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Item C23 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 of contract with New Truman Medical to provide employment physical services. ITEM BACKGROUND: It is desired to have Truman Medical as a backup Provider to conduct employment physical services when needed. PREVIOUS RELEVANT BOCC ACTION: None CONTRACT/AGREEMENT CHANGES: N/A STAFF RECOMMENDATIONS: Approval TOTAL COST: approx. $500 INDIRECT COST: BUDGETED: Yes —X__No DIFFERENTIAL OF LOCAL PREFERENCE: COST TO COUNTY: approx. $500 yr SOURCE OF FUNDS: Ad Valorem REVENUE PRODUCING: Yes_ No X AMOUNT PER MONTH Year w � �� APPROVED BY: County Atty IPurc asing Risk Manageme " DOCUMENTATION: Included X Not Required DISPOSITION: AGENDA ITEM# Revised 7/09 MONROE COUNTY BOARD OF COUNTY COMMISSIONERS CONTRACT SUMMARY Contract# Contract with: New Truman Medical Effective Date: March 19, 2014 Contract Purpose/Description: Contract to rovide em Expiration Date: o h n ym p ysical sernces Contract Managen am 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: Appr x $5 0 yr Current Year Portion: Budgeted? Yes X No � $0 Account Codes: 001-06500-510-316- Grant: $ County Match: $ - Estimated Ongoing Costs: $ ADDITIONAL COSTS For: LiNot included in dollar value above (eg.maintenance,utilities, janitorial,salaries,etc.) CONTRACT REVIEW Changes Date Out Date In Needed ewer Division Director a1 l Yes[]No [Y T Risk Management ��". Yes[-] O.M.B./Purchasing ::2- YesDNofkj County Attorney Yes[]N oar Comments: OMB Form Revised 9111P95 MCP#2 „i � w ,-mm AGREEMENT EMPLOYMENT PHYSICAL SERVICES TABLE OF CONTENTS SECTION ONE - Scope of Services SECTION TWO - County Forms and Insurance Forms ATTACHMENTS: A. Post-offer and Fit for Duty Physical Forms (4 pages) B. DOT Physical (9 pages) C. Respirator Physical "Part 1" (4 pages) Respirator Physical "Part II" (5 pages) Respirator Policy "III" (12 pages) D. NFPA Guidelines 2000 Edition — Firefighter Physical (49 pages) t ,,,,,,,,.i ,,,,,,,,,,�.J ,,,,r:✓✓ ,r,,,,,,,�.,,. c„ ,,,,,,,ems. ,,,,,,,,,� ,,,,,,,,:r�,,,,,, ,,,..d i i I I' MONROE COUNTY f CONTRACT FOR EMPLOYMENT PHYSICAL SERVICES THIS AGREEMENT("Agreement") is made and entered into this 19th day of March 201 MONROE COUNTY("COUNTY"), a political subdivision of the State of Florida, whose address ss is 1100 Simonton Street, Key West, Florida 33040 and New Truman Medical Center, P.A. ("CONTRACTOR"), whose address is at 540 Truman Avenue, Key West, FL 33040. 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. B. The contractor is responsible for obtaining employee or prospective employee in order o discuss the resu tshwith Monroe County BOCC. C. The contractor will provide the required services at the location of: 540 Truman Avenue Key West, FL 33040 Phone: 305-296-4399 Fax: 305-294-8270 D. All urine screens will conform with the standard chain of custody protocols mandated by state and federal regulations. E. The Contractor will have an employee designated as coordinator or facilitator to assist in the communications with the Monroe County BOCC's primary contact personnel. F. Appointments will be available throughout the business hours of the facility: Monday— Sunday 9:00 a.m. — 5:00 P.M. Walk-ins will also be accepted if an appointment cannot be reasonably scheduled. G. The facility will be available 24 hours a day, 7 days a week for post accident, random and reasonable suspicion alcohol and drug screening. • The Human Resources office will contact Amber McGill or Deena Richardson via private phone line to request that the physician administer the test. • The authorized Human Resources representative or the authorized supervisor shall complete the appropriate forms either the same business day (or by the next business day if the test is after normal working hours) in order for the physician to perform the required test. 2 • The employee will be tested at the physician's facility located at 1446 Kennedy Drive, Key West. H. Appointments will be seen by the contractor in a reasonable and timely fashion. I. The Contractor will provide the County with at least a 24— 48 hour turnaround time for the receipt of any drug and/or physical results. J. The Medical Review Officer will be available for contact by the Monroe County BOCC or its employees to answer questions about the effect of prescribed drugs. Part of the requirements set forth by the State of Florida drug free workplace policy, which Monroe County has adopted, and the Department of Transportation, the County must have a qualified Medical Review Officer"MRO" perform drug screening services. The MRO receives lab reports from the laboratory(as governed by regulations); Reviews lab reports for integrity, authenticity, false negatives, and false positives; interprets lab results, including verification of lab positives; reports lab reports to the employer(as defined by rules and regulations). K. The personnel shall not be employees of or have any contractual relationship with the County. To the extent that Contractor uses subcontractors or independent contractors, this Agreement specifically requires that subcontractors and independent contractors shall not be an employee of or have any contractual relationship with County. L. All personnel engaged in performing services under this Agreement shall 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 COLINTY'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 term of this contract will be for one (1) year beginning March 19, 2014 and 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 Section 7. 3 7,7 .. ... ....: .........,. .... ... - ,,,m .. .... Section 5. 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. Either party may terminate this Agreement without cause upon sixty (60) days' 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. Section 8. CONTRACTOR'S ACCEPTANCE OF CONDITIONS A. CONTRACTOR hereby agrees that he has carefully examined the RFP, his response, and this Agreement and has made a determination that he/she has the personnel, equipment, and other requirements suitable to perform this work and assumes full responsibility therefore. The provisions of the Agreement shall control any inconsistent provisions contained in the specifications. All specifications have been read and carefully considered by CONTRACTOR, who understands the same and agrees to their sufficiency for the work to be done. Under no circumstances, conditions, or situations shall this Agreement be more strongly construed against COUNTY than against CONTRACTOR. B. Any ambiguity or uncertainty in the specifications shall be interpreted and construed by COUNTY, and its decision shall be final and binding upon all parties. C. The passing, approval, and/or acceptance by COUNTY of any of the services furnished by CONTRACTOR shall not operate as a waiver by COUNTY of strict compliance with the terms of this Agreement, and specifications covering the services. D. CONTRACTOR agrees that County Administrator or his designated representatives may visit CONTRACTOR'S facility (ies) periodically to conduct random evaluations of services during CONTRACTOR'S normal business hours. E. CONTRACTOR has, and shall maintain throughout the term of this Agreement, appropriate licenses and approvals required to conduct its business, and that it will at all times conduct its business activities in a reputable manner. Proof of such licenses and approvals shall be submitted to COUNTY upon request. F. Pursuant to Florida Statute §119.0701, Contractor and its subcontractors shall comply with all public records laws of the State of Florida, specifically to: i. Keep and maintain public records that ordinarily and necessarily would be required by Monroe County in the performance of this Agreement. ,=, „ „ ,, 77 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. 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: New Truman Medical 540 Truman Avenue Key West, FL 33040 Section 10. RECORDS CONTRACTOR shall maintain all books, records, and documents directly pertinent to performance under this Agreement in accordance with generally accepted accounting principles consistently applied. Each party to this Agreement or their authorized representatives shall have reasonable and timely access to such records of each other party to this Agreement for public records purposes during the term of the agreement and for four years following the termination of this Agreement. If an auditor employed by the COUNTY or Clerk determines that monies paid to CONTRACTOR pursuant to this Agreement were spent for purposes not authorized by this Agreement, the CONTRACTOR shall repay the monies together with interest calculated pursuant to Section 55.03 of the Florida Statutes, running from the date the monies were paid to CONTRACTOR. Section 11. EMPLOYEES SUBJECT TO COUNTY ORDINANCE NOS. 010 AND 020-1990 The CONTRACTOR warrants that it has not employed, retained or otherwise had act on its behalf any former County officer or employee subject to the prohibition of Section 2 of 5 �. --11.. —.._. 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 an Agreement with a public entity for the construction or repair of a public building or public work, may not perform work as a CONTRACTOR, supplier, subcontractor, or CONTRACTOR under Agreement with any public entity, and may not transact business with any public entity in excess of the threshold amount provided in Section 287.017 of the Florida Statutes, for the Category Two for a period of 36 months from the date of being placed on the convicted vendor list. Section 13. GOVERNING LAW, VENUE, INTERPRETATION, COSTS AND FEES This Agreement shall be governed by and construed in accordance with the laws of the State of Florida applicable to Agreements made and to be performed entirely in the State. In the event that any cause of action or administrative proceeding is instituted for the enforcement or interpretation of this Agreement, the COUNTY and CONTRACTOR agree that venue shall lie in the appropriate court or before the appropriate administrative body in Monroe County, Florida. Section 14. SEVERABILITY If any term, covenant, condition or provision of this Agreement(or the application thereof to any circumstance or person) shall be declared invalid or unenforceable to any extent by a court of competent jurisdiction, the remaining terms, covenants, conditions and provisions of this Agreement, shall not be affected thereby; and each remaining term, covenant, condition and provision of this Agreement shall be valid and shall be enforceable to the fullest extent permitted 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 6 The terms, covenants, conditions, and provisions of this Agreement shall bind and inure benefit of the COUNTY and CONTRACTOR and their respective legal representatives, ti the successors, and assigns. g representatives, Section 17. AUTHORITY Each party represents and warrants to the other that the execution, delivery and performance this Agreement have been duly authorized by all necessary County and corporate°Hance of required by law. action, as Section 18. ADJUDICATION OF DISPUTES OR DISAGREEMENTS COUNTY and CONTRACTOR agree that all disputes and disagreements shall be attempted be resolved by meet and confer sessions between representatives of each of the parties. f to issue or issues are still not resolved to the satisfaction of the parties, then an he the right to seek such relief or remedy as may be provided by this Agreement o by shall have This Agreement shall not be subject to arbitration. r by Florida law. Section 19. COOPERATION In the event any administrative or legal proceeding is instituted against either party the formation, execution, performance, or breach of this Agreement, COUNTY relating CONTRACTOR agree to participate, to the extent required by the other party, in all proceedings, hearings, processes, meetings, and other activities related to the substance of this Agreement or provision of the services under this Agreement. COUNTY and CONTRACTOR specifically agree that no party to this Agreement shall be required to enter into any arbitration proceedings related to this Agreement. Section 20. NONDISCRIMINATION COUNTY and CONTRACTOR agree that there will be no discrimination against any person, and it is expressly understood that upon a determination by a court of competent jurisdiction that discrimination has occurred, this Agreement automatically terminates without any further action on the part of any party, effective the date of the court order. The parties agree to comply with all Federal and Florida statutes, and all local ordinances, as applicable, relating to nondiscrimination. These include but are not limited to: 1) 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 290ee-3) as amended, relating to confidentiality of alcohol and dru abuse patient records; 8) Title VIII of the Civil Rights Act of 1968 (42 USC ss. 3601 et se g 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 a q')� as time, relating to nondiscrimination on the basis of disability; 10) Monroe County Code Chapter p 7 L 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 appl to the parties to, or the subject matter of, this Agreement. y 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 this Agreement. in Section 22. CODE OF ETHICS COUNTY agrees that officers and employees of the COUNTY recognize and will be required 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 bona fide 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 on of the COUNTY and the CONTRACTOR in this Agreement and the acquisition of any acommercial 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 8 ,7777... ... ., 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 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 9 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 alternative, the CONTRACTOR may require all Subcontractors to obtain insurance consistent with the attached schedules; however CONTRACTOR is solely responsible to ensure that said insurance is obtained and shall submit proof of insurance to COUNTY. Failure to provide proof of insurance shall be grounds for termination of this Agreement. The CONTRACTOR will not be permitted to commence work governed by this contract until satisfactory evidence of the required insurance has been furnished to the COUNTY as specified below. Delays in the commencement of work, resulting from the failure of the CONTRACTOR to provide satisfactory evidence of the required insurance, shall not extend deadlines specified in this contract and any penalties and failure to perform assessments shall be imposed as if the work commenced on the specified date and time, except for the CONTRACTOR's failure to provide satisfactory evidence. The CONTRACTOR shall maintain the required insurance throughout the entire term of this contract and any extensions specified in the attached schedules. Failure to comply with this provision may result in the immediate suspension of all work until the required insurance has been reinstated or replaced and/or termination of this Agreement and for damages to the COUNTY. Delays in the completion of work resulting from the failure of the CONTRACTOR to maintain the required insurance shall not extend deadlines specified in this contract and any penalties and failure to perform assessments shall be imposed as if the work had not been suspended, except for the CONTRACTOR's failure to maintain the required insurance. The CONTRACTOR shall provide, to the COUNTY, as satisfactory evidence of the required insurance, either: • Certificate of Insurance or • A Certified copy of the actual insurance policy. The County, at its sole option, has the right to request a certified copy of any or all insurance Policies required by this contract. All insurance policies must specify that they are not subject to cancellation, non-renewal, material change, or reduction in coverage unless a minimum of thirty(30)days prior notification is given to the County by the insurer. The acceptance and/or approval of the Contractor's insurance shall not be construed as relieving the Contractor from any liability or obligation assumed under this contract or imposed by law. 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 10 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. 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. 33.3 Workers' Compensation 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 advice or services of a professional nature, the Contractor shall purchase and maintain, throughout the life of the contract, Professional Liability Insurance which will respond to damages resulting from any claim arising out of the performance of professional services or any error or omission of the Contractor arising out of work governed by this contract. 11 77 �� ,ww,w�rrrac(/r'l((%(/(l%��I((/%�( ��r'flfd✓�i��u�f f��Pr(��a 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 COUNTY, its Mayor, the Board of County Commissioners to indemnify Officers, and the Employees, and any other and hold harmless the suits, claims, demands, actions, costs, obligations,aaons ' appointed Boards and Commissions, agents, individually and collectively, from all fines, out of the sole negligent actions of the CONTRACTOR fees, or liability of any kind arising caused by the willful nonperformance of the CONTRACTOR RACTOR or substantial and unnecessary answerable for an and shall be solely responsible delay Y and all accidents or injuries to persons or roe and performance of this contract. The amount and forth hereunder shall in tr way be construed as limitingProperty arising out of its type of insurance coverage requirements set Paragraph. Further the CONTRACTOR agrees to defend a acts attributable to the sole negligent act of the scope of indemnity set forth in this the CONTRACTOR. nay all legal costs attendant to RACTOR. At all times and for all purposes hereunder, the CO and not a employee of the Board of County Commissioners. agreement shall be construed so as to find the CONTRACTOR or any of his/her employees, CONTRACTOR is an independent contractor contractors, servants or agents to be employees oft No statement contained in this Monroe County. As an independent contractor the CONTRACTOR County Professional judgment and comply tY Commissioners for P y with all federal, state, and local statutes, ordinances,o'rddinances,nau eta and regulations applicable to the services to be provided. s The CONTRACTOR shall be responsible for the completeness supporting data, and other documents prepared or compiled under its obligation and shall correct at its expense all significant errors and accuracy of its work, plan, disclosed. The cost of the work necessa here for this project, CONTRACTOR and any damage incurred b °r omissions therein which may be g necessary to correct those errors attributable to the caused by such errors shall be chargeable to the CONTRACTOR. This y the COUNTY as a result of additional costs to any maps, official records, contracts, or other data that may be provided by the COUNTY or other public or semi-public agencies. Provision shall not apply Y The CONTRACTOR agrees that no charges or claims for for any delays or hindrances attributable to the COUNTY Portion of the services specified t this con damages shall Progress made a it shall be compensated for s the COUNTY b tract. Such delays or hiind ances fa , any for the CONTRACTOR to complete the work schedule. Such extension Of a for a reasonable period de between the parties. an agreement shall be made r 12 IN WITNESS WHEREOF, the parties hereto have caused these presents to be executed on the day of 20_. (SEAL) MONROE CO UNTY BOARD OF COUNTY COMMISSIONERS Attest: AMY HEAVILIN, CLERK By by Deputy Clerk Mayor/Chairman (CORPORATE SEAL) ATTEST: NEW TRUMA IICAL CENTER, P.A. Print name by MONROE COUNTY ATTORNEY APP VED AS.TO F M. CY THIA L. ALL ASSISTAN COU TY ATTO NEY Date. _I — .01 13 �,,..�, ,..,., , m yw� �� i SECTION ONE SCOPE OF SERVICES i EMPLOYMENT PHYSICAL SERVICES The scope of services to be provided on an as needed basis by the Provider but not be limited to, the following. The forms to be reviewed and comp I ed b the include, Contractor are attached to this agreement (Attachments A - P Y the All results will include: E)• • Written interpretation of test results in common terms an significance of each abnormality or written explanation of those esuls which r the outside the normal range. are • Examining physician's written recommendation concerning future action on condition considered outside the normal range. any • Written recommendation of specific reasonable accommodations in accord the ADA. accordance with SE RVICE DRUG SCREEN: When requested, a drug screen will FEE (Collection, Lab, MRO be performed by the physician and review) 10 panel State will be either scheduled or done on a Re uirement walk-in basis. $60.00 After hours drug testing for post $25.00 accident, random, and reasonable per test sus icion dru screenin .DRUG SCREEN: When requested, a drug screen will (Collection, Lab, MRO be performed by the physician and review) 5 panel will be either scheduled or done on a Department of walk-in basis. $40.00 Transportation Re uirement After hours drug testing for a .00 moving violation or an accident $25 test where a fatali occurs. per test Medical Review Officer The MRO receives lab reports from (MRO)REVIEW Included the laboratory(as governed by regulations); Reviews lab reports for integrity, authenticity, false negatives, and false positives; interprets lab results, including verification of lab positives;reports lab reports to the employer(as B defined b rules and re lations .LOOD ALCOHOL When requested, Blood Alcohol (Collection, Lab, MRO review Screens will be performed by the h sician and will be either $30.00 14 � , scheduled or done on a walk-in basis. After hours testing for post accident, $25.00 per random and reasonable suspicion test BREATH ALCOHOL alcohol screen. When requested, may be used for screening. If breath alcohol screen is $30.00 Positive, a blood screen will be erformed. After hours testing for post accident, $25.00 per random,and reasonable suspicion test alcohol screening. If breath alcohol screen is positive, a blood screen will be performed at the rate designated above. PPD- TB screen When requested, a PPD-TB screen will be scheduled and performed by the $25.00 Physician during the facility's normal business hours. HEPATITIS A When requested, a Hepatitis A inoculation will be scheduled and (Series each Performed by the physician during the to al)s of 2 facility's normal business hours. HEPATITIS B When requested, a Hepatitis B inoculation(s) will be scheduled and Performed by the physician duringthe $ each facility's normal business hours. (Secrvesries of 3 TYPHOID When requested, a Typhoid inoculation total will be scheduled and performed by the N/A Physician during the facility's normal TETANUS business hours. When requested, a Tetanus inoculation Combined will be scheduled and performed by the with Physician during the facility's normal Diphtheria business hours. DIPHTHERIA When requested, a Diphtheria below: inoculation will be scheduled and $55 Performed by the physician during the facility's normal business hours. DOT PHYSICAL: When requested, a DOT physical will (SEE ATTACHMENT be scheduled and performed by the $65.00 "B"to be completed by physician during the facility's normal employee and physician) business hours. Includes exam and physician review of employee health history and job description. The DOT physical is initially performed in con'unction with a ost-offer 15 physical. Thereafter, only a DOT physical is performed by the physician. Physician may also perform a urine drug screen if requested separately by Monroe Coun BOCC. POST-OFFER When requested, a post-offer physical PHYSICAL: will be scheduled and performed by the (SEE ATTACHMENT physician during the facility's normal $65.00 "A"to be completed by business hours. Includes exam and employee and physician) physician review of employee health history and job description. Physician may also perform a urine drug screen if requested separately by Monroe CountyBOCC. FITNESS FOR DUTY When requested, a Fitness for Duty PHYSICAL (SEE Physical may be requested at any time ATTACHMENT"A"to be by the employer in the employee's $65.00 completed by employee respective area of work. The exam will and physician) be scheduled during the facility's normal business hours. Includes physician review of employee health history, exam, review of job duties and medical records if necessary. Physician may also perform a urine drug screen if requested separately by Monroe County BOCC. RESPIRATOR When requested, a Respirator physical PHYSICAL(SEE will be scheduled and performed-by the ATTACHMENTS "C" physician during the facility's normal $85.00 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: ChestX-ray and S rirome CHEST X RAY Chest X Ray is normally done in conjunction with the Respirator $45.00 physical if there is an issue with the s irome results. SPIROMETRY Normally done in conjunction with the Respirator physical.. All employees who use a respirator will have a $45.00 S irome when hired. Normally done in conjunction with the HEARING/AUDIOGRAM appropriate physical. May be requested $30.00 s aratel b Monroe Coun BOCC. 16 ,,.,....,7,,, CHEMICAL Tests Glucose(sugar), kidneys, liver 1 PANEL/CMP tube of blood drawn , y ' ( $25.00 CBC Test to see if Anemic; if any infections 25$ .00 Within the body; if dehydrated(test from 1 of the tubes of blood drawn .LIPIDS Tests good cholesterol and bad )' (CHOLESTEROL) $35.00 cholesterol ( one of the tubes of blood Fawn UA DIP Normally done in conjunction with the DOT h sical. $10.00 UA WITH MICRO The Contractor shall retain all records pertaining to this contract for a$per 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 f of inspection or audit during normal business hours, at the Contractor's place(s) of poses business. 17 Ir SECTION TWO: COUNTY FORMS AND INSURANCE FORMS LOBBYING AND CONFLICT OF INTEREST CLAUSE SWORN STATEMENT UNDER ORDINANCE NO. 010-1990 MONROE COUNTY, FLORIDA ETHICS CLAUSE "NEW TRUMAN MEDICAL" (Company) "...warrants that he/it has not employed, retained or otherwise had act on his/her behalf any former County officer or employee in violation of Section 2 of Ordinance No. 010-1990 or any County officer or employee in violation of Section 3 of Ordinance No. 010-1990. For breach or violation of this provision the County may, in its discretion, terminate this Agreement without liability and may also, in its discretion, deduct from the Agreement or purchase price, or otherwise recover, the full amount of any fee, commission, percentage, gift, or consideration paid to the former County officer or employee." (Signatu Date: 3Xy! STATE OF: COUNTY OF: Subscribed and sworn to (or affirmed) before me on (date) by (name of affiant). He/She is personally known to me or has produced (type of identification) as identification. NOTARY PUBLIC My Commission Expires: 18 NON-COLLUSION AFFIDAVIT l of the city of according to law on my oath, and under penalty of perjury, depose and say that 1. 1 am of the firm of the bidder making the Proposal for the project described in the Request for Proposals for proposal with full authority to do so; and that I executed the said 2. The prices in this bid have been arrived at independently without collusion, consultation, communication or agreement for the purpose of restricting competition, as to any matter relating to such prices with any other bidder or with any competitor; 3. Unless otherwise required by law, the prices which have been quoted in this bid have not been knowingly disclosed by the bidder and will not knowingly be disclosed by the bidder prior to bid opening, directly or indirectly, to any other bidder or to any competitor; and 4. No attempt has been made or will be made by the bidder to induce any other person, partnership or corporation to submit, or not to submit, a bid for the purpose of restricting competition; and 5. The statements contained in this affidavit are true and correct, and made with full knowledge that Monroe County relies upon the truth of the statements contained in this affidavit in awarding contracts for said project. (Signature) / Date: < ( STATE OF: COUNTY OF: Subscribed and sworn to (or affirmed) before me on (date) by (name of affiant). He/She is personally known to me or has produced (type of identification) as identification. NOTARY PUBLIC My Commission Expires: 19 DRUG-FREE WORKPLACE FORM The undersigned vendor in accordance with Florida Statutes Section 287.087 hereby certifies that: NEW TRUMAN MEDICAL (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 that this firm complies fully with the above requirements. (Signatu Date. STATE OF: COUNTY OF: Subscribed and sworn to (or affirmed) before me on (date) by (name of affiant). He/She is personally known to me or has produced (type of identification) as identification. NOTARY PUBLIC My Commission Expires: 20 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 NEW TRUMAN MEDICAL (Contractor's name) nor any Affiliate has been placed on the convicted vendor list within the last 36 months. (Signatu Date: STATE OF: COUNTY OF: Subscribed and sworn to (or affirmed) before me on (date) by (name of affiant). He/She is personally known to me or has produced (type of identification) as identification. NOTARY PUBLIC My Commission Expires: 21 J MONROE COUNTY, FLORIDA RISK MANAGEMENT POLICY AND PROCEDURES f CONTRACT ADMINISTRATION MANUAL Indemnification and Hold Harmless For Other Contractors and Subcontractors The Contractor covenants and agrees to indemnify and hold harmless Monroe C County Commissioners from any and all claims for bodilyinjury our), Board of injury, and property damage (includingJ ry (including death), personal losses, damages, and expenses (including ttorney'sf es) wh chMonroe ari eooutyof,a ndcany onnec her with, or by reason of services provided by the Contractor or any of its Subcontractors in any n tier, occasioned by negligence, errors, or other wrongful act of omission of the Contractor or its Subcontractors in any tier, their employees, or agents. In the event the completion of the project (to include the work of others) is delayed or 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 NEW TRUMAN MEDICAL Prior to the commencement of work governed by this contract, the Contractor shall obtain Workers' Compensation Insurance with limits sufficient to respond to the applicable state statutes. In addition, the Contractor shall obtain Employers' 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 Insurance Program. If the Contractor participates in a self-insurance fund, a Certificate of Insurance will be required. In addition, the Contractor may be required to submit updated financial statements from the fund upon request from the County. 23 GENERAL LIABILITY INSURANCE REQUIREMENTS FOR EMPLOYMENT PHYSICAL SERVICES BETWEEN MONROE COUNTY, FLORIDA AND NEW TRUMAN MEDICAL Prior to the commencement of work governed by this contract, the Contractor shall obtain General Liability Insurance. Coverage shall be maintained throughout the life of the contract and include, as a minimum: • Premises Operations • Products and Completed Operations • Blanket Contractual Liability • Personal Injury Liability • Professional 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. 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 $ 100.0pp Bodily Injury by Acc. $ 500.000 Bodily Inj. by Disease, policy limits $_100.000 Bodily Inj. by Disease, each emp. 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 per Occurrence and Including errors and omissions $750,000 Aggregate The Monroe County Board of County Commissioners shall be named as Additional insured on general liability policy. 