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Item C22 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 Dr. Samess, M.D. and Fishermen's Hospital to provide employment physical services. ITEM BACKGROUND: On April 20, 2014, this contract will expire. The providers have agreed to continue to provide the services as in the current contract at no increase in fees. PREVIOUS RELEVANT BOCC ACTION: The BOCC approved the original contract on April 20, 2011. The,Contract was amended on October 17, 2012 to add Fisherman's Hospital, Inc. as a party when Dr. Samess became an employee of Fishermen's Hospital. CONTRACT/AGREEMENT CHANGES: 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. $2,800 yr INDIRECT COST: BUDGETED: Yes X No DIFFERENTIAL OF LOCAL PREFERENCE: COST TO COUNTY:4pprox. $2 800 yr SOURCE OF FUNDS: Ad Valorem REVENUE PRODUCING: Yes_ No X AMOUNT PER MONTH Year APPROVED BY: County Atty( O IB%Purc asin Risk Mana e g g ment]& DOCUMENTATION: Included X Not Required DISPOSITION: AGENDA ITEM# Revised 7/09 MONROE COUNTY BOARD OF COUNTY COMMISSIONERS CONTRACT SUMMARY Contract# [Hos ontract with:Dr. Samess and Fishermen's Effective Date: March 19, 2014 pital Expiration Date: Contract Purpose/Description: Second Amendment to renew contract 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 $2,800 Current Year Portion: $245.00 n Budgeted? Yes X No— Account Codes: 001-06500-510-316- Grant: $ _ - 7 County Match: Estimated Ongoing Costs: $ ADDITIONAL COSTS /yr For: (Not included in dollar value above) (eg.maintenance,utilities,janitorial,salaries,etc.) CONTRACT REVIEW Changes Date Out Date In Needed _viewer Division Director Yes[]NoRf Risk Management .1,Hy Yes[]No[j?/ 7 OO.M.B./PurchasingLl---I Yes No® , L -I County Attorne y,,M .,O J/ Yes[]No 1 Comments: OMB Form Revised 9/11/95 MCP#2 SECOND AMENDMENT TO CONTRACT FOR EMPLOYMENT PHYSICAL SERVICES This amendment("Amendment") dated March 19, 2014 is entered into by and between Monroe County("County"), Fisherman's Hospital, Inc. ("Hospital") and Ronald R. Samess, M.D. ("Dr. Samess") (collectively, Hospital and Samess are referred to as "Contractor"). WHEREAS, the County and Samess entered into a Contract for Employment Physical Services ("Agreement") on April 20, 2011, whereby Dr. Samess agreed to furnish employment physical services; and WHEREAS, on October 17, 2012 the Agreement was amended in order to add the name of Fishermen's Hospital because on or about July 1, 2012, Dr. Samess became an employee of Fishermen's Hospital in Marathon, Florida and all invoices for services provided under the Agreement would be issued under the name of Fishermen's Hospital, Inc.; and WHEREAS, the current contract expires on April 20, 2014 and the County continues to need the services listed in the Agreement; 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 Sections 4, 7 and 8 of Agreement as follows: 1. 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. 2. 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. 3. A new paragraph (F) is added to Section S of the Agreement (CONTRACTOR'S ACCEPTANCE OF CONDITIONS), as follows: F. Pursuant to Florida Statute§119.0701, Contractor and its subcontractors shall comply with all public records laws of the State of Florida, specifically to: i. Keep and maintain public records that ordinarily and necessarily would be required by Monroe County in the performance of this Agreement. ii. 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. 4. 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) Fishermen's Hospital, Inc. Attest: Secretary Hal W. Le 'ch Chief cutive Officer N Ronald R. Samess, M.D. d By: Ronald R. Samess MONROE COUNTY ATTORNEY ROVED T F RM: YNTHIA L. HALL ASSIS Al COUNTY ATTORNEY Date �'J 89 14' 3 r 5 AMOMMENT TO CONTRACT FOR EMPLOYMENT PHYSICAL SERVICES is an amendment("Amendment')to the Contract for Employment Servlmo�Cftmemenn by mW bomn Monroe County(`County?and Ronald Same®s,,V.D. ('Dr. SaumeW or Tontracuml made and entered into by the Cou and Dr. Same68 on April 20, 2011. WHEREAS, the County Yand Contractor en tered red into an Agreement on Apri 20, 2011, whereby Dr. Samess agreed to furnish employment physical services; and : :�"�"►w�{� .. .'"VOW°S on Qr about July 1,2012, Dr. &Mum became an lshe ' ,• Fn l's fh Marathon, Y n, Florida;and � and WHEREAS,the County continues to need the services listed in the Agrser�snt� ' WHEREAS, it Is necessary to amend the Agreement in order to add the of Fishermen's Hospital because all invoices for services provided under the Ag will now be issued under the name of Fisherman's Hospital, Inc. ; I NOW THEREFORE,for good and valuable consideration, the parties ag to the terms and conditions set forth below. i i I 1. Fishermen's Hospital, Inc., 1't Professional Centre, 5701 Overseas j Highway, Ste. 17, Mandhon FL 33050 is added as a party to the Agreement. i 2. BY executing this Amendment, Fisherman's Hospital indicates Its oTsent to be bound by the terms and conditions of the Agreement, as amended hereto Dr. "'A the'Co - - ,x,. a` . ,�•ig v4 ,• .. ,� ur�'��i�th�l WI�OV�IL�Ui0� c :§:, i•.�.A; 5 . .� addition _ofi•fi I 3. The person signing below on behalf of Fishermen's Hospital we that he has all necessary authority to execute this Amendment on behalf of Fis 's Hospital and to bind Fishermen's Hospital to the terms and conditions of the Ag ment and this Amendment. 4. This Amendment is made retroactive to July 1, 2012. effect. 5. All other terms and conditions of the Agreement remain in full force land 1 I i' M • I IN WITNESS WHEREOF, the parties hereto have caused this Amendment to be O the day and year first above written. i Board of County Commissioners . Kolhage, Clerk of Monroe County y Deputy Clerk /o '�//.2 Mayor/Chairman � I Fishemren's Hospital, Inc. I Hal W. tsf'Ir Sri, DBA, FACHE Chief O�cer Ronald R. Samess, M.D. Rongk am LL- MO E COUNTY ATTORNEY MVO «= f;YNT111A L. MALL iM -C '�y1 ORNASSIST NT TEY Date Z II i i " I i I .-------. MONROE COUNTY CONTRACT FOR EMPLOYMENT PHYSICAL SERVICES ril 20 1, by MONROE COUNTY( THIS AGREEMENT("Agreemenr)is made and entered into this 20th day of-COUNTY"), a political subdivision of the State of Florida, whose address Is 1100 Simonton Street, Key West, Florida 33040 and Ronald R. Samess M.D. ('CONTRACTOR"), whose address is 1"Professional Centre 5701 Overseas Hiahwav STE, 17. Marathon, FL 33050. Section 1. SCOPE OF SERVICES 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. i B. The contractor is responsible for obtaining proper releases from the employee or prospective employee in order to discuss the results with Monroe County BOCC. C. The contractor will provide the required services at the location of: Ronald R. Samess, M.D. 1 s1 Professional Centre 5701 Overseas Highway, STE. 17 o Marathon, FL 33050 Phone: 305-743.2253 Fax: 305-743.5363 o i D. All urine screens will conform with the standard chain of custody mandated by state and federal regulations. protocol= E. The Contractor will have an employee designated as coordinator oW_ I n facilitator to assist In the communications with the Monroe County 138CCim c primary contact personnel. F. Appointments will be available throughout the business hours of the facility: Monday—Friday 9:00 a.m.—5:00 p.m. Closed 12-1:30 for Lunch Fridays: Physician leaves at noon. Facility open until 3:00 P.M. for procedures, such as drug screens,which do not require a physician be present. Walk-ins will also be accepted if an appointment cannot be reasonably scheduled. G. Appointments will be seen by the contractor in a reasonable and timely fashion. H. The Contractor will provide the County with at least a 24—48 hour 2 turnaround time for the receipt of any drug or physical results. I. The Medical Review Officer will be aMlable for contact by the Monroe County BOCC or its employees to answer questions about the effect of prescribed drugs. Part ol'the requirements set forth by the State of Florida drug free workplace policy, which Nionroe County has adopted.and (lie Department of Transportation, the County must have a quali lied kledical Review Otfiicer"MRO" perform druc,creening scr%ices.Thc 'VIRO receives lab reports from the:laboratory(as go%crned by regulations); Reviews lab reports liar integrity,authenticity, false negatnes,and false positives; interprets lab results. including verification of lab positives;reports lab relxirfs to the employer(as detined by rules and regulations). J. 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. K. 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&L& 11 and renewable at the County's option for two(2)additional consecutive one year terms. 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 thirty30) days notice of intent to terminate. If either party desires to modify this Agreement, t 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 3 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& 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 S. 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 p g ent 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. D. CONTRACTOR agrees that County Administrator or his designated re visit CONTRACTOR'S facilityies g m evaluations may ( ) periodically to conduct random evaluations of services during CONTRACTOR'S normal business hours. E. CONTRACTOR has, and shall maintain throughout the term of this Agreement, appropriate licenses and approvals required to conduct its business, and that it will at all times conduct its business activities in a reputable manner. Proof of such licenses and approvals shall be submitted to COUNTY upon request. 4 0 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: Ronald R. Samess, M.D. 1e1 Professional Center 5701 Overseas Hwy, STE. 17 Marathon, FL 33050 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, 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 asa 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. 5 Section 13. GOVERNING LAW,VENUE,INTERPRETATION,COSTS AND FEES This Agreement shall be governed by and construed in accordance with the laws of the State of Florida applicable to Agreements made and to be performed entirety 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 by law unless the enforcement of the remaining terms, covenants, conditions and provisions of this Agreement would prevent the accomplishment 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 attorney'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 the benefit of the COUNTY and CONTRACTOR and their respective legal representatives, successors, and assigns. Section 17. AUTHORITY Each party 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. 6 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 out 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) Title 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 290se-3) as amended, relating to confidentiality of alcohol and drug abuse patient records, 8)Title 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 Code Chapter 13, Article VI, which prohibits discrimination on the basis of race, color, sex, religion, national origin, ancestry, sexual orientation,gender 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. 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 25. 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. 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 8 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, and a Drug-Free Workplace Statement, 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 regarded as an original, all of which taken together shall constitute one and the same instrument and any of the parties hereto may execute this Agreement by signing any such counterpart. Section 32. SECTION HEADINGS Section headings have been inserted in this Agreement as a matter of convenience of reference only, and it is agreed that such section headings are not a part of this Agreement and will not be used in the interpretation of any provision of this Agreement. 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 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 altemative, 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 fumished 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 9 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. I 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 Contractors insurance shall not be construed as relieving the Contractor from any liability or obligation assumed under this contract or Imposed by law. The Monroe County Board of County Commissioners, its employees and officials will be included as"Additional Insured"on general liability policies. 33.2 General Liability Insurance Requirements For Contract Between County And Contractor Prior to the commencement of work governed by this contract, the CONTRACTOR shall obtain General Liability Insurance. Coverage shall be maintained throughout the life of the contract and include, as a minimum: • Premises Operations • Bodily Injury Liability • Expanded Definition of Property Damage The minimum limits acceptable shall be: $300,000 Combined Single Limit(CSL) If split limits are provided,the minimum limits acceptable shall be: $200,000 per Person $300,000 per Occurrence $50,000 Property Damage An Occurrence Form policy is preferred. If coverage is provided on a Claims Made policy, its provisions should include coverage for claims filed on or after the effective date of this contract 10 i � In addition, the period for which claims may reported should extend for a minimum of twelve (12)months following the acceptance of work by the County. The Monroe County Board of County Commissioners shall be named as Additional Insured on all policies Issued to satisfy the above requirements. 33.3 Workers' Compensatlon Insurance Requirements Prior to commencement of work governed by this contract, the CONTRACTOR shall obtain Workers' Compensation Insurance with limits sufficient to respond to the applicable state statutes. In addition, the CONTRACTOR shall obtain Employers'Liability Insurance with limits of not less than: $100,000 Bodily Injury by Accident $500,000 Bodily Injury by Disease, policy limits $100,000 Bodily Injury by Disease, each employee Coverage shall be maintained throughout the entire term of the contract. Coverage shall be provided by a company or companies authorized to transact business in the state of Florida. 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 Contractor arising out of work governed by this contract claim arising out of the performance of professional services or any error or omission of the The minimum limits of liability shall be: $250,000 per occurrence and$750,000 aggregate Section 34. INDEMNIFICATION The CONTRACTOR does hereby consent and agree to Indemnify and hold harmless the COUNTY, its Mayor, the Board of County Commissioners, appointed Boards and Commissions, Officers, and the Employees, and any other agents, individually and collectively, from all fines, suits, claims, demands, actions, costs, obligations, attorneys fees, or liability of any kind arising out of the sole negligent actions of the CONTRACTOR or substantial and unnecessary delay caused by the willful nonperformance of the CONTRACTOR and shall be solely responsible and answerable for any and all accidents or injuries to persons or property arising out of its performance of this contract. The amount and type of insurance coverage requirements set forth hereunder shall in no way be construed as limiting the scope of indemnity set forth in this paragraph. Further the CONTRACTOR agrees to defend and pay all legal costs attendant to acts attributable to the sole negligent act of the CONTRACTOR. At all times and for all purposes hereunder, the CONTRACTOR is an Independent contractor and not an employee of the Board of County Commissioners. No statement contained in this 11 ` 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. N TNESS WHERE F, the panties hereto have caused these presents to be executed on the of �� 0 I BOARD OF COUNTY COMMISSIONERS L. KOLHAGE, CLERK NROE COUNTY, FLORIDA ti 0. by ' Deputy Clerk I mayor/Chairman (CORPORATE SEAL) RONALD R. SAMESS, M.D. ATTEST: By by Title: MONK E COUNTY ATTORNEY AP OVI ASr!F, Rr•T�I'n I_ AI I_ ASSISTi. T ��Ty ou RNEY -A 12 L SECTION ONE J 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: a 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. 7RU E CREEN: FEE When requested, a drug screen will n,and Lab, be performed by the physician and view) 10 panel will be either scheduled or done on a $35.00 tateRequirement walk-in basis. DRUG SCREEN: When requested,a drug screen will (Collection and Lab, be performed by the physician and I *MRO review)S panel will be either scheduled or done on a $35.00 Department of walk-in basis. Transportation R uirement *MRO REVIEW Drug screens will be forwarded to N/A Dr. Burton for MRO review. Dr. Burton will bill Dr. Samess directly for a ent of MRO review. BLOOD ALCOHOL When requested,Blood Alcohol (Collection, Lab, MRO Screens will be performed by the review) physician and will be either scheduled or done on a walk-in N/A basis. A testing facility must be available 24 hours a day, 7 days a week for Post accident, random, and reasonable suspicion alcohol screening. BREATH ALCOHOL(if When requested,may be used for available) screening. If breath alcohol screen is Positive,a blood screen will be N/A rformed. 13 I If Physician wishes to propose other means of screening method,please Provide testing method explanation and accuracy. A testing facility must be available 24 hours a day, 7 days a week for Post accident, random, and I reasonable suspicion alcohol screening. PPD-TB screen When requeste11 d,a PPD-TB screen will be scheduled and performed by the physician during the facility's normal $30.00 business hours. A PPD-TB screen will be performed with the new hire Firefighter Vh ical. HEPATITIS A When requested,a Hepatitis A inoculation will be scheduled and I performed by the physician during the N/A facility's normal business hours. HEPATITIS B When requested,a Hepatitis B inoculation(s)will be scheduled and N/A Performed by the physician during the facility's normal business hours. TYPHOID When requested,a Typhoid inoculation will be scheduled and performed by the physician during the facility's normal N/A A business hours. TETANUS When requested,a Tetanus inoculation will be scheduled and performed by the Combined Physician during the facility's normal with business hours. Diphtheria DIPHTHERIA below: When requested,a Diphtheria inoculation will be scheduled and N/A Performed by the physician during the facility's normal business hours. DOT PHYSICAL: When requested,a DOT physical will (SEE ATTACHMENT be scheduled and P Yb "B"to be completed b �°��by the P Y physician during the facility's normal $95.00 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 Physical-Thereafter,only a DOT physical is performed by the physician. Physician may also perform a urine dru screen if requested senaratei.,b 14 u� r.... Monroe County BOCC. POST-OFFER When requested,a post-offer physical PHYSICAL: will be scheduled and performed by the $70.00 (SEE ATTACHMENT physician during the facility's normal "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 County BOCC. FIREFIGHTER When requested,Firefighter physical PHYSICAL(SEE will be scheduled and performed by the ATTACHMENTS"E"to physician during the facility's normal $75.00 be completed by employee business hours. Includes exam and *Fee Also and physician). physician review of employee health includes history and job description. Respirator Physician may also perform a urine Physical at drug screen if requested separately by no additional Mon roe Co unty BOCC. charge. Also required.EKG, Chest X-ray, Spirometry, Hearing/Audiogram, Stress Test,PPD-TB screen. FITNESS FOR DUTY When requested,a Fitness for Duty $70.00 PHYSICAL(SEE Physical may be requested at any time ATTACHMENT"A"to be by the employer in the employee's 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 rmintu BOCC. RESPIRATOR When requested,a Respirator physical *$80 PHYSICAL(SEE will be scheduled and performed by the ATTACHMENTS"C" physician during the facility's normal PART I&II to be 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 SpHrometry. *See Firefighter Physical EKG Normally done in conjunction with the $80.00 Firefighter physical. 15 CHEST X RAY Chest X Ray is normally done in Physician conjunction with the New Hire provides Firefighter and Respirator physical if order to Key there is an issue with the EKG or West spiromet y results. Diagnostics. Key West Diagnostics bills County directly SPIROME'TRY Normally done in conjunction with the ($75.00) Respirator physical. All Firefighters and employees who use a respirator will $20.00 have a Spirometry when hired. Normally done in conjunction with the HEARING/AUDIOGRAM appropriate physical. May be requested $30.00 separately by Monroe County BOCC. STRESS TEST(SEE Normally done in conjunction with the Physician ATTACHMENT"D"for new hire Firefighter physical. provides explanation of services to Performed thereafter for firefighters as order to Dr. be performed by needed. Boros. Dr. physician) Boros schedules test with Firefighter. Boros provides results and bill($200)to HR with copy of results to Samess. Samess sends results via fax to HR. CHEMICAL Tests Glucose(sugar),kidneys, liver(1 Fee included PANEUCMP tube of blood drawn). in Firefighter Normally done in conjunction with the physical Firefighter Physical. CBC Test to see if Anemic; if any infections Fee included within the body; if dehydrated(test in Firefighter from I of the tubes of blood drawn). physical Normally done in conjunction with the Firefighter Physical. LIPIDS Tests good cholesterol and bad $55.00 (CHOLESTEROL) cholesterol ( one of the tubes of blood drawn) Normally done in conjunction with the 16 i a i i Firefi ter Physical. UA HP Nonnally done in conjunction with the *Included in DOT physical physical fee UA WITH MICRO Normally done in conjunction with the *Included in Firefighter Ph ;cal physical fee • The Contractor shall retain all records pertaining to this contract for a period of four(4) years after the termination of this contract. • The County, the Clerk, the State Auditor General, and agents thereof shall have access to Contractor's books, records, and documents required by this contract for the of inspection or audit during normal business hours, at the Contractor's place(s)purposes business. 4 17 SECTION ONE: COUNTY FORMS AND INSURANCE FORMS LOBBYING AND CONFLICT OF INTEREST CLA SE SWORN STATEMENT UNDER ORDINANCE NO. 010-1990 MONROE COUNTY, FLORIDA ETHICS CLAUSE "RONALD R.SAMESS M On (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 without violation of this provision the County may, in its discretion, terminate this Agreement 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." (Signature) Date:_�azi2�o10 U STATE OF: (� COUNTY OF: I 1 Subscribed and sworn to(or affirmed)before me on JY) �, �.� ,)1) (I (date)by_ - (name of afilant). He/She Is personally known to me or has produced (type of identification)as identification. NOTARY PUBLIC MY Commission No"Pubk•Btft d Fbdd@ Conan I 1 1 OD f2M 0=WT 0*VfiftdNd0yAWL ,.. w+urrrrcrnarmmup%%G�r I � m i L NON-COLLUSION AFFIDAVIT I' of the city of my oath, and under penalty of perjury,depose and say that according to law on 1. 1 am of the firm of Proposal for the project described in the Request for Proposals the adder making the Proposal with full authority to do so; and that I executed the said 2. The prices in this bid have been arrived at independently with collusion, consultation, communication or agreement for thepurpose competition, as to any matter relating to such price wi ay restricting bier 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 se Of restricting competition;and purpo 5. The statements contained in this affidavit are true and correct, and made with full knowledge that Monroe County relies upon the truth of the statements contained in this affidavit in awarding contracts for said projject. (Signature) \ Date: STATE OF: Qlc� COUNTY OF: Subscribed and sworn to(or affirmed)before me on (date)by V— A L (name of afflant). tLejfte Is Personally known to me or has produced (type of identification)as identification. p' NOTARY PUBLIC 0,48, w PAMMEIAL.PUIIAR My Commission Exp frotq ,,.SWo of Ftodde 19 .•g Mp Comm oe Nov T7. " Coop Worn 100 7373N ' l 8ondedlMauphPfatlo�INOWYAM DRUG-FREE WORKPLACE FORM The undersigned vendor in accordance with Florida Statutes Section 287.087 hereby certifies that: RONALD R.SAMESS. M.D. (Name of Business) 1. Publishes a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the workplace and specifying the actions that will be taken against employees for violations of such prohibition. 2. Informs employees about the dangers of drug abuse in the workplace, the business' policy of maintaining a drug-free workplace,any available drug counseling, rehabilitation, and employee assistance programs, and the penalties that may be imposed upon employees for drug abuse violations. 3. Gives each employee engaged in providing the commodities or contractual services that are under bid a copy of the statement specified in subsection(1). 4. In the statement specified in subsection (1), notifies the employees that, as a condition of working on the commodities or contractual services that are under bid, the employee will abide by the terms of the statement and will notify the employer of any conviction of, or plea of guilty or nolo contendere to, any violation of Chapter 893 (Florida Statutes)or of any controlled substance law of the United States or any state, for a violation occurring in the workplace no later than five(5)days after such conviction. 5. Imposes a sanction on, or require the satisfactory participation in a drug abuse assistance or rehabilitation program If such Is available In the employee's community, or any employee who is so convicted. 