Costs: $ /yr For: (Not included in dollar value above) (eg.maintenance,utilities, janitorial,salaries,etc.) CONTRACT REVIEW Changes Date Out Date In Needed AReviewer Division Director o� 1 Yes❑NoTf Risk Management 'Fq Yes[]NoE� O.M.B./Purc ing L-La7-,Y Yes❑No® m_ � - County Attorney - ,1 Yes❑No - I Comments: OMB Form Revised 9/11/95 MCP#2 FIRST AMENDMENT TO CONTRACT FOR EMPLOYMENT PHYSICAL SERVICES This is an amendment ("Amendment") dated March 19, 2014 is entered into by and between Monroe County ("County") and Michael Burton, D.O. ("Contractor"). WHEREAS, the County and Contractor entered into a Contract for Employment Physical Services ("Agreement") on April 20, 2011, whereby Michael D. Burton, D.O. agreed to furnish employment physical services; and WHEREAS, the current contract expires on April 20, 2014 and the County continues to need the services listed in the Agreement; and WHEREAS, there is now an increase in fees; and WHEREAS, Florida Statutes section 119.0701(2) provides that "each public agency contract for services must include a provision that requires the contractor to comply with public records law"; NOW THEREFORE, in consideration of the mutual covenants contained herein the parties agree to amend Section 1 of the Scope of Services and Sections 4, 7 and 8 of Agreement as follows: 1. Section 1, Scope of Services of the Agreement is revised to increase fees as follows: DOT Physical $45.00 Post-Offer Physical $40.00 Firefighter Physical $40.00 2. Paragraph 4.2 of the Agreement is revised to read as follows: Following the expiration of the initial term and any subsequent terms listed in paragraph 4.1, this Agreement shall automatically renew for successive one- year terms unless and until either party gives the other notice of cancellations in accordance with the terms set forth in paragraph 7, below. 3. Section 7, CONTRACT TERMINATION, in the Agreement is revised to read as follows: Either party may terminate this Agreement because of the failure of the other party to perform its obligations under the Agreement. Either party may also terminate this Agreement without cause, on sixty (60) days' written notice to the other party in accordance with Section 9 of this Agreement. The COUNTY shall pay contractor for all work performed through the date of termination. 4. A new paragraph (F) is added to Section 8 of this Agreement (CONTRACTOR'S ACCEPTANCE OF CONDITIONS), as follows: F. Pursuant to Florida Statutes 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. Provide the public with access to public records on the same terms and conditions that Monroe County would provide the records and at a cost that does not exceed the cost provided in Florida Statutes, Chapter 119 or as otherwise provided by law. iii. Ensure that public records that are exempt or confidential and exempt from public records disclosure requirements are not disclosed except as authorized by law. iv. Meet all requirements for retaining public records and transfer, at no cost, to Monroe County all public records in possession of the contractor upon termination of this Agreement and destroy any duplicate public records that are exempt or confidential and exempt from public records disclosure requirements. All records stored electronically must be provided to Monroe County in a format that is compatible with the information technology systems of Monroe County. 5. All other terms and conditions of the Agreement remain in full force and effect. [THE REMAINDER OF THIS PAGE INTENTIONALLY LEFT BLANK] 2 IN WITNESS WHEREOF, the parties hereto have caused this Amendment to be executed the day and year first above written. (SEAL) Board of County Commissioners Attest: Amy Heavilin, Clerk of Monroe County Deputy Clerk Mayor/Chairman (CORPORATE SEAL) Michael D. Burton, D.O. Attest: BY ,/ - d1 Print Name i a Title MONROE COUNTY ATTORNEY AP ; OVE AS TO FOR NTHIA L. 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C v_ oa �' !� �°. c+'Z7 D i b tT � n, [� $ c b 4 `K ti m ° K = o, Cry S '� • 5.0 `� trq ,� qti ro `7Q � x � gn "� ra � de� �ro � •c5, ao" ', ` 'r . � � °' =�' °r0, 9 : -3,an.arn ° °, .a d p, 3 raF y o o c ro `e m.moo.4 a 'Q E° ' o � -�i 3i � c o :, ° —. -h off,v 9r' f o . 1A „ �' �°' o p1 ? y '�•$ �' o a re �n ° A^b a-d C H n a vn roams � roa 3a• 'o ti - d W ' �• -- o y�• o to c,, B w a �, 0-, 6 r, „ � ° o',�' �i.o ° �'a C' ? p' y �" A oo n y = d k �i' "J�' �- As w rp Q A y o ff O a.a y a .o~' . a r' C 3, VJ o � - r.7 "� d Mar-31-2011 08:38 From-EMPLOYEE SERVICES 305 202 4564 T-929 P.002 F-085 MONROE COUNTY CONTRACT FOR EMPLOYMENT PHYSICAL SERVICES THIS AGREEMENT("Agreement")is made and entered into this 20th day of April.2011, by MONROE COUNTY CCOUNTY"), a political subdivision of the State c f Florida,whose address is 1100 Simonton Street, Key West, Florida 33040 and Koo b 6-11?ie ("CONTRACTOR"),whose address Is 1446 Kennedy Drive, Key West, FL 33040. Section 1. SCOPE OF SERVICES Michael D.Burton,D.O. CONTRACTOR shall do, perform and carry out in a professional and proper manner certain duties as described in the Scope of Services—Section One--which Is attached hereto and made a part of this agreement. CONTRACTOR shall provide the scope of services in Section One for COUNTY. CONTRACTOR warrants that It is authorized by law to engage in the performance of the activities herein described, subject to the terms and conditions set forth In these Agreement documents. The CONTRACTOR shall at all times exercise independent, professional judgment and shall assume professional responsibility for the services to be provided. Contractor shall provide services using the following standards, as a minimum requirement: A. The CONTRACTOR shall maintain adequate staffing levels to provide the services required under the Agreement. B. The star is responsible for obtaining proper releases from the GMPjere employee or prospective employee in order to discuss the results with Monroe County BOCC. The contractor will provide the required services at the location of Key West Family Medical Center 1446 Kennedy Drive Key West, FL 33040 _ Phone: 305.294-8900 Fax: 305-294-6201 �"' � D. All urine screens will conform with the standard chain of custody pretocol :n mandated by state and federal regulations. m E. The Contractor will have an employee designated as coordinator oc o facilitator to assist In the communications with the Monroe County BOCc3M o nmary contact personnel. LVthe business hours of the facility: Monday—Friday 8:30 a.m.—5:3Q p.m. and Saturday 10:00 am-- 12,00 p.m. Walk-ins will also be accepted If an appointment cannot be reasonably scheduled. G. The facility will be available 24 hours a day, 7 days a week for post accident, random and reasonable suspicion alcohol and drug screening. a The Human Resources office will contact Dr. Burton via private phone line to request that the physician administer the test. • The authorized Human Resources representative or the authorized supervisor shall complete the appropriate forms in order for the physician to perform the required test. 2 Mar-31-2011 08:39 From-EMPLOYEE SERVICES 305 202 4564 T-920 P.003 F-086 • The employee will be tested at the physician's facility located at 1446 Kennedy Drive, Key West. Appointments will be seen by the contractor In a reasonable and timely fashion. y ,).,b r2iy��el1 ,¢e��!-�� I. The Contractor will provide the County with turnaround time for the receipt of any drug 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 M RO 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 niles 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 be fully qualified, and, if required, to be authorized or permitted under State and local law 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 manages, comply with Health Insurance Portability and Accountability Act(HIPAA) privacy and security rules. Physical examinations will be conducted by, or under the direct supervision, of a physician or medical doctor currently licensed and practicing general medicine In the State of Florida. The examining physician may employ assistants properly licensed and trained, as necessary, to perform laboratory tests and/or assist in all phases of the examination. Section 3. COUNTY'S RESPONSIBILITIES 3.1 Provide all best available Information as to the COUNTY'S requirements for the Scope of Services described in Section One to this Agreement. 3.2 Designate In writing a person with authority to act on the COUNTY'S behalf on all matters concerning said services. Section 4. TERM OF AGREEMENT 4.1 The Initial Agreement term will be for one(1)year beginning the 20th day of it 2&LI. and renewable at the County's option for two (2)additional consecutive one year terms. 3 Mar-31-2011 08:38 From-EMPLOYEE SERVICES 305 202 4564 T-929 P.004 F-093 4.2 The terms of this Agreement shall be from the effective date hereof and continue for a period of one year. This Agreement shall be automatically renewed for successive one- year periods until either party gives the other notice of Cancellation in accordance with the terms set forth below. The Contractor must provide the Contractor with at least thirty(30) days notice of intent to terminate. If either party desires to modify this Agreement, it shall notify the other In writing at least thirty(30) days prior to the effective date of such modification. In the case of proposed modification the party receiving the notification of the proposed modification shall itself notify the other party within ten (10)days after receipt of notice of its agreement to the proposed modification. Failure to do so shall terminate this Agreement. Section S. COMPENSATION Compensation to CONTRACTOR is outlined in the Scope of Services—Section One. Section 6. PAYMENT TO CONTRACTOR 6.1 Payment will be made according to the Florida Local Government Prompt Payment Act. Any request for payment must be In a form satisfactory to the Clerk of Courts for Monroe County (Clerk). The request must describe in detail the services performed and the payment amount requested. The CONTRACTOR must submit invoices to the appropriate offices marked Human Resources. The respective office supervisor and the Administrator of Human Resources, who will review the request, note his/her approval on the request and forward it to the Clerk for payment. 6.2 Continuation of this Agreement is contingent upon annual appropriation by Monroe County Board of County Commissioners. Section 7. CONTRACT TERMINATION Either party may terminate this Agreement because of the failure of the other party to perform its obligations under the Agreement. COUNTY may terminate this Agreement with or without cause upon thirty(30) days notice to the CONTRACTOR. COUNTY shall pay CONTRACTOR for work performed through the date of termination. Section 8. CONTRACTOR'S ACCEPTANCE OF CONDITIONS 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 to be done. Under no circumstances, conditions, or situations shall this Agreement be more strongly construed against COUNTY than against 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. 4 Mar-31-2011 08:39 From-EMPLOYEE SERVICES 305 202 4564 T-029 P-005/022 F-086 i D. CONTRACTOR agrees that County Administrator or his designated representatives may visit CONTRACTOR'S facility (ies) periodically to conduct random evaluations of f services during CONTRACTOR'S normal business hours. w,h► .fWAjw,�- ,a,��;�A 1,, , 44, 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. Section 9. NOTICES Any notice required or permitted under this agreement shall be in writing and hand delivered or mailed, postage prepaid, to the other party by certified mail, returned receipt requested, to the following: To the COUNTY: Human Resources Administrator 1100 Simonton Street, Suite 2-268 Key West, Florida 33040 To the CONTRACTOR; Key West Family Medical Center 1446 Kennedy Drive Key West, FL 33040 Section 10. RECORDS CONTRACTOR shall maintain all books, records, and documents directly pertinent to performance under this Agreement In accordance with generally accepted accounting principles consistently applied. Each party to this Agreement or their authorized representatives shall have reasonable and timely access to such records of each other party to this Agreement for public records purposes during the term of the agreement and for four years following the termination of this Agreement. If an auditor employed by the COUNTY or Clerk determines that monies paid to CONTRACTOR pursuant to this Agreement were spent for purposes not authorized by this Agreement, the CONTRACTOR shall repay the monies together with interest calculated pursuant to Section 55.03 of the Florida Statutes, running from the date the monies were paid to CONTRACTOR. Section 11. EMPLOYEES SUBJECT TO COUNTY ORDINANCE NOS. 010 AND 020-1990 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 Ordinance No. 010-1990 or any County officer or employee in violation of Section 3 of Ordinance No. 020-1990. For breach or violation of this provision the COUNTY may, in its discretion, terminate this agreement without liability and may also, in its discretion, deduct from the agreement or purchase price, or otherwise recover the full amount of any fee, commission, percentage, gift, or consideration paid to the former County officer or employee. 5 ........ Mar-31-201i 0e:38 From-EMPLOYEE SERVICES 305 202 4564 T-828 P-000/022 F-085 Section 12. CONVICTED VENDOR A person or affiliate who has been placed on the convicted vendor list following a conviction for public entity crime may not submit a bid on a Agreement with a public entity for the construction or repair of a public building or public work, may not perform work as a CONTRACTOR, supplier, subcontractor, or CONTRACTOR under Agreement with any public entity, and may not transact business with any public entity in excess of the threshold amount provided in Section 287.017 of the Florida Statutes,for the Category Two for a period of 36 months from the date of being placed on the convicted vendor list. Section 13. GOVERNING LAW,VENUE,INTERPRETATION, COSTS AND FEES This Agreement shall be govemed by and construed in accordance with the laws of the State of Florida applicable to Agreements made and to be performed entirely in the State. In the event that any cause of action or administrative proceeding Is instituted for the enforcement or interpretation of this Agreement, the COUNTY and CONTRACTOR agree that venue shall lie In the appropriate court or before the appropriate administrative body in Monroe County, Florida. 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 to any extent by a court of competent jurisdiction, the remaining terms, covenants, conditions and provisions of this Agreement, shall not be affected thereby; and each remaining term, covenant, condition and provision of this Agreement shall be valid and shall be enforceable to the fullest extent permitted this Agreement would prevent the accomplishment by law unless the enforcement of the remaining terms, covenants, conditions and provisions of Of the original intent of this Agreement. The COUNTY and CONTRACTOR agree to reform the Agreement to replace any stricken provision with a valid provision that comes as close as possible to the intent of the stricken provision. Section 15. ATTORNEY'S FEES AND COSTS The COUNTY and CONTRACTOR agree that in the event any cause of action or administrative Proceeding is initiated or defended by any party relative to the enforcement or interpretation of this Agreement, the prevailing party shall be entitled to reasonable attomey's fees, and court costs, as an award against the non-prevailing party. Mediation proceedings initiated and conducted pursuant to this Agreement shall be In accordance with the Florida Rules of Civil Procedure and usual and customary procedures required by the Circuit Court of Monroe County. Section 16. BINDING EFFECT The terms, covenants, conditions, and provisions of this Agreement shall bind and inure to e benefit of the COUNTY and CONTRACTOR and their respective legal represe th ntatives, successors, and assigns. 6 Mar-31-2011 08:40 From-EMPLOYEE SERVICES 305 292 4564 T-020 P-007/022 F-085 Section 17. AUTHORITY Each parry represents and warrants to the other that the execution, delivery and performance of this Agreement have been duly authorized by all necessary County and corporate action, as required by law. Section 18. ADJUDICATION OF DISPUTES OR DISAGREEMENTS COUNTY and CONTRACTOR agree that all disputes and disagreements shall be attempted to be resolved by meet and confer sessions between representatives of each of the parties. If the issue or Issues are still not resolved to the satisfaction of the parties, then any party shall have the right to seek such relief or remedy as may be provided by this Agreement or by Florida law. This Agreement shall not be subject to arbitration. 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 and CONTRACTOR agree to participate, to the extent required by the other party, in all proceedings, hearings, processes, meetings, and other activities related to the substance of this Agreement or provision of the services under this Agreement. COUNTY and CONTRACTOR specifically agree that no party to this Agreement shall be required to enter Into any arbitration proceedings related to this Agreement. Section 20. NONDISCRIMINATION COUNTY and CONTRACTOR agree that there will be no discrimination against any person, and it is expressly understood that upon a determination by a court of competent jurisdiction that discrimination has occurred, this Agreement automatically terminates without any further action on the part of any party, effective the date of the court order. The parties agree to comply with all Federal and Florida statutes, and all local ordinances, as applicable, relating to nondiscrimination. These include but are not limited to: 1) Me VII of the Civil Rights Act of 1964 (PL 88-352) which prohibits discrimination in employment on the basis of race, color, national origin; 2)Title IX of the Education Amendment of 1972, as amended (20 USC ss. 1681- 1683, and 1685-1686). which prohibits discrimination on the basis of sex; 3)Section 504 of the Rehabilitation Act of 1973, as amended (20 USC S. 794), which prohibits discrimination on the basis of handicaps: 4) The Age Discrimination Act of 1975, as amended (42 USC ss. 6101- 6107) which prohibits discrimination on the basis of age; 5) The Drug Abuse Office and Treatment Act of 1972 (PL 29-255), as amended, relating to nondiscrimination on the basis of drug abuse; 6) The Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (PL 91-616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; 7) The Public Health Service Act of 1912, ss, 523 and 527 (42 USC ss. 690dd-3 and 290ee-3) as amended, relating to confidentiality of alcohol and drug abuse patient records; 8) Me VIII of the Civil Rights Act of 1968 (42 USC ss. 3601 et seq.), as amended, relating to nondiscrimination in the sale, rental or financing of housing; 9) The Americans with Disabilities Act of 1990 (42 USC s. 1201), as may be amended from time to time, relating to nondiscrimination on the basis of disability; 10) Monroe County Cade Chapter 13, Article VI, which prohibits discrimination on the basis of race, color, sex, religion, national origin, ancestry, sexual orientation, gander identity or expression, familial status or age; and 11) any other nondiscrimination provisions In any Federal or state statutes which may apply to the parties to, or the subject matter of,this Agreement. 7 Mar-31-2011 08:40 From-EMPLOYEE SERVICES 305 282 4564 T-028 P.008/022 F-085 Section 21. COVENANT OF NO INTEREST COUNTY and CONTRACTOR covenant that neither presently 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 Agreement. Section 22, CODE OF ETHICS COUNTY agrees that officers and employees of the COUNTY recognize and 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, conflicting employment or contractual relationship; and disclosure or use of certain Information. Section 23. NO SOLICITATION/PAYMENT The COUNTY and CONTRACTOR warrant that, In respect to itself, It has neither employed nor retained any company or person, other than a bona fide employee working solely for it, to solicit or secure this Agreement and that It has not paid or agreed to pay any person, company, corporation, individual, or firm, other than a bonafide employee working solely for it, any fee, commission, percentage,gift, or other consideration contingent upon or resulting from the award or making of this Agreement. For the breach or violation of the provision, the CONTRACTOR agrees that the COUNTY shall have the right to terminate this Agreement without liability and, at its discretion, to offset from monies owed, or otherwise recover, the full amount of such fee, commission, percentage, gift, or consideration. Section 24. PUBLIC ACCESS The COUNTY and CONTRACTOR shall allow and permit reasonable access to, and Inspection 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 in conjunction with this Agreement; and the COUNTY shall have the right to unilaterally cancel this Agreement upon violation of this provision by CONTRACTOR. Section 21 NON-WAIVER OF IMMUNITY 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. Section 26. PRIVILEGES AND IMMUNITIES All of the privileges and Immunities from liability, exemptions from laws, ordinances, and rules and pensions and relief,disability,workers'compensation, and other benefits which apply to the activity of officers, agents, or employees of any public agents or employees of the COUNTY, when performing their respective functions under this Agreement within the territorial limits of the COUNTY shall apply to the same degree and extent to the performance of such functions and duties of such officers, agents, volunteers, or employees outside the territorial limits of the COUNTY. 8 Mar-31-2011 08:41 From-EMPLOYEE SERVICES 305 282 4564 T-926 P.009/022 F-086 Section 27. LEGAL OBLIGATIONS AND RESPONSIBILITIES Non-Delegation of Constitutional or Statutory Duties. This Agreement is not intended to, nor shall It be construed as, relieving any participating entity from any obligation or responsibility Imposed upon the entity by law except to the extent of actual and timely performance thereof by any participating entity, In which case the performance may be offered In satisfaction of the obligation or responsibility. Further, this Agreement is not intended to, nor shall it be construed as, authorizing the delegation of the constitutional or statutory duties of the COUNTY, except to the extent permitted by the Florida constitution, 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 them, of this Agreement to enforce or attempt to enforce any third-party claim or entitlement to or benefit of any service or program contemplated hereunder, and the COUNTY and the CONTRACTOR agree that neither the COUNTY nor the CONTRACTOR or any agent, officer, or employee of either shall have the authority to Inform, counsel, or otherwise indicate that any particular individual or group of individuals, entity or entities, have entitlements or benefits under this Agreement separate and apart, Inferior to, or superior to the community in general or for the purposes contemplated in this Agreement. Section 29. ATTESTATIONS CONTRACTOR agrees to execute such documents as the COUNTY may reasonably require, including, but not being limited to, a Public Entity Crime Statement, an Ethics Statement, aFJd H , Lobbying and Conflict of Interest Clause, and Non-Collusion Agreement. Section 30. NO PERSONAL LIABILITY No covenant or agreement contained herein shall be deemed to be a covenant or agreement of any member, officer, agent or employee of Monroe County in his or her Individual capacity, and no member, officer, agent or employee of Monroe County shall be liable personally on this Agreement or be subject to any personal liability or accountability by reason of the execution of this Agreement. Section 31. EXECUTION IN COUNTERPARTS This Agreement may be executed in any number of counterparts, each of which shall be g rearded 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 by slgning any such counterpart. Section 32. SECTION HEADINGS only, and It is agreed that such section headings are not a part of this Agreement a Section headings have been inserted In this Agreement as a matter of convenience of reference used in the interpretation of any provision of this Agreement, nd will not be Section 33. INSURANCE POLICIES 33.1 General Insurance Requirements for other Contractors and Subcontractors. As a pre-requisite of the work governed, the CONTRACTOR shall obtain, at his/her own 9 Mar-31-2011 06:41 From-EMPLOYEE SERVICES 306 292 4684 T-629 P.010/022 F-085 expense, insurance as specified in any attached schedules, which are made part of this contract. The CONTRACTOR will ensure that the insurance obtained will extend protection to all Subcontractors engaged by the CONTRACTOR. As an alternative,the CONTRACTOR may require all Subcontractors to obtain insurance consistent with the attached schedules; however CONTRACTOR is solely responsible to ensure that said insurance is obtained and shall submit proof of insurance to COUNTY. Failure to provide proof of Insurance shall be grounds for termination of this Agreement. The CONTRACTOR will not be permitted to commence work governed by this contract until satisfactory evidence of the required insurance has been furnished to the COUNTY as specified below. Delays in the commencement of work, resulting from the failure of the CONTRACTOR to provide satisfactory evidence of the required insurance, shall not extend deadlines specified in this contract and any penalties and failure to perform assessments shall be Imposed as if the work commenced on the specified date and time, except for the CONTRACTOR's failure to provide satisfactory evidence. The CONTRACTOR shall maintain the required Insurance throughout the entire term of this contract and any extensions specified in the attached schedules. Failure to comply with this provision may result in the immediate suspension of all work until the required insurance has been reinstated or replaced and/or termination of this Agreement and for damages to the COUNTY. Delays in the completion of work resulting from the failure of the CONTRACTOR to maintain the required insurance shall not extend deadlines specified in this contract and any penalties and failure to perform assessments shall be imposed as if the work had not been suspended, except for the CONTRACTOR's failure to maintain the required insurance. The CONTRACTOR shall provide, to the COUNTY, as satisfactory evidence of the required Insurance,either. • 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. 