25 2014 Attachment UK NO.OF ATTACHED SHEETS: mr.LP1t:AL NECORD REPORT OF MEDICAL HISTORY oar o s in ormation is for official and medically-c—onfiden-tFal use only and will not be released to unaut orized persons 1. NAME OF PATIENT(Last,first,middle) 2.IDENTIFICATION NUMBER 7Position 4a. HOME STREET ADDRESS(Street or RFD;City or Town;State;and ZIP Code) S.EXAMINING FACILITY 4b. CITY c.STATE 4d.ZIP CODE 6. PURPOSE OF EXAMINATION 7. STATEMENT OF PATIENT'S PRESENT HEALTH AND MEDICATIONS CURRENTLY USED(Use additional pages if necessary) a. PRESENT HEALTH b.CURRENT MEDICATION REGULAR OR INTERM. c.ALLERGIES(Include insect bites/stings and common foods) Cl.HUGHT e. WEIGHT 8. PATIENT'S OCCUPATION (Check one RIGHT HANDED LEFT HANDED 10. PAST/CURRENT MEDICAL HISTORY CHECK EACH ITEM YES NO DON'T CHECK EACH ITEM YES NO DON'T CHECK EACH ITEM YES NO DON'T KNOW KNOW KNOW Household contact with anyone Shortness of breath Bona,joint or other deformity with tuberculosis Pain or pressure In cheat P Loss of finger or toe Tuberculosis or positive TB test Chronic cough Painful or"trick"shoulder Blood in sputum or when Palpitation or pounding heart or elbow coughing Heart trouble Recurrent back pain or any Excessive bleeding after injury or High orgliver ressure back injury dental work Cramss Plegs "Trick"or locked knee Suicide attempt or plans Frequenn Foot trouble Sleepwalking Stomactestinal trouble Nerve Injury Wear corrective lenses Go[[bladder trouble or Paralysis(including infantile) Eye surgery to correct vision gallstones Epilepsy or seizure Lack vision in either eye Jaundice or hepatitis Car,train,sea or air sickness Wear a hearing aid Broken bones Frequent trouble sleeping Stutter or stammer Adverse reaction to medication Depression or excessive worry Wear a brace or back support Skin diseases Loss of memory or amnesia Scarlet fever Tumor,growth,cyst,cancer Nervous trouble of any sort Rheumatic fever Hernia Periods of unconsciousness Swollen or painful joints Hemorrhoids or rectal disease Parent/sibling with diabetes, Frequent or severe headaches Frequent or painful urination cancer,stroke or heart disease Dizziness or fainting spells Bed wetting since age 12 X-ray or other radiation therapy Eye trouble Kidney stone or blood in urine Chemotherapy Hearing loss Sugar or albumin in urine Asbestos or toxic chemical Recurrent ear infections Sexually transmitted diseases exposure Chronic or frequent colds Recent gain or loss of weight Plate,pin or rod in any bone Severe tooth or gum trouble Eating disorder(anorexia bulimia, Easy fatigability Sinusitis etc.) Been told to cut down or Hay fever or allergic rhinitis Arthritis,Rheumatism,or criticized for alcohol use Head injury Bursitis Used illegal substances Asthma Thyroid trouble or goiter Used tobacco NSN 7540-00-181-B368 Previous edition not usable Prescribed STANDARD ICFO 6-96) GSA (REV. FIRMR(41 CFR) 201.9.202-1 i„� MEDICAL RECORD REPORT OF MEDICAL EXAMINATION DATE OF EXAM 1. LAST NAME-FIRST NAME-MIDDLE NAME 2. IDENTIFICATION NUMBER T Position 4. HOME ADDRESS(Number,street or RFD,c fy or town,state andZlP Code) 5. EMERGENCY CONTACT(Name,and address ofconted) 6. DATE OF BIRTH 7. AGE 8. SEX 9. RELATIONSHIP OF CONTACT FEMALE F1 MALE 10.PLACE OF BIRTH 11.RACE WHITE BLACK AMERICAN INDIAW HISPANIC HISPANIC AS A' ALASKA NATIVE WHITE BLACK ISLANDER 12e.AGENCY 12b.ORGANIZATION UNIT 13.TOTAL YEARS GOVERNMENT SERVICE a. MILITARY T. CIVILIAN 14.NAME OF EXAMINING FACILITY OR EXAMINER,AND ADDRESS 15.RATING OR SPECIALTY OF EXAMINER 16.PURPOSE OF EXAMINATION 17.CLINICAL EVALUATION N11AMUR- MAL (Check each Item In appropriate column,enter NE"Ifnot evaluated.) Mq MAL (Check each Item In appmpdate column,enter NE"Hnot evaluated.) MAL A.HEAD,FACE,NECK AND SCALP O.PROSTATE(Over40 orcllnloaltyIndicated) B.EARS-GENERAL(INTERNAL CANALS) P.TESTICULAR (Auditory acuity underltems 39 and 40) C.DRUMS(Perforation) R.ENDOCRINE SYSTEM D.NOSE S.G-U SYSTEM E.SINUSES T.UPPER EXTREMITIES(Strength,rangeofmotlon) F.MOUTH AND THROAT U.FEET G.EYES-GENERAL(Visual acuity and refraction under dorm28,29,and36) V.LOWER EXTREMITIES(Except feet)(Strength,range ofmotion) H.OPTHALMOSCOPIC W.SPINE,OTHER MUSCULOSKELETAL I. PUPILS(Equaft and reaction) X.IDENTIFYING BODY MARKS,SCARS,TATTOOS J.OCULAR MOTILITY(Associated parallel movements nydagmus) Y.SKIN,LYMPHATICS K.LUNGS AND CHEST Z.NEUROLOGIC(Equilibrium tests under Item 41) L.HEART(Thrust,size,rhythm,sounds) AA.PSYCHIATRIC(Specify any personality deviation) _ M.VASCULAR SYSTEM(Varicosities,etc.) N.ABDOMEN AND VISCERA(Include hernia) NOTES: (Describe every abnormality In detall. Enter pertinent Item number before each comment Continue In Item 42 and use additional sheets If necessary.) 18.DENTAL(Place appropriate symbols,shown In examples,above or below number of upper and lower teeth.) REMARKS AND ADDITIONAL DENTAL o / x �317 TR—T DEFECTS AND DISEASES Restorable Non- Missing 1 2 3 Replaced 1 2 3 Fixed restorable 0 Teeth 32 Teeth 3 3t 30 Teeth Dentures Dentures R L 1 1 2 3 4 5 8 7 8 9 10 11 12 13 14 15 16 E H 32 31 30 29 28 27 26 25 24 23 22 21 20 19 18 17 T T 19.TEST RESULTS(Copies of results are preferred as attachments) A.URINALYSIS: (1)SPECIFIC GRAVITY B.CHEST X-RAY OR PPD(Place,date,film numberand result) (2)URINE ALBUMIN (4)MICROSCOPIC (3)URINE SUGAR C.SYPHILIS SEROLOGY(Specify test used D.EKG E.BLOOD TYPE AND RH F.OTHER TESTS and results) FACTOR NSN 7540-00-634-4036 STANDARD FORM 88(Rev.10-94)(EG) 88-126 Designed using Perform Pro,WHS1010R,Jan 97 Prescribed by GSAIICMR FIRMR(41 CFR)201-9.202-1 ,,,,,,,�� ,,,,,,,, ,,,, ,,,,,,,.,,, 11.FEMALES ONLY DON'T DATE OF LAST MENSTRUAL DATE OF LAST PAP SMEAR DATE OF LAST MAMMO- CHECK EACH ITEM YES NO KNOW PERIOD GRAM Treated for a female disorder IN N/A N/A N/A Change in menstrual pattern N/ CHECK EACH ITEM. IF"YEo'EXPLAIN IN BLANK SPACE TO RIGHT. LIST EXPLANATION BY ITEM NUMBER. ITEM YES�NO 12.Have you been refused employment or been unable to hold a Job or stay in school because of: a.Sensitivity to chemicals,dust,sunlight,etc. b.Inabillty to perform certain motions. c.Inability to assume certain positions. d.Other medical reasons(If yes,give reasons.) 13.Have you ever been treated for a mental condition? (If yes,specify when, where,and give details.) --44r Have-you ever been denled-life-Insurance? (If year state reason and give details.) - 15. Have you had,or have you been advised to have,any operation. Of yes,describe and give age at which occurred.) 16.Have you ever been a patient in any type of hospital? (If yes, specify when, where,why,and name of doctor and complete address of hospital.) 17. Have you consulted or been treated by clinics,physicians,healers, or other practitioners within the past 5 years for other than minor illnesses? (If yes,give complete address of doctor,hospital,clinic,and details.) 1 B.Have you ever been rejected for military service because o physical,mental,or other reasons? (If yes,give date and reason for rejection.) 19.Have you ever been discharged from military service because of physical,mental,or other reasons? fif yes,give date,reason,and type of discharge,whether honorable,other then honorable,for unfitness or unsuitability.) 20.Have you ever received,is there pending,or have you ever applied for pension or compensation for existing disability? (If yes,specify what kind, granted by whom,and what amount, when, why.) 22. Have you ever been diagnosed with a learning disability? (If yes, give type, where,and how diagnosed.) 23. LIST ALL IMMUNIZATIONS RECEIVED certify that I have reviewed the foregoing information supplied y me and that it Is true and compete tote beat of my know a ge. authorize any o t e octors, ospita s,or clinics mentioned above to furnish the Government a complete transcript of my medical record for purposes of processing my application for this employment or service. I understand that falsification of information on Government forms is punishable by fine and/or imprisonment. 24a.TYPED OR PRINTED NAME OF EXAMINEE 24b.SIGNATURE 24c.DATE NOTE: HAND TO THE DOCTOR OR NURSE, OR IF MAILED MARK ENVELOPE "TO BE OPENED BY MEDICAL OFFICER ONLY". 25.PHYSICIAN'S SUMMARY AND ELABORATION OF ALL PERTINENT DATA(Physician shall comment on all positive answers in Items 7 through 11. Physician may develop by interview any additional medical history deemed important,and record any significiant findings here.) 26a.TYPED OR PRINTED NAME OF PHYSICIAN OR EXAMINER 26b.SIGNATURE 26c.DATE STANDARD FORM 93 (REV. 6-96)BACK • NAME IDENTIFICATION NUMBER NO.OF SHEETS ATTACHED MEASUREMENTS AND OTHER FINDINGS 20.HEIGHT 21.WEIGHT 22.COLOR HAIR 23:COLOR EYES 24.BUILDTEMPERATURE 26.BLOODPRESSURE rl SLENDER MEDIUM HEAVYOB(Arm at heart level) 27.PULSE(Ann atheartlevel)q. SYS. RECUM-B. Syg' STANDING SYS. A•SITTING B.RECUMBENT C.ST D GR EXERCISE E,2 MINS.AFTER SITTING pIAS. BENT DIAg, (5mins.) DIAS (3mfns) 28.DISTANT VISION 29.REFRACTION RIGNT 20/ CORR.TO 20/ By 30.NEAR VISION S. CX CORR.TO BY LEFT 20/ CORR.TO 20t BY S. CX 31.HETEROPHORIA(Tp--VdWance) CORR.TO BY ESO EXO R.H. L.H. PRISM DIV. PRISM CONY. PC CT PD 32,ACCOMMODATION 33.COLOR VISION(Test usedandrpsult) 34.DEPTHPERCEP UNCORRECTED RIGHT LEFT (Test used and s001e) CORRECTED 35.FIELD OF VISION 36.NIGHTVISICiV(Teat used and snore) 37.RED LENS TEST FT RIGHT LE 38.INTRAOCULAR TENSION 39.HEARING RIGHT LEFT 40.AUDIOMETER 41.PSYCHOLOGICAL AND PSYCHOMOTOR(Testa-used-and score) RIGHT WN /15SV /15 250 500 1000 2000 3000 4000 6000 8000 256 512 1024 2048 2896 4096 6144 8192 LEFT WN /15SV /15 RIG LEFT 42.NOTES(ConBnued)AND SIGNIFICANT OR INTERVAL HISTORY 43.SUMMARY OF DEFECTS AND DIAGNOSES(List diagnoses with Item numbera)tbnal sheets If 44.RECOMMENDATIONS-FURTHER SPECIALIST EXAMINATIONS INDICATED(Speclty) 45A.PHYSICAL PROFILE P U L H E S 46.EXAMINEE(Check) A.❑IS QUALIFIED FOR In accordance with attached Job B.❑IS NOT QUALIFIED FOR description 45B.PHYSICAL CATEGORY 41.IF NOT QUALIFIED,LIST DISQUALIFYING DEFECTS BY ITEM NUMBER A B C E 48.TYPED OR PRINTED NAME OF PHYSICIAN SIGNATURE 49.TYPED OR PRINTED NAME OF PHYSICIAN SIGNATURE 50.TYPED OR PRINTED NAME OF DENTIST OR PHYSICIAN(Indkate which) SIGNATURE 51.TYPED OR PRINTED NAME OF REVIEW NG OFFICER OR APPROVING AUTHORITYSIGNATURE STANDARD FORM 88(Rev.10-94)BACK w ,,,,,,,,z. ,,, 3 3 n a B o ❑❑❑❑ ❑❑❑ ❑❑❑ m N D 3 � p � . 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C m 0 Z 2 UZ)5 M-* rn m w w 0— :q -= Cc, S j to Sul �c R 9 m 0 cn CL!;IL 0 0 00 &0 w > W V�m LU ir a: }� m { � E | | § to ir-i a 0 2 3 5 ?p. m i c-, ( ƒ ;U) CC m M m IL © ■LU LU 4 LL .4 m IL a U L) ■ T IE/ f § . n �) `7777 77-77 ....................... ..,, . .v.. 1 1 yl1IQI1 IYIUUI%0QI /,%1j t IvulIJura 2014 Attachment "C" k1 Evc-du atiOn Questionnai-re To the employer: Answ,43 to questions in Section 1,axxi to question 9 in Section 2 of Part A,do no- t require a medical e'��ation, To the employee:Can you read?(check onek Youremployer ...................»...............................................................,.........................0 Yes p yer must allow you to answer this questionnaire during ❑No convenient to you.To maintain your confidentklity,your employer or cttlnl working hours,or at a,time and place that is and vour employer must tell you how to deliver or send this uestio for must not look at or review your q nnaire to the healthcare professional who will rem The following information must be provided b every ery employee who has been selected to use any type of respirator(ply Pit). j Z\iame• Job Title: Age(to nearest year} Sec(check one) 0 r l de ❑Female Date: Height feet_inches Weight: lbs. —! Check the type of reepiartoryou will we(you Can check Phone aumberwhese you cam be reached more than one c�tegory} care pesaon who reviews this ' by the health a. 0 N,R or P b�respirator p'�1etOr(fi�mask; The best time to call you at this�b�a� r non-cmidge hype only ` a' 0 Other type(Ibr exam 1 h'Pe poweredar P half-or full facepieae P ng,applied air,self cont4ned peiion who will review you how to contact ire healtti cafe _ breathing apparatus). Y p gertold this(check osrer 0 Yes 0 No6�hoar reap .»....... ». ...0 If"yes,"what type(sk Yes ONO Part A— Section 2 Questions 1 through 9�beln000w answered by every employee (P�check yes orwho has been selected to use any type of respirator L Do you cuaerdiy smoke tobacco,orha ve you smoked tobacco in the last month?»................. 2 Have You everbad ...........»»••••••0 Yes ❑No a. Seizzures argr of tfre following conditions? b. iabetes(su�gardisease}....»........»»...»..»...»...........»».... ..»..........».....»»......»......»..»»....»........................O Yes O No c- Mier*reactions that interfere with breathin................».».......... ... ......»............»....................................0 Yes d. Claustrophobia � ..».......... ❑No "str'oP (�.of closed »..»..»..»....»»...»...»»....».»»...»».......»..»....».....0 Y e. Trouble eIIin m P ce9r ..................... es 0 No 3 sm g odors: ..........»......»................................"...............»...--•........»................».............»...»»...0 Yes ❑No .Have you ever had any of the followin .......»»..».».....»............•................... .»......»»»...0 Yes ❑No a. Asbestosis: g orlaagpmb�, c• C theta:..........»....................�........».................................................................. ».................................. ........... ..... .ayes ❑No Chronic bronchitis: .»............. »..........»................................».....».................... ......0 Yes O No e.. Emphysema: .................................................................................................................................................................»....................»..................0 Yes O No f. Pneumordw vlosis: ............................ »................................ .. ..........................»....0 Yes ONO ......... ..»...................................❑Yes ❑No 8- Silicasi�..»....»... .».................................»...........»............ h .».»....................»....».»....».......»...».»»»..... ................».......................»...0 Yes ONO Pneumotltorax(collapsed lung}.........................» .».....».».....».»».»...................»..........»..O Yes I Lung oth r: ....»..»....»..».. .»...».................................................. ❑No _ 1• Broken rilu: ..................................».........».................. »..................... ..........................»..oyes 0 No kM. ..� ..................................... . ..................»....0 Yes ❑No •...p.•UiPf.7S.V.�: L Any chest irqurles or surgeries. ............».. es IIRo ........... Any other lung problem that you've been told about: .................................»............... .0 Yes ONO .............»»...................»......................0 Yes ONO ..M-W~ y ...W.M 4.Do you tunvntly have any of the following symptoms of PulmOnaxy or lung illness? � a. Slwrlttess of breath: .........»...........» b. Shortness of breath when walking fast on'ievel.ground or Walking Yes 0 No c. Shortness of beeuth when walking with other people at do ordin g up a slight hill or e:,,,,,,,,,,,,,,,0 Ycs O No d. Have to stopfor breath when w P P +n'Y Puce on level ground: ..................0 Yes ❑No walking at your own pace on level ground:...............»..................... e. Shortness of breath when waslun.or dre\ssirt o .........a Ym 0 Nn f Shortness of breath that interferes with your job: .... """""'•••••••0 Yes O No g. Coughing that produces phlegm( spuh m): .......................... ..........................................................❑Yes ❑No 1�. Coughing that wakes you early in the monung:. ............................... .............................................0 Yes ❑ No as L Coughing that occurs mashy , }you are lying down.....».....................................................................0 Yea O No looci in ....................0Yss 0 No ). Coughing up the last month .... kWheezing: ..................»»......».».»...... .........................................................».........».................................»0 Yea O No .......................»........................................ I. Wheezing that interferes ..............».................. ............0 Yes O No with your job:..................»...................................................M. Chest pain when you breathe deeply:.....................».. "'.......................»•••••»0 Yes. 0 No ..».....................................................................».........0 Yes O No no y° symptoms that you think may be related to lung problems: ............................ . .....................0 Yes ❑No S.Have you ever had any of the following Cardiovascular or heartprvbla=? a. Heart attarc: .....».».................................» b. Stroke. ...............».»...»»»........».»........».......................»...................................».......»........................ ....0 Yes 0 No c. Angina:..»»».....:»»......»».........».... ................"...............»......»......»...........»....»............».....»»..».....»..0 Yes 0 No d. Heart failure: ...................».». .....»„.»...»:..........»...."..........»...................».. .........................»............»....0 Yes ❑No e. Swelling in your legs or feet(not caused by walking);...»....... »......... ..».......».»..............................»....»..0 Yes O No f Heart aahydwda(heart beating .................»....................'»..............................»....❑Ye 0 No s ._.. _...-- �Yh».........»............». • ......................................emu.®Yes..._ 0 No IL Any other heart problem that you've been told about:..».......................................................»....... »....»......».».»......."""O Yes O No »..................».......».......».0 Yes O No L Have you everhad any of the following�o�yy.�or mp heartsytom? a. Frequent pain or tightness in your chest» _ b. Pain or tightness in your chest during physical activity,»...».»....».....»»..............»»........."».»._»...""»..»••O Yes ❑No cPain or tightness ................................»...........»»»...»..........»»»...0 Yes O No � ghtiuels in your chest that interferes with yourjbtx »»...».».».............»........»....» e. Heartburn or In the Past oye have you noticed your heart ski g beat:»».............».»»............»0 Yes O No PPing or missing a indigestion that is no ...................... Yea O No f not b eating:.»....»....»..»»..............»..Any other symptoms that you think may be related . ble... : ............... ••........»•••••.... •••0 Yea ❑No m heart or drrulatian problems 7.Do you cuaently take aledica"On forany of the follawing ptvblerns? »...».....0 Yes O No a. Breathing or lung problems:»»» b. ...........»........ ...»...........»...»......».............................................»...........................»....0 Yes Heart trouble:...»......... 0 No cBlom pressure: »............................ .............................................»...............................................»...............0 Yes O No .........»........................................»...0 Yes ❑No ti. .......................................................................0 Yes O No If you've used a respirator;have you everhad any of the following problems?(If you've never used a respirator go to question 9) a. Eye irritation:......».».......»».......»........................................... b. Skin allergies or rashes; ..........................»................. .. .........................................•0 Yes ❑No cAnxiety: ....».................................................................."..................................................................................0 Yes 0 No .............................»............................................................................. General weakness or fatigue:........................... ......0 Yes O No d. ................................................................................................0 Yes O No e. Other problem that interferes with your respirator use:................................. `............................................0 Yes ❑No Y II ��m mr'r Il/rtYri�i a,uflYA0111,f(l!l �IC,1I"-AY;u lk,wpktldp y"'uuld you like to t.,lk to the he Jlth rJR "stt;tvera to this y4e,K„ professiul>.d who will n�v• nrtJ in!:............................... ..... .......... ....... ... letiv th is yu�,s t iu nnr ire a bout .. your .............. .................. <�u��tfr)s1s ............... lulu I�by ......7 Y�•s 7 Nu low must hl�,lnsw�!rt�d(+ ,� sr�lf�unt.rinik)l+rt�,llhin•.1 Y t(ry vntFluyiy1 who h,�s bev thl•,�..luI.tiuns its vulunt�ryFFJratus(SCBA).Fur vnt k) •lye n w.lt tv�J t�)user o F y s who b'""?l+vwn e lthrr J full-lay v kr G�to use uthv Filrr rt'+piratur 1; r tyl+,s of............ n'.+Firltlas 10. If-Ave you ever lost v is oion in either eye(tem 11. p Y°rPeRm•rnen .•u�wl-rir Do you cunvntl y have,my of the ............ J. �V�!ar1:()nt l�tl4.11YIV followi ...................'>Y1 ts 7 �► ng vision proble»a? tly� 'o Color lJ. Other blind:.........................................................................................................•.... ...... ..............3 Y"S rJ Nu ar v' n ru ........... ....0 Yis............. .............................0 Y( L7-"Wive You ever had an g broken •...• ............... -- 13�p 'uy to your earn,lncludln a b �ear �t cunen hive am of the to owk' -g p met _ 0 0. a. piffj�ulty ,,u,in� bCe b. ra C. Any u hearing W:........................................................................................................ ........er g or ear problem:................... ......................................... •• .............0 14LYlm NO 0 No .....quar ................. Q No Have you ever had ................. ................. 15* Do .......................... a• ` have any of the followin .............r]Yc� 0 NO Vey in 4nyof your g musculoskeletal problems? b. B,nJc pain:............... ate'hanJk lei,or feet ........................................... ..................... ......... .................................0 Ye, O No J. Pain or sttfltt fully moving your arms Jnd leg+: ............... ........... esswhen you leJrt fo .................................Q Y es 0 No .................................. f• Difficulty fully moving Your n'Oredd u or badcward-it the �, ........................................Q Yre O No ................................. Difficulty fully movie o p or down: .............. ......... moving Your he .................Q Y pd � head Side to side;...... ................. m° 0 NO ................. g• vlty ndtng at your kml, ........ ............ ........................................ ...........0 Yes O No h. DOkultysqu., tingto .................. ....................................... ........................................ O Y« i• Climbing"nigh !�'Ound: O No ........... ... ...................................... S t of stuirr or a WJJer .... ........... ... ............Q ...................... Yes O No 1• Y her muscle or skeletul � t more 25 l ..........a Yes Q No Problem that inf<.rfeng w. ...........................................Q Y 0 No P�B � using a n�spirator........ �.............................Any of the fulluwin, ""'•Q Yes O No ''ire PnA.'s•5iunal wl o wjl1Uov�W t nd utheryuE-itiuns not listed,m.r he yucstionnJire, Y be Jdded to the questionnaire Jt 1. In �d�st!tiun of the health yotr&zrn'AjmA`moL,'nugb` 'Imyouworkinthan of g Jt high altitud ov °''Yl;en:................ es( er'Aft feet)orin a pWce that or other s ............ has love Ymptoms when yuu'm working •............under th(se cund,tiurus; r L:1t work o .................. y rat home,have 7 Vu You ever be .............. •O Yrs (e&PsM farnes,ur dust e. osed to h.rzarslo J�Vu ),or you come into �solvents,h skit contact with •lzarsl°ls a"bome chewk ds hazardous chemk dw...... RESPIR,ATpR USE J PHYSICAL Name Age Sex Home Address Telephone Occupation Length of Employment I agree to the release of this information for State and Federal regulatory extent provided by applicable laws. rY Purposes to the DATE _ SIGNED EMPLOYER ❑Follow-up Medical Evaluation Physical Required. (Positive response—Question 1 ❑Post-Offer Physical: Medical Evaluation Physical Required, • •%Ic.% Ire:•WOU No 11MIC 3.11.ave yuu.Wworlwd with any of the outeri.ds,orunderany of the conditions,listed below: ,j. Ash-itt,.w:............................................................................................................................................................3Ytw h, SilH-a 6' � in•andbUstiny):...................................... . . . Cunl;stvn/too ajt(r.I,.t,,rindinit t r wt•IL]int;this mate-ri.11):............................................................................3 Yt-c .1. Vveyllium: ..........................................................................................................................................................]Y's ��. •lluminum:..............•...............................•..........................................................................................•..............]Yt s f. Coal(for example,minui};r Nu tSfmn: .............................................................................................................................•.....................................]Yl°{ ]Nu h. f in:......................................................................................................................................................................'7 Y%-j i. Ou-sty vinininmetiLs:....................................................................................................................................... ..]Y's j. Vtht-r Iwanluus expisures: ............................................................................................................................3 YkS �]Nu dr.scr h?thaneexposurtm i.List any second jobs or side businesses you have: 5.List your previous occupations 6.List youravnvnt and previous hobbies 7.Have you been in the nWAaq services?..................................................................................................................a Yes O iVo if"yes,"were you exposed to biological or clumrical agents(either in truirdng or combutZ ..................................0 Yes O No LHave you everworlked on a HAZNIAT team? .......................................................................................................0 Yes 0 No 9.Other than medications for breathing and lung problevas,head trouble,blood pressure,and seizures mentioned earlier in this questionnaire,are you taking any other medications for any reason (including over-the-counter me&-ation#............................:.......................................................................................0 YCS O No if"yam" name the medications if you know them: 10.sVM you be using any of the following items with your respimtor(s)? a. HEPA Filters: .................................................................................................................................................... b. Canisters(fur example,gas masks):................................................................................................................ri ye. r]NO c. C.utnLl*m..................................................................................................................... 11. I low often are you expected to use the respirator(s)h a. Escape only(nu n•scue}............................................................................................. b. Emeri envy nrscue only:•....................................................................................................•..............................0 Yes O No C. Less than 5 hours per week..............................................................................................................................13 Ycs O,.'u ILess than 2 Imum per day:...............................................................................................................................!]YIs Q M) c.,.. 2 to-I hoursMdayr...... _ .. ... ' _ ......... ......... ......... ......... ......... .............. a YLS ra No f. 0%or4 hours per,iay:.........................................................................................................•.............................OYkS ONO M M, mm T i rill/i �J /////%/iiiiiirriii • %1C.%► p&•IAU l?.i0e 141.+.in 12. During the period you 41v using the nypirator(s), Ls your work effort; �. l.ig;ht(b•as than_'M kcal per hour): If"v,•s," luau to �dr;c•s � ................................................................................................................. ng, this p�riod last during the avers ge shift: �Nt� Exam +I��s of a light week�� b has•.._miiv. l g, f fort are sitting;while wnti%typin*drafting,or performing light.Ls. -mhly vv ark ur,tmiding;��bile oE��rating;a dnll pmsa(l•3 Ib�.)ur ri�ntnalling;rnarhina s. l+. Irderate(ill)to 30 kcal lvr hour):. If"""how lung;d(x%this P ring,thy.av rage,hit period teat du......�....�.....�..............�................................................................� hm._mins. Examples of mederute work 14601t are sitting;while nailing;or filing,driving;a truck or bus in urban traffic;standing;while drilling,nailing;, performing m.A.mbly work,or transferring a maderatL•load(alv)ut 15 ll*a.)at trunk level;walking;on a level Surface•about 2 mph or down a 34egpn-x,•grade alv)ut 3 mph;or pushing a wheelbamnv with a lu•uvy load(alv)ut IM lbs.)un a level surface. C. Heavy(abuve 331)kcal per hour): If"yc�s,'how tun dues this Period ...............................................................0 Yis O 1Vo f; Period Last during the i%verage s hrs. mire. E%JmplrS of!wavy work are lifting a heavy Ivad(about at)lbs.)from the tloc>r to your waist ur shoulder,working on a Wding duck;shuveling;standing while bricklaying or chipping castings;walking up an 11-cleSme ggade about 2 mph;climbing stairs with a heavy load(about 30 N.). 1&Wal you be wearkWpmtectivectottt�rt or egiaTpment other. -_ -- _- --- g• ( then the respirator,when you m useirag your respiratoe........................................................................ If ..............................................................................0 Yes 0 No ••yes.' plc•s.ribNthispruhtitive.luthing,and/orcyuipmer�t 14.Will you be working under hot conditions(temperature exceeding 77Wa ........................... MWiU you be woddng under humid conditioner...................................................................................................0 Yes 0 No 17. Dewribe any special or hazardous conditions you might encounter when you're using your respirator(s) (for example,confined spaces,life-thwatenieg gasp I& Prvvide the following Information,if you know it,for each toxic substance that you'll be exposed to where you've using your nespirator(s): ,dame of the first toxic suh,tarxe: FstimatVd maximum expinure level pp?r shift: MCA IN&-*OU DiN IIYIZ*l Duration of jvr shift: NLAMU of the Svtonj to.Xk qLame.of fvrshilL. Duration of"Pmure per shift N-Ame of the third to, .subsume; Estimated maximum exposure level per ship Duration of ex�ppoqum.�per 5.hi The name e of other toxic s u b a tiv xv 9 that You'll be exposed to while using Your n!spimtor your 19.Dle�scnnbe any specW m9ponsalij,"es Y,,,U have while others(for exAmple,rescue,securityp using Your r"p'='or(.9)that may alfect the safety And well-being of 7- � �uww�reJ 1Ic. (rnt•,*Au 1`&Ilk I( PLHCPFOIIOW. U Medic Examina 17mployee Minter tiox, Copy of rwoMmendation given to employee? Y lob tides es0a RLN•asnnwndAliuns,+bout��mpluy14.sue ul'life nos Date of this follow-ups Vn"Istionss. pirstt�r. Reasons forfouuw-up r AcHonas Need for follow-up medical evaluLldons. _. . _. Date signeds- Signed: _ . , Doe givens 1 RESPIRATOR USE PHYSICAL See Attached Job Descriptioa uariE AGE SEX HOME ADDRESS TELEPHONE OCCUPATION LENGTH OF EMPLOYMENT tt jnJormatlon jor State and Federal re ulato agree to the release ojth ... . ry p rposes: ATE --- _ SIGNED CARDIO-PULMONARY TION 1• HEIGHT WEIGHT_ 2. HEART: Murmers: Rate Rhythm Enlargement 3. LUNGS: Pulmonary Function Within Normal Limits Outside Normal Limits 4. PA CHESTX.RAY: Within Normal Limits Outside Norma!Limits S' RECONSIENDATIONS: It is my opinion that the above named patient is_qualified to wear a Respirator in the performance o ist /he 1.1 not r duties medically PHYSICIA�Y I MONROE COUNTY SAFETY POLICIES AND PROCEDURES MANUAL 7. Use only safety type lathe dogs or those with flush set screws. 8. DO NOT HOLD emery cloth in your hand while polishing revolvin work. Use a wood block or jig for this purpose. Onl u g handles. Y se files with 9. When machine rods or bars that project beyond the head stock, enclose the projecting portion in a stationary pipe supported on a suitable stand. 10. The machining of irregularly shaped castings, crankshafts, and similar objects where the tool is not in contact with the work during the entire revolution of the chuck, IS EXTREMELY HAZARDOUS. The operator MUST BE CONSTANTLY ON THE ALERT to avoid being caught or struck by the work. 11. Do not knock chips off the tool or lean over the lathe to inspect the work while it is running. 10.17 PERSONAL PROTECTIVE EQUIPMENT A. Gloves: On operations where gloves are necessary, wear the proper type specified by your Supervisor. B. Hard Hats: Hard hats are provided by the County to protect your head against the danger of head injury from falling or flying objects, or from electrical shock and burns. Be sure your hat is in good condition and has a chin strap. There is no protection if the hard hat is knocked off. If an area is designated as "HARD HAT AREA" all persons entering these areas shall be required to wear a hard hat. C. Respirators 1• POLICY It is the policy of Monroe County to protect its employees from hazardous atmospheres through a comprehensive program of recognition; evaluation; engineering, administrative and work practice controls; and personal protective equipment, including respirators. To the greatest extent feasible, hazard elimination and engineering and work practice controls shall be employed to control employee exposure to within allowable exposure limits. However, where these measures are not feasible or fully effective or are under development, Monroe County shall provide appropriate respirators to affected employees under this program. Monroe County is committed to full compliance with applicable federal and state regulations pertaining to employee respiratory protection. 