6. Makes a good faith effort to continue to maintain a drug-free workplace through implementation of this section. As the person authorized to sign the statement, I certify at this firm complies fully with the above requirements. (Signature) Date: STATE OF: �Pl � COUNTY OF: XN)HILL Subscribed and sworn to(or affirmed))before me on 3 (date)by (name of affiant). He/She is personally known to me or has produced (type of Identification)as identification. K1yW NOTARY PUBLIC My Commission Expires: MEtAI PUMiAR Nahn Puble.SU to of Fiore MyCWnbd n Ex*�Nov27,2011 20 c r oo 73»09 Through Nd*W Nc"Aaan .T. ..... ,,. 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 placed on the convicted vendor list.' I have read the above and state that neither Ronald R. Sanum M.D.(Contractor's name) nor any Affiliate has been placed on the convicted vendor list within the last 36 months. (SignatLi,�e) 1 � Date: STATE OF: COUNTY OF: 1 t Wlll1►9� - Subscribed EInd swam to(or affirmed)before me on ai I I (date) Y b - � (name of affiant). Ha/She is personally known to me or has produced (type of identification)as identification. NOTARY PUBLIC My Commission Expires: �y*•"" a PAMELA L.PUZR = Notary Public•Stale of FkWda • Mar E*n Nor V,1011 Conaahefon/DO 737309 ••.:• 9W4ed7h *N85Mft1NdWA=n 21 ........� �.................. MONROE COUNTY, FLORIDA RISK MANAGEMENT POLICY AND PROCEDURES CONTRACT ADMINISTRATION MANUAL Indemnification and Hold Harmless For Other Contractors and Subcontractors The Contractor covenants and agrees to indemnify and hold harmless Monroe County Board of County Commissioners from any and all claims for bodily injury (including death), personal Injury, and property damage (Including property owned by Monroe County) and any other losses, damages, and expenses (including attorney's fees) which arise out of, in connection with, or by reason of services provided by the Contractor or any of its Subcontractor(s) in any Her, occasioned by negligence, errors, or other wrongful act of omission of the Contractor or its Subcontractors In any tier, their employees, or agents. In the event the completion of the project (to include the work of others) is delayed or suspended as a result of the Contractor's failure to purchase or maintain the required Insurance, the Contractor shall indemnify the County from any and all increased expenses resulting from such delay. The first ten dollars ($10.00) of remuneration paid to the Contractor is for the indemnification provided for above. The extent of liability is in no way limited to, reduced, or lessened by the insurance requirements contained elsewhere within this agreement. 22 WORKERS' COMPENSATION INSURANCE REQUIREMENTS FOR EMPLOYMENT PHYSICAL SERVICES BETWEEN MONROE COUNTY, FLORIDA AND RONALD R. SAMESS, M.D. Prior to the commencement of work governed by this contract, the Contractor shall obtain Workers' Compensation Insurance with limits sufficient to respond to the applicable state statutes. In addition, the Contractor shall obtain Employers'Liability Insurance with limits of not less than: $100,000 Bodily Injury by Accident $500,000 Bodily Injury by Disease, policy limits $100,000 Bodily Injury by Disease, each employee Coverage shall be maintained throughout the entire term of the contract Coverage shall be provided by a company or companies authorized to transact business in the state of Florida. If the Contractor has been approved by the Florida's Department of Labor, as an authorized self-insurer, the County shall recognize and honor the Contractor's status. The Contractor may be required to submit a Letter of Authorization issued by the Department of Labor and a Certificate of Insurance, providing details on the Contractor's Excess Insu rance Pr ogram.ra m. If the Contractor participates In a self-insurance fund, a Certificate of Insurance will be In addition, the Contractor may be required to submit updated financial statements from theufu d upon request from the County. 23 GENERAL LIABILITY INSURANCE REQUIREMENTS FOR EMPLOYMENT PHYSICAL SERVICES BETWEEN MONROE COUNTY, FLORIDA AND RONALD R. SAMESS, M.D. Prior to the commencement of work governed by this contract, the Contractor shall obtain General Liability Insurance. Coverage shall be maintained throughout the life of the contract and Include, as a minimum: a Premises Operations Products and Completed Operations • Blanket Contractual Liability I • Personal Injury Liability I • Professional Liability • Expanded Definition of Property Damage The minimum limits acceptable shall be: 00 000 Combined Single Limit(CSL) If split limits are provided, the minimum limits acceptable shall be: I i $ 200,000 _per Person $ 300,000 per Occurrence 50,000 Property Damage An Occurrence Form policy is preferred. If coverage is provided on a Claims Made policy, its provisions should include coverage for claims filed on or after the effective date of this contract. In addition, the period for which claims may be reported should extend for a minimum of twelve (12)months following the acceptance of work by the County. The Monroe County Board of County Commissioners shall be named as Additional Insured on all policies issued to satisfy the above requirements. 24 INSURANCE REQUIREMENTS Worker's Compensation $ 1 000 Bodily Injury by Acc. $ 500.000 Bodily Inj. by Disease, policy Imts $ 101Bodily Inj, by Disease, each amp. General Liability, Including ; 300.000 Combined Single Limit Premises Operation Products and Completed Operations Blanket Contractual Liability Personal Injury Liability Expanded Definition of Property Damage Professional Liability $250,000 Including errors and omissions $750,000 per Aggregate Occurrand The Monroe County Board of County Commissioners shall be named as Additional insured on general liability policy. 25 EMPLOYMENT PHYSICAL SERVICES ATIACHMENT A NO OF ATTACHED S,HktTS MWICAL RECORD REPORT OF MEDICAL HISTORY Is 10,offlelfil mrW mmsdIdWcanFI=IB1use antV andrWW-"0--tyg;;=t0 wNYf I,1/sf! p•ffOM 1 NAME OF PATIENT rLasf.trot,ehabKa/ 2 IDENTIFICATION NUMBER Position I 4a HOME STREET ADDRESS-Sfloor am ROD.City r Torn Shlo,and Np[oat/ 5 EeAppMNG FACIUTV 1 " " '-• sb CICIT SWE l4d 21PCODE ri PURpOSE OF EKAMNAr*m 7 STATEMENT OF PATIENTS PRESENT HEALTH AND MEDICATIONS CURRENTLV USED fuse aagrrond peep rI rnsaary/ a PRESENT HEALTH _ b CURRENT MEDICATION REGULAR OR INTERM c.ALLERGIES#AcAra4 nswr blhrrsrol rear criminal rooda/ s -- 0 PATIENT SOCCI1PA71UN - 9 ARE YUU rclielpile RIGHT HANDED LEFT HANDED 10.PAST/CURRENT MEDICAL HISTORY CHECK EACH ITEM VE9 NO KNOW CHECK EACH ITEM vES No Do"rKNOW CHECK EACH ITEM VES NO DON'T KNOW Household contact with anyone Shorovss of Imal Bens.font or ether delormAv with nubercutoss Pern or Presuro n chost Lou of finger or too Tubrctdosq or{reserve TB lost Chrome cough P rNlul Of'Inch shoulder Blood n SOtd m of vrrn Palpdrrsn at Poll j hest ar elbow II coughing Heart trouble Rocunem back pan or env k E■coume blaedno after nhey or Kph r low blood proseun beck injury dell work Cramps in yourI a Tne ' nr Iked knee ---• Surado snompt or plans frequent nd"ernn Foot trouble SlnpwNing Stamach.liver at intestinal trouble Norw M(wV Wow corrective lenses sell bledder trouble or Perch-hnaMdny m/anftw Eve surgery to correct valrrl Osman" Epeapsy r sNlare Loeb vision in enter we Jeundree or hpNMs Car.Ill sae a or ucknesa Went a hero"ail Broken bore Frequent trouble reepr" Stutter Of stammer Adverse loocten to tsedcatan Depression or eussnra wan" Weer•bran r back auppoft Skit d�seese Lou of mall of awwaa Scal lover Tumof r g myth,cyan tArltr Nervous Double of errlr sort gheumepe foyer feeede Penoda of wltaneaoYrNea Sw~at painful lams Hemorrhoids or tocta disease PrenUabkr"with dabr"Ihm: . Frequent or mere headaches Froqua l r peal uin l cancart disease Dueness r fanning$PON Bed we"ante age I? - K.wwn therapyEve irouWeIGdney atone r Wood m umeSuper r albumin n wineAsbeerreedRecunem er iMetlrena 5eauegy ir-m—w Hod doeaseo eepo- - .. _ __Raterlt gin r o6 ofo7 wsglht tareny Done Severe toaM or gum trouble _ ErnB disorder lanrewwa bulorw Easy faepatil Snu■ips rK 1 - •- Bean told to tut down r� May Iwn to dWgc shill -__ '- - -' -- cnec pad for ak:ollol use i —_M Rhwmapam or Neatl Injury-,_ _ Sursit'sshe I Used III gal substance -_ ANhme Thyroid trouble or pater bad tobacco -t-• NSN 754000 tat a7GB Previous edition not uselso Pmwmbed by ICMR/GSA 'REV "Ti FIRMR 141 CFRI 201 9 202 1 It FEMALES ONLY CHECK EACH ITEM ySS DON'T DATE OF LAST MENSTRUAL DATE OF LAST PAP SMEAR DATE OF LAST MAMMO No KNOW PERIOD GRAM Trewsd for a rsmws daardw NIA__ N/A N/A N/A Chat"rn mweeual paver" N CHECK EACH ITEM IF YE; EXPLAIN IN BLANK SPACE TO RIGHT LIST E%PLANATION BV tTEM NUMBER ITEM YES, NO t 2 Hew veu bun raed ha wrgloymwt of been umblo to hold a lob or st&y in school became el• > i IF- a SWSMVdV to Ch rr"cela dial,wx*Vlm,oft b fnebalty to perform caRwn mefrons C Insbaey to Mato.cortm flGMrome d Other medical alum(If yes,give rtose"s) t 1 Have you ew bean treated for a mental card"anf fit free.specrly WAew,wltrr.and"sbrwb/ 14 Navo yeU ew boo"dorvod Irfe MulMulattow lit yoo,state ro ."site Allies" Aw+t ewaAa I 15 Here you had or hm you ban sw dod to how+try eperolrae ",yes desc"br and pw ago sr--tw o died f 0 e you ern on a Pa n— type a neppl y►t �Aopalwhim. I m.wh�why eM namV o/donor o rd ce•patip eddies. 17 Howe n you cadled a been treated by clewcs,prysicarr•,heelers, Ofee1N bearers vrdhn 1M Poll S Vows for Glow then mw d*#"0 IN yob gve cowwwo address at donor,hespW,C=".and vnb eve you ever &elect e1 sery p Phvwcsl mental er other roesenel of Ws.Per ebt*end mere" Aw rgoefgn 1 10 hove you Over bNn docnwgpd Iran m4l"ary gov"bell, of phYsreal,man rer laL or eg &•.eery& g/YR gret qa4 Mellon and 'YAW of dachorgA WAodlw ftMA big,GI1W then Jamleebh,jpr ""hint"of tatfebnup/ 20 Have Vow ow roaMs&a mat•pendorg,Gr hav You ever appyd for Pension at mROene•on la orrs OubAIV IN yet,tpa'cdlr whof a,"d PwMd Ay whom and what a,"ewnf,whin why.l 22 Nsw veu ever boar Aopreed with a foomne duabaay2 IN yes. 9,ve type,whare&renew dbgnesed l 21 LIST ALL 1 I codify IKSI I fiiv• �Yqor or.Means merrlrtrrod sloev M Itrvsh our 4 vormmpnt•panpwe memc"pt of ne—rrrlay medreal Heard Iw Ipepouo of f my%noo m e ey undererarro Mat labercwren of nte"nwyrr en Gevomnw"fame a punishable by line wldlof wwroo vrarll e r aIMMrGlrefl la tale arRPbYRMRt d rrvice I 24s TYPED OR PRINTED NANE�DXAMONEE SIGNATURE 24C DATE NOTE: HAND TO T!#OOCTOR OR NURSE,OR W MAK.ED ARK ELOPE"TO BE OPENED BY M Al 2PHYSICIAN Y OFFICEp OBAy", LA A I F ALL R N A I reran Male cOr"m&rl on M develop by„ efwew any ae0emnw"Mated lrafory deemed s"pglenl.end record any s gndemed Andnp+here>JOeNwt a"JWM I p p,�,�, / We; f YWd OR PPOWE6 NAME i PHYSICIAN DR EXA INEq 2eb SIGNATURE — 20C DATE STANDARD FORM 93 IREv If 4el BALK MEDICAL RECORD REPORT OF MEDICAL EXAMINATION ar!OF EXAM 1 LASTNAM!•RRSTNAME M02CLENAME 2 IDENTIFICATIONNUMS R ! 1 Position 1 NC111!ADDRESS(wnev~-MFO,Mo er eowf 341* Mf 27P O-t" S EMERGENCY CONTACT rNwr dAO+dtrtlfs dmmsfJ 0 DATE of BIRTH T A" S SEfI 9 RELATIONSHIP OP CONTACT FEMALC MALE 10 PLACE OF BIRTH I 1 RACE Nme CLACK � THAW ma AP+9C MSPNiC ASWUPACIRC 12.AGENCY I29 ORdWWT10NuwrJL f3 TOTAL YEARS GOVlRNMEN7 SERVICE a MILITARY 0 CIVILIAN 14 OFF! RAC6JTV OR EXAMINER.AND ADDRESS IS RATING ORlpE..r"OFEXAYINCR I6 PURPOSE OF E) m",%710N 1T.CLWICAL EVALUATION (c►Hell..atnlln,ealapr�wrcdw,.�.nwr nlwna.w/.Ne) It (rn.al«a1�wRr, A MIAD.rACE NECKANDSGLP mWNLMM79E•�nOfMhrLd) o PnoBTAlErwe�,owatile.q,,w,,,wJ B CARS•OENERAI(MIiFRANLCAALILS) i P T!lTICULAR JAumbry 1r>a1BJr uaelflditlffr 29 pfdaq C ORUAMS Palkrftlky) O NOSE R ENDOCRINE SYSTEM [ 9MU6E8 !G•USYSTEM F MOIliFI ANO TFtIOAT T UPPER E%TRlMITlS JS01ptp01,rallBddelobon) 6 EYlS•O#IAERAL(v'a�y U FEET rxu�.Md �"rm►arrs �U•� V LONERE7MRMITESIE III A1fq(S09f1Bp•Pon"dyf�yyf)M OPTlMWOlCpf1C I PUPILS r �� W SPINe.ONlRMUSCULOSIRItTµ J OCULAR MOTILITY(ANoc419dp9raBNI/f0f m *4yK�y INO X IDENTIFYBOOYMARKS,BCARl,7ATIpOB K LL9dGs ANO CHEST Y SIGN,LYMPHATICS L HEART(Rlfup 940.1hill pyapy 2 NEURO1.001C1Qbu6'OwmryBpuel�r,ianrH) AI VASCULAR SYSTEMM PSYCHIATRIC JS ply da1MWn)rValkodlee.ameJ N ASOOdEN AND VISCERA(afolfldrAtinNq) . S IDaacAb�f11�rYA0Aa11r11phd9w EfOarpsfrhrM,lyminrNOerOfrt>r9eadf 'oontnwfK hMI�bIIArtI 'pl0uaaaMylws/nraouecy.J 1601!NT o(PWm pppYY>Pf10ll WNW h.xpfphR@bovapONOwnunl0v YppNrdLnwr01M1 REMAR164AND _ 1 rem o DEFECTS AND� . N7AL u.... R f1 16 to L 7 2� Zx 21 20 19 to 17 r T 1s TEST RESUlTB ICOPIa9 d NIlldta a1M 111fN6nad as aRaldgnwRsl A URINALY31s (1)SPECIPIC OMVITY 12)UNINE ALBUMIN (al AUCROW..001C B C2lST 7af.RAY OR PPD IPLer;dbN�Ay1f 1fumOwandayy0 (3)WANE SUGM III NI, C&V S SEROLOpY(Splleay fay used O EKG !SLOW TYPE AND AN fe A 1 FACTOR I Ori JTE - NSN T 9a.I2a -.9 P-0—Pie 1M,SdON M 9f STANDII FARM!B(RM 10•WI ILG{ P'ow"d 1, GWO4R FptMR(41 1}TI)20 t•9 202.1 r T,,,,,,,7 ,,,,,, ,,,r, ^• �.��, ,,. �.-... NAAIC IDENTIFICATON NUfIBER IID OF SHEETS ATTACHED 20 HOGNT 21 Vii i1T 22 COLOR HAIR 22 COLOR EYlS 3 24 AND OTHER FiNpryQg 2�O1nLD 25 T2inIPEMTIIRE 2e BLOOD PREgsuREl�,.In..nrwi MELsLE tOfUM HFAVY OSESa mrnND ars RECU srs sTANOrao srs A 81TTWD S RECIIAPBENT 27 PtASENnnslnNn`.wy DIAS SENT DLS femme) aAg f3R*s) 0 AFTEREXERCISE E 2NPiS AFTER 2e OISTANTVISKIM 20 REFW1C" �IOIvr 20 CaRR To 211:11 By g x NEAR VISION LEFT 2w CORR To z1b Con TO Sr 31 HE7EROPHOR1A,4S L4Lfi s Cx If CORR To By ESO Ex O R N L H PRISM ON PRISM CORM PC CT PO u ACCCOMMOCATION �]COLQiVISION/TamUbwlane'" RIGHT LEFT tris►w.d'wa�10l� UNCORRECTED J6 FlEfAOFVISION >B NIONTNSION(Tp► yl/ CORRECTED R13NT LEFT d W'1y7j;0*ICALA1O fl� 3e INTRApCyLAq�NS1pN70 PEAFeNG f0 AUDIOMETER. RKL1T LEFLANOPSY HCMOTORIfcmaRIGHTVMN 1SSV tee SDS f000 2000 2e00 2Ss sIx foe. 2Me 2eee LEFT-NY nssv Ills ! 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I EMoLOYMENT PHYSICAL SERVICES ATTACHMENT C R for Medical Evaluation estio ' Po the employer.Ai-e-wa-m to yurwlwr»in Ste bon 1,dnJ to yutwuon 4 in Stt twn 2 of Part A,Jo not ntlurm a rntdra ad —tamnutx,n. 10 the employee:Can►atu rnaJ?(t l k-%k orw•):...................... ........ .. ..... ................................ ....]Ytw ']NJ) 1 our vMrloyvr mu%1 allow you to drawrr this yutwttonndrrn Junng rm,rmal working lxturs,t,r at d temp anJ Platp thrt r5 t onwmaent to you. To tnarntdtn your t t►nGJenttalty,your rmpk,yt-r or%uprrvtsttr must rt<tt kx,k Lit or n,u►rw)a,ur mswrrr, .out your t'mpa,yrr must loll vt,u lwtw to Jelrt,rr or%t-nd fts,yutwtu►rntmna to the lw%ehh tam profrswol-wl who will n.vw•w it. 1 fht•fitllawIng ntfonnatwm must tM-Pm%rJrJ by?wiry vmploytti-wlxt has Iven w•kr tod tt►liw.rny type of n�sPrmtur (Pk•.tw rnnt). Name:-- Job ritle: Age(to neatest years Sex(t het k t ne) 0 tittle O Randle Daher Height feet_int hew Weigh lbs. Check the type of eespiratoryou will use(yuu can t.hrt k more thtut one category} Phone number when you can be marked by the health a. O N,K or P disposdblr,nvpirator(filter-mask, ' case Pelson who reviews Nils(Include dtra code): nor?-cartndige type only). The best time to call you at this number. a. ❑Other type(for example,half-or fuU-faceprere type,Pnwilmd-air pm*in&Supplied-dir,selfiw"ned Has your employer rt hm4thing dppdratus). ee told you bow to contact the health ca pomon who w review this(d,A ck inw):0 Yes O No Have You worry a respirator. 0 Yaw 0 No whdt type(sk Part A—Seaton 2(Mandel MY) Questions 1 through 9 t+ektw crust be dnswered by every empktyare who has bern%elm teJ to use dny type of nwpirdtor (ph%v e t I%%-k"yes"or"no"). 1.Oo you cunnWly smoke tobacco,or have you smoked tobacco in the Last month? ...................................O Yes O No 2 Have you ever had any of the f0gowipg conditlons? a. Seinrrtw(fttsr ......................................................»..........................................................................................O Yes 0 No h. Drtlw9es(sugar Jistwse):........... ..... .............................. r. AlleryPr reattkins that interh,re with brc thin ............................................................_.......................................................O Yes O No J. Claustrophobia(fear of cMsr l-m plactw} ............................................................... ... .............................O Yes O No e. rn►uble SmrU .. ingotinim ............_.......................... ........................................................................................................................O Yes O No 1.Have you ever had any of the following pulmonary,or lung problems? d. ,lit+es4xws: ............................................... .................................... 7 Yt,s 17 No h. Atithma:................................. ..............................._................. t. Chntnw fin,rwhrtis: .................................................................................................................................. :]Yiw ],Vo ............................ J. Fmphyw'tnd:........................................ ..... .. ............. .............. ful+t'n uittu5: ... ............ .... .. ................................._ .... ..... ...... .... . .... ..... ....... 7 Ytw J NJ)............ ........ .... ........ .. ..... ... ..... t • Jtit ..... J Yt•s h. fhx•tnnotltam t(aullatwt'J lung): ... ,Its 'J No Nn,lu�n nbe: •• ... .. J Yty J do k \t»t lxwl nyunaw a,r.urE;rntr• .... ._.. .. .. � . J t'r� 'J Ao I I. \n) ,1h,•r ltntg prt"em that)„u'tv 1„rn told.?toot: ,t't s J Vu rr�rrrs� �tcA�eesemt t�a�re�30ot 4.Do you currently have any of the following sytnptGuw of pulmonvy or lung illness? a. Slxirtnt"of hmalh: ................................................. ... ...................................... ... .............]Yew .]No h. Shurtrrewv of tin-alh whi-n walking,fa%t on le%el gmund or walking up a%light hill or in,hire: .. ... >Ytw J No tihxrrtrn-ss of bmith when walking w r►h tithwar pi-frpk-al an 4wdnwry pace on It%e-1 grinund: .... ....]Yrs U No J. Have to%tier fiir brnath wlu-n w.rlkrnl;at your own pact-an k-ve4 hnlund:................................. .... ]Yew ' No e. Shartni-m of hroath w hre•n wa%hing or cln-.rtne,you m4f.... f. ......................... . . . . .. ........... Y4-w Surtm,%q of bwath that interfenw with our leh: . .............................................. .... >Nu .. ..............J Yew U Nu g. Coughing that pnxhuces phk'pn(thre k%putum): ........... ._..... .... .................. .. ........................7 Yes `.)No h. Couloung that wakes you twrly in this morning:..................................................... 3 Yes J No r. Coughing that ex t urs mervtly when you ary lying down: .......................................................................J Yes ] 1. Coughing up blood m the last month:........................»»............................,...... r No k. Mit-t-ang: ............................................................................................................. ......................................>Ycw U No I. 6Ylx-eiin that urtivfrtrs w ................... ..�]Yes 0 No gwith your pob..».........................................................................................».......']Yes ']No m. Chr!st pain when you bnwthre dspdy:...».................................................................................... ..r]Yrw 7 No ............. n. Any tither symptoms that you thank may be reldte•d to hung pmblems: ...............................................0 Year UM, S.Have you ever had any of the following eardiovaseular orhead pmbiems? a. Heart attack. ............................»..................».....................................»..................................... ..O Yes O No ................... b. StMAP:..............».........................................».»...........................»...........»......._...................... .....O Yes O No c. urr: .............»...........»....».....................................................................»........................................O Yes O No P. Swelling ...............».,. _._............................».......O Yes O No .............................................................. Ilin to your�or feet("caused by watkin�:. .......................»..............................0 Yeas O No L Heart arrhythnda(heat*1%%iting rtreWLuiy):............».............».....................»................................ .O Yes O No h. High Wood.other he ewoure:.... .»...».................................»..».................._...........................................................O Yes O No yproblem that you've been told about: ..........................._.....».......................................O Yes O No 6.Have you ever had any of the following caedlovasrnlar or heart symptoms? a. Fmquent pain or tightness in your chest:..................».....................»..................................... .......O Yes 0 No b. Pain or tightness in your chest during physical activity: ........................................................ c. Pain c ..........0 Yes O No >r tightness in your chest thmt u tm4e m with your F*................................................................ .O Yos O No J. In the past two years,have you notkred your lawt skipping or m6sing a beat:...................................0 Ye+q 0 No e. Heartburn or indigestion that is not Mated to eating;»............................................. ...0 Yes' 0 No f. Any other symptoms that you think may be na{atrd to heart or c in-ulation problems: ......................O Yes 0 No 7.Do you cwm.dy*rake medication for an of the following �y owing problem? a. Braathrng ur lunp probleats:».........»........................................................................ ..O Yes ❑No b. HPart trouble:........................... ...........................». (. Bkxx1 pmssue+e: .................................y........................................................................_............................_...O Yes 7 iYu J. SrfLlln'4(hls): ......................................................... ...................................._...............................0 Yr•s ]Vo »................................................................................0 Yes 7 No r L If you've used a respirator,have you ever had any of the following problems? Of yuu'vo iwwrr used a re--ptra►tir go to cluP\tMM 9) a. Eves rml.rtu+n:................................ I.. �ktn alk•rlpew or ra.hrs. ...................... ................................ .................. ... .................... .... ..':h Y'e+ ']:�1e+ ..... ................... .. ... .... .. 1 aw Vey .l. t;eaw ml wetirkrxw+ur fartiyue�: ... . ..... J Te r J\o . . .. ... ... . .. . .. . �• tither pn+hlvm that rnte,rfi•n-.with%arur n-%prrator I Entb"3 VCA W8M31 D PAIVdMM 9.Would you like to talk to the health can profs+rional who will review this yuevtionnai a about your ' .II LVNi lot(his yutwttnnd : ....................... .]lI'% „No Quv%LI tnh W to 13 Mow IIIU%I IN,LIIISWI-n-l by eery emplo)t4a Whtt has 1wen ti1'6 ted tit Uw vidwr a full-fa1t exit o tt nwplrator or a.oaf.untamed breathing apparatus(SCOA).For enlpkt%t4-,whit ha,6e barn wlet letl to uae olho-r t)fN-%ttf nwpuatom, answttnng►htwt quomiom is voluntary. 10.1lave you ever lost vision in either eye(tempoordy or pennanentlyp ........................................................]Yv% U No 11.no you cunmdy have any of the following vision problems? a. ..............................................................................................3 Ym U No b. Wow 1;1 x ............................................................................................................................................3 Yes U No t. Coker bWni.._......._........»...............................................................................................................................0 Yes Q No J. l74her eye or vision pnkk�m:...........................»..............»......_...................................................................0 Yes Q No 12.Have you ever had an in jury to your ears,,including a broken ear deem;................».................................0 Yes U No M Do you cunvndy have any of the following hearing problems? a. Difficulty hearing:..................................................................................................................................❑Yes O No b. Wedr a hearing aLL1:..............«................................................................................................_.......................❑Yes 0 No c. Any other hearing or tar prubkom:......................_.......................................................................................O Yes O No 14.Have you ever had a back ie*W.......................»......._........_.............................................................................Cl Yes ❑No 15.Do you cunandy have any of the following muwukmkeleW problems? A. Weakness in any of your arms,hands,legit,or feet:..................................................................................O Yes U No b. Back pain:..............................._................................_....................................................................................0 Yes O No t. Ddfhulty fully mooing your arms anti kW: .........................................................................................l]Yes 1]No J. Painter stiffness when you Ivan Forward or bakward at the wdlst: ................_....................................0 Ytm 0 No e. Drf&ulty fully moving your head up or down: ..........................................._...........................................0 Yes O No f. Difficulty fuUy moving your head side to side: ..........................................................................................O Yes O No g. Difficulty bvndwg at your knees:......................