33.2 General Liability Insurance Requirements For Contract Between County And Contractor Not applicable L33.3 Workers'Compensation Insurance Requirements Not applicable 10 I Mar-31-2011 06:42 Prom-EMPLOYEE SERVICES 305 292 4664 f-920 P.012/022 F-095 IN WITNESS WHEREOF, the parties hereto have caused these presents to be executed on the a�0 day of AQEY 201L. BOARD OF COUNTY COMMISSIONERS DANNY L. KOLHAGE, CLERK tl OF MONROE COUNTY, FLORIDA &4an,,ram Deputy Clerk by �tltlNTT � ayor/Chairman CORPORATE SEAL)ATTEST: MICHAEL D. BUR : D.O. By by Title; i 10ON OE COUNTY ATTORN A RO AS O R ASSIS AN T r'01 INTY ATTORNEY 12 Mar-21-2011 08:42 From-EMPLOYEE SERVICES 306 282 4564 T-828 P.011/022 Fr08s 33.4 Professional Liability Requirements Recognizing that the work governed by this contract Involves the furnishing of advise 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 liability shall be, $250,000 per occurrence and$750,000 aggregate Section 34. INDEMNIFICATION oaf, S Aro The CONTRACTOR does hareb a and a to Indemnl d hold`harmless the Y 9 COUNTY, its Mayor, the Board o unty Commissioners, appoint cards and Commissions, Officers, and the Employees d any other agents, individu and collectively, from all fines, suits, claims, demands, ons, costs, obligations, attom fees, or liability of any kind arising out of the sole negli t actions of the CONTRACT or substantial and unnecessary delay caused by the wi nonperformance of the CON CT and shall be solely responsible and answerable f any and all accidents or inj to persons or property arising out of its performa of this contract. The amount d type of insurance coverage requirements set forth h under shall in no way be cons as limiting the scope of indemnity set forth in this pa ph. Further the CONTRACT agrees to defend and pay all legal costs attendant to a attributable to the sole neglige 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 find the CONTRACTOR or any of his/her employees, contractors, servants or agents to be employees of the Board of County Commissioners for Monroe County. As an independent contractor the CONTRACTOR shall provide independent, professional judgment and comply with all federal, state, and local statutes, ordinances, rules and regulations applicable to the services to be provided. The CONTRACTOR shall be responsible for the completeness and accuracy of its work, plan, supporting data, and other documents prepared or compiled under its obligation for this project, and shall correct at its expense all significant errors or omissions therein which may be disclosed. The cost of the work necessary to correct those errors attributable to the CONTRACTOR and any damage incurred by the COUNTY as a result of additional costs caused by such errors shall be chargeable to the CONTRACTOR.This provision shall not apply to any maps, official records, contracts, or other data that may be provided by the COUNTY or other public or semi-public agencies. The CONTRACTOR agrees that no charges or claims for damages shall be made by it for any delays or hindrances attributable to the COUNTY during the progress of any portion of the services specified in this contract. Such delays or hindrances, If any, shall be compensated for by the COUNTY by an extension of time for a reasonable period for the CONTRACTOR to complete the work schedule. Such an agreement shall be made between the parties. i!i filar-31-2011 00:43 From-EMPLOYEE SERVICES 305 282 4664 T-928 P.013/022 F-065 SECTION ONE SCOPE OF SERVICES EMPLOYMENT PHYSICAL SERVICES The scope of services to be provided on an as needed basis by the Provider and 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 $45.00 Requirement walk-in basis. After hours drug testing for post $145.00 accident, random,and reasonable per test suspicion drug screening, DRUG SCREEN: When requested,a drug screen will (Collection, Lab,MRO be performed by the physician and review)S panel will be either scheduled or done on a $45.00 Department of walk-in basis. Transportation Requirement After hours drug testing for a $145.00 moving violation or an accident per test where a fatali occurs. MRO REVIEW P rms O review f drug N/A g6reens need r_ Sames Dr. on will ' Dr. Same ectly for ymant of M review. BLOOD ALCOHOL When requested,Blood Alcohol (Collection,Lab,MRO Screens will be performed by the review) physician and will be either $40.00 scheduled or done on a walk-in basis. After hours testing for post accident, $140 per test random and reasonable sus icion 13 Mar-31-2011 08:43 Frail-EMPLOYEE SERVICES 305 282 4664 T-828 P.014/022 F-085 i alcohol screen. BREATH ALCOHOL(if When requested,may be used for available) screening, If breath alcohol screen is Positive,a blood screen will be $40.00 erformed. After hours testing for post accident, S 140.00 per random,and reasonable suspicion test alcohol screening. If breath alcohol screen is positive,a blood screen will be performed at the rate designated � above. PPD-TB screen When requested,a PPD-TB screen will be scheduled and performed by the $20.00 Physician during the facility's normal business hours. A PPD-TB screen will be performed with the new,hire Firefighter h cal. HEPATITIS R When requested,a Hepatitis A $90.00 inoculation will be scheduled and Performed by the physician during the facili s normal business hours. HEPATITIS H When requested, a Hepatitis 13 inoculations)will be scheduled and $75.00 each Performed by the physician during the (Series of 3 facility's normal business hours. TOTAL_ TYPHOID When requested, a oid inoculation $225) will be scheduled and Performed by the N/A physician during the facility's normal TETANUS business hours. When requested, a Tetanus inoculation Combined will be scheduled and performed by the with Physician during the facility's normal Diphtheria business hours.DIPHTHERIA When requested, a Diphtheria below: inoculation will be scheduled and $35.00 Performed by the physician during the facility's normal business hours. DOT PHYSICAL; When (SEE ATTACHMENT requested,a DOT physical will "'B"to be completed b be scheduled and performed by the $35.00 P Y physician during the facility's normal employee and physician) business hours. Includes exam and Physician review of employee health history and job description. The DOT physical is initially performed in conjunction with a post-offer h ical.Thereafter,onl a DOT 14 liar-31-2011 08:43 From-EMPLOYEE SERVICES 305 282 4584 T-020 P-016/022 F-086 Physical is performed by the physician. Physician may also perform a urine drug screen if requested separately by Monroe Coup BOCC. P When requested,a post-offer physical PHHYSICAL:YSICAL: will be scheduled and performed by the (SEE ATTACHMENT physician during the facility's normal $35.00 "A"to be completed by business hours. Includes exam and employee and physician) physician review of employee health history and job description. Physician may also perform a urine drug screen if requested separately by Monroe Ccun BOCC. r IREFIQHTER When requested,Firefighter p7health PHYSICAL(SEE will be scheduled and perform ATTACHMENTS"E"to physician during facility's be completed by employee business hours. Includes exam and physician), physician review,of employee history and job description. Physician may also perform a drug screen if requested separately by Monroe County BOCC. Also required;EKG, Chest x-ray, Sprometry,Hearing/Audiogram, Stress Test,PPD-TB screen. FITNESS FOR DUTY When requested,a Fifiess for Duty PHYSICAL(SEE Physical may be requested at any time ATTACHMENT"A"to be by the employer in the employee's $100.00 completed by employee respective area of work. The exam will and physician) 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 Coup BOCC. RESPIRATOR When requested,a Respirator physical PHYSICAL(SEE will be scheduled and performed by the ATTACHMENTS"C" PART I&If to be physician during the facility's normal $35.00 business hours. Includes exam and completed by employee physician review,of employee health and physician) 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 S riromet 15 Mer-31-2011 08:44 From-EMPLOYEE SERVICES 306 282 4564 T-920 P.018/022 F-088 EKG Normally done in conjunction with the $50.00 Firefi ter ieal. CH EST X RAY Chest X Ray is normally done in conjunction with the New Hire $55.00 Firefighter and Respirator physical if there is an issue with the EKCI or s irometry results. SPIROME TRY Normally done in conjunction with the Respirator physical. All Firefighters and employees who use a respirator will $78.00 have a S ironletry when hired Normally done in cowunction with the HEARING/AUDIOGRAM appropriate physical. Maybe requested $35,00 --srately bly Monroe Conn BOCC, STRESS TEST(SEE Normally done in conjunction with the ATTACHMENT"D"for new hire Firefighter physical. $200.00 explanation of services to Performed thereafter for firefighters as be performed by needed. h leian) CHEMICAL Tests Glucose(sugar),lcidn PANEUCMP tube of blood drawn). liver(1 $40.00 Normally done in conjunction with Firefi ter h ical, CBC Test to see if Anemic;if anyinfecti within the body;if dehydratedons $30.00 from 1 of the tubes of bld drawn). Normally done in conjunction with Firefi ter h 'cal. LIPIDS Tests good cholesterol and bad (CHOLESTEROL) cholesterol( one of the tubes of blood $70 drawn) UA DTP Firefighter Physical Normally done in conjunction with the $10.00 UA WITH MICRO DOT h sical. Normally done in conjunction with the $15.00 The Contractor ll shall retain alllrecords pertain ng to this contract for a period of fo years after the termination of this contract. ur(4) • The County, the Clerk, the State Auditor General, and agents thereof shall have access to Contractor's books, records, and documents required by this contract for the purposes of inspection or audit during normal business hours, at the Contractor's place($) of business. 16 Mar-31-2011 08:40 FrWEMPLOYEE SERVICES 308 202 4884 T-828 P.021/022 F-088 MONROE COUNTY, FLORIDA RISK MANAGEMENT POLICY AND PROCEDURES CONTRACT ADMINISTRATION MANUAL Indemnlflcation and Hold Harmless For Other Contractors and Subcontractors Each party agrees to indemnify, defend,and hold harmless the other, its officers, board members, agents,and employees from any and all claims, suits, demands, penalties, liabilities, costs or expenses in any form, Including but not limited to attorneys'fees and costs at both trial and appellate level, arising from any negligent, willful or wrongful conduct on the part of the party, its officers, board members, agents and employees when acting within the scope of their employment or agency. This paragraph should in no way be considered a waiver of sovereign Immunity or an attempt to extend the parties'liability beyond the limits established in Section 768.28, Florida Statutes. The extent of liability Is In no way limited to, reduced, or lessened by the Insurance requirements contained elsewhere within this agreement. 17 Mar-31-2011 08:46 From-EMPLOYEE SERVICES 306 212 4604 T-029 P-022/022 F-085 INSURANCE REQUIREMENTS Professional Liability $250,000 Including errors and omissions $750,000 Agg eg fence and I$ Mar-31-2011 03:41 From-EMPLOYEE SERVICES 306 292 4694 T-029 P.020/022 F-096 PUBLIC ENTITY CRIME STATEMENT "A person or affiliate who has been placed on the convicted vendor list following a conviction for public entity crime may not submit a bid on a contract to provide any goods or services to a public entity, may not submit a bid on a contract with a public entity for the construction or repair of a public building or public work, may not submit bids on leases of real property to public entity, may not be awarded or perform work as a contractor, supplier, subcontractor, or CONTRACTOR under a contract with any public entity, and may not transact business with any public entity in excess of the threshold amount provided In Section 287,017. Florida Statutes,for CATEGORY TWO for a period of 36 months from the date of being ph3cad on the convicted vendor list." I have read the above and state that neither Michael D.Burton D.M (Contractor's name)nor any Affiliate has been placed on the convicted vendor 11st within the last 36 months. (Signature) Date: STATE OF: COUNTY OF: Subscribed and sworn to(or affirmed) before me on (date)by I— � I z - (name of affiant). HH)She is personally known to me or has produced (type of Identification)as identification. NOTARY PUBLIC My Commission Expires: 1j A u,,.• My AIAN► EXPIRES P%"f OD 6W, 9f 8Wft7m,N*� 19 Mar-31-2011 08:46 From-EMPLOYEE SERVICES 306 202 4104 T-029 P.018/022 F-096 No -c0 USI AF IDAVYT 1, Michael D.Burton,D.O. of the City of_ � 1t�4 �-r my oath, and under penalty of perjury,depose en s�a that "— according to law on Y 1. 1 am Michael D.Owt.K D.O. of the flnn of the bidder making the Proposal for the projgZ described in a equest for Proposals for �hfull and that I executed the said propothority to do so; 2. The prices in this bid have been arrived at independently without collusion, consultation, communication or agreement for the purpose of restricting competition, as to any matter relating to such prices with any other bidder or with any competitor; 3. Unless otherwise required by law, the prices which have been quoted In this bid have not been knowingly disclosed by the bidder and will not knowingly be disclosed by the bidder prior to bid opening, directly or indirectly, to any other bidder or to any competitor, and 4. No attempt has been made or will be made by the bidder to induce any other person, partnership or corporation to submit, or not to submit, a bid for the purpose of restricting competition; and 5. The statements contained in this affidavit are true and correct, and made with full knowledge that Monroe County relles upon the truth of the statements contained in this affidavit In awarding contracts for said project. (Signature) Date:.— }z:/I/ STATE OF: COUNTY OF: Subscribed and sworn to(or affirmed)before me on L (date)by�J'Y� .��1�,�,yv (name of afflant).OHShe is Personally known to me or has produced (type of identification)as identification. LYN MyC0MWSSKW#0D6M7J EXPIRES:3ePtember29,2011 y Commissio "Eb pins: 20 Mar-31-2011 06:44 From-EMPLOYEE SERVICES 306 202 4664 T-029 P.017/022 F-006 SECTION TWO: COUNTY FORMS AND INSURANCE FORMS LOBBYING AND CONFLICT OF INTEREST CLAUSE SWORN STATEMENT UNDER ORDINANCE NO.010.1990 MONROE COUNTY, FLORIDA ETHICS CLAUSE Michad 0.Burton,D KEY WES FAMILY MEDICAL_ C� ENTER" (Company) "...warrants that he/it has not employed, retained or otherwise had act on his/her behalf any former County officer or employee In violation of Section 2 of Ordinance No. 010-1990 or any County officer or employee in violation of Section 3 of Ordinance No. 010-1990, For breach or violation of this provision the County may, In its discretion, terminate this Agreement without liability and may also, in Its discretion, deduct from the Agreement or purchase price, or otherwise recover, the full amount of any fee, commission, percentage, gift, or consideration paid to the former County officer or employee." .0. (Signature) / Data: ,3w STATE OF: COUNTY OF: of IA-Mf t Subscribed and sworn to(or affirmed)before me on (date)by I (name of affiant). He/She is personally known to me or has produced (type of identification)as identification. R MY COMMISSION 1 DD 919371 EXPIRES:September 29,2011 N"Will, eondd 71w lbYry Puhfc Ihidrr,lrn yw✓ NOTARY PUBLIC My Commission Expires: ZI EMPLOYMENT PHYSICAL SERVICES AI TACHMENT A MEDICAL RECORD NO.OF ATTACHED SHEETS: REPORT OF MEDICAL HISTORY a 1n a►matlon a for o c a an me c con ant LJse o an w not re ase to uncut o►ze peraon9 1 NAME OF PATIENT ICpt.first,frrrdy/el 2 IDENTIFICATION NUMBER Position era.HOME STREET ADDRESS+Slnrel a RFD, Gly ur Town,Stale,and ZlP Cork/ 5 ib CITY STATE 4d.ZIP CODE 5 PURPOSE OF E%AIAINAfION -----�- 7 STATEMENT OF PATIENT'S PRESENT HEALTH AND MEDICATIONS CURRENTLY USED(Use addhonal pages r/necessary) a. PRESENT HEALTH b.CURRENT MEDICATION REGULAR OR INTERM., C.ALLERGIES tlncArde insect hrresr'slings and Comman loodsl 9 PATIENT'SOCCl1PATION --__._ et Otte RIGHT HANDED 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 Household tuberccontauloses whir anyone Shortness of breath KNOW with tuhereuloaq Bons,Ions err other deformity Pam or pressure in chsal Tubercrdosls Of Positive TO test Loss of linger or toe Chrtrnic cough Blood in sputum or when Palpitation or'trick' shoulder coughing alpitation or pounding heart or elbow Henn trouble Excessive bleeding after injury or High or low blood pressure b injury ac r Deck pain or any dental work bask njury Ciempa n your legs Suicide attempt of plena 'Trick'or locked knee Sleepwalkul Frequent indigestion g Stomach,liver or intestinal lrouble Foot trouble Wear corrective lenses Nerve Inlury Eys surgery to correct vision gallstones bladder trouble or gallstones Paralysis fdre/luding inlanrilel Lack vision in either eye Epilepsy or selzure Jaundice or hepatrtia Wear a hearing old Car,IreM,sea or air sickness Broken poop Stutter or stammer Frequent trouble sleeping Adverse reaction to morNcaton Weer a brace or back support Skin diseases Depression or excessive worry Scarlet fever i Lose of memory or amnesia urror,growth,cyst,cancer Rheumatic laver Hemla Nervous trouble of tiny sort -- Swollen dr painful lonla Hemadtads or rectal disease Periods of unconaciouanaas Frequent or severe headaches Parent/sibbng wdh dmbatas Oirzrruss or fainting spell! , Frequent ar painful urination cancer,stralie or Mart disease - --_. Bed wettin m untie er radiation therapy g ante age 12 Eye trouble - - %ray err oth KidneY stone or blood Heerinq loss '. Chemotherapy Retu^an"—' tear mfettiom _ .., alburrun n urine -- Asb silos or tone: - -. Seauapy trsnamdlad dgsases -he^vcat 9 Chian¢orcr-____..�- expoaurs I Rxere •--- Severe tomh�a� gain or loss of weght -' qum trouble Water Pm or rod in am bone - Smusihs - - attil g disorder lonorema bulimia. Easy latigabddy - Msy fever or allergic rhndir _ _.._ _ Bean told to cut down or --- Pfaad mpuy _- Arthnhs,Rheumatism.or -- Criticized for alcohol _-^-- Burarba 8 tee Asthma - -'- -- Used illegal subatancp Thyroid trouble ttr goner - NSN 7540 o0-tat a1GB _ tJsed IoEacco _._ _ Previous edraon not usable Prescribed by ICMR/GSA 'REV 6 961 FIRMR 141 CFRI 201 9 202 1 I i 11.FEMALES ONLY CHECK EACH ITEM YES NO DO=Tlll..T DATE OF LAST PAP SMEAR DATE OF LAST MAMMO KN GRAM Treated for a famate dsordsr N/ N/A NIA Change in menstrual pattern N/ CHECK EACH ITEM. IF-YE., EXPLAIN IN BLANK SPACE , L15T E%PLANATION BY ITEM NUMBER. ITEM YES' NO 12.Have you been refused employment or been unable to hold a job or slay in school because at: 1 .• ,w a.Sensitivity to chemicals,dust,sunlight,etc. b Inability to perform certain motions. c.lnabddy to assume certain positions. d.Olher medical reasons III yes,give reesons.) 13.Have you over been treated for a mental condition? /ll yes,Specify when, where,and give details.) 14 Have you ever been denied life insurance) fit yes,seta reason and give details.) 1 S.Have you had,or have you been advised to have,any operation, lit yes.describe and give age se which oecumM.) 10.Have you ever been a patient in any type o hosgta lI yes, specify when,where,why,and name of doctor and compere,address 01 hospital,I 17.Have you consulted or been treated by clinics,physicians,healers, or other ractiti ra one witHn the past 5 years for other 01an minor ss nllnees�fit yes,give complete address oI doctor.hospital,clinic,and defa s.) I a.Have you ever been reject forrrWitory service because o physical,mental,or other reasons? II/yes,gr've dare and reason /or rejection.) 19.Have you over been Quchuged from mAhery service because of physical,mental,or other reasonsr (i/yes,gi've date,reason,and fype of discharge;whether honorable,other than honorable,for unAtness or unsuifebilily.l 20.Have you ova received,is(here petrdnp,or have you over applied for pension or compensation for existing disability? IN yes.speciM what kind, granted by whom,and whet amount,when why,) 22.Have you ever been diagnosed with a learning dtiabity) 111 yes, give type,where,and how diagnosed.) 23 UST ALL IMMUNIZATIONS RECEIVED icenilythall ee renew I orvgonrng nn ormatnon su y me 1 t s true coin ate to 1 e sl O rlt now or Uses mentioned above to furnish Iha Go. au nze overnment a complete aanscdpt of my medical record for roses of roeessi m ga station for ttdf emt o mint er aerv�e.sl understand that fabdeatbn of information on Gov...forms rs y Pu P P Meeting Y application jX y Punis►nebls 6 Ilns endla irrprlsonmenL 24a.TYPED OR PRINTED NAME OF EXAMINEE 246.SIGNATURE 24c.DATE NOTE: HAND TO THE DOCTOR OR NURSE,OR IF MAILED MARK ENVELOPE"TO RE OPENED 26.PHYSICI BY MEDICAL OFFICER ONLY". AN'S S A V EL/t Rq I FALL PERTINENT DATA IPAys cram shall comment on all develop by mterwew any add h0na modest history deemed dmporrent,and record any srgndre;ant lvnd !K rn here jp0sifive answers inItems 7 through 11. Physic-.may 28e. ?VPED OR PRiNiED NgME OF PHYSICIAN OR EXAMINER 70b SIGNATURE _ 28c DATE STANDARD FORM 93 IREV 0.961 BACK MEDICAL RECORD REPORT OF MEDICAL EXAMINATION DATE OF EXAM I LAST NAME•FIRST NAME-MIDOLE NAME 2.IDENTIFICATION PIUMBEq 3 POSitiOR 4. HOME ADDRESS(Num6ei afleaf a, ,cNy jw M".slate and ZIP Coors; S. EMERGENCY CONTACT(IYama andaeklass o/mNad) 8, DATE OF BIRTH 7 AGE a. SEX 9. RELATIONSHIP OF CONTACT El FEMALE M MALE 10 PLACE OF BIRTH 11 RACE WHITE BLACK AMERICAN INOIANI ZPANIC HISPANIC ASIAWPACIFiC 12a.AGENCY ALAS(A NAT E WHIIE BLACK ISLAND R 12b.ORGANIZATION UNIT 13.TOTAL YEARS GOVERNMENT SERVICE a. MILITARY b.CIVILIAN 14 NAME OF EXAMINING FACILITY Oq ExAMINER,AND ADDRESS tS.ItAl7NG OR SPECIALTY OF EXAMINER 15.PURPOSE OF EXAMINATION 17.CLWICAL EVALUATION MAL (Check Oath item In appropriate column.enfarWE'Nnof evelratad.) NAL (Check each item h e A.HEAD,FACE.NECKANDSCALP pproprbbcolumn,enter WE-Nrlblevaluated.) M Ower40OrcNnlcaAy/ndlcabd) B.EARS-GENERAL(INIERIWL CANALS) O.PROSTATE(P.TESTICULAR (Audibry aculfy under Rolm 39 and 40) C.DRUMS(Pardoraflon)D NOSE R.ENDOCRINE SYSTEM E.SINUSES S.G•U SYSTEM T.UPPER EXTREMITIES(Strano.rarpeoYmofan) F MOUTH AND TIiROgT U.FEET G EYES-GENE RAIL(VrwNxuuyandeMvcloournarlhne242RmWjo) V LOWER EXTREMITIES E H OPTHALMOSCOPIC r xeepiteen(SAan9m.ratKleotmoNon) I. PUPILS E W.SPINE,OTHER MU5CULOSKELETAL ( Wbtb mid rq=Jar) X.IDENTIFY'NO BODY MARKS.SCARS,TATTOOS J.OCULAR MOTILITY(Aesoclabd)xaralbl movements nyate0muy ------------- K.LUNGS AND CHEST Y.SKIN,LYMPHA71CS L.HEART(Thrwt.she.rhyMm.sandy Z.NEUROLOGIC(EqullDRum feats urlalor Ilan 41) M.VASCULAR SYSTEM V AA.PSYCHIATRIC(SpeoNyenypersonal7ydeHalbN ( erfboaibbe,etc) N ABOCArEN AND VISCERA(include hernia) NOTES: (DaacdbO•+erY abnamblly/n dpfaN. Enter pORAenf,fsm number bsl6rO eecA OarerlMt Contlnue In item/2 and usO addlfbna/sheers Nnec8x&wy.) I DENTAL(PfadeaPlb'ow—aymbob.snown in examples.above orbebwnumbero/uppsrandk>herfeelh.) 0 r REMARKS AND A001T1� i--�Realoney Moo- X ONAL DENTAL reemnb4 �' M�^e �j Re�ee �y)y—�� P d DEFECTS AND OISEASES o �eei rI Teeu, 37 r«In x x x Gamy as f• % 1 Dentures pmw R Mf I 2 3 4 S 8 7 a 9 10 11 12 13 L 32 31 30 29 2a 27 28 14 IS 18 2S 24 2 T 3 22 21 ZO 19 IB 17 F T 19.TEST RESULTS(Copra of re9ulf9 are prelarred as altachrnenta) A URINALYSIS'. (1)SPECIFICGRAVITY B CNESTX- (2)URINE ALBUMIN RAY OR PPO(PUM date•nkn numberandnmauy N)MICROSCOPK: /y �f1 Q W)URINE SUGAR N ram{ 1'1pt C SYPHILIS SEROLOGY(SPec4 reel ue6d 0.EKG E BLOOD TYPE AND Rh F and rawAS) (� FACTOR .f` OTHER TESTS •— NSN 7540.00�.40jn S&126 r7e+9nw uwne Peowm Pie 1NISOQR on n7 STANDARD FORM N(Rev 10.94)IEO) P'ftC16ed by GSA/ICMR FlRMR tall CFR)201.9 202.1 NA1MC IDENTIFICATION NUMBER �OF SHEETS ATTACHED 20 HEIGHT M�s� MENTS AND OTHER FINoINCg 21 AIHEIGHT 22.COLOR HAIR 23.COLOR EYPS 24 BuaD _ SLENDER 25 TEMPERATURE 29 BLOODPRESSURE(Armathe.rf,e►el) MEDIUM HEAVY OBESE A SYS. B SVS. eanI&" SITTING DIAS BENT* YS STANDING SYS. A.SITTIIVD B.RECUMBENT T D (5 mbls.l DIAS (3 mbs) •AFTER EXERCISE E.2 MINS AFTER _ 28.DISTANT VISION 29 REF 1—NI 20/ COfiR.TO 2pi RACTION BY S CX 30 NEAR VISION LEFT gal CORR TO 20f By CORR TO 31 HETEROPHORIAISIxv.Ayd,$janw) S. CX BY N CORR TO BY ESO EXO R H. L H PRISM DIV PRISM PC C� 32.ACCOMMODATION 33 COLOR VISION(T.st 1,..,1,W1e PO RIGHT LEFT (Tesfue.dnndxws)�I� UNCORRECTED JS.FIELD OFVISION 38 NIGHT VISION(Tesfweda/Idsm,�) CORRECTED RIGHT LEFT A 37.RED LENS TEST-l I� 35 INTRAOCULAR TENSION J9.HEARINO RIGHT LEFT 40.AUDIOMETER 41..PSVC RIGHTW/V ,15SV 1S HOLOGICALANOPSYCHOMOTOR(Tasfsus.d.,,d,.,.) 256 5012 10 �204E 2895 4000 9000 a000 I 4098 a1a �!� LEFTIANV /15SV 115 RIGH 8192 LEFT 42.NOTES jco,#_W)AND SIGNIFICANT OR INTERVAL HISTORY 43 SUMMARY OF DEFECTS ANp DIAGNOSES Ll (U,. ..aciftm.l a*W,dnec.s..ry) I dla9,luxs wlfh Item nulrtter.) 44 RECOMMENDATIONS.FURTHER SPECIALIST EXAFWNATIONS INDICATED(SPeyy) 45A.PHYBICAL PROFILE P U L H E S A ISOUALIFlEDFOR B IS NOT IFlEOFOR In accordance with attached job OUAL 47 IF NOT QUALIFIED,LISTDISOUALIF/ING DEFECTS scrip ITEM Ntion 458 PHYSICAL CATEOORY A B C 49 TYPED OR PRINTED NAMME OF PHYSICIAN E SIGNATURE 49 TYPED OR PRINTED NAME OF PHYSICIAN uIGHATURE 50 TYPED OR PRINTED NAME OFDENTIST OR PHYSICIAN /ndlc4 f a wrath) SIGNATURE 51 TYPED OR PRINTED N AMEOFREVIEWIN13 OFFICER ORAPPRGVINGAUTHOR, SIGNATURE STANDARD FORM 8d IRer I0-9413gCK EMPLOYMENT PHYSICAL SERVICES AI IACHMENT$ Ij ! ► a --- ❑aa-aaa aa❑ a o o- m Q� a❑❑ ❑oa ❑❑a o ��--� ca ca CD w � wQ � s � � � o I m o �_ 0 m 1 A > >, y ,n m o ~ 7 NO O O a N O CL G I I 7 C N ^ g m mi g • ..i cx I 3 3 ca 8 a8 fl 8 A n �2 0 w m w m 0 or 0_ 0 CL ❑ ❑ ❑o❑❑❑ m � b U : ❑❑❑� Q 3 w cr. d a o � a $ m cn � nn a3. 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(�I„k k o PY r must allow y ^').................................................................................................... t,tnu,niont to,you. Tom.tintainyOur�nfid�nlrbi�lityti�murtrmkrurtiuust JY,�" .,nJ your,'ntplttyt'r ntu5t lull you how" d,•liv,'r it 5,•0 r(' Y during normal working Ix,urs,ur at a tima• ,-No ntJ Pla,•t,(Nit is Th,•foltowinl,infi,rmatian must Fx•PntviJ,•d by ov,•ry,m to�,,mnain to)th,•hm lth,�ar���l rk f,yyictnaliw}x�wil a`sw,•r, (Pl,w,w Print). P y , Who has htti� 1 n vi,.w it. n"t k�t4u �ol type.of r,spiratar name: Job Title: Age(to nearest year): Sex(c•hec k one) O Nlcrl. O&male Date:�_ Height;__�feet_i1x-Ft.s Weight:_—_It's. C heck the tyP e of respirator you will use(you c Phone numberwhem you can :ut,hec k be reached more than one cdte t care Pelson who rev{ews this by the health a. O N �ry) The best (include dreg cYxle): midge Eire only). (filter-mask, time to call you at this number. Y)• a• O Other type(for e Has Your emPloyer told you how to con type,Powered-ak P�,� 'c` pk'�huff-ur full-fdtepiece Person who will review this fart the health care breathrng VNratus). g' PPS-fir,self-contui�d (check tune):O Yea O No Have you worn a as rf" Poor. O Yew ❑No Yes;'what tYPe(s):--� Pad — Section 2(Mandatory) -- Questions 1 through 9 below trust he dnswer,ed hy,,Very Nmployee who has hc�en select (plea.".ch,•ck"yes'or"no"), e,l to u.9e any type of"Pr tor 1. Do you currently smoke tobacco,or have you smoked tobacco in the last month? ..,, 2.Have you ever ...............................❑ had any of the folio Y"S ❑Na d. SE.'- M►itrgconditions? h. DiabetM(sugar di"ease):...................................................................................... V. d. Allergic reactions that interfere with breathing................ .................................................. ....................O Yes ❑No P. Trt,sttrle 5 ixtbw(fear Of Closed-in pl rc,$a): ..... ....................................................................................... 0 Yes O No meping odors: O Yes O No 3. Have you ever had any of the following..........................................................................................................O Yes ❑No Pulmonary orlon •.................. d• Ashestasi9 B pmblems? .......................... �' C rttmc hn, ]ye.5 Q NO . ..................... ►1• Fnt h O Ycw -J N,t �'• r,tt•um mid�................................................................................................................................................... -1Y,•c No 'nt ... ......t...t..,.....,.l........................................................... ........ .............. No 'idit„%,s: 7 Y, No •untut ........... .]Y"I J I tu},t aner: . ............... J Yt•s rihs: . ..... .............. No) 1m t h,a miuru-%ttr bury,,•ritesI. 1 : ,�. ....,..l•.t. ny 1dhi•r lun d ............... . ... .... .... .........Pn t•mth.rt �„u t• >.1 YYot•ti" J `o ..... ......•• .i Ytr ...... ...... .............. .1'th %u truosue a Mr-A hk WMI Deft May a 2M1 4. Do you currently have any of the following symptoms of pulmonmy or lung illness? a. Slx,rtnPtis of hrealh ........................................................... h. Shortness of hrnath when walking,fast on level ground or w,,16,q up a slight hill or in,line: >Yes 0 N,, Shortnc-ss of breath when walking with pother lx-ph•at an ordinary pace on level ground: .............:j Yee d. I lava to--top for bnwth when walking;at your own pat a on Ievel j,"mund:................. �J No ... e. Shortrx-ss of breath when washing„r dntssing your-;elf. ••....•............J Yes 7,No ............................. .................................... >Yes 7 No f. Shortnt�of breath that interh•nh with your joh ""' g;- C,uphing that produces phlel" (this k sputum) h. Coughing that wakes you early in the monning.......................................................................................7 Yes ]No '>Yes >No i. Coughing;that,xvurs mostly when you are lying down j. Coughing up blood in the last month: i]Yes ❑No k. Whet-Ang: ........................ .....................................................................................................U YQ. iJ No +s with your jub........................................................................................................0 Yes 0 No I. Wheeling that intarfen m. Chest pain when you breathe deeply: .......................................................................................................!>Yes 1J No n. Any other symptoms that you think may hP related to lung problems: ....................... .......❑Y,-9 0 No ............❑Yes Q No S.Have you ever hid any of the following cardiovascular or heart problems? a. Heart attack: ................................. . b. Stroke: ..............................................................................................................U gee D No c. Angina:............................... ............................................................................0 Yes 0 No ..... .......................O Yes ❑No d. Heart failure: ............... ....................................... ............. ... ............................................ e. Swelling in your legs or feet(not c a used by WuMn ............................... O Yes O No .............. f. Heart arrhyt (heart bcwtin lees art ........................................ hnva e g gal y):....................... bloodpressure: ........................... ❑Yes O No h. Ang. y other heart problem that you've been told about: ................................................ 0 Yes O No O Yes ❑No 6.Have you ever had any of the following cardiovascular or heart symptoms? a. Frequent pain or tightness in your chest: .............. b. Pain or Nghtness in your chest during physical artivity:...........................................................................O Yc.'s O No C. Pain or tightness in your chest that interferes with your job: 0 Yes ❑No d. In the past two years,have you noticed your heart ski 0 Yes 0 No e. Heartburn or indigestion that Lq not related to eating: t'Frng or missing a beat: O Yes 0 No f. Any other symptoms that you think may be related to he......................................... 0 YE" O No art or circulation problems: ..................... .O Yes O No 7.Do you currently take medication for any of the following problems? a. Breathing or lung problems: h. Heart trouble: 0 Yes ❑No o. Blcxxl prns�ure: ............................ O Yes d ............................................................................................ ]No Seiiures(fits): ............................ ............ ..........0 YF�s .......................................... 'J No ...........................................................................O Yee 7 No 8. If you've uAed a respirator,have you ever had any of the following problems? Of y ou've rmver used a nwpirator g„to question 9) •r. Ev,•irritation:.........•....... . .................................... h. Skin.ill rg;ies or rashes: •U Y,w 'J No leerlets ............................................ ..........•:................. ...............................................................................U Y,w •J No . .......................... .............'. Y,w r r fatigue:.... ..... No ........................... �•. em that mterfeny►%tlh�•uur mspiralor ace:.... ... Other problem ......................... J J 's 'J No Enclosare 3 • MCA t A 8=1 OR*Any 8,M1 9, Would you like to talk to the health rare professional who will review this questionnaire about your .ans-wv R to thc5 questionnWre:.......................................................................................................... .>Ylw Qta.wtions 111 to 15 helow must IN-answerad by every employm who has peen seltr tad to LISP eidwr a fu11-fa.,-pittie m--pirator ,ar a st,If-.ont,,ux-d bmathtng-IPraritus(SCBA). For omploy(ti-i w1%)have IN-Un SOV4 tee to use other typ,'s of n-;pirators, wiswenng,thaw questions is voluntary. 10. Have you ever lost vision in either eye(temporarily or permanently): ............. .]yr,s r]No .............................. 11. Do you currently have any of the following vision problems? a. Wear.onta.t lenses.:.........................................................................................................................................J Yin, O No b. Wear I;lasses............................................................................... �. Color blind: ......................................................................O Y.s O No J. Other e ............................................................................................................................O Yes ❑No yeor vision problem:............................................................................. ...O Yes O No ......................................... 12.Have you ever had an injury to your ears,including a broken ear drum:...................................................O Yes ❑No 13. Do you currently have any of the following hearing problems? a. Difficulty hearing: ......................................................................... b. bVear a hearing aid:...........................................................................�..:.........................................................O Yes O No c. Any'other hearing or ear problem:...............................................................................................................0 Yes O No ............................................O Yes O No 14.Have you ever had a back in#ury:......................................................_.................. .............................................O Yes O No 15.Do you currently have any of the following musculoskeletal problems? A. Weakness in any of your arms,hands,legs,or feet:........................................... . b. Bank ......................................O Yes ❑No i. Back Diffitin fully moving........................... .....................................................................................................O Yes O No wing your arms and legs: ......................................._....... O Yes O No ............... d. Pain or stiffness when you lean forward or backward at the waist:.......................................................O Yes O No e. Difficulty fully moving your head up or down: ............................................ ................................... f. Diffieul full movie """"""...............................O Yr:s O No tY Y g your head side to side: .....................................................❑Yes O No g. Difficulty bending at your knees:......................................_.............. h. Diffxul the ............................................................O Yes ❑No i. Climb g asq attt squatting stairsor pound:dder......................................................................................... O Yes ❑No carrying morn than 25 lbs.:............................... O Yes O No ............................ j. Any other muscle or skeletal pmblem that interferes with using a respirator:......................................❑Yes O No part B Any of the following questions,and other questions not listed, may be addad to the questionnaire at the dis.nation of thtr healthr are professional who will review the questionnaire. 1. In your present job,are you working at high altitudes(over 5,UW feet)or in a place that has lower than iumnal amounts of ofygen:........................... .............................. J No nr other s)mptoms wlx,n you'n,working;under thtwa,anditions:........................ 2. At. W * rat home,hi)have Iuevy r been o,e�iohazanouf II;ents Z� u 4uforne.himes,or r , te 11 ` ,1 h hazardous. .,1'N J Nil s RESPIRATOR USE PHYSICAL Name Home Address Age Sex _ Telephone Occupation Length of Employment I agree to the release of this information for State and Federal regulatory extent provided by applicable laws. Purposes to the DATE SIGNED EMPLOYER ❑Follow-up Medical Evaluation Physical Required. (Positive response—Question 1-8). ❑Post-Offer Physical: Medical Evaluation Physical Required. 9-VVOUIJ YOU like to talk to the health care professional w answers to this questionnaire............................................ who wo review I"questionnaire about your C3 No Qu('stiolls IU to 13 bylaw Must 1.4?"'V""n?d by every(,niplov(%, A-If-contiint-d bn?jthinl,,"PPdr-Jtus(SCOA).For en;* 4 , . has b"M selvisl?d to use either full-ficerieve""Or-Itor or tht.4!qU&-' riovts wix)have bpenselettLQ to ust,other tvpt,.s of--tiOM Ls VOIL111tary. rs ns, e 10-F14ve You ever lost vision in either eye Itemporarily or permanenily)' 11.Do You currently have any of the foUowing . ........................................................0 YLS ri%4, a. Wearruntktlenses: visiOnproblems? b. Wear glasses:......... ...... .....................Q yes Color blind:........... . 13 O Nu d. Other eye orvisiL)n'p*rt)b*I*L.m: .. _ .... .... ........ *.**.. **... ..............*........................C3 yes (a\10 yes Q No M Have you ever had an ini .............................................C3 Yes Q Floury to your ears,including a broken ear'drunL. 13.Do YOU currently have any of the W .......................................................C3 yt's Q No a. owing hearing problems? Difficulty hearing.......................................................................................................................................... .......................................... b. Weara hearing aij.................................................................................... ................Q Yes C3 No '7' Any Other II'Mring or edr problem:................. ........................................................C3 Yes ............................................................................................ 0 No 14-Have you ever had a back injury; C3 Yes U jNjO IS. .......................................................................13 yes C3 No Do you currently have any of the following Musculoskeletwil problems? I. Weakness in any Of Your x=%hands,legs,or feet: b. 04ck pain:.........................................................................................................................................................Q Yes C3 No C Difikulty fay moving your arms and legs: C3 Ym c3 No J- Pain or sd&ess when you kan��aetl 0,b4dcward ...........Q Yes Q No e. at the waisL............................ ....................DifficultyfiWYmoving Yo up or dow= Q yes Q No f Difficulty fiWY moving Your head side to side:........................................ C3 Yes C3 No K. Difficulty h. DdJLWty C3 Yes Q No squatbending at your km":...................................................................................................................Q Yes Q No ting to the ground:.................................................................................................................Q Yes a No i' CUmb'ng 4 flight Of swim or a ladder carrying more U.Mn 25 lbs.: j- Any Other muscle or skeletal problem thAt interferes with using a respirator.. Q Yes C3 No PatB ...........................................Q Yes Q No Any of the following questions,-tnd Other questions not Wed,IndY be added to the questionnaire`:"re Profess"on'd who will review the quLlstionnWre. at thedkCretion of the health 1-41 YOUr present job,see you wodcing at than norrmi amounts of OxYgeL high altitudes(over5,=feet)or in a place that lower has Or other symptoms when you're working under these conditions: .....................................................................Q yes Q No 2.At wodk or4t home,have You ever been exposed to C3 Yes C3 INO hazardous solvents,hdzardous airborne chenticaIg e-9 I Pses,fumes,or dust),orhave you come into skin contact with hazardous chenticafir..............................Q yes Q No AICA lrt,)L-WOU Die IM,to 3.FfAve you overworked with any of the M;Ikeristbf,or under any Of the Conditions,listed below: ,J. ............................................................................................................................................................ b. SibW in s4ndblastinjo: ]Yew p C. Tungsten/Labatt((..I, ..Q yos L\10 ,.grinding or welding this MaWrIal): d. Beryllium: ................................................... J ..........Q ......................................................................................................:3 ri NIU V. Aluminum:..........................................................I............................................................................................. No f. Coal(for example,mining} :1 J;. rrx)n:.............................................. ...................................................... ...............U Yin C3,N ........................................................ Q YLS O h. Tin: .. i. DWAY emiamnienLs: ...........U Yos j. Other hwzjrduus ex . ....... pxsums: U yes C]L\40 IVL%,,describe these exposures: .............................................................Cl yes 0,\;o 4.Liskany second jobs or side businesses you have. S.List your previous occupations: 6.List your current and Previous hobbies.. 7.Have you been in the military services? If"Yes,"were You exposed to biological or chemk Q Yes C3 No Ml agents(either in training or combat} ..................................0 yes Q No 8-Have you ever worked on a HAZNfAT team?.....................................................................................................C)yes U No 9.Other than medications for breathing And lung problems,heart trouble,blood pressure,and seizures mentioned earlier in thisqueslionvAim,am you taking any other medications for any mason (including over-the-cvuriter mcxULations): If"Ye%"name the medications if you know them: Q Yes Q No 10.WM you be using any of the"Owing items with your respirator(s)? a. HEPA Filters: ............................................................................................................................................... C3 Yes 0 No b. Canisters(for example,gas masks): c. Cartridges: Q Yes ............. ............................................................0 .........................................................Q Yes C3 No 11.How often Am YOU expected to use the respimlor(sp. a. Escape only(no resLuey b. Emergency rescue only: 0 Yes Q No • c. Less than 5 hours per week..............................................................................................................................Q Ws C3 No a. Less than 2 hours per day: C)Yes Q NO e. 2 to 4 hours per dar.......................... Q Yes Q .............................................................................................................. No f. Over 4 hours per day: C]y(S Q No .....0 Yes Q No MC.%t1V4-, 1J 11*1012111 12 During the period you am using the mspimtor(s),is yourwork effort: a. Lil,hl(1«s than ilk)kcal ). per hour................... It'y, "how lun+ ..........[,dues this ............. pericxllastJurin .... .... g the average shin .................� Examples of a tight work effort an-sitting while writin+ tv in+ his._'mina. li[,ht,Lsw�mbly work or st uidin+while a ['' .p fs drafting or pc�rfurming b. 1 Iodc raG�( X[lu Sot) !, Operating a dull press(I-3 lbs.)orcontwilin If..ti,e,s., ��per hour}................................................. F,mac'Itin�s. how lun[;dues t � ............... this period last luring the!ave Y'"i �]No E'camples of me>derate work effint arc sittin• rabe.shilk b while nailing or fill r g'—miss. urban traffic;standing while drilling nailin► rlh.driving a 4vek or bus in a moderate load(about 35 Iles.)at trunk level;walking on a I gel surfarekb,au or t�f`�nb a 3ile;-9M"I;rade afv)ut 3 m ph or down a level surface. ph;or pushing a wheelbarrow with a heavy load(about 1W[bs.)on c. Heavy(above 13)kcal per hour): If"yes,,,how lung dues this Period ................................................................ F'e' List d ......❑YCs tiring the average she& ❑Nu Erampics of he.'avy work am lilting a heavy laid(about 5U lbs. °'tins. or shoulder,working on a Iuaciin d )�'om the floor to your waist walking .ilkin► g uck;shoveling;standing while bricklaying b up an tl-degtree k7ade about 2 m or chipping casting; ph:climbing stairs with a heavy load(about 5t)Ibs,), 13.We11 you be wearing protective Clothing And/or egwpment(other than the when you're using your respirator: If"YM,,desenbe this protective elothin....................»........................................................................... g and/or equipment .................0 Yes p No 14.Wt71 you be working Wider hot conditions(temil e 15.Will you 6e working under humid co P r�+rre exceeding 77)s�....................................................0 Yes 0 No nditiom............................................. ...................... .........0 Yes O No 17.Describe any special or hazardous condition You ght (for e:ramp(e,corrtiiredspaces,life-tlrr4atg kmiencourtberwhenyan'n!usingyourmsprtos{s) 19.Provide the fogowing Womtation, when you're using your if you know it;for eachtoxic substance that yon'i]be er tespirrtor(s): posed to Name of the first toxic substance: Estimated maximum exposure level pershi&. HCA Int-MM D.&IiYIZ00 Duration of i-xMsum'rwr shift: Name of the jcrond toxic:subst uKF. &timatctl nl'Lx mum c<pasure level pershift: Duration of exposure per shift Name of the third toxic:substamw Estimated maximum exposure level per shift: Duration of exposure per shift: The name of other toxic substances that you'll be exposed to while using your respirator 1t Desk any"s e,sen tbilgie9 you'll have while«sing you uthe:9(for example,"rescue,secvrityk respirators)that n,d Y Vert the safety and well-being of i r&MP4j Y AICA riit•-Wu udg ok12 PLHCP Follow. REMployee Name: UMedical Examin • anon Copy of recomatendation given to employee?C3 Job title: Yes O Yo Rie:omrtienJatiarLs about employee use Of aspirator. Date of this follow-up: L.icnAitions- Reasons for follow-up Actions: [need for follow-up medical evWuutions- Signed: Date signed; Date given: RESPIRATOR USE PHYSICAL See Attached Job Description NAME AGE SEX HOME ADDRESS TELEPHONE OCCUPATION LENGTH OF EMPLOYMENT I agree to the release of this information for State and Federal regulatory purposes DATE SIGNED CARDIO-PULMONARY EXAMINATION 1. HEIGHT WEIGHT 2. HEART: Murmers: Rate Rhythm Enlargement 3. LUNGS: Pulmonary Function Within Normal Limits Outside Normal Limits 4. PA CHEST X-RAY: Within Normal Limits Outside Normal Limits 5. RECOMMENDATIONS: It is my opinion that the above named patient is is not medically qualified to wear a Respirator in the performance of his/her duties. PHYSICIAN EMPLOYMENT PHYSICAL SERVICES AT rACHMENT D 1582_1 yright 0 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 MMedical Rrquinnunu forF-us lr1gk4rr and lnforntation *FaeDrparr--t pAYsmQO 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 Meeting 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 Eebruary 11,2000,and 1.2000.upersedes all previous editions.hpproved asThis edition of NFPA 1582 was a an American National Standard on February Origin and Development of NFPA 1582 Ajoint 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- ial/Physical Requirements for Fire Fighters was created under the Fire Service Occupational -Wehr and Health Committee in 19W 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 con NFPA 1001,Standard for F"mr F704-pyo euianol P h' rained in Section le 1. They were deleted from NFPA 1001. f Q"�`I1Ot1O"t'applied only to the entry level, set for a sition Legal opinion and federal laws show Po m ow tat a that requirements PP1Y co anyone who would be or a 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 rep. sented conditions that,if they exist in the candidate or current fire fighter,would not allow this person to perform firefighting operations.Category B conditions must be evaluated on a case-by-case basis so that the fire department physician can determine if the medical condi- tion in a particular candidate orcurrent fire fighter would prevent that person from perform. ing fire-fighting operations. Medial evaluations. medical examinations, record keeping, and confidentiality were addressed in Chapter2.Chapter 3 contained thecompri actual medical conditions that se 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 areas of emergency medicine; vision; h&dng; 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 physicianu,and sample Physician checklist forms. Additional explanatory material was added or enhanced to provide the user with addi- tional id a number nfoation regarding medial conditions whose categories were changed. These therapeutic and-coagulation.of cardiac conditions,diabetic conditions,seizure disorders,asthma,and oagttlation. 1582-2 MEDICAL REQUIRE 61EIM FOR FIRE FIGHTERS AND INFORMATION FOR FIRE DEPARTMIEVT pHVSICANS The 2000 edition of this standard reflects(1) the technical committee's recognition that medical technology I$continually changing and (2) the commiuee's effort to incorporate those medical technology changes within the standard.Just o the committee recognizes med- ical technology advances,it is incumbenton the fire department department physician changes in the essential functi (s) t to communicate with the lire t Conversely,the fire department physician must keep the fire department Fire department performs. est changes in the medical field. partment updated on the lac Fire department physicians are the primary,users of NFpk 1582.Committee members feel that allowing the fire department physician more latitude In determination of a member's ability to perform essential functions willassist Users in enforcing the standard, committee has changed the title of the standard to NFPA 1582 Standard on A(ediealo�jin. menu for Fire Fghrers and Afonmotion jar Fire Deparimenl Physieiartt The topic of incidentscene 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:cardiacvision,hearing,neurological,and metabolic. those of appendix was added to this edition comparing the requirements of this standard with CtR 1910.134.the OSEL-k respiratory x of both documents,and this appendix p ry protection regulation.There are many user ppe dix clarifies the companion areas of each. J 7 CO,%t*IrITEE PERSONNEL I582_3 Technicpl Committee on Ftre Service Occupational Medical and Health Murray L Lama.Chair Virginia Beach Fire Dept,VA(U) Rep.NFP:\Fire Service Section David j.HariLo,US.Army trot,ofSutgical Research, TX(SET Debotab L Pritchett,Lawrence Township Fire Dept., Kimberly S.Sevilla,Bio-Qre.MI(SE) IN(L) Paul"Shoe"Slake.Cityof Baytown Fire&Rescue Services. Rep.Indianapolis Metropolitan Professional Fire TX(E] Fighter Union Rep.Industrial Emergency Rpponae WorkingCroupGoonM M.Sachs,[OCAD Emergency Services Group, Matz S•HoVdd.Yale Unive-icy,CC(SE( PA[SE Aathoery L Clork,Renton County Airport Board OH[fi) Rep.Fairfield Community Fire Co..Inc. Thom"J.Cuff.Jr..Firemens Ann.of the State of Daniel G.Sarno,ENH-OMEGA,IL[SE) New York.NY(UI James Sewell.Seattle Fire Dept.,WA(L) Tammy DiAoda,Reno Fire Dept..NV(U) Rep.Int'I Assn.of Fire Chiefs John F.Folan,Northside Medical Assoc..NY(SE) Philip C.Sdukbtw&LaFarge Fire Dept.,WI[L] Richard D.Gerkio,jr.,Good Samaritan Hospital/Phoenix Rep.Nat'l Volunteer Fire Council Fire Dept..AZ[El Robert M.Stratman,West Metro Fire Protection District, Juan Gotisales,Medflem The Exercise Science Inst.. CO[RT] Tx(RT) Rep.Metropolitan State College of Denver W.Larry Kenney,Penn State University,PA[RT] Andy C.Teeter,Tulsa Fire Dept,OF[U] Rep.Landy Jacobs&Assoc. Rep.Inel Fire Service Training Assn. Frank P Mine*,New Yoekk s City D De.NV(U IVtiq dos'Cooperative Personnel Services,CA[SE) NVG L Na P (U]] - Teresa Wtam.Santa Ana College.CA[SE) U] ilsott.Truckee Meadows Fire Protection District. Don N.Whittaker,Lockheed-Martin Idaho Technologies Rep.Fire Dept Safety Officers Aun. Co.,ID(E) Delia*WBILms,Phoenix Fire Dept..AZ[E] Alternates David W.Dodson,Loveland Fire DepL,CO[U] (AIL to G.L Neilson) Tbomaa R." New York City Fire DepL,NY(U) Mlebael S.Gray.Virginia Beach Fire DepL,VA(U] (AIL to F.P.Minea) (AIL to M.E.Login) Hriss V.Moore,Phoenix Fire DepL.AZ(E) (Alt to D.Williams) Stephen N.Foley.NFPA Staff Liaison T hir Jia cha is the membership at the time the Committer mar ba&kd on the firtal test of Air edition.Sin"that gem is the membership stay hark Occumid A hey to chwifteadow is joand at the back of me datument, NOTE. Membership on a committee shall not In and of itselfconatitute an endorsement of the Association or any document developed by the committee on which the member serves. Committee Scopes This Committee shall have primary responsibility for documents on occupational medi- cine and health in the working environment of the fire service. ,y 2000 Ecroon 1582-4 SIEDIGkL REQIjIREXIENTS FOR FIRE FIGWMRS,\ND INFOMLITION FOR FIRE DEPARTMENT PFMICL►NS Contents Chapter 1 Administmtion ..... 1-1 Scope...••_••,•,..•• . 1582- 5 3.18 Tumors and Mall 82- S grant Diseases.. 1582-I0 1•= Purpose. ......... ................ 15 3-19 Psychiatric ....... 1582- 5 sY Conditions.. . 1582-11 I.3 Implementation „•. •••••••••••"" 3.20 Chemicals,Drugs, ••••��••••���•� 1582- S gs,and Medications.. . 1582-11 I-I Definitions.. •... ...•........ .... 1582- 5 Chapter 4 Infectious Disease Program ..•.•.•.•,, 1582-11 Chapter 2 Medical Process ,,,,,, ,, 1582- 6 4-1 Infection Control Pro 2.1 Medical Evaluation Process, gym'•..•••••••••• 1582-1l 1582- 6 4-2 Exposure Incidents, r 2 2 Fire Department Roles ""' 1582-11 ` 2.3 Pre lacrment bI 1582- 6 4-3 Tuberculosis............. _ P Medical Evaluation.. 1582- 6 '1-1 Immunizations.. 1582 I l 2-4 Periodic Medical Evaluation . 1582-11 2-5 Return-to-Duty Medical Evaluation...... 1582- 7 1582- 7 24 dfedical Evaluation Records,Results, Chapter S incident Scene Rehabilitation _ Reporting,and Con6dendaliy and Medical Treatment ..,,,,,•,,,,, 1582-11 1582- 7 5.1 Incident Scene Rehabilitation ...., ' Chapter 3 Category A 5-2 Incident Scene Safety and Health ,,••..•' 1582-11 � � and Category.$ .. 1582-11 Medical Conditions 5-3 Evaluation and Triage of 3.1 Medical Conditions1882- 8 Member Injuries . Affecting Ability . 1582-11 to Perfornt.• - 5-4 Incident Scene Rehabilitation Tactical 3.2 Head and Neck... •'.."'••• 1582- 8 Level •'' I582- 8 Management Component.. 3.3 Eyes and Vision.. I582-11 3-1 Ears and Hearing............... 1582- 8 Chapter 6 Referenced 3-5 Dental........ 1582- 8 P Rrbllcatiom..,,,,,,, „ 1582-12 6 Nose.Oro ph 1582- 8 3 and Larynx,?tymx,Trachea.Esophagus, ApPeaditt A Explanatory Material .............. 1 3.7 Lungs and Chest Wall.. ......... .. 1582- 8 582-12 3 8 H Vascular Sys 1582- 9 Appendix a Information for Heart and V teen Fin Department 1582- Physicians 3-9 Abdominal Organs and Gastrointestinalsystem 9 �� 158Y-YI _ 3-10 Genitourinary System.....0 1582- 9 Appendix C Essential Structural F¢ Fi&d g 3.11 Spine,Scapulae,Ribs,and 1582- 9 Functions.. ................. ' •.. 1582-26 Sacroiliacjoints •.. 3-12 Extremities .... '•''''''•••• 1382-10 Appendix D Guide for Fire Deparemeat 1582- Admiaiistrators., 3 l3 Neurological Disorder . 10 158Y-26 3-14 Skin...... •.............. 1582-10 .......... 3.15 Blood and Blood-Forming O r•••s , ••.''' 1582-10 Appendix It Sample Forms, Ban .....3-�16 Endocrine and Metabolic Disorders...... 1582-10 1582-33 3.17 Systemic Diseases and Miscellaneous 1582-10 Appendix F Referenced Publications ..........Conditions..... 1582-33 ......... ............ I582-10 Iadest............•...........................1582-48 v 2000 Edubn i53:_g NFPA 1582 14 Detuatiooa. Standard on 14.1' APProved. Acceptable to the.utthority havingjuris- diction. Medical Requirements for Fire Fighters and 1-1'2� Authority Having Jurisdiction. The organization. office. or individual responsible for approving equipment, Information for Fire Department Physicians materials.an installation.or a procedure. didate. A 2000 Edition commence performanceeson who has as a membery made application to NOTICE: .Lr >iren,k(•►fisllawing the number or letter tits• would14.4 Category atego�&fedu'd Condition. . medical condition that ignaung a paragraph indicates chat esplanamry matenrl on r P person from perfuming z,a member in a the Paragraph can he Gxmd in AppendN A twining or emergency opt.-rational entin>nment by rest lnforma,ion nn referenred pnblicauons can be found in a significant risk to the safety and health ofthe person or others• Chapter 6 and Appendix F. 14.5 Category B Medical Condition. A medical condition that.haled on its severity or degree,could preclude a person Chapter 1 from performing as a member in a training or emergency p Administration operational environment by presenting a significant risk to 1-1 Scope. the safety and health of the person or others. 14 6 Drug. Any substance,chemical.over•thetounter medi- I-1.1 This standard shall contain medical requiremenn for cation.or prescribed medication that could affect the perfor- members,including full-time or part-time employees and paid mance of the member. or unpaid volunteers.It also shall provide information forphy- 14.7 Essential Job Function. Task or assigned duty that is sicians regarding other areas of fire department medicine, critical to successful performance of the job. including infection control and fireground rehabilitation. 14.8 1-I.2 These requirements are a applicable to public,gosernmen- I-1.9 Evaluation. See Medical Evaluation. sal,military.private.and industrial fire department o Exposure Tncideaa A specific eye. mouth. or other providingrescue•fire suppression. ��aOm mucous membrane, non-intact skin, or parentetal contact PPt�on,emergency medical d of services. with blood•body fluids•or other potentially infectious materi- emerg nc materials mitigation.special operations and other als. or inhalation of airborne pathogens. ingestion of food- emergenry services. borne pathogens or toxins. 1-1.3 This standard shall not apply to industrial fire brigades 14.10 Fire Department Physician. The licensed doctor of that also can be known as emergency brigades, emergency medicine or osteopathy who has been designated by the fire response ne emergency response.tpeams emergency-organizations,or department to provide professional expertise in the areas of occupational safety and health as they relate to emergency 1-2 Purpose. services. 1-2.I The purpose of this standard shall be to specify mini- I.4.11 Functional Capacity Evaluation. An assessment of the mum medical requirementsofhisfor correlation between that individual's capabilities and the candidates and current mem- essential job functions. ben. It also shall provide other information regarding fire 1-4.12 Health and Fitness Coordinator. The person who,under department activities that assist the department physician in the supervision of the fire department physician,has been desig- providing proper medical support for members. nated by the department to coordinate and be ra 1-2.26 The implementation of the medical requirements out- the health and fitness programs of the de ponsrbk for lihed in this standard shall help ensure that candidates and 14-13 Health and Safety Officer. The member of the foe current members are medically capable of performing their department assigned and authorized by the fire chief as the required duties and shall help to reduce the risk of occupa- manager of the safety and health program and who performs clonal injuries and illnesses, the duties and responsibilities specified in this standard.This 1-2.3 Nothingherein shall be intended to restrict an urisdic- individual can be the incident safety officer or that can also be Lion from exceeding yr ffieding these minimum requirements a separate function. 