10-59 i MONROE COUNTY SAFETY POLICIES AND PROCEDURES MANUAL 2. PURPOSE The purpose of this program is to protect the health of Monroe County employees who may be exposed to hazardous atmospheres in the conduct of their work and to provide appropriate protection from these hazards, without creating new hazards. This program sets forth the County's practices for respirator use, provides information and guidance on the proper selection, use and care of respirators, and contains requirements for establishing and maintaining a respirator program. 3. SCOPE This program applies to all Monroe County employees who need to wear a respirator to perform assigned duties. Examples of chemicals or operations that Pose potential respiratory hazards and involve respirator use are Asbestos - Facilities Maintenance Dust— Facilities Maintenance & Roads & Bridges Spray Paint Operations— Fleet Management Immediate Danger to Life & Health (IDLH) — Fire Rescue, Airborne/Bloodborne Pathogens— Fire Rescue Herbicides— Roads & Bridges, Airport Maintenance Household Waste — Solid Waste 4. ROLES AND RESPONSIBILITIES General Manager— Employee Services Director- Supports the Respiratory Protection Program and assigns a Respirator Administrator with responsibility and resources to administer the program. Respirator Administrator—Safety Officer- Has overall responsibility for the Respirator Protection Program including monitoring respiratory hazards, and conducting program evaluations. Has knowledge about respiratory protection and maintains an awareness of current regulatory requirements and good practices. Approves Respiratory Protection Programs for each operation that involves use of respirators. Approves training program for employees. 10-60 MONROE COUNTY SAFETY POLICIES AND PROCEDURES MANUAL Approves fit test procedures for employees Approves respirator makes and models for use. Performs employee exposure monitoring upon initial Work in a hazardous atmosphere and whenever work conditions change that mayy affect employee exposure. Performs employee exposure monitoring in accordance with Federal an State OSHA regulations d Uses generally accepted sampling techniques and analytical methods including generally accepted quality assurance and control measures. Reports all findings to the supervisor within five days of receipt of analytical results from the laboratory, at a minimum. Upon request, performs surveys and makes recommendations for hazard control. Respirator Technician - Supervisor Complete initial respirator training, refresher training and maintain records. In addition, complete any recommended respirator manufacturer training prior to servicing respirators and their components. Perform and document semi-annual inspections of each air purifying respirator and monthly inspections of each supplied air respirator issued by the employer or maintained in its inventory. Ensure that compressed breathing air cylinders are hydrostatically tested on schedule. Remove from service and tagout any defective respirator parts. Perform maintenance and repairs for respiratory protection equipment in accordance with the manufacturer's instructions. Maintain an inventory of respirators and associated parts and equipment in a clean, secure area. Issue respirators when so directed in writing, inspecting to confirm that the respirator or equipment is of the type specified in the respirator plan or program. Issue spectacle kits to employees who require corrective lenses with their respirators. Perform tests for compressed air quality and inspect breathing air compressors periodically 10-61 MONROE COUNTY SAFETY POLICIES AND PROCEDURES MANUAL Supervisors Initiate and approve a written Respiratory Protection Program for each operation that involves respirator use 9 Complete the initial and respirator refresher training of the type attended by employees under their supervision Initiate safety briefings on respiratory protection of each new project or task that involy sresp Sato ry issues shazardt the starts for affected employees under their supervision d Ensure that any use of respirators by employees under their supervision is in accordance with this program and a written Respiratory Protection Program and Worksite-Specific Respiratory Protection Plan that has been approved by the Supervisor and the Respirator Administrator, or designee Record any complaints related to respirator usage, act promptly to investigate the complaints, correct any hazards, and get medical assistance, when indicated. Report first aid and medical treatment in accordance with Monroe County procedures. Report every respirator related incident to the Respirator Administrator before the end of the work shift Ensure that their employees have the requisite training, fit testing, and medical clearances before authorizing them to wear any respirators Prohibit any employee with lapsed or incomplete respirator clearances to work in hazardous atmospheres. Enforce any restrictions imposed by the occupational physician on individual employees, including the need for corrective lenses Physically check each respirator prior to its assignment to their employees to be sure that it is of the type specified in the written plan. Inform each affected employee of the results of exposure monitoring within one day of receiving such results and assure inclusion of all exposure reports in the County's recordkeeping system Monitor employee compliance with the respirator program requirements Employees Use respiratory protection in accordance with the instructions and training provide Immediately report any defects in the respiratory protection equipment and whenever there is a respirator malfunction, immediately evacuate to a safe area and report the malfunction 10-62 77 , , f MONROE COUNTY SAFETY POLICIES AND PROCEDURES f MAN UAL Promptly report to the supervisor any symptoms of illness that may be related to respirator usage or exposure to hazardous atmospheres f Report any health concerns related to respirator use or changes in h status to the occupational physician g ealth Wash their assigned reusable respirators at the end of each work shift when used and disinfect assigned respirators at least weekly Store respirators in accordance with instructions received Observe any restrictions placed on work activities by the occu physician. pationaI Be clean shaven in all facial areas that seal to the respirator fa� ce piece. Allow no headpieces, Band-Aids or other items beneath a respirator seal or head-strap assembly. Inspect the respirator immediately before each use, in accordance with training provided. Perform a user seal, negative and positive respirator fit check each time a respirator is donned in accordance with training provided. S. PERMISSIBLE PRACTICE Any respirator worn by a Monroe County employee on the job shall be issued by Monroe County under this program. Respirators shall be issued by Monroe County and worn by exposed employees whenever airborne contamination levels are not otherwise reduced to within the allowable limits. A written Respiratory Protection Program and Worksite-Specific Respirato Protection Plan shall be prepared and approved by the Supervisor and the ry Respirator Administrator prior to any employee respirator use, including voluntary usage or emergency use. This plan shall identify the location and tasks, identify and quantitative the air contaminants or o xye specify the appropriate respirator, and specify any limitat onsn uchciency as air, monitoring, respirator cartridge change out frequency, etc. Each operation involving respirator use must have a signed and approved written plan. Upon an employee's request, an appropriate respirator shall be issued for voluntary use when exposure to contaminant levels is at or above 50 percent of allowable limits, but within allowable limits, or when exposed to nuisance dusts molds, pollen, etc. Reasonable efforts should be made to reduce such exposures. 10-63 i '7 7 , I, MONROE COUNTY SAFETY POLICIES AND PROCEDURES MANUAL Regardless of exposure level, employees who are exposed to any recognized carcinogen, mutagen or teratogen in the performance of their work assignments may request and receive an appropriate respirator for voluntary use and in addition, affected employees already assigned a respirator may request a respirator that provides a higher protection factor than the one provided by Monroe County for that work. The Monroe County Hazardous Material Emergency Response Plan required for chemical spills or releases, fire response, pathogen exposures, etc. shall include a Respiratory Protection Program and Worksite-Specific Respiratory Protection Plan whenever there is a reasonable potential for a respiratoryry hazard. The plan includes Monroe County's Fire Rescue, Public ork Solid Waste response. sand I At no time, however briefly, shall a Monroe County employee be exposed to contaminant levels that are more than three times the allowable 8-hour time- weighted average limits without respiratory protection No employee may work alone while wearing a respirator. Each respirator wearer shall have at least one employee assigned responsibility to perform periodic status checks throughout the duration of respirator use. When SCBAs are worn, at least one standby person, located outside of the hazardous atmosphere and equipped with an SCBA, shall be in constant attendance, ready to provide immediate assistance and to call for emergency help, if needed 6. Respiratory Protection Program and Works ite-Specific Respiratory Protection Plan Each operation that involves respirator use shall have a written Respiratory Protection Program and Worksite-Specific Respiratory Protection Plan that is approved and signed by the Supervisor and Respirator Administrator. This plan, which may be a part of a job hazard analysis, site safety plan, confined space entry permit or other document, shall contain an identification of the atmospheric hazard(s) and the respective measured or expected concentrations) at each location or operation, the respective allowable concentration limits, the type of respirator(s) approved, monitoring requirements, emergency response procedures, and limitations, such as the frequency of respirator cartridge change-out. This document shall be updated annually and more frequently if conditions change. This document shall be available at the job location and shall be maintained for 30 years as an exposure record. 7. RECOGNITION AND EVALUATION OF AIRBORNE CONTAMINANTS A hazard assessment shall be initially performed in each workplace by the Supervisor or Respirator Administrator. Where the presence or potential presence of airborne 10-64 n MONROE COUNTY SAFETY POLICIES AND PROCEDURES MANUAL contaminants is recognized or suspected the Respirator Administrator appointed evaluator shall perform evaluations to determine if allowable I maser are exceeded or potentially exceeded. The results of the hazard assessment shall be communicated to the General Manager and affected supervisors and employees. For workplaces in which the hazard assessment produces no findings of potential exposures, Supervisors shall monitor the workplace and request a hazard assessment whenever materials or processes change. Whenever the hazard assessment identifies potential exposures to hazardous atmospheres, an annual reassessment shall be performed, unless a more frequent assessment is required by OSHA. In addition, the Supervisor is responsible for requesting a reassessment by the Respirator Administrator whenever materials or processes change. 8. EVALUATION OF AIRBORNE CONTAMINANT CONTROLS When hazardous atmospheres are recognized, elimination of the hazardous material or feasible engineering and work practice controls shall be instituted to reduce contaminant levels to within allowable limits. If such measures are not completely successful or if the condition is temporary, personal protective equipment, including respiratory protection shall be selected and worn. The Safety Officer shall reassess the workplace when controls are instituted to measure their effectiveness in reducing employee exposure to hazardous atmospheres. 9. SELECTION AND ISSUANCE OF RESPIRATORS Selection of the appropriate respirator shall be documented in the written Worksite-Specific Respiratory Protection Plan. If the atmosphere is uncharacterized, it must be assumed to be IDLH and a Positive pressure SCBA or combination supplied-air respirator with SCBA must be worn. Respirator selection shall comply with OSHA requirements for specific substances, such as asbestos, lead, etc. At a minimum the assigned protection factor of the selectee's respirator shall equal or exceed the hazard ratio. All respirators used by Monroe County employees shall be approved by NIOSH. No components shall be substituted, unless they are listed in the approval by NIOSH. Any change or modification to a respirator may void the respirator approval and may adversely affect its performance. Any restrictions or limitations recommended for a particular respirator by the respirator manufacturer shall be observed. The Supervisor shall inspect each respirator or component prior to issuance and shall assure that the respirator assembly is complete, sanitary and in good working order upon issuance. Atmosphere-supplying respirators shall be 10-65 r MONROE COUNTY SAFETY POLICIES AND PROCEDURES MANUAL returned to the Supervisor at least monthly for periodic inspection and air purifying respirators shall be returned for periodic inspection at least semi- annually. A log shall be maintained of these periodic inspections. The Supervisor is responsible to ensure that each respirator user under the Supervisor's supervision is currently approved for respirator use, including medical, fit testing and training certifications. Employees with expired certifications shall not be permitted to work in hazardous atmospheres or to voluntarily wear a respirator until their lapsed requirements are updated. Each respirator must be inspected by its wearer immediate) prior according to instructions provided in the respirator training. Any defects shall be reported to the Supervisor before entry into a hazardous atmosphere. A user seal check shall be performed by the wearer immediately prior to entering the hazardous atmosphere. Monroe County will provide an appropriate spectacle kit to each respirator wearer who requires corrective lenses and will pay for prescription safety lenses for the kit initially and as needed. Contact lenses shall be permitted if the employee's ophthalmologist or optometrist authorizes their use by the employee in hazardous atmospheres with negative pressure and positive pressure respirators in a written communication to Monroe County Employees who are issued a respirator are responsible for its maintenance, daily inspection and storage while the unit is in their control. 10. FIT TESTING Each respirator wearer shall be fit tested, using llrotocols approved by the Respirator Administrator. Frequency testing shall be performed if required by the Federal Code of Regulations for specific substances or if the wearer's facial contours change, such as by weight gain or loss, facial surgery, etc. On the occasion of each fit test, employees may choose their respirator from an array of face pieces from different manufacturers and sizes approved by the Respirator Administrator. Fit test certifications shall be prepared and signed by the person performing the fit test and must name the tested employee; the make, model and size of respirator fit tested; and the result of the fit test. A copy shall be provided to the Supervisor. Monroe County required fit tests, including reasonable employee time and travel costs, shall be paid for by Monroe County. A medical evaluation as described in Section 10.17.C.11 must be performed before an employee is fit tested. 11. MEDICAL APPROVAL FOR RESPIRATOR USE 10-66 3 ..,,,...l,a ..,,.,,,.... ........e ..,�....: .........n: .777 r MONROE COUNTY SAFETY POLICIES AND PROCEDURES MANUAL Each respirator wearer shall be approved for respirator use by the Coun 's designated physician before the employee is required to wear a respirator (including before being fit tested). The physician shall be provided co py of employee's duties, respirator types to be worn, and air contaminants, as well he s any applicable OSHA standards governing the medical evaluation, such as the Respiratory Protection standard and applicable substance-specific standards in addition to the Respirator Medical Evaluation Questionnaire to be completed b the employee being examined. The questionnaire shall be filled out by t he y employee confidentially during the employee's normal working hours or at a time and place convenient to the employee - preferably in the Human Resour office location nearest to the employee's worksite location. ce 1 The physician's approval shall be a written certification that lists the respirator types approved for use by the individual (i.e., negative pressure air purifying, Powered air purifying, pressure demand SCBA) and any restrictions on the employee's use of respiratory protection, including the need for corrective lenses. The physician's certification shall not disclose any confidential medical information, but shall clearly list or describe any restrictions to be observed. Medical evaluations shall be performed by the County's designated physician and the cost of the respirator medical evaluation shall be budgeted and paid by employee's department including reasonable time and travel expenses of the employee. Payment for special medical diagnostic procedures needed to assess the ability of an employee to safely wear a respirator shall be approved in advance by the Respirator Program General Manager. No medical treatment costs shall be paid by the employee under this program. Medical records created under this program shall be handled in accordance with requirements for confidentiality, employee access and retention If it is found that an employee is not physically able to wear a respirator, arrangements must be made by the applicable Supervisor and Department Head to have the duties associated with a respirator be performed by another qualified employee within the department. 12• TRAINING Each respirator wearer, supervisor of a respirator wearer, respirator technician and Officer must be trained and updated as needed. Upon successful completion of respirator training, the instructor shall sign a certification that names the employee trained, the type(s) of respirator and the training date. A copy shall be provided to the supervisor. A record shall be maintained of the training topics covered. 10-67 7,7`77, f MONROE COUNTY SAFETY POLICIES AND PROCEDURES MANUAL Monroe County approved respirator training shall be conducted by or aid fo by Monroe County including the employee's reasonable time and tr P r participate in such training. avel to 1 13. DEFINITIONS Air purifying respirator(APR)—a type of respirator that removes specific contaminants from air by use of filters, cartridges or canisters b P through the air-purifyingelement. APRs do not supply o Y Passing ambient air PP Y oxygen. Allowable limit—the maximum concentration of a substance in air that is er by regulation or voluntary standards to protect employee health. These cone matted trat may be expressed in terms of an 8-hour time-weighted average, a 15-minute short- term term average or as an instantaneous upper ceiling limit. An example is the OSHA Permissible exposure limits (PEL). Assigned protection factor—the level of respiratory be Provided by a given class of respirators to a Properly fitted and tra ned user.tThis factor is assigned by OSHA in substance specific standards and by ANSI in the voluntary national standard, Z88.2. Atmosphere-supplying respirator—a type of respirator that supplies the user with breathing air from a source independent of the ambient atmosphere, and includes supplied-air respirators (SARs) and self-contained breathing apparatus (SCBA) units. Canister or cartridge—a container with a filter, sorbent or catalyst, or combination of these items, which removes specific contaminants from the air passed through the container. Demand respirator—an atmosphere-supplying respirator that admits breathing air to the face piece only when a negative pressure is created inside the face piece by inhalation. Dust mask—see filtering face piece. Emergency situation—any occurrence such as, but not limited to, equipment failure, rupture of containers, or failure of control equipment that may or does result in an uncontrolled significant release of an airborne contaminant. Employee exposure—exposure to a concentration of an airborne contaminant that would occur if the employee were not using respirator y protection. End-of-service-life indicator(ESLI)—a system that warns the respirator user of the approach of the end of adequate respiratory protection, for example, that the sorbent is approaching saturation or is no longer effective Escape-only respirator—a respirator intended to be used only for emergency exit. Filter or air-purifying element—a component used in respirators to remove solid or liquid aerosols from the inspired air. 10-68 J� MONROE COUNTY SAFET Y PO LICIES CI ES AND PROCEDURES MANUAL Filtering face piece (Dust mask)—a negative pressure particulate respirator with a filter as an integral part of the face piece or with the entire ace piece composed of the filtering medium. Fit factor—a quantitative estimate of the fit of a particular respirator to a specific individual, and typically estimates the ratio of the concentration of a substance in ambient air to its concentration inside the respirator when worn. Fit test—use of a protocol to qualitatively or quantitatively evaluate the fit of a respirator on an individual. Hazardous atmospheres—an atmosphere that contains a contaminant(s) in excess of the allowable limit or contains less than 19.5 percent ox ygen. Hazard ratio—a number calculated by dividing the actual air contaminant concentration by the allowable limit. Immediately dangerous to life and health IDLH poses an immediate threat to life would cause irreversible adverse health effect,ospheretorawould impair an individual's ability to escape from a dangerous atmosphere. Loose-fitting face piece—a respiratory inlet covering that is designed to form a partial seal with the face. National Institute for Occupational Safety and Health (NIOSH)—a Federal institute responsible for conducting research and making recommendations for the prevention of work-related illnesses and injuries. It tests and issues approvals for respirators. Negative pressure respirator(tight fitting) —a respirator in which the air pressure inside the face piece is negative during inhalation with respect to the ambient air pressure outside the respirator Occupational Safety and Health Administration (OSHA)—the Federal or state agency with authority to issue and enforce workplace health and safety regulations. Oxygen deficient atmosphere—an atmosphere with oxygen content below 19.5 percent by volume. Physician or other licensed health care professional (PLHCP)—an individual whose legally permitted scope of practice (i.e., license, registration or certification) allows him or her to independently provide or be delegated the responsibility to provide some or all of the health care services required by this respirator program. Positive pressure respirator—a respirator in which the pressure inside the respiratory inlet covering exceeds the ambient air pressure outside the respirator. 10-69 MONROE COUNTY SAFETY POLICIES AND PROCEDURES MANUAL Powered air-purifying respirator (PAPR) —an air-purifying respirator that uses a blower to force the ambient air through air-purifying elements to the inlet covering. Pressure demand respirator—a positive pressure atmosphere-supplying respirator that admits breathing air to the face piece when the positive pressure is reduced inside the face piece by inhalation. Protection factor— a ratio calculated by dividing the air contaminant concentration outside a respirator by the concentration inside the respirator. This is measured in a quantitative fit test. Qualitative fit test (QLFT) —a pass/fail fit test to assess the adequacy of respirator fit that relies on the individual's response to the test agent. Quantitative fit test (QNFT) —an assessment of the adequacy of respirator fit by numerically measuring the amount of leakage into the respirator. Respiratory inlet covering —that portion of a respirator that forms the protective barrier between the user's respiratory tract and an air-purifying device or breathing air source or both. It may be a face piece, helmet, hood, suit or a mouthpiece respirator with nose clamp. Self-contained breathing apparatus (SCBA) —an atmosphere-supplying respirator for which the breathing air source is designed to be carried by the user. Service life—the period of time that a respirator, filter or sorbent or other respiratory equipment provides adequate protection to the wearer. Supplied-air respirator (SAR) or airline respirator—an atmosphere- supplying respirator for which the source of breathing air is not designed to be carried by the user. Tight-fitting face piece— a respiratory inlet covering that forms a seal with the face. User seal check— an action conducted by the respirator user to determine if the respirator is properly seated to the face D. Foot and Toe Protection The appropriate foot protection is required for work functions that include lifting heavy objects that may be dropped on the feet, electrical protection, piercing protection, chemical protection, fire protection and working in areas that are designated as high hazard areas and require foot protection i.e.; around fork lifts and rolling stock. 10-70 777 riiiiil�io New Truman Medical Agreement 2014 1582'1 Attachment T" pyright®2000 NFPA,All Rights Reserved NFPA 1582 Standard on Medical Requirements for Fire Fighters and Information for Fire Department Physicians 2000 Edition This edition of NFPA 1582,Standard on Medical Requirements forFrn Fighters and Information for Fin Department Physicians,was prepared by the Technical Committee on Fire Service Occu- pational Medical and Health,and acted on by the National Fire Protection Association,Inc., at its November Meeting held November 14-17, 1999,in New Orleans,LA.It was issued by the Standards Council on January 14,2000,with an effective date of February 11,2000,and supersedes all previous editions. This edition of NFPA 1582 was approved as an American National Standard on February 11,2000. Origin and Development of NFPA 1582 Ajoint task force of members representing both the Technical Committees on Fire Service Occupational Safety and Health and Fire Fighter Professional Qualifications began address- ing medical requirements for fire fighters in March 1988.A standing subcommittee on Med- ical/Physical Requirements for Fire Fighters was created under the Fire Service Occupational Safety and Health Committee in 1990 and was responsible for the development of NFPA 1582. This new document covered the medical requirements necessary for persons who perform fire-fighting tasks. Medical requirements that were previously contained in Section 2-2 of NFPA 1001,Standard for Fm Fighter Professional Qualifcations,applied only to the entry level. They were deleted from NFPA 1001.Legal opinion and federal laws show that requirements set for a position must apply to anyone who would be or is in that position.These medical requirements are therefore intended to apply to candidates as well as to current fire fighters. Two categories of medical conditions were created,Categories A and B.Category A repre- sented conditions that,if they exist in the candidate or current fire fighter,would not allow this person to perform fire-fighting operations.Category B conditions must be evaluated on a case-by-case basis so that the fire department physician can determine if the medical condi- tion in a particular candidate or current fire fighter would prevent that person from perform- ing fire-fighting operations. Medical evaluations, medical examinations, record keeping, and confidentiality were addressed in Chapter 2.Chapter 9 contained the actual medical conditions that comprise the r requirements. Extensive advisory and informational material was developed in the appendixes to aid fire department administrators and fire department physicians. The committee completed its work in January 1992,and the first edition was presented to the Association membership at the 1992 Annual Meeting in New Orleans,Louisiana. The second edition of this standard reflected the numerous changes in medical technol- ogy that have impacted structural fire fighters.The technical committee was assisted by phy- sicians whose expertise covered the areas of emergency medicine; vision; hearing; and cardiac,pulmonary,neurological,and metabolic conditions. The technical committee endeavored to update six critical areas and moved some of the previous Category A text to Category B.They then enhanced some of the Category A material that would prohibit an individual from being hired or to continue as a fire fighter.The com- mittee also added additional appendix text in the areas of ADA requirements, explanatory material for both fire department administrators and fire department physicians,and sample physician checklist forms. Additional explanatory material was added or enhanced to provide the user with addi- tional information regarding medical conditions whose categories were changed. These included a number of cardiac conditions,diabetic conditions,seizure disorders,asthma,and therapeutic anti-coagulation. ,„ 1582-2 MEDICAL REQUIREhlEy rS FOR FIRE FIGHTERS AND INFORMATION FOR FIRE DEPART&IENT pHy5ICLA,YS The 2000 edition of this standard reflects (1) the technical committee's recognition that medical technology is continually changing and (2) the committee's effort to incorporate those medical technology changes within the standard.Justas the committee recognizes med- ical technology advances,it is incumbent on the fire department to communicate with the fire department physician changes in the essential function(s) the fire department performs. Conversely,the fire department physician must keep the fire department updated on the lat- est changes in the medical field. Fire department physicians are the primary users of NFPA 1582.Committee members feel that allowing the fire department physician more latitude in determination of a member's ability to perform essential functions will assist users in enforcing the standard.Therefore,the committee has changed the title of the standard to NFPA 1582,Standard on Medical Requin- ments for Fire Frghters and Information for Fire Department Physician, The topic of incident scene rehabilitation and accountability are included in this edition, since the fire department physician may provide guidance or assistance at the rehabilitation unit. In addition, specific areas concerning the following conditions were clarified or expanded:cardiac,vision,hearing,neurological,and metabolic. An appendix was added to this edition comparing the requirements of this standard withr those of 29 CFR 1910.134,the OSHA respiratory protection regulation.There are many users " of both documents,and this appendix clarifies the companion areas of each. i a �y N j, Y 20M ECRIon COMMITTEE PERSONNEL 1582_3 Technics Corntnittee on Fire Service Occupational Medical and Health Murrey E.Loflin,Chair Virginia Beach Fire Dept,VA[U] Rep.NFPA Fire Service Section David J.Barillo,U.S.Army Inst.of Surgical Research, TX[SE] Deborah L,Pritchett,Lawrence Township Fire Dept, KimberlyS.Bevins,Bio•Care,MI[SE] IN[LJ Paul"Shoe"Blake,City of Baytown Fire&Rescue Services. TX[E] Rep.Indianapolis rletropolitan Professional Fire Fighters Union Rep.Industrial Emergency Response Working Group Gordona M.Saclu,IOCAD Emergency Services Group, MmT S Bogucki,Yale University,Ct[SEJ [ ] Anthony L Clark,Kenton County Airport Board,OH(U] Rep.Fairfield Community Fire Co.,Inc. Thomas J.Cuff,Jr.,Firemens Assn,of the State of Daniel G.Sarno,ENH New York -OMEGA,IL[SE] IVY[U] James Sewell,Seattle Fire Dept,WA[L] Tammy DiAnda,Reno Fire Dept.,NV[U] Rep.Int'1:1ssn.of Fire Chiefs John F.Folan,Northside Medical Assoc.,NY[SEJ Philip C.Stittleb Richard D.Gerkin,Jn,Good Samaritan Hospital/Phoenix Rep.Nat'l Volunteer FiteCouncil Fire pt [L] Fire Dept,AZ(E] Juan Gonzalez,Xedflex:The Exercise Science Inst., CO CRTRobert] TX Ste 'West Metro Fire Protection District, TX[RT] Rep.Metropolitan State College of Denver •Larry Kenney,Penn State University,P.A.CRT] Andy C.Teeter,Tulsa Fire Dept,OK[U] Rep.ra Lan y Jacobs&Assoc, Rep.Int'I Fire Service Training Assn. od,Las Vegas Fire Dept,NV(U] Frank P.Mineo,New York City Fire Dept,NY[U] _, Kathyw Wam Cooperative Personnel Services,CA[SE] NV[UGary]Nan+Truckee Meadows Fire Protection District ,Santa Ana College,CA[SE] Don Whittaker,Lockheed-Martin Idaho Technologies Rep.Fire Dept Safety officers Aura. [E) Decker Williams,Phoenix Fire Dept.,AZ[E] Alternates David W.Dodson,Loveland Fire Dept,CO[U] (Alt to G.L.Neilson) Thomas R Luby,New York City Fire Dept,NY[U] Michael S.Gray,Virginia Beach Fire Dept,VA[U] (Alt to F.P.Mineo) (Alt to M.E.Loflin) Brian V.Moore,Phoenix Fire Dept,AZ(E] Stephen N.FoI (Alt to D.Williams) ey+NFPA Staff Liaison Thi list relbrrsentr the membership at the time the Committa was balloted on flu final kzt o j lion Si nee that time,changer in the membership may have occurred.A kq to clwy7calion,r it found at the bath of the daniment. NOTE; Membership on a committee shall not in and of itself constitute an endorsement of the Association or any document developed by the committee on which the member serves. C°mmittee Scope:This Committee shall have primary responsibility for documents on occupational medi- cine and health in the working environment of the fire service. r, 2000 Edition 1582-4 MEDICU REQUIREMENTS FOR FIRE FIGHTERS AND INFORMATION FOR FIRE DEPARTMENT PHYSICIANS Contents �r. Chapter 1 Administration ..................... 