_..........................................................................................O Yes O Nu h. Difficulty squatting to the Iguund: .................._..........................................................................................Q Yes (]No i. Climbing a flight of slurs or a ladder cdrr)nng morn than 29 Ibs.:.............................._.........................„O Yes 0 No 1. Any other mustle or skelet d pmbktm that Interferes with using a respuattlr.......................................O Yes ❑No Pact B i%ny of Ow Wowing quwAKxw,auld other qutt%Wns not lasted,may btu added to the quttstittnnalrr at the dcst rrtntn of tit,N%Ilth CAM profesrn►Iud who%dl n-a lew the yuo%itonnatre. 1.In your present job,are you working at high altitudes(over 5,WO feet)or in a place that has lower OwnIll►rmdi atnttullis t►f ofyl:►'n:........................................................ .............. ....................................... _]1'Ir ]Nit I or tttlwr%)mptttmv wlx-n vou'nt working under t6-%v unxldutrati:........... ...... .. Q Yoe J v41 2.m wurit ur at home,have you ever been e%pomd to haranlous solvents,hatanious airbome t hemicdls (v 1; );.ewq, luoiv%.or aiu.t).I►r ha%e. lou t trine iota•hit t tmlat t all lm/ardt►u%.N-mlt ak... J,,.Nti I RESPIRATOR USE PHYSICAL 4 Name Age Sex Home Address Telephone Occupation Length of Employment I agree to the release of this information for State and Federal regulatory purposes to the extent provided by applicable laws. DATE SIGNED i ❑Follow-up Medical Evaluation Physical ENIPLOYER Required. (Positive response—Question 1-8). ❑Post-Offer Physical: Medical Evaluation Physical Required. 9.Would you like to talk to the health care professional who will review this questionnaire-about your amwersto this questformalm........................ ..................................................................................................a Y41 -3 No Questlotib 10 to 13 bt-kiw must 1-4-inswermi by vvvr'v empluyie who hw beenw6ttJ to u.%-vith-ra full-(.karmaP*jplrjtor or a%elfontjux%l bri-dthinjr,apparatus(SCOA).For empknees wlu-,have been seek%ted U)ust-other ti,res of n-sptritors,jrswering Lhtww,qua-%ttons ei voluntary. LO.Have you everlost vision In eithereye(temporarily or permartentift. .......................................................a Yes U.N. it Do you cunvndy have any ofthe following vision problem? a. Wear miitikt le-rw-g........................................................................................................I......................10 Y45 0 No b. Wear&,Aw......................................................................... .....................................................................0 Yes a NO e, ..."*-,*,-,****,*,,,-,*.....**,,-,,**,,*,,,*,**,"*,,*,*-,*,,,**-,—*,-,,.(3 Yes 13 No d, Other eye or visiun problem:...................................................................................................................a Yt-s 06%40 M.Have you ever had an injury to yoweam Including a broken eardrums..............................._............. .,..,...0 Y,,s Q No ti Oo you currently have any of the following hearing problem? 4. Dffkuky hemnl;.......__..........................................................................................................Q Yes 0 No b. Weara hearing&U- ......................................—.-.Q Yes 0 No c. Any other he%uing or ear problem:................................................. Yes Q No 14.Have you everhad a back injury:...............................................................................................................0 Yes QNo 15.Do you currently have any of the Mowing masculoskelartal,problem? a. Wealmm in any of your arum hands legs,or feet...............................................................................0 Yes ClNo b. EWA Pain:..............:...................... ..............................................................................................0 Yes QNo c. Difficulty fidly moving yourarm and leSc ......................................................................................Q Yes Q No ,1* Pain orsljfhutsss when you lean lbrward or b4ckwaxt 41 the waist ........*-----a yes C,No e. Difficulty fully moving your head up or down: ........_.........................................................................U Yes U No EDifficulty My moving your head side to sule..................................................................................—...Q Yes QNd & Dtffkulty bending dt your krwm...........................................................................................................0 Yes 13 No ILDifficulty squatting to the gmnansi.......................................................................................................QYes UNo L Climbing a flight of stairs or a ladder carrying more than 25 U:.........................................................CI Yes QNo Any other muscle or skeletal problem that interferes with using 4 respirator..................................._.....0 Yes QNo Pat a Any of the Wowing questiom anal,other questions not listed,may be added to the questionnaire A the discretion of the health care professional who will review the questionnaire. 1.In your present job,an you waddrig at high altitudes(over!LM feeq or in A place&A has lower thannormal amounts of oxygen....__............................................................... ......................................0 Yes Q No or other symptoms when you're working under these conclitiom........................................................................ayes a No I Atwo&oral home,have you ever been exposedto hazardous solvents,hazardous airborne chemicals (e.g.peen,bww%or dust),or haws you come into skin condo with huankm chemicals:..............................0 Y95 0 No ........... ............ i MCN fnA•via DIN 10UHID I Have you overworked with any of the materials orundec4ny of the conditions,liatcal be{ow: a. A,%,%(o :.......................... b. Stilt r(c,.Y.In W"lbU%tInl0............................ ......... .............................................................................J]Y++s 0 Nei CC. Tungt<•n/ud+all(a.l,},'rtrtcfinl;c�rw��41rn thrsmrG�rio{.... ................................................................0YL% 7Nu . Tun1,,hum:........ g }.........................................................._..............0 Ycs 7 No J. Aluminum:................................................................................................................................ ................0 Yes ']No f: Cmd(fi)r rxwmple,mininl;}...�..»....... _..................................................................... ...........................................7 Yes 7 Vo !;. (Ran:..................................................... ....................................................................................0 t.-s ONO h. (Co ................... ................................................................................................. Yes O No.................................................................. O»...............................................0 Yes ]Nu A. Duaty +nvuonm��nts:.._.....» I. Oth-r hazaalous 1,mpu.suns:...........................................................................................................................O Yis 0 No If"ycw,"drncr�ls+tl+ese e+rpusuns:..........................................».........................»..................._........................_...a Yl s O No i 4.List any second jobs or side businesses you have: S.List yourprevious occupations: 6.Listyourcuaentand previous bobbies: 7.Have you been in the mili"services?. If yes,,"were you exposed bo biological aWn or chaftAl agents(either in tr_niri ........................._..................... ....0 Yes O No gormmbut} ._......................_..._._.OYes ONO S.Have you ever worked on a HATIAT team?.......,�... .._................................................ ...............-..._0 Yes O No ' 9.Other?ban medications for breathing and lung problem heart trouble,blood mentioned eadierin"quationnaire,are you P�s�,and seauas (ik>rudingnva-the-��urtber •. bkQ1B any ache:medicatlons forarry reaswr a%%J ations):»_......»»...._...._................._......................... .»...0 Yes 1) If"yes."name the nkedimtions if u "'"" 0 No you know them: 10.WM you be using any of the following items with your nspirator(s)2 a. HEPA Edterx _ b. _.. ...................................................._...............................................0 Yes 0 No Canrstets(for a wmple,YrM mar................................. c. C utndges:......................................_.._............ ........................................._......._....»................a Yes 0 NO . ......................». ........0 Yes O No IL How often are you expected to use the re ph_ft(S)?; a. Escape only(no r%mok............... b. Emergency rescue only:............ »..........._............................................................................................a Yes ❑No ....»»....».......................................................................................................»..O Yes (allo r. Lass than S hours Per week ......................... ................................................................0 Ye: O e. 2 to 4 hours per NO J. Less than 2 hours per play:._.................day.»...........»... ............».._»...................................._..........._........_.............»........._.......0 Yes ONO f. Over 4 hours per day y:............................»................................................ .................. .................... . .......................0 Yes ONO »... .................. .........0 Yes ONO ��taa..:r+u 1�tAtZrq 12.During the period you am using the respirator(s),is your work effort a. Ul:ht(Ines than 2UU k,al per luwr) ....... If"y��y lxaw lun►dtHs this .............................................................................. ................ ....� pia I, ppruxl Laat dung the a%vrage shdk hie._____mins. Exinip1moN light workoffurt Jr-otting while wnting,tyrinty draAanp,,or rt,rfonning lat;ht-wA-Mbly work,or standing w hill uM-Ming a Jnll press(1-3 lbs.)ur centwiling ma.lunu.s. I•. %1"J"ratr OM w-W kcal per hourk........................................ If"ytw how lung Joes this jxv%vl last duri n theavera•r� b +bilk his.____mans. EXamplt-s of tnedivote work efhirt aria sating while trading or filiry;driving a truth or bus In urban tniffit;►unding while JnU!n&rwalang,perhirmwl;assembly work,or trarnsfcrrirng a mmit,rite"(about 3 lbs.)at trunk leswk wallung on a level surface about 2 mph or Juwn a 5-10 rtt-grade Amut 3 mph;or pushing a wheelbaevw with a lv%ivy load(about IOU tbs.)on a Itnel surface. c. Heavy(above_U'U k it!1%,r hour):......................_........................... If"yes,"how long dues this period List during the avers►e s »..«.«.....».............................................0 Yts O No b hdh this.,_,_,corn. Examples of hxwvy work are hfhng a hoavy bud(ab"00 lbs.)from the door to your waist or shuukler,workingona loading doLit.showlin&Sf uulmg while bm*Uying or rhippingcasstin walkrahg up an tl-Jegwe grade,about 2 mph-climbing stairs with a heavy load(about 30 Rm). U WM you be wearing protective clothing=4(areguipaait(other than the respirator when you've using" your eta»»..«.».._.».......».......................» _....».......»».»»..»..»...................................................O Yes 0 No prutedive t lotlhi ng and/or equipment 14L WM you be woddng urderhotconditions(kvgw ahue exceeding 77PFx............._...................»...».......... ..0 Yes 0 No I&WiU you be woddng humid c under ondIttons:»».....»........«.... .0 Yes O No 1 i 17.Desct"any special or twardous conditions you nag&ertcounterwhen you're using your respirators) (foe exarnpte,confined spaces,IffiRlindellft vlsftk I A Provide the following infewuUoq,if you know it;for each toxic substance brat you'll be exposed to when you're using yo wnsphator(sk Name of the first todcsubskrtre: Estimated ra.raimum erpnsure level per sh&- � VIG In�t-;Y/ti Dye 1MZ09 Durrtron of i,xixMuR per shift: I N.lme Of tht•'AXUnd tQXX Subst MW. I Estunj d maxunum exposure level pershdh i � 1 Duration of exposure pershdt f I I I Name of the third toxic subskner: Estimated maximum exposure level per stint Duration of exposure per stuff; The name of other toxic substances that you'll be exposed to while using your respirator: 19.DeKrIbe any special responsibilMes yodll have while using your respiotor(s)that may affect the safety aid well-being of others(foe example,rescue,sec9rityk A II a y1WtJ Ott\foal-;tUU PYcI1YCfq PLHCP Follow-Up Medical Examination eimployee MUM Copy of ncommerWAtion given to employee?O Yeq O Yo job title. ReLummend ibons shout employee use of the nspu-rtnr. l.imhations- Date of this follow-ups Reasons forfoUow-up i Actions: Need for follow-up medical evW6-ibons- Dace signed Signed Date givem i RESPIRATOR USE PHYSICAL i See Attached Job Description NAME AGE SEX i 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: a 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 S. RECOWNIENDATIONS: It is my opinion that the above named patient is is not medically qualified to wear a Respirator in the performance of Modber duties. PHYSICIAN rl r EMPLOYMENT PHYSICAL SERVICES 152®( 4tiACHMEHT� ynght C 2000 NFPA.All Rights Reserved MA 1582 Standard on Medical Requirements for Fire Fighters and Information for Fire Department physicians 2000 Edition This edition of NEPA 1582,Standard on bledant RrqubvwmU jw tinj%*Wrr and/njoneWwft fi'ART&Page Php-ans,was prepared by the Technical Committee on Fire Service Occu. j patianal Medical and Health,and acted at by the National Fire protection Association.Inc., at its November Meeting held November 14-17. 1999.in New Orleam,LA.it was issued by the Standards Council an January li,2000.with an effective date of February 11.2000,and supersedes all previous editions. This edition of NFPA 1582 was approved as an American National Standard on February 11.2000. aed Develo pment pmast of NFPA 1582 A joint mist force of members representing both the Technical Committees on Fire Service Occupational Safety and Health and Fite righter Professional Qualifications began address- ing medical requirements for fire S�ggh(�nrn in March ISM.A standing subcommittee on Med- kW Physical Requirements for Faeilgluers was crested under the Fire Service Occupational Safety and Health Committee in 1990 and was responsible for the development of NFPA ib82, This new document covered the medical requirements necessary for persons who petftim fire-fighting tasks. Medical requirements that were previously contained in Section 2-2 of NFPA 1001,Stowdard jot Aw Fighyrq>fisnmnal QuabYlkedinis,applied only to the entry level. They were deleted from NFPA 1001.Legal opinion and federal laws show that requirements set for a position must apply to anyone who would be or is in that position.These medical requirements are therefore intended to apply to candidates as well as to current fire fighter. Two categories of medical conditions were created.Categories A and&Category A repro sented conditions that,if they exist in the candidate or current Are fighter,would not allow this person to perform Bre4ghthtg operadons.Category 8 conditions must be evaluated on a castrby-case basis so that the fire department physician can determine it the medksl condi- tion in a particular candidate or current fine lighter would prevent that person from perform. Ing Are-fighting operations. Medical evaluations. medical examinations, record keeping, and confidentiality were addressed In Chapter 2.Chapter b contained the actual medical conditions that comprise the requirements. Extensive advisory and informational material was developed in the appendlxses to aid fire department administrator and fire department physicians. The committee completed its worst in January 1992,and the fast edition was presented to the Association membership at the 1992 Annual Meeting in New Orleans,Louisiana. The second edition of this standard reBeaed the numerous changes in medial technol- ogy that have impacted structural fire fighter.The technical committee was assisted by phy- sicians whose expertise covered the areas of emergency medicine; vision; hFaring; and cardiac,Pulmonary.neurolo and metabolic nary gial, k conditions, The technical committee endeavored to update six critical areas and moved some of the previous Category A text to Category 8 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- Winee also added additional appendix text in the areas of ADA requirements,explanatory material for both fire department administrators and fire department physicians,and sample physician checklist fonts. Additional explanatory material was added or enhanced to provide the user with addi- tional information regarding medical conditions whose categories were changed. These included a number of cardiac.conditiont,diabetic conditions,seisure disorders,asthma,and . therapeutic and-coagulation. I i MEDICAL RLQUIMIENTS FOR FIRE FIC"TERB,eND""FORMATION FOR FIRE DEPARTMENT pH GIC4►NS The 20M edition of this standard reflects(1)the technical commiuee'a recognition that medial technology is continually changing and (2)the wmmuttee's ego"r to incorporate tha ical technothou logy technology changes within the Standard.]ust as the committee rern logy advances,it is incumbent on the fire deparnnene to cammun ca with es fire paretnent physician changes in the essential funetioo(s) the fire department performs. Conversely,the An department physician must keep the Ore department u - est changes in the medial field. pdatd on the lat- Fire department physicians are the primary users of lf".k 1581 Committee members feel drat allowing the fire department physician were latitude in determination of a members ability to perform essential f4rnctions will assist users in enfomg the standard.Therefore the committee has changed the tide of the standard to yEpR 15g9,Slondantl err Alydtral FLquh +` stunts jar F W F.Slkrers and Injormotton fa►Rya Departmnrt Ph�mr imtc The topic of incident scene rehabilitation and accountability are included in this edition. since the Ore department physician May bilitation unit. In addition, specific areas concerning then following c e or conditions were clistance a the aAfi d or expanded.-cardiac,vision,hearing,neurological,and metabolic. ' An appendix was added to this edition comparing the requirements of this standard with X� those of 29 CFR 1910.134.the OSHA respiratory protection mtgmtbuion.[lucre ate many t►sers of both documents,and this appendix clarifies the companion area of each. , 2000 Eaout t „,,, „� 7, COMMITTEE PERSONNEL 15fi�9 Tecbnipl Conuaittee on Fire Service Oct.vpatic nal Medical and Health Virginia Bch Fire DVL VA(U) Rep.NFPA Fire Service Secuen David TX ;spills.U S.Array last.of Surgteaa Research. Deborah L l4it S. IN or ehett,I wmnce Township Fire Dept.. Kimbedy Pad boo�ss.sto.Care,all(SEI slake.City of 6ayrown Fire ls Rescue Serwe,. Rep.Indianapolis Metropolitan Professlo ail Fire TX IE1 Fighters Union Rap lndustrml Emergency Reapmpe Working Group Gor E�hL 34�'I��Emwpncv Services Group. Mery S sogodd.Yale Unrsernry,CC ISE� Anthony L Clari,I(enean Carnry Airport goad.OH IUI Rep.Fairfield Community Fit*Co.Inc. ThOtowl Cuft jr+Firemens Assn.of the Sure of Dar"G.Ste.E.iH•OMEGA.IL(SEI New York NY fUI James Sawas,Seattle Fire Dept.,WA ILI T+m"f DiAmdk Remo Fire Dept.,Nv IUI Rep.Int'I-Am".of Fire Chiefs Johm F.Iabn.N°Mmde Medical Arsoe,NY(SEI Philip C Sdedsbrarg.LsFarge Fire De Richard D.Gerkle.Jr Good Samuntam Hosprtali Phoenix Rep.Nat'I Volunteer Fire Fire D �WI ILI THra Dept..AZ Gale (E1 Robert M.Stratmps.West aktro Fire Protection District, X(RTTI afedfiex:The Exercise Science Ina.. CO(RT1 W.Iu^7 Rsosy.Penn Scam Universal,.PA(RT) Andf�Team.Tuba an ree`D Ilege of Denver Rep.Tandy Jacobs 4 Assoc. Rep.Int'1 Fire Service Tramming�ti) Frank PP.M w*,New York Vegas n"De L.Nv(U) 1 T��Cooperative Personnel Services.CA[SEI Gary L Neitsaq Tmkee (U) Teresa Wads.Santa Ana Cofte,CA[SE J NV(U) Meadows Fire Protection DutncL Dar N.Whittaker.Lockheed. Martin R Fire De Co..ID[E IIdahO Technologies eP' Pt.Tay 011icea AWt. Dacler W=ams.Phoenix Fire Dept..AZ(EI David W:D°ds°e,Loveland Fire Dept..CO f UI � Niches I S.G•L.Neilson) Thomas R.Lsbf.New York City Fire Dept..NY(U) Gil.VirBinis Eesxh FIrc Dept,VA(UI (Alt.m F.P.Mimeo) (Alt.to M.E [n) setae V.Moon.Phoenix Fire Dept..AZ(E1 (Ak to D.Williams) Stephen N.Foie),NFPA StaffLlalson p dal in µ *esslasA�p a/At 4w ale Cexstiltmr was llswllstrd an Ne ftnsi tear of Ufa rdsfssw Saw U1ar""tt'rsk7 NV lmw erranrrt A'b se c"1444aHsns i./baas at As baai yae duuatnu. NOfE; WElbership on acommitteashan not In and Of ItIeWconst1twe an endorsement Ofthe Association or anf document developed by the committee on which the member serves, cineand health Scapa This Committee shall have primary responsibWly for documeors on Occupational me:di• in the working envinsnnsext*(the fire service. s 2=91 i 1582-4 1IEDIGIL 4EQUIRE34ENt3 FOR flRt FICli7 EILS,LND IYFORbI.\1TON FOR FIRE DEPARTNElVT PFIySIt L10g Content! Chapter 1 Adednisaation . .. .... ...... . . 1582- 5 3-18 Tumors and b ign am......... t^ 1-1 Scope........ .. ........ . . Irl ant Diu 1582-10 1382- 5 S19 Psychiatric Condition. ... . . 1•2 Purpose....... ........... .. U82- 5 ... ..... 1382-11 1.3 implementation.. ... .. 3-20 Chemicals.Drugs.and Stedicanon. 1582-11 ••... 1382- S !-! Definitions... ......... ..... 1382- 5 Chapter 4 Infectious Diseases Program ... ... . IS92-11 Chapter 2 Medical Process •• iS82- 6 4-1 Infection Control Program....... 1592-11 2.1 Medical Evaluation Process....... ....... 1582- 6 4.2 Exposure Incidents. . .. 1582-11 2.2 Fire Department Roles. 1582- 6 4.3 Tuberculosis.. ... .. 1S82-i l 2.3 Preplacement Medical Evaluation.. 1562- 6 44 Inimuniration.. ,1582-11 2.4 Periodic Medical Evaluation . . ... 1582- 7 2.3 Return-to-Duty Medical Evaluation .. 1582- 7 Chapter 5 Incident Scene RehabWtation 26 Medical Evaluation Records.Results. and Medics Treatanesu ............. 1382-11 Repotting.and Contidenuality.......... iS82- 7 5-1 Incident Scene Rehabilitation ...........1382-11 Chapter S e'A and Casegiaty11 5.2 Incident Sane Safety and Health ..... ..1582-11 5-5 Medical Coadidats....... .... 1382- Evaluation and Triage of 8 Member Injuries.. 3-1 Medical Conditions Affecting Ability .....•............1582-11 to Perform., 5-4 Incident Scene Rehabilimdon Tactical Level 3-2 Head and Neck.... • 1582•- 8 Management Component.......... .... 1582-11 3.3 Eves and Vision.... 1382- 8 3.4 Ears and Hearing.... Chapter 8 Referenced PoblIca dans............. ' 3-5 Dena1. .. .. .... 1382- 8 1582-12 36 Nose,Oropharynx.Trachea.Esophagus,and 1382- 8 Appendix A Ei�laustor7bfsteciai..............lS8Y-12 i Larynx:........................ lSBY- 8 37 Lungs and Chat Wall.................. 1582- 9 APPessanx a fafetmatieo for Fire Depamt S8 Heart and Vascular System ............. 1582- 9 Pbysichm••••••••••••• .......1582-21 -- SA Abdominal Orpris and Gastrointestinal v System........ ..................... 1382- 9 Appsndis c F-eadd Switch"Fir-Ffgbefag Sl0 Genitourinary System.................. iS82- 9 1382-26 5-11 Spine.Scapulae.Ribs,and Sacroiliacloints .................... 1562-10 APPcftdix D Geidtt for Fite Department 3-12 Extremities. ................. 1SM10 Adminhisatom. .1582-26 5-13 Neurological Disorders ........... .... 1582-10 3-14 Skin. 1382-10 ApI 6 Sample Foams.. S;I5 Blood and Blood-Forating Organ ....... 1582-10 ..................IS32-33 3-16 Endocrine and Metabolic Disorders. .... 1s82-10 Appendix F Referenced Publira<dis"......,, S17 Systemic Diseases and Miscellaneous ..1582-33 Conditions........................... 1382-1 r lflee Edtim 6 I NFPA 1582 14 Defbiidmm 14.10 Approved. A�eeptabler to the itithfiriry hawngpuris- Sundard on dscuon. Medical Requirements for Fire Fighters clad 1-4,20 Authority Jtirudietion. The organization, office. or indevidual responsible Gar appnnin;equipment. Information for Fire Department Plipicians materials,an insullation,or i procedure 14-31 2000 Edidoo commence p rformwi a as.1 member m A person who hie, ode application to NOTICE 441 A+terrrdt(')fallowing the number ter letter des• wrntid pr14.4 eclude a person a from Lion. A menfunq i air member in 1i theON-a sgara a ph cgrrpli indreate�flue espl.uramry matenal on 1r lrtin or emcr rile paragraph can i,e Gxmd in.►ppendr•�. , gencv operational eminmmeng by presenung Infurmadnn an refe•rnred pnbtrnfums can be found m A significant nsk to the aafery And health of the person or otberi. Lb.tpter6and 1ppendnF• 14-5 Category B Medical Condition. A medical condition that,based on to seventy or degree.could preclude a person Chapter 1 from performing as a member in a training or emergency Adrtsizi6tration operational environment by presenting a significant risk to 1.1 Scope. the safety and health of the person or others. 14.6 Dnig. Any substance,chemical,oter-the<ounter medr 1.1.1 This standard shall contain medical requirements for cation.or prescribed medicAtion thAt could affec member,including full-time or part-time emplovees and paid mince of the member. t the perfor- or unpaid volunieen-It also shad provide information forphy- I-LT Essential fob Fuacdom Task or assigned duty that is sicans repreling other areas of fire department medicine, critical to successful performance of the job. including infecufm control and fireground rehabilitation, I4.8 Evaluadoa See Medical Evaluation. 1•1.4 These requirements areapplicable to Public.Smernmen• 14.9 Exposure lnddeuL A specific eve. mouth, or other nil,military.private.and industrial fire depatsmentorgarriradons mucous membrane, non-intact skin, or parenteral contact providing rescue.fire suppression.emergency medical services, with blood.body fluids.or other potentially hazardous materials mtagadon,special operations, and other iniectio emergenrysernces als,or inhalation of airborne pathoSensngesdon of food. borne pathogens or toxins. 1-1.3 This standard shall not apply to industrial fire brigades 14.10 Pine 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 fire rest rase Plant teams emergency organizations,or department to provide professional expertise in the areas of mine emergencyresponse occupational safety and health as they relate to emergency 1.4 porpose. services. 14-I1 Functional Capacity ErAheadoe.An assessment of the I-LI The purpose of this standard shall be to specdb mini- correlation between that individuals capabilities and the mum medical requirements for candidates and current mein- wentialjob functions ben. It also shall provide other Information department a tin regarding fire 1-L12 Health and Flue Coordinator.The person who,under department proper that amigo rite department physician in the supervision of the fire department physician,has been desig- providmg proper medical support for member. Hated by the d 1-140 The Implementation of the medical requirements out- epartment t coordinate and be responsible for the health and fitness programs of the department. Mined in this standard shall help ensure that candidates and I-L13 Health and Safety Officer. The member of the fire current members are medically capable of performing their department assigned and authorized by the fire chief as the required dudes and shall help to reduce the risk of occupger o the Utirty and health program and who performs tonal injuries and illnesses a- manager f the duties and responsibilities specified in this standard This 1-2.3 Nothing herein shall be intended to restrict any junsdic- individual can be the incident safety officer or that can also be don from exceeding these minimum requirements. a separate function. 1.3 Implementation. 14-14 Iofecdws Control Officer. The person or pesos within the fire department who are responsible for managing 1-3.1 For candidates, the medical requirements of this gran• the department infection control program and for coordinat- dard shall be Implemented when this standard is adopted by ing efforts surrounding the investigation of an exposure. an authority having jurisdicuon,on an effective date specdfed I-L13 Infection Control program, The fire departments for- by the authonty having jurisdiction. mal program relating to the control of infectious and commu- 1-3.4• When ihu standard is adopted by aJurisdicuon, the m�eral disease hazards where employees, patients, or the authority havinglunsdiction shall set a date or dates for cur- other p to en wly infectiow ma eriab in theblic could be exposed to fire departmentfluid& or rent members to achieve compliance with the requirements work environment.This program includes,but is not limited of this standard and shalt be permitted to establish a phase- to,implementation of written policies and standard operating in schedule forcompliance wtth specific requirements of this procedures regarding exposure follow-up measures,Immuni- dsrupti In order to minimize pcnonal and departmental muons, member' health screening programs and educa- tional tional programs atloo Edaton i ISg?�i %'FOI AL R&2t.IRLMENTS FUR FIRE Ffr:HTERS.1.vD INFr)HW 1nON FUR FIRE DEP%R MIErT PH1Sft.•f\�S 14 16 Medical Evaluation. The analvsa of mfurmaaon for 2.2 Fire the purpose of making a determination of medical cerdnca•the Rotas. ion.Medical evaluation can include a medical examrnanun 2•!.1 The fire department>hall have an otficulh deviulnaed 1�.17 Medical Esarmaadasi. ,�esamtnanon performed or physician who shall be responsible far guldtng,direcang,and — directed by the fire department physician. advising the members with regard to their herlrh,tieness,and nd 1-i.lg bled"Services,Em1wPIL7. The provision of treat. D.partsultaberr"u Orru in for urn.&tired by HeldNFP. I mV Srun�tanl Fri i ment—,uch as rust aid cardtopttlmonasr revuscrouan.basic p 'lam u !Xrrdrh Pn�r.Si bfrsupport.advanced kfe support•and ocher pre.hospital pro- 2.2.20 The fire department phvstci.sn shall be a licensed doc. cedures Including ambuLtace trarispartation—to panents. tar of medicine or osteopathv 14-19 Medied iv Cadged• A determination by the fire depart. 2.2.3• For the purpose of conducting medial evaluations. meet al require nwr the this smte or current member meets the the fire department pinskian shall understand the phvsiolog. medical requrrcmema of that swndarrl. Ica[and psychulogfcal demands placed an member and shall 1-1.20• Member. A person involved in performing the dunes understand the environmental conditions under which mem• i and responsibt6aes of a fire department•under the auspices bers must perform.The fire department shall provide the fire of the Organization.A rue department member an be a full• department phvsicun with a currentjob description for all fire rime or part•ame employee or a paid or unpaid volunteer,can department pwtaoits and tanks. - occupv any position or rank within the fire department,and 2.2.4 The fire department shall require that the fire depart. can engage in emergency operations. ment health and safety officer and the health and fitness coor• If" Member,Current•A person who is already a mem• dinmor ntatntsan a liaison with the fire de partment han ber and whose duties require the performance of essential to ensure that the health maintenance process(oPthecfre fire-lighting funCaons. department is maintained. 14.21 Shall. Indicates a mandatory requirement, 2.2-3 }in Physician Rates. 1-4222 SbouhL indicates a recommendation or that which is Departmentadvised but not required. 2.2.5.1 The fire department physician shall evaluate the per. !on to ascertain 14.23 StamdamL A document, the main test of which con- in this standard.the presence of any medical conditions lured tuns only mandatory provisions wing the word"shall*to indi- cate requirements and which is in a form generally suitable for 2.2.3.2 When medical evaluations are conducted bva physician mandatory reference by another standard or code or for adop. ether than the fire department physician,the evahuation shall don into law Nonmandatory provisions shall be located in an be reviewed and approved by the fire department physician. appendix,footnote,or fine-print note and are not to be con. Evsluadod sidered a pan of the requirements of a standard, 2 3• Pteplaeement Medical I-424 Tactical Level Nthagess mt Comparsent M 0. 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 of Chapter 3 em commonly known as'division.* of*sector." of this standard prior to entering into a trainingr become a member or ormin P m m tional environment asa m mg to � emergency opera. member. Cbapter Mesatl 2.3.2 The candidate shall be evaluated according to the med- 2.1 Medial Evaluation process, ial requirements of Chapter 3 of this standard to assess the 2.1.10 P effect of medical conditions on the candidate's ability to per. The fire department shall establish and implement farm as a member. a medical evaluation Process an s for candidatesd current members. 2-3.3 A candidate shall not be certified as meeting the medi- 2•l.2 The medial evalwtion process shall include preplaCe, cal requirements of this standard if the fire department physi- ment medical evaluations,periodic medical evaluations,and ciao determines that cite candidate has any Gregory, A medial condition u specified in Chapter 3 of this standard, return.to.dury medical evaltutiotts. 2.1.3 The fire department shall ensure that the medical eval• 2 a'requirements candidate Of this shall rat be certified r meeting the phy- Process and all medical sietan determines that the dean rd if the fire department r Category a uaaon evaluaaona meet aU f the requirements of Section 2.1, dilate has f stand 6 medical condition u specified in Chapter 3 of that standard 2.1.4 Each candidate or current member shall coa cooperate. u that is of sufficient severity to prevent the candidate from ocipate.and comply with the medical evaluation p process and essentalf performing.ti ns of m with oembut era without posing a significant shall provide complete and accurate information to the fire risk to the safety and health of the candidate or others. department physician. 2.1.5• Each candidate car current member shall report.on a 2.3.4.1 The determination of whether a reasonable accom• timely barn,to the fire de odation shall be made by the authority havingjuritdicuon in partment physician any exposure or conJuncuon with the fire department physician. medical condition thu could interfere with the ability of the individual to perform as a member. 2.3.5 If the candidate presents with an acute medial problem or new acquired chronic medical condition 2.1.6 The medical evaluation shall be at no cost to the candi• with the candidates ability to perform the functions ofa mem- due,current member.or other member ber.medical certification shall be postponed unal that person Z00a Ed6on �IEpu.u,PRiH'E,�,y h.0 recovered tram thla condition and preeents to the tirc hysiaan determtnea that the member h u r Gi my g department for review epeafied in(,)taper J of thte stamfrtd that f - is o con Y-a• Periodic Xfedied Evaluation, sent seventy to prevent the member from Perim ming,with or Y-t,.l The current member shall be certified annriaflh without reasonable accommodation,the eswrtual tunctions,s f , or at the request of either the fire department or the member,by health of the membep or o bar �i�tnt rial to the safety and the fire department phnutan as meeumg the medtual require- 2.4.3.1 The determination of reasonable accmmmodauan ments of Chapter 3 ot•this standard in nrder to determine that members medical abtiitr to continue participauag in a trait- sh til be made br the authonty havtnglurtAiction in conjunc. Ing or emergency operanonal environment Asa member Ariz tion with the fire department ph.saa in applicable OSHA standards,such ae 29(.FR 1910 120,•Hai- 24.4 If the current member presents with an acute dine, ardour W.ute 011" ttons and Emergency Response.'21h9(fR or recently Acquired chronic medical condition.the evalua- I JI0 134.'Respiratory Protection,'.9 Ct7i 191i)9S.-Occupa- turn shall be deferred until the member has recovered from tiunal Moue Exposure,'and 29 rTR I')IQ 10J1),'Bbs„dborne the cnnduton and presents to the tire department to return pathugens,'shall be followed, to duty 24.1.1 The components of the annual medical evaluation as specttied In 24,1.2 shall be permitted to be performed by 2.3 tO'��'K' '�E n. qualified personnel as authorized by the tire department 2-5.1• A current member who has been atment fn)m duty for phvuaan.When other qualified personnel are used,the fire a medical condition of nature or duration that could affect department physictan shall review the data gathered during performance as a member shall be evaluated by the fire the evaluation. department phnician before returning to duty. 2-f.1 2 The annual medical evaluation shall consist of the fob Y-5.Y The fire department physician shall not medically cer- loinng- , ufy the current member for return to duty if anv Category A (1) An Interval medical history medical condition specified in Chapter 3 of this standard is(_) An Interval occupational hutory, including significant present. I exposures (3) Height and weight 2-L30 The fire department physician shall not medically cer. i (4) Blood pressure tify the current member for return to duty if any Category B fl (5) Heart rate and rhythm medical condition specified in Chapter 3 of this standard is 2�4.1.3• In addition to the annual medical evaluation,the fire present'hoperformance s determined rm rtnce m a member.The fi W be severe enough to affm the department members tf 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- (1) Ages 29 and under—at least every s years men t and alternauve duty assignments or other programs that (2) Ages 30 to 39—at least every 2 years would allow a member to gradually return to full duty. I (3) Ages 40 and above—every year 2.5.49 The department shall provide as 2-Ll.4• The medical examination shall Include examination and encouragement to the member s as to his opportunity, of the following components return to Gull duty. (1) Vital signs—namely,pulse,respiration,blood pressure, 23 Medical Evaluation R and,ifindicated,temperature CoaGdeadality, Beards,Recites,Reporting,and (2) Dermatological system (3) Ears,eyes,nose,mouth,throat 2-6.1 Ali medical information collected ss part of a medical (4) Cati icramular system- evaluation shall be considered confidenual medical informa- (3) Respiratory system tion and shall be released by the fire department physician (6) C.viroinuestinal system only with the specific written consent of the candidate or cur- (7) Genitourinary system rent member (9) Endocrine and metabolic systems 24.2 The fire department physician shall report the results of (1 Neurological e uulesical systaltem system the medical evaluauon to the candidate or current member, (11) o r system including any medical condition(s)disclosed during the med- (l l)Audiometry acuity teal evaluation,and the recomteendauon as to whether the (12)Vistctl acuity and peripheral vision testing candidate orcurtYnt member is medicallycerdfied to perform (13)pulmonary function testing as a member (1 1)Laboratory testing,if indicated (13)Diagnmuc imaging,If indicated 243 The fire department physician shall Inform the fire (16)Electrocardiography,if indicated department fire chief or designee only as to whether or not the te or current Is medicall24.2 A current member shall not be certified as meeting the form as at member The specific wrtt enn consent of tithcerdfiee canndi- medical requirements of this standard If the fire department due or current member shall be re"red in order to release physician determines that the member has any Category A conftdenual medical Information regarding this condition to medical condition specified in Chapter 3 of this standard, the fire department. 2.43• A current member shall not be certified as meeting the 24.4 All medical record keeping shall comply with the medial requirements of this standard if the fire department requirements of29 CFR 1911)20,:Medical Recordkeeping.' 20tt0 9aOnih i 1384 9 MEDICAL REQUtRE.%{EYTS FOR FIRE FIGHTERS AND INFOMIATION FOR FIRE DEFARTMW PIt1SICL4..•5 r Chapter 3 Category A and Category g 34 Eats amd Heating. Medical Conditions 34.1 There shall be no Category A medial conditions. 3.1 111edkal Coodidem Affecting Ab(Ety to Perform. Cate. 34•2' Category B medial conditions shall include the fol- gory A and Category B medical conditions shag help the lowing: examiner understand the type of condition that could result In rejection or acceptance.The medical conditions listed are (a) Hearing r thatdefici m the pure tone thresholds m the organized by organ system.In the corresponding A unaided worst ear that is etplanatory nutenal,a diagnostic example is often in Appendix (1) Greater than 25 dB in three of the four frequencies with the fat.In addtunn,the rationale for the rejection is pit► a. 500 Hz seated in terms of the effect of the medical condition on the b. 1000 Hz capability of the person ro perform as a member. c. 2000 Hz t 13 Head and Neck: OR d. 3000 Hz 3-2.1 Head. (2) Greater than 30 dB in any one of the three frequencies 3-L1.1 There shall be no Category A medical conditions. a. 500 Hz r_ b. 1000 Hz 3•L1.20 Category B medial conditions shall include the fol- c. 2000 Hs lowing. AND (1) Deformtues of the skull such as depressions or exostmes (3) In addition avenges greater than 30 dB for the four fre• (2) Deformiaes of the skull associated with evidence of du- quenaes ease of the brats,spinal cord.or peripheral nerves a. 500 Hz (3) Lou 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 odds 3.2.2.1 There shall be no Category A medical conditions. (e) Severe agenesb or traumatic deformity of the auricle (f) Severe 3-Lt.2• Category B medical conditions shay include the fol. ( ) i re s syndrome a or labyr deformity of the mauoid lowing (h) Odds mediadrome or IabytinthiW ;- (1) Thoracic outlet syndrome (i) Any other ear condition that results in a person not (2) Congenital cysts, chronic draining fistulas, or similar being able to perform as a member and results in a person lesions being unable to Pau a job specific functional hearing talk rest (3) Contraction of neck muscles or a hearing in noise tell, (f) Any other neck condition that results In a person not 3-5 Dental. being able to perform as a member 3-3.1 There shall be no Category medical conditions, 33 Eyes and VWO4 3-5-r Category B medical conditions shall include the fo1- 3-3.10 Category A medical conditions shall include the fol- lowing lowing: (1) DiseasesoFthejawsorassoeiatedtissues (a) forvirvu( Ear visual (2) Orthodontic appliances Q0- acuity shall be at least 20/30 (3) Oral tissues,extensive loss binocular, corrected with contact lenses Or spectacle$. Far (4) Relationship between the mandible and manilla that pre- visual acuity uncorrected shall be at least 20/100 binocular for dudes satisfactory pastorthodondc replacement or abil- wearers of hard contacts or spectacles, ity to use protective equipment (b) Pimplier/vuton.Visual field perfornance without tor- (5) An other dental condition that results in a person not rection shall be 140 degrees in the horizontal men Car. in being able 10 perform as a member each rye. 3.6 Nase,Oropbarymst,Trachea,ENOPhaguv,and Larym 3.3 20 Category B medical lowing lowing:conditions shall include the fal- 3.6.1' Category A medical can shall include the fol- lowing- � , (1) Dtreases of the rye such as retinal detachment,progres. (1) Trischeostomy Jive reunopathy,or optic neunth (2) Aphonia (.) Ophthalmological procedures such as radial ketatotomy or repair of retina)detachment 3-6.2* Category B medical conditions shall include the fol- lowing: (3) AnyOtherrye condition that results in a person notbeing (1) Congenital or acquired deformity able to perform an a member (2) Allergic respiratory disorder 2000 E04wi C-ITEGORY A AND CATEGORY 8 MED(CAL CONDITIONS 1382_g (3) Sinussus,recurrent (f) Dyiphonta 38.2 VasewarSystem. (5) Anosmia 34.2.1 Theresh.ill be no Cat (6) Any other nose.ampharyttx,trachea,eso h • Category A medical conditions, ynx condition that results in a P a81O,or Ian 3-8.2.P Category B medical conditions shall include the fol. perform as a member or t0 Communicate effectivelyable e to lowing. (1) Hypertension 3.7 Lungs;and Cben Wafi, (2) Peripheral vascular disease such as Ravnaud's 3-7.1* Cat ,ti 3 non Piienom�. 3-7.1lowing:Category medical conditions shall include the fol- ( ) Recurrent thrombophlebitu (4) Chronic lymphedema due to lymphadenopathy orsevere (1) Active herstopeysis venous valvular incompetency (2) Pulmonary ma (5) Cob (�) Active tuberculosis se ngenital or acquired lesions of the aorta or major ves. nary hypertension (6) Oinked circulatory instabihcy as indicated by orhostatic hypotension.persistent tachvcardia,and severe periph. 3-7.2• Category B medial conditions shall include the fol. oral vasomotor disturbances lowing: (7) Aneurysm of the heart or major vessel (1) Pulmonary resecuonal surgery,chest wall surgery,pneu- (B) A eoabK vascular condition that results in a person not g perform as a member (4) mothBronchia(asthma or reactive airways disease 3 9 AbdoodoW O (3) E%evxhoraa4 chew wallagm r$aoa aed Gastrointestinal[System (I) Chroruc obstructive airwa s �hr abnorouliaes 3 9.1 There shall be no Category A conditions (5) Hypoxemic disorders 3.9.2• Category B medical conditions shall include the fol- (6) IntendtW lung dbeasea lowing. (7) Pulmonary vascular diseases,pulmonary embolism (1) Cholecysdeis (8) Bronchiectuis (2) Gasuids (9) Infectious diseases of the lung or pleural space (3) GI bleeding (10)Any other Pulmonary condition that results in a (4) Acute hepatitis not being able to perform as a member person (5) Hernia 3.8 Hart and V (6) Iefiammatory bowel disease asedsrSysxem. (7) Intestinal obstruction 34.1 Heart. (6) Pancreadtis (9) Resection.bowel 3.8.1.10 Category A medical conditions shall Include the fol. (10)Ulcer,gastrointestinal lowing. (11)Curhosb,hepatic or bdiary (1) Angina pectoris,current (12)Chronic active hepatitis (2) Heart failure.current (13)Any other gastrointestinal condition that results in a pen (3) Acute son not being able to perform the doges of member per+ardltis,endocatdltis,or myocarditis (4) Syncope.recurrent 3-10 Cisolen,gi S7etem (5) Automatic implantable cardiac defibrillator 3.10.1 Reprodued". S4.1.2• Category 8 medial Conditions shall include the fah 3.10.1.1 There shall be no Ca lowing. A medical co nditions. o'oro. (1) Significant vahviar lesions of the he �� _• Category B medical conditions shall include the foi- thedc valves art.including pros. 8' (2) CoronaryarterY direase,including history of m (1) Pregnancy,for its duration Coronary coronary are myocardial (-) Dysmenorrhes angioplasty,and similar prroocedursessurgM or coronary (3) Endometriosis,ovanan cysts,or other gynecologic con- (3) Atrial tachycardia,Rutter,or fibrillation ditions (3) Ain bundle branch bloc (4) Tesucular or epididymal tmals ovrt bundle block k second-and third-degree air. (5) Any other genuai condition that results in a person not (5) Ventncular tachycardia Ong able to perform as a member (6) Hypertrophy of the heart 3.10.2 Urinary Ste. (7) Recurrent paroxysmal tachycardia 3-10.2.1 There shall be no Cat(a) History of a congenial abnormality e6°ry A medical conditions (9) Chronic pericardim,endocarrilds,or m 3-10.2.2• Category S medical conditions shall include the fol. (10)Cardiac pacemaker or lowing• (11)Coronary artery vasmpasm (1) Diseases of the ludney (12)Any other cardiac condition that results in a person not (2) Diseases of the ureter.bladder.or prostate being able to perform as a member (3) Any other urinary condition that results in a person not being able to perform as a member 2M Ewron I 1582-lil MEDICAL REQI;IRLSIEW3 FOR FIRE FIGHTERS AND!N I' FORt1,\TIOIV FOR FIRE DEP 1RT\IE\T PMSICLlt45 3.11 Spine,Scapulae,Ribs,and S&aoWar joirtu shall be no 11!.1 There Ca o A m 3.14 Sign, eg ry medical conditions. 3.14.1 There shall be no Category A medical conditions. 3.11.20 Category B medical conditions shall include the fol- 3.14.2• Category B medical conditions shall include the fol. - lowing- i (1) Anhntis lowing (2) Structural abnormality,fracture,or dislocation (Y) Acne or inflammatory stun disease Ecze(3) Nuclriu pulpomn, herniation Of.or history of laminec- (3) Any otherdermatologie cnndition that results in the pea tomy,diacectomy or fusion son not being able to perform as a member (41 Ankrioemg spondylim (3) Any other spinal condition that results in a person not 3.15 Blood and Blood-rorming organ. - being able to perform as a member 3.15.1• Category A medical conditions sh.tll include the fol- I 3.I2 Ewsemidea, lowing: 3.12.1 There shag be no Cate o (1) Hemorrhagic states requiring replacement therapy g ry A medical conditions (2) Sickle cell disease(homouvgotu) 3.12.2• Category B medical conditions shall include the fol. 3.1i2• Category B medical conditions shall include the fol- ^- lowing; lowing; (1) 4mtt2tion of motion of a joint (1) Anemia (2) Amputation or deformity ofa joint or Iamb (2) Leukopenia (3) Dislocation ofajoint (3) POIyXytumiavem (4) Joint reconstruction, ligamentous instabilit, or joint (4) Splenomegaly replacement (S) History ofthromboembolicdisease (5) Chronic osteoarthdtis or traumatic arthritis (6) Any adter hematological condition that results in a per- (6) Inflammatory arthrids son not being able to Perform as a member (7) Anyother extremity condition that results in aperson not 3.16 Fadoerine and MetabolFe Dim derc, being able to perform as a member k3.16.10 Diabetes mellitus,which is anted with insulin or an 3.13 Neurological Dyordm oral hypoglycemic agentand where an individual has&history 3.13.1• Cate A of one or more episodes of incapacitating hypoglycemia,shall towing gory medical conditions shall include the lot- be a CategoryA medical condition. (1) Atmdas of heretic degeneuatiye 3.16.20 Category B medical conditions shall include the fol- - (:) Cerebral arteriosclerosis L evidenced lowing; episodaofneurol Impairmentby documented (1) Diseases of the adrenal gland,pituitary gland,pamthy- !3) Multiple sclerosis neurological r evidence of raid gland,or thyroid gland ofcWcW significance P years activity Progression (2) Nutritional deficiency disease or metabolic disorder withinive previous three (3) Diabetes mellituu requiring treatment with insulin or oral (4) Progressive muscular dystrophy or atrophy (S) All epileptic conditions to include simple p hypoglycemic agent without a history of incapacitating Parma. flnlited, and p dal•complex hypoglycemia otter than those with complete o control during previous ({) In a p Any er nher endocrine no be ng able tmetabolic o perform as a member reautcs five years,normal neurological examination,and deeni- `t ve statement ffoto qualified neurological specialist. 3.17 Systemic Diseases and!•f fseelianeats Coniditfoas free i 1f an epileptic member ha ge i n the a e medical r seizure- 3-17.1 There shall be no CategoryA free interval al shall From&change in the rn to a regimen, 3•l7.!• Category B medical conditiotmis�shy!Incl&13ude the foF that individual shall not be cleared for rerun to ert�ghting lowing duty until he or she has completed eve years without a seizure on the new regimen. (1) Connective time disease,such at dermuo _ and arthritis itis 3.13.30 Category B medical conditions shall include the fol- (2) Ressidaals from past thermal i jurrheumatoid a d ribs lowing.• (3) Documented evidence of a red (1) Congenital malfonnanons with recurrent p resulting residutonal l i heat stress (2) Migraine (4) An other system lc or resulting ultdual injury y systemic condition that results in a person not (3) Clinical disorders with paresis. being able to perform a a member ton,deformity,abnormal motor ac brtyacaordhna- senu iL.or complains of pain activity. °r°uhq'of 3.18 Tumors and Maltgoaot Dbeases (4) Subuachnoid or intracerebral hemorrhage 3.18.1 There shag be no Category A medical condi dons. (S) Abnormalities from recent head injury such as severe cerebral contusion or concussion 3.18.2* Category B medical condiuons shall include the fol- (6) Any other neurological condition that results in a lowing; not being able to perform as a member Perms (1) hfidignant disease that is newly diagnosed,untreated,or currently being treated. 2t100 Eaoon [,Vf 10E.VT SCENE RV EkBILIT MON,ts,0`i1E0Ir tL 1RILM(EAT I58Y-lI a. Candidates shall be subject to the prouona tit'_•J 5 of this t em d. y 4=_. All members slug be evaluated according to current b. Current memhen shall be subject to the pr sasrons of resulCDCts shag be cones mmunicated o and%Is"e�urg, Th .. e 2-11 of this standard, department plhseichan. by(2) Treated malignant disease that is evaluated on the hauls Of an Ind)sidual's current phssical condition and on the Akehhasd of the di 't••/• lrnmunirations. All members shall he Immunized cease to recur or progress. 30inst infectious diseurs as required by the authority having An$other tumor orsiaularcondtuontharesultsinaper- Jurodicuon and by 29 CIR 1'JIO 103t1 -Bli),xibnrne Father son not being able to perform as a member Bens•- The fire department ph)ucwn ship enstire that all 3.19 Psychiatric Conditiois& members are Ofered currently recomistended nnmunlz,ttsona. 3.19.1 There shall be no Category A medical condiuons 3.19.2• Category B medical conditions shall include the fol- Chapter S Incident Scene Rehabilitation lowing- (1) A history of Psschatnc condition or substance abuse 3-1 Incident Scene Rehabilitation. problem ii.t• The fire department shall develop standard operating i 2) Any other pstchsatnc condition that results in a person Procedures that outline a mtematic approach for the rehabul- not being able to perform as a member Itation of members op*r2ungh at incidents. Prosisiuns ressed in these 3-19.3 Candidates and current members shall be evaluated tion and treatment,procedures food and fluid replenishment.hment.ccrrewv rota- based on the indisidual's current condition. tion,and relief from extreme climatic conditsons. 3.20 Che d als,Dnrg%and SkAlleados. 5.1.20 The incident commander shall consider the circurn- 3•Y0.1 There shall be no Category A medical conditions. stances of each incident and initiate mitand rehabilitation of 3•Y0.2• Ca members in accordance with the fire department's standard 3- the C2ttVr 8 medical condidons shall include the use Operating Procedures and with NFPA 1561.Srandod on 8rneY Samen Incident dtanagement System, (1) Antkoagulant agents (2) Cardiovascular agents 5.2 hsddemt Seems Safety and Health. (3) Narcotics 5.2•l The Incident safety officer shall ensure that the incident (f) Sedative-hypnoda commanderestablishesan incident scene rehabilitation tacti- (5) Stimulants cal level management component during emergency opera- (6) Psychoactive agents Lions as required by NFPA 1521, Skmdmd for Frye DepeNgwu (7) Steroids SO*opkir (8) Any other chemical,drug,or medication that results in a 5-R2' Transport capable emergency medical services(EMS) 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 Chapter 4 of members.Basic life support(BLS)shall he the minimum Infecdoue Disease Program level of available care.Advanced life support(AE.S) care is preferable where it is available.4.1 Iafectit►m Control Progreso• 4.1.1 The fire depament shall maintain infection control 5.3 Evaluation and Triage of Member Injurtea.' Prognrm as delineated in NFPA 1581,Standard on fire iarpar4 5'3.1 In the event of an injury to a member during emergency MM/t!/ewon Conhof Pmg ores. operations. EMS personnel shall asses and treat the injury 4.1.2 The fire department physician shall maintain a Rayon based on operatinglocal EUS Protocol and fire department standard with the infection control officer as specified in NFPA 1581. Procedures. 4.2 Exposure Iiscidom 5.3.21 Protocols and procedures guiding E&MS providen car. Ing for All or injured members during emergency operations 4 2 1• All blood and;or body fluid n owres shall be shall be developed by the US medical director m collabora- reported immediately,and medical P uon with the fire department physician and chief %-%tied within 2 hours' exposure. Medical eassessmnt elent shall 5-4 [neidentSceneRebabilitationTac conform to current CDC guidelines tits!Level Management Component. � 4-Y,2• Ali other exposure incidents shall be reported and 5-4.1 The rehabilitation tactical level management comps• assessment provided within 24 hours of exposure, neat shall be designated per department standard operat- 4.3 Tuberculosis, Ing procedures,such as large-scale incidents,long-duration incidents.The fire department shall provide a tuberculosis moo, extremesxtremes or those associated with significant temperature i by CD ndicated by CDC program that wrap test members at least annually and as 34.2 The rehabilitation tactical level management compo- iC guidelines.Tuberculosis(TB)tesung inter. vent shall be established sn a safe environment away from the vals shall conform to current CDC guidelines. hasardotn area of the incldena zotl0 Emoon I 158'."1` �IEDIt:\l.RLt�I IRE�IE`75 FpR FIItL Fltif a rERY%%n I-Nr0R%L%rlt)N F7R FIRE DEN%RTMrNT Ft� tY$ft:LVW Ir3* The mOtIces needed at el managementr rcomponen shall include nclude an�ronment ui limit temperattire,tress.medical equipment.and adequate Appendix A Explanatory Material medical staiF Apprntirx A As not a in tM mdnt bvr it tnddwltd nr a '/ ppapnor o/this�7P{d„r4, 5-4.41 Membem shall be 31si ! /nnnatitninf prirp. Drip Tli4 npp,ni� scribed by de geed to rehabilitation as pre* rnntauar.x0j"01(mvatatrr14nam6rndio1-- ondvithdwappli, l•nusual circa tanccs inch Iong�lurandard Pauun�nctdpro sdu ties, cable bxt pwir"hL lions rehuinnq Ireavv a tertton, or severe weather e%tremes A-1-2.2 There u a direct relationship between the medical vltall require an alcerattOn In procedures. requirements and the job destnpoon of members.The Job 5-13• Member, amvtnq at «habuhtatxin shall be brteth dr'cnption should include all essenual job funcuons of m v esuond by b e N medical ens m cal vtatf'alsout % •bout emergency an � uon,heat stress,cold alas,p any s mptonts of dehvdi�, q c7' d n nemrgetic�v I►fersilsers perfottn hvsical copal -ion.and,or car. a v]nety of emergency operations including tire fighting, diopulmonary abnormaliyex•%nv member having•igniticant s mer3•:niv medical care,hazardous materials ntiygayon,and avm toms shall be special operations Nonemer P moved to an area whet r a:vessment by g�Y ditties can Include,and are advance life support personnel can be performed, not limited to,training,station and vehicle maintenance,and physi tness. Each fire 5-1.6 Members assigned to rehabilitation shall be encouraged develop fi written job descrip department fo members. identify v and to add,remote clothing to regain normal b.)dv rem %tore, dcwelo a Pexample pe emen rah bfunctio ng Functions, rovides tit p I of drink tluitla faster,eleerrolvte replacement drinlsl,and teat. es,entialjob[unctions for members, 54.7 No tnember shall be reassigned to return to duct until A-1-3.2 The speuNc determination of the authority having medical evaluation and hydration has occurred for at least Jurisdiction depends on the mechanism under which this scan. 10 m nuts in rehabilitation and after being cleared by dard is adopted and enforced Where this standard is adopted medical staff. voluntaniv by a articular fire de r its own too.the 3-4-8 AJI members entering and leaving rehabilitation shall be authority hawing jurisdiction shouldPenth[o�e chief or the tracked through the the incident management system and be del into nt Where reap nsible for ith j operation of he fire ro � personnel accountability vvstem. cgW p and cn&rced by a body having regulatory authority over a fire department. such as federal.state. or local government or Chapter 6 Referenced Publicadonsi political subdivision,this body is responsible for making those determinations as the authority having Jurisdiction,The com- pliancefollowing program should Lille Into account the services the fire enced within this standard as mandatory requirements and department is required to provide, the financial resources shall be considered pars of the requirements of this standard. available to the fire department,the availabilityof personnel. The edition indicated for each referenced mundatory docu- the availability of trainers,and such other factors aswill affect ment is the current edition at of the date of the NFPA issuance the fire department's ability to achieve compliance. Of this standard.Some of these mandatory,documents might Arl-1,l Approved, The National Fire Protection Association also be referenced in this standard for specific informational does not approve,Inspect,or cerf0y any itutau,tians,proms purposes and,therefore,are also Ititd in Appendix F. dures,equipment,or materials;nor does it approve or evalu- fi.l-1 NFPA Publicadona, National Fire Protection Associa. are testing laboratories. In determining the acceptability of uon,l Batterymarch Park,P.O.Box 9101 Quincy,MA 0°:ti9. insfalladons,procedures,equipment,or materials,the author- 9101. with having jurisdiction may base acceptance on compliance WA 1300.Standard an FF t►t NFPA and Xevlth �t stint rid Sa/.h or other appropriate standards.In the absence of Pmgmxk 1997 edition. such standards,said authority may require evidence°f proper NFPA 1321,Standard/or Fla arpvotnenr Sa/eep��1997 installation,procedure,or use.The authority having jurisdic• edition. don may also refer to the luungs or labeling practices of an NFPA 1361.Standanl on£nr%"q Savua lnnddnr,Ndro organization that is concerned with product evaluations and is mm'Systtnt,12M edition. thus in a position to determine compliance with appropriate vFP,A 1381.Stant6md on Anaparimtnt ln/eaton Gonna[pfir standards for the current production of listed items, grime.2M edition. 8-L2 U.S.Government PubGcati Ad-t-2 Authority Having Jurisdiction. The phrase'authority Publications, [:S I:ovemnunt Print- hang junsdretion'is used in hTPA documents in a broad ingoHice,Washington.DC 20401. manner,since jurudicuoro and approval a Title_i9,t",w/r a/fedna!Rr,ilddrmt.Part 1310 loll.•H trstd- their responsibilities. Where puc ,ale yctertvary.as do ous 1lasce Operations and Emergency Response,'1986 Sfi diction may be a federal,state,local.or authority Itavin less Title 29,CodtofFederadRdgulatturu Part 1910.!ht,'Respira- °then regional department or individual such as a fire chief, tory Protection."1998. fire marshal:chief of a fire Prevention bureau,labor depari- Title 1_9.CO*a/F.derd ftwwsou Fart 19 0 95, ment. or health depaent; btulding Official: electrical Donal Yore Exposure.'1980 1 't7c rtm cupa• inspector,or others having statutory authority For insurance Title:9.r„&of&4"d Rtgti4igtnt,part 191i?30,'atcdicW Purposes.an insurance inspection department•rating bureau. Recordkeeping,'19811 or other insurance company representative maybe the author- T9. iction. In many itle th gin .s/Fr'd^at�6^rk+mnr.Pert 1910 1030,'Blood• owner Orghis or herdesignated agent assumes the roleof the home Pathogeny,'I�y)g authority having jurisdicuon,at government installauans,the Zti00 Eaagn \PPENOM, � 158:-1.f commanding Officer or departmental oifkul may he the ,�.!- 311thonn having juuiadiction S 3 See Appendix D.Section 04.Lepi Con.aleratiiutb in ;•I-{.3 Candidate. In an employment context, the 1nlerr Applying the Standard. c.1na with Dbab111ties Apt(discussed in furtherdetad in A en- functional al Cep therapy, strength Ealtern t %irk he all act;, dixDiregUim that any,medical esaminationtobecond,acted ltiesthatcanbehelpful PP IUVI th t c n aciryeyailiatx]1ts.and alternate dui+are all acts• take place after an offer of employment is made and poor to the commencement of deities.Therefore,to the andemp piment �-3.2•l.i t'-it ,context,the definition of the term ean�re.i should be applied the 2.1.2follo my ry B medical conciiuom of die head ruched, so as to be erm emb rs h that requirement' r l) Deformities of the skull.such as depresswm or esoa- Volunteer members have been deemed to be employees toaea,of a de in some states orJunbdictions.'Volunteer fire departments should seek legal counsel as to their Irdal reapOmlbduies m tive equipment. Deformitie7eof the skull the c riots It 1n these mattm the members inability to properly wear protective A-14.gp Member. See Appendix C.Essential S equipment Fighting Functions, pp Structural Fire. (°) Deformities of the skull associated%with evidence of ills• cue ofthe deformities an brain. resultlin theoPotentialeral nervesfor sudden lithe A-Y•l.l See Appendix D.Guide for Fire Drparnnent.{dminir Mors• plcitation, the inability to properly wear protectise A•:-I.S Exposures and medial conditions that ahotdd be equipment.and the inability 10 communicate effectively reported if they can interfere with the ability of the lndnsdti il due to oroph Sm d absence of the bonvslubawncr of the to P�1m as a member include,but are nut 6mlti d to,the (3j Loss oforcon following skull (if associated with disease interfering with perfor• matte or tfapproprrate protecuon cannot be provided for (1) Exposures to hazardous materials or toxic wbslances the area without interfering with protectrve equipment (2) Expoatue to infectious or eonwgrous diseases and%iston).Loss of or congenital absence of the bony sub.(3} Trines or in stance of the skull can result in the inability to properly (4) Use of prescription or nonprexnpuon drugs w ea e�rc equipment and the inability to comma ni. (S) Pregnancy ely due to oropharyngeal d%3funcuon AY•22 See A v (4) •Any other head condition that results In a person not Appendix D,Section D-2,Choosinga Fire Depart. being able to perform as a member. ment Physician. MY•23 See X3-2.2.2 Category B medical conditions of the neck include Appendix B. Information for Fire Department the following. Physiciarm Appendix C. Essential Structural Fire•Fighung (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 firformed a by members.A fine department needs to provide the inability to perform work don? and j�Ph that the fire ysician with a job daeription of all posi• (_) Congenital cysts, chronic draining fistulas, or similar understand the physical and mental department physician uan can n all lesions (if lesions or underlying disease interferes with members regardless ofds Po Performance). Congenital cysts, Chronic draining frstu• for Fire a Position or rank Appendix D,Guide lam,orsu nflarlesionscan result in the inabilityto properly for ensuring that the Administrators, de artme also provides guidance dance wear protective equipment. P Peru. Partment physician b provided nicate effectively u too and al dysfuitynction. tartly this information. P �geaf (3) Contraction ofneck muscles(if it interferes with wearing A•2.3 See Appendix B. Section B-3, Guidance for Medical Of protective equipment or ability to perform duties). Ebaluations The contraction of neck muscles can result in the inabil•a.Y-3.i See Appendix D,Section D•1.Le itv to properly wear protective equipment,and the inabil• Applying the Standard 6ai Considerations in iry to perform functions as a member due to limitation of A Y4 flexibility. Appendix B, Section B•3, Guidance for Medical (4) Any other neck condition that results in a Evaluations being able to perform as a member. person not A62�•1.3 At the discretion of the fire department physician, include t Category A m an examinadon can be Performednerg ry medical conditions of the eves and vision expected from the schedu gi !-{13 Cthan would be urrent medical include the following: , conditions and coronary risk factors could mandate more fee (1) Far tnsual a� at l lax•corrected with contactleuri7e or spectacles least 20/30 binocu-quest medical ex uninauons. acuity uncorrected is at lent qp il00 binocular for wear. A-24.•.{ See Appendix B,Guide for Fire Department Ph - so of hard contacts or spectacles.Successful long-term Y soft convect lens wearers (that s, six months without a A-24.3 See Appendix D,Section D,!•Le Problem) are not subject to the uncorrected standard. Applying the Standard Cotaidelauons in lnadegwte far visual acuirycan result in the failure to be able to road placards and street signs or to see and A•2.5.1 A department should set protocols respond to imminentiv hazardous situations Of time absent from duty and/or medical c�dmg l ilia ('!) Pis en require the de uoa� degrees n the horizontalperformance e dnri c rreh department physician to evaluate a member eye. (Members cannot have Just monocular vision.) 2=Edition IiA:-11 '%It:Ut(_w,t.pEQVIRENIEvTS A)K ripE 1`10A tTIEKa LMtl t%F0 k.%LkPttl-1 FOR FIRE Utp%RT%1t,4T Pill'Ia'I 1�) cular when vs 14)m can route an suddelt ineapaeawuon lh) Severe esternal otitis,that is,recurrent lu,s of hearing when debris ts lodge d an one eye.[n adequate orcumprs can reudt in the malmliry o hear sounds of low intensity or o messed peripheral vision can result in cite folb)win:; can re Lush woiccthe from icy i ground none• riov,ill to failure to a. Failure o Perform�nb dudes and maintain visual con. respond to imminently hazardous suuauoits, tact with a partner (c) Severe a;enesis or uaumaue defurraiev of the auricle b Inabihn to maintain safety near moving objects can result in the mabihev to properly wear protective equip. C. Pour balance on uneven surface, ment and the inability to hear sounds of low inteitauvor to dos, d. Unaticcetisful performance in envirtnmenta where tingw%h voice from backgraind nose, leading to failure to vtaital cues arc critical to personal satety respond to imminently hararduus,atuacuns. AJ-3 v Category B medical conditions of the eves and►Ision (d) Severe mratoidius nr surgical deformity of the mastoid include the fallowin;: can result in the inability to property wear protective equip. the ll Diseases of the eve such as retinal detachment,pmgrer m 3ttand ices from nabili background not e.leading tali e Of low intensev or todta Nave reunopathv,or optic neunus(severe or progressive) ►e+pond to imminently hazarrloes situations. These diseases of the eye can result in the failiare to read (e1 lfenaere's syndrome or evere labyiinthius may result placards and street signs nr to see and resp4md w imml- in the potential for sudden incapacitation and the inability to v nendnend hazarfisus Situations.ons. (2) almologacal procedures such as radial keraot• perform job functions due to limitations of balance. omv .end repair of retinal detachment. With retinal "I'(ai Otitis media n or the inability, can resort in frequent episodes detachment,sufficient time (1-S weeks for radial kera• hear sounds of low iintensatvorr to tsd ungwsh voform ivork and ice from btyto tonomv and Lasak-type surgeries,three months for reti- ck- na(detachment)must hayr passed o allow srabaliizaacn ground nose,(ending o failure to respond o ammmently haz- oC visual actiem and to ensure that there are no ardour situations, cal complications. Theta ophthalmological��ur (9) Any other ear condition that results in a person not IP P Procr dures may result in the failre to be able o read being able t°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. nentiv,hazardous situations. (S) Anyothereye condition that results In a person not bang owing Category B dental medical conditions include the fol- able o perform as a member.persons with severe color vision loss will likely fail the acuity rcgwrement. (1) Diseases of the Jaws or associated tissues(those that are Formerly,color vision deficiency was lisled as a Cate- incapadtating or preclude ability to use protective gory 8 medical condition.However,it isCelt that within equipment). Means or the jaws or associated tissues most cases this condition will not affect the ability of a can result in the inability to property 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(these that preclude the ability vision deficiency nE the individual and consider the color tO use protective equipment).The wearing of onhadon. vision rercqquirements or the member's job and reach an tic appliances can result in the inability to properly wear ind)vidaaal determination, protective equipment. A K Y There are currently no hearing tests that will allow the (3) Oral tissues,e41teruive loss(that which precludes satisfac- fire department physician to accurately predict whether the tory Postorthodondc replacement or ability to use pro- Are fighter will adequately be able to perform essential Job resulrestive equipment). Extensive loss of oral trues may dunes.Joh specific hearing tests should be individualized for enttand the Inabil in the ity o to co communicate of ectively ly wear protective disc to each department and its specific jab Ain<tions.The Mowing specitic tasks can ass►st eo direct development of oropfwryngeal dysfunction. list of hearing• hearing protocols. (1) Relationship between the mandible and maxrlfa that pre- cludes (1) Understanding spoken commands•both over the radio ty o use Protective equipment. tori ant.T c replacement or abll- and while wearing SCBA i P equipment.Thb condition can result in the inability to properly wear protective equipment (-) 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 (3) Anv other dental condition that 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-34.1 Categary A medical conditions of the nose,orophar- sonablyemulated incident scene background noise and SCBA ynx,trachea,esophagus.and larynx include the following ty gush voice from inability to noiseOw cannle di oofailureutn (I) Tracheosomy A tracheostom can result in the inability y respond to imminently hazardota situations.(Sw dos 9_4 f) to properly wear protective equipment,the inabdiry to Category B medical conditions of heating include the fol• perform job functions due to limitations of endurance, lowing and the inability to communicate effectively due to (al Unequal hranng can result in the inabilityo Lxalire oropharyngeal dysfunction. sounds,leading to mnng in the result i o (2) APhonla•regardless of cause Aphonta cast result in the rescue and other localization inks,ability perform search and anal dysfunction o communicate effectively due to oropharyn• gem!dysfunction 20M Eason 771 I .APPENDIX.A ' l58!_Ig A-U-2 Category B medical conditions of the nose,orophu. 19) Infectious ythx.trachea,ewphagus.and larval include the following; dlaeases of the lung or pleural tprce. f l) Congenial or acquired deformity that interferes die (In)Any other pulmonary condition that results in a person ability to use protective e w m not being able to perform as a member acquired defortm can 9 P ens A congenital ly A-]-B.I.I Category A medical conditions of the heart and nenilor t In the inability to properly m include the following: �' wear protective equipment. War syste I=) •Alleigtc respiratory disorder(uncontrolled).Ailer,c res. (l) Angina pectoris current.Artgtna pectoris an result t^ pirawry disorder can fault in frequent episodes w'pain, frcgtient episodes or nor inability Pto the Inability to perform wont,and slat inability to fun_ Peen work, functions as a member due to lineations of ndurancce. i thee potential fries or sudden Ineap.tcitation.imprtrment.and (3) Sinusitis.recurrent(severe,requiring repeated hospital. (2) Heart failure, current. Heart failure can result In Erse- izatwns or cursing impairment) Recurrent sinusitis can quent episodes of pain or inability to perform result in frequent episodes of pain and the Inability to gressive illness leaing to functional imairment,and the perform work, (fib Dysphonia (severe).Severe dv (') inability to communicate etiecuveW sphonia can result In the � t�foesudden incapacitation. -Acute ricardlus, endocardius, or mwcardids. These nose due to oropharvn• conditions can result Infrequent epiwdes of pain or the (3) Any other nose. g� o . inability to perform work. oropharpnx,trachea.esophagus.or jar- (4) Syncope.recurrent.Recurrent syncope can result in the tnx condition that results In a person not being able to potential for sudden Incapacitaoon. perfoi In.0 a member or to communicate effectively (3) ,Lutomauc implantable cardiac defibrillator An auto- A3.7.1 Cursory.;medical conditions of the lungs and chest magic implantable cardiac defibnllator can result of the wail include active hetnoptysis,etnlaverna, ulttio potential for sudden incapacitation. tension,and active tuberCtllosis.These condstioihs mcanhre ult in the inability to perform functions as a member due to lima• cular system Category e the ollowic ng loons of the hears and vas tadons of endurance. A•3.7.2 Category B medical conditions of the lungs (I) theuc.valves.Specific cant vahrular srecommions of endat include te heart. ghe fob wall includeetthiUlowing. and chest lowing: (1) Pulmonary resectionsl surget)t cheat wall surgery,pneu- a• Aftdal s4xcau Mival stenosis h acceptable If in sinus mothorax (that is. history of recurrent spontaneous rhythm and steaosls is mild,that is,valve area>1.5 cm' pneunwthotax). These conditions can result in the or pulmonary inability to perform functions as a member due to limits. ty/rc4na�Mimtra(insufficiencytolic c 33 triers Mg, dons of strength7 b. enure!ins is acceptable if dn endurance and may result in the in sinus rhythm with normal left ventricular size and Potential for sudden incapacitation. function. (8) Bronchial asthma or reactive airways disease (frequent c• AN*stmoAr.Aortic stenosis Is acceptable if stenosis medication tax orsymPtolnscaused by exposures to exer- Is mild. that is,mean aortic valvular pressure gradi- don,heat and cold or products ofcombusdon and other ent c 40 min Mg. irritant inhalation) Bronchial asthma or reactive atnways disease can result in frequent episodes of pain or the d Aarie Aortic regurgitation is acceptable if Inability to peKorin work,the left venuicuar sue is normal or slightly increased and potential for sudden Inca• syswfic function is normal. pacitiition,and the inability w perform functions as a e' P►ortAr vislwt Prosthetic valves are acceptable unless member due to limitations ofendutance. full anticoa (3) Fibrotherax,chest wall deforms diaphragm (_) Coronary gelation is in effect I des. r1brothorax,chest q P gm abnormal!• try artery disease,including history r myocardial wall deformity, and diaphragm imfuction, coronary artery bypass st abnormalities can result in the inability to perform func- angioplasty. and similar procedures. Peersoonns at mildly dons as a member due to limiations of endurance, increased risk for sudden incapacitation are acceptable (4) Chronic obstructive airways disease Chronic obstructive for fire fighun Mild auvays disease can result in the Inability to Presence of each of the fob owing risk is defined by the dons as a member due to limitations ofendutancce.func• (5) Hypoxemic disorders.Hvpoxemic disorders can result in b.a. otmal ventricular election fraction the inability w perform functions as a member due to Normal exercise tolerance,>10 metabolic equivalents limitations of endurance. (hIETS) (6) [nterstttsal lung diseases. lntmntial lung diseases an d. Ab �eofexerclse4nducedlschemiabyexercisetesting result in the inability to functions as a member a strict of exerttse induced complex ventricular due to llmitatioma of endurance. rsh7thmias i 7) Pulmonary vascular diseases, ulmoembolism. e• Absence of hemodynamically significant stenoaa on all monary vascular diseases and pulmo emholism an for coronary arteries(k50 percent lumen diameter result in frequent episodes of pain and the inability to (3) Arlan! ^g)'ors ctasfiti myocardial ret�ylanaton perform functions us a member due w limitations of (4) Left bundle branchusecond-and th add tter.or fibrillation endurance. (81 8ronchteceuis vriulh a ifs tricul2r bock.These blocks will result in dequal ation Pulmonary function or�qu Oven- 'cant frequent impairment Bran- tri unlerate exercise an be performed with an adequate heart chiectasis can result in the inability to perform functions response They can result in frequent episodes of as a member due to limitations of endurance. Pain.the inability to perform work.and have the poten- tial for sudden incapacitation. 20M gelatin i, 1a82-LK MEUH;tt RVIL IRBIENTti rule F1Rt Fle:IITERS"D I"iFOOLt"o.Y FrnR RE F UEP%IMI �, 1 E. T PI lNSlt L1:'-5 43) Veritncular mchvcardra. V result in the potential for sudden uncap nnaon.end IA the to limitations of endurance and the enAbIltty to perform inabdiry to perform job functions due to linuunons of lob functions due to limnutiona cif balance. strength or endurance. 1%) .tneurysm of the hear or major bevel. congenital or (5) Hspertrophv of the heart Iiypenrophy of the heart can xqurred.Ast ane setup n the potential for aidden incapacitation and the result to frequent�issod f the prier or nujor vessel can Inability to rrform oh function Incapacitation dine to limitations of form work•and the Potential f es of paxidden ncaelr cci 3t per- Pthe endurance. 181 "nvother snscular condition that results in tips uti 1 17) Recurrent paroctsmal tachycardia R he"IN able to perform as a member Person nol coal rxhveardu can resent,c the current paruass. incapacitation and the salt i to potential for swiden A-3-9•2 Category B medical conditions of the abdomen d deft to limitations of strength or endurance�ob functions organs and gastrointestinal system include the foll�rvtng (d) Histury '(a congenital abnormality that has been neared l 1 Cholecystitis (that which causes frequent bvsurgery but with residual complications or that tha&reated not stones or infection) Cholec"ads can resultPatti due to been treated by surgery,leaven episodes of pain or the inability to perform orkr`�uent turns. {congenital abno g residuals or compbca- s rmalto can result in frequent (-) Castntis (that which causes recurrent pain and Impair. episodes of pain or nabibe} to perform work and the ment).C sustts can result in frequent episodes of pain or putentW for sudden Incapacitation. the nabilitv to perform work (9) Chronic Pencardius,enducardiuu.or mvoprdtas.These (3) Cl bleeding can cause fatigue. and or hemodvnamk conditions can result n the Inability to perform rib fuec- instability resulting m inability to perform wwork. tiona due to limitations of endurance. (I) :4vte hepatitis (until reaoliition of acute he (l0)Cardiac pacemaker, If the Person s Pacemakerdepen. determined by clinical esamnation and appropriate la& dent.then the risk with caden acceptable.Those with ca failure due to Tr oratory taanauma is not g)•Acute hepauns can result in frequent rdiac pacemakers can have the e (l I)Coronary pisodes of pain or the inability to perform work potential for sudden incapacitation. (5) Hernia (unrepaired inguinal or abdominal hernia that artery vasospyim.Those with cardiac artery could obstruct during du vasorpasm can have the potential for sudden incapaci- i ryc a on can result in the ration. Potential for sudden incapacitation l 1_r)Arty other cardiac condition (6) Inflammatory bowel disease(that which causes disabling that results n a person not Win or diarrhea).Inflammatory bowel disease can result being able to perform as a member. in frequent episodes of pain or the Inability to perform A-34-2.2 Category B medical conditions of the vascular work. It is a progressive Illness leading to functional tem include the following; sYs- Impairment. (1) Hypertension that is uncontrolled, (7) Intestinal obstruction (rho is recent Obstruction with requires medication Ilkehr to interfePore�wyirh the pedrCar- 9nro pi or ImP3irment).An i pain, rite ntestinal Obstruction trut o o�result n fre. mane of duties.Acceptable hypertension Is a blood Ares and the potential for sudden incapaciratioPnesEorn work sure less than 180/100 and no target organ dame (8) Pancreatitis Hypertension isa progressive illness leading to functional ) Pancr dds can res(that is, rult n recurrent o uent m�ides of imp the mint (2) Peripheral vasculard ease.such as Ray n incapacitatie.on. pain or the inability to perform work episodes of non,that Interferes with perfornaesc�d fja or (9) Resemanct of.bowel(if frequent diarrhea precludes perfor- the individual likely to have significant risk of seven episodes d oin orbowel resection can result in frequent injury.Peripheral vascular disease ease resins m frequent (l0)Mier, s of pain or the inability Perform work. episodes of pain or the inability to perform work and the trolled by drat ors (where symptoms are uncon. inability to perform functions as a member due to limit:v. rains in frequent episodes of p gastrointestinalain or the ity o P an eons of endurance. (') Recurrent ehro form work. mbophlebitis.Recurrent thrombephlebi- (1 1)Cirrhosis,hepatic or biliary(that which is symptomatic or to can rains in frequent episode of pain or the inabtliry in danger of bleeding),Cirtfioss can result n frequent .1 perform work and the ono of a eo perform functions as a member due to limitations of endurance pisodes of Pain or the inability to perform work. (41 Chronic lymphedema due to JYdura ads or severe (1_)Chronic active hepatitis. Chronic. active he venous valvular incompetency.Chromic lP y result m frequent episodes of pain or the inand1ti o pit result n the inability to perform functions asa member form work. 9 PeM1 due m limitations of endurance. (13)Any other gastrointestinal condition that resulm in a per- (5) Congenital or acquired lesions of the aorta or major yes- son not being able to perform as a member. sell,forevample,syphilitic aoruts,demonstrable uhero A-3.10.1.2 Cate sclerosis that interferes with circu(auon,and con organs include die fo5 medical conditions of the reproductive acquired dilatation of the aorta Congenital or acquired (1) lesions of the aoru or major vessels can result In the Banc' Pregnancy can result in frequent episodes of potential for sudden incapacitation and the inability to pan or the inability to perform work;perform job functions due to limitations of endurance r to Perform work due to limitations ofenmmrve nabil- ( ) Marked circulatory nstabili ss orthostatic rbthryor svength: and the inability to proP�edr�yflietat 6 ty hypotension.persistent eachrcardia,i and severe era h. ' Protecuve eral vu omotor disturbances.Marked circulatory tnstabil- equipment($ir Bd i,�ucriw.) P P (-) Dysmenorrhea that leads to recurrent incapacitation. it)can resole in the Inability to perform job functions due DYsmenorrhea can result in frequent episodes of pain or the inabtliry to perform wont. 2aoa Editsm _ a �rrEvutx � 1 ig2�l i (3) Endumetrious,ovarian cysts,oruther gvnec0lul,�c condt- tions (severe. leading to re tncapacitAtionl dt,lncaunn. It ring a of Endontetrwsu.ovanan exclude a person.Dnlncatoni�ira J,nnc caoll I' n r ult�� dltions can result m f tea'and other gynecologic inn- inability ro tequent episodes of pain or the Perform functions as A member due to inability to Perfore work. tuns of strength or ne.ihiltty (1) Testicularorep,dld�mal mass(that which regtures tined'• (4) Joint econ,trricuon. It Cale,aluation) At0ticularoreptdtdymalma,s can readt feplacemunt. In ca.,es Where rKurr,.nttetl��itv. residual In frequent episodes of pain or the inabdrty to pert:wm ual limitation of motion rrf a degree to Interture with success. "9rii Thu u a progressive illness leading to functunal ful And,ale performance of tint•pghunq dunes.surges• Impairment. for a torn anterior cnicrate 11••mment cntild d' (3) Anv other genital condl non that results in A isgtialrfv it person not gtwdncep atrengrli is nut nor:n.11 or it'the knee Is being able o perform as a member. del clops pain or sr,elhng when itre�,ed LZx or ,11.3.10 2.2 Category B medical conditions of the trrinary iss• thin`of die joint can result,n the inabilito sperform tem include the follow-,ng t'uncaon%as a member due mitatans of stun (i) Diseases of tfie kidney requiring diahsis. Due flexibility to li gth or Diseases of the ISI t-hrontc oateoAitliritu or traumatic anhnas tin tasty kidney can result in frequent episodes of pain sir the where recurrent exacerbations leads to Impairment) inability to perform work Kidney disease is A progressne Chronic osteoarthrith or traumatic arthnas Lan Illness leading to functional Impairment. trequent episodes of pain,the inabthiv to result in (2) Diseases of the ureter, bladder,or prostate that require And the inability to perform hinctuns As a member ue frequent or prolonged treatment. These diseices can to limitations of siren th, result in frequent episodes of n (nil EnAammatory arthritis(ill cueswhe a its se%ernce.Or el'recur- (3) Anv other urinary condition that results in a rent or a progressive illness or soh deformity or hmita. person not moo of Hoge of motion of a degree to in being able to perform as a member with r. successful and safe performance of lire-lighting dudes). A-3.11 2 Category B medical conditions of the spine, sca u• Inflammatory arthritis can result in frequent episodes W.nbs,and sacruillacioinrs include the following- P pain. the inability to perform work.And the iats,o (I) Arthritis that results in rogrimpairmentg perform functions as a member due to limitations of non of movement.Art!ro is aye or limita. strength.endurance,or flexibility: leads to functional Impairrnent,Uthnwssive illness thatcan result n the (_) 'may other extremity condition that results in a inability to perform funcuons as a member due to limits• being able to perform as a member. person not sons of endurance or flexibility. A-3.13.1 Category A medical conditions of a neurological (2) progressive or recurrent ity. haccure or dislocation that is a nature include the following progressive or recurrent impaitrtient.These conditions (a) ACWZS of the heredode enerative e. are progressive illnesses leading to functional impair• heredodegenerauve ape can result in the inability to perform ment.These Illnesses can result in the inability to per• functions a member due to limitations of pe.AA�as of the form ftmcuons as a member due to limitations of strength or Aembiliry. (b) Cerebral arteriosclerosis as evidenced by documented (3) Nucleus pulposus, herniation of,or history of laminec• episodes of neurological impairment.Cereb Wary dscecwm siscan on a or fusion. yew rteriosc Y sion. lc in the lero. e in ability a These conditions tie pro- due to hmitations of strength sail/or bola functions ass member gesslve illnesses leading to functional impairment and the inability to properly wear protective equipment. (c) Progresswe multiple sclero,u a multiple sc4rosb with M) Ankylosing spondylius.This condition can result in the evidence of progression within previous three silt inability w rform functions as A mein sclerosis can result ye Auld le bet due to limits. It in the inability to perform functions as a lions of en urance or Ae:ibiligc member title to"MII2uons of strength or Arcibi)irn (S) Any other spinal condition that results in a person not being able to perform as a member. uonean result wve tucular the dystrophv or atrophy This condi- X3•12 2 Category B medical conditions of the extremities ber due to limitations of strength and/or balance.erform ns as a mein• include the following; (e) Epileptic conditions.After a provoked seizure,with the (!) Gmltauon of motion of a joint of a degree to interfere precipitant identified and alleviated.with subsequent with successful and safe er CT or 111Ri scan,normal EEC,normal neuroloica Min free duties.The limitation of motion performance cytrc g�imn ofrecurrence mthout medicatiod forone year.andwith defin• I the inabilityto hive statement from a qualified neurolotpcal,pecrAl(st,a mem. perform functions 23 a member due to ber can be cleared to return to duty limitation of llettibiliry, (2) Amputation ordeformiryofajnintorhmbofadegreeto A-3.13.3 Category B medical conditions of a neurological interfere with successful and safe rlimbofadrmance of fire. tighangdudes The amputation or deform itvofAJointor nature ICongental nclude the malformations(that is,severe limb can result in the inabilityto perform functions as a formations that interfere with the ability tow r member due to limitations off sire vascular mal- (3) Dulocauonofa oint.Rec gtcation fajonee. equipment) Congenital malfrsrirlauons an cult in the J went dislocation of a de or inability to properly wear protective egwpntent ctive dislocation with residual limitation uFmo�ion ofa degree to interfere with successful and safe Perforntanceoffire- (b) Migraine(that is. recurrent,with Impairment uncon• fighting duties.successful surgery for recurrent shoulder trolled).Migraines can result in frequent rplsodes ofpain or the inabilin,to perform work 20M EQAen moon i lSt1'=-1 Y M[DU_1L RE41,11.111VAIErTS F(3R FIRE Ff';IITEP.3 VsD IYF0R.%I.%Ti()N FOR FIRE 0kP%Rh1k VT Plf1SI LINs (c) Clinical disorders with paresis,paralvs)s,dvscnordina. (1) Any other hematolugual cundauun that results in a uon,deformity.abnormal mutoractrvtty,abnurmaittyofsema• person not being able to perform as a member. _ uon, or complaint of pain (progressne or severe) These disorders air progressive illnesses leading to funcuonal A-3.16.1 r�egory A medical conditions impairment of rnducnnrimpairmentTliev can result in rrwbibty to perform font- metabolic c6orders include diabetes mellitus that is tre and ated nuns is a member due to limitations of strength,ikxtbility,tar with ilisulin or an oral hvlroglycemic agent and that includes a balance. history of une or more episodes of incapacitating h Id) Subaraehnoid or mtracerebral hemorrhage. ventled mta Diabetes mellitw can result in the potential)for utiden either Clinically Of hp laboratory studies.except for those cor- incapacitation rected with ven ieattun by laboratory studies and report Of treating phvsncian. Subarachnoid or intracerebral hemur- A•3-16.2 Categoiv B medical conditions of endocrine and rhage is a progressive illness le•.4n; to functional impair- metabolic disorders includes the following: ment. This illness can result in the potential for sodden (a) Diseases of the adrenal gland,pitWLu)gland paratliv. incapacitation. fold gland,or thvroid gland of clinical siyauticance(that is. It) Abnormalities from recent head Injury.such as severe avmptomatic and poorh controlled) These diseases can result s cerebral contusion or concussion. The abnomuligi can in frequent epbodes of pain, the inability to perform work, result in the potential for sudden incapacitation, and the potential for sudden incapacitation. - (f) Any other neurological condition that results In a per- (b) Nutritional deficiency disease or metabolic disorder - s')n not being able to perform as a member (where clinically significant and not correctable replace.A•3.14.2 C:ategon B medical conditions of the shin include men,therapvorothermedicanon) NutritonaldeEiyice clL, the following• ease or metabolic disorder can result in frequenr episodes of (a) Acne or inflammatory skin disease (if condition re- pain or the inability to perform work. cludes good fit of protective egwpmrnt, such as P (C) Diabetes mellitus requiring treatment with insulin or piece,or prevents shaving).Acne ip inQ t. such vs�Face oral hypoglycemic agent-Diabetes mellitus can result in epi- can e.or n theinabilityisvi to properly wear protective kin disease fob of Pain or inability,to perform work.it a a progressive (i p equipment. illness leading to functional impairment and can result in the (b) Eczema f broken skin results in impairment from potential for sudden incapacitation. Isonal nfections or pain orinterferes with seal between skin and per- (it) Any other endocrine or metabolic condition that episodes o pain r thetInability to P arf�wworrresuk in frequent results in a person not being able to perform as a member. (c) Any other dermaeologic condition that results in the A-3.17.2 Cate B medical conditions person not being able to perform as a member, and miscellaneous conditions include the followinng: diseases A4.13.1 Category A medical conditions of blood and blood- (a) Connective tissue disease,such as dermatomyositis. forming organs includes the fallowing lupus eeythematosus.scleroderma.and rheumatoid arthrf- (a) Hemorrhagic states requiring replacement theca cis(wheremanifestedbysystemicimpairmentorlimitations lion etpm o von c stabrand's py ofmotion).'�se connective(issue diseases are progressive hemophilia).These hemorrhagic disease, can resulttoop Illnesses leading to functional impairment and the inability episodes of pain or the inability to perform work.infrequentfl function as a member due to limitations of strength or (b) Sickle cell disease (homo its . flexibility. disease can result in frequent episodes of pain or the iinabcility to per. (b) Residuals from past thermal injury(for example.frost- form work and the potential for sudden incapacitation. bite resulting in significant symptomatic discomfort).Residu- 6 from A-4.1&2 Category B medical conditions of blood and blood. Perform functions as thermal member d result limitations ofStrength. forming organs include the following endurance,or flexibility. (a) Anemia (in cases that require regular tramfusions). (C) Documented evidence of a redis sition to heat Anemia an result in frequent episodes of pain or the inability stress with recurrent episodes or resulting residual injury. A to perform work Mena 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 rune- (d) My other systemic condition that results in a person tonal impairment. not being able to perform as a member.(c) Polycvthemu vera (where severe, requiring trear- A,.3.1&2 Calegory B medical conditions of tumors and malig. menti PolKYthemia vera can result in frequent episodes of porenual for suds ^ant diseases can include the following pain or the inability to perform work and the flees Incapacitation (d) lenom I (a) The medical evaluation of any person with malignant Sp ego y(where the spleen is susceptible to nip- disease that is newly diagnosed.untreated.or currently being cure from blunt trauma) Splenomeilaly can result in the treated will be deferred. potential for sudden incapacitation. rion with treated (e) History of thrombeembolu disease (that is, more aced Any asseed on that person'srcurr et physical condition aarittlame should be nd on than one episode or an underlying condition) A history re the likelihood of that person's disease to recur or progress rhromboembolie disease can result in the potential for so Of d.den incapacitation. (b) Any other tumor or similar condition that results in a person not being able to perform as a member. 2000 Ed"n -4PPE,"iDIX A 1982_19 A.1l9.! Gregory B medical conditions of a pspchiatne a MTV include the following (a) ,� b• patita B surface Antibody (HBsAb), if not pry. substaw abuse with a history of a psyc(n(atr(c concituoa or ly known to be positive problem should be evaluated based on that c. HePadto B surface Antigen(HB.sA ),if not penon's current condition. Psychiatric conditions and sub• known so be positive HBsAb g previously "ranee abuse problems can result in frequent episodes of pain d. Hepatica C Anub or the Inabdm to perform work and the Potential for sudden a If HN prop o�(HGkb) incapacitation.These conditions are progressive illnesses lead. should be d hYis is to be given,the following tests to hirietional impairment one•. lb) Any other psychiatric condition that results in a person I CBC not being able to perform as a member. 2. Clucose,renal and hepatic chemical function i3.2 Gregory B medical conditions concerning them,- (4) L.uting of testing to be done on source patient.Including drugs,and medications include the following- the following: (a) Anticoagulant agents such as coumadin can be permit- a. HIV red if the anucoagulased state is controlled such that the pro- b HII Ag thrombin time or hJR has been in the therapeutic age on a c. HCAb stable medical regimen for at least one month and that no (S) If source is available,intetmew for HIM.HepB,and HepC other coesnting conditions would either contribtue to a risk/statts. bleeding diathesis or by themselves preclude certificire c for full duce Andcoagudant agents can result in frequent cation on o (6) Determinationmbarcoup of risk and need for PEP of pain or the inabdity to perform work,as well as the potential (7} Member counseling regarding PEP medication(s) and odes for sudden incapacitation. p° _ side effects of treatinerit.A printed fact sheet should be (b) Cardiovascular agents(for example.anti avallable for the member to review can result in uem episodes PI hyplity to yes) (8) If PEP prophylaxis is to be given.it should be done as fieq l��da off pain inability to per- soon as possible after the incident.preferably within 2 form work,as well as the incapac(ation. hours. (c) The use of narcotics can result in"Item episodes of (9) Members on prophylaxis need to be followed(preferably pain d the inability ti perform work,as sMe(I a the potential by an ED specialist)for the duration of their treatment. for sudden incapacitation. (to)Assessment of tetanus status and administration of dT (d) The use of sedadve-hypnotics can result in frequent booster,it appropriate episodes of pain or the inability to perform work,as well as the (L 1)Assess HepB status potential For sudden incapacitation. � (e) The use of stimulants can result In a If on titer, 0furImmunizedhtr with a positive posrimmuni• Of pain or the inabili to frequent episodes radon titer,no further treatment is needed ry perform work,as well as the potential for sudden incapacitation. p° Is. If previously immunized, titer was negative. and (� The use g source is HBsAg positive or high risk,give Hepatitis B psychoactive agents can result in frequent Immune Globulin(HBIG)as soon as possible—pref- episodes of pain or the inability to perform work,ad well as the etably within 24 hours— potential for sudden incapacitation, and a dose of Hepatitis B vacdne. pain or the inability to perform work, (g) The use of steroids can result in frequent episodes of c. Erpreviously Immunized and deer is unknown.draw aperson not being able to perform as a member is included user. (h)Anyother chemical,drug,or medication that results in L. If titer is positive,no further treatment is needed• k in this group. 2. ff titer is negative and source is HIlsAg positive or high risk,then give Hepatitis B Immune Giobuhn A42.1 Physicians who care for members need to be familiar (HBIG)as soon as possible—preferably within and keep uPio.date with the most current recommendations 24 hours—and a dose of Hepatitis 8 vaccine. for post<trpostue Prophylaxis (PEP) for bloodborne atho- d If Previously immunized with negative deer and rerac- 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-1 month later, This should be based on the following dements; e- If new immunized,give HBIG and begin Hepatitis 8 (t) Fact sheet that explains inlay language the risks of infer- vacelne series.p instructions should include the following lion, the various prophylactic and therapeutic options, (I2)Fol(owri the testing and follovwp that will be needed and recom- a. Adverse events and side effects of PEP meddations for Persona( behavior(i.e.,safe sex, blood b. Signs and symptoms of rctioviral illness(fever,aden- donation,and so forsh)following an exposure, opathy,cash) (2) Classification cable to determine the exposure type and c. Appointments for follow-up blood work,including the � recommendation for prophylaxis.Current recommetuda- following: dons of L'S.Department of Heald,and Human Services. 'I. HIV at 6 weeks,3 months,and 6 months Centers for Disease Control and Prevention,and Public Health Services 2. HBsAb and/or HCAb at 6 weeks,3 month.and 6 (3) Listing of testing to be done on exposed member,includ- monk'if source is HepB and/or HepC positive ing the following- 3. Every other week CBC,renal and liver function.If receiving PEP 2000 Eosori 1582=1) %lEDIC-kL PXVIRESIE`TS FOR FIRE FIGHTER,]C,,O t,%FORSLLCipN FOR FIRE DEP 1RT.%IE--T Pln,5lrJ.%.%S A-i•=.: R»t-expipure prophylaxis may also be indicated Mr ,the tollowmq dise.ue or long-duration Incident.Medical evaluation and ire (11 Diphtheria atment (n she on-scene rehibdttatton area should be conducted (2) Hepatitis A according to emergency medical sernce (E.%lSl protocols (3) �lemngrw developed by the fire department in Consultation with the fire 14l Pertusiis deParonent phimcian and the EXIS medical director. If (3) Rabies advanced life support I A(-S)personnel are available,that level (6) VSnceUa Zoster of E.45 care is preferred "3-1 An A442 Weather Lctors during emergency incidents can annual TS program should include the following: impact aevereh on the safety and health otmembers.w are (1) Documentatiiin of a nwo ste u ruve operating during extremes of heat or cold.Where these fac. I PPD)prior to this PPD or a 0-mm PPD within they oat ton combine with longduraaon incidents or satuauons that I sear P regture heavy exertion,the risks to members increase rapidly. (2) Placement of PPD and rncading by a trained.dex cited The tine department should develop procedure,in consults. reader within ill hours to i'_hours of p(acemen gnat d tion with the Are department physician,to provide relief from ben with a history of punitive PPD should All out a ties• adverse climatic conditions. tionnaire. q The following are typical rehabilitation considerations for (3) PPD resides should be documented in millimeters(mm). operations during hot heather extremes: A test with no Awn reaction should be recorded as 0 min (1) NfrMng fadgaed or unamgned members away from the (i) A PPOskin test will be considered positive if the following hazardous area of the incident conditions are present: (2) Removmq personal protective equipment a. Greater than S mm in someone who is Immunosu (3) Ensuring that Personnel are out of direct sunlight prated p- (4) Ensuring that there is adequate air movement over per- b Greater than 10 mm in someone with a normal sonnel,either naturally or mechanically immune system who Is at risk forconversion due to an (a) Providing members with fluid replenishment.especially exposure water C. Greater than 10 mm Increase from previous reading (6) Providing medical evaluation for personnel showing (5) UPPD is positive(conversion),the followingstepsshould 3 symptoms of heat exhaustion or heat stroke he fin: The following are typical rehabilitation considerations for a. Fdl cut questionnaire operations during cold weather extremes: b. Obtain chest x-ray (1) Moving fatigued or unassigned members away from the c. Evaluate for active disease hazardous area of the incident d. Evaluate for preventative therapy (2) Providing shelter from wind and tern (9) Paterdin temperature extreme (6) if active disease is diagnosed, the member has to he g members with fluid replenishment,especially removed from any duty until she/he has been deter- slater mined to be noninfecuous. This will occur when ado- (+) Providing medical evaluation for members showing signs quate therapy has been instituted, the Cough has related injury of frostbite, hypotiiettnia or other coid- resoJred•and 3 Consecutive sputum smears for add-fast bacillus(AFS)on different days are negative. A-S2.2 The assig nment gnment of an ambulance or other support Ar4.3.2 In the event of an exposure to TB,the following steps crew to duration or he habilitation function is essential during long. should be taken: av evertion incident operations.This crew can (1). Member should rcecive a PPD within li days assist with rehabilitation functions as well as be available to sure.Member with a history of of expo- Ad�Ced immediate basic life support needs for members. out a Me beers with a ry Positive PPD should fill PPS (paramedic) level of evaluation and (2) Repeat PPD or treatment has to be available quickly.how eP questionnaires q ever, to ensure haul r the d be o r v 12 weeks after the first done 6 weeks to P Pe k el aEcare. (3) If PPD is positive(conversion) or questionnaire is The medical stall;has to have an assigned medical director. P per(5)and(6 of A-t.3.1. tea- Physician.a mote physician e an On-scene iataa base hospital.or department ctr rive,proceed as ) .4 4 29 CtR 1910 1030 requires that members be offered He medial direction facility. sum B immunization at no cost to the member Member who A-5.3 2 For ' choose to decline the o9erofthis immunizmbeadon are required w to for incidents or escalating incidents, medical sign a written declination.The declination becomes quit o control can be established by the Are department physician or member s confidential health data � medical director at the incident scene. m of NFPA of id ntial health Rn base as specified in Section Burn Injury.When a member suffers a burn injury, he or and ffeeltA Qepa►tsrertt arcupctsviscl,Sy/� she should be evaluated as to the extent of injury Firstdegree and receive off red Members art allowed to recant at any tame s. dams can be treated on scene,and the member may Continue ry Second-degree bums should be evaluated by a physician A-5-1.1 Having a preplanned rehabilitation program famihar with burns.such as an emergency applicable to most incident P gram that is physi- cian.a member of a burn unit,or a fire e deup^arttrrent lan safety of members.This mph m essential for the health and Second-degree burns and higher are conditions thatdde imand rehabilitation for simple orrshom.fueanod^;ns�de^�s^ !�u that the member be removed front emergency response duty. a process to transition into the rehabilitation needs of A large After the burns have healed to the extent that there as cheml risk tar entry into the member's body of body fluids and chem- t000 Etawai u•rltVUle R tofulll duty.nterrd during rc drn gulartirs,he or vhr can return co f Inhalation.At the emergency deprrtmrtit, T(hr Assie^can Burn A*waatiun hashave the yrcum shiiisW cntena fair referral to be evaluated for p�mblehti vide for c n�If��z��nd should c burn center They are second-and dtrcddegne horns with Is subpected,treatment with a nan cle anudorm kit hould be characterthtia a foguwr. initiated Since inducing methemaglabinemta in a Patient (1) Exceeding_0 percent body surface area(BSA) with an elevated carboxvheniottltihin level may further im se (2) Exceeding 10 percent BSA for ante under W it user 30 oxygen dehserv,Only sodium thwsulfate shuuld be given uu. 13) Any third-degree burn over 3 percent BSA astir. if treatment with hvperhanc Oxv;en b.taned,nuntes 14) Involving hands,fret.face,perineum.grnttAta,or malor may be mod• ` joints l51 joints errntiaf invnlvinq extremities or shot '1' 6.3 Items that can umbt in [unsung temperature strew in (5) C'MU by contact with chemicals.tie orc h t G htnhn cold envinmments include heat,blinkta,and protection from I-I Coupled with smoke inhalation in ury g B the vend.For hot weather.items vh«tid include adegwee shady, (3) Associated with multiple trauma 1 tans.atr-condstorunq,and mistmq shitenu.F.iid and hvcirauoa (D) lnwhing patients with Prcswtin nredv include water and oral fluids,food,broth,and fnut.Also, illness g significant medical for hydsatirni. a gt).sq mixture uF water and an eleetrolvne repluemene dnnL can be prtsvided Medical equtpnuent should '6farr"I"Aelelaf*Miss.Stains and sprains are amuinq the include blood pressure etU& stethoscopes. Oxygen. cardiac most common member injuries.When they occur during pen- monitors.thermumeters,and intrahenom fluid yid supplies. oils when circulating catememb snra are[ugh,such as an the A.3-i.f The incident commander shuuld consider the cir• se a my of, the urvinj Under member might s.he o she the cumutancas of each incident and make suitable Provisions for seventy of the ing an Under such conditions he or she might rest and rehabilitation of membEn operating at the incident continue working and worsen the in�uty. Evaluation of these type of injuries on the fire_ scene. For example, when members consume air from two be difficult.The injury might worsen with unit due to swelling.Irin . J(:BA air cylinders (twoeylinder rile), thry should be muscle m,and increased B• assigned to rehab. pain perception after the emer- gency l is over.Any acute Injury that leads to swelling or . 34-5 The measurement of the pulse rate has been used by multi in more than a trivial limitation ofmadon should prob- some fire departments in assessing members during rehabilim. ably be evaluated by a physician. lion.A persistently elevated pulse could be a sign of excesaihe fmdh fsAalatroir.Smoke inhalation is fortunately becoming stress on the body due to dehydration,heat stress,exhaustion, less common,due to the use ofself<ontained breathing appal or cardiopulmonary disease.The use of a pulse rate has roc nnis.Amember with smoke inhalation should be treated with been studied in a manner that allows strict medical protocol to 100 percent oxygen and tsarsported to an emergency he rat merit Burro involving greater arrt 15 percent of bod depart commended.The pulse rue combined with the remain- 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 operadons. with more severe airway bunts.bower airway injury can be associated with carbonaceous sputum,wheezing,rates,than- chi. and chest pain. Pulmonary function tests can reveal a A decrease in forced expiratory volume in one second IFEVI). PPenda 8 Information for A chest radiograph may disclose infiltrates or atelect sh. �e Deps rtmew Physicians Hypoxemu may be seen on arterial blood gas analysis A nor, TAir appnidix it mail chest radiograph and normal an mat blood gas results do ussmt but u ntcludidd it a Pew e!dw a°��u Mup�doe.not,however,rile out significant smoke inhalation I u �° ormaaona/purpsm Endotracheal incubation should be performed if litre is &I Occupational Safety and Health Problems for Members. central nervous system.suidor•h)pnxernia(PO,less than 50). 9-1.1 General. Fire righting and emergency response are hvperarbia (Pr-Or greater that 50), ruff-thickness burns of very diffiicultjobs.People in these jobs perform functions that thr face or neck,airway or pulmonary edema,or inability to are physically and psychologically very demanding These handle secretions. Positive end-expiraton,pressure (PEEP) functions are often performed under very difficult conditions. should be used if hypoxemia persists despite incubation and (.%eAppeadrxC.) administration of 100 percent oxygen.Inhaled beta-agonise and antichohnergics can be used for bfGnCb03pasm.Systemic 1-1.2 Physical Load Studies have shown that fire-fighting corucosteroids are not recommended for pneumoniw or pul- functions require working at near minimal heart rates for pro- monary edema.Anubuittcs may be needed if sputum gram longed periods of time. Heavy protective equipment(includ- stain and culture with fever and Ieukoiytosis suggest the pros- ing respirators) and the heat from the fire contribute to this ence of a bacterial pneumonia. physical load. Down,umber Certainly the scenario involving the dbcovery B-1.3 TOiuc Sbstancd. Members and emergency response of an uncon.uots member is one that is difficult to manage personnel also are exposed to many toxic substances during given the phychological responses of all involved.Of course, their work Carbon monoxide is the most common contami- i the first priority u the safe removal of the victim from the hr:-a nanr studies have shown individual exposures chat are as high tammeded out and a se area Then the Auway.Bleeding.Cardiac(ABCs)are m 5000 ppm during actual fires.Other significant e%pasuces Elie sur.ey performed Tramport to a common during Include �vanrde, acrolein, hydrogen hospital should be expedited, chloride,nitrogen dioxide,and benzene.The burning ofpLw Any unconscious member should be created with 100 per- tics and other synthetic materials can e,%pove members to cent oxygen,since carbon monoxide poisoning a common other toxic materials,such as hsoeyanates and rutrosamines. and cyanide poisoning pnutbfe as secondary effects of smoke Flazardots materials incidents can involve exposures to many 2000 Ebhm \ll'Dlr\L Rfre,11,IRENIEATy FOR FIRE F1t:liTEtU \%D 000KNl.\ ION SIR Flat?DCP CRT\Ile\T PI R11i-L\�� Other tu'W matenal,.Although the use of respirators helps to B-" Guidance for Medical Evaluations. rajuce exposures mecharucal, ensitnnmental, and behat- tanl faCturs can limn their use during all phases of a tire 11-2.1 Preplacement and Baseline Medical Evaluations. The awulable health duo on members are linuted While Preplacement medical etaluauaes assets an undntduu(s the protecuun for members has improved over the List aeterut health status hefare usignment to a pouuon The purpose of t ran expuxirrs might be changing due to the intraductain of etalwtitin f,to.u,cert in whether the inditidual has anv more,vntheuc matertab.liven the delay between exposure health Condition that prevenb him ocher tnim pe^Mrmingtht An onset (that 6. l.uencv) of man•Occupational dineaseb. lob. inclt►dung the abiht to wear protecute equipment currant tar Past health studies of members might not rcilect required for the job.The evaluauon should also identify any future health rules. These limitations should be recoymued health problems that could wbsanaapt sFgr ly the then reviewing the available,tidies phtsicsl demands and working conditions Baadine ine meedical information concerning the apphcant s health status can then s'!.i Increased Risk of injury and Disease. Atmlable data be cnmpared to%ubaequent e•aluanon result for the purpose indicate that members have increased ruk for injuries. nil• of determining whether the individual his anv svariificsne monary disease, cardiovascular disease, cancer, and tuiue- health trends that can be occupationally related. induced herring loos. The increased oak for injuries u Two types of information are essential for a medical pre. member du expected,,jtven the demands and circumstances of this work. Ftrst�he physicimcnt an mution stunderstta d those athemworking candid ties Fatalities and serious injCines from burns or other fire,terse and phssital demands of this occupation. Appendix C pro- hazsred!can occur tides a tilt of the environmental funars encountered in fire The risk for resptratury di,c=e occurs due to the re,pira. fighting and emergency respunse.The physician also should ton'damage caused by many of the components of fire smoke obtain additional information from the fire department (for example, particulate, acrolem, nitrogen o tides,sod ko regarding specific job dudes and task lists(if the fir depart- acute reductions in Pulmonary funcuon and even by x- meat has conducted a validation study or job anahsis) and on.) p should be familiar with the organization of the fir depart. are not uncommon after bra, even in asvon has men ment.For the evaluation of some medial conditions,the phv members.Permanent damage from smoke inhalation has also scion 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 fir 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 been able to detect this change. Increased use of protective Second,the physician needs to have accurate. Elie fu c- equipment and jab selection factors(ill Members trnsferring Donal limiout the tations sassiociiaated or medical thatccondiuon.h and�an to other duties)could account for these inconsistent findings, understanding of how physical demands and working candi- The strenuous work demands of fire fighting combined uons would impact an that condition.An accurate diagnosis is with exposures to carbon monoxide and ocher toxic sub- often the key factor in determinin the stances can increase the risk for cardiovascular disease For example.different skin diseasegcan hap vee similaelin cal among members.Acute respiratory changes also can stress appearances but can markedly differ in their response to etevi- the cardiovascular system This increased cardiovascular d!r ronmenal exposures. The physician should also recognise . that individual variability can exist between persons with the care risk has been documented even in some morality stud its.despite the job selection factors that tend to mask any same clinical condition increase when compared to the general population Other Upon completion of the examination,the physician should studies have not detected this risk.Certainly, the combine- Inform the authority havingjurisdiction whether the applicant born of the physical stress of fire righting and exposures for a to medic2llyqualt6d to perform;as a member. 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 iry 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. increased cancer risk for members has been found in sew fire deparrtment Physicery year,each ian. This rt1 drwill be ic Il cvaluau n1tincludes eral recent nudies.While not totally consistent.these studies an update on the member's medical history,including anv sig- genetally show an increased risk of brain cancer,(gastro n tes. nificant changes,a brief review of symptoms,and a report on Una!canceni colon cancer,prostate cancer,lymphoma,and any significant job-related exposures expenencd during the leukemia among members in many different parts of the past year.Height,weight,visual acuity,and blood pressure arc world.increased incidence of other cancer saes has also been measured and recorded.The extent of the medical e:valuauon shown in sonic studies.Several studies are currently under way and additional testing wi to further etaluate dus risk condiuon If depend on the members medical voiae•inducd hearing loss has now been documented in A more thorough evaluation.;ncludingamedicalexamina- several studies of members. Members might also be at risk lion.is conducted on a periodic basis.For individuals less than from other spectfic exposures including infectious diseases 31)years of age, the medical evaluation and examination is and hoer,kidney,or neuroloKical damage from a sure to conducted at least every three years;for those 30 to 39 years of ,pecdie chemicals, xp° age,at least every two years;and for those ill years of age or over,every year. This evaluauon should include an updated :Or10 Enron APPLNUV%a medical And interval history,complete ph"Ical examination, vision testing,aurdiometry,pulmonary function testing.And a i 1�)Audiometry CBC,unnalvsls.glucose.SUN.creaumne.leer function cats, (I=)Visual acuity And peripheral vwort testing and lipid profile (13)Pulmonary function testing The use of chest xravq In surveillance activities in the (14)lsboratory testing,if indicated abueace of significant expo+ures,symptoms,or medical find. (13)Diagnostic imaging,if indicated ings has not been shown to reduce respiratory or other health (1 b)Electra.ardiognphy if mduated impartment Therefore,only preplacement chest x rays are B-2,3.2,1 Laboratory Tests. CBC. biochemical test battery. recommended No firm g+udeUnn fur stress electmcardiuRraphy rn asynip• lipid prnti e.h%Ieild be conducted for detteeeang specificIll. tomauc mdividuah have been developed. There have been nesset as well as developing a baseline for leer comprnson, problems with falae•pobiuve results from this testing,especially in younger age groups and in women.in those with one or &2.3a:.2 !Grin. A baseline chest x-rav can be helpful for f more risk factors for coronary artery disease,there is probably t p Individuals with a history of respiratory health problems or lustiticauon for performing the testing a well,strew tests are simiptoms.For others,it can be useful for later comparison more important in those whose work dealt with public safety B-2.3.2.3 Stress tests can be performed using a treadmill,bum le.or die helpful for individuals w Pulmonary function stair climber, as long as the protocol berm usedtesting can be helpful for mdiytdttals with a htstory of respires- increases in workload metabolic equnalent of restm gradually tors health problems and as a baseline for later comparison.A expenditure(3IETS).A wbmaxiirwl test,with the end ins baseline test should be administered by an experienced per- being the attainment of 85 percent of predicted ma.Ix mal 7on ns Only ae best efforts that n technically acceptable and demo heart rate(P%IHR),may be performed.Addiounal informa- onecrota the best vital by an tnFVC)an should be used to uon gained by performing a maximal sym tom-limited test calculate the forced vital capacity(F�'C)and forcedexplratory might not be worth the additional time,4l rrt,cost,and risk volume m one second(EEY1). A reasonable approach is to start periodic treadmill testing B-2.3.2.4 Andiomerry. Audiograms should be performed in on members at age 40.In those with one or more coronary an ANSI•approaed soundproof booth (AVSI S3.1, .►faanautn artery 3disease risk factors(premature family history(less than Prrmwt6lr Amhww VAw Levels jot.{tad Test ) with agehypertension.diabetes mellitus,cigarette smoking, equipment calibrated to ANSI standards(ANSI53.6,specoco- and hvpercholesterolemia(tool cholesterol greater than 240 iron for Audumwkrs). U a booth is unavailable,the test room or HDL cholesterol less than 35)1.testing should be started by sound pressure levels should not exceed those specified in the age 35.The frequency of testing should increase with age,but federal OSHA noise regulations(0-9 CFR 1910.95). at the minimum the sac should be done at lease every two yeas.Testing can also be done as indicated for those with &o'2 S Econd cted. (Perin Baseline electrocardiography lectroaudorams p suggestive of coronary an disease,at reported in should be conducted (Periodic resting electrocardiograms symptoms their yearly medical histories or interim reports, have not been shown to be useful,but may be reasonable as a Conversely it is known that even maximal stress testing fro- members age increases.) quently misses cardiac abnormalities seen during actual fire- B-2.6 Repordeg die Results of the fighdngdutip. individuals participating in a medical leevalluacal tionpshhoo ld be 3-2.3 Contest of the Medical Evaluation. Informed ahead of time about the purpose of the medical 8-=3.1 llted O �� evaluation and the content of the exam.The results of any a"Pa History. The medical hit medical evaluation are considered to be confidential medi- tory should cover the penon'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 f?rth•Symptom review is also important for detecting early and recommendations arising from the evaluation should be signs of nclu e a addition,a comprehensive medical history expressed in general terms without specific diagnostic infor- should include a penonal health history,a Family health his• mation.In cases where more specific information is needed Cory,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 peraon's pate occu- should be obtained from the candidate or member.Blanket pational and environmental exposures or general "release of medical information" forms should 3•2.3.2 Medical Examioadon. The medical examination not be used. Includes the following organ systems and tests: In most cases•a simple staterifent like one of the following (1) Vital sips, willsuflice: such as Aube, respiration, blood pressure, and.if indicated,temperature (A) Based on the results of the preplacement medical eval- (:) Dermatological uauon of December 10.1996,jape Doe is(or is NOT)medi- (3) Ears,eyes,nose,mouth•throat tally certified to engage in training and emergency operations s (4) Cardiovascular for Anyt6m Fire Department. (5) Respiratory (b) Based on the results of the preplacement medical eval- (h) Gastrointestinal uation of December 10.1996,John Doe is NOT medically cer- (7) GCnitounnary, tilled to engage in training and emergency operations for (8) Endocrine and metabolic Anvtown Fire Department.He has been advised of the medical (9) Musculoskeletal reasons for this recommendation and of the policies and pro- (10)Neurological cedures Available to him if he disagrees with the results of the medical evaluation. 2=Eaton i 13tl7==i \ttiDN:tt REQL IItE\{gNTS FUR fIRE FIO;R tL`i.1Vp INFt)ItW t t()It FIRE OEP%RTMErT let f1-It;I\Nis 13-2.5 Second Opiniotu. Fire department poohcies and proce• Admintstrauon(l t CFR67 131ti 1975)does not grant medical dures should allow for a medical second opinion when a candi. certitieates to di.►beucs treated with insulin and w%trely limits date or member disagrees with the results or recommendations those on oral by of a medial examination Conducted by the fire department pugircemie agents physician or when the fire department Physician is uncertain 9-3.2 Asthma and Reactive Airways Disease. The diagnosis about the hmitatioiu or prognosis of the Individual s amtltuon. of,uthma and related airwas hs peractivity dsorder%b often Often other physicians will not be familiar with the dunes and confounded by definitional owes Fur the purposes of demands of fir fighuneI and emergency response.When pm f member certification. a variety Of airway disorders that ble, site fire an abdepAout h p(+the en should help educate the meet the folluwing criteria can be included. Aathma a a other Physician about haw the end should condition could chronic infismmatory disorder of the airways In suscepti• affect or be affected by rice righting If there is still disagreement ble individuals,this infiammauon causes symptoms that are about the condruun°r placement recommendruun, a third usually associated with widespread but variable airtiow physician(acceptable to both the Ciro department and the can- obstruction that is often reversible,either spontaneously or t9date)can be consulted with treatment,and causes an associated increase in airway 8:.6 Muwuloskeletal System, fesponstyeness to a variety ofstimuli. Iems encountered in this astern wish need func�uonal capacityes or carob• Since asthma is a highly prevalent disease, a number of evaluation to determine fitness for duty Physical therap Pr nu prodi member ua�exerc ecants ilandcolduire saairarealllpxuentp��; %iders often design tests for employers to determine ability to *(an asthma attack.Some of these exposures are unasoidable. perform tasks similar to those wired x tiai job functions.These tests should be basedton direct of their cmea- cams consisen. even with stent ens with an as�m EA use, If a candidate has a dimany s or sym(y surements of the actual job functions. These functional need to be considered.An asthma attack du�a many con will capacity evaluation 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 g suppression physician who is not familiar member of the public. with the essenbal job functions of a member. The following factors can be used to help in certificdon: B'-3 Specific Medical Coeditiom. (l) Persistence of airway obstruction between attacks (as �3.1 Diabetes bkl4tiss The major concern for diabetic ,� measured by spirometry) members to the risk of becoming hypoglycemic during Bee (2) Need and frequency of steroid and bronchoddator use ground operations or other emergency responses Both exog (frequent bronchodilator me suggests persistent airway enous insulin and oral hypoglycemic agents can be associated hyperactivity) that can rapidly progress from (3) Usual type of tiiggets in the applicant (allergic, inlet with episodes of hypoglycemia . reliable a°us exercise induced,etc.) impaired judgment to unconsciousness. The most predictor of hypogivicem)a is a history of it. In one study of (4) History of hospitaiiatlon, emergence room,or urgent insulin-dependent adolescents conducted at the Joslin Clinic treatment insulin (Bha ee and WoRidorf 1991). all 196 patients experienced (5) Length ardent:between attacks hypoglycemia at least once during the two-year observation (6) Notmirnal symptoms and other estimates of airway Insta- period.Of these"15 percent were classified as severe,based on bility loss of consciousness,seizure,or the clinical need for thera- peuuc gluagon or intravenous glucose. it was Moderate asthma or wore could disqualify an individual particularly for member duties.Unknown factors such as the suppression concerning that 24 percent of hypoglycemic episodes of airway hyperactivity with anti-inBammato detected by blood glucose monitoring were inapparent to the reduce the possibility of a sudden or severe attack are on patients.The probable Causes ofhypoglycemia were identified investigation and could modeler current suggestions. in 71 percent of cases,and the most common were strenuous exercise and skipped meals or snacks Both of these preciP(- I163.3 heart Disease. The medical conditions relating to the rants 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 fortes at the lization, strenuous exercise increases insulin sensitivity Bethesda Conference published recommendations for ath- (Wasserman and Sinman 1994). With the tighter glycemic lets compeungwith cardiovascular disease in the foumdo/thr control that is now known to decrease and delay onset of ilia• Amencon College 9/Cmdio/ogh in October 1994,The analysis belie complications,there is a concomitantly increased likeli- used by the task force has relevance to the evaluation of mem- hood of exemse-induced hypoglycemu (Wasserman and ben with cardiovascular disease.Firefighting activities have a Sinman 1994) high Made component (i.e. nnJucing predominan tly an increase in blood pressure)and a moderate to high dynamic Insulin is dearly associated with a much higher risk of symptomatic hypoglycenua than are oral agents. In the component(i e,inducing predominan dy 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 hyp°gfycemic axis force with respect to athletic activities that have these agents,x long as they have stable weights,diets, and renal physical demands(high smut,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 D-3.4 patient to be evaluated for fitness for duty individually,there merit can cause adverse reproductive in the fire-fighting for h males n some case law that duallowed blanket exclusion of sasuhn• and females Medical evidencee:cnts to indicate that them col dependent diabetics from public safety poaiuons (Fire ,ie exposure,heal,noise,and physical exertion can affect yanous Police Personnel Reporter 1994) The Federal Aviation endpoints of reproducuve health including ferubty,fetal loss, 2000 Emeriti and growth parameters of the otT-spring All candidate,arl,l members should be educated ab,nut thc,e rhka and ah„ttt tha reactive somic that c:nl he aitnlnlic#1 to a rtwersible,inrlrrk. need to take appropriate steps to lim,t their ex asures •PretIPirallt.These circunbta►ttrs tl1,not nta ta,,inly re pre.there could be some sltuatlons when. a male or mrmherwntintjngtf�inrmbar It to ti„n•;erl�ritutable Incapacitation n a aciprecipitant Wn of fenLilr mrmbar e,attempting to conceive a child and is hawing not asrecwteol w,th tentral necvuu+-swam e.2fjlf Li• 1, dtion his In three sfej mother where a complete mettical rwabl• end eliminated and it,r m,hvidual fLu uo rruiTener.air 1%,. anon his not ftnt o a llun ar eatsa for the,Inferiohrv,tem• rneun;year then he or-sIie u piohaLly not more 111.dv t�hi,e porary uagihmrnt on a M-sIuntan IxLsis 10 alternatine din or a auuther►ennire than the rest o1 the general P"pnlanon o 12-h, leave a of absaice-should be considerarl. �(rd,talewtdrnce exun that certain toxic substancra orwn• ter 11N151 %Ght fire department phigclill%hill wanta grwl,ticrt ditions that are present in the Hre�ghung environment are di,ee�not.Int.ic hie ep lt %g to vent%that ep vdisidilal with a liututy of erizllrrs dangerous to the safets and well-being of the teats.Theretnrr. Eptlepw 1, oil r3nuN.,i b, the present a of`unprovoked. It Is Important to tducate all members about these risks and die r-unrent scintrcs—P-1 tsimal duon(en,If the central ner• f re%%om for recommending that pregnant members restrict their firchttppressan actimurs.Foere wous s`stem cluractenzad by an abnormal cerebral neuronal dance that the feuu a especially senstue m carbon'%m,xtoude. 19)4) Treatment of patients with epllepev Is onlyvanabli btic• ;otsd a%,• discha a with or without loss of cotixloiune�' (Castillo a known significant component of file smoke Although the ceseful-w,th roughly 41)Percent elf paucntsattainirr;remisstoit use of SC" is assumed to be protelcme, sometnirs ouch on inu-onimbant therapy (Halter and Hesciortfer lf))0. equipment is not used throughout a fire stippression or hiz• Spencer 1:r951 Remission I% defined a rise wears without ard,ous matenab inetdenL The use of such equipment aho recurrence of sevure anivi v (Annegers. Hattser, and Elve. increases other feral stre%sors,such as exertion and heat.Other back 197 9) Ftnher complicating the rtutess•forduty issue is concerns are those tmolving physical work.Prolonged,cartel- the fart that only 34)percent of Patients who achieve remtasiiin Intl,heavy lifting,and expolaced t ra i temperature extremes and do %a withotit toxic-side effects of the anu•convul,ant drug birth weight have been related to an increase of preterits and low, I Casclno 1994). birth weight infants Bet'ause the fatia should be protected Partial.simple epilepsy,or recurrent seizures that do not from theft fight bepregnant exposures t the earliest possible time,the member impair consciou,nttu,are felt to be a disqualifying condition who might be pregnant should obtain early pregnancy testing because of the uncertaintt,'regarding how touch of the brain Recognizing potential risks to the fetus from the firc•fighun; might be Imolved, and the risk of ro environment is a relatively recent event•and ream.members regions of the brain,particularly in the highly epileptogenic might not be aware of these risks. propagation to oilier Based on a recent U.S,Supreme Court decision(lnterna• environment This st3ndard is sormewhat moreeliberal thancer n that promul• Moral Union at al.v,Johruon Controls,Inc,591;S•L,W•4_0. gated by the Federal Aviation Administration of the Us ?March°0, 1991),die ability to perform as a member is to be Dep'+ranent of Transportation for aircraft the basis for the medical certification without consideration of 67.l3161995).All epileptics.regardless of therapeutic sucecem health risks to the fens. However. the r are dented first,second•,or third-class medical certificates• should be counseled on the Potential risks to her fetus due to pt under the provisions of 14 CAR 67 19•'Special issue of her exposures during fire fi huts excr $ $duties. bledicalCertificates.' Any member who becomes pregnant should be offered the 84 References, opportunity at any time during the pregnancy to be voluntar- ily removed from firefighting duties and from other duties Annegers,J F., W.A Hauser,and L R. Elveback 1979. J inwlving rho hoards or physical,eras that might endanger er +Remission of Seizures and Relapse in Patients with Epilepsy," the fatus.if pracucal.the member should be offered voluntary Epr 'w't:''y P psy reassignment to an alternative position.At such ume.s the Bhaua,V.,and J.I.Wolfsdorf 1991 'Severe Hypoglycemia Pregnant member an no longer be medical) c in Youth with insulin-Dependent Diabetes Niellins: Fre• being capable of Performing fire4ighting duuaYthe�member uent, and Causative Factors.'Pith si should be reassigned to otherduties Al such time as the mem• q y ^u !197. BAsso ci Association. 19 firrgnru,td Command National Fire Protec• ber a no longer pregnant.the member should be reinstated cion Assoclaoon.I983. to the position held prior to being pregnant.Nursingmem Cassino. G. D 199-L _ ben should also be advised about the potential etposilrea to E111111radws are d ratiti°r^t.��vClinn Proceedings pg-1199. their infants. 'Emergency Incident Rehabilitation.' United States Fire �3.5 Noise indlteed Hearing Loss. T Wm,nairarion 1F.�#1 12). hu category can pnse fire&Ps(tgPiumaelReplyrim dtfTbecausembrr1994,p.1h9 es because a high percentage of current members Hitiser.W A.,and D C. HesdortTer. 90 ha,e notseynd,ired hearing loss due to their exposures as quenty Cau,es and Comm 'Epilepsy Fre• quences'�Cwy York Demos. members.imislemrnettlon of hearing r onservanon prnifi-isms and r National Fire incident Reporting System (NFIRS) data p ot;ns h to reduce noise exposures should lead to a base. decrease In the preraknce of this condition to the future. NFPA 1341,SMndanf for Fir.Department So/dy Omen, 199i B•3.6 Seizures and Epilepsy. it s important to distinguish edition. between a hatory of-sazures and epilepsy As much as it) Public low it)1.316, 1990,Tide I-EmploymenL cent of the in 3 Spencer.S. Personal Communication, 1995 (Spencer is population will experience at least one seizure in a lifetime.whereas let than I percent of the population g1u1,1irs andf esso t Of nc I V and director of the Clinical Epilepsy for a diagnosis ofepdep y(Ha rand Hrsdortfer 1990) Narn P )ltc Monitoring Services conditions producing seizures in the pediatric School of Jlediane) g t rs at Yale University known to remit prior to adulthood.and many addults�P see Title l;, Ct „r f stssrvo a 13- vk l n>'r RrXtrGrtrunr, Pan 1910 ItMO.Suit Parts [h.'Air Cnnumininrnts' iaa0 Earoa+ i lStl =ii %1CDh:1i,REQL IRESIENT3 FUR FIRE F14;NTE9S \ND IYF0RJL%TlQN FOR FIRC ocr%x mChT 1-11YUCLVI -Tunic emike uthalatwn: Cyanide pnisonng in fire vic- tims.'Junes,f et if. -A- -rn A—,d,;f Emrr1nu7 .tlHlnrnr •ppendix D Guide for fire Department. to, 3 31:.1907 W-US—an,D H.and&Sinman 1991 'Exericne in Inch. Thu appredix is not a pirf o/chi rrfrun„rorru o/list,ETA{,wr.vidiials with IDDH hrw.'Ota Can I-, f. umrttt b,u u indtid"i fern rof rrmruwnul pit pnvs oniv. D•1 Legal Cw�idetadons in Applying the Standard. The can.�►ppendis;C Essential Spveptsal fire.F'ighting .idemoun ofan application or can tinued emplatment,)fa mem. Furicdom ber Hissed on medtcal or Ph)vical PRformance etaluatiutu imohes Tits apprri,4r u nru a part of tiv r"Pormtonts of this,4T'p,{,� prior it)mao�thatdnwithout mnent��caooro Tu thin end. nor 4>marts an pl deu*m bawd tin the um.n'btu,ratriudrl/orinfitrmattondpurposesnnly regrti standard.the authoritywit)t fo )trudtcaon nusfit trash to C-1 The medial requirements in this aandard were based on cottauh�ndi cgiiye(, in-depth eoruideranon of essential structural Arc-fighung 0-1.1 TdivWuals with Handicaps or Disabi'Gaes, The Reha• functions Thee essential functions are what members are et• biliruion Act of 1073,as amend 'a petted to perform at emergency incidents and arc d re,, d Implementing regulations, prohibit discrimination seq.. d from the Perfotmanee objectives stated n NFPA IIN)l. Stan- those with handicaps or disabilities under any,lard/erlirnFiglti►ProfirssooalQunyfuraww. ing financial assistance from the federal goveemmmeent The Essential t nctions are Performed to and xTected by the �encsns with Dbabilides Act of 19t)n,-L^1:S.C.§ l_'lUl.et follinvingenvironmenai factors: seq..also prohibits empluvment discrimination by«rttn Pn. (1) Operating both is a member of a team and irtde n. tzte emplover again$(individuals with disabilities.In addition, dendv at incidents of uncertain duration many a te antes ha enacted legulaoon Prohibiting ducnminadon ('_) Spendingcxtensive omeoutside Against those with handicaps or disabilities.These laws prevent (3i Toeradngg extreme fluctuations tit temperature while eats the exclusion.denial of benefits,refusal to hire or promote,or formngduaes;fie III tell ate required to h other handicap p o rrdisatoty conduct against abilicvs where the Individual individual bored on a ically demanding worft n hot(up o 4°F),heumid(up in or out reasonab a act mmodatio .performvthe essential 100 percent)atmospheres while mearingrieq equipment that functions of the job without creating undue hardship on the significantly impairs b g (4) Erepenenang frequent transition from hot to cold and shouus. ld be undert or ken with these issues in in minlkauon d�u s � from humid to dry atmospheres (3) from hit(n wet.)r R or muddy areas The medical requirements of the I'M7 edition of this san- (6) Performing a variety of tasks on spp�ery ��" Initially developed and found o o job-rtiated by a faces such as on rooftops or from ladder haa�ous stir subcommittee comprised of medical donors, phlsiofogical (%) itorlung in arras w�hee sustaining traumatic or thermal th NFPA conscialists,and ensus�ance droaMs.mak)ng sysfessionals.as tem m Changes for injuries is possible the current edition have been Proposed f(A) Facing exposure to carcinogenic dusts such as asbestos. posed re similar ex P Po by a task group com- toxiche standard provides. to the mon substmonoxide. r o such as hydrogen cyanide,act&.carbon extent feasible.that decisions concerning candidates and cur- or skin de,or organic solvents,either through inhalation rent members with medical ailments,handicaps,orduabiliues or skin convict (9) Facing exposure to infectious agents such H be made after case4by<ase medical evaluations.Thus, most or HIV z,Hepatitis 8 medical conditions have been assigned to Category t). (l0)Wearing personal protective equipment that corer ys The medical requirements in this edition of the standard approximately n Ili whole C g WCe revised based on the essential functions contained in (11)Performing physicallydemanddingtroi rage wkulegwearin�� APPcnduc C It a recognised that some fire-fighting functions itive-pressure breathing 8 Pro' and tasks can vary from location to location due to differences g equtpmrnt with 1.3 in.of water in department site,Atncuonal and column reasfance fo exhaladon at a flow of 4O L/min orquipm nt differences, (12)Performing complex tasks during life-threatening otherffactors.Therefore,it the responsibility evel of urbanization. o UUIiWCL and feach divid- emergencies (13)Working for long periods of time.requiring sustained the essentiaartment functions Peto document. ormed in the lo�pjob analysis.that ljunsdicuon are Physical activity and intense concentration (t{)Facing bfeerdeaeh decisions during a substantially similar to those contained in Appendix C. (13)Being exposed to grotesque sights and smells associated to document the essential)Nnons There are a wide variety ctiom b of a member with martin id trara and burn atoms However,at a minimum,any method utilized should be cur (I6)Malting outd uanat p periods from rest to near-maximal exer- rent.in wnung.and meet the provisions of the Amencam with ion without tvarstt tip periods Disabilities Act 129 CFR 1630._ n)(3)]Job descriptions (1%)Operating in environments of high noise, y. '( J pitons should limited mobility,at heights.and in enclosed or confined tasks and functioncritical s.Thefvquencyand/orduradonoftasst work behaviors and kper- spaces (19) $sang manwl and formance,and the consequences of wore to perform the task d environmen- (19)Relying an senses power tools in the performance of ducts should be specified The working Of ght.hearing,smelt,and touch to W hazards in the work s pperformed shons uld be described help determine the nature of the emergency,to maintain The job description should be made available to the fie Pen.snal safety,and to make critical decaaions in a con- serytce physician for use dunng the preplacemenr medical fused,chaotic,and potentially life-threatening environ- examination for the individual determination of the medical ment throughout the duration of the operation suitability of applicants for member i0C0 Erslan D APPE.VO{\O 1382—2 D-1.2 .lea-Dscrurd"don Laws. Finally, users of this sun_ dard should be aware that.while courts are likely go give con- tonal need to be con deeicians d.as specialties y� PMstetan ich�P 3. siderable weight to the existence of a nationally rccogntted ground and experience.Knowledge of occupational medicine standard such u VFP.i,1382,Stiredotd sit,Hadirnl R.Titiv mu and experience with occupational health programs,obed usne IM fin'Aghlert and Iitiornuuwn/or Per Dosrrmm:phvttnonr would be helpful.;e q. Alsi4r u Stout Qkway Fin Drperrimmi. 497,4.W hd 118 {IIPJ3)1,reliance on the standard alone could be insiuFuient The phvucan has to be committed to meeting the",tire. to withstand a challenge under the anti-discrimination Ilia. meets of the program,including apprnpriatc record keeping. Even in the case of Cuegory A medical condiuotu,courts can His ar her willingness to work with the department to connn. still require additional expert evidence concemingan indisid- uallY unpravv the program is also important.Finally,his or her ual candidate's or member's inability to perform the essential concern and interest in the program and in the individuals in functions of the job.Until the courts provide furtherguidance the department is vital. ist this developing area of law, some uncertainty as to the de3ree and nature of the evidence required to esahl'tsh coin- There ire many options for obtaining phvssciin servhcea. pliance with the antiducnnnination laws will retrain (a) Physicians could be paid on a service base or through a contractual arrangement. D-1.3 Individuals Who Are Members of Protected Claaees tie+g�Color (b) For volunteer departments,led physicians could be +Re an,of National Origin). Title V1I of willing to volunteer their services for the program,with add)- the Civil Rights Act of 1964.as amended.42 I:S.C.2000e,and anal member armngements for pa rvenu of laboratory test- implementing regulations by the Equal Employment Oppom tnq.x-rays.and so forth mty Commission (EEOC) prohibit discrimination in employ meat on the basis of race,sex,color,religion,or national origin (c) Some departments could utilize a local health care (Le.. protected classes), Under Tide VM an •erneompl is facility for medical care.However,in that case,due department person with'!S or move employ. defined,generally,to mean a should be sure to have one individual physician responsible ces for each working day in each of 2 for the 0 or more calendar weeks Pam-record keeping,and so forth. i in the current or preceding calendar yeas'(42 U.S.C.2010e) (d) In some cases,it could be possible to have the medical Several federal jurisdictions have held that unpaid volunteers examination by an notconsrdred to be the fire department physician.while some of 'employees'under Tide V'iI. the associated costs could be defrayed by the member's own -Additionally. many states, sues and localises have health imsunricc.For example.the health insurance provider I adopted similar legulatton.Generally,phvstcal performance could allow the member to have a yearly or other requirements that result in'adverse impact'on mein- h'Ph�d• normally performed by the member's personal physician.The health bers of a protected class (e.g.. on the basis of gender)tie are insurance provider could allow that physical to be per- requited to be validated through a study in accordance wkh formed by the fire department physician Mneh some de EEOC guidelines,if such requirements are to be relied on in reimbursement. degree of making employment decisions. Under EEOC guidelines, a D.3 Coo study validadng employmentatandardsj ane urisdiction can �Oa the Medical Evaluation program, An indi. vidual 6rom within the deputnent should be assigned the be transportable to another jurisdscdon (and therefore used responsibility for managing the health and fitness program, in lieu of conducunga separate study).However,specific pre- including the coordination and scheduling of evaluauans 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 i relying on a G-Amparted validation study the information necessary for decisions about placement D-1.4 Pregeaoryand Repnkluedv ons. as scheduling appointments.and so forth. well as matey court decisions. Including the U A Supreme Confidentiality of all medical data is critical to the success Court's decision in InkritadoadUraori,a cif,uJ�Cowroh, of the program.Members need to feel assured that the infor- Ine. (499 U.S. 187. 111 S.CL 1196(1991)1,have Inge creel nation provided to the physician will not be inappropriately the requirement of Tide VII tvigh respect to shared. No fire department supervisor or manager should Pis pregnancy and have access to medical records without the ex reproduction.The authority having jurisdiction should seek consent of the member.There are occasions,however when the as q counsel in spelling llcer r c questions concern- specific medical information a needed to make a decision ing these requirements as well s other requirements that can about placement. return to he imposed Pa by state or local taws. P wrsi;k, and so forth, and a fire li department manager must have more medical information D-2 Choosing a Fire Department for decision making.In that situation,written medical consent should be considered in choosinga fire factors should be obcuned from the individual to release the specific There are relative few h went physician. Inforrmation necessary for that deasion. ing and are a OccupationalpKratis with formal residency train- Budgetary c meet physician needs to be ualied to provide eprofessi fire onal it onportant thstratnts at components affect the medical f the program program. beTherefore,it is important eeperdse in the areas of occupational safety and health as these pnantized such that essen sal elements are not lost.With d areas relate to emergency services.For the purpose ofconduct tional funding, other Programs or testing can be added to ing medical evaluations.the fire department enhance the program. understand the physiological and PhYn�i needs to placed an members and needs to understandpltio the demands nnm tit and Table 29 represents a eompanson between NFPA 1382 tal conditions under which members have to perform, and OSHA 29 CfR 1910 19i. 2M eason MEDICAL REQN(RE?TENTS Fr3k FIRE FIC(ITENS ANt)INFgR.�I.\T(UN F01t F t RE t)EP.%R r%(EVT Pl t!S(CL%.`S Table D; C°mparimm of OSHA 29 CIX Parts 1910 134.-bledkal �9""!Aw"tr/i0'F+��Shprs and Re9uirsmenes"and NFPA IS82 b f 6nsetiow�iir fRir Depsrtinnie�R�2000 Edition •�Oi�O"f 0e,tiledi°°! N"A 158? OSHA 1910.134 2-1 Medical Evaluation Process The employer must establish and implement 2.1.1•The fire department shall establish and implement a me4ual evalua- tarn elements of the written respiratory pro. uon process for candidates and current members. Program necessary to ensure that any emmpplovea using a respirator voluntartly is med. ically able to use that respirator,and that the respirator s cleaned,stored,and maintained >,s that its use does not present a hazard m the user. Exception:Employers are not required to include in a wntten respitatory protection pro- gram those employees whose only use of rapi. raton involves the voluntary use of filtering face pieces(dust masks) ApppendwiD-3 Coordinating the Medical Evaluation Program.M individual (3)The employer shall des' froin the health and department should h uld be assigned the responsibility for mar administrator who is qualified 1w a program aVieduhe health an fitness and fin.including the coor+dinauon and waim or experience that is cam nen�su e liaison between the examinations.Ths person should also act as with the complexityof the department and the physician to make sure that each inter or overse th r iramrn��to admin• has the meat nand necessary for decisions about ptaeemene.scheduling gram and conduct their wry rocecdon pt o- appointments.and so forth. th eqevaluations of ConfidentWiry of all medical data is critical to the success of the program, a Prim effectiveness. vlembers must feel assured that the information provided to the physician will not be inappropriately shared.No fire de partmalter should have access to medical records withouttthhet supervisor written can. sent of the member.There are occasions when specific medical informauon is needed GOep rrttment m ion about placement.return to work.and so forth, that and i fire d anager must have more medical information.In ediculal to situation, he specific info n ati ntneceaea3houldry for that decuio obtained rthe individ. Budgetary constrains can affect the medical imporunt that components of the pnL Therefore.it is uaf elements are not lost.With addition finding,oprio�therdp uch thatosse as ing can be added to enhance the program. 2.1.2 The medical evaluation process shall include preplacement medical evaluations.periodic medical evaluations.and re ry, (1)General.The employer shall provide a I ations. turn-to du medical evalu. medical evaluation to determine die 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 i medical evalu- ations when the employee is no longer required to use a respirator (SAM 1 a/1) I 2000 Eamm