1-3 Implementation. 14.14 lofecdon Control Officer. The person or persons 1-3.I For candidates, the medical requirements of this start- within the fire department who'are responsible for managing the department infection control program and for coordinat- dard shall be implemented when this standard is adopted by i^g efforts surrounding the investigation of an exposure. an authority havingjurisdiction,on an effective date specified 14.15 infection Control Program.!ontr The free department's for- by the authority havingjurisdicLion. mal program relating to the control of infectious and commu- nicable 1-3.2' When this standard is adopted by a jurisdiction, the general public ecould be exposed to blood, body fluids, or authority having jurisdiction shall set a date or dates for cur- hazards where employees, Parrots, id the in the rent members to achieve compliance with the requirements work environment fire program fectious include but u not limited end of this standard and shall be permitted to establish a phase- to,implementation ofwritten policies and standard operating in schedule for compliance with specific requirements of this procedures regarding exposure folloswup measures•immuni- standard in order to minimize personal and departmental disruption. muous, members' health screening programs, and educa- tional programs. 2000 Edition 158Y-h vfEDi(•_-kL ttEo-)CiRE.%IE, FOR FIRE Fh;HTERS ANE)rNFORJL%TiON FOR FIRE DEFAR r%PENT pFltStl L\v5 14.16 Medical Evaluation. The analysis of information for 2.2 Fire Depamnent the purpose of making a determination of medical certiftca• Rules. ton.Medical evaluation can include a medical examinatiun. 2.2.1 The fire department shall have an officially designated 14-17 Medical Examination. An examination performed or Physician who shall be responsible for guiding,directing _ directed by the fire department physician. advising the members with regard to their health,fitness,and suind uty as 14-18 Medical Services, Emergency. The provision of treat. DP/tanitmea g Ority foro pn regWred by a,cn 1 NFI ch Ipm�Standnnl on Fir. men[—•such as first aid cardiopulmonary resuscitation,basic life support,advanced life support.and o ther pre•hospital pro rti 2.r of The fire department physician shall be a licensed dot• cedures including ambulance transportation—to patients. for of medicine or osteopathy.14-19 Medically Certified. A determination by the fire depart- 2.2.3• For the purpose of conducting medical uations, ment physician that the candidate or current member meets the the fire department phmsician shall understand the p evaluations. ions. medical requirements of this standard• ical and Psychological demands placed on members and shall 14.20• Member. A person involved in performing the duties understand the environmental conditions under which mem• and responsibilities of a fire department,under the auspices ers must perform.The fire department shall provide the fire of the organization.A fire department member can be a full• department physician with a current job description for all fire time or part-time employee or a paid or unpaid volunteer,can department positions and ranks, occupy any position or rank within the fire department.and 2• can engage in emergency operations, P 2.4 The fire department shalt require that the fire depart. 142t1.1 Memiser, C ment health and safety officer and the health and fitness coor. asrcnL A person who is already a mem• dtnator maintain a liaison with the fire department physician her and whose duties require the of performance essential to ensure that the Health maintenance process for the fire firefighting functions. department is maintained. 14.21 Shan. Indicates a mandatory requirement which is 2.2 S Fire Department Physician Rule, 14-22 Should. indicates a recommendation or that advised but not required. 2.2.5,1 The fire department physician shall evaluate the per. on to ascertain 14-23 Standard. A document, the main text of which con• in this standard•the presence of any medical conditions listed tains only mandatory provisions using the word"shall'to indi- cate requirements and which is in a form generally suitable for mandatory reference by another standard or code or for adop- other When medical evaluationsntpare conducted bya physician tion into law.Nonmandato r other than the fire department physician,the evaluation shall appendix,footnote,or fine print no a and are no be t tobated e con. be rimed and approved by the Ere de sidered a part of the requirements of a standard. plaeemeat Medleal E��dO�partr[[ent physician. 2.3• Pre tical 1 ana ment u Lave! Maetagem�t Comp I C)• A 2.3.1 The candidate shall be certified by the fire department management unit identified in the incident management sys physician as meeting the medical requirements department 3 , ten commonly known as'division." group."or"Sector." of this standard prior to entering into a Mining program become a member or performing in an emergency cope to Chapter 2 Medical process clonal environment as a member. B ry opera. 2.3.2 The candidate shall be evaluated according to the med- Y•1 Medical Evaluation prates ical requirements of Chapter 3 of this standard to Y•1.1' The fire department shall establish and implement effect of medical conditions on the candidate's ability to ss the a nitieciical evaluation process for candidates and current forth a member. tY per• members. 2.3.3 A candidate shall not be certified as meeting 2.1.2 The medical evaluation process shall include preplace- the medi. cal requirements of this standard if the fire department physi• ment medical evaluations, periodic medical evaluations.and clan determines that the candidate has any Category A return-to-duty medical condition as specified in Chapter 3 of this standard. ry medical evaluations. cand date 2.1.3 The fire department shall ensure that the medical n�, ical requirements re eints of shall standard if the firedepar as tment phy- uation process and all medical evaluations meet all of the ical rc u requirements of Section 2•l, stctan determines that the candidate has a Category B medical condition as specified in Chapter 3 of this standard 2.1.4 Each candidate or current member shall cooperate. ar• that is of sufficient severity to prevent the candidate from ticipate.and comply with the medical evaluation P performing,with or without reasonable accommodation,the shall provide complete and accurate information to the Fire risk to the safety and health of the candidate or others. process and essential functions of a member without posing a significant department physician. 2.1.5• Each candidate or current member shall re rt,on a 2.3.4.1 The determination of whether a reasonable accom• timely bass,to the fire department physician an exposure modation shall be made by the authority having jurisdiction in medical condition that could interfere with the ability of the or c°njunction with the fire d individual to perform as a member, eparunent physician. 2•i.6 The medical evaluation shall be at no cost to the candi• 3.5 If the candidate presents with an acute medical problem or newly acquired chronic medical condition that interferes with the candidate's ability to perform the functions ofa mem. date,current member.or ocher member. ber,medical certification shall be postponed until that person 2000 Ediean �IEUIt:hf 11ROr:ESS 159:-7 has recovered from this condition and presents to the fire physician determines that the member has it Category B can. department for review. dition specified in Chapter 3 of this stanrdadd that is of suffi- cicnt severity to prevent the member from perfuming,with or 24 Periodic tiledicrl Evaluation. without reasonable accommodation,the essential functions u f 24.1 The current member shall be certified annually, or at a member without poling a si- gnificant risk to the safety and the request of either the fire department or the member,by health of the member or others. the fire department physician as meeting the medical require- 2 4.3,1 The determination of reasonable accommodation ments of Chapter 3 of this standard in order to determine that shall be made be the authority havingjurisdictiom in conjunc. member's medical ability to continue participating in a train- tion with the fire department physician. ing or emer;encv operational environment as a member.Anc applicable OSH-i standards,such as •?') t:FR 1910.1_0."Haz- 24.4 If the current member presents with an acute illness ardour Waste Operations and Emergency Response.'29 CFR or recently acquired chronic medical condition. the evalua. 1910.134.`Respiratory Protection,'29 dR 1910.95. Occupa- Lion shall be deferred until the member has recovered from dunal Noise Exposure,'and 29 QFR 19111.1030,"Bluadborne the condition and presents to the fire department to return Pathogens,'shall be followed, to duty. 2 4.1.1 The components of the annual medical evaluation as 2-5 Return-to-Duty U"cal Evaluation. specified in 2 4.1.1 shall be permitted to be performed by qualified personnel as authorized by the fire department 2-3.1' A current member who has been absent from duty for physician.When other qualified personnel are used,the fire a medical condition of a nature or duration that could affect department physician shall review the data gathered during performance as a member shall be evaluated by the fire the evaluation. department physician before returning to duty. 24.1.2 The annual medical evaluation shall consist of the fol- 2.5.2 The fire department physician sliall not medically cer. lowing: tify the current member for return to duty if any Category A (1) An interval medical history medical condition specified in Chapter 3 of this standard is (2) An interval occupational history, including significant present. exposures 2-5.30 The fire department physician shall not medically cer- (3) Height and weight tify the current member for return to duty if any Category B (4) Blood pressure medical condition specified in Chapter 3 of this standard is (5) Heart rate and rhythm present that is determined to be severe enough to affect the 2.4.1.3* In addition to the annual medical evaluation,the fire member's performance as a member. The fire department department shall include a medical examination according to physician, In conjunction with the authority having jurisdic. the following schedule- lion,shall take into account the member's current duty assign- ment and alternative duty assignments or other programs that (1) Ages 29 and under—at least every 3 years would allow a member to gradually return to full duty. (2) Ages 30 to 39—at least every 2 years (3) Ages 40 and above--every year 2-5.4• The department shall provide guidance,opportunity, and encouragement to the member so as to expedite his safe 241.4' The medical examination shall include examination return to full duty, of the following components: (1) Vital signs—namely,pulse,respiration,blood pressure, 2.6 Medical Evaluiadon Records,Results,Reporting,and and,if indicated,temperature Confidentiality, (3) Ear,eyes,nose system 2.6.1 All medical information collected as part of a medical (3) Ears,eyes,nose,mouth,throat evaluation shall be considered confidential medical informa- (4) Cardiovascular system- don and shall be released b the fire department physician (6) Gastrointestinal system (6) Respiratory system only with the specific written consent of the candidate or cur- (7) Genitourinary system rent member. (S) Endocrine and metabolic systems 2-6.2 The fire department physician shall report the results of (9) Musculeskeletal system the medical evaluation to the candidate or current member, (10)Neurological system including any medical condition(s)disclosed during the med- (11)Audiometry ical evaluation, and the recommendation as to whether the (12)Visual acuity and peripheral vision testing candidate occurrent member is medically certified to perform (13)Pulmonary function testing as a member. ( )Laboratory rating,if indicated (15l3)Diagnostic imaging,if indicated 2.63 The fore department physician h sician shall inform the fire (16) Electrocardiography,if indicated department fire chief or designee only as to whether or not the candidate or current member is medically certified to per- 2.4.2 A current member shall not be certified as meeting the form as a member.The specific written consent of the candi- medical requirements of this standard if the fire department date or current member shall be required in order to release physician determines that the member has any Category A confidential medical information regarding this condition to medical condition specified in Chapter 3 of this standard. the fire department. 2.4.30 A current member shall not be certified as meeting the 2.6.4 All medical record keeping shall comply with the medical requirements of this standard if the fire department requirements of 29 UR 1910.20,`Medical Recordkeeping.- 20oo Edlrwn I, 15A2 9 MEDICAL REQUIREMENTS FOR FIRE FIGHTERS AND INFORMATION FOR FIRE DEPARTMENT PIn-3ICL.%,,S ------------- Chapter 3 Category A and Category B 3-4 Ears and Hearing. Medical Conditions g 3.4.1 There shall be no Category A medical conditions. 3-1 Medical Conditions Affecting Ability to Perform. Cate- 34.2' Category B medical conditions shall include the fol- gory A and Category B medical conditions shall help the lowing. examiner understand the type of condition that could result in rejection or acceptance.The medical conditions listed are (a) Hearing deficit in the pure tone thresholds in the organized by organ system.In the corresponding Appendix A unaided worst ear that is explanatory material,a diagnostic example is often included (1) Greater than 25 dB in three of the four frequencies with the list.In addition,the rationale for the rejection is pre- a. 500 Hz sented in terns of the effect of the medical condition on the b. 1000 Hz capability of the person to perform as a member. c. 2000 Hz 1 3.2 Head and Neck d. 3000 Hz OR 3.2.1 Head. (2) Greater than 30 dB in any one of the three frequencies 3.2.1.1 There shall be no Category A medical conditions. a. 500 Hz b. 1000 Hz 3.2.1.2' Category B medical conditions shall include the fol- c. 2000 Hz lowing: AND (1) Deformities of the skull such as depressions or exostoscs (3) In addition averages greater than 30 dB for the four fre- (2) Deformities of the skull associated with evidence of dis. quencies ease of the brain,spinal cord,or peripheral nerves - a. 500 Hz (3) Loss or congenital absence of the bony substance of the b. 1000 Hz skull c. 2000 Hz (4) Any other head condition that results in a person not d. 3000 Hz being able to perform as a member (b) Unequal hearing loss 3-2.2 Neck. (c) Atresia,severe stenosis,or tumor of the auditory canal (d) Severe external otitis 3-2.2.1 There shall be no Category A medical conditions. (e) $even agenesis or traumatic deformity of the auricle cal deformity of 3-2.2.20 Category B medical conditions shall include the fol- (g) M ni syndrome or su I byrinthitis the mastoid _ lowing: (h) Odtis media (1) Thoracic outlet syndrome (i) Any other ear condition that results in a person not (2) Congenital cysts, chronic draining fstulu, or similar beinbeing able to prase a job specific functional form as a randresults wring ty)<person t lesions (3) Contraction of neck muscles or a hearing in noise test, (4) Any other neck condition that results in a person not 3.5 Dental. beingable to perform as a member 3-5.1 There shall be no CategoryA medical conditions. 3-3 Eyes and V-tsfon- 3-5.20 Category B medical conditions shall include the fol- 3-3.1* Category A medical conditions shall Include the fol- lowing: lowing. (1) Diseases of thejaws or associated tissues (a) Farvirual acuity.Far visual acuity shall beat least 20/30 (3) Orthodontic appliances ensive loss binocular, corrected with contact lenses or spectacles. Far (4) Relationship e>l tons e etween e mandible and maxilla thatpre- visual acuity uncorrected shall be at least 20/100 binocular for ({) dudesb cluto satisfactory posuipmedontic replacement or abil- wearen of hard contacts or spectacles. _ fry to use protective equipment recdon slrapll be 40 deg tfiliam rees field performance without end anon (5) Any gable dental condition member results in a person not the being able to perform as a member each rye. 3.6 Nose.Orgpharynx.Trachea,Esophagus,and Larynx. 3.3.20 Category B medical conditions shall include the fol- 3-6.1• Category A medical conditions shall include the Col- lowing: ,- lowing: , (1) Diseases of the eye such as retinal detachment,progres- (1) Tracheostomy - sive retinopathy,or optic neuritis (2) Aphonia (2) Ophthalmological procedures such as radial kerdtotomy 3.6.20 Category B medical conditions shall include the fol- or repair of retinal detachment (3) Anyothereye condition that results in a person not being lowing. able to perform as a member g (I) Congenitalc es i acquired deformity (2) Allergic rppiratory disorder '. 2000 Edflan CiTEGORY A AND CATEGORY O MEDWAL CONDITIONS 1582-9 (3) Sinusitis,recurrent 38.2 Vascular System. (4) Dysphonia 38.2.1 There shall be no Category A medical conditions. (5) Anosmia (6) Any other nose,oropharynx,trachea,esophagus,or lar- 3-8.2.20 Category B medical conditions shall include the fol- ynx condition that results in a person not being able to lowing: perform as a member or to communicate effectively (1) Hypertension 37 Lungs and Chat Wall. (2) Peripheral vascular disease such as Raynaud's phenome- non 3.7.10 Category A medical conditions shall include the fol. (3) Recurrent thrombophiebitis lowing: (4) Chronic lymphedemaduetolymphadenopathyorsevere venous valvular incompetency (1) Active hemoptysis (5) Congenital or acquired lesions of the aorta or major ves- (2) Empyema Sels (3) Pulmonary hypertension (6) Marked circulatory instability as indicated by orthostatic (4) Active tuberculosis hypotension, persistent tachycardia,and severe periph- eral vasomotor disturbances 3-7.20 Category B medical conditions shall include the fol- (7) Aneurysm of the heart or major vessel lowing: (8) Any other vascular condition that results in a person not (1) Pulmonary resectional surgery,chest wall surgery,pneu- being able to perform as a member mothorax (2) Bronchial asthma or reactive airways disease 3-9 Abdominal Organs and Gastrointestinal System. (3) Ftbrothotax,chestwall deformity,diaphragm abnormalities 3.9.1 There shall be no Category A conditions. (4) Chronic obstructive airways disease 3.9.2* Category B medical conditions shall include the fol- (5) Hypoxemic disorders lowing: (6) Interstitial lung diseases (7) Pulmonary vascular diseases,pulmonary embolism ( ) Cholecystitis (8) Bronchiectasis (2) Gastrids (9) Infectious diseases of the lung or pleural space (3) GI bleeding (4) Acute hepatitis (10)Any other pulmonary condition that results in a person (5) Hernia not being able to perform as a member (6) Inflammatory bowel disease 3.8 Heart and Vascular System. (7) Intestinal.obstruction (8) Pancreadds 38.1 Heart. (9) Resection,bowel (10)Ulcer,gastrointestinal 3-8.1.10 Category A medical conditions shall include the fol- 01)Cirrhosis,hepatic or biliary lowing: (12)Chronic active hepatitis (1) Angina pectoris,current (13)Any other gastrointestinal condition that results in a per- (2) Heart failure,current son not being able to perform the duties of member (3) Acute pericarditis,endocardids,or myocarditis 3.10 GenitourinaySystem. (4) Syncope,recurrent (5) Automatic implantable cardiac defibrillator 3.10.1 Reproductive. 34.1.2• Category 8 medical conditions shall include the fol- 3.10.1.1 There shall be no Category A medical conditions. lowing: 3-10.1.20 Category B medical conditions shall include the fal- (1) Significant valvular lesions of the heart,including pros- lowing: thetic valves (1) Pregnancy,for its duration (2) Coronary artery disease,including history of myocardial (2) Dysmenorrhea infarction,coronary artery bypass surgery, or coronary (3) Endometriosis,ovarian cysts,or other gynecologic con- angioplasty,and similar procedures ditions (3) Atrial tachycardia,flutter,or fibrillation (4) Testicular or epididymal ma3s (4) Left bundle branch block,second-and third-degree atri- (5) Any other genital condition that results in a person not oventricular block being able to perform as a member (5) Ventricular tachycardia 3-10.2 Urinary System. (6) Hypertrophy of the heart (7) Recurrent paroxysmal tachycardia 3-I0.2.1 There shall be no Category A medical conditions. (8) History of a congenital abnormality 3.10.2.20 Category B medical conditions shall include the fol- (9) Chronic pericarditis,endocardids,or myocarditfs lowing: (10)Cardiac pacemaker (1) Diseases of the kidney G 1)Coronary artery vasospasm (2) Diseases of the ureter,bladder,or prostate (12)Any other cardiac condition that results in a person not (3) Any other urinary condition that results in a person not being able to perform as a member being able to perform as a member 2000 EdMW imurtrwxurary r� l//%"Y/i S EN, f U8 —Iq �f r 0lr AL REQUIREMENTS FOR FIRE FIGHTERS AND INFORMATION FOR FIRE DEPARTMENT p I' HISICLlNS 3.11 Spine,Scapulae,Ribs,and Sacroiliac Joints. 3.11.1 There shall be no Category A medical 3.14 Skfa, B conditions. 3-14.1 There shall be no Category A m 3-1 1-2* Category 8 medical conditions shall include the for- 3.14.Y• Category B medial conditions medical conditions. - leeving: ors shall include the fol. r (1) Arthritis lowing (2) Structural abnormality fracture,or dislocation (1) Acne Or) Eczema inflammatory skin disease (3) Vuelers pulposus, herniation of,or history of laminec- (3) Any other dermatologic condition that results in the pew tomy,ducectomv or fusion(4) Ankyiosing spon son not being able to perform as a member dylitis (5) Any other spinal condition that results in a person not 3-15 Blood and Blood-Forming Organs. being able to perform as a member 3•15.1• Category A medical conditions shall intrude the fal- 3.I2 Ettremities. lowing: 3.1 Y.I There shall be no (1) Hemorrhagic states requiring replacement therapy Category A medical conditions, (2) Sickle cell disease(homorygous) 3•12�.2• Category B medical conditions shall include the fol. 3.15_2• Cate o B lowing g ry medical conditions shall include lowing the fol. (1) Limitation of motion of a joint (I) Anemia (2) rlrttputationor deformity ofajointorlimb (2) Leukopenia (3) Dislocation of a joint (3) poly (4) joint reconstruction, ligamentousno egal veto instability, or joint (4) Splenomegaly replacement (5) History of thromboembolic disease (5) Chronic osteoarthritis or traumatic arthritis (6) Any other hematological condition that results in a per (6) Inflammatory arthritis son not being able to perform as a member (7) Anyother extremity condition that results in a person not 3.16 Endocrine and Metabolic Disorders• being able to perform as a member 3-13 Neurological DisOrdgm k3.16.1• Diabetes mellitus,which is treated with insulin or an oral hypoglycemic agent and where an individual has a history ofo3.13.1• Category A medical conditions shall include the fol- be anCategoryA medical co ndtiicn itatin hypoglycemia,lowing: e or more episodes gyp glycemia,shall (1) Ataxias of heredo•degenetative type 3-16.20 Category B medical conditions shall include the fol-• (2) Cerebral arteriosclerosis zs lowing episodes of neurological im evidenced by documented (1) Diseases of the adrenal gland, pituitary (3) Multiple sclerosis with ac impy or evidence of r roid gland,or thyroid gland of cnical gland. parathy within previous three yeats P ogression (2ent ) Nutritional deficiency (4) Progressive muscular d (3) Diabetes mellitus requiring treatments with disorder dystrophy or atrophy h insulin or oral (5) Al!epileptic conditions to include simple partial,complex hy'oglycemia agent without a history Partial. generalized, of incapacitating and Psychomotor seizure disorders (4) Any ether endocrine or metabolic condition that results other than those with complete control during previous in a person not being able to perform as a member five Years,normal neurological examination,` tive statement from qualified neurol and defini- °gical specialist 3-17 Systemic Diseases and Miscellaneous Conditions. 3-13.2 If an epileptic memberexperiences a llve-yearsei3ure- free interval resulting from 3.17.1 There shall be no CategoryAmedical conditions, that individual shall not be cleared for return ntofimedical regimen, 3•17.2• Category g medicol conditions shall include the fol- duty until he or she has completed five tts w 1h without fighting (owing: on the new regimen. Y�without a seizure (1) Connective tissue disease,such as dermatomyositit,lupus _ 3 13.3• Category$medical conditions shag include the fol. (Y) �udetma os,scleroderm lowing: a,and rheumatoid arthritis (3) Documented evidenast ce of a!Injury (1) Congenital malformations with recurrent episodes or resulting residual i juition to ry (2) Migraine (4) Any other systemic condition that results in a person not (3) Clinical disorders with paresis, being able to perform as a member lion,deformity.abnormal Paralysis, dYsc°ordina- rural motor activity,abnormality of 3.18 liimon and Mali sensation,or complaint of pain 3-18.1 There shall be (;) Subarechnoid or intracerebral hemorrhage 8u'ns Diseases. (5) Abnormalities from recent head injury such as severe no Category A medical conditions. cerebral contusion or concussion 3.18.2• Category B medical conditions shall include the fol- (6) Any other neurological condition that results in a person lowing; not being able to perform as a member (1) Malignant disease that is newly diagnosed.untreated,or 2t>DO EeiGon INCIDENT SCENE REMWILITtTION AND SIEDIGIL TREATMENT 1582_1 I a. Candidates shall be subject to the provisions of':•3.5 4.1.2• All members shall be evaluated according to current of this standard. CDC guidelines following any tuberculosis exposure. These b. Current members shall be subject to the provisions of results shall be communicated to and reviewed by the fire 2-4.4 of this standard. department physician. (-) Treated malignant disease that is evaluated on the basis 4 4. immtrnizadons All members shall he immunized of an indi of the current physical condition and on cite against infectious diseases as required by the authority having likelihood of the disease to recur or progress. � ry (1) Ana other tumor orsimilar condition that results in a per- Jurisdiction and by '29 UR 1910.1030 -Bloodborne Patho- member. gens.' The fire department physician shall ensure that all son not bring able to perform as members are otFcred currendy recommended immunizations. 3-19 Psychiatric Conditiorm 3.19.1 There shall be no Category A medical conditions. Chapter 5 Incident Scene Rehabilitation 3-19.20 Category B medical conditions shall include the fol- and 3ledical Treatment lowing: 3.1 incident Scene Rehabilitation. (1) A history of psychiatric condition or substance abuse problem 5-1.1• The fire department shall develop standard operating (2) Any other psychiatric condition that results in a person procedures that outline a systematic approach for the rehabil- nor bring able to perform as a member itation of members operating at incidents. Provisions addressed in these procedures shall include medical evalua- 3.19.3 Candidates and current members shall be evaluated don and treatment,food and fluid replenishment,crew rota- based on the individual's current condition. tion.and relief from extreme climatic conditions. 3.20 Chemicals,Drugs,and Medicatiorm 5.1.20 The incident commander shall consider the circum- 3 20.1 There shall he no Category A medical conditions. stances of each incident and initiate rest and rehabilitation of members in accordance with the fire departments standard 3-20.20 Category B medical conditions shall include the use operating procedures and with NFPA L361,Standard on Emer- of the following: genry Services Incident Management System (1) Anticoagulant agents 5-2 Incident Scene Safety and Health. (?) Cardiovascular agents 5.2.1 The incident safe officer shall ensure that the incident (4) Narcotics commander establishes an incident scene rehabilitation tacti- (4) Stimuli-hypnotic cal level management component during emergency opera- (5) Stimulants dons as required b NFPA 1521, Standard for Fire Department (6) Psychoactive agents q y Offun (7) Steroids (8) Any other chemical,drug,or medication that results in a 5.2.2• Transport capable emergency medical services(ENIS) person not being able to perform as a member 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 Chapter 4 Wectious Disease Program level of available care. Advanced life support (ALS) care is preferable where it is available. 4-I Infection Control Program. 5.3 Evaluation and Triage of Member injuries. 4.1.1 The fire department shall maintain infection control programs as delineated in NFPA 1581,Standard on Fire Depart- 5.3.1 In the evcnt of an injury to a member during emergency ment infection Contrai ftram. operations, EMS personnel shall assess and treat the injury based on local ENIS protocol and fire department standard 4.1.2 The fire department physician shall maintain a liaison operating procedures. with the infection control officer as specified in NFPA I581. 5.3.2' Protocols and procedures guiding ELIS providers car. 4-2 Exposure Incidenm ing for ill or injured members during emergency operations 4-2.1• All blood and/or body fluid exposures shall be dons�hlwith cite ft er epartmenbe developd by the tlphys cianland chiefn collabora- reported immediately. and medical assessment shall be pro- vided within 2 hours of exposure. Medical assessment shall 54 incident Scene Rehabilitation Tactical Level Management conform to current CDC guidelines. Component. 4.2.2• All ocher exposure incidents shall be reported and 5-4.1 The rehabilitation tactical level management compo assessment provided within 24 hours of exposure. nent shall be designated per department standard operat- 4-3 Tuberculosis. ing procedures,such as large-scale incidents,long-durationincidents, or those associated with significant temperature 4.3.10 The fare department shall provide a tuberculosis mon- extremes. itoring program that will test members at least annually and as 5-4.2 The rehabilitation tactical level management compo- indicated by CDC guidelines.Tuberculosis (TB) testing inter. nent shall be established in a safe environment away from the vals shall conform to current CDC guidelines. hazardous area of the incident. 2000 Edition 1a82-1'= -%IL•'DI(*-%R QUIREMEVTS FOR FiRL FIt1H•fERS.k.Nn INFORIUTIUN FOR FiRE DEPARTMENT PI'MWI AN5 54.3• The resources needed at the rehabilitation tacucal level management component shall include an environment Appendix'� Explanatory btateria! to limit temperature stress,medical equipment,and adequate medical atilt .appendix A is not a part of the requirrmenu of this,bFp{&,cu• mint hug it included for infmmatinnal purp,rses only. This nppen,Gx 54.4• Members shall be assigned to rehabilitation as pre- c.ontaintexplenatnrym,ateri4 number►dtocormpond:uuhglteapp(i. scribed by departmental standard operating procedures. ruble text parigrapht. Unusual circumstances.such as long-tiuration incidents,situa- tions requiring Iteavv exertion, or severe weather extremes A-1 2.2 There is it direct relationship between the medical shall require an alteration an procedures. requirements and the job description of members. The job 5-4.3• Members arriving at rehabilitation shall be briefly description should include all essential job functions of mem- questioned by medial staff about any s}mptoms of dehy�dta• bets,both emergency and nnnemergency.Members perform [ion,heat stress.cold stress,physical exltarutinn.and,'or car- a vanery of emergency operations including fire fighting, dinpulmonary abnormalities.. member Navin si ificant tmrr3cnev medical care,hazardous materials mitiy+ation,and g 3tr special operations.Nonemergency duties can include,and are symptoms shall be moved to an area where assessment by not limited to,training,station and vehicle maintenance,and advance life support personnel can be perforated. physical fitness. Each fire department needs to identify and 5-4.6 Members assigned to rehabilitation shall be encouraged develop a written job description for members.Appendix C. to add, remove clothing to regain normal bodv temperature, Essential Fire-Fighting Functions, provides an example of drink fluids(water,electrolyte replacement drinks),and rest. essential job functions for members. 54.7 No member shall be reassigned to return to dun•until A,•L-3.2 The specific determination of the authority having medical evaluation and hydration has occurred for at Teas[ jurisdiction depends on the mechanism under which this stan- 11) minutes in rehabilitation and after being cleared by dard is adopted and enforced.Where this standard is adopted medical staff. voluntarily by a particular fare department for its own use,the 5-k.8 All members entering and leaving rehabilitation shall be aatthoriry having jurisdiction should be the fire chief or the properly assigned by the incident management system and be depacal entity that is responsible for the gaJiva d of the fire tracked through the personnel accountability system. enforced bodyWhere this standard r legally adopted and enforced by a body having regulatory authority over a fire department, such as federal. state, ar local government or Chapter 6 Referenced Publications Political subdivision,this body is responsible for making those determinations as the authority having jurisdiction.The cam- 6-L The following documents or portions thereof are refer- Pliance program should take into account the services the fire enced within this standard as mandatory requirements and depaable to h required t provide, the Financial resources shall be considered part of the requirements of this standard. available bi ity fire department,the availability of personnel, The edition indicated for each referenced mandatory docu- the rare of trainee,and such other factors e.will affect ment is the current edition as of the date of the NFPA issuance the[ire department's ability to achieve compliance. of this standard.Some of these mandatory documents might A-14.1 Approved. The National Fire Protection Association also be referenced in this standard for specific informational does not approve, inspect,or certify any installations, proce- purposes and,therefore,are also listed in Appendix F. dures,equipment,or materials;nor does it approve or evalu- 6.I.I NFPA Ptiblicadons. National Fire Protection Associa- ate testing laboratories. In determining the acceptability of lion,I Batterymarrh Park,P.O.Box 9101.Quincy.MA 02269- installations,procedures,equipment,or materials,the author- 9101. icy having jurisdiction may base acceptance an compliance NFPA 1500,.Standard on Fair Department Occupatwnal Safety with NFPA or other appropriate standards.In the absence of and Health Program, 1997 edition, such standards,said authority may require evidence of proper NFPA 1321,Standard for Fire Deputment Safety Office, 1997 installation,procedure,or use.The authority havfngjurisdic- edidon. lion may also refer to the listings or labeling practices of an NFPA 1361,Standari on Emergency Services Incident Xiang organization that is concerned with product evaluations and is meat System,2000 edition. g''' thus in a position to determine compliance with appropriate NFPA 1581,Standard oat Fes Department fnfectson Control Pro- standards for the current production of listed items. gram,2000 edition. A-14.2 Authority Having jurisdiction. Ile phrase'authority 6-1.2 V.S.Government Publications. U S.Gmertiment Print. having jurisdiction" is used in NFPA documents in a broad ing Office,Washington.DC 20401. manner,since jurisdictions and approval agencies vary,as do Tide 29, Carle of FederalRegulrationt,Par[1910.120.'Hazard- their responsibilities. Where public safety is primary, the ous Waste Operations and Emergency Response,"1986. authority having jurisdiction may be a federal,state,local.or Title 29,Code ofFederal Regulatio",Part 1910.134,'Res ira- other regional department or individual such as a fire chief; Cory Protection,"1998. P fire marshal:chief of a fare prevention bureau,labor depart- Title 29, Codeof Federal Rrxnlah a.mu part 1910.95,'Otto ment, or health department; building official; electrical tional Noise Exposure,"1980. P inspector,or others having statutory authority.For insurance Title?9, r'ali of Federal Regulatwnt,Part 1910•20."Mc.dical ortotthher in unnce compa.in insurance ny representection ative maybe the author- Rrcordkeeping," 1981), Title'29,Code of Federal ReguLaa mi,Part 1910 lt)31), owner r or his ority having dher designated agent assumes thiction. tn many circumstances, eamle of the borne Pathogens,"1995. authonry having jurisdiction;at government installations,the 2000 Edition ACNENDM A I582_I:1 commanding officer or departmental otficial may be the A-2-5.3 See Appendix D.Section D-I.Legal Conrra(eratiuns in authority having jurisdiction. Applying the Standard. A-14.3 Candidate. In an employment context, the Ameri- A-2-5.4 Physical therapy,strength training, work hardening, cans with Disabilities Act(discussed in further detail in Appen- functional capacity evaluations.and alternate dairy are all actiy. die D)requires that any medical examination to be conducted ities that can be helpful. take place after an offer of emplrnment is made and prior to ,r the commencement of duties.Therefore,in the emplotment A-3•`.1.2 ('air{a+ry B medical conditions rat the brad include context,the definition of the term candidate should be applied the fullowiny. so as to be consistent with that regarirement. 1 t) Deformities of the skull. such as depressions or exos- Volunteer members have been deemed to be emplovees roses,of.a degree that interferes with the use of protec. in some states or jurisdictions. Volunteer fire departments tive equipment. Deformities of the skull can result in should seek legal counsel as to their legal responsibilities in the member's inability to properly wear protective these matters. equipment. A-lam 20 3fember. See appendix C.Essential Structural Fire- (2) Deformities of the skull associated with evidence of dis. Fighting Functions. ease of the brain,spinal cord,or peripheral nerves.These deformities can result in the potential for sudden inca. A-2-1.1 See Appendix D.Guide for Fire DepartmentAdminis- pacitation. the inability to properly wear protective trators. equipment.and the inability to communicate effectively A•2.1.5 Exposures and medical conditions that shoidd be date to oropharyngeal dysfunction. reported if they can interfere with the ability of the individual (3) Loss of or congenital absence of the bonysubstance of the to perform as a member include, but are oat limited to,the skull (if associated with disease interfering with perfor• following- manse or ifappropriate protection cannot be provided for the area without interfering with protective equipment (1) Exposures to hazardous materials or toxic substances and vision).Loss of or congenital absence of the bony3ub- (2) Exposure to infectious or contagious diseases stance of the skull can result in the inability to properly (3) illness or injury wear protective equipment and the inability to communi. (4) Use of prescription or nonprescription drugs sate effectively due to oropharyngeal dysfunction. (5) Pregnancy (4) Any other head condition that results in a person not A 2.2.2 See Appendix D.Section D-`:,Choosing a Fire Depart- being able to perform as a member. ment Physician. A-3-2.2.2 Category B medical conditions of the neck include A-2-2.3 See Appendix B. Information for Fire Department the following: Physicians. Appendix C. Essential .structural Fire-Fghting (1) Thoracic outlet syndrome (symptomatic).Thoracic out- Functions provides a generic description of job tasks per- let syndrome can result in frequent episodes of pain or formed by members.A fire department needs to provide the inability to perform work. fire department physician with a job description of all posi• (2) Congenital cysts, chronic draining fistulas, or similar lions and ranks so that the fire department physician can lesions (if lesions or underlying disease interferes with understand the physical and mental demands placed upon all performance). Congenital cysis, chronic draining fists• members regardless of position or rank.Appendix D,Guide W.orsimilar lesions can result in the inability to properly for Fire Department Administrators, also provides guidance wear protective equipment,and the inability to commu- for ensuring that the fire department physician is provided nicate effectively due to oropharyngeal dysfunction. with this Information. (3) Contraction of neck muscles(if it interferes with wearing A4.3 See Appendix B. Section B-3, Guidance for Medical of protective equipment or ability to perform duties). Evaluations. The contraction of neck muscles can result in the inabil- ity to properly wear protective equipment,and the inabil- A•2.3.4 See Appendix D.Section D-1.Legal Considerations in iry to perform functions as a member due to limitation of Applying the Standard. flexibility. A-2-4 See Appendix B. Section ", Guidance for Medical (4) Any other neck condition that results in a person not Evaluations. being able to perform as a member. A 2-i 1.3 At the discretion of the fire department physician, A-3-3.1 Category A medical conditions of the eves and vision P P Y include the following-an examination can be performed sooner than would be expected from the schedule given in 2-4.1.3.Current medical (1) far t iruai acuity.Far visual acuity is at least 20/30 binocu- conditions and coronary risk factors could mandate more fre- lar.corrected with contact lenses or spectacles.Far visual quent medical examinations. acuity uncorrected is at least 20/100 binocular for Department wear- A-2-i.1.4 See Appendix B,Guide for Fire De Ph - ers of hard contacts or spectacles. Successful long-term sicians. P Y soft contact lens wearer (that is. six months without a problem) are not subject to the uncorrected standard. A-24.3 See Appendix D,Section D-1.Legal Considerations in Inadequate far visual acuity can result in the failure to be Applying the Standard. able to read placards and street signs or to see and A-2.5.1 A department should set protocols regarding len th respond to i mminently hazardous situations. 6 (2) Periphend virton.Visual field performance without correc- of time absent from duty and/or medical conditions that lion is 140 degrees in the horizontal meridian in each require the department physician to evaluate a member. eye. (Members cannot have just monocular vision.) 2000 Eften liA'd-I} btr•.0 ciL KEQUIREJtEVTS MK FIRL FRA ITEKS)OM 1\FO RA\t' N FOK Flltk UEP.IRTSIEVT PH\Slra,\VS Monocular vision can result in sudden incapacitation (h) Severe external otitis,that is,recurrent loss of heating when debris is bodged in one eye.inadequate or comprvr can reslilt in the inability to hear sounds of low intensity or to mised penpl[eral vision can result in the following: distinguish voice from background noise,loading to failure to a. F.tilure to perform jnb duties and maintain visual con- respond to imminently hazardous sittiatiorts. tact with a partner (c) Severe agenesis or traumatic defurmiw of the auricle b. inability to maintain safety near moviugobjects can result in the inability to properly wear protective equip. c. Pour balance on uneven surfaces men[and the inability to hear sounds of low intensity or to dis- c. Unsuccemfrd performance in environment,-. %here tinguish voice from background noise, loading to failure to visual curs are critical to personal safety resp mid to imminently hazardous situations. A-3.7.2 Category B medical conditions of the eyes and vision (`i) Severe ntastoiditii or surgical deformity of the mastoid include the following: can result in the inability to properly wear protective equip. ment and the inability to hear sounds of low intensity or to dis- (1) Diseases of the eve such as retinal detachment,progres- tin,fish voice from background noise, leading to failure to wive retinopathy,or optic neuritis(severe or progressive). respond to imminently hazardous situations. These diseases of the eye can result in the failure to read (e) `leniere's nricirome or severe labvtinthids may result placards and street signs or to see and respond to immi- in the potential for sudden incapacitation and the inability to nently hazardous situations. perform job functions due to limitations of balance. (2) Ophthalmological procedures such as radial keratot- M Otitis media(chronic)can result in frequent episodes omy and repair of retinal detachment. With retinal of pain or the inability to perform work and the inability to detachment,sufficient time 0-2 weeks for radial kera- hear sounds of low intensity or to distinguish voice from back- tonomy and I aaik-type surgeries,three months for reti- ground noise,leading to failure to respond to imminently haz- nal detachment)must have passed to allow stabilization ardous situations. of visual acuity and to ensure that there are no postsur- gical complications. These ophthalmological proce- (g) Any other ear condition that results in a person not duies may result in the failure to be able to read being able to perform as a member can be classified as a Cat- placards and street signs or to see and respond to immi- egory B medical condition of hearing. nently hazardous situations. A-3-5.2 Category B dental medical conditions include the fol- (3) Anyothereye condition that results in a person not being lowing: able to perform as a member. Persons with severe color vision loss will likely fail the acuity requirement. (1) Diseases of the Jaws or associated tissues (those that are Formerly,color vision deficiency was(fisted as a Cate- incapacitating or preclude ability to use protective equipment). Diseases of the jaws or associated tissues gory B medical condition.However,it is felt that within most cases this condition will not affect the abilityof a can result in the inability to properly wear protective member to perform the essential functions of his or her equipment. job.The fire service physician should consider the color (2) Orthodontic appliances (those that preclude the ability vision deficiency of the individual and consider the color to use protective equipment)-The wearing of orihodon. vision requirements of the member's job and reach an tic appliances can result in the inability to properly wear individual determination, protective equipment. (3) Orel tissues,extensive loss(that which precludes sadsfac- A*3.4.2 There are currently no hearing tests that will allow the tory posto rthodontic replacement or ability to use pro- fire department physician to accurately predict whether the tective equipment). Extensive loss of oral tissues may fire fighter will adequately be able to perform essential job result in the inability to properly wear protective equip- duties.Job-specific hearing tests should be individualized for ment and the inability to communicate effectively due to each department and its specific job functions.The following oropharyngeal dysfunction- list of hearing-specific tasks can assist to direct development of (4) Relationship between the mandible and maxilla that pre- hearing protocols. eludes satisfactory postorthodondc replacement or abil- (l) Understanding spoken commands, both over the radio ity to use protective equipment.This condition can result and while wearing SCBA in the inability to properly wear protective equipment (2) Hearing alarm signals, including building evacuation, and the inability to communicate effectively due to low air signal on the SCBA,and PASS alarms oropharyngeal dysfunction. (3) Hearing and locating the source of calls for assistance (i) Any other dental condition dlat results in a person not from victims or other fire fighters being able to perform as a member. All of the above tasks will need to be performed with rea- A-3.6.1 Category A medical conditions of the nose,orophar- sonably simulated incident scene background noise and SCBA ynx,trachea,esophagus,and larynx include the following: noise.The inability to hear sounds of low intensity or to distin- guish voice from background noise can lead to failure to (1) Tracheostomy.A tracheostomy can result in the inability respond to imminently hazardous situations.(See also B-4.3.) to properly wear protective equipment, the inability to Category B medical conditions of hearing include the fol- perform job functions due to limitations of endurance, lowing: and the inability to communicate effectively due to oropharyngeal dysfunction. (a) Unequal hearing can result in the inability to lucahze (2) Aphonia.regardless of cause.Aphonia can result in the sounds,leading to failure in the ability to perform search and inability to communicate effectively due to oropharyn- rescue and other localization tasks, goal dysfunction. 2000 EWtwn APPENDIX A 1582-1a A-3-6.2 Category B medical conditions of the nose,orophar- (9) Infectious diseases of the lung or pleural spPace. ynx.trachea,esophagus.and larynx include the following: GO)Any other pulmonary condition that results in a person (1) Congenital car acquired deformity that interferes with the not being able to perform as a member. ability to rise protective equipment. A congenital or A-3.8-1.1 Category A medical conditions of the heart and vas. acquired deformity can result in the inability to properly cular system include the following wear protective equipment. (") Allergic respiratory disorder(uncontrolled).,tiler;c res. (l) Angina pectoris. current. Angina pectoris can result in piston•disorder can result in frequent episodes of pain, frequent episodes of pain or inability to perform work, the inability to perform work,and the inability to perform Progressive illness leading to functional impairment,and functions as a member due to limitations of endurance. the potential for sudden incapacitation. (3) Sinusitis,recurrent(severe,requiring repeated hospital. (2) Heart failure, current. Heart failure can result in fre. izations or causing impairment).Recurrent sinusitis can quent episodes of pain or inability to perform work,pro. result in frequent episodes of pain and the inability to gfessive illness leading to functional impairment,and the perform work. potential for sudden incapacitation. (4) Dvsphonia (severe). Severe dvsphonia can result in the (3) Acute pericarditis, endocarditis. or myocardids. These inability to communicate effectively due to oropharyn- conditions can result in frequent episodes of pain or the Beal dysfunction. inability to perform work. (3) Arty other nose,oropharynx,trachea,esophagus,or IaF (4) Syncope,recurrent.Recurrent syncope can result in the ynx condition that results in a person not being able to potential for sudden incapacitation. perform as a member or to communicate effectively. (5) Alit°madc implantable cardiac defibrillator. An auto- A 3-7.1 Category A medical conditions of the lungs and chest madc implantable cardiac defibrillator can result in the wall include active hemoptysis, empvema, pulmonary hyper- potential for sudden incapacitation. tension,and active tuberculosis.These conditions can result A 3.8.1.2 Category B medical conditions of the heart and vas. in the inability to perform functions as a member due to limi. cular system include the following: tations of endurance. (1) Significant valvular lesions of the heart, including pros- A-37.2 Category B medical conditions of the lungs and chest thetic valves.Specific recommendations include the fol- wall include the following: lowing: (1) Pulmonary resectional surgery,chest wall surgery,pneu. a. Mitral stenosis, Mitral stenosis is acceptable if in sinus mothorax (that is, history of recurrent spontaneous rhythm and stenosis is mild,that I%valve area>1.5 cm2 pneumothorax). These conditions can result in the or pulmonary artery systolic pressure<35 min Hg. inability to perform functions as a member due to limits- b. A%litrral iruujficrenry.Miu-al Insufficiency is acceptable if lions of strength or endurance and may result in the in sinus rhythm with normal left ventricular size and potential for sudden incapacitation. function. (2) Bronchial asthma or reactive airways disease (frequent c• Aortic stenosis.Aortic stenosis is acceptable if stenosis medication use or symptoms caused by exposures to exer- is mild, that is, mean aortic valvular pressure gradi- tion.heat and cold,or products of combustion and other ent<20 rnm Hg. irritant inhalation).Bronchial asthma or reactive airways d. Aortic rrgulitation.Aortic regurgitation is acceptable if disease can result in frequent episodes of pain or the left ventricular size is normal or slightly increased and inability to perform work,the potential for sudden inca- systolic function is normal. pacitation. and the inability to perform functions as a e. PmsAedc valves.Prosthetic valves are acceptable unless member due to limitations of endurance, full anticoaguladon is in effect (3) Fibrothorm.chest wall deformity,diaphragm abnormali- (2) Coronary artery disease,including history of myocardial u ties. Fibrothorax, chest wall deformity, and diaphragm Infarction, coronary artery bypass surgery, coronary abnormalides can result in the inability to perform func- angioplasty, and similar procedures. Persons at mildly lions as a member due to limitations of endurance, increased risk for sudden incapacitation are acceptable (4) Chronic obstructive airways disease.Chronic obstructive for fire fighting. Mildly increased risk is defined by the airways disease can result in the inability to perform Cunt- presence of each of the following: lions as a member due to limitations of endurance. a. Normal left ventricular ejection fraction (i) Hypoxemic disorders.Hvpoxemic disorders can result in b. Normal exercise tolerance,>10 metabolic equivalents the inability to perform functions as a member due to (NIETS) limitations of endurance. c. Absence of exercise-induced ischernia by exercise testing (6) Interstitial lung diseases. Interstitial lung diseases can d. Absence of exercise-induced complex ventricular result in the inability to perform functions as a member arrhythmias due to limitations of endurance. e. Absence of hemodynamically significant stenosis on all (7) Pulmonary vascular diseases,pulmonary embolism. Pul- major coronary arteries 050 percent lumen diameter monary vascular diseases and pulmonary embolism can narrowin result in frequent episodes of pain and the inability (3) Atrial tachycardia,flutter,o to g)d orsucce r.o myocardial rev:scu(ariation perform functions as a member due to limitations of r fibrillation endurance. (i) Left branch, second-and third-degree a[r%oven (f!) Bronchiectasis with significant residual impairment of tricular block.These blocks will result in disqualification pulmonary function or requiring frequent therapy.Bron- race responss se.They c can be anrresult n fed requent ntt an eepisodes of chiectasis can result in the inability to perform functions pain,the inability to perform work,and have the poten- as a member due to limitations of endurance. sal for sudden incapacitation. 20o0 Edition 158E-1ti MEDIC%L RVIL:IRFME`TS FOR Ft RE FItaITERS.\-'D IAFOR.NL%TION FOK Ft RE 13 EPA)tTSIENT 111 n's14 L1`i (3) Ventricular tachvcardia. Ventricular tachycardia can to limitations of endurance and the inability to perform resttlt in the potential for sudden incapacitation and the job functions due to limitations of balance. inability to perform job functions due to limitations of (7) ,aneurysm of the heart or major vessel, congenital or strength or endurance. acquired.An aneurysm of the heart or major vessel can (5) Hypertrophy of the heart Hypertrophy of the heart can result in frequent episodes of pain, the inability to per- result in the potential for sudden incapacitation and the form work,and the potential for sudden incapacitation. inability to perform job functions due to limitations of (8) Anv other tascular condition that results in a person not endurance. heing able to perform as a member. (7) Recurrent paronsmal tachycardia. Recurrent parot%s mal tachvcardia can resttlt in the potential for sudden i.3-9.2 Category B medical conditions of the abdominal incapacitation and the inability to perform job functions organs and gastrointestinal system include the following: due to limitations of strength or endurance. (1) Cholecystitis (that which causes frequent pain due to (8) History of a congenital abnormality that has been treated stones or infection).Cholecvsdds can result in frequent by surgery but with residual complications or that has not episodes of pain or the inability to perform work. been treated by surgery, leaving residuals or complica- (2) Gastritis (that which causes recurrent pain and impair- dons. A congenital abnormality can resttlt in frequent ment).CAStrlti3 can result in frequent episodes of pain or episodes of pain or inability to perform work and the the inability to perform work. potential for sudden incapacitation. (3) CI bleeding can cause fatigue, and or hemodynamic (9) Chronic pericarditis,enducardids,or myocarditis.These instability resulting in inability to perform work. conditions can result in the inability to perform job font- (4) Acute hepatitis (until resolution of acute hepatitis as [ions due to limitations of endurance. determined by clinical examination and appropriate lab. (10)Cardiac pacemaker. If the person is pacentakerdepen- oratory testing). Acute hepatitis can result in frequent dent,then the risk forsudden failure due to trauma is not episodes of pain or the inability to perform work. acceptable.Those with cardiac pacemakers can have the (5) Hernia (unrepaired inguinal or abdominal hernia that potential for sudden incapacitation. could obstruct during duty).A hernia can result in the (11)Coronary artery vasospasm.Those with cardiac artery potential for sudden incapacitation. um can have the potential for sudden incapaci- tation. (6) Inflammatory bowel disease(that which causes disabling (12).any other cardiac condition that results in a person not pain or diarrhea).Inflammatory bowel disease can result being We to perform as a member. in frequent episodes of pain or the inability to perform work. It is a progressive illness leading to functional A'18.2.2 Category B medical conditions of the vascular sys- impairment. tem include the following: (7) Intestinal obstruction (that is, recent obstruction with (1) Hypertension that is uncontrolled,poorly controlled,or impairment).An intestinal obstruction can result in fre- requires medication likely to interfere with the perfor- quent episodes of pain, the inability to perform work, mance of dudes.Acceptable hypertension is a blood pres- and the potendal for sudden incapacitation. sure less than 180/100 and no target organ damage. (9) Pancreadds (that is. chronic or recurrent with impair- Hypertension is a progressive illness leading to functional ment). Pancreatitis can result in frequent episodes of impairment with the potential for sudden incapacitation. pain or the inability to perform worst. (2) Peripheral vascular disease,such as Raynaud's phenome- (9) Resection,bowel (if frequent diarrhea precludes perfor- non,that interferes with performance of duties or makes mance of dury).A bowel resection can result in frequent the individual likely to have significant risk of severe episodes of pain or the inability to perform work. injury. Peripheral vascular disease can result in frequent (10) Ulcer, gastrointestinal (where symptoms are uncon- episodes of pain or the inability to perform work and the trolled by drugs or surgery).A gastrointestinal ulcer can inability to perform functions as a member due to limits- result in frequent episodes of pain or the inability to per- Lions of endurance. form work. (3) Recurrent thrombophlebitis. Recurrent thrombophlebi- (11)Cirrhosis,hepatic or biliary(that which is symptomatic or Lis can result in frequent episodes of pain or the inability in danger of bleeding). Cirrhosis can result in frequent to perform work and the inability to perform functions as episodes of pain or the inability to perform work. a member due to limitations of endurance. (12)Chronic active hepatitis. Chronic, active hepatitis can (d) Chronic lymphedema due to lymphopathy or severe result in frequent episodes of pain or the inability to per- venous valvular incompetency.Chronic lymphedema can form work. result in the inability to perform functions as a member (13)Anv other gastrointestinal condition that results in a per- due to limitations of endurance. son not being able to perform as a member. (5) Congenital or acquired lesions of the aorta or major vex A-110.1.E Category B medical conditions of there roductive sell,for example,syphilitic aortitis,demonstrable athero- organs include the following: p sclerosis that interferes with circulation, and congenital acquired dilatation of the aorta.Congenital or acquired (1) Pregnancy.Pregnancy can result in frequent episodes of lesions of the aorta or major vessels can result in the pain or the inability to perform work;progressive inabtl- potential for sudden incapacitation and the inability to ity to perform work due to limitations of endurance,fler- perform job functions due to limitations of endurance. ibility, or strength; and the inability to properly wear (6) Marked circulatory instability as indicated by orthostatic protective equipment.(See B-4.3,Reprwluctivr.) hypotension, persistent tachycardia, and severe periph- (2) Dysmenorrhea that leads to recurrent incapacitation. eral vasomotor disturbances.Marked circulatory instabil- Dysmenorrhea can result in frequent episodes of pain or icy can result in the inability to performjob functions due the inability to perform work. 2000 Eddiam APPENDiX A 1•iy:-1 i (3) Endumetrimis,ovarian cysts,or other gynecologic condi• dislocation. if nn;e of motion is intaca would not tions (.severe, leading to recurrent mcapacitatinn). exclude a person. Dislocation of.tjuint can re+tilt in the Endometriosis,ovarian cysts,and other gynecologic con- inabiliy to perform functions as a member due to limita- ditions can result in frequent episodes of pain or the tions of strength or flexibility. inability to perform work. (4) joint reconstruction, ligamentous instability, or joint (4) Testicular or epididymal mass(that which requires medi- replacement. Its cases %where recurrent or with residual cal evaluation).A tes ocular orepididymal mass can result limitation of motion of a degree to interfere mth success in frequent episodes of pain or the inability to perform ful and»fe performance of fim-fighting duties,Sur work. This is a progressive illness leading to functional geryr for a torn anterior cniciate lit-tment could disqualify if impairment. quadricep strength is not normal or if the knee is lax or (3) Any other genital condition that results in a person not deselops pain or swelling whert itressed. These condi- being able to perform as a member. buns of the joint can result in the inability to perform A•3•10.:.: Category B medical conditions of t]le urinate sys• functions as a member due to limitations of strrngdi or tem include the following: fexibilits. (1) Diseases of the kidney requiring dialysis. Diseases of the (3) Chronic osteoar•thritis or traumatic arthritis (in cases kidney can result in frequent episodes of pain or the where recurrent exacerbations leads to impairment). inability to perform work.Kidney disease is a progressive Chronic episoostcodes ai traumatic arthritis can result in illness leading to functional impairment. Frequent episodes of pain,the inability to perform work (2) Diseases of the ureter, bladder, or prostate that require and the inabiliy to perform tunctions as a member due frequent or prolonged treatment. These diseases can to limitations of strength,endurance,or flexibility. (6) Inflammatory arthritis(in cases%where it is severely recur- result in frequent episodes of pain or the inability to per- form work. rent or a progressive illness or%%ith deformity or limita- (3) Anv other urinary condition that results in a person not lion of range of motion of a degree to interfere with being able to perform as a member. successful and safe performance of firefighting duties). Inflammatory arthritis can result in frequent episodes of A-3-11.2 Category B medical conditions of the spine, smpu- pain, the inability to perform%work,and the inability to I'ae,ribs,and sacroiliac joints include the following: perform functions as a member due to limitations of (1) Arthritis that results in progressive impairment or limits• strength,endurance,or flexibilin: don of movement. Arthritis is a progressive illness that (7) Any other extremity condition that results in a person not leads to functional impairment.Arthritis can result in the being able to perform as a member. inability to perform functions as a member due to limits- A-3.13A Category A medical conditions of a neurological uons of endurance or flexibility. nature include the following: (2) Structural abnormality.fracture,or dislocation that is a progressive or recurrent impairment.These conditions (a) Ataxias of the heredodegenerative type.Atastfas of the are progressive illnesses leading to functional impair- heredo-degenerative type can result in the inability to perform ment.These illnesses can result in the inability to per- functions as a member due to limitations of balance. form functions as a member due to limitations of (b) Cerebral arteriosclerosis as evidenced by documented strength or flexibility. episodes of neurological impairment.Cerebral arteriosclero. (3) Nucleus pulposus, herniation of, or history of laminec• sis can result in the inability to perform functions as a member tomy, discectomy, or fusion. These conditions are pro- due to limitations of strength and/or balance. gressive illnesses leading to functional impairment and (c) Progressive multiple sclerosis or multiple sclerosis with the inability to properly wear protective equipment. evidence of progression within previous three years.Multiple (4) Ankylosing spondylids.This condition can result in the sclerosis can result in the inability to perform functions as a inability to perform functions as a member due to limits- member dire to limitations of strength or flexibility. (ions of endurance or Flexibility. (5) Any other spinal condition that results in a person not (d) Progressive muscular dystrophy or atrophy.This condi- being able to perform t a member. don can result in the inability to perform functions as a mem- ber due to limitations of strength and/or balance. A•3.12.2 Category B medical conditions of the extremities (e) Epileptic conditions.After a provoked seizure,with the include the following: precipitant identified and alleviated,with subsequent normal (1) Limitation of motion of a joi nt of a degree to interfere CTor MRl scan.normal EEC,nqrmal petrological exam,free With successful and safe performance of fire•tighung of recurrence without medication for one year,and with defrn- duties.The limitation of motion of a joint can result in itive statement from a qualified neurological specialist,a mem- the inability to perform functions as a member due to ber can be cleared to return to duty. limitation of flexibility. A-3-13.3 Category B medical conditions of a neurological (2) Amputation or deformity of a joint or limb of a degree to nature include the following: interfere with successful and safe performance of fire- fighting dudes.The amputation or deformity of a joint or (a) Congenital malformations(that is,severe vascular mal- limb can result in the inability to perform functions as a formations that interfere with the ability to wear protective member due to limitations of strength and/or balance. equipment) Congenital malformations can result in the (3) Dislocation of a joint.Recurrent dislocation of ajoint or inability to properly wear protective equipment. dislocation with residual limitation of motion of a degree (b) Migraine (that is, recurrent,with impairment uncon- to interfere with Successful and safe performance of fire- trolled).Migraines can result in frequent episodes of pain or fighting duties;successful surgery for recurrent shoulder the inability to perform%work. 2000 EdMan 158243 MrDIG\L REQUIREMENTS FOR FIRE FICAITERS ANU INFORMATION MR FIRE DEPA1tMENT PIMWL\NS (c) Clinical disorders with paresis,paralvsis,dyscoordina- (1) Any other hematological condition that results in a lion,deformim abnormal motor activity,abnormality ofsensa. person not being;able to perform as a member. Lion, or complaint of pain (progressive or severe). These disorders are progressive illnesses leading to functional A-3.16.1 Category A medical conditions of endocrine and impairment.They can result in the inability to perform func• metabolic disorders include diabetes mellitus that is treated Lions as a member due to limitations of strength,flexibility,or with insulin or an oral hypoglycemic agent and that includes a balance. history of one or more episodes of incapacitating hypoglyce. (d) Subarachnoid or intrscerebral hemorrhage, verified mia. Diabetes mellitus can result in the potential for sudden either clinically or by laboratory studies.except for those cor- incapacitation. rected with verification by laboratory studies and report of A-3.16.2 Categnry B medical conditions of endocrine and treating physician. Suharachnoid or intracercbral hcmor- metabolic disorders includes the following: rhage is a progressive illness leading to Functional impaia tnent. This illness can result in the potential for studdcn (a) Diseases of the adrenal gland,pituitary gland.paratli,., incapacitation. roid gland,or thvroid gland of clinical significance (that is, te) AhnormaliLies from recent head injury,such as severe symptomadc and poorly controlled).These diseases can result cerebral contusion or concussion. The abnormalities can in frequent episodes of pain, the inability to perform work, _ result in the potential for sudden incapacitation. and the potential for sudden incapacitation. (t) Any tither neurological condition that results in a per- (b) Nutritional deficiency disease or metabolic disorder son not being able to perform as a member. (where clinically significant and not correctable by replace- , ment therapy or other medication).Nutritional deficiency dis- A-3.14.2 Category B medical conditions of the skin include ease or metabolic disorder can result in frequent episodes of the following: pain or the inability to perform work. (a) Acne or inflammatory skin disease (if condition pre- (c) Diabetes mellitus requiring treatment with insulin or eludes good tit of protective equipment. such as SCBA face oral hypoglycemic agent. Diabetes mellitus can result in epi- piece,or prevents shaving).Acne or inflantmatory skin disease sodes of pain or Inability to perform work.It is a progressive can resultin the inability to properlywear protective equipment. illness leading to functional impairment and can result in the (b) Eczema (if broken skin results in impairment from potential for sudden incapacitation. infections or pain or interferes with seal between skin and per- (d) Any other endocrine or metabolic condition that sonal protective equipment). Eczema can result in frequent results in a person not being able to perform as a member. episodes of pain or the inability to perform work. (c) Any other dermatologic condition that results in the A-3.17.2 Category B medical conditions of systemic diseases person not being able to perform as a member. and miscellaneous conditions include the following: A 3.15.1 Category A medical conditions of blood and blood. (a) Connective tissue disease.such as dermatomyositis. forming organs includes the following: Iupus erythematosus, scleroderma,and rheumatoid arthri- tis(where manifested by systemic impairment or limitations (a) Hemorrhagic states requiring replacement therapy of motion).These connective tissue diseases are progressive (for example, von Willebrand's disease, thrombocytopenia, illnesses leading to functional impairment and the inability hemophilia).These hemorrhagic states can result in frequent to function as a member due to limitations of strength or episodes of pain or the inability to perform work. flexibility. (b) Sickle cell-disease (homozygous). Sickle cell disease (b) Residuals from past thermal injury(for example,frost- can result in frequent episodes of pain or the inability to per- bite resulting in significant symptomatic discomfort).Residu- form work and the potential for sudden incapacitation. als from past thermal injury may result in the inability to A n-1B.2 Category B medical conditions of blood and blood- perforce functions as a member due to limitations of strength, forming organs include the following. endurance,or flexibility. (a) Anemia (in cases that require regular transfusions). (c) Documented evidence of a predisposition to heat Anemia can result in frequent episodes of pain or the inability stress with recurrent episodes or resulting residual injury. A to perform work. Anemia is a progressive illness leading to predisposition to heat stress can result in the potential For sud- functional impairment. den incapacitation and the inability to perform functions as a (b) Leukopenia(where chronic and indicative of serious member due to limitations of endurance. illness). Leukopenia is a progressive illness leading to func- (d) Any other systemic condition that results in a person tional impairment. not being able to perform as a member. (c) Polycythemia vera (where severe, requiring treat- A 3.18.2 Category B medical conditions of tumors and malig- ment). Poly�ythemiu very can result in frequent episodes of nant diseases can include the following: pain or the inability to perform work and the potential for sud- den incapacitation. (a) The medical evaluation of any person with malignant (d) Splenomegaly(where the spleen is susceptible to rup- disease that is newly diagnosed.untreated,or currently being ture from blunt trauma). Splenome.ply can result in the treated will be deferred. potential for sudden incapacitation. Any person with treated malignant disease should be miu- (e) History of rhrombocmbolic disease (that is, more aced based on that person's current physical condition and on than one episode or an underlying condition) A history of the likelihood of that person's disease to recur or progress. rhromboembolic disease can result in the potential for sud. (b) Any ocher tumor or similar condition that results in a den incapacitation. person not being able to perform as a member. 20M Edition APPENOIX,k 1582—t9 A 3.19.2 Category B medical conditions of a pxychiatric a. HIV nature include the following: b. Hepatitis B surface Antibody owl known to be sh (HBsAb), if not prev(- (a) Any person with a history of a psyeltiatrie condition or Y po 'rive substance c. Hepatitis BsurfaceAntigen(HB abuse problem should be evaluated based on that sr1g),ifnotpreviowly person's current condition. Psychiatric conditions and sub- known to be positive HBLkb stance abuse problems can result in frequent episodes of pain d. Hepatitis C Antibody(HC4b) or the inability to perfntm work and the potential for sudden e. If HIV prophylaxis is to be given,the following tests incapacitation.These conditions are progressive illnesses lead- should be done: ing to functional impairment 1. CBC (b) Any other psychiatric condition that results in a person 2, Glucose,renal and hepatic chemical function not being able to perform as a member. 3. Pregnancy test for females A 3-20.2 Category B medical conditions concerning chemi. (4) Listing of testing to be done on source patient,including cals,drugs,and medications include the following: the following: (a) Anticoagulant agents such as coumadin can be permit- a. H1V ted if the anticoagulared state is controlled such that the pro- b• HB.Ag thrombin Lime or INR has been in the therapeutic range on a c. HCAb stable medical regimen for at least one month and that no (3) If source is available,interview for HIV.HepB,and HepC other coexisting conditions would either contribute to a risk/status. bleeding diathesis or by themselves preclude certification for (6) Determination of risk and need for PEP HI duty.Andcoagulant agents can result in frequent episodes (7) Member counseling regarding PEP medication(s) and of pain or the inability to perform work,as well as the potential side effects of treatment A printed fact sheet should be for sudden incapacitation, available for the member to review. (b) Cardiovascular agents(for example,andhypertensives) (8) If PEP prophylaxis is to be given, It should be done as can result in frequent episodes of pain or the inability to per. soon as possible after the incident, preferably within 2 form work,as well as the potential for sudden incapacitation. hours. (c) The use of narcotics can result in frequent episodes of (9) Members on prophylaxis need to be followed(preferably pain or the inability to perform work,as well as the potential by an ID specialist)for the duration of their treatment for sudden incapacitation. (10)Assessment of tetanus status and administration of dT (d) The use of sedative-hypnoda can result in frequent booster,if appropriate episodes of pain or the inability to perform work,as well as the (11)Assess HepB status potential for sudden incapacitation. a. If previously immunized with a positive post-immuni- (e) The use of stimulants can result in frequent episodes zadon titer,no further treatment is needed. of pain or the inability to perform work,as well as the potential b. If previously immunized, titer was negative, and for sudden incapacitation, source is HBsA positive or hi risk, (f) The use of psychoactive g p high g Hepatitis B psyc agents can result in frequent Immune Globulin(HBIG)at soon as possible—pref- episodes of pain or the inability to perform work,as well as the erably within 24 hours—and a dose of Hepatitis B potential for sudden incapacitation. vaccine, (g) The use of steroids can result in frequent episodes of c• If previously immunized and titer is unknown, draw pain or the,inability to perform work. titer. (h) Anyodher chemical,drug,or medication that results in 1. if titer is positive,no further treatment is needed. a person not being able to perform as a member is included 2. If titer is negative and source is H"positive or in this group, high risk,then give Hepatitis B Immune Globulin A-4.2.1 Physicians who care for members need to be familiar (HBIG) 33 soon as possible—preferably within and keep up-to-date with the most current recommendations 24 hours—and a dose of Hepatitis B vaccine. for Post-exposure prophylaxis (PEP) for bloodbome atho- d. If previously immunized with negative titer and revac- gen (BBP)exposures.Also there should be a written protocol tinted with a negative titer,give HBIG immediately for dealing with members who present with BBP exposures, and a second dose I month later. This should be based on the following elements: e• if never immunized,give HBIG and begin Hepatitis B vaccine series (I) Fact sheet that explains in lay language the risks of infec- don, the various prophylactic and therapeutic options, (12) Follow-up instructions should include the following the testing and follow-up that will be needed and recom- a. Adverse events and side effects of PEP mendations for personal behavior (i.e., safe sex, blood b. Signs and symptoms of retroviral illness(fever,aden- donation,and so forth) following an exposure. opathy,rash) (2) Classification table to determine the exposure type and C. Appointments for follow-up blood work including the recommendation for prophylaxis.Current recommenda- following: lions of U.S.Department of Health and Human Services, 1. HIV at 6 weeks,3 months,and 6 months Centers for Disease Control and Prevention,and Public 2. HBsAb and/or HC4b at 6 weeks.!months,and 6 Health Services. months,if source is HepB and/or HepC positive (3) Listing of testing to be done on exposed member,includ- 3. Every other week CBC,renal and liver function,if ing the following: receiving PEP 2000 Eckdon 1582:I) MEDICAL RL•QCIRENIENTS FOR FIRE FIGHTERS AND 1NFOR.%LiCION FOR FIRE DEPMUMENT PinSIC0045 -4-2.2 Post-exposure prophylaxis may also be indicated for ur long-duration incident. Medical evaluation and treatment the followingd(seases: in the on-scene rehabilitation area should be conducted (1) Diphtheria according to emergency medical service (EMS) protocols (2) Hepatitis A developed by the fire department in consultation with the fire (3) Meningitis department physician and the EMS medical director. If (4) PCRussis advanced life support(AIS)personnel are available,this level (5) Rabies of EMS care is preferred. (6) Vancella Zoster A-5-1.2 Weather factors during emergency incidents can A-1r3.1 An annual TB program should include the following: impact severeh•on the safety and health of members,who are operating during extremes of heat or cold.Where these f3e- (1) Documentation ofa avo-step petrified protein derivative can combine with longduntion incidents or situations that (PPD) prior to this PPD or a 0-mm PPD within the past require heavy exertion.the risks to members increase rapidly. 1 year. The fire department should develop procedures,in consults- (_) Placement of PPD and reading by a trained,designated don with the fire department physician,to provide relief from reader within 48 hours to 72 hours of placement. %lem- adverse climatic conditions. ben with a history of pis.iitive PPD should fill out a gues- The following are typical rehabilitation considerations for tionnatre. operations during hot weather extremes: (3) PPD resents should be documented in millimeters(mm). (l► Moving fatigued A test with no skin reaction should be recorded as 1)mm. or unassigned members away from the (4) A PPD skin test will be considered positive if the following hazardous area of the incident conditions arc present: (2) Removing personal protective equipment a. Greater than 5 tam in someone who is immunosei (3) Ensuring that personnel are out of direct sunlight pressed p- (4) Ensuring that there is adequate air movement over per- sonnel,either naturally or mechanically b. Greater than 10 mm in someone with a normal (5) Providing members with fluid replenishment,especially immune system who is at risk for conversion due to an water exposure (6) Providing medical evaluation for personnel showing c. Greater than 10 mm increase from previous reading signs or symptoms of heat exhaustion or heat stroke (5) If PPD is positive(conversion),the followingsteps should The following are typical rehabilitation considerations for be taken: operations during cold weather extremes: a. FillObtain outain chesti-rav (1) Moving fatigued or unassigned members awes from the b. Obtain chest x-ray Y C. Evaluate for acdve disease hazardous area of the incident d. Evaluate for preventative therapy (2) Providing shelter from wind and temperature extremes (3) Providing members with fluid replenishment,especially (6) If active disease is diagnosed, the member has to be water removed from any duty until she/he has been deter- (4) Providing medical evaluation for members showing signs mined to be noninfectious. This will occur when ade• or symptoms of frostbite, hypothermia, or other cold- quate therapy has been instituted, the cough has related injury resolved,and 3 consecutive sputum smears for acid-fast bacillus(AFB)on different days are negative. A_5 2.2 The assignment of an ambulance or other support crew to the rehabilitation function is essential during plong- A-{-3.2 In the event of an exposure to TB,the following steps duration or heavy-exertion incident operations.This crewcan should be taken: assist with rehabilitation functions as well as be available to te basic life (1)` for members. sure.Member ben with atve a history of positive PP within 14 D should of fil Advanced life supP support (paramedic) rt levelof evvaluati n and out a TB questionnaire. treatment has to be available quickly,however, to ensure the (2) Repeat PPD or questionnaire should be done 6 weeks to proper level of care. 12 weeks after the frrsL The medical staff has to have an assigned medical director. (3) If PPD is positive (conversion) or questionnaire is posi- This can be an on-scene physician such as a fire department five,proceed as per(5)and(6)of A--3.1. physician,a remote physician at a base hospital,or a central medical direction facility. atias B immunization at requires co to the member. em that members be ebers wred ho A-S-3.2 For major incidents or escalating incidents, medical choose to decline the offer of this immunization arc required to control can be established by the fire department physician or sign a written declination.The declination becomes part of a medical director at the incident scene. member's confidential health data base as specified in Section Burn Injury. When a member suffers a burn injury, he or 8-4 of NFPA 1500.Standard on Fire Drparrmmi Occupational,Safety, she should be evaluated as to the extent of injury.first-degree and Health Pmgram.Members are allowed to recant at any time burns can be treated on scene,and the member may continue and receive offered immunizations. duty.Second-degree bums should be evaluated by a physician familiar with burns,such as an emergency department physi- A-5.1.1 Having a preplanned rehabilitation program that is cian,a member ofa bum unit,or a fire department physician. applicable to most incident types is essential for the health and Second-degree bums and higher are conditions that demand safety of members.This program should oudine an ongoing that the member be removed from emergency response dury. rehabilitation for simple or short-duration incidents as well as After the bums have healed to the extent that there is minimal a process to transition into the rehabilitation needs of a large risk for entry into the member's body ofbody fluids and chem- 2000 Edthon AVVENUI\B icals encountered during regular duties,he or%he can return inhalation.At the emergency department.the victim should to full duty. have an arterial carboxvhcmrrglobin determined and should The Ariterican Burn.Association has criteria for referral to he evaluated for possible Ltunide toxicity if cyanide Poisoning a burn center.They are second-and third-degree burns with characteristics as follows: is suspected,treatment with a aanidr antidote kit should he initiated. Since indtncing methemoglobinemia in a patient (I) Exceeding*20 percent body surface area(BSAI with an elevated carbnxvhemoglobin level may further impair (2) Exceeding 10 percent BSA\for age under W or over 30 oxygen delivery,only strdium thinsulfatr should be given ini- (3) Any third-degree barn over 3 percent BSA tially. If treatment with hyperhanc oxvgen is started. nitrite% (4) Invohing hands,fret.face,perineum,genitalia,or nnajor may he used. joints (5) Circumferential involving extremities or chest ';5-4.3 Items that can assist in limiting temperature stress in cold emironmenrs include he-it, u t,blankr ,and protection from ( ) Coouple (h) Cuple d with smoke inhalation injury by contact with chemicals,electricity,or lightning the wind.Forhotweather,items ihottld include adequate shade, Fans,air-conditioning,and misting systems.Fend and hydration (8) Associated with multiple trauma nerds include water and Ural fluids,food,broth.and fntit.Also, (9) Invol%ing patients with pre<xisting significant medical for hvdratirnt. a 50/50 mixture of water and an electrolyte illness replacement drink can be prodded.Medical equipment should Aluvuloskeletal Sprains. Strains and sprains are among the include blood pressure toffs. stethoscopes, oxygen, cardiac most common member injuries.When they occur during peri- monitors,thermometers,and intravenom fluid and supplies. ods when circulating catecholamines are high,such as on the A•5--4 The incident commander should consider the cir. fireground, the injured member might underestimate the cumstances of each incident and make suitable provisions for severity of the injury.Under such conditions.he orshe might rest and rehabilitation of members operating at the incident continue working and worsen the injury. scene. For example, when members consume air from two Evaluation of these type of injuries on the frreground'can SCBA air cylinders (two-cylinder rule), they should be be difficult.The injury mightworsen with time due to swelling, assigned to rehab. muscle spasm,and increased pain perception after the emer- gency call is over.Any acute injury that leads to swelling or A-5-1.5 The measurement of the pulse rate has been used by results in more than a trivial limitation ofmotion should prob- some fire departments in assessing members during rehabilita- ably be evaluated by a physician. rion.A persistently elevated pulse could be a sign of excessive Smoke fnhalathm Smoke inhalation is fortunately becoming stress on the body due to dehydration,heat stress,exhaustion, less common,due to the use of self-contained breathing appa- or cardiopulmonary disease.The use of a pulse rate has not rattrs.A member with smoke inhalation should be treated with been studied in a manner that allows strict medical protocol to 100 percent oxygen and transported to an emergency depart be recommended.The pulse rate combined with the remain. ment.Bums involving greater than 15 percent of body surface der of the clinical evaluation of the member may be used to area,facial burns,singed hair,and airway soot are associated determine if the member can return to operations. with more severe airway burnt. Lower airway injury can be associated with carbonaceous sputum,wheezing, rates,rhon- chi, and chest pain, Pulmonary function tests can reveal a Appendix B Information for decrease in forced expiratory volume in one second (FEVI). Fire Department Physicians A chest radiograph may disclose infiltrates or atelectasis. Hypoxemia may be seen on arterial blood gas analysis.A nor- This appendix is not a part ofthr►equiremenls ofMis NFP,9 doc- mal chest radiograph and normal arterial blood gas results do ument but is included for informational proposes only. not,however,rule out significant smoke inhalation injury. Endotracheal intubation should be performed if there is B-I Occupational Safety and Health Problems for Members. central nervous system,stridor,hypoxemia(PO,less than 60), 3-1.1 General. Fire fighting and emergency response are hypercarbia (PCO,greater than 50). full-thickness bums of very difficult jobs.People in these jobs perform functions that the face or neck,airway or pulmonary edema,or inability to are physically and psychologically very demanding. These handle secretions. Positive end-expiratory pressure (PEEP) functions are often performed under very difficult conditions. should be used if hypoxemia persists despite intubation and (.See Appendix C.) administration of 100 percent oxygen. Inhaled beta-agonists and anticholinrrgip can be used for bronchospasm.Systemic 3-1.2 Physical Load. Studies have shown that fire-fighting corucosteroids are not recommended for pneumonids or pul- functions require working at near maximal heart rates for pro- monary edema. Antibiotics may be needed if sputum grim longed periods of time. Heavy protective equipment(includ- stain and culture with fever and leukocytosis suggest the pres- ing respirators) and the heat from the fire contribute to this ence of a bacterial pneumonia, physical load. Doran Afembe►.Certainly the scenario involving the discovery B-1.3 Toxic Substances. Memben and emergency response of an unconscious member is one that is difficult to manage personnel also are exposed to many toxic substances during given the psychological responses of all involved. Of course, their work.Carbon monoxide is the most common contami- the first priority is the safe removal of the victim from the haz- nant;studies have shown individual exposures that are as high ardous area.Then the Airway, Blending,Cardiac(ABCs) are as 5000 ppm during actual fires.Other significant exposures carried out and a secondary survey performed.Transport to a common during fires include cyanide, acrolein, hydrogen hospital should be expedited. chloride,nitrogen dioxide,and benzene.The burning of plas- Any unconscious member should be treated with 100 per- tics and other synthetic materials can expose members to cent oxygen,since carbon monoxide poisoning is common other toxic materials,such as isoeyanates and nitrosamines. and cyanide poisoning possible as secondary effects of smoke Ilazardous materials incidents can involve exposures to many 2000 Edition 1582 %IEDIGII.REQUIREMENTS FOR FIRE FIGHTERS A-ID(rFORNU riON FOR FIRE DEPARTMENT PI Rtili-L\v5 other tunic materials.Although the use of respirators helps to B" Guidance for Medical Evaluations. reduce exposures. mechanical, environmental, and behav- ioral factors can limit their use during all phases of a tire. B-'..1 Preplacement and Baseline Medical Evaluations. The available health data on members are limited.Whale Preplacement medical evaliwtions zvsevs an individual', the protection for members has improved over the last several health status before assignment to a position.The ptirpose of years.exposures might be changing due to the introduction of the evaltiauon is to ascertain whether the individual has any. more vntheoe materials. Given the delay be weenintro assure health condition that prevents him or her from pertormingthe' P lob. including the ability to wear protective equipment .and onset. I that is, latency) of many occupational illnesses, current or past health studies of members might not reticct health for the job.The evaluation should also identify any future health risks. These limitations should be recognized phasic problems that could in subs©angst%a¢grayae a the S physical demands and working conditions'. B urtine medical when re%irwing the available sttadies. information concerning the applicant's health status can then B-1.4 Increased Risk of injury and Disease. available data be compared to stibsequent evaluation results for the purpose indicate that members have increased risk for injuries,pill- health trends that can be occupather the ionally relvidual ated n' significant monary disease, cardiovascular disease, cancer, and noise- Two rapes of information are essential for a medical pre- induced hearing loss. The increased risk for injuries is placement evaluation of those performing member deities. e�pected,given the demands and circumstances of this work. First,the physician must understand the working conditions Fatalities and ieriaers injuries from burns or other fare.,cene and physical demands of this occupation. Appendix C pro- hazards can occur, %ides a list of the environmental factors encountered in fare The risk for respiratory disease occurs due to the respira- fighting and emergency response.The physician also should tort•damage caused by many of the components of fire smoke obtain additional information from the fare department (for example, particulate, acralein, nitrogen oxides,and'so reo rding specific job dunes and task lists (if the fire depart- on.).acute reductions in pulmonary function and even by pox- merit has conducted a validation study or job analysis) and p should be familiar with the organization of the fire depa"- emia are not uncommon after fires, even in asymptomatic ment.For the evaluation of some medical conditions,the phy. members.Permanent damage from smoke inhalation has also sician will need to obtain further information about specific been reported.Studies of chronic pulmonary changes from job duties in order to make a determination. This might fire fighting have not had consistent results.Some follow.up require on-site inspections and consultation with fire depart- studies have shown a greater rate of decline in pulmonary ment personnel. function among members over time, while others have not Second,the physician needs to have accurate information been able to detect this change. Increased use of protective about the person's disease or medical condition, the func- equipment and job selection factors(ill members transferring tional limitations associated with that condition, and an to other duties)could account for these inconsistent findings. understanding of how physical demands and working candi- dons would impact on that condition,An accurate diagnosis is The strenuous work demands of fire fighting combined often the key factor in determining the person's capability. with exposures to carbon monoxide and other toxic sub- For example,different skin diseases can have similar clinical stances can increase the risk for cardiovascular disease among members. Acute respiratory changes also can stress appearances but can markedly ysffer in their response to size the cardiovascular system.This increased cardiovascular dis- ro t individual exposures. The physician should also recognize ease risk has been documented even in some mortality stud- that individual variability can exist between persons with the ies, despite the job selection factors that tend to mask any same clinical condition. increase when compared to the general population. Other Upon compaction a the examination,the physician should P P inform the authority having jurisdiction whether the applicant studies have not detected this risk. Certainly, the combing- is medically qualified to perform as a member. Lion of the physical stress of fire fighting and exposures for a person with preexisting coronary heart disease would be B-2.2 Periodic Medical Evaluations. The periodic medical expected to increase the risk of a myocardial infarction or evaluation is designed to evaluate the person's continued abil- other acute event.However,the degree of this acute risk and icy to perform his or her dudes and to detect any other signif. whether fire fighting also contributes to the development of icant changes in the condition of his or her health.The latter coronary heart disease is uncertain. includes possible job-related changes or abnormalities. lued by the Increased cancer risk for members has been found in,ev. fire department physician. This atedi aal evaluation includes eras recent studies.While not totally consistent,these studies an update on the member's medical history,including any sig- generally show an increased risk of brain cancer,(gastrointes- nifacant changes,a brief review of symptoms,and a repo"an final cancers) colon cancer, proscate cancer,lymphoma,and any signifacantjob•related exposures experienced during the leukemia among members in many different parts of the past year.Height,weight,visual acuity,and blood pressure are world.Increased incidence of other cancer sites has also been measured and recorded.The extent of the medical evaluation shown in some studies.Several studies are currently under way and additional testing will depend on the member's medical to further evaluate this risk. condition. Noise-induced hearing loss has now been documented in A more thorough evaluation,including a medical examina- sry studies of members. Member might ht also be risk Lion'is conducted on a periodic basis.For individuals less than g 30 years of age, the medical evaluation and examination is from other specific exposures including infectious diseases conducted at least every three years;for those 30 to 39 years of and liver, kidnev, or neurological damage from exposure to age,at least every two years;and for those 40 years of age or specific chemicals. over,every year. This evaluation should include an updated 2000 Eason APPE?NUIX B 1582-j;) medical and interval history,complete phvsical examination, 01)Audiometry vision testing.audiometry.pulmonary function testing.and a (12)Visual acuity and peripheral vision testing CBC,urinalysis,glucose.BUN,creatinine.liver function tests, ((3)pulmonary function testing and lipid profile. (1.0 Iaboratory testing,if indicated The tue of chest x-rays in surveillance activities in the (15)Diagnostic imaging,if indicated absence of significant exposures,symptoms,or medical find- ings his not been shown to reduce respiratory or other health (lb) Electrocardiognphy,if indicated impairment. Therefore, only preplacement chest x-rays are B-2.3-11 Laboratory Tests. CSC, biochemical test batterv, recommended. urinalysis,glucose. BUN,creatinine,liver function tests.and i No firm 3tudelines for stress electrocardiography in vymp- lipid profile.should be conducted for detecting specific ill- tomatic individuals have been developed. There have been nessrs as well as developing a baseline for later comparison. problems with false-positive results from this testing,especially in younger age groups and in women. In those with one or B-2.3.2.2 !Grays. A baseline chest x-rav can be helpful for more risk factors for coronary artery disease,there is probably individuals with a history of respiratory health problems or justification for performing the testing.As well,stress tests are symptoms.For others,it can be useful for later comparison. more important in those whose work deals with public safety. B-2.3.2.3 Pulmonary Function Testing. Pulmonary function ''h? ' Stress tests can be performed using a treadmill.bicycle,or testing can be helpful for individuals with a history of respira- stair climber, as long as the protocol being used gradually tort'health problems and as a baseline for later comparison.A increases in workload metabolic equivalent of resting energy baseline test should be administered by an experienced per- expenditure (NETS). A submaximal test, with the endpoint son.Only a spirogram that is technically acceptable and dem- being the attainment of 95 percent of predicted maximal onstrates the best efforts by an individual should be used to heart rate (PMHR), may be performed.Additional informa- calculate the forced vital capacity(FVC)and forced expiratory lion gained by performing a maximal symptom-limited test volume in one second(FEVI). might not be worth the additional time,effort,cost,and risk. A reasonable approach is to start periodic treadmill testing &2.3.2.4 Audiometry. Audiograms should be performed in on members at age 40. In those with one or more coronary an ANSI-approved soundproof booth WNSI S3.1, Ma.,dmum artery disease risk factors(premature family history(less than Permissible Ambient Muire Levels for Audiometric Tat Rooms) with age 55). hypertension, diabetes mellitus, cigarette smoking, equipment calibrated to.ANSI standards(.A..NISI S3.6,SpM ca- and hvpercholesterolemia(tool cholesterol greater than 210 tion for Audwivide►s). If a booth is unavailable, the test room or HDL cholesterol less than 35)),testingshould be started by sound pressure levels should not exceed those specified in the age A5.The frequency of testingshould increase with age,but federal OSHA noise regulations(29 CFR 1910.95). at the minimum the test should be done at least every two B-2.3.2.5 Electrocardiography. Baseline electrocardiography years. Testing can also be done as indicated for those with should be conducted. (Periodic resting electrocardiograms svmptonu suggestive of coronary artery disease,as reported in have not been shown to be useful,but may be reasonable as a their yearly medical histories or interim reports. member's age increases.) Conversely,it is known that even maximal stress testing fre- quently misses cardiac abnormalities seen during actual fire- B-2.4 Reporting the Results of the Medical Evaluation. All fighting duties. 6t: individuals participating in a medical evaluation should be B-2.3 Content of the Medical Evaluation. informed ahead of time about the purpose of the medical evaluation and the content of the exam.The results of any B-2.3.1 Medical and Occupational H%story, The medical his. medical evaluation are considered to be confidential medi- tory should cover the person's known health problems,such cal information,subject to customary patient-physician con- as major illnesses,surgeries,medication use,allergies,and so fidentiality restrictions. Under most circumstances, results "?rth. Symptom review is also important for detecting early and recommendations arising from the evaluation should be signs of illness. In addition,a comprehensive medical history expressed in general terms without specific diagnostic infor- should include a personal health history,a family health his- mation.In cases where more specific information is needed tory, a health habit history, an immunization history,and a in order to make a decision on the status of a candidate or reproductive history.An occupational history should also be member,a specific consent form releasing that information obtained to collect information about the person's past occu- should be obtained from the candidate or member,Blanket pational and environmental exposures. or general "release of medical information" forms should not be used. 13-2.3.2 Medical Examination. The medical examination In most cases,a simple sateriment like one of the following includes the following organ systems and tests: will suffice: (1) Vital signs, such as pulse, respiration, blood pressure, (a) Based on the results of the preplacement medical eval- and,if indicated,temperature tation of December 10, 1996,Jane Doe is (or is NOT) medi- (3) Ears,eyes,nose,mouth,throat (2) Dermatological tally certified to engage in training and emergency operations (4) cardiovascular for Anytown Fire Deparunent (5) Respiratory (b) Based on the results of the preplacement medical eval- (6) Castrointestinal uation of December 10, 1996,John Doe is NOT medically cer- (7) Genitourinary tired to engage in training and emergency operations for Anytown Fire Department He has been advised of the medical (9) Endocrine and metabolic reasons for this recommendation and of the policies and pro- cedures available to him if he disagrees with the results of the (10)Neurological medical evaluation. 2000 Editn �*amawr�r✓col�al�rr�!v��;(,!l�ll��l!I/ ,�%/�/NO/ 15S2-24 %IEDI(.%L REIJUREMENT3 FUR FIRE FiGRTERS.41113 INF0R.NL%Tt()N FUR FiRE DEP.\RTbiLNT PIR-JICI.\NS B-4.3 Second Opinions. Fire department policies and proce- Administration(14 CFR67.131ti 1905)dues not grata medical dures should allow for a medical second opinion when a candi- certificates to diabetics treated with insulin and severely limits date or member disagrees with the results or recommendations those on oral hypoglycemic agents. of a medical examination conducted by the fire department physician or when the fire department physician is uncertain B-3•2 Asthma and Reactive Airways Disease. 'The diagnosis about the liminuotu or prognosis of the in6-idual's condition. of asthma and related airway hyperactivity disorders is often Often other physicians will not be familir with the duties and confounded by definitional issues. For the purposes of demands of fire fighting and emergency response.When pussi- member certification. a variety of airway disorders that ble, the fire department physician should help educate the meet the following criteria can be included. Asthma is a other physician about how the individual's condition could chronic inflammatory disorder of the airways. In suscepti- atfect or be affected by fare fighting.If there is.still disagreement ble individuals,this intlammation causes symptoms that are about the condition or placement recommendation, a third usually associated with widespread but variable airflow physician (acceptable to both the fire department and the can- obstruction that is often reversible,richer spontaneously or didate)can be consulted. with treatment,and causes an associated increase in airway B-16 Hfusculuskeletal System. Some of cite injuries or rob responsiveness to a variety of stimuli. lems encountered in this system will need functional capacity member applince cants will a is a 'requirehly special disease, ration. Combos videm ion to deterdesign tits fitness for duty.Physicsl therapy pro- lion products,exercise,and cold air are all potent provokers olden often design tests for employers to determine ability to of an asthma attack.Some of these exposures are unavoidable, perform tasks similar to those required as part of their es' even with SCBA use. If a candidate has a diau�uosis or rymp dal job functions.These tests should be based on direct men• toms consistent with an asthma like disease,many factor will surements of the actual job functions. These functional need to be considered.An asthma attack duringa suppression capacity evaluations can be especially useful when a member activity could harm the member, his fellow members, or a has been cleared for full duty by a physician who is not familiar member of the public. with the essential job functions of a member. The following factors can be used to help in certification: B•3 Specific Medical Conditions. (1) Persistence of airway obstruction between attacks (as B-3.1 Diabetes Mellitus. The major concern for diabetic measured by spirometry) members is the risk of becoming hypoglycemic during fire. (2) Need and frequency of steroid and bronchodilator use ground operations or other emergency responses.Both exog• (frequent bronchodilator use suggests persistent airway enous insulin and oral hypoglycemic agents can be associated impaired judgment t hyperactivity) with episodes of hypoglycemia that can rapidly progress from (3) Usual type of triggers in the applicant (allergic, infec- unconsciousness. The most reliable uous•exercise-induced,etc.) predictor of hypoglyceo mia is a history of it.insulin In one study of (4) History of hospitalization, emergency room, or urgent dependent adolescents conducted at the Joslin Clinic treatment (Bhatia and Wolfsdorf 1991), all 196 patients experienced (5) Length of time between attacks hypoglycemia at least once during the two-year observation (6) Nocturnal symptoms and other estimates of airway insta- period.Of these,15 percent were classified as severe,based on bitty loss of consciousness,seizure,or the clinical need for thera. peutic glucagon or intravenous glucose. it was particularly for member duties.dutiest Unknown factoa or worse ln uch aaat, an individuion al concerning that 24 percent of hypoglycemic episodes of airway hyperactivity with anti-inflammatory medications to detected by blood glucose monitoring were inapparent to the reduce the possibility of a sudden or severe attack are under patients.The probable causes of hypoglycemia were identified investigation and could modify current suggestions. in 71 percent of cases,and the most common were strenuous exdtcise and skipped meals or snacks. Both of these precipi• B-3.3 Heart Disease. The medical conditions relating to the tants are likely to occur in emergency responders,especially cardiovascular system have been reviewed since the previous fire service personnel.In addition to accelerating glucose ud- edition (1997) of this document The task forces at the lization, strenuous exercise increases insulin sensitivity Bethesda Conference published recommendations for ath- (Wasserman and Sinman 1994). With the tighter glycemic letes competing with cardiovascular disease inthefournolajtlu control that is now known to decrease and delay onset of dia- AmMcan College of Cardiology. in October 1994. The analysis betic complications,there is a concomitantly increased likey- used by the task force has relevance to the evaluation of mem- hood of exercise-induced hypoglycemia (Wasserman and ben with cardiovascular disease.Fire-fighting.activities have a - Sinman 1994). high static component Insulin is clearly associated with a much higher risk of pressure) and tadmodegrate to high d namic increase in blood r symptomatic hypoglycemia than are oral agents. In the component(i.e..inducing predominantly an increase in heart absence of a history of incapacitating hypoglycemic episodes, rate).Sports with a similar set of demands include wrestling, and with close medical monitoring,there is probably no rea- body building,and boxing. Recommendations made by the son to exclude members who are taking oral hypoglycemic task force'with respect to athletic activities that have these agents,as long as they have stable weights, diets, and renal physical demands(high static,moderate dynamic) have been function.Although the Americans with Disabilities Act(Public followed in this document. Law 101-336 1990) does not appear to require each diabetic B•3.4 Reproductive, Exposures in the firefighting environ- patient to be evaluated for fitness for duty individually,there menu can cause adverse reproductive effects for both males is some case law that disallowed blanket exclusion of insulin- and females.Medical evidence exists to indicate that chemical dependent diabetics from public safety positions (Fire & exposure,heat,noise,and physical exertion can affect various Police Personnel Reporter 1994). The Federal Aviation endpoints of reproductive health including fertility,fetal loss, 2000 Edumn and growth parameters of the offspring. All candidates acid reactive seizme that c:ut he attributed to a re%ersiblc.underly. members should be educated about these risky,end alynit the in{precipitant.These circumstances der not Ityzy"arils reprt. need to take appropriate steps to limit their exposures. sent an ongoing risk of sudden,unpretficuhle incap rcitatiun of :Uso, there could be some situations where a male or a member.If.t inember lr:u a single seizure.a clear precipitant female member is attempting[o conceive►child and h.rvin{ tint assnciated with central nervotis*stem damage rs identified difficult•.In these situations,where a complete medical eyalit. and eliminated.and tine inithidual has it,)recurrence river the ation has not Wenufied another cause for this infertility,tem. ensuing year,then he or she is prohably not more likely W h.rve purzry:usignment on a imluntar y basis to alternative citiry or a another seizure than die rest of the general p�spnlation (Spen. leave of absence should be considered. cer 191)5).Most fire department phv%iciam will wanta gnaliticd Medical evidence exists that certain ruxic substances or con- neurologist to verih that an individual with a historti of seizures ditiuns that are present in the tire-fighting environment are dues not,in fact.have epilepsy. dangerous to the safety and well-being of thefetus.Therefore. Epilepsy is dr.t•,now:d by the presence of "unprovoked, it is important to educate all members about these risks and the recurrent seizures—paromsmal disorden of the central ner• reasons for recommending that pregnant members restrict vrous system characterized by an abnormal cerebral neuronal their fire-suppression activities.For example.there is;grad evi• discharge with or without loss of conaciorrsness' (Cascitna dense that the fetus is especially sensitive to carbon monoxide. ITN)•Treatment of patients with epilepsy is only variably suc. a known significant component of tire smoke.Although the cessful,with roughly il)percentof patients attaining remission use of SCBA is assumed to be protective, sometimes such on and- omtilssnt therapy (Hauser and Hesdortfer 196j0; equipment is not used throughout a tire suppression or hazy Spencer I N51. Remission is defined as five years without ardous materials incident. The use of such equipment also recurrence of seizure activity (Annegers, Hauser. and Elve. increases other fetal stressors,such as exertion and heat.Other back 1079). Farther complicating the fitness-fordun•issue is concerns are those involving physical work. Prolonged stand- the fact that only:50 percent of patients who achieve remission ing,heavy lifting,and exposures to temperature extremes and do so without toxic side effects of the and-convulsant drug humidity have been related to an increase of preterm and low (Ciscino 1994). birth weight infants. Because the fetus should be protected Partial,simple epilepsy,or recurrent seizures that do not from these exposures at the earliest possible time,the member impair consciousness,are felt to be a disqualifying condition who might be pregnant should obtain early pregnancy testing, because of the uncertainty regarding how much of the brain Recognizing potential risks to the fetus from the firefighting might be involved, and the risk of propagation to other environment is a relatively recent event,and many members regions of the brain, particularly in the highly epileptogenic might not be aware of these risks. environment of the fireground(Spencer 1995). Based on a recent U.S.Supreme Court decision (Interna- This standard is somewhat more liberal than that promul- donal Union et al.v.Johnson Controls.Inc..59 C.S.LW 4209. gated by the Federal Aviation Administration of the U.S. ?March 20, 1991).the ability to perform as a member is to be Department of Transportation for aircraft pilots (14 CFR the basis for the medical cer•dfication without consideration of 67.13161995).All epileptics,regardless of therapeutic success health risks to the fetus. However, the pregnant member are denied first-,second-,or third-class medical certificates, should be counseled on the potential risks to her fetus due to except under the provisions of 14 CFR 67.19."Special issue of her exposures during fire-righting duties. &ledical Certificates." Any member who becomes pregnant should be offered the 34 References. opportunity at any time during the pregnancy to be voluntary Annegers,J. F., W. A. Hauser, and L R. Elveback. 1979. ily removed from fire-fighting duties and from other duties "Remission of Seizures and Relapse in Patients with Epilepsy," involving the hazards or physical stress that might endanger Epilplia 20:729. the fetus.Ifpractical,the member should be offered voluntary Bhatia,V..and J.L Wolfsdotf.1991."Severe Hypoglycemia reassignment to an alternative position. At such time as the in Youth with Insulin-Dependent Diabetes Mellitus: Fre- pfegnant member can no longer be medically certified as quenty and Causative Factors:Pediatrics,88:1137. being capable of performing fire-fighting dudes,the member Brunacini,Alan.Fimgmund Command National Fire Protec•should be reassigned to other duties.At such time as the mem• lion Association, 1985. her is no longer pregnant, the member should be reinstated Cascino, G. D. 1994. EPi&P"- Contemporary Persprctioa on to the position held prior to being pregnant. Nursing mem- Euntuadon and Treatment,Mayo Clinic Proceedings 69:1199. bers should also be advised about the potential exposures to "Emergency Incident Rehabilitation," United States Fire their infants. Adminiuration(FA#1 12). B-3.5 Noise-Induced Hearing Loss. This category can pose Firr.&PofirrPenemnd Reparter,,November 1994.p.169. diffrculues because a high percentage of current members Hatiser•W.A..and D. C. Hesciortfer. 1990."Epilepsy:Frey have noise-inditced hearing loss due to their exposures as quency.Causes and Consequences."New York:Demos. members. Implementation of hearing conservation programs National Fire Incident Reporting System (NFIRS) data and programs to reduce noise exposures should lead to a base• decrease in the prevalence of this condition in the future. NFPA 1321.Standani for Fin D"r(rrrrnt.Safety Olricer, 1997 edition. 3-3.6 Seizures and Epilepsy. It is important to distinguish Public Caw 11)1.336. 1990.Tide I—Employment. between a history of seizures and epilepsy.As much as 10 per- Spencer.S.. Personal Communication, 1995. (Spencer is cent of the population will experience at least one seizure in a professor of neurology and director of the Clinical Epilepsy lifetime,whereas less than I percent of the population qualities and Electrophysiologic Monitoring Services at Yale University for a diagnosis of epilepsy(Hauser and Hesdortfer 19%).Many School of Medicine.) conditions producing seizures in the pediatric age group are Title 14. Cwk frrr Frderat R%uGrhuns, Part 1910.1000, Suh- known to remit prior to adulthood,and many adults sustain a parts 13-16.:fir Contaminants." 2C00 Edtiwn ISti2-26 HEDICtL REQI.'iRE.&iENTS FOR FiRE FU:HTERi AND INFORNUTiON FOR FiRE DErAKr%IENT rll\SICLINS "Toxic smoke inhalation: Cyanide poisoning in fire vic- Appendix D Guide for Fire Department Admi tistratots rims.'Jones.J. et al.. Amrritan Juresnal of Emer.mPne7 Medicine 5:31 198 7. T/au abpendix is not a/pert of he relrainmentt of this.'-FP.i,Gin. Wasserman,D.H..and B.Sinman. 1991."Exercise in[ndi- lenient but it inaiur4vi for enform,etional purp,ays aniy. yid iaLs with IDDNI"Diabrih,Can, 171924. D-I Legal Considerations in Applying the Standard. The con. Appendi�c C Essential Structural Fire-Fighting sideration of an applicadun or continued employment of a mem- g g ber bussed on medical or physical performance evaluations intohes Functions a determination that is not without legal implications.To this end This appriedix u nut a pan p fhr requirements,if thu.W-P.A dux• pnor to making an adverse employment decision bussed on the cement brit is encludeel for inf,nmahimal purposes only. forgoing standard.the authority with jurisdiction might wish to Consult with counsel.i -1 The medical requirements in this standard were based on D-1.1 individuals with Handicap , andica ndepth consideration of essential structural fire-fighting bilitation Act of(973,as amended or Disabilities. The Reha• ,'_9 U.S.C.,91 et seq..and functions.These essential functions are what members are el* petted to perform at emergency incidents and are derived implementing regulations, prohibit discrimination against from the performance objectives stated in NFPA 1001. Stan- those with handicaps or disabilities under any program receiv- darlforFire FighterProfesswnalQwAiliattiortt. ing financial anistance from the federal government. The Essential functions are performed in and at7ected by the Americans with Disabilities Act of 1990,4-4 U.S.C.§ I:10[, at Following environmental factors: seq.,also prohibits employment discrimination by certain pri- vate employers against individuals with disabilities.In addition, (l) Operating both us a member of r team and indepen. many states have enacted legislation prohibidng,iiscriminadon dendv at incidents of uncertain duration against those with handicaps or disabilities.These laws prevent (1) Spending extensive time outside exposed to the elements the exclusion,denial of benefits,refusal to hire or promote,or (3) Tolerating extreme fluctuations In temperature while per- other discriminatory conduct against an individual based on a forming dudes:fire lighten are required to perform phys- handicap or disability,where the individual involved can,with ically demanding work in hot(up to 400°F),humid(up to or without reasonable accommodation, perform the essential I'M percent) atmospheres while wearing equipment that functions of the job without creating undue hardship on the significantly impairs body-cooling mechanisms. employer or program involved. Application of this standard (4) Experiencing frequent transition from hot to cold and should be undertaken with these issues in mind. from humid to dry atmospheres The medical requirements of the 1997 edition of this stan- (3) Working in wet,icy,or muddy areas lard were initially developed and found to be job-related by a (6) Performing a variety of tasks on slippery,hazardous sur- subcommittee comprised of medical doctors, physiological faces such as on rooftops or from ladders specialists,and fire service professionals.as processed through (7) Working in are:s where sustaining traumatic or thermal the NFPA consensus standards-making system. Changes for injuries is possible the current edition have been proposed by a task group com- (8) Facing exposure to carcinogenic dusts such as asbestos, prised of similar expertise. The standard provides, to the toxic substances such as hydrogen cyanide,acids,carbon extent feasible,that decisions concerning candidates and cur- monoxide,or organic solvents,either through inhalation rent members with medical ailments,handicaps,or disabilities or skin contact be made after case-by-case medical evaluations. Thus, most (9) Facing exposure to infectious agents such as Hepatitis B medical conditions have been assigned to Category B. or HIV The medical requirements in this edition of the standard (10)Wearing personal protective equipment that weighs were revised based on the essential functions contained in approximately 50lb while performing fire-fighting tasks Appendix C.it is recognized that some fire-fighting functions (11.)Performing physically demanding work while wearing pos. and tasks can vary from location to location due to differences Itive-pressure breathing equipment with 1.3 in. of water in department size,functional and organizational differences, column resistance to exhalation at a flow of 40 L/min geography, level of urbanization, equipment utilized, and (12)Performing complex tasks during life-threatening other factors.Therefore,it is the responsibility of each individ- emergencies ual fire department to document, through job analysis, that (13)Working for long periods of time, requiring sustained the essential functions performed in the local jurisdiction are physical activity and intense concentration substantially similar to those contained in Appendix C. (14) Facing lifrardeath decisions during emergency conditions There are a wide variety ofjob apalytic techniques available (13)Being exposed to grotesque sights and smells associated to document the essential functions of the job of a member. with major trauma and burn victims However,at a minimum, any method utilized should be cur- (16)Making rapid transitions from rest to near-maximal exer• rent,in writing,and meet the provisions of the Americans with tion without warm-up periods Disabilities Act[:9 CFR 1630.2(n)(3)).Job descriptions should (17)Operating in environments of high noise,poor visibility, focus on critical and important work behaviors and speck limited mobility;at heights;and in enclosed or confined tasks and functions.The frequency and/orduration of task per. spaces formance.and the consequences of failure to perform the task 118) Using manual and power tools in the performance of dudes should be specified The working conditions and environmen- (l9)Relying on senses of sight, hearing,smell,and touch to tal hazards in which the work is performed should be described. help determine the nature of the emergency,to maintain The job description should be made available to the fire personal safety, and to make critical decisions in a con- service physician for use during the preplacement medical fused, chaotic, acid potentially life-threatening environ- examination for the individual determination of the medical ment throughout the duration of the operation suitability of applicants for member. 2000 Edhon APPENDIX 0 1582-27 D-1.2 Anti-Divesvnination Laws. Finally, users of this scan- Therefore, physicians with specialties other than occupa. dard should be aware that,while courts are likely to give con- donal need to be considered,as well as the physician's back- siderable weight to the existence of a nationally recognized ground and experience.Knowledge of occupational medicine standard such as NFPA 1582,Standard an,Hedical Requirements and experience with occupational health programs,obviously, for Fir. Fighters and information for Fin. Department Physicuins would be helpful. (e.g., .Vtti&r v. Sioux tarrewav Are Department, 497 N.W 2d 898 The physician has to be committed to meeting the require- (I'3H3)),reliance on the standard alone could be inititFicient ments of the program,including appropriate record keepin g. to withstand a challenge under the anti d scrimination laws. His or her willingness to work with the department to contin- Even in the case of Category A medical conditions,courts can ually improve the program is also important.Finally,his or her still require additional expert evidence conceming an individ- concern and interest in the program and in the individuals in ual candidate's or member's inability to perform the essential the department is vital. functions of the job.Until the courts provide furtherguidance in this developing area of law, some uncertainty as to the There are many options for obtaining phcsician services. degree and nature of the evidence required to establish com- pliance with the antidiscrimination laws will remain. (a) Physicians could be paid on a service basis or through a contractual arrangement. 134.3 Individuals Who Are Members of Protected Classes (b) For volunteer departments,local physicians could be (Race,Sex,Color,Religion,or National Origin). Tide VII of willing to volunteer their services for the program,with addi- the Civil Rights Act of 1964,as amended,42 V.S.C.2000e,and tional member arrangements for pavement of laboratory test- implementing regulations by the Equal Employment Opportu- ing,x-rays,and so forth. nitp Commission (EEOC) prohibit discrimination in employ- ment on the basis of race,sex,color,religion,or natio (c) Some departments could utilize a local health care nal origin facility for medical care.However,in that case,the departmen t (i.e., protected classes). Under Tide V11, an "employer" is should be sure to have one individual physician responsible defined,generally,to mean a person with"15 or more employ- for the record kee and so forth. ees for each working day in each of 20 or more calendar weeks program, pin g' in the current or preceding calendar year.'(42 U.S.C.2000e) (d) In some cases,it could be possible to have the medical Several federal jurisdictions have held that unpaid volunteers examination by the fire department physician,while some of are not considered to be"employees'under Tide 161I. the associated costs could be defrayed by the member's own health insurance.For example,the health insurance provider Additionally, many states, cities, and localities have could allow the member to have a yearly physical, normally adopted similar legislation. Generally, physical performance performed by the member's persona) physician.The health or other requirements that result in"adverse impact'on mem- care insurance provider could allow that physical to be per- bers of a protected class (e.g., on the basis of gender) are formed by the fire department physician with some degree of required to be validated through a study in accordance with reimbursement. EEOC guidelines,if such requirements are to be relied on in making employment decisions. Under EEOC guidelines, a D-3 Coordinating the Medical Evaluation Program. An indi- study validating employment standards in one jurlsdicdon can vidual from within the department should be assigned the. be transportable to another jurisdiction (and therefore used responsibility for managing the health and fitness program, in lieu of conducting a separate study).However,specific pre- including the coordination and scheduling of evaluadons and conditions must be met in this regard,and the authority hav- examinations.This person should also act as liaison between ing jurisdiction should seek the advice of counsel before the department and the physician to make sure that each has relying on a transported validation study. the information necessary for decisions about placement, scheduling appointments,and so forth. D-1.4 Pregnancy and Reproductive. Federal regulations, as Confidentiality of all medical data is critical to the success well as many court decisions, including the U.S. Supreme of the program.Members need to feel assured that the infor- Court's decision in International Union,et al.v.Johnson Centrob, mation provided to the physician will not be inappropriately Inc. (499 U.S. 187. 111 S.CL 1196 (1991)1,have interpreted shared. No fire department supervisor or manager should the requirements of Tide VII with respect to pregnancy and have access to medical records without the express written reproduction.The authority having jurisdiction should seek consent of the member.There are occasions,however,when the advice of counsel in resolving specific questions concern- specific medical information is needed to make a decision ing these requirements as well as other requirements that can about placement, return to work, and so forth, and a fire be imposed by state or local laws. department manager must have more medical information for decision making.In that situation,written medical consent D-2 Choosing a Fire Department Physician. Several factors should be obtained from the individual to release the specific should be considered in choosing a fire department physician. information necessary for that decision. There are relatively few physicians with formal residency train- ing and certification in occupational medicine.The fire depart- Budgetary constraints can affect the medical program. Therefore,it ment physician needs to be qualified to provide professional is important that components of the program be expertise in the areas of occupational safety and health as these Prioritized such that essential elements are not lost.With addi- areas relate to emergency services.For the purpose of conduct tional funding, other programs or testing can be added to ing medical evaluations,the fire department physician needs to enhance the program. understand the physiological and psychological demands D4 Table D-4 represents a comparison between NFPA 1382 placed an members and needs to understand the environmen- and OSHA 29(FR 1910.134. cal conditions under which members have to perform. 2000 Edition i 1582-24 t1EDICAL 11.9QVIRE}IENTS FOR FIRE FIGHTERS AND INFOR.%t.%rION FOK FIRE oer-%Xr1IENT PFI\SICI uNs Table D-1 Comparison of OSHA 29 CFR,Parts 1910.134."Medial Requirements"and NFPA 1582.Standard on Medical Reyrdrements1or Fire Fighters and Information for Fire Department Physicians,2000 Edition NFPA 1582 OSHA 1910.134 2-1 Medical Evaluation Process. The emplover must establish and implement those elements of the written respiratory pro- 2.1.1•The fire department shall establish and implement a medical evalua- tecuon program necessary to ensure that any rion process for candidates and current members. emplovee using a respirator voluntarily is med- ically able to use that respirator,and that the respirator is cleaned,stored,and maintained so that its use does not present a hazard to the user. Exception:Employers are not required to include in a written respiratory protection pro- - gmm those employees whose only use of respi- rators involves the voluntary use of filtering face pieces(dust masks). Appendix D-3 Coordinating the Medical Evaluation Program.An individual (3)The employer shall designate a program from within the department should be assigned the responsibility for man- administrator who is qualified by appropriate s rig the health and fitness program,including the coordination and training or experience that is commensurate scheduling of evaluations and examinadons.This person should also act as with the complexity of the program to admin- liaison between the department and the physician to make sure that each ister or oversee the respiratory protection pro- has the information necessary for decisions about placement,scheduling gram and conduct the required evaluations of appointments,and so forth, the program effectiveness. Confidentiality of all medical data is critical to the success of the program. [embers must feel assured that the information provided to the physician will not be inappropriately shared.No fire department supervisor or man- ager should have access to medical records without the express written con- sent of the member.There are occasions 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.In that situation,written medical consent should be obtained from the individ- ual 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 essen- tial elements are not lost.With additional funding,other programs or test- ing can be added to enhance the program. 2-1.2 The medical evaluation process shall include preplacement medical (1)General,The employer shall provide a evaluations,periodic medical evaluations,and return-toduty medical evalu- medical evaluation to determine the ations. 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 employee is no longer required to use a respirator. (Shun 1 of 3) 2000 Cotton APPENDIX D I582-29 Table D4 Comparison of OSHA 29 CM Part 1910.134,-Medical Requirements-and NFPA 1582,Standard on Aledical Rrgairements for F v Fighters and Information for Fue Department Physicians,2000 Edition (Continued) NFPA IS82 OSHA 1910.134 2-I.3 The tire department shall ensure that the medical evaluation process �(3) Follow-up medicsl examination. and all medical evaluations meet all of the requirements of Section 2-1. I it 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 S in Sec. don 2.Part A of Appendix C or whose initial medical examination demonstrates the need for follow-up medical examinations. (H)The follow-up medical examination shall include anv medical tests,consultations,or diagnostic proceditres that the physician or licensed health care professional (PLHCPI deems necessary to make a final determina- tion. 2-1.4 Each candidate or current fire fighter shall cooperate,participate,and (7)Additional medical evaluations.At a mini- comply with the medical evaluation process and shall provide complete and mum,the emplover shall provide additional accurate information to the fire department physician. medical evaluations that compply with the 2-1.50 Each candidate or current fire fighter shall,on a timely basis,report requirements of this section ii to the fire department ph sician any exposure or medical condition that M An employee reports medical signs or could interfere with the ability of the individual to perform as a fire fighter. symptoms that are related to ability to use a 24.1.1 The components of the annual medical evaluation specified in respirator, 2-4.1.2 of this section shall be permitted to be performed by qualified per- (ii)A PLHCP,supervisor,or the respirator pro- sonnel as authorized by the fire department physician.When other quali- gram administrator informs the employer that fied personnel are used,the fire department physician shall review the data an employee needs to be re-evaluated; gathered during the evaluation. (iii) Information from the respiratory protec- tion program,including observations made during t"it testingg and program evaluation, indicates a nee tf for employee re-evaluation; or (iv)A change occurs in workplace conditions (e.g..physical work effort,protective clothing, temperature) that may result in a substantial increase in the physiological burden placed on an employee. (Shut 2 o/5) 2000 Edhan 1582-30 MEDICAL REQUtREN11UNTS FOR FIRE FICHTERS.LYD INFOILNO.TiON FOR FiRE DEPARTMENT PFhSICIANS Table D4 Comparison of OSHA 29 CM Parts 1910.134."Medical Requirements"and NFPA 1582,Standard on Medical Regreimmmtr for Fire Fighters and Information Jbr Fire Depaetrnmt Pk=cian*2000 Edition (Continued) NFPA 1582 OSHA 1910.134 2-2 Fire Department Roles. 121 Medical evaluation procedures. 2.2.1 The fire department shall have an officially designated physician who (i)The employer shall identify a physician or Shall be responsible for guiding,directing,and advising the members with other licensed health care professional regard to their health,fitness,and suitability for duty as required by NFPA (PLHCP) to perform medical questionnaire or an initial medical examination that obtains 151A Stundmd on Fnr Department Occupational Safety and Health PmgmnL the same information as the medical question- naire. 2.2.2 The fire department physician shall be a licensed doctor of medicine or osteopathy. (ii)The medical evaluation shall obtain the information requested by the questionnaire in D-2.Choosing a Fire Department Physician.Several factors should be consid-Sections I and 2,Part A of Appendix C of this ered in choosing a fire department physician.There are relatively few physi-section. 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- tions,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- s - 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.Forvolunteer 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 ease,the department should be strsg to have one individual physician responsible for the program,record keeping,and so forth.In some cases it could be possible to have the medieval 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. (Sheet 3 of 1) 2000 Emuon APPENDIX D 1582-31 'table D-; Comparison of OSHA 9-9 CFR,Parts 1910.134,"Medical Requirements"and NFP.4 1582,Standard on Medical Requirmkmts for Firs Fightsrs and Information for Firs Department Physicians,2000 Edition (Confirmed) NFPA 1582 OSHA 19 10.134 2.2.30 For the purpose of conducting medical evaluations.the fire depart- (e)Medical evaluation.Using a respirator may ment phvsician shall understand the physiological and psychological place a physiolo cal burden on employees demands placed on members and shall understand the en ironmental con. that vanes with the type of respirator worn,the ditions under which members must perform.The fire department shall pin- fob and the workplace conditions in which the vide the fire department physician with a current job description for all fire respirator is used and the medical status of department positions and ranks. the employee.Accordingly,this paragraph specifies the minimum requirements for medi. cal evaluation that employers must implement i B-1 Occupational Safety and Health Problems for Fire Fighters.Fire fighting to determine the employee's ability to use a I and emergency response are very difficult jobs.People in these jobs per- respirator. form functions that are physically and psychologically very demanding. I These functions are often performed under very difficult conditions.(See (5)Supplemental information for the PLHCP. Appendix C.)Studies have shown that fire-fighting functions.require work• ing at near maximal heart rates for prolonged periods of time.Heavy pro- I(I)The following information must be pro. tective equipment(including respirators)and the heat from the fire vided to the PLHCP before the PLHCP makes contribute to this physical load. a recommendation concerning an employee's ability to use a respirator: Fire fighters and emergency response personnel also are exposed to many (A)The type and weight of the respirator to toxic substances during their work.Carbon monoxide is the most common be used by the employee; contaminant;studies have shown individual exposures as high as 5000 ppm in actual fires.Other significant exposures common in fires include cya- (B)The duration and frequency of respirator nide,acrolein,hydrogen chloride,nitrogen dioxide,and benzene.The use(including use for rescue and escape); burning of plastics and other synthetic materials can expose Fire fighters to other toxic materials such as isocyanates and nitrosamines.Hazardous mate- (C)The expected physical work effort; rials incidents can involve exposures to many other toxic materials.While (D)Additional protective clothing and equip- the use of respirators helps to reduce exposures,mechanical,environmen- ment to be worn;and sal,and behavioral factors can limit their use during all phases of a fire. (E)Temperature and humidity extremes that be encountered. (ii)Any supplemental information provided previously to the PLHCP regarding an employee need not be provided for subse- quent medical evaluation if the information and the PLHCP remain the same. (iii)The employer shall provide the PLHCP with a copy of the written respiratory protec- tion program and a copy of this section. Note to parsgnph(e)(3)(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 employers to have employees medically reevaluated solely because a new PLHCP has been selected. (Shan 4 of 3) 20W Edition 1582-32 MEDIC 1L REQUIREMENTS FOR FIRE FIGHTERS,AND INFORJLITION FOR FIRE DEPARTMENT PI tfSlrl.LNS Table D-i Comparison of OSHA 29 CM Parts 1910.134,"%Iedical Requirements"and M A 1582,Standard on,Nedica! Requirements far Fre Fighters and Information for Fne Deparniuw Phyairtans,2000 Edition (Continued) .YbMk 1582 OSHA 1910.134 2-1.1 The current membershall be certified annually,or at the request of (6) Medical determination.In determining either the fire department or the member,by the fire department physician the employee's ability to use a respirator,the as meeting the medical requirements of Chapter 3 of this standard in order employer shall: to determine that membei s medical ability to continue participating in a training or emergency operational environment as a member.Any applica- (i) Obtain a written recommendation regard- ble OSHA standards,such as 29 CfR 1910.1-90,'Hazardous Waste Opera- ing the employee's ability to use the respirator dons and Emergency Response,"29 CFR 1910.134,'RespiratoryProrection," from the PLHCP.The recommendation shall 29 CFR 1910.95,"Occupational Noise Exposure,"and 29 CFR 1910.1030, Provide only the following information: 'Bloodborne Pathogens,"shall be followed. (A)Any limitations on respirator use related to the medical condition of the employee,or relaung 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 (C)Astatement that the PLHCP has provided the employee with a copy of the PLHCP's writ- 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 finds that the employee is med- ically able to use a negative pressure respirator, then the employer is no longer required to provide a PAPR. (4)Administration of the medical question- naire and examinations. (i)The medical questionnaire and examina- tions shall be administered confidentially dur- ing the employee's normal working hours or at 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 naive and the examination results with the PLHCP. (Sleet J o/J) 2000 Edbon