1582- 5 3-18 Tumors and Malignant Diseases... .. . 1582-10 1-1 Scope............................... 1582- 5 3-19 Psychiatric Conditions.. 1582-11 1-2 Purpose............................. 1582- 5 3-20 Chemicals,Drugs,and Medications....... 1582-11 1-3 Implementation ...................... 1582- 5 1-4 Definitions........................... 1582- 5 Chapter 4 Infectious Disease Program ........... 1582-11 Chapter 2 Medical Process .................... 1582- 6 4-1 Infection Control Program.............. 1582-11 i 2-I Medical Evaluation Process.••••••...... 1582- 6 4-2 Exposure Incidents .................... 1582-11 2-2 Fire Department Roles................. 1582- 6 4-3 Tuberculosis.......................... 1582-11 2-3 Preplacement Medical Evaluation........ 1582- 6 4-4 Immunizations........................ 1582-11 2-4 Periodic Medical Evaluation ............ 1582- 7 2-5 Return-to-Duty Medical Evaluation....... 1582- 7 Chapter 5 Incident Scene Rehabilitation 216 Medical Evaluation Records,Results, and Medical Treatment ............. 1582-11 Reporting,and Confidentiality.......... 1582- 7 5-1 Incident Scene Rehabilitation ........... 1582-11 5-2 Incident Scene Safety and Health ........ 1582-11 Chapter 3 Category A and Category B 5-3 Evaluation and Triage of Medical Conditions................. 1582- 8 Member Injuries ...................... 1582-11 3-1 Medical Conditions Affecting Ability - 5-4 Incident Scene Rehabilitation Tactical Level to Perform............................ 1582-r8 Management Component.. . 1582-11 3-2 Head and Neck....................... 1582- 8 3-3 Eyes and Vision......... 1582- 8 Chapter 6 Referenced Publications.. 3.4 Ears and Hearing..................... 1582- 8 1582-12 3-5 Dental ........................... ... 1582- 8 Appendix A Explanatory Material ,,,,,,,,,,,,,, 1582-12 3-6 Nose,Oropharynx,Trachea,Esophagus, andLarynx .......................... 1582- 8 3-7 Lungs and Chest Wall.................. 1582- 9 Appendix B Information for Fire Department 3-8 Heart and Vascular System ............. 1582- 9 Physicians ....................... 1582-21 3-9 Abdominal Organs and Gastrointestinal System.............................. 1582- 9 Appendix C Essential Structural Fire-Fighting 3.10 Genitourinary System.................. 1582- 9 Ftmctions.,,.....,,,,,,,,,,,,,,,. 1582-26 3.11 Spine,Scapulae,Ribs,and Sacroiliac Joints ........ .............. 1582-10 Appendix D Guide for Fire Department 3-12 Extremities .......................... 1582-10 Administrators.................... 1582-26 3-13 Neurological Disorders ,,,,,,,,,,,,,,,, 1582-10 3-14 Skin................................ 1582-10 Appendix E Sample Forms.................... 1582-33 '1�15 Blood and Blood-Forming Organs ....... 1582-10 3-16 Endocrine and Metabolic Disorders...... 1582-10 Appendix F Referenced Publications ........... 1582-33 3-17 Systemic Diseases and Miscellaneous Conditions........................... 1582-10 Index....................................... 1582-0 s 2000 Ed lon ADMINts-rPwrION 1582-5 NFPA 1582 1-4 Derwtions. 14.1• Approved. Acceptable to the authority having juris- Standard on diction. 14.2* Authority Having Jurisdiction. The Fire organization, Medical Requirements for re Fighters and office. or individual responsible for approving equipment, Information for Fire Department Physicians materials,an installation,or a procedure. 14.3' Candidate. A person who has made application to 2000 Edition commence performance as a member. 14.4 Category A Medical Condition. A medical condition that NOTICE: An asterisk(*)following the number or letter des would preclude a person from performing as a member in a ignatittg a paragraph indicates that explanatory material on training or emergency operational environment by presenting the paragraph can be found in Appendix.1 a significant risk to the safety and health of the person or others. Information on referenced publications can be found in Chapter 6 and appendix F. 14.5 Category B Medical Condition. A medical condition that, based on its severity or degree,could preclude a person from performing as a member in a training or emergency Chapter 1 Administration operational environment by presenting a significant risk to the safety and health of the person or others. 1-1 Scope. 14.6 Drug. Any substance,chemical,over-the-counter medi- 1-1.1 This standard shall contain medical requirements for cation.or prescribed medication that could affect the perfor- members,including full-time or part-time employees and paid mance of the member. or unpaid volunteers.It also shall provide information forphv 1-4.7 Essential Job Function. Task or assigned duty that is sicians regarding other areas of fire department medicine, critical to successful performance of the job. including infection control and&reground rehabilitation. 14.8 Evaluation. See Medical Evaluation. 1-1.2 These requirements are applicable to public,governmen- 14.9 Exposure Incident. A spec eve, mouth, or other tal,military,private,and industrial fire department organizations mucous membrane, non-intact skin, or parenteral contact providing rescue,fire suppression,emergency medical services, with blood,body fluids,or other potentially infectious materi- hazardous materials mitigation, special operations, and other als, or inhalation of airborne pathogens, ingestion of food- emergency services. borne pathogens or toxins. 1-1.3 This standard shall not apply to industrial fire brigades 14.10 Fire Department Physician. The licensed doctor of that also can be known as emergency brigades, emergency medicine or osteopathy who has been designated by the fire response teams,fire teams,plant emergency organizations,or department to provide professional expertise in the areas of mine emergency response teams. occupational safety and health as they relate to emergency services. 1-2 Purpose. 14.11 Functional Capacity Evaluation. An assessment of the 1-2.1 The purpose of this standard shall be to specify mini- correlation between that individual's capabilities and the mum medical requirements for candidates and current mem- essential job functions. bers. It also shall provide other information regarding fire 14.12 Health and Fitness Coordinator. The person who,under department activities that assist the department physician in the supervision of the fire department physician,has been desig providing proper medical support for members. nated by the department to coordinate and be responsible for 1-2.2* The implementation of the medical requirements out the health and fitness programs of the department lined in this standard shall help ensure that candidates and 14.13 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 duties and shall help to reduce the risk of occupa- manager of the safety and health program and who performs tional injuries and illnesses. the duties and responsibilities specified in this standard.This 1 jurisdic- individual can be the incident safety officer or that can also be -2.3 Nothing herein shall be intended to restrict any a separate function. lion from exceeding these minimum requirements. 14.14 Infection Control Officer. The person or persons 1-3 Implementation. within the fire department who'Are responsible for managing the department infection control program and for coordinat 1-3.1 For candidates, the medical requirements of this start- ing efforts surrounding the investigation of an exposure. dard shall be implemented when this standard is adopted by an authority having jurisdiction,on an effective date specified 14.13 Infection Control Program. The fire department's for- by the authority having jurisdiction. mal program relating to the control of infectious and commu- nicable hazards where 1-3.2* When this standard is adopted by a jurisdiction, the general public a could be exposed to blood,oyees, patients body fluids, or authority having jurisdiction shall set a date or dates for cur- other potentially infectious materials in the fire department rent members to achieve compliance with the requirements work environment.This program includes,but is not limited of this standard and shall be permitted to establish a phase- to,implementation of written policies and standard operating in schedule for compliance with specific requirements of this procedures regarding exposure follow-up measures, immuni- standard in order to minimize personal and departmental zations, members' health screening programs, and educa- disruption. tional programs. 20W Edition 1582-6 MEDICAL REQUIRE.WENTS FOR FIRE FIGHTERS AND fNFOR I.kTION FOR FIRE DEPAR'MIENT PHySICIANS 1-4.16 Medical Evaluation. The analysis of information for the purpose of making a determination of medical certifica- 2.2 Fire Department Roles. tion.Medical evaluation can include a medical examination. 2-2.1 The fire department shall have an officially designated 1-4.17 Medical Examination. An examination performed or Physician who shall be responsible for guiding,directing,and ~ directed by the fire department physician, advising the members with regard to their health,fitness,and suitab1-4.18 Medical Services, Emergency. The provision of treat- DJ. artilment Occupity for y ional Safety arul K as required by ra dt lPiq 0.Standard ore F:n ment—such as first aid,cardiopulmonary resuscitation,basic ;"a life support,advanced life support,and other pre-hospital pro- 2-2.2* The fire department physician shall be a licensed doc- cedures including ambulance transportation—to patients, for of medicine or osteopathy. 14.19 Medically Certified_ A determination by the fire depart. *2-2.3 For the u ment physician that the candidate or current member meets the fire P +pose of conducting medical evaluations, re department physician shall understand the physiolog- medical requirements of this standard. ical and psychological demands placed on members and shall 14.20* Member. A person involved in performing the duties understand the environmental conditions under which mem- nd responsibilities of a fire department,under the auspices bers must perform.The fire department shall provide the fire of the organization.A fire department member can be a full- department Physician with a current job description for all fire time or part-time employee or a paid or unpaid volunteer,can department positions and ranks. occupy any position or rank within the fire department.and 2-2.4 The fire department shall require that he fire depart- can engage in emergency operations. meat heath and safety officer and he heath and fitness coor- 1•-4.20.1 Member, Current, A person who is already a mem- dinator maintain a liaison with the fire department physician bee and whose duties require he performance of to ensure that e health maintenance process for e fire fire-fighting functions, essential h h department is maintained. 14.21 Shall. Indicates a mandatory requirement 1-4.22 Should. Indicates a recommendation or that which is 2-2.5 Fire Department Physician Roles. advised but not required. 2-2.5.1 The fire department physician shall evaluate he per- !on to ascertain he presence of any medical conditions listed rains only mandatory provisions us using the word"shall"to ndi- in his standard. care requirements and which is in a form generally suitable for 2-2'S'2 When medical evaluations are conducted by a physician mandatoryreference b another standard or code or for ado other than the fire department physician, the evaluation shall y lion into law.Nomm�datory provisions shall be located in an appendix,footnote,or fine-print note and are not to be be reviewed and approved by the fire department physician. con- sidered a part of the requirements of a standard. 2-3* Preplacement Medical Evaluation. - 1.4.24 Tactical Level Management Component (TLMC). A 2-3.1 The candidate shall be certified b he fire de management unit identified in he incident management sys- P y Partment h icin as meeting he medical requirements of Chapter 3 tem commonly known as"division,""group,"or"sector." of his standard prior to entering into a trainingprogram become a member or performing in an emergency opera- tional environment as a member. Chapter 2 Medical process 2-3.2 The candidate shall be evaluated according to he med- 2-1 Medical Evaluation Process. ical requirements of Chapter 3 of his standard to assess he effect of medical conditions on he candidate's ability to per- 2-1.1* The fire department shall establish and implemen[ form as a member. a medical evaluation process for candidates and current 2-3.3 A candidate shall not be certified as meeting he medi- members. cal requirements of this standard if the fire department physi- 2-1.2 The medical evaluation process shall include preplace- clan determines that the candidate has any Category A ment medical evaluations, periodic medicol evaluations, and medical condition as specified in Chapter 3 of his standard. return-toduty medical evaluations. 2-1.3 The fire department shall ensure that he medical eval- 2-3.4* A candidate shall not be certified as meeting the med- ical requirements of this standard if he fire department phy- uation process and all medical evaluations meet all of he sician determines that the candidate has a Category B requirements of Section 2-1. medical condition as specified in Chapter 3 of this standard 2-1.4 Each candidate occurrent member shall cooperate, ar- eat is of sufficient severity to prevent the candidate from ticipate,and comply with the medical evaluation process and essential functions of a member without posing a significant shall provide complete and accurate information to the fire risk to hie safety and health e of,with or without th a the department physician. he cann accommodation,didate or others. 2-1.5* Each candidate or current member shall report,on a modation shall be made by the authorityhavin 'urisdic 2-3.4.1 The determination of whether a reasonable accom- timely basis,to the fire department physician any exposure or conjunction with the fire department physician. medical condition that could interfere with the ability of the gJ non in individual to perform as a member. 2-3.5 If the candidate presents with an acute medical problem or newly 2-1.6 The medical evaluation shall be at no cost to the candi- with the candidate's date's ability to perform tuired chronic medical he functions interferes of mem- date,current member,or other member. bee,medical certification shall be postponed until that person 2000 Edtt(on ' JI L MEDWtf PROCESS 158•2-7 has recovered from this condition and presents to the fire department for review. physician determines that the member hitsa Category B con_dition specified in Chapter 3 of this standard that is of sufii. 24* Periodic Medical Eva►uat3oa. cient severity to prevent the member from performing,with or without reasonable accommodation,the essential functions of 24.1 The current member shall be certified annually, or at a member without posing a significant risk to the safety and the request of either the lire department or the member, by health of the member or otiters. the fire department physician as meeting the medical require- ments of Chapter 3 of this standard in order to determine that 2-al•3.1 The determination of reasonable member's medical ability to continue artici atinv shall be made by the authority having jurisdic accommodation in Iodation ing or emergency operational environment aP a member Arr tion with the fire department physician. applicable OSHA standards, such as 29 CFR 1910 120 "Haz- 2-4.4 If the current member presents with an acute illness ardous Waste Operations and Emergency Response."29 CFR or recently acquired chronic medical condition.the evalua- 1910.134."Respiratory Protection,'29 CFR 1910.95."Occupa- tion shall be deferred until the member has recovered from tional Noise Exposure,"and 29 CFR 1910.1030,"Bloodbome the condition and presents to the fire department to return Pathogens,"shall be followed. to duty. 24.1.1 The components of the annual medical evaluation as specified in 24.1.2 shall be permitted to be performed by 2-5 Return-to-Duty Medical Evaluation. qualified personnel as authorized by the tire department 2-5.1* A current member who has been absent from duty for physician.When other qualified personnel are used,the fire a medical condition of a nature or duration that could affect department physician shall review the data gathered during performance as a member shall be evaluated by the fire the evaluation. department physician before returning to duty. fol- lowing.2-1.1.2 The annual medical evaluation shall consist of the fol- 2-5.2 The fire department physician shall not medically cer- tify the current member for return to duty if any Category A (1) An interval medical history (2) An interval occupational history, including significant medical condition specified in Chapter 3 of this standard is exposures resent. (3) Height and weight 2-5.3* The fire department physician shall not medically cer- (4) Blood pressure tify the current member for return to duty if any Category B (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 that is determined to be severe enough to affect the department shall include a medical examination according tophysician,beans performance as member. The fire department in conjunction with the authority having jurisdic- the following schedule: don,shall take into account the member's current duty assign- (1) Ages 29 and under—at least every 3 years ment and alternative 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. (3) Ages 40 and above—every year 2-5.4* The department shall provide 24.1.4* The medical examination shall include examination and encouragement to the member so asdto expedite his safe of the following components: return to full duty. (1) Vital signs—namely,pulse,respiration,blood pressure, 2-6 Medical Evaluation Records,Results,Reporting,and and,if indicated,temperature Confidentialit V. (2) Dermatological system (3) Ears,eyes,nose,mouth, throat 2-6.1 All medical information collected as part of a medical ('1) Cardiovascular system evaluation shall be considered confidential medical informa- (5) Respiratory system lion and shall be released by the fire department physician (6) Gastrointestinal system only with the specific written consent of the candidate or cur- (7) Genitourinarysystem rent member. (8) Endocrine and metabolic systems 2-6.2 The fire department physician shall report the results of (1 Neurological system system the medical evaluation to the candidate or current member, (10)Neurological system including any medical condition(s)disclosed during the med- (11)Audiometry ical evaluation, and the recominendation as to whether the (12)Visual acuity and peripheral vision testing candidate or current member is medically certified to perform (13) Pulmonary function testing as a member. (14)Laboratory testing,if indicated (15)Diagnostic imaging,if indicated 2.6.3 The fire department physician shall inform the fire (16)Electrocardiography,if indicated department fire chief or designee only as to whether or not the candiis medically certied to per- ate 24.2 A current member shall not be certified as meeting the form as ad ember.The spec ficor currentewrit en consent off the candi- medical requirements of this standard if the fire department date or current member shall be required in order to release physician determines that the member has any Category A confidential medical information regarding this condition to medical condition specified in Chapter 3 of this standard. the fire department. 24.3* A current member shall not be certified as meeting the 2-6.4 All medical record keeping shall comply with the medical requirements of this standard if the fire department requirements of 29 CFR 1910.20,"Medical Recordkeeping." 2000 Edison 1582-8 MEDICAL,REQUIREMENTS FOR FIRE FIGHTERS AND INFOP,%IATION FOR FIRE DEPARTMENT PHYSICIANS Chapter 3 Category A and Category g 3-4 Medical Conditions Ears and Hearing, 3-1 Medical Conditions Affectin 3-4.1 There shall be no Cate go g Ability to Perform. Cate. 3.4.20 Cate ory B medic g ry A medical conditions. gory A and Category B medical conditions shall help the lowing(a) Hearing deficit in the pure tone thresholds in the $ al conditions shall include the � examiner understand the type of condition that could result fol- in rejection or acceptance.The medical conditions listed are organized by organ system.In the corresponding ondin Appendixunaided worst ear that is explanatory material,a diagnostic example is often included with the list.In addition,the rationale for the rejection is pre. (1) Greater than 25 dB in three of the four frequencies sented in terms of the effect of the medical condition on thea. 500 Hz capability of the person to perform as a member. b. 1000 Hz c. 2000 Hz 3.2 Head and Neck d. 3000 Hz 3-2.1 Head. OR There shall be no Cate o (2) y Greater than 30 dB in any one of the three frequencies 3•Y.1.1 gory A medical conditions. 500 Hz 3-2.1.2* Cate B b. 1000 Hz i lowing: gory medical conditions shall include the fol- C. 2000 Hz AND (1) Deformities of the skull such as depressions or exostoses (2) Deformities of the skull associated with evidence of dis- quenc(3) In addition averages greater than 30 dB for the four fire ease of the brain,spinal cord,or peripheral nerves '-' 500 es Hz (3) Loss or congenital absence of the bon a• 10 H skull y substance of the b• 1000 Hz 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 3.2.2.1 There shall be no Cate o (d) Severe external otitis $ ry A medical conditions. (e) Severe agenesis or traumatic deformity of the auricle 3-2.2.2w Category B medical conditions shall include the fol- (f) Menfe Severe mastoiditis or surgical deformity of the mastoid lowing: g syndrome orlabyrinthitis ' (1) Thoracic outlet (h) Otitis media _ 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 pass a job-specific functional hearin (3) Contraction of neck muscles or a hearing in noise test. $task test (4) Any other neck condition that results in a person not 3-5 Dental. being able to perform as a member 3-5.1 There shall be no CategoryA medical conditions. 3.3 Eyes and Vision 3-5.2* Category lowing g ry B medical conditions shall include the fol- lowin ons shall include the fol CategoryA medical conditions shall (1) Diseases of the jaws or associated tissues (a) Farvrsua[ (2) Orthodontic appliances guy.Far visual acuity shall be at least 20/30 (3) Oral tissues,extensive loss binocular, corrected with contact lenses or spectacles. Far acuity uncorrected shall beat 1 (4) Relationship between the mandible and maxilla that pre- visual wearers of hard contacts or east 20/100 binocular for eludes satisfactory postorthodontic replacement or abil- spectacles. ity to use protective equipment (b) Perrphera[vrsion.Visual field performance without cor- (5) Any other dental condition that results in a person not ' rection shall be 140 degrees in the horizontal meridian in each eye. being able to perform as a member 3.3.2+ Category 3.6 Nose,Oropharynx,Trachea, g ry B medical conditions shall include the fol- 3-6.I Cate opb 'and Laryrrx- g ry`�medical conditions shall include the fol- lowing- lowing- (1) Diseases of the eye such as retinal detachment,progres- (1) Tracheostomy sive retinopathy,or optic neuritis (2) Ophthalmological procedures such as radial keratotomy 3-6.2' Cater o or repair of retinal detachment Category B medical conditions shall include the fol- (3) Any other eye condition that results in a person not being long able to perform as a member g (1) Congenital or acquired deformity (2) Allergic respiratory disorder ?, 20W Edition E CATEGORYA AND CATEGORY B MEDICAL CONDITIONS 1582_g (3) Sinusitis,recurrent (4) Dysphonia 3-8.2 Vascular System. (5) Anosmia 3-8.2.1 There shall be no Category A medical conditions. (6) Any other nose,orophatynx,trachea,esophagus,or lar- 3-8.2.2* Category B medical conditions shall include the fol- ynx condition that results in a person not being able to lowing perform as a member or to communicate effectively (1) Hypertension 3-7 Lungs and Chest Wall. (2) Peripheral vascular disease such as Raynaud's phenome- non 3-7.1* CategoryA medical conditions shall include the fol- (3) Recurrent thrombophlebitis lowing: (4) Chronic lymphedema due to lymphadenopathy or severe (1) Active hemoptysis venous valvular incompetency (2) Empyema (5) Congenital or acquired lesions of the aorta or major ves- (3) Pulmonary hypertension sels (4) Active tuberculosis (6) Marked circulatory instability as indicated by orthostatic 3 7.2* Category B medical conditions shall include the fol- hypotension, persistent tachycardia, and severe periph- eral vasomotor disturbances lowing: (7) Aneurysm of the heart or major vessel (1) Pulmonary resectional surgery,chest wall sure (8) Any other vascular condition that results in a person not mothorax g ry.pneu- being able to perform as a member (2) Bronchial asthma or reactive airways disease 3-9 Abdominal Organs and Gastrointestinal System. (3) Fibrothorax.chest wall deformity,diaphragm abnormalities 3-9.1 There shall be no Category A conditions. (4) Chronic obstructive airways disease (5) Hypoxemic disorders 3-9.2* Category B medical conditions shall include the fol- (6) Interstitial lung diseases lowing: (7) Pulmonary vascular diseases,pulmonary embolism (1) Cholecystids (8) Bronchiectasis (2) Gastritis (9) Infectious diseases of the lung or pleural space (3) GI bleeding (10)Any other pulmonary condition that results in a person (4) Acute hepatitis not being able to perform as a member (5) Hernia (6) Inflammatory bowel disease 3-8 Heart and Vascular System. (7) Intestinal obstruction 3-8.1 Heart. (8) Pancreatitis (9) Resection,bowel 3-8.1.1* Category A medical conditions shall include the fol- (10) Ulcer,gastrointestinal lowing: (11)Cirrhosis hepatic or bill ary (1) Angina pectoris,current (12)Chronic active hepatitis (13) (2) Heart failure,current 'may other Sastrointestinal condition that results in a per- son not being able to perform the dudes of member (3) Acute pericarditis,endocarditis,or myocarditis (4) Syncope,recurrent 3-10 Genitourinary System, (5) Automatic implantable cardiac defibrillator 3.10.1 Reproductive. X8.1.2* Category B medical conditions shall include the fol- 3-10.1.1 There shall be no Category A medical conditions. di l in lowing: (1) Significant valvular lesions of the heart, including pros- 3-10. �* Category B medical conditions shall include the fol- thetic valves lowing (2) Coronary artery disease,including history of myocardial (1) Pregnancy,for its duration infarction, corona artery b y (2) Dysmenorrhea coronary ry bypass surgery, or coronary (3) Endomeuiosis,ovarian cysts,or other gynecologic con- angioplasty,arcu'osty,and similar procedures d(tions (3) Atrial tachycardia,flutter,or fibrillation (4) Left bundle branch block,second-and third-degree atri- (5) Any other genital(4) Testicular or lcondition that results in a person not oventricular block being able to perform as a member (5) Ventricular tachycardia (6) Hypertrophy of the heart 3-10.2 Urinary System. (7) Recurrent paroxysmal tachycardia 3-10.2.1 'There shall be no Category A medical conditions. (8) History of a congenital abnormality 3-10.2.2* Category B medical conditions shall include the fol- (9) Chronic pericarditis,endocardids,or myocarditis lowing: (10)Cardiac pacemaker (11)Coronary arteryvasospasm (1) Diseases of the kidney (12)Any other cardiac condition that results in a person not (2) Diseases of the ureter,bladder,or prostate (3) Any other urinary condition that results in a person not being able to perform as a member being able to perform as a member 20M Edition m 1582-1U b(Ep(r„A-REQU[RE�fEYIS FOR FIRE FIGHTERSYD[NFORb WT(ON FOR FIRE DEPARTMENT pi{yglr"NS 3-1 I Spine,Scapulae,Ribs,and Sacco' 3-11.1 There shall be no Category rLac Points. 3-14 Skin, g ry A medical conditions. 3-14.1 There shall be no Category lowin * Category B medical conditions shall include the fol- 3.14.2* g ry A medical conditions, lowing Category B (1) Arthritis lowing: g ry medical conditions shall include the fol- lowing- (1) i (2) Structural abnormality,fracture,or dislocation (1) Acne or inflammatory skin disease (3) Nucleus pulposus, herniation of, (2) Eczema(3) or history of Iaminec- tomy,discectomv or fusion Any other dermatologic condition that results in the (4) Ankylosing spondylids son not being able to perform as a member Per- (5) Anv other spinal condition that results in a e o 3-15 Blood being able to perform a p rs n not and Blood.Forming Organs. member 3-15.1* Cate o 3-12 Extremities, lowing: g ry A medical conditions shall include the fol- (1) Hemorrhagic states requiring replacement therapy Category A medical conditions. (2) Sickle cell disease(homozygous) 3-li2* Category B medical conditions shall include the fol- 3-15_2* lowing Category B medical conditions shall include the fol- r` lowing: (1) Limitation of motion of a joint (2) Amputation or j (1) Anemia f of a oint or limb (2) Leukopenia (3) Dislocation ofajoint (3) Poly e (4) Joint reconstruction, ligamentous � min very replacement instability or joint (4) Splenomegaly (5) History of chromboembolic disease (5) Chronic osteoarthritis or traumatic arthritis (6) Any other hematologi (6) Inflammatory arthritis cal condition that results in a son not being able to perform as a member Per- (7) Anyother extremity condition that results in a person not being able to perform as a P 3-16 Endocrine and Metabolic member y� Disorders, 3-13 Neurological Disorder �r��' Diabetes mellitus,which is treated with insulin or an eurolo cal ent and where an individual of one or more episodes of incapacitating hypoglycemmia,shad lowing- (1) * Category A medical conditions shall include the fol- be a Category A medical condition. lowing (1) Ataxias of heredo-degenerative type -16. * Category B medical conditions shall include the fol-. - (2) Cerebral arteriosclerosis as g- S' episodes of neurologicalevidenced by documented impairment (1) Diseases of the adrenal gland, pituitary,gland, parathy- roid (3) Multiple sclerosis with activity or evidence of Progression land or thyroid within previous three years P gression it ieoid gland of clinical significance (2) Nutritional deficiency disease or metabolic disorder (4) Progressive muscular dystrophy or atrophy (3) Diabetes mellitus re (5) All epileptic conditions to include simple hypoglycemic agent withoutt treatment his of'incapacitating itati g Partial, generalized, and P P�aL complex hypoglycemia other Psychomotor seizure disorders (4) Any other endocrine or metabolic condition that results than those with complete control during previous in a person not being able to perform as a member five years, normal neurological exantination, and defini- five statement from qualified neurological 3.13.2 If an epileptic member P specialist. 3-17 Systemic Diseases and Miscellaneous Conditions. Free interval resulting from a change in the medi-eaCe enure- 3-17.1 There shall be no Category that individual shall not be cleared for re A medical conditions. duty until he or she has completed five ears to fire ghang lowing Category B medical conditions shall include the fol- or the new regimen. y without a seizure (1) Connective tissue disease,such as dermatomyosids,lupus _ 3-13.3* Category B medical conditions shall include the fol- (2 Residuals from sclerod anal and rheumatoid arthritis lowing: ) role from past thermal anal injury (1) Congenital malformations (3) Documented evidence of a predisposition to heat stress (2) Migraine with recurrent episodes or resulting residual injury (3) Clinical disorders (4) Any other systemic condition that results in a person not with paresis, paralysis, dyscoordina- being able to perform as a member lion,deformity,abnormal motor activity, ab sensation,or complaint of pain normality of 3-18 Tumors and (•1) Subarachnoid or in Malignant Diseases, - (5) Abnormalities from ecenbh ad injury hemorrhage as severe 3.18 1* here Category all be no Cate o cerebra!contusion or concussiong rYA medical conditions. 3-18.2 B medical conditions shall include the fol- (6) Any other neurological condition long' not being able to Perform that results in a person (1) Malignant disease that is newt din P rm�a member currently being treated, y diagnosed,untreated,or 20M Ed don I� �I INCIDENT SCENE REFLA-BILITATION AND MEDICAL TREATMENT I582_11 a. Candidates shall be subject to the provisions of 2.3.5 4-3.2* All members shall be evaluated accordin,• to cur of this standard. CDC guidelines following any tuberculosis exposure. Trent b. Current members shall be subject to the provisions of results shall be communicated to and reviewed by the fire 2-4.4 of this standard. (2) Treated malignant disease that is evaluated on the basis department physician. of an individual's current physical condition and on the 4-4* Immunizations- All members shall be immunized likelihood of the disease to recur or progress. against infectious diseases as required by the authority ha (3) Anv other tumor or similar condition that results in a per- jurisdiction and by 29 CFR 1910.1030 "Bloodborne Path o- son not being able to perform as a member. gens." The fire department physician shall ensure that all members are offered currently recommended immunizations, 3.19 Psychiatric Conditions. 3-19.1 There shall be no Category A medical conditions. 3-19.2* Category B medical conditions shall include the fol- Chapter b d Medic Scene Rehabilitation lowing and Medical Treatment (1) A history of Psychiatric condition or substance abuse 5-1 InadentSceaeRehabilitadon. problem 5-1.1* The fire department shall develop standard operating (2) Anv other psychiatric condition that results in a person procedures that outline a systematic approach for the rehabil- not being able to perform as a member itation of members operating at incidents. Provisions add in these rocedures shl include medical essed 3-19.3 Candidates and current members shall be evaluated tionrand treatment,food and fluidal u d�replen replenishment,crew ota based on the individual's current condition. lion,and relief from extreme climatic conditions. 3-20 Chemicals'Drugs,and Medications. 5-1.2* The incident commander shall consider the circum- 3-20.1 There shall be no Category A medical conditions. stances of each incident and initiate rest and rehabilitation of 3-20.2* Category B medical conditions shall include the use p members procedurin es and witce with h the l 1 gl ta dard on E� of the following: operating r 8enry Services Incident Management System. (1) Anticoagulant agents 5-2 Incident Scene Safety and Health. (2) Cardiovascular agents (3) Narcotics 5-2.1 The incident safety officer shall ensure that the incident (4) Sedative-hypnotics commander establishes an incident scene rehabilitation tacti- (5) Stimulants cal level management component during emergency opera- (6) Psychoactive agents lions as required by NFPA 1521, Standad for Frye Department (7) Steroids Safety Offerer• (8) Any other chemical,drug,or medication that results in a 5-2.2* 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 of members. Basic life support (BLS) shall be the minimum Chapter 4 Infectious Disease Program level of available care. Advanced life support (ALS) care is preferable where it is available. 4-1 Infection Control Program. 4.1.1 The fire department shall maintain infection control 5-3 Evaluation and Triage of Member Injuries. programs as delineated in NFPA 158I,Standard on Fin Depart- 5-3.1 In the event of an injury to a member during emergency ment Infection Control Program, operations, EMS personnel shall assess and treat the injury based on 4.1.2 The fire department physician shall maintain a liaison operating p ELMS cleduresprotocol and fire department standard' with the infection control officer as specified in NFPA 1`58I. 5-3.2* Protocols and procedures guiding EMS providers car- 4-2 LVosure Incidents• ing for ill or injured members during emergency operations 42.1* All blood and/or body fluid exposures shall be shall be developed by the EMS rngdical director in collabora- tionreported immediately, and medical assessment shall be pro- vided within 2 hours of exposure. Medical assessment shall 5-4 Incident Scene Rehabilitation Tactical Level Management conform to current CDC guidelines. Component. 4-2.2* All other exposure incidents shall be reported and 5-4.1 The rehabilitation tactical level management compo- assessment provided within 24 hours of exposure. nent shall be designated per department standard operat- 4-3 Tuberculosis. ing procedures,such as large-scale incidents,long-duration 4-3.1* The fire department shall provide a tuberculosis mon- incidents, or chose associated with significant temperature extremes. itoring program that will test members at least annually and as 5-4.2 The rehabilitation tactical level management compo- indicated by CDC guidelines.Tuberculosis (TB) testing inter- nent shall be established in a safe environment away from the vals shall conform to current CDC guidelines. hazardous area of the incident. 20M Edition -.^.,,.... r;��a4uwm�r�risaaiG��O//%%,�10%/✓/0/%%�0/O/9 1382-1= SIEDf(;alr ItLQ(.rIREMC?1'i'$FOR FIR E,-F1CH'I'ERSANp INFORNL\TION FOR FIRE DEY.IRT&IL•NT P!-ty5[(;L1N5 5 4.3" The resources needed at the rehabilitation tactical level management component shall include an environment to limit temperature stress,medical equipment,and adequate Appendix A Explanatory Material medical sratf: •�* :�[rmbrrs shall be Appendix A is not a part of the requim.nents o f tllfs:bFP4 do assigned to rehabilitation as meat but is included or in cu- seribrd by departmental pre. contains expLsnato f formational purposes only. This appendix p'rtnental standard operating procedures. cable text pro a 7 materi1t4 nurnbenrd to c Unusual circumstances,such as long-duration incidents,situa- tions p p ornspond with the app[i- requiring I 7tery 'exertion,Pr a severe weather extremes A-1-12 There is a direct relationship between the medic shall require an alteration in procedures. requirements and the job description of members. The job 5--1.5-1 [embers arriving at rehabilitation shall be description should include all essential job functions of mem- questioned by medical stag'about any symptoms of deh drn- tion, heat stress,cold stress,physicalbees,both emergency and nonemer en diopulmonary abnormalities. nv member Navin as d�°r car- .r variety of emergencv operations ginc uding IMemfire rs fighting emergency medical care,hazardous materials mitigation,and symptoms shall be moved to am assessment gniticant special operations.Nonemergenry duties can include,and are advance life support personnel can be performed by not limited to,training,station and vehicle maintenance, 54.6 Members assigned to rehabilitation shall be encouraged physical fitness. Each fire department needs to identify and to add/remove clothing to regain normal body temperature, developa drink fluids(water,electrolyte replacement drinks),and rest. Essential Fire-Fighting Functions,Provides or ears exaamplec of P ) essential job functions for members. 5-4.7 No member shall be reassigned to return to dun•until A-1-3.2 medical evaluation and hydration has occurred for at least jurisdictionedepends on Mechaani of the rwhic 10 minutes in rehabilitation and after being authority having medical staff g cleared by deed is adopted and enforced. mum untandar i this steel 5-1.8 All members entering and leaving rehabilitation shall be voluntarily by a a Where this standard is adopted particular fire department for its own use,the Properly assigned by the incident management system and be authority having jurisdiction should be the fire chief or the tracked though the political entity that is responsible for the operation of the fire o personnel accountability system. department. Where this standard is legally enforced by a body having regulatory authority over a fire department, such as federal, state, or local government or Chapter 6 Referenced Publications political subdivision,this body is responsible or making 6-1 The followin do determinations as the authority havingjurisdiction.The oom enced within this standard °r P°moons thereof are refer- pliance program should take into account the services the fire shall be considered mandatory requirements and department is required to provide, The edition indicated for each a ch referencedl �mathis d tstandard. mailable to the fire department, �e financial resources meat is the current edition as of the date of the D'docu- the availability of trainersad such other factorsavailability oas will affect of this standard,Some of these mandatory NFPA issuance the fire department's ability to achieve compliance also be referenced in this standard for specific informatiocuments nal A 1�.1 Purposes and,therefore,are Approved. The National Fire Protection Association also listed in Appendix F. does not approve, inspect, or certify any installations, proce- dures,NFPA Publications. National Fire Protection Associa- equipment,or materials;nor does it approve or evalu. tion, 1 Batterymarch Park,P.O.Box 9101,Quin �� ate testing procedures,equipment, materials,the authoof r- 9101. cy,iVIA 0__69. determining the acceptability r- ,NFPA 1500. Standard on Fire D art ity hang jurisdiction may base acceptance on compliance and Health Program, 1997 edition. ►acne Occupational Safety with NFPA or other appropriate standards.In the absence of NFPA 1521, Standard or Fire Dep such standards,said authority may require evidence of proper edition. f artment Safety Offu� 1997 installation,procedure,or use.The authority Navin u NFPA I561,Standard on Emices of an tion may also refer to the listings or lobelia g� nsdic- ment System C7 .n,y Semites Incident Manage. Organization that is concerned with product evaluations d is y tem,2000 edition, thus in a position to determine compliance with appropriate NFPA 158I,Standard on Fin Department In artjec gram,2000 edition. tion Control Pro- standards for the current production of listed items, 6-1.2 U.S.Government Publications. A-14.2 Authority Having Jur�� m The h rasing Office,Washington,DC 20401. C.S.Government Print_ having jurisdiction" is used in NFPA inauthori broad Title 29, Code of Federal Re lati manner,since jurisdictions and approval agencies vary, ous Waste Operations and Emergency Part'910.120,"Hazard- their responsibilities. Where public safety is do he Tide 29, Code ojFederal Re S cY Response,"1986, authority havingiurisdiction may be a federal,state, local,or tory Protection," fFed "u'Part '910.134,"Re'5pira- other regional department or individual such as a fire chief; Tide 2 fire marshal,chief of a fire prevention bureau,labor depart 9, Code of Federal Regulates Part 1910.95, " ment, or health department; tional Noise Exposure,"1980. Occupa- inspector,or others having tatutorylautthoriity For insurance l Title a Code o Federal purposes,an insurance inspection de Recordkee in ," f Luions, Part I91U.?p, ".Medical or other insurance company representative may be the au P g 1980. department,rating bureau, Title 29, Code of Federal Regukztio Part '910.1030,"Blood- �' Navin jurisdiction. Y thor- borne Pathogens,"I995. 1 having risdiction. In man owner or his or her designated agent assumes the role th 2lll)0 Edition authority having jurisdiction;at government installations,the r f, i APPENDIX A 1582-l3 commanding officer or departmental official may be the authority having jurisdiction. A 2-5.3 See Appendix D,Section D-1,Legal Consideratio A-1-1<.3 Candidate. In an employment context. the Amen- Applying the Standard. in cans with andidDisabiIte. Act(discussed in further detail in A en- A 2-5.4 Physical therapy, strength training, work hardening, Pp functional capacity e%aloiations,and alternate dtin are all activ_ disc D)requires that any medical examination to be conducted take place after an offer of employment is made and prior to ides that can be helpfoil. the commencement of duties.Therefore,in the employment A 3-2.1.2 Category B medical conditions of the head include context,the definition of the term c4ndida[eshould be applied the following-so as to be consistent with that requirement. • Volunteer members have been deemed to be employees (1) Deformities of the skull. such as depressions p exec, in some states or jurisdictions. Volunteer fire departments toles,of degree that interferes with the we of putt c. in should seek Iegal counsel as to their legal responsibilities in rive equipment. Deformities of the skull can result in these matters. the member's inability to properly wear protective quipment. A 1-t<.20 Member. See Appendix C.Essential Structural Fire e Fighting Functions. (=') Deformities of the skull associated with evidence of dis- ease of the brain,spinal cord,or peripheral nerves.These i A-2-1.1 See Appendix D,Guide for Fire Department Adminic deformities can result in the potential for sudden inca- trators• pacitation, the inability to properly wear protective A-2-I.5 Exposures and medical conditions that should be equipment,and the inability to communicate effectively reported if they can interfere with the ability of the individual dole to orop ng vital absence of the bonvsubsmnce of the to perform as a member include, but are not limited to, the (3) Loss of or congenital following: skull (if associated with disease interfering with perfor- mance or if appropriate protection cannot be provided for (1) Exposures to hazardous materials or toxic substances the area without interfering with protective equipment (2) Exposure to infectious or contagious diseases and vision).Loss of or congenital absence of the bonysub- (3) Illness or injury stance of the skull can result in the inability to properly (4) Use of prescription or nonprescription drugs wear protective equipment and the inability to communi- (5) Pregnancy cate effectively due to oropharyngeal dysfunction. (4) Any other head condition that results in a person not A 2-2.2 See Appendix D,Section D-2,Choosing a Fire Depart- being able to perform as a member. ment Physician. e+►3-2.2.2 Category B medical conditions of the neck include A 2-2.3 See Appendix B, Information for Fire Department the following: Physicians. Appendix C. Essential Structural Fire-Fighting (1) Thoracic outlet syndrome Functions provides a generic description of job tasks per- syndrome (�Pt°mark) es ofpThoracic out- formed by members.A fire department needs to provide the lets inability to p can result in frequent episodes of pain or fire department physician with a job description of all osi- (2) Congenital work bons and tanks so that the fire de p g �� chronic draining fistulas, or similar understand the physical and mental demands placed upn can on all lesions a lesions g underlying disease interferes with stu- members regardless of position or rank.Appendix D, Guide performance). Congenital cysts, chronic draining properly for Fire Department Administrators, also provides i lac,r prorsotective lesions can result in the inability to properly for ensuring [hat the fire department guidance wear protective equipment,and the inability to commu- p rtment physician is provided nicate effectively due to ore h p aryngeal dysfunction. with this information. A 2-3 See Appendix B, Section B-3, Guidance for Medical (3) Contraction of neck muscles(if it interferes with wearing of protective equipment or ability to perform duties). Evaluations. The contraction of neck muscles can result in the inabil- A 2-3.4 See Appendix D,Section D-1,Legal Considerations in icy to perform functions as a m mber dueicy t proper wear protecve equipment,to limitation f Applying the Standard. flexibility. A 2-4 See Appendix B, Section B-3, Guidance for Medical (4) Any other neck condition that results in a person not Evaluations. being able to perform as a member. A-2-4.1.3 At the discretion of the fire department physician, include 1 Category medical conditions of the eves and vision an examination can be performed sooner than would be nclude the following. expected from the schedule given in 2-4.1.3.Current medical (1) Far visual acuity.Far visual acuity is at Ieast 20/30 binocu- conditions and coronary risk factors could mandate more fre- lax,corrected with contact lenses or spectacles.Far visual quent medical examinations. A-2-4.1.4 See Appendix B,Guide for Fire Department Ph _ acuity uncorrected is at least 20/100 binocular for wear- ers•of hard contacts or spectacles. Successful long-term sicians. Y soft contact lens wearers (that is, six months without a problethe uncorrected standard. A-2-4.3 See Appendix D,Section D-1,Legal ConsiderationsInadeq )te far visual acuitare not subjecty in can result n the failure to be Applying the Standard. made ua h, able to read placards and street signs or to see and A-2-5.1 A department should set protocols regarding len th 9 respond to imminently hazardous situations. of time absent from duty and/or medical conditions that ( ) Penphera[virion'Visual field performance without correc- require the department physician to evaluate a member. lion is 140 degrees in the horizontal meridian in require each eye. (Members cannot have just monocular vision.) 2000 Edition � ...m...m.._ 1582-14 SILDICkL RLQUIRENIENTS FOR FI RC Ft(;I ITER5.•\ND INF'OR.\.L\rtoN FOR F[RL'DLP.\RTbILYT PEDSICL\VS N[onocular vision can result in sudden incapacitation when d e ip is lodged in one rye.Inadequate or corn to- (Ir) Srrrrr external otitis,that is,recurrent lass of hr ' mired Peripheral vision can result in the following- P can result in the inability to hear sounds of low intensity b dispond to voice from background noisy,leading to failure ° a. Failure to perform job duties and maintain visual con. pond to imminently hazardous situations. ty or to tact with a garner yes b. Inability to maintain safe C. Poor balance on uneven surface., ovrrrg objects can(result�in the inab inability top opeor rldCwearn,rot protective equip.' ncle d. UnsuccessfirI Performance in environments where mew h nt dvoi e the r from background noise to hearsounds Ilradnn�rrt rty or Co d� visual cues are critical to tin is personal safety rrsp��rld to imminently hazardous situations. ' ° farlure to A-3-3-2 Category B medical conditions of the ryes and vision include the following (d) Severe mastoiditis or surgical deformity of the mastoid cment an result in the inability to properly wear protective equip_ (1) Diseases of the eye such as retinal detachment, o anguish and the inability abili background noise,low intensity or to dis- sive retinopathy,or optic neuritis(severe orprogressive).s These diseases of the eye can result in the f read respond to imminent! h leading to failure to Placards and street si ns Y azardotu situations. $ or to see and respond to immi- (e) Meniere's svndrome or severe labyrinthitis may r nentiy hazardous sittrati°ns in the potential for sudden incapacitation and the inability r (2) Ophthalmological procedures such as radial keratot- Y result omv and repair of retinal detachment. With retinal perform job functions due to limitations of balance. ty to detachment, strflicient time 1.� M Otitis media (chronic) can result in frequent episodes de ac and ( weeks for radial kera- °f pain or the inability to perform work and the inability to Y Lasik-type surgeries,three months for yeti- hear sounds of low intensity nal detachment)must have ground noise,leading to faure or s o�es distinguish voice from back- of visual acuity and to ensure that thereno post gical complications. These ardour situations. pond to imminently haz_ postsur- ophthalmological proce- (9) Any other ear condition that results in a dares may result in the failure to be able to read erson not being able to perform as a member can be classified as a Cat placards and street signs or to see and res nently hazardous situations, pond to immi- eg°�'B medical condition of hearing, (3) Any other eye condition that results in anot lows 2 Category B dentaI medical conditions include the fol- able to perform as a member.Persons with severe color lowing - able loss will likely fail the acuity requirement. (1) Diseases of the jaws or associated tissues (those that are Formerly, color vision deficiency was Iisted as a Cate- gory B medical condition. However,it is felt that within incapacitating or preclude ability [o use protective most cases this condition will not equipment). Diseases of the jaws or associated tissues member to affect the ability h a can result in the inability to properly wear protective Perform the essential functions of his or her equipment. job.The fire service physician should consider the color • vision deficiency (2) Orthodontic appliances (those that preclude the ability ry of the individual and consider the color to use protective equipment).The wearing vision requirements of the member's Job and reach an pp'antes can result in the inability to Properly we individual determination. tic a Ir g of orthodon- ',3�•2 There are currently no hearing tests that will allow the Protective equipment. P Y wear (3) Oral tissues,extensive loss (that which precludes satisfac- fire department physician to accuratelyt°ry postorthodondc replacement or ability to use pro- fire fighter will adequately be able to predict whether the duties.Job-specific Perform essential job tective equipment). Extensive loss of oral pecifia hearing tests should result in the inabilityto tissues may ui each department and its s ecific j individualized for ment and the inability to properly case eprotective ffectively due to List of hearing-specific P °b functions.The following oro ha tasks can assist to direct development of P ryngeal dysfunction. hearing protocols. (4) Relationship between the mandible and maxilla that re. (1) Understanding spoken commands, both over the radio cl to useprotective equipment This co p and while wearing SCBA satisfactory P°storthodontic replacement or abil- (2) Hearing alarm signals, including in the inability to properly wear Protective equipment low air signal on the SCBA,a g building evacuation and the inability to communicate effectively due to (3) Hearing and locating the sous a of alarms oropharyngeal dysfunction. calls for assistance (5) Any other dental condition that results in a person not from victims or other fire fighters All of the above tasks will need to be Performed being able to perform as a member. sonablysimtrlated incident scene background with tea- A-3 6.1 Category A medical conditions of the nosy,orophar- noise.The inability to hearsounds Oflowointe sity or to distin- guish voice from back ise andSCBA Ynx.trachea,es noise. and larynx include the following:respond is imminently hazardous rise can situations. a o failure to (1) Tracheostom . Y A tProte rive equipment,can result h the inability Category B medical conditions of hearing include the fol- to Prop Job wear sedur to limitations of endurance, oropto haryngeallowing; perform (a) Unequal!rearing can result in the inabili to localize and the inability to communicate effectively due to sounds.Leading to failure in the abilityto oropharyngeal dysfunction. inability (2) Aphonia, regardless of cause. rescue and other localization tasks, perform search and inability to communicate effectiively due etororopharyn- seal dysfunction. 2000 Edition 1 -rrrrr�,urrra...gff#F"1,, APPENDIX A 1582-15 `�- " Category B medical Conditions of the nose, oco har- ynx,trachea,eso ha P (9) Infectious diseases of the lung or pleural space. p gus,and larynx include the following: (10 (1) Congenital or acquired deformity that interferes with the )not being otherPulmonary perform as condition that results in a ability to use protective equipment. Person acquired deformity can result i the inability to Properly ember. A 3-8.1-1 Category A medical conditions of the heart and vas. wear protective equipment. cular system include the following: (=�) Allergic respiratory disorder(uncontrolled).Allergic res- (1) Angina pectoris, current. Angina piratory disorder can result in frequent episodes of pain, the inabidis o perform work, frequent episodes of pain or inability tytto performswo in k, functions as a member d nd the inability to Perform progressive illnesswork, tie to limitations of endurance, the potential for sudden incapacitation. impairment,and (3) Sinusitis,recurrent (severe, requiring repeated hospital- (=�) Heart failure, current. Heart failure can _ izations or causing impairment) Recurrent sinusitis can quent episodes of pain or inability to perform work, result in frequent episodes of pain and the inability to gressive illness leading to functional impairme tl and th perform work. pro- (1) Dysphonia (severe), were dvs Potential for sudden incapacitation. r inability to communicate effectivelytdue cOrocoltha the (3) Acute pericarditis, endocarditis, or myoarditis. These t3' Beal dysfunction. p ryn. .. conditions can result in frequent episodes of pain or the (5) Any other nose, oro ha inability to perform work, ynx condition that results ,n arachea,esophagus,or lar- (4) Syncope,recurrent.Recurrent syncope can result in the perform as a member or to communicate cate effecerson not tively. to (5) Automatic implantable cardiac being potential for sudden incapacitation. A 3-7-I Category A medical conditions of the lungsmatic implantable cardiac defibrillator clan result in the wall include active hemoptysis, empvema, Pulmnary and tension,and active tuberculosis.These conditions can result Potential for sudden incapacitation. Pulmonary epuc- in the inability to perform functions as a member due to!sins- A 3-8'1.2 Category B medical conditions of the heart and vas- tations of endurance. cular system include the following- (1)3-7.2 Category$medical conditions of the lungs and chest (1) Significant valvular lesions of the h wall include the following: thetic valves.Specific recommendation include ntglre fol- (1) Pulmonary resectional sure lowing mothorax (that is, history su of rgery, chest wall surgery, pneu- a- Mitral sk%aris. Mitrai stenosis is acceptable if in sinus rrenpneumothotaac), These Cnti uonsucan creation tan eous rhythm and stenosis is mild, inability to perform functions i a member due to limits- or thatsu is,Valve mmrea> g.cm= the b. Atitpral inru�artery systolic pressure<35 min Hg,dons of strength n endurance and may result in the 'ffu�'Mitral insufficiency is acceptable if Potential for sudden incapacitation. in sinus rhythm with normal left ventricular size and (2) Bronchial asthma or reactive airwaysfunction. medication use or symptoms disease (frequent C. Aortic stenosis.Aortic stenosis is acceptable if stenosis symptoms caused by exposures to exer. is mild, that is, tion,heat and cold,or products of combustion and other mean aortic valvular pressure grads. irritant inhalation),Bronchial asthma or reactive airways ent<20 min Hg. disease can result in frequent episodes of pain or the d Aortic mgurgitahom Aortic regurgitation is acceptable if left ventricular inability to perform work, the potential for sudden Inca- systolic function senis onor al or slightly increased and pacitation, and the inability member due to limitations o en Perform functions as a e. Prosthetic valves Prosthetic valves are acceptable unless (3) FbrothoraY,chest wall deforms full anticoagulation is in effect ties. Fbrothorar, chest ry,diaphragm abnormali- (2) Coronary artery disease,including history of myocardial abnormalities wall deformity, and diaphragm infarction, coronary can result in the inability to perform func- angioplasty, and similar Procedures. Person at mildly coronary lions as a member due to limitations of endurance, P (4) Chronic obstructive airways increased risk for sudden incapacitation are acceptable airways disease Can result the iinasability too perform func- presence of each of the following- obstructive for fire dons fighting. Mildly increased risk is defined by the lions as a member due to limitations of endurance. (5) HYpoxemic disorders,Hypoxemic disorders can result in a' Normal left ventricular ejection fraction the inability to perform functions as a member due to b Normal exercise tolerance,>IO metabolic equivalents limitations ofendurance, (NETS) (6) Interstitial lung diseases. Interstitial lung diseases can , result in the inability to perform functions as a member C. Absence oo f exercise-induced ci e-indu ied co by exercise testing d. Absence of exercise-induced complex ventricular due to]imitations of endurance. arrhythmias(7) Pulmonary vascular diseases, pulmonary embolism. Put- e' 'absence of hemod monary vascular diseases and pulmonary embolism can ynamicallysignifigncstenosis on all result in frequent episodes of sin and major coronary arteries my percent lumen diameter perform functions as a P the inability to narrowing),or successful o myocardial revascularizadon member due to limitations of (3) Atrial tachycardia,flutter,or fibrillation endurance, (4) Left bundle branch, second-and third-degree (8) Bronchiectasis with significant residual impairment tricular block.These blocks will result in disqualification Pulmonary function or requiring frequent therapy.went of Pulmchiec na can result in the inability to perform functions unless exercise h be performed with u adequate heart Bron- rate 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. 2000 Edidon 1582-16 SflillIC,1L REO r L IREJIENTS FOR FIRE FIGHTERS:1YD[NFOR�(1T 1ON FUR FIRE llEf'.1RT,LENT N[i�SICLINS (5) Ventricular tachycardia. result in the entricular tachycardia can potential for sudden incapacitation and the inability to prrfo,Tn 'ob to limitations of endurance J functions due to limitations of job functions due to lim,tation a°�balancr,ry to strength or endurance. perform (6) Hypertro by of (7) '�eurysm of the heart or P the heart. Hypertrophy of the heart can major v result in the potential for sudden incapacitation and the acquired.An aneu J essel, congenital or inability to result in frequent episodes the ain t or major vessel perform job functions due to (imitations of can endurance, form work,and the P the inability to (J) Recurrent (8) Any other Potential for sudden inc per- paroxvsmal tachycardia, ascular condition that results in aPacitado n. mal tachycardia can result in the Recurrent paro being able to Performperson not incapacitation and potential for sudden e13-9.2 a member. due to limitations the inability to rrfo Category 8 medical conditions of the abdominal ofstren P 1°b functions organs and(8) Historyofa congenital g�or endurance, gastrointestinal g tsl abnormality (I) Cholerystitis system include the following-residual complications ec has been treated (that which been treated by sue plications or that has not stones or infection). causes frequent pain due tins• .1 con fiery leaving residuals or complies- episodes of p ) Cholecvstitis can result in frequent t episodes Of pain abnormality can Pain or the inability to pain or inability result in frequent (2) Gastritis (that which taus Perform work. potential for sudden inca aci to Perform work and the ment).Gastritis can result es Feq ent e psod and a(9) Chronic pericarditis,endocarditisn the inability top impair- Potential can result in the• °r myocarditis.These Perform work, P pain or (3) CI bleeding can cause fatigue, bons due to limitations of endurance to pert°trnJ°b fom- tnstabiliry resulting and or hem(IO) Cardiac ace (1) Acute hepatitis in inability to perform °dynamic pacemaker. If the Person is pacemaker-depe� (until resolution of �vork. dent,then the risk forsuddrn Failure due to determined b acute hepatitis as acceptable.Those trauma is not dete Y clinical examination and a with cardiac pacemakers oratory testing). Acute he atitis ppCOPriate lab. potential for sudden incapacitation. can have the episodes of Pain or the in P an result in frequent (1I)Coronary arterydiac pa (5) Hernia u P p ability to perform work vasospasm. Those ( nee aired inguinal or abdominal hernia that vas spasm can have the with cardiac artery could obs tation. potential for sudden incapaci_ potential for suddentruct (12) o during duty).A hernia can result in the Y they cardiac condition that results in a P (6) Inflammatory being able to Perform person not Pain or diarrhea).I disease (that which causes disabling P rm a s a member. ) Inflmnmato nresult t A 3•8.2.2 Category 8 medical conditions of the in frequent episodes of ry bowel disease can result rem include the following work. It is a CO Pain or the inability to perform vascular s- progressive illness leading (1) Hypertension that is sY imPalRrtent. to functional requires medication likely trolled, (7) Intestinal obstruction Poorly controlled,or impairment)- (that is, recent obstruction with mance of duties. 1h inter fere with the P rment).An intestinal obstruction sure i Acceptable hypertension it a the Pe quent episodes of pain the inabilityt can result in fre- ess man 180/I00 and no potential for sudden incapacitation.Perform work, target organP es• and the Hypertension is a progressive illness leading dsmage' (8) Pncreatids impairment with the potential for sudden inca ancdonal meet . (that ,s, chronic or recurrent with (2) Peripheral vascular disease ) Pncreatitis can result in ides of non, ,such as Ra P c,tation, pain or the inabilityto frequent episodes of that interferes with erfo maud's phenome- (9) Resection,bowel perform work. the individual likelyP rmance°(duties or makes (if frequent diarrhea precludes perfor- injury.Peripheral to have significant mance of duty)•A bowel resection can result in frequent P vascular diseasen risk or severe episodes of episodes of pain or the inabilitycan result in Frequent (IO) Ulcer, pant st the inability inabilityto to per work and the gastrointestinal ry CO Perform work Perform functions as a member due to limits- trolled by drugs (where symptoms are u bons of endurance, gs or surgery) ,4 ncon- (3) Recurrent throm result in frequent episodes of gastrointestinal ulcer can bophlebitis. Recurrent thrombophlebi- form work Pain or the inability tis can result in freq nodes of to per- to Perform vent ep' pain or the inability (11)Cirrhosis,hepatic or bills p rm work and the inability to per functions as ,n do `3'(that which is a member due to limi gee of bleedin symptomatic or (I) Chronic 1 limitations of endu episodes of pain or rho inabilityrCirrhosis can result in frequent ymphedema due to l Lance. venous valvular incom YmPhopathy or severe (12) Chronic active hepatitis. Chronic, activenhepatitis can result in the inabili Petency.Chronic lymphedema can result in frequent episodes of inability to perform functions as a form work P Pain or the inability to per- due to limitations of endurance. member (5) Congenital or acquired lesions of the aorta or major yes- (13)Any other gastrointestinal condition sets,forexample,syphilitic aortitis,demonstrable athero- son not being able to that results in a per- sclerosis that interferes wi g perform as a member. acquired dilatation of the th circulation, and congenitalorgans i.2 Category B medical conditions of the reproductive lesions of the organs include the Following aorta or Congenital or acquired Potential for sudden inca ajor vessels can result in the (1) Pregnancy.Pregnancy pain or a inabil can result in frequent episodes of -,progressive inabil- perform job functions due to ii and the inability to ry to Perform (6) Marked circulatory limitations of endurance. i4'to perform work due eto limitations of endurance,fles- h otensiirc ry instability as indicated a durranorthosta. ibili Persistent tachycardia, and tY or strength; and the inability era(vasomotor disturbances.,Marked circulatory inperiph-stsbil_ 2 Protective equipment.($�B44, 1O Properly wear ity can result in the inability (') DYsmenorrheaReproductive) a tyro erfo that leads to recurrent incapacitation. P rin job functions due Dysmenorrhea can result in frequent episodes of pain or 2000 Edition the inability to perform work. f i r %h� APPEND(\:k 1582_17 (3) Endometriosis,ovarian cysts,or other gynecolo c condi- tions (severe, leading to recurrent incapacitation), dislocation, if nn�e of Endometriosis,ovarian rysts,and other gynecologic con- �' motion o intact, would not ditions can result in Frequent episodes n pain is the exclude a person, Dislocation of a joint can result in the g inabilia to perform functions as a member due to limita- inability to perform work. dons of strength or flexibility. (4) Testicular or epididymal mass (that which requires medi- (4) Joint reconstruction, ligrnmentous instability cal evaluation).A testicular or epididymal mass can result replacement. In cases where recurrent or with ru dual in frequent episodes of pain or the inability to perform limitation of motion of a degree to interfere with success. work. This is a progressive illness leading to functional ful and safe performance��t'fire-fi�htin�=duties, impairment for a torn anterior cruciate lil,*ament could disqualify if (5) Any other genital condition that.results in a person not quadricep strength is not nor(i or if the knee is lax or being able to perform as a member. de�•elops pain or swelling when stressed. These condi- A-3-10.2.2 Cates (ions of the joint can result in the inability to perform Category B medical conditions of die urinary sys- functions as a member due to limitations of strength or rem include the following flexibility: (1) Diseases of the kidney requiring dialysis. Diseases of the (5) Chronic osteoar•thritis or traumatic arthritis kidney can result in frequent episodes of pain or the (rn cases where recurrent e.�tacerbadons leads to impairment). inability to perform work.Kidney disease is a progressive Chronic osteoarthritis or traumatic arthritis can result in illness leading to functional impairment, frequent episodes of pain, the inabilin to perform work, (2) Diseases of the ureter, bladder, or prostate that require and the inability to perform functions as a member due frequent or prolonged treatment. These diseases can result in frequent episodes of pain or the inability spew to a limitations ac hcenis g(p castes where is is severely recur- form work. (6) Inflammatory (3) An other urinary p rent or a progressive illness or with deformity or limita- Y condition that results in a person not tion of range of motion of a degree to interfere with being able to perform as a member. successful and safe performance of fire-fighting duties). A 3-11.2 Category B medical conditions of the ire sea u_ Inflammatory arthritis can result in frequent episodes of lae,ribs,and sacroiliac joints include the of thinge p Pain. the inability to perform work, and the inability to perform functions a member due to limitations of (1) Arthritis that results in progressive impairment or limits_ strength,endurance,,or flexibility: tion of movement.Arthritis is a progressive illness that (7) Any other extremity condition that results in a person not leads to functional impairment.Arthritis can result in the inability to perform functions as a member due to limits- being able to perform as a member. tions of endurance or flexibility. A 3.13.1 Category A medical conditions of a neurological (2) Structural abnormality, fracture, or dislocation that is a nature include the following: progressive or recurrent impairment. These conditions (a) Ataxias of the heredo-degenerative type Alas of the are progressive illnesses leading to functional impair. heredo-degenerative type can result in the inability to perform ment. These illnesses can result in the inability to per- functions as a member due to limitations of balance. form functions as a member due to limitations of strength or flexibility. (b) Cerebral arteriosclerosis as evidenced by documented (3) Nucleus pulposus, herniation of, or history of laminec- siscan result in the nability to perform functions as a member tomy, discectomy, or fusion. These conditions are pro- due to limitations of strength and/or balance. gressive illnesses leading to functional impairment and the inability to properly wear protective equipment (c) Progressive multiple sclerosis or multiple sclerosis with (4) Ankylosing spondylids. This condition can result in the evidence of progression within previous three years.Multiple inability to perform functions as a member due to limita- sclerosis can result in the inability to perform functions as a lions of endurance or flexibility. member due to limitations of strength or flexibility. (5) Any other spinal condition that results in a person not (d) Progressive muscular dystrophy or atrophy,This condi- being able to perform as a member. tion can result in the inability to perform functions as a mem- A 3-12.2 o Categ rY B medical conditions ber due to limitations of strength and/or balance. include the following: of the extremities (e) Epileptic conditions.After a provoked seizure,with the (1) Limitation of motion of a joint of a degree to interfere precipitant identified and alleviated,with subsequent normal CT or MR!scan,normal EEG,normal neurological exam,free with successful and safe performance of fire-fighting of recurrence without medication forone year,and with defrn- duties.The limitation of motion of a joint can result in itive statement from a qualified neurological specialist,a mem- the inability to perform functions as a member due to ber can be cleared to return to duty. limitation of flexibility. (2) Amputation or deformity of a joint or limb of a degree to A 3-13.3 Category B medical conditions of a neurological interfere with successful and safe performance of fire- nature include the following: fighting duties.The amputation or deformity of a joint or (a) Congenital malformations(that is,severe vascular mal- limb can result in the inability to perform functions as a formations that interfere with the ability to wear protective member due to limitations of strength and/or balance. equipment). Congenital malformations can result in the (3) Dislocation of a joint.Recurrent dislocation of a joint or inability to properly wear protective equipment. dislocation with residual limitation of motion of a degree (b) Migraine to interfere with successful and safe performance of fire- trolled). Migraines (that is, recurrent, with impairment a o r Fighting duties;successful surgery for recurrent shoulder to can result in frequent episodes of pain or the inability to perform work. 2000 Ed don i 158t'—!,y XIEDIGIL REQ(,'IRLSIEVTS FOR FIRE FIGFITENS.1.\U INFURNI:\T[UN FUR FIRE DEC:\RT�IENT C[i\StrL1V5 (c) Clinical disorders with paresis, paralysis, tion,deformity,abnormal motor activity,abnormality°f ensa- (� Any other hrmatolobdcal condition that results in a lion, or complaint oC pain (progressive or severe). Person not being able to perform as a member. f disorders are progressive gressive illnesses leaden ) These impairment They can result in g to functional A-3-16.1 Category A medical conditions of endocrine and lions as a member due to limitations ofstrength,flexibility,or with insulin or an oral h inability perform font- metabolic disorders include diabetes mellitus that is treated balance. YPoglycemic agent and that includes a (d) Subarachnoid or intracerebral hemorrhage, mistory of one or ia. Diabetes melt us can esult intthePotentia h either clinically or by laboratory s P g verified g YPob*Iycr- 1 ry'coders,exce t for those tor- incapacitation, potential for sudden reefed with verification by laboratory treating physician. studies and report of rhage is a progressive bIlness le ding to noid or tfunctio a!racerebral hmpair- A 3-16.2 Category B medical conditions of endocrine and impair- ment. Th illness can metabolic disorders includes the following- is incapacitation. result in the potential for sudden (a) Diseases of the adrenal gland,pituitary land, a (e) Abnormalities from recent head injury, void gland, or thyroid gland of clinical significance (thatles, cerebral contusion or concussion. J ry such as severe symptomatic and poorly controlled).These diseases can result result al the potential for sudden incapacitation.healities can in frequent episodes of pain, (f) Any other neurological condition that results in a r_ Pei the inability to perform work, _ and the potential for sudden incapacitation. son not bring able to perform a9 a Pr (b) Nutritional deficiency member. (where clinically significant and isease or not correctablelic byreplace- the fol•2 Category B medical conditions of the skin include ment therapy or other medication).Nutritional drF the following; ease or metabolic disorder can result in frequent episodes deficiency dis- (a) Acne or inflammatory skin disease pain or the inability to perform work, q P des of eludes good fie of protective a tie (�condition pre- (c) Diabetes mellitus requiring piece, or prevents shaving) q Pmrn4 such as SCBA face q g treatment with insulin or can result in the inability tpAcnerl such skin disease oral hYP°glycemic agent. Diabetes mellitus can result in epi- P y ear protective equipment. sodes of pain or inability to perform work. It is a progressive (b) Eczema (if broken skin results in impairment from potential for sudden incapacitation, P gressive � P illness Leading to functional impairment and can result in the infections or pain or interferes with seal between skin and per- sonal protective equipment). Eczema can result in frequent (d) �Y other endocrine or metabolic condition that episodes of pain or the inability to perform work, results in a person not being able to perform as a member. (c) Any other dermatologic condition that results in the A 3-17.2 Category person not being able to perform as a member. g ry B medical conditions of systemic diseases A-3.15.1 Category and miscellaneous conditions include the following: formes organs g ry`�medical conditions of blood and blood- (a) Connective tissue disease, such as dermatomyositis, g includes the following; (a) Hemorrhagic lupus erythematosus, scleroderma, and rheumatoid arthri- (for example,emo hagicvon states requiring se replacement t emPY tis(where manifested b Of motion).These connective tissue ic d diseases are progressive limitations hemophilia).These hemorrha c slat cYt penis, illnesses leading to functional impairment and the inability episodes of pain or the inability es an result in frequent P gressive tY perform work. to function as a member due to limitations of strength or (b) Sickle cell disease (homo ° flexibility. can result in frequent episodes Of or Sickle cell disease form work and the P Pain or the inability to per. (b) Residuals from Potential for sudden incapacitation. bite resulting in significant st thermal injury(for example,frost- form Category g aIs fromSymptomatic discomfort) .g ry medical conditions of blood and blood- endurance, e,or es b thermal member due to limitations of strength, forming organs include the following injury may result in the inability to (a) Anemia (in cases that require r endurance,or flexibility, regular transfusions). (c) Documented evidence of a predisposition to heat Anemia can result in frequent episodes of pain or the inability stress with recurrent episodes or resulting residual injury. A to perform work. Anemia is a progressive functional impale. Anemia P gressive illness leading to predisposition to heat stress can result in the potential or ud- (b) Leukopenia (where chronic and indicative of serious den incapacitation and the inability to illness). Leukopenia is a progressive member due to limitations of endurance. perform functions as a lion s impairment. P g essive illness leading to func- (d) Any other systemic condition that results in a person (c) Polyrythemia very (where s not being able to perform as a member. Yry emia ment). pol th evere, requiring treat- where can result in frequent episodes of `,3-18.2 Category B medical conditions of tumors and malig pain or the inability to perform work and the potential for sud- nant diseases can include the following; den incapacitation. (d) Splenomegra (where the spleen is susceptible to rup- disease that is newly diagnosed,ed,untreated,or currently cure from blunt trauma). edical evaluation of y person with malignant Potential for sudden incapacitpatioOmegaly can result in the treated will be deferred. y being (e) History of thromboembolic disease (that is, more Any person with treated mall than one story o or an underlying ated based on that person's currentsphysicalase should be ed on Yi g condition) ti history of the likelihood of that person's disease torecu�oriprogress on than one disease can result in the potential for sud- den incapacitation. (b) Any other tumor or similar condition that results in a 20l)D Edition person not being able to perform as a member. r, J 1 i APPENDIX A 1582_19 n nature i Category B medical conditions of a psychiatric nature include the following: a. FIN (a) Any person with a history of a psychiatric condition or b. Hepatitis B surface Antibody (HBsAb), if not substance abuse problem should be ously known to be positive previ. person's current condition. Psychiatric conditions and sub-ased on that c known to be Positive atitis B surface HgsAb HB stance abuse problems can result in frequent episodes of pain d. Hepatitis C AntibodyH )'if not previously or the inability to perform work and the potential for sudden (HCAb) incapacitation.These conditions are progressive illnesses lead- e. If HIV prophylaxis is to be given, the following fists ing to functional impairment should be done: (b) Any other psychiatric condition that results in a person I. CBC not being able to perform as a member. 2. Glucose,renal and hepatic chemical function 3. est for females A 3-20.2 Category B medical conditions concerning chemi- (`l) Listing of testing t be done on source alien inc cals,drugs,and medications include the following the following: P 4 Iuding (a) Anticoagulant agents such as coumadin can be permit- a. HN ted if the anticoagulated state is controlled such that the pro- HBsAg thrombin time or INR has been in the therapeutic range on a . HCAb stable medical regimen for at least one month and that no (5) If source is available,interview for HIM,HepB, other coexisting conditions would either contribute to a risk/status. bleeding diathesis or by themselves preclude certification for P and HepC full duty.Anticoagulant agents can result in frequent episodes (�) Determination of risk and need for PEP of pain or the inability to perform work,as well as the potential ( ) Member counseling re for sudden incapacitation, g regarding PEP medication(s) and side effects of treatment.A printed fact sheet should be (b) Cardiovascular agents (for example,antih ertensives available for the member to review. can result in 6-equent episodes of pain or the inability to per ($) a n PProphylaxis is to be given, it should be done as form work,as well as the potential for sudden incapacitation. hours. possible after the incident, preferably within 2 station. (c) The use of narcotics can result in frequent episodes of (9) Members on prophylaxis need to be followed(preferably pain or the inability to perform work,as well as the potential by an ID specialist) for the duration of their treatment. for sudden incapacitation. (d) The use of sedative-hypnotics can result in frequent (10)Assessment of tetanus status and administration of dT episodes Tof he or the sedative -inabilityto booster,if appropriate potential for sudden incapacittion,perform work,as well as the (I1)Assess HepB status (e) The use of stimulants can result in frequent episodes a• If previously immunized with a positive post immuni- of pain or the inability to perform work,as well as the potential zation titer,no further treatment is needed. for sudden incapacitation. b. If previously immunized, titer source is HBsA was negative, and The use of psychoactive agents can result in Frequent Immune Globulin (HBIG)as soon as possible--pref- episodes of pain or the inability to perform work,as well as the erabl within 24 hours_ give Hepatitis B potential for sudden incapacitation. y and a dose of Hepatitis B (g) The use of steroids can result in frequent episodes of vacate. pain or the inability to perform work. c. If previously immunized and titer is unknown, draw (h) Any other chemical,drug, titer. person not being able to perform as a medication ember is ncluded I. If titer is positive,no further treatment is needed. in this group 2. If titer is negative and source is H ositive r high risk,then give Hepatitis B Immune Globulin A42.1 Physicians who care for members need to be familiar and keep up-to-date with the most current recommendations (HBIG) as soon as possible p preferably within for Post-exposure prophylaxis (PEP) for bloodborne patho- previously hours—and a dose of Hepatitis B vaccine. gen(BBP) exposures.Also there should be a written protocol cind If Previously immunized d with negative titer and immediately for dealing with members who present with BBP exposures, and a d with a negative titer,give HBIG immediately This should be based on the following elements: and a second dose 1 month later. e. If never immunized,give HBIG and begin Hepatitis B (1) Fact sheet that explains inlay Ian vaccine series. lion, the various prophylactic and�therap u is options,infe (12)Follow-up instructions should include the following the testing and follow-up that will be needed and recom- a• Adverse events and side effects of PEP mendations for personal behavior (i.e., safe sex, blood donation,and so forth) following an exposure, b..oP�Y�h symptoms of retroviral illness (fever,aden- (2) Classification table to determine the exposure type and c. Appointments for follow-up blood work,including the recommendation for prophylaxis.Current recommenda- tions of U.S.Department of Health and Human Services, following: and Public I. HNat 6 weeks,3 months,and 6 months Centers for Disease Control and Prevention, Health Services, 2. HBsAb and/or HCAb at 6 weeks,3 months,and 6 (3) Listing of testing to be done on exposed member,includ- months,if source is HepB and/or HepC positive ing the following 3. Every other week CBC,renal and liver function,if receiving PEP 2000 Ecodon 1582-20 MEDICAL,REQL:[F E.YTS FOR FIRE FICK-tERS.,,YD 4YFORN[A'tIUN FOR FIRE DEP:\1tTJIENT PI YSICI.%.4S i `�"1'=•= P°st�xposure prophylaxis may also be indicated for the following diseases: or long-duration incident. Medical evaluation and treatment (1) Diphtheria in the on-scene rehabilitation area should be conducted (2) Hepatitis A according to emergency medical service (EMS) protocols (3) Meningitis developed by the Eire department in consultation with the fire (4) Pertussis department physician and the ENIS medical director. If (5) Rabies advanced life support(ALS)personnel are available,this level (6) Uaricella Zoster of ENIS care is preferred. A-4-3.1 An annual 1g A-i-1.2 Weather factors during emergency incidents can Program should include the following- impact severely on the safety and health of members,who are (1) Documentation ofa nvo-step purified protein derivative operating during extremes of heat or cold. Where these fac- (PPD)prior to this PPD or a 0-mm PPD within the tors combine with long-duration incidents or situations that 1 year. Part require heavy exertion,the risks to members increase rapidly. (2) Placement of PPD and reading by a trained, designated The tire department should develop procedures,in consulta- bensreader within 48 hours to 72 don with the fire department physician,to provide relief from tiers with a history of punitive PpD should fill out.Mom- adverse climatic conditions. wire. q The followingare (3) PPD results should be documented in millimeters(tram). typical rehabilitation considerations for operations during hot weather extremes: A test with no skin reaction should be recorded as 0 mm. (1) Nloving fatigued or unassigne members away from the conditions are present: hazardous area of the incident (4) A PPD skin test will be considered positive if the following d a. Greater than 5 mm in someone who is immunosu (2) Removing personal protective equipment (3) Ensuring that personnel are out of direct sunlight pressed P- (4) Ensuring that there is adequate air movement over per- b. Greater than 10 mm in someone with a normal immune system who is at risk for conversion due to an sonnet,either naturally or mechanically (5) 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) If PPD is positive(conversion),the followingsteps should signs or symptoms of heat exhaustion or heat stroke be taken; The following are typical rehabilitation considerations for a. Fill out questionnaire operations during cold weather extremes: b. Obtain chest x-ray (I) Moving fatigued C. Evaluate for active disease area of t unassigned members away from the he incident d. Evaluate for preventative therapy (2) Providing shelter from wind and temperature extremes (6) If active disease is diagnosed, the member has to be (3) Providing members with fluid replenishment,especially removed from any duty until she/he has been deter- water mined to be noninfectious. This will occur when ade- (4) Providing medical evaluation for members showings' quate therapy has been instituted, the cough has or symptoms of frostbite, h resolved, and 3 consecutive sputum g related injury YPdthermia, or other cold- bacillus(AFB)on different days areen smears acid-fast A5.2.2 The assignment of an ambulance or other support A-4-3.2 In the event of an exposure to crew to the rehabilitation function is essential during long- should be taken: P TB.the following steps duration or heavy-exertion incident operations.This crew can (4, Member should receive a PPD within 14 da assist with rehabilitation functions as well as be available to ys of ex o• Provide immediate basic life support needs for members. sure.Members with a histo ry of positive PPD should pfill Advanced life support (paramedic) level of evaluation and out a TB questionnaire. treatment has to be available quickly,however, to ensure the (2) Repeat PPD or questionnaire should be done 6 weeks to Proper level of care. 12 weeks after the first The medical staff has to have an assigned medical director. (3) If PPD is positive (conversion) or questionnaire is posi- This can be an on-scene physician such as a fire department ace,proceed as per(5) and(6) ofA-4-3.1. physician,a remote physician at a base hospital,or a central A44 29 CFR 1910.1030 requires that members be offered Hep. medical direction facility. atitis B immunization at no cost to the member.Members who A 5-3.2 For major incidents or escalating incidents, medical choose to decline the offer of this immunization are required to control can be established by the fire department physician or sign a written declination. The declination becomes part of a medical director at the incident scene. member's confiaential health data base as specified in Section Burn fnjury. When a member suffers a burn injury, he or 8-4 of aahA 1000,Standard on Fire p� she should be evaluated as to the extent of injury.First-degree and Health Pro a�"nr Occupational Sajely 3m Members are allowed to recant at any time burns can be treated on scene,and the member may continue and receive offered immunizations. duty.Second-degree burns should be evaluated by a physician .,5-1.1 Having a preplanned rehabilitation program familiar with bums,such as an emergency department applicable to most incident types is essential for the aml td cian,a member of a burn unit,or a fire depart pha f. safety of member.This program should outline an health l din Second-degree burns and higher are conditions that demand rehabilitation for simple or short-duration incidents as well as that the member be removed from emergency response duty. a process to transition into the rehabilitation nerds of a large After the burns have healed to the extent that there is minimal risk for entry into the member's body of body fluids and chem- 2000 Edition ....lM......11lr7r"g AI'l'END(X g 158'L_�ll tof encountered during regular duties,he or she can return to full dory, inhalation. At the emergency department, the victim should Tlrr:lmerican Burn Association has criteria for referral to have an arterial carboxyhemoglobin determined and should a burn center.They are second_and third-degree burns with be evaluated for possible cyanidecyanide toxicity.If aanide ois characteristics as follows: h is suspected, treatment with a cranidr antidote kit should be p oning (1) Exceeding20 ( ) initiated. Since inducing methemoglobinemia in a - percent body surface area BSA with an elevated carboeyhemo (2) Exceeding IO percent BSA For ageSlobin level may further Impair (3) Exceeding Any eding third-degree burn over 5 under 10 or over 50 oxygen delivery,only sodium thiosulfate should be en Pair Percent BSA tially. if treatment with hvperbaric oxygen is started, nitrites (3) Involving hands,feet,face, gi ini- joints perineum,genitalia,or major may be used (5) Circumferential involving extremities or chest A54-3 Items that can assist in imitin (5) Caused by contact with chemical s,electricity,or lip cold environments include heat,lblanke rem rat r e r from (7) Coupled with smoke inhalation injury ry� lightning stress 1° o g the wind.For hot weather,items should include adequate shade, (�9) Involving Associated with multiple trauma Fans,air-conditioning,and misting systems.Food and hydration (9) Invoking patients with re-existin significant medical needs include water and oral fluids,food,broth,and Civic.atio�� illness p g �1 for hydration, a 50/50 mixture of water and an electrolyte bl us�5keleW sp rnss' Sins and sprains are among the include repl blood acement rtpressnk urer Pu�,s tethoscope equipment should most common member injuries.When theyoccur during ods when circulating g peri- monitors,thermometers,and intravenous fl id ar�d en, cardiac g catecholamines are high,such as on the e e severity of, the injured member might underestimate the A '4 The incident commander should consider the cir- severity of the injury.Under such conditions,he or she might cumstances of each incident and make suitable provisions for continue working and worsen the injury, rest and rehabilitation of members operating at the incident Evaluation of these type of injuries on the fireground'can scene. For example, when members consume air from two be difficult.The injury might worsen with time due to swelling, SCBA air cylinders muscle spasm,and increased Pain (two-cylinder rule), they should be emer- gency call is over.Any acute injury after the emer- assigned to rehab. results in more than a trivial limitation f motion should prob- some fire The measurement of the pulse rate has been used by ably be evaluated by a physician, departments in assessing members during rehabilim- Sn+olre Inhalation Smoke inhalation is fortunately becoming uon A Persistently elevated pulse could be a sign of excessive Tess common,due to the use of self-contained fortunately e a stress on the due to rates.A member with smoke inhalation should be treated with been studied in ay manner that allows strict'heat stress,erotoc o to g ppa- or cardiopulmonary disease, The use of a ol 100 percent oxygen and trans p� rate has not menu Burnsoxygein ported to an emergency depart be recommended.The pulse rate combin d with the remain- g greater than 15 percent of body surface der of the clinical evaluation of the member may be used to area,facial burns,singed hair,and airway SOOt are associated determine if the member can with more severe airwayreturn to operations• burns. Lower airway injury can be associated with carbonaceous sputum,wheezing, vales, rhon- chi, and chest pain. Pulmon ary decrease in forced expiratory volumefunction Toone second reveal a d chest radio p ry (FEVI). Appendix B Information for graph may disclose infiltrates or atelectasis. Fire Department Physicians HYpoxemia may be seen on arterial blood map chest radio gas analysis.A nor- Thrs appendix is not a part of the re i not,however,radiograph asigrinormal smoke arterial blood gasi result do ument but is included or in remento only. 1VFPA don Endotracheal intubation should be performed if there is pationalSafe fo,� Healthpr bier only. cP.ntr-al nervous system,stridor,h 13l Occupational Safety and Health Problems for Members. hYpercarbia (PCps eater than 50),xemia(PQ_lei than�) gi,l General. Fire righting the face or neck airwayfull-thickness burns of very difficult jobs.People in the ejobs perform response are functions that or pulmonary edema,or inabilityto handle secretions. Positive end—expiratory ure are physically and psychologically very demanding. should be used if hYPoxemie persists despite intubatio(PEEP) functions are often performed under verydifficultThese administration of 100 percent oxygen. Inhaled beta-agonists (See Appendix C.) conditions. and anticholinergics can be used for bronchospasm.Systemic ysical Load. Studies have shown that firefighting corticosteroids are not recommended for pneumonitis or pul- monary l�I'2 Ph functions require working at near,maximal heart rates for pro- edema. Antibiotics may be needed if sputum gram stain and culture with fever and feuko fosse Bugg p longed periods of time. Heavy ence of a bacterial pneumonia �7 suggest the res- ing respirators) and the heat from tthe fires olntributrltocths Down Member Certainly the scenario involving the discovery physical load. of an unconscious member is one that is difficult to manage ry Personnel Toxic Substances. �d to ma and emergency response given the Psychological g personnel also are exposed to many toxic substances during the first priority is thesafe removal of the vic involved.om the haz_ their work Carbon monoxide is the most common contami- ardous area.Then the Airway, Bleeding, Cardiac (ABCs) nant;studies have shown individual exposures that are as high carded out and a secondary surveya ) are as 5000 ppm during actual fires. Other significant exposures hospital should be expedited. Performed.Transport to a common during Any unconscious member should be treated with 100 r_ fires include cyanide, a e burning' n, hydrogen chloride,nitrogen dioxide,and benzene.The burning of plas- ticscent oxygen, since carbon monoxide poisoning is common and other and cyanide, sPoisoning csynthetic materials can expose members s.possible as secondary effects of smoke Hazer toxic matematerials i such as isn moll es and ores ami any Hazardous materials incidents can involve exposures to many 2000 Edition 158:-22 %IEOfC,,I [Zt�UIRENIENTS FO(t FIR E FIGHTERS AND INFORJLUION FOR FIRE DERIRTIIENT PI rt;SICI.\Ns Other toxic materials.Although the use of respirators helps ��to n reduce exposures. mechanical, environmental, and beha�= iora(factors can limit their use during all phases of a fire Guidance for Medical Evaluations. While Preplacement and Baseline Medical Evaluations. The available health data on members are limited. the protection for members has improved over the last several Preplacement medical evaluations assexs an individ years,exposures might be changing d health status before assignment to a position.The u ual s more svntiietic materials. Given[the delay between healthyuuction�C tlir r�aluation is to ascertain whether the individual has a of health condition that prevents him or her from performingthn and onset, (that is, latency) of many occupational illnesses, job, including the ability to wear protective equipment current or past health studies of members might not reflect 9 pment required for the job, The evaluation should also identify any future health risks. These limitations should be recognized health problems that could be substantially a when reviewing the available studies. go mated by the physical demands and working conditions. Baseline medical information concerning the applicant's health status can then B-1.} Increased Risk of��.and Disease. Available data be compared to subsequent e�a(uation results for the u indicate that members have increased risk for injuries, pul- monary of determining whether the individual has any significant � purpose disease, cardiovascular disease, cancer, and noise- health trends that can be occupationally related. induced hearing loss. The increased risk for injuries is expected,given the demands and circumstances of this work. Two types of information are essential for a medical Pre. Fatalities and serious injuries From burns or other fire-scene placement evaluation of those performing member duties, First, the physician must understand the working conditions hazards can occur. physical demands of this occupation. Appendix C pro- vides a list of the environmental factors encountered in fire The risk for respiratory disease occurs due to the respira- fighting and emergency response.The physician also should tort'damage caused by many of the components of fire smoke obtain additional information from the fire department es and task(for example, particulate, acrolein, nitrogen oxides, and so regarding specific job dutisk lists (if the fire depart- on.)Acute reductions in pulmonary function and even hypox- emia are not uncommon after fires, even in asymptomatic mint has conducted a validation study or job analysis) and should be familiar with the organization of the fire depart- members.Permanent damage from smoke inhalation has also ment.For the evaluation of some medical conditions,the phy- been reported. Studies of chronic pulmonary changes from sician will need to obtain further information about specific fire fighting have not had consistent results.Some follow-up job duties in order to make a determination. This might studies have shown aof P require on-site inspections and consultation with fire depart. function among members over 3time, while notherPulmonary have not ment personnel. been able to detect this change. Increased use of protective equipment and job selection factors(ill members tra rotecin Second, the physician needs to have accurate information about the person's disease or medical condition, the func- to other duties)could account for these inconsistent finding$ tional limitations associated with that condition, and an The strenuous work demands of fire fighting combined understanding of oon that conditionical aAn accurworking te diagnosis g is with exposures to carbon monoxide and other toxic sub, tions would impact stances can increase the risk for cardiovascular disease often the key factor in determining the 's capability. For example,different skin diseases can haveave si similar clinical among members. Acute respiratory changes also can stress appearances but can markedly differ in their response to envi- ronmentalthe cardiovascular system.This increased cardiovascular dis ease risk has been documented even in some mortality stud_ atindi exposures. The physician should also recognize that individual variability can exist between persons with the ies, despite the job selection factors that tend to mask any increase when compared to the genet population. ether same clinical condition. Upon completion of the examination,the physician should studies have not detected this risk. Certainly, the combina- inform the authority havingjurisdiction whether the applicant tiori of the physical stress of fire fighting and exposures for a is medically qualified to perform as a member. Person with preexisting corona B-2.2 Periodic Medical Evaluations. The expected to increase the risk of a heart disease would be evaluation ction or other acute event.However,the degree of thismyocardialacuf errisk and ICY o perform hishis or her duties and to Bete periodic any othe medical abilsignif- whether fire fighting also contributes to the development of designed to evaluate the person's continued abil- icantchanges 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 sev- fire department physician. This medical evaluation includes Every year,each member will be medically evaluated by the eral recent studies.While not totally consistent, these studies an update on the member's medical history,including any si . generally show an increased risk of brain cancer, anal cancers) colon cancer, prostate cancer,( (gastrointes- nificant changes,a brief review of symptoms,and a port on leukemia among members in man y'mphoma,and any significant job-related exposures experienced during the world.Increased incidence of other cancer sites has also been measured,and recorded.The extent of the medical evaluation y different parts of the past year.Height,weight,visual acuity,and blood pressure are shown in some studies.Several studies are currentlyunder way and additional testing to further evaluate this risk g will depend on the member's medical condition. Noise-induced hearing loss has now been documented in Amore thorough evaluation,includinga medical examina- srveral studies of members. Members might also be t risk from other specific exposures including infectious diseases lion,a conducted on a periodic basis.For individuals less than and liver, kidney, or neurological damage from exposure to 0 Years of age, the medical evaluation and examination is conducted at least every three years;for those 30 to 39 years of specific chemicals. age,at least every two years;and for those 40 years of age or 2000 Edition over, every,year. This evaluation should include an updated .. 7_77,5, ,,,,,,,,5,„,,i, rmmurriuurr�uai�a�uaa�ra��/�r, i PE,NDIX B 1582-23 medical and interval history,complete physical examination, vision testing,audiometry,pulmonary function testing,and a (11)Audiometry CBC,urinalysis,glucose,BUN,creatinine,liver function tests, P and lipid profile. (12)Visual acuity and peripheral vision testing The use of chest x-rays in surveillance activities in the (13) Pulmonary function testing (11)Laboratory testing,if indicated absence of significant exposures,symptoms,or medical find- (15)Diagnostic imaging,if indicated ings has not been shown to reduce'respiratory or other health (16) Electrocardiography,if indicated impairment. Therefore, only preplacement chest x-rays are recommended. B-2.3.2.1 Laboratory Tests. CBC, biochemical test battery, f No firm guidelines for stress electrocardio urinalysis,glucose, BUN, creatinine, liver function tests,and tomatic individuals have been developed. Thrrehhave been lipid profile, should be conducted for detecting specific ill- in with false-positive results from this testing,especially nesses as well as developing a baseline for later comparison. in younger age groups and in women. In those with one or B-2.3.2.2 ;(rays, A baseline chest x-rav can be helpful for more risk factors for coronary artery disease,there is probably irato justification for performing the testing•As well,stress tests air rsyrniptom For othersviduals with a ,rt can bery of useful r� health o later comparison. or more important in those whose work deals with public safety. '� •' Stress tests can be performed using a treadmill,bicycle,or 8-2.3.2.3 P on. testing can bt a helpful for cndi duals tion with Pulmonary history of res ir,� stair climber, as long a the protocol bring used gradually increases in workload metabolic a trivalent of resting energytory health problems and as a baseline for later comparis n.A (�(ETS). ,�submaximal test, with the endpoint baseline test should be administered by an experienced per- expenditurebring the attainment of 85 percent of predicted maximal son.Only a spirogram that is technically acceptable and dem- hrart rate (Plv(HR), may be performed Additional onstrates the best efforts by an individual should be used to informa- tion gained by performing a maximal symptom-limited test might not be worth the additional time,effort,cost,and risk calculate the forced vital capacity(FVC)and forced expiratory A reasonable approach is to start periodic treadmill testing volume in one second(FEVl). on members l age approach h those with one or more coronary B•2 3 2.4 Audiometry, Audiograms should be performed in artery disease risk factors an ANSI-approved soundproof booth [premature family history(less than Perminible Ambient Noise Levels for Audiom ttric NSITest 1' Sf rmum age 55), hypertension, diabetes mellitus, cigarette smoking, equipment calibrated to ANSI standards (,A-NSI 53.6,S ci c - and hypercholesterolemia(total cholesterol eater than 2Z Rooms) with or HDL cholesterol less than 35 (ion for Audiometers). If a booth is unavailable, the test room )1.tesdngshould 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 at the minimum the test should be done at least every two (^9 CFR 1910.95). years. Testing can also be done as indicated for those wish B-2.3.2.5 Electrocardio h Y.symptoms suggestive of corona should be conducted PeriodicB resting electrocardiograms line their yearly medical histories or int Rmdrepo��reported in have not been shown to be useful,but maybe reasonable as a Conversely,it is known that even maximal stress testing fee-quendmember's age increases.) fighting duties. F- misses cardiac abnormalities seen during actual Ere- B-2.4 Reporting the Results of the Medical Evaluation. All fightin B-2.3 Content of the Medical Evaluation, individuals participating in a medical evaluation should be informed ahead of time about the Purpose 8-2.3.1 Medical and Occupational Into evaluation and the content of the exam.The results of any Cory should cover the ry. The medical his- medical evaluation are considered to be confidential medi- as major illnesses,surgeries,medication use,allergies,and so fidentiality restrictions. Under most circumstances,roblems,such cal information,subject to customary forth. Symptom rypntient-physician con- tom review is also important for detecting early and recommendations arising from the evaluation should be signs of illness. In addition,a comprehensive medical history maces, results should include a personal health pre expressed in general terms without specific diagnostic infor- tory, a health habit history, an immunizati n history,!and a n order th his- mation. lto make n cases hdeciere sion on the ore rstatus of a candidate or reproductive history.An occupational history should also be member,a specific consent form releasing that information obtained to collect information about the person's past occu- should be obtained from the candidate or member.Blanket pational and environmental exposures. or genera! "release of medical information" forms should B-2.3.2 Medical Examination. The medical examination not be used. includes the following organ systems and tests: In most cases,a simple statement like one of the following (1) vtal signs, such as pulse, respiration, blood pressure, well suffice: and,if indicated,temperature (a) Based on the results of the preplacement medical eval- (2) Dermatological(3) uation of December 10, 1996,Jane Doe is (or is NOT) medi- Ears,eyes,nose,mouth,throat cally certified to engage in training and emergency operations (4) Cardiovascular for Anytown Fire De a (5) Respiratory p rtment ( ) Gastrointestinal (b) Based on the results of the preplacement medical eval- uation of December 10,1996,John Doe is NOT medically cer- (7) Genitourinary tified to engage in training and emergency operations for (8) Endocrine and metabolic Anytown 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. 20W EcWcn 77777 1' 77 I� 1582-24 aINIEDICAL REQUIREMENTS FOR FIRE FIGHTERS.>ND INFORKNTION FOR FIRE DEPARTME.NTpI[tS[CIANS B-2.5 Second Opinions. Fire department policies and proce- Administration(14 CFR 67.1316 1995)does not grant medic al dunes should allow for a medical second opinion when a candi- certificates todiabetics treated with insulin and severely limits date or member disagrees with the results or recommendations of a medical examination conducted by the fire departmentnow on oral hypoglycemic agents. physician or when the fire department physician is uncertain B-3.2 Asthma and Reactive Airways Disease. The diagnosis about the limitations or prognosis of the individual's condition. of asthma and related airway hvpenactivity disorders is often Often other physicians will not be confounded by definitional issues. For the purposes of familiar with the duties and demands of tire fighting and emergency response.When possi- member certification, a variety of airway disorders that ble, the fire department physician should help educate the meet the following criteria can be included. Asthma is a other physician about how the individual's condition could chronic inflammatory disorder of the airways. In suscepti_ affect or be affected by fire fighting.If there is still disagreement bee individuals,this inflammation causes svmptoms that are about the condition or placement recommendation, a third usually associated with widespread but variable airflow Physician (acceptable to both the fire department and the Can_ obstruction that is often reversible,either spontaneously or didate)can be consulted. with treatment,and causes an associated increase in airway B-2.6 Musculoskeletal System, Some of the injuries or P rob- responsiveness to a variety of stimuli. Since asthma is a highly prevalent disease, a number of elms encountered in this system will need functional capacity P member applicants will require special evaluation. Combus- evaluation to determine fitness For duty.Physical thecaP. pro no- lion products,exercise,and cold air are all potent provokers viders often design tests for employers to determine ability to of an asthma attack.Some of these exposures are unavoidable perform tasks similar to those required as part of their essen- even with SCBA use. If a candidate has a diagnosis or symp. tial job functions.These tests should be based on direct mea- toms consistent with an asthma-like disease, many factors will surements of the actual job functions. These functional capacity evaluations can be especially useful when a member need to be considered.An asthma attack during a suppression has been cleared for full duty by a physician who is not familiar activity could harm the member, his fellow members, or a with the essential job functions of a member. member of the public. The following factors can be used to help in certification; B-3 Specific Medical Conditions. (1) Persistence of airway obstruction between attacks (as B-3.1 Diabetes Mellitus. The major concern for diabetic Y P metry) members is the risk of becomingh a (2) Need andfrequency of steroid and bronchodilator use ground operations or other emerency responses. oche Sog enous insulin and oral hypoglycemic agents can be associated (frequent ry)nchodilator use suggests persistent airway hyperactivity) with episodes of hypoglycemia that can rapidly progress from (3) Usual type of triggers in the applicant (allergic, infec- impaired judgment to unconsciousness. The most reliable tious,exercise-induced,etc.) predictor of hypoglycemia is a history of it. In one study of (4) History of hospitalization, emergency room, or urgent insulin-dependent adolescents conducted at the Joslin Clinic treatment (Bhatia and Wolfsdorf 1991), all 196 patients experienced (5) Length of time between attacks hypoglycemia at least once during the two-year observation (6) Nocturnal symptoms and other estimates of airway into period.Of these,15 percent were classed as severe,based on loss of consciousness,seizure, or the clinical need For the11_ biliry peutic glucagon or intravenous glucose. It was particularlyModerate asthma or worse could disqualify an individual concerning that 24 percent of h for member duties. Unknown Factors such as the suppression detected by blood glucose monitoring hypoglycemic to des of thereduce he possibility of a sudden or severe attack are under airway hyperactivity with anti-inflammatory medications to patients.The probable causes of hypoglycemia were identified investigation and could modify current suggestions. in 71 percent of cases,and the most common were strenuous exercise and skipped meals or snacks. Both of these precipi- B-3.3 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 uti- edition (1997) of this document. The task forces at the lization, strenuous exercise increases insulin sensitivity Bethesda Conference published recommendations for ath- (Wasserman and Sinman 1994). With the tighter glycemic letes competing with cardiovascular disease inthefournalofthe control that is now known to decrease and delay onset of dia- American College of Cardiology, in October 1994. The analysis betic complications,there is a concomitantly increased likey- used by the task force has relevance to the evaluation of mem- hood of exercise-induced hypoglycemia (Wasserman and berg with cardiovascular disease.Firefighting activities have a Sinman 1994). high static component inducing P redominantl an Insulin is clearly associated with a much higher risk of increase in blood pressure) and iamoderate to high dynamic symptomatic hypoglycemia than are oral agents. In the component(i.e.,inducing predominantly an increase in heart absence of a history of incapacitating hypoglycemic episodes, rate).Sports with a similar set of demands include wrestling, and with close medical monitoring, there is probably no rea- body building, and boxing. Recommendations made by the son to exclude members who are taking oral hypoglycemic task force with respect to athletic activities that have these agents, as long as they have stable weights, diets, and renal Physical demands (high static,moderate dynamic) have been function.Although the Americans with Disabilities Act(Public followed in this document. Law 101-336 1990) does not appear patient to be evaluated for fitnes t re lire each diabetic B-3.4 Reproductive. Exposures in the fire-fighting environ- is some case law that disallowed blanket exclusion al insulin- ment can cause adverse reproductive effects for both males dependent diabetics from public safe exclusion Positions Fire g- and females.Medical evidence exists to indicate that chemical Police Personnel Reporter public .safety P ( exposure,heat,noise,and physical exertion can affect various The Federal Aviation endpoints of reproductive health including fertility,fetal loss, 2000 Edition I I APPENDIX g 1582'_5 and growth parameters of the offspring. members should be educated a th Auks a All nd about the reactive srizi.ire that can be attributed to a reversible, undrrly- nerd to take appropriate steps to limit tiueir exposures. ►nlr precipitant.These circumstances du not iicccyaarily rrpre- Vso, there could be some situations where a male or a member.JnFng risk of rr It:u a sine female member u attempting to conceive a child and is having not associ:urd with centrallnrrrvouspsysdtem hlr incapacitation of difficuilty.In these situations.where a complete medical e�alti- and eliminated.and tier indi�idua!Vslemr ree.ad leer identified de i ation has not identified another cause for this infertility,rem- rnsuin;�year,then he ie damage is idre r e Pomry assignment on a voluntary basis to alternative dun•or a another seizure than tine rest of the eneral ,urrnce over the leave of absence should be considered. 'Ire is probably not more likely to p.- Medical evidence exists that certain toxic substances orcon- ter olog.%(ust tier department physicians will pvain g111� � ditions that are present in the fire-fighting l neurol��tsrist to veritF that an individual with a hiswry of seizures dangerous to the safety and well-being of the fetus.Therefore:,men t are d°Epilepsv iss not,in cd a. O-s epilepsy.fle presence it is important to educate all members about these ruts and tier reasons for recommending that pregnant members restrict recurrent seizures— P ace ders f t "unprovoked, their fire suppression activities.For r. vous system cluaracterPzed by an abnorrmal cerebral neuronal he central nrr- dence that the fetus is especiallvsensitive to carbon monoxide. 1994).Treatment of patients with 'c.rmple,there is good r�i- discharge with or without loss of coriscioitsnev' a•known significant component of fire smoke.Although the cessful,with roughly 40 percent of patients attainin?re�ciri° use of SCBA u assumed to be protective, sometimes such on early omvlsant therapy epilrpsw is only variably suc- equipment is not used throughout a Fire suppression or haz- Spencer I995). Remission u defined as five veers mission ardous materials incident P. (Hauser and Hesdorffer 1990; with increasesotherfetalci ent. The a of such exertion equipment also back 197 Out and recurrence of seizure activity (•g the fit Hauser, and issue is concerns are those imolvin 9). Further complicating the fitness-for-duty issue is r ing,heavy lifting,and exposuress of temperature exnged stand- the fact that emes and do so without toes Percent of patients who achieve remission humidity have been related to an increase of pretetm and low (Cascino I994). side birth weight infants. Because the fetus should be protected Partial,simple epilepsy, or recurrent a urrhe anti -convulsant drug from these exposures at the earliest possible time,the member impair consciousness,are felt to be a disqualifyingcondition who might be pregnant should obtain early pregnancy testing, because of[he uncertain re es f the do not tion to other Recognizing potential risks to the fetus from on environment u a relatively recent event,and ma fire fightin; might be involved, and the regarding how much of the brain many members regions of the brain, particularly risk n th of e highly ep'leptogen c might not be aware of these risks. Based on a recent U.S.Supreme Court decision (Interns- environment of the fireground(Spencer 1995),tional Union et al.v.Johnson Controls,Inc-59 U.S.LW.4209, gated by This standard u somewhat more liberal than that promul- iVlarch 20, 1991), the ability to perform the Federal Aviation Administration of P as a member t to be Deportment of Transportation For aircraft pilots (1ek the basis for the medical certification without consideration of 67.1316 1995),All epileptics,regardless of therapeutic suc CFR cess health risks to the fetus. However, the re should be counseled on the potential risks Pregnant grant member due o are denied first-, second-, or third-class medical certificates, her exposures during firth htin except under the provisions of 14 Any memberwho becomes re duties. Medical Certificates." CFR67,I9,"Special Issue of opportunity at any time during grant should be offered the B-} References. ily removed from fire-fightingg the pregnancy to be voluntar- ily duties and from other duties Annegers,J. F., W. A, Hauser, and L R. Elveback. 1979. involving the hazards or physics stress that might endanger 'Remission mica on of Seizures and Relapse in Patients with Epilepsy," the fetus.Ifpractical,the member should a offeredenda reassignment to an alternative position. At such time as the p 0:7_y. �' Bo th V,,and J.I.Wolfsdorf I991."Severe Hypoglycemia Pregnant member can no longer be medically certified as in Youth with In Diabetes Mellitus; Fre- being capable of performing fire-fighting dudes,the member quency and Causative Factors,"Pediatrics,88:1I37, should be reassigned to other duties.At such time as the mem- ber u no longer re Brunacini,Alga.Firegmund Command National Fire Protec- g pregnant, the member should be reinstated tion Association, 1985. to the position held prior to being pregnant. Nursing Cason°• G. D.bets should also be advised about the potential exposures o 1994 Eprlep y, Contemporary pe►spectives on Evaluation and Treatment, Mayo Clinic Proceedings 69:1 I99. their infants, "Emergency Incident Rehabilitation," United States Fire 8-3.5 NoisrIaduced HearingAdministration (FA#112). difficulties because a high rcen gels category can pose Fire f�PolicePersorinel Reporter,November 1994,p. 169. have noise-induced hearing loss duee of to their texposures as q nt members Hauser,yCauses and Cons quences."New York:Demos. members, Implementation of hearing conservation C° uene_ Elesdorffer. 1990. "Epilepsy:Fre- and programs to reduce noise exposures should P a g to a NauUa� Fire Incident Reporting System (NFIRS) data decrease in the prevalence of this condition in the future, base. NFP,1 152I, Standard far B••3.6 Seizures and Epilepsy. It u important to disdn edition. Fin Department.Safety Officer, 1997 between a history of seizures and a ile Soh Public Law 101-336, 1990,Tide I-Employment. �ast o ech as 10 per Spencer, S., Personal Communication, 1995. (Spencer is cent of the population will experience a in a lifetime,whereas less than I percent of the population ualifies Professor of neurology and director of the Clinical Epilepsy for a diagnosis of epilepsy(Hauser and Hesdorffer 1990).Many and ElectrophYsiologic,Monitoring Services at Yale University conditions producing seizures in the pediatric age ) School of Medicine.) Sub- known to remit prior to adulthood,and many adults are a Title 16, Code far Federal Regulations, Part 1910.1000, Sub- parts 13-Iti,"Air Contaminants." 2000 Edition i i P 1582—:36 MEDICAL.REcZC:IRE�"EINTS FOR FIRE FIGHTERS AND INFORNLMON FOR FIRE DEPARTMENT PItYs[CI.1NS "Toxic smoke inhalation: Cyanide poisoning in fire vic- tims."Jones,J. et al., Ammcan,fournal o Em `�'ppeII�'t D Guide for Fire De 5:3I7, 1987. f e19-1Y A&dicine part:nentAdministrators Wasserman,D.H.,and B.Sinman. 1991."Exercise in Indi- This appendix is not a part of the requirements of this rbFp.i do viduals with[DDM."Diabede Care, 17:924. ument but it included for informational purposes only. D-I Legal Considerations in Applying PP 3mg the Standard. The con- Appendix C Essential Struc tural Fire-Fighting sideradon of an application or continued employment of a mem- Funetions ber based on medical or physical performance ev�luadons involves a determination that is not without legal implications.To this end, This appendix rs not a part of the requirements of this NFRA doc. Prior W making an adverse employment decision bayed on the ument but is included for infiirmational purposes only. foregoing standard the authority with jurisdiction might wish to C-1 The medical requirements in this standard were based on consult with counsel. in-depth consideration of essential structural fire-fighting functions.These essential functions are what members are ex- D-1.1 Individuals with Handicaps or Disabilities, The Reha- pected to perform at emergency bilitadon Act of I973,as amended, 29 U.S.0 791 et seq.,and g ry incidents and are derived implementing regulations, prohibit discrimination from the performance objectives stated in NFP.-k I001, Stan. moose with handicaps or disabilities under anyprogram dord for Fare hi hter receiv- against i g Projvssional Qualrfrcations. ing financial assistance from the federal government. The Essential functions are performed in and affected by the Americans with Disabilities Act of 1990, 42 U.S.C. § 12101,et following environmental factors: seq., also prohibits employment discrimination by certain did pri- (1) Operating both as a member of a team and inde en- gate employers against individuals with dently at incidents of uncertain duration P many states have enacted legislation prohibitingdisabilities: ninaaonon, (2) Spending extensive time outside exposed to the elements against thOSe with handicaps or disabilities.These laws prevent (3) Tolerating extreme fluctuations in temperature while per- �e exclusion,denial of benefits,refusal to hire or promote,or forming duties;fire fighters are required to perform ys. handicap discriminatory conduct against i individual based with a ically demanding work in hot(up to 4000 P handicap or disability,where the individual involved can,with 100 percent) atmospheres while wearing humid( to or without reasonable accommodation, perform the essential significantly impairs body-cooling mechan equipment up functions of the job without creating undue hardship on the (4) Experiencing frequent transition from hot to cold and employer or program involved. Application of this standard should be undertaken with these issues in mind from humid to dry atmospheres (5) Working in wet,icy,or muddy areas The medical requirements of the 1997 edition of this stan- (6) Performing a variety of tasks on slippery hazardous sue- dard were initially developed and found to be job-related by a subcommittee comprised of medical doctors, physiological faces such as on rooftops or from ladders (7) Working in areas where sustaining traumatic or thermal specialists,and fire service professionals,as processed through injuries is possible the NFPA consensus standards-making (8) Facing exposure to carcinogenic dusts such as asbestoscarbon, the current edition have been proposed system. Changes for toxic substances such as hydrogen prised of similar expertise. The sttandard provides, the monoxide,or organic solvnts either through inhalation rent members with medical ailments,handicaps,ordisabilities extent feasible,that decisions concerning candidates and cur- or skin contact (9) Facing exposure to infectious agents such as Hepatitis B be made after case-by-case medical evaluations. Thus, m or HIV P medical conditions have been assigned to Category B. (IO)Wearing personal protective equipment that wet The medical requirements in this edition of the standard approximatelypersonal n lb while performingequipment fire-rightingtsky were revised based on the essential functions contained in Appendix C.It is recognized that some ionfire-fightingdued functions I 1) Performing physically demanding work while wearing pos- and tasks can vary From location to location due to differences itive-pressure breathing equipment with 1.5 in. of water in department size,functional and organizational column resistance to eehaladon at a flow of 40 L/min(12)columcom lex en differences, Performing P tasks during life-threatening geography, level of urbanization, equipment utilized, and emergencies other factors.Therefore,it is the responsibility of each individ- ual fire department to document, through job analysis, that physical activity and intense concentration g the essential functions performed in the local jurisdiction are (14) Facing l activity a decisions during oration ry conditions substantially similar to those contained in Appendix C. (15)Being exposed to grotesque sights and smells associated There are a wide varietyof'ob al with major trauma and burn victims to document the essential functions o)f th techniques lof a meamber. (16) Making rapid transitions from rest to near-maximal exer- However, at a minimum, any method utilised should be cor- don without warm-up periods rent,in writing,and meet the provisions of the Americans with (17)Operating in environments of high noise,poor visibility, Disabilities facus o Critical29 CPRimportant160.2(n)(3)L fob descriptions should limited mobility;at heights;and in enclosed or confined tasks and functions.The frequency and/or duration of task per- spaces work behaviors and specific formance,and the conseences of failure to perfo (18) Using manual and power tools in the performance of dudes should be specified.The working conditions and nvivironmen- (19)Relying on senses of sight, hearing,smell,and touch to tal hazards in which the work is performed should be described. help help determine the nature of the emergency,to maintain personal safety,and to make critical decisions m icon- The job description should be made available to the fire fused, chaotic, and potentially critical dcisionn a con- service physician for use during the preplacement medical life-threatening examination for the individual determination of the medical meet throughoutchaotic, athe duration of the operation suitability of applicants for member. 2000 Edition APPENDIX D D-1.2 158-2-27 And-Discrimin3tian Laws. Finally, stan- dard should be aware that,while courts aresl kely to give cers of this - tional siderable weight to Therefore, physicians with specialties other than occupa_ 8 the existence of a nationally reco ized need to be considered,as well as the physician's back- standard such as ground and experience.I+nowledge of octh physician's medicine NFPA 158�,Standard on hfedicai Rrgruremerrts and experience with occupational health programs. for Fire Fighters and In for Fin D art (e•g•, Lbliller v. Sioux Calera �' "�tt Physirians would be helpful. P grains,obviously, (1993 ay Fin.Department, 497 N.W.2d 838 )1,reliance on the standard alone could be insufficient to withstand a challenge under ments Of the cu n has i c committed to meeting the require � g the antidiscrimination Paws, program.including a Even in the case of Category His or her willingness to work nth(hedeate record dt0 coning. still require additional expert vidence con earning an indi ual candidate's or member's inability to perform fly improve the program is also important Finally,functions a the'ob. ty the essential concern and interest in the program his other functions this s Of t rn Until the courts provide furtherguidance the department is vital. P gram and in the individuals in degree and nature of the evidence reqrea of law, some uired ed to establish concertainty as to me There are many options for obtaining g physician services- pliance with the and-discrimination laws will remain. (a) Physicians could be paid on a service basis or through D=1.3 Individuals Who Are Members of Protected Classes a contractual arrangement. g (Race,Sex,Color,Religion,or Natio (b) For volunteer departments, local physicians could be the Civil Rights Act of 19ti4,as ��°)' Tine VII of willing to volunteer their services for the ro amended,42 U.S.C.t 00e,opp and tional member arrangements for payment of laboratory implementing regulations , the Equal Employment O P grater,with a est- nity Commission (EEOC PP°rn+- ing,x-rays,and so forth, rest- implementing on the basis of race,sep`crcolor,religion anon i national origin (i.e., protected classes), Under Tide (c) Some departments could utilize a local health ca1e defined,generally,to meant a VII, an "employer is facility for medical care.However,in that case,the de ees for each working day person with"15 or more employ- should be sure to have one individual Parnnent g y in each of 20 or more calendar weeks for the program,record keeping, Physician responsible in the current or preceding calendar ear," 2 P g.and so forth. Several federal jurisdictions have held that unpaidU.S.C.2 to e) (d) In some cases,it could be possible to have the medical are not considered to be"employees"under Tide VII. volunteers e:camination by the fire department the associated costs could be defrayed by the membehile rsnv♦of rn Additionally, many states, cities, and localities have health insurance.For example,the health insurance provider adopted similar legislation. Generallv, Physical performance could allow the member to have a earl or other requirements that result in"adverse imp "on mem- performed by the member's personal h pcian. The normally health bers of a protected class (e.g., on the basis of gender) are care insurance provider could allow P health required to be validated through a study in accordance with formed b that Physical to be per- EEOCguidelines,if such re y the fire department physician with some degree of making employment decisions.eUnder EEOC guidelinents are to be relied s,ra reimbursement study validating employment standards r one jurisdiction can D.3 Coordinating the Medical Evaluation be transportable to another jurisdiction (and therefore used �O�m indi- vidual from within the department should be assigned the in lieu of conducting a separate stud responsibility for man n conditions must be met in this regard. However,specific hoy pre. including the coordination a d schedulin the health g ofevaluadons fitness program, ing jurisdiction should seek mod'and the authority haw examinations.This person should also acgas Ion between relying on a transported validation advice of counsel before the department and the physician to make sure that each has the information necessity for decisions about placement, wellD-1.4 Pegnanryaad Reproductive, Federal regulations, as schedulingappointmenis,and so forth. as many court decisions, including the U.S. Supreme Confidentiality of all medical data is critical to the success Court's decision in International Union, ai v ohnson Inc. (499 U.S. 187, 111 S. J Con � of the program,Members need to feel assured that the infor- the requirements of Title 1196 (1991)], have interpreted mar°n provided to the VII with respect shared. ro free department will not be inappropriately reproduction. The authori pect to pregnancy and partment supervisor or manager should ty having jurisdiction should seek have access to medical records without the express the advice of counsel in resolving specific questions concern- of the member.There are occasions,however,when ing these retten quirements as well as other requirements that can specific medical information is needed to make a decision be imposed by state or loco!laws. about Placement, return to w k, and so forth, and a fire department manager must have;more medical information D-2 Choosing a Fire Department Physician. for decision making.In that situation written, should be considered in choosing a firesde Several factors should be obtained from the individual to releaserthe specific There are relatively few physicians withdepartment physicianal residency . information necessary ing and certification in occupational medicine.The re depart- g m+y constraints that n decision. meat physician needs to be Bud e ' affect the medical program. expertise physician the areas sOf to be qualified to Provide professional Therefore,it is important that components of the program�m areas relate to emergency Pure health as theseduct- Prioritized such that essential elements are not lost Wirth addi- g ry services.For the purpose of conduct uonal funding, other programs or testing can be added to ing medical evaluations,the fire department physician needs to program. understand the enhance the r grata. placed to members and needs e physiological and psychological demands tal conditions bees whichand n e tubers understand a eao P��o�ronmen. � Table D-4 represents a tom and OSHA 29 CFR 1910.134. Pinson between NFPA 1582 2000 Edition ,.,.,g,-, Y 1582-28 S[EDIG%L.REQUIRE•.N[E.NM FOR FIRE FICI ITEILS A.ND'NFOP-MAT[ON FOR FIRE DEPARTN[ENT PI ns[CG4VS L Table D-4 Comparison of OSHA 29 CM Parts 1910.134,"Medical R Regaisementr far Fise F%hk-and Information fbr Fire Department Pkitr cions 2000 Edition d N��1582.Stcndard on Medical NFPA 1582 1 OSHA 1910.134 2-1 Medical Evaluation Process. The employer must establish and implement -1.I The fire department shall establish and implement a medical evalua- those leroents of the written respiratory pro- lion process for candidates and current members. program necessary to ensure that any employee using a respirator voluntarily is med- ically able to use that respirator;and tliat the resperator is cleaned,stored,and maintained so that its use does not present a hazard to the user. Exception:Employers are not required to include in a written respiratory protection pro- gram those employees whose only use of respi- rators involves the voluntary use of filtering face pieces (dust masks). A ppendix D-3 Coordinating the Medical Evaluation Program.An individual (3)The employer shall designate a program ithin the department should be assigned the responsibility for man- administrator who is qualified by appropriate he health and fitness program,including the coordination and ling of evaluations and e`taminadons.This person should also act as with the com Iexi of the rotraining or experience that is commensurate between the department and the physician to make sure that each ister or oversee the respiratory rotecdon pro-information necessary for decisions about placement,schea ea p p� tO admin- tments,and so forth, B gram and conduct the required evaluations of the program effectiveness. entiali. of ali medical data is critical to the success of the program. rs must feel assured that the information provided to the physician be inappropriately shared No Fire department supervisor or man- ager should have access to medical records without the express written con- sent of the member.There are occasions when specific medical information is needed to make a decision about placement,return to work,and so forth, and a fire department manager must have more medical information.In that situation,written medical consent should be obtained from the individ- ual to release the specific information necessary for that decision. Budgetary constraints can affect the medical program.Therefore,it is important that components of the Program be prioritized such that essen- tial elements are not lost.With additional funding,other programs or test- ing can be added to enhance the program, eva The medical evaluation process shall include preplacement medical (1) General,The employer shall provide a eva'luadons,periodic medical evaluations,and return-to-duty medical evalu- medical evaluation to determine the ations. employee's ability to use a respirator,before the employee is fit tested or required to use the respirator in the workplace.The employer may discontinue an employee's medical evalu- ations when the employee is no longer required to use a respirator. 2000 Edition r1PPENDIX D 1582-29 Table D-E Comparison of OSHA 29 CFA%Paris 1910.1349":Medical Re�9u tsfor Far Fighters and In��►+ation r Fisr Dep Requirements"and NFPA 1582,S Medicalf° arbnmt Pky cianti 2000 Edition (Continued) tandard on NFPA 1582 OSHA 1910.134 2-1.3 The fire department shall ensure that the medical evaluation process (3) Follow-up medical examination. and all medical evaluations meet all of the requirements of Section 2-1. (i)The employer shall ensure that a follow-up medical examination is provided for an employee who gives a Positive response to any question amongg questions 1 through 8 in Sec- tion_,Part A of Appendix C or whose initial medical examination demonstrates the need for follow-tip medical examinations. (ii) The follow-up medical examination shall include anv medical tests,consultations,or diagnostic procedures that the physician or licensed health care professional (PLHCP) deems necessary to make a final determina- tion. 2-1.4 Each candidate or current fire fighter shall cooperate, artici ate and comply with the medicsl evaluation process and shall provide complete and mum, the employer shall provide additional accurate information to the fire department physician. (�)Additions!medical evaluations.Ac a mini- PI 5'Each candidate or current fire fighter shall,on a timely basis,report medical evaluations that tomppIy with the to the fire department ph sicisn any exposure or medical condition that requirements of this section could interfere with the ability of the individual to perform as a fire fighter. y `pt employee reports medical signs s 2-4.1.1 The components of the annual medical evaluation specified in symptoms that are related to ability to use a 2�.1.2 of this section shall be permitted to be performed b respirator, sonnet as authorized by the fire department physician.Why nosh qualified p (ii)A administrator supervisor,or the respirator Pro- fied personnel are used,the fire department physician shall review the data �mP oye n`needs�be`�-�luated r that gathered during the evaluation. (iii) Information from the respiratory protec- tion prom,including observations made during t testing and program evaluation, indicates a need for employee re-evaluation; or (iv)A change occurs in workplace conditions e ical work � ti tective clothing, temperature) that mayrrsuln a substatial increase in the physiological burden placed on an employee. (Sheet 2 oj5) 2000 Sd uon j I582-30 biEDiG►i.REQUIpE%iENTS FOR FIRE FIGHTERS AND INFORMATION FOR FIRE DEPARTMENT P j-n P 'SiCIA.YS f Table D4 Comparison of OSHA 29 Cj%parts 1910.134,Requesrments fbr F Ftg ee W-and Information for Far "Meth d Requirements"and NFPA 1582,Standard Phyaiefa,s,2000 Edition (Continued) °f Medical NFPA 1582 OSHA I910.134 2-2 Fire Department Roles. (2) Medical evaluation procedures. 2-2.1 The fire department shall have an officially designated physician who (i) The employer shall identify a physician or shall be responsible for guiding,directing,and advising the members with other regard to their health,fitness,and suitability for duty as required by NFPA (PLHCP) oeper perform d health care medical questionnaire - 1500,Standard on Fte Department O'Cupational Safety and Health Pnog ", or an initial medical examination that obtains F the same information as the medical question- 2-2.2 The fire department physician shall be a licensed' doctor of medicine or osteopathy. li mire. dical evaluation D-2 Choosing a Fire Department Physician.Several factors should be consid-Sections Hand 2,Part A of A hall obtain the infornmadon re nested by the questionnaire in Bred in choosing a fire department physician.There are relatively few physi-section. cians with formal resider Appendix C of this residency raining and certification in occupational medicine.The fire department phys;clan shall be qualified to provide pro- fessional expertise in the areas of occupational safety and health as they relate to emergency services.For the purpose of conducting medical evalua- tions,the fire department physician shall understand the physiological and psychological demands placed on fire fighters and shall understand the environmental conditions under which fire fighters must perform Therefore,physicians with other specialties need to be considered.The background and experience of the physician should be considered.Knowl- edge of occupational medicine and experience with occupational health programs obviously would be helpful. The physician must be committed to meeting the requirements of the pro- gram including appropriate record keeping.His/her willingness to work with the dep Finally,his/her concern and interest in the program artment to continually improve the program is also important. the department is vital. and in the individuals ' in There are many options for obtaining physician services.They could be paid on a service basis or through a contractual arrangement For volunteer departments,the local physicians might be willing to volunteer their services for ra and with additional arrangements to pay for laboratory testing,x- rays, d so forth.Some departments might want to utilize a local health care facility for their care.However,in that case,the department should be stop to have one individual physician responsible for the program,record keeping,and so forth.In some cases it could be possible to have the medical examination by the fire department physician,while some of the associated costs could be defrayed by the fire fighter's own health insurance.For exam- ple, the health insurance provider might allow the fire fighter to have a yearly physical,normally performed by the fire fighter's personal physician. The health care insurance provider can allow that physical to be performed by the fire department physician with some degree of reimbursement. (Sheer 3 of S) 20M EdlUon w I APPENDIX D 1582-31 f Table D-} Comparison of OSFL12g CFI parts 1910.134,"Medical Requirements" �quirrrnaets for Feas Fighters aced 1 equirements and NFPA 1582 � F'e��-0�YJ�"=,2000 Edition (Continued) Standard on Medical NFPA 1582 OSHA 1910.134 2-2.3'For the purpose of conducting medical evaluations,the fire de art meet physician shall understand the physiological and psycholo cal p (e) Medical evaluation.Using a respirator may demands placed on members and shall understand the environmental con- that vanes with th place a�s with cal burden on employees ditions under which members trust perform.The fire department shall pro- °tYPe ofres�iratorwoch the vide the fire department physician with a current job description for all fire o p and the workplacee the medicalmedons in ical status of e department positions and ranks. respirator is usedd an the employee.Accordingly,this paragraph B-1 Occupational Safe specifies the minimum requirements for medi- ry and Health Problems for Fire Fighters.Fire& htin cal evaluation that employers must implement and emergency response are very difficult jobs.People in these jobs per. respirator. 1 form functions that are physically and psychologically very demanding, g to determine the emp oyee's ability to use a These functions are often performed under very difficult conditions. (See (5)Supplemental information for the Appendix C.) Studies have shown that fire-fighting functions require work- ing at near maximal heart rates for prolonged periods of time.Heavy pro- (i) The followin information must be pro- tective equipment(including respirators) and the heat from the fire g contribute to this physical load. tided to the PLHCP before the PLHCP makes a recommendation concerning an employee's Fire fighters and emergency response personnel also are exposed to many ability to use a respirator. toxic substances during their work.Carbon monoxide is the most common (A)The type and weight of the respirator to contaminant;studies have shown individual exposures as high as 5000 ppm be used by the employee; in actual fires.Other significant exposures common in fires include rya- (B)The duration and frequency of respirator nide.acrolein,hydrogen chloride,nitrogen dioxide,and benzene.The use(including use for rescue and escape); burning of plastics and other synthetic materials can expose fire fighters to other toxic materials such as isocyanates and nitrosamines.Hazardous mate- (C)The expected physical work effort; rials incidents can involve exposures to many other toxic materials. le the use of respirators helps to reduce exposures,mechanical,environmen- tal, (D)Additional protective clothing and equip- ment and behavioral factors can limit their use during all phases of a fire. to be worn;and (E)Temperature and humidity extremes that be encountered. (ei)Any supplemental information provided previously to the PLHCP regarding an employee need not be provided for subse- quent medical evaluation if the information and the PLHCP remain the same. (iii)The employer shall provide the PLHCP with a copy of the written respiratory protec- tion program and a copy of this section. Note to paragraph (e)(5)(iii):When the employer replaces a PLHCP,the employer must ensure that the new PLHCP obtains this information,either by providing the docu- ments directly to the PLHCP or having the documents transferred from the former PLHCP to the new PLHCP However,OSHA does not expect employers to have employees medically re-evaluated solely because a new PLHCP has been selected. (Sheet 4 of 5) 2000 Edition 1582-32 MEDfCu,REQUIREMENTS FOR FIRE FIGHTERS I:IFORSWI'(O!Y FOR FIRE DEPARTMENT ptitSlClaIVS 'Table D 4 Comparison of OSHA 29 CFA RequiremenLt for Fite F�M a,d t do Parris 1910..134,"Medical Requirements"and n f6r Ftse NFPA 1582,Smnda„d on dtedieai Dep�^�it 1'��,2000 Edition (Co,rtinued) NFPA 1582 f OSHA 1910.134 2-4.1 The current member shall be certified annually,or at the request either the fire department or the member,by the fire department Physician the employee's ability to use a respirator,the as meeting the medical requirements of Chapter 3 of this standard in order employer shall:Medical determination.In determining to determine that member's medical ability to continur participating in a (raining or emergency operational environment as a member.Any applica- (i) Obtain a written recommendation re�ard- ble OSHA standards,such as 29 CFR 1910.120,"Hazardous Waste Opera- g tions and Emergency Response,"29 CFR 1910.134,*Respiratory Protection," fr the empployee's ability to use the respirator 29 CFR 1910.95,"Occupational Noise Exposure,"and 29 CFR 19I0.1030, from the PLHCP.The recommendation shall "Bloodboe Pathogens,"shall be followed. provide only the following information: rn (A)Any limitations on respirator use related to the medical condition of the employee,or relating to the workplace conditions in which the respirator will be used,including whether or not the employee is medically able to use the respirator.; (B)The need,if any,for follow-up medical evaluations;and the statement with a copy of the PL.HCP's writ_ employee with recommendation. (ii) If the respirator is negative a pressure res. pirator and the PLHCP finds a medical condi- tion that may place the employee's health at increased risk if the respirator is used,the employer shall provide a PAPR if the PL.HCP's medical evaluation finds that the employee can use such a respirator,if a subsequent med- ical evaluation finds that the employee is med- ically able to use a negative pressure respirator, then the empployer is no longer required to provide a R. (4)Administration of the medical question- naire and examinations. (i)The medical questionnaire and examina- tions shall be administered confidentially dur- in�the employee's normal working hours or at a time and place convenient to the employee. The medical questionnaire shall be adminis- tered in a manner that ensures that the employee understands its content. (ii)The employer shall provide the employee with an opportunity to discuss the question- naire and the examination results with the PLHCP. (Sheet 5 of 5) 2000 Edition 7,.,,,,,, J APPENDIX F 1582_33 Appendix E Sample Forms Appendix F Referenced Publications Thu appendix is not a part ojtlre n9ui�rments of this NFp,9 doc- ument but is included jo,in j��l F 1 The following praposu only. g documents or portions thereof are r E-1 Physica!Exam S enced within this standard for informational u efer- can report results of the �periodic fire department physician and are thus not considered art P �05� only P medical evaluation,which is standard unless also listed in Chap Chapter 6.The edition drements icated designed to evaluate a member's continued ability to perform his di her dudes and to detect any significant changes in the the here fore issuch ance of this standarce is the d current edition as of the date of condition of his or her health, on a form like the Physical F 1.1�NFP� Exam Summary.(SuF n!E 1, '8r' ) A Publications. National Fire Protection ry Q don, 1 Batterytnarch Park,P.O,Box 9101,Quincy,!v[A 02289. A�°cta- cian can record information from e fire depdepartmentenr phvsi- 9101. E-2 Medical Examination Report.' Th a form Like the Medical medical e,•tamination on NFPA 100I, Standard for Fire Examination Report.(SeeF-%n, eE_Z) lions, 1997 edition. Fighter P►ofusfonal Qua*a, F 1.2 ANSI Publications. American National Standards Insti- tute, Inc., 11 West 42nd Street, 13th floor, New York, NY 10036. ANSI S3.1,1bfaximumPemd$ihkAmbient VoiseZ ve&flrAudi_ ometric Tut Room, 1991 edition. ANNSI S3.6,Speditcation jorAudiomekn, 1996 edition. 2000 Edtlon r, s„ 1582-34 MEDICAL REQU1REhIE, FOR FIR E FIGHTERS AND 44FORNIATION FOR FIRE DEPARTMENT PHYSICU\NS FIGURE E•1 Form for Fire department physician's report Employer. Physical Exam Summary Employee's Name: Position Title: Date of Exam: Examining Physician: Components Within Normal Abnormal, Abnormal, Significant Changes Performed Limits Able to Perform Unable to Perform : .- Job Tasks Job Tasks Noted from Previous ❑ Physical exam Exam(If applicable) ❑ Audiogratn _. ❑ Pulmonary function ❑ Treadmill stress ❑ EKG-12lead ❑ Chest x-ray ❑ Mammogram ❑ Pelvic/Pap ❑ Laboratory tests 47 other Explanation of Abnormal Results/Significant Changes: ❑ Medically cleared to perform job tasks ❑ Denied medical clearance for current job tasks NFPA Physigl Exam summary(I of 2) 2000 Edition �. ,�rc .... APPENDIX F ' FIGURE E-1 (Conti,,,e) 1582_35 ' Hof P.I.: Mc/Ms, is a v.0.Fire Fighter Police Officer with the department.The purpose of this annual Physical is to establish fitness for the candnu Of those duties.He/she has en o ed p Y J Y good health.Mc/Mts. anon voiced the following questions: Medical History Surgical History — D.M. Medications — HTN —Orthopedic — CVD —ENT — Asthma —Optho —Other Allergies Social History ROS —Smoke GI —PPD _Quit _Henratochezia PkYr —Stool caliber Exercise _Bowel habits Alcohol G.U. Amount Stones Frequency _Hematuria CV Chest pain SOB Resp _Cough Wheezes FH _SOB — DM Physical Audio' HTN Insert physical here _HFM -- CVD _Speech range Vision EKGffW Near HR Blood Fat H/H_� _Target WBC____.. . _ Corrected —Intetp Glu Stool OB Stage achieved Choi Positive Pulm HDL _ Negative FVC Ratip____ UA %Pred Risk — Blood FEVI LFTs Protein %Pred SGOT Glucose SGPT GGT Other NFPA Phyefgt Exam Summery(2 at 21 2000 EdBon F 1582—$6 MED[CAL,REQUIREMENTS FOR FIRE FIGHTERS AND"'FOR MATION FOR FIRE DEPARTb[ENT PItYS[CL4YS FIGURE E.2 Medical examination report form. Medical Examination 1.NAME(Last) (First) (Middle) . 2'SEX 3.DATE OF EXAMINATION8.REASON FOR PRESENT 4. PLANT OR DIVISION 5.SOC.SEC.OR 6 EMPLOYEE NO. .00CUPATION 7.DATE LAST E MINATION E�NINATION ❑ PRE-PLACEMENT ❑ D.O.T. 9.TEMP. 10.PULSE ❑ SURVEILLANCE [) MIGRATION � 11.BLOOD PRESSURE ❑ F.I.T.12.HEIGHT 13.WEIGHT 14.TITMUS SNELLING FT IN. 15.VISION UNCORRECTED CORRECTED 16.COLOR VISION DISTANT RE 20/ BOTFI (Use Code)* y T LE 20/ RE 20/ BOTH NEAR 20/ LE 20/ BOTH LE 20/ RE 20/ BOTH LE 20/ l7.PERIPHERAL, Area Examined Clinical Evaluation •18. Head and neck Use Code Remarks(Describe all"Code Is"in detail) 19. Thyroid ---------- ------------ -------------------- LYmph nodes 20. Eyes ---- Fundi ----------------- ------------------- 21. Ears 22. Nose and sinuses 23; Mouth and throat 24. Teeth 25. Chest and lungs ------------ -- Breast ---- -------------- 26. Heart - 27. Abdomen 28. Inguinal,e.g.+hernia 29. Genitalia *Code: 0—Within normal limits l_ Significantly abnormal X Not examined NFPA ModkW Eumindnon Form(1 of 12) 2OW Edition i '7 777 7,, APPENDLXF FIGURE E-2 (�) 1582-37 30. Pelvis 1 31. Anus and rectum Prostate ------ ------------------- ---------------- ---- -------------------- Proctoscopic 32. Spine 33. Skin 34. Arens Hands --------------------- ------------------- 35. Legs Feet -------------------- - ------------------- 36. Peripheral-Vascular 37. Neurologic 38. Emodonal status 39• Other 40.Urine dip: Glucose: Albumin: S.G.: Herne: Leukocyte-Esterase: Other. 41.Flex 42.Step test 43.Body fat 44.PFr 45.Audio 46.Chest x-ray(use 0, 1,or X) 47.EKG(use 0, 1,or X)and specify test used • if 48.Hemacult 49.Back oval. 50.Tetanus 51.PPD 52.Saws test •Code: 0—Within normal limits 1_Significantly abnormal X—Not examined NFPA Moolegt EYamina0on Furm(2 of 12) 2000 EdlOon J 158 11 2-38 hIEDICAL REQUIREMENTS FOR FI RE FIGHTERS AND INFORTW I'IOIY FOR FIRE RE PHYSICGAIYS FIGURE E•2 (Continued) 1 53.Other x-ray or laboratory findings 1� 1� (in Physician's summary,remarkst and diagnoses,including recommendations made to (include code numbers for diagnoses and conditions found) Patient 55.Recommendations/Restrictions It O 56.R.N.signature 57.Physician's signature A Patient's signature 59.Work qualification: 60.Contact person: t 61.Date: 62.Initial: 'Code: 0—Within normal limits 1—significantly abnormal X_. Not examined NFFa Y.dleal Eramlrotlan Form(J of 1� �. 2000 Edition %/" 73 Y APPENDIX F 1582-39 FIGURE E-2 (Co ahu,,,d) Health History Yes No If"Yes,"Giv e ve Details. Have You Had Any Surgeries/Operations: On your back,arm,leg,or knee? ❑ ❑ To treat a hernia? ❑ ❑ Varicose veins? Other operations? ❑ 13 Have you ever been hospitalized? ❑ ❑ Allergy—Have You Ever Had or Do You Currently Have: Serious allergy? ❑ ❑ Bad reaction to any medication? ❑ ❑ Advised not to take any medication (e.g.,aspirin)? - ❑ ❑ Sidn—Have You Ever Had or Do You Currently Have: Hives/eczema or rash? ❑ ❑ Chronic skin problems(e.g..cuts slow to ❑ ❑ heal)? Excessive skin dryness? ❑ ❑ Problems with"easy bruising"? ❑ ❑ Chemical or jewelry rash/sensitivity? ❑ ❑ Neuro—Have You Ever Had or Do You Currently Have: A psychiatric or emotional problem? ❑ ❑ Numbness/weakness/paralysis? ❑ ❑ Dizziness or fainting spells? ❑ ❑ Severe/frequent or migraine headaches? ❑ ❑ Head injury,concussion,or skull fracture? ❑ ❑ Neurological disorders? ❑ ❑ Seizures or blackouts? ❑ ❑ Stroke? Eyes/Ears—Have You Ever Had or Do You Currently Have: Hearing loss? ❑ ❑ Frequent ear infections? ❑ ❑ NFPq Med W Euminatlon Fonn(4 of 12) 20M Edtlon YEO � OT1582-10 MEDICAL REQUIREMENTS FOR FIRE F[GHS . TERS�► O[ 1YFOD1TThH4YN RFIRE FIGURE&2 (Contim E) f; Health History Yes No It"Yes,"Give Details. Ringing in ears? �I Other ear problems? ❑ ❑ Glaucoma or cataracts? ❑ ❑ Red eyes? ❑ ❑ Eye injury/vision loss? ❑ ❑ ' Other eye problems(e.". ❑ ❑ .strain from VDT use)?❑ ❑ G123ses/contacts? Date of last vision screen? ❑ ❑ Head/Neck—Have You Ever Had or Do You Currently Have: Date of last dental exam: Recent problems with teeth/dentures? ❑ Frequent mouth ulcers/infections? ❑ Sinus or hay fever? ❑ ❑ Frequent sore throats? ❑ ❑ Frequent nose bleeds? ❑ ❑ Trouble with thyroide. . ❑ ❑ medication)? ( g•taking thyroid ❑ ❑ Problem requiring radiation treatment to the neck area? ❑ ❑ Lungs—Have You Ever Had or DO You Currently Have: Asthma or wheezing? Coughed up any bloody ❑ ❑ Shortness of breath without a ❑ ❑ PParent reason? ❑ ❑ TB or a positive skin test for TB? ❑ Pneumonia or pleurisy? ❑ Do you cough eve ❑ ❑ ry may'especially in the morning? ❑ ❑ Pain or tightness in chest? More than ❑ ❑elute episodes of bronchitis in ❑ ❑one year? .. Ever smoked tobacco in any form? Had a chest x-ray? ❑ ❑ How❑ per da long: Yrs. packs Y: When quit: ❑ Last time: NFPA Madlear Examinadon Form(3 of 12) 2000 Edition uuNi,�lue/�f/2Yf1///llllll////A2 APPENDrK F 1582—I1 FIGURE E-2 (Continued) F h History Yes No It"Yes,"Give Details, —Have You Ever Had or Do You Currently Have: atic fever or heart murmur? ❑ ❑ isease? ❑ ❑ for heart condition? ❑ ❑ 1 lly cold or bluish-colored hands ❑ ❑ ood pressure.If"Yes,,how is it ❑ ❑ ❑ Medicine ❑ Diet ❑ Exercise have a history of elevated cholesterol? ❑ ❑ Anemia or any blood disease? ❑ ❑ Phlebitis,varicose veins,or blood clots/ poor circulation? ❑ ❑- Chest pain with activity? ❑ ❑ GI—Have You Ever Had or Do You Currently Have: Ulcers? ❑ ❑ Hiatal hernia? ❑ ❑ Indigestion,pain,or unusual burning in stomach? Vomiting of blood? ❑ ❑ Bloody/tarry ❑ ❑ bowel movements? ❑ ❑ Colitis or nervous stomach? ❑ ❑ Yellow jaundice or hepatitis? ❑ ❑ Problems with your pancreas? ❑ ❑ Gallbladder disease? ❑ ❑ Kidneys—Have You Ever Had or Do You Currently Have: Bladder or kidney infections? ❑ ❑ Kidney stones? ❑ ❑ Burning or discomfort on urination,or frequent urination? ❑ ❑ Hernia? ❑ ❑ Blood in urine? ❑ ❑ NFPA Madlaal Examination Form(8 of 12) 2000 Edition ..... .,. . 1582-42 MEDICAL REQUIREMEVrS FOR FIRE FIGHTERS AND INFORMATION FOR FIRE DEPAR'I:NIENT PHYSICIANS H FIGURE E-2 (C �� Health History Yes No If"Yes,"Give Detalls. Miscellaneous--Have You Ever Had or DO You Currently Have: Diabetes or sugar in your blood or urine? ❑ ❑ Cancer of any kind? ❑ ❑ Muscle-Skeletal—Have You Ever Had or Do You Currently Have: , Arthritis,rheumatism,neck,back,or spine injury or disease? Been treated for a back problem? ❑ ❑ ❑ ❑ �,- Recurrent stiffness or back pain? ❑ ❑ Bursitis,tendonitis? ❑ ❑ Recurrent pulled muscles or sprains? ❑ ❑ Hand or wrist injury or problem? ❑ ❑ T Hip or knee injury or problem? ❑ ❑ Ankle or foot injury or problem? ❑ ❑ Frostbite? ❑ ❑ Job requiring heaver lifting or standing,or sitting for long penods of time? Any broken bones? ❑❑ ❑❑ ,F. For Females Only—HaVe You Ever Had or Do You Currently Have: Menstnial irregularities? ❑ ❑ Recurrent problems of the female organs? ❑ ❑ Breast masses or lumps? ❑ ❑ \\ Do you practice monthly breast self-exam? ❑ ❑ Have you ever had a mammogram? ❑ ❑ Date of last pap smear. ❑ ❑ For Males Only—Have You Ever Had or Do You Currently Have: Prostate or testicular problems? ❑ ❑ ,, Breast tenderness,swelling,or lumps? ❑ ❑ Do you practice monthly testicular self exam? ❑ ❑ NFPA MWaal R+r+Weatron Form(7 or 17) 2000 Ec000n '.......""'•",^ NNiiWllllMIIIWAltlll II APPENDIX F 1582-43 FIGURE E-2 (Contmned) L - Health History General Lifestyle I. (Check the answer that best describes you.) General health O Poor O Fair %Sm belt use O Good O Excellent O 0-24% O 25-49% O 50-74% Daily stress O 75-I0090 O Low Cl Moderate O ugh Average hours sleep Cl 6 hours or less O 7-8 hours Average meals daily O 1 meal O 8 hours or more O 2 meals O 3 or more 'Number of eggs per week O 0-1 O 2 O 3 or more Average number red meat meals per week O 0-1 O 2-3 O 3 or more Average number of alcoholic bevemges/beers O 0-5 per week ' O 6-14 O 15 or more Yes No- If"Yes,"Give Details. 3DQ400 o Youminuttes each time?times three per week? ❑ ❑ Identify types of exercise. ❑ ❑ Are you more than 30%above your ideal weight? ❑ ❑ Have you received a tetanus booster is the last 10 years? ❑ ❑ ' 'You been immunized against hepatitis B? ❑ . ❑ Year immunized: Do you take any prescription medication? ❑ ❑ Do you take nonprescription medication(or - Over-the-counter drug)on a regular basis? ❑ ❑ General Lifestyle If. Do YOU Participate in a workplace wellness/ ❑ ❑ help promotion program? Which of the following would you like to see offered and would you participate in? Cholesterol screen ❑ ❑ Blood pressure screen ❑ ❑ Weight loss ❑ ❑ Nutrition program C3 , Stress management ❑ ❑ Smoking cessation ❑ ❑ CPR ❑ ❑ NFPA Atedleal ftamtn4d"Form(e W 12) 2000 9ddon u;aeattru...(NJNdINl7fii. 1582-44 MEDICAL REQ,t1IREb1ENT5 FOR FIRE FICHTERS AND INFORNUTION FOR FIRE DEPARTNI ENT P�ICLIN5 FIGURE E-2 (Condmed) Health History Yes No If"Yes,"Give Details. Blood drive ❑ ❑ Health risk appraisal ❑ ❑ Self-directed exercise ❑ ❑ Health education program ❑ ❑ - x Women's health ❑ ❑ Work History 1. Have you ever. Been restricted in your work or given"light ^ duty"because of your health or injury? ❑ ❑ ` Left a job because of health problems? r Been injured on the job and treated by a ❑ ❑ doctor? Received compensation for an industrial ❑ ❑ injury or illness? Are you receiving any health care treatment ❑ El(e•g.,physical therapy,chiropractic, acupuncture,medical,etc.)? ❑ ❑ Been hospitalized in the last five years? ❑ ❑ _ Have you had any illness or injury that we have not asked you about? Work History 11: Do you have hobbies,such as furniture refs_ ishing,painting,hunting,shooting,or model building? Do you moonlight or have a second job? ❑ ❑1% ❑ ❑ Work History III. Exposures—Have You Ever Worked Around the Following: Chemical plant? ❑ ❑ Coke oven? ❑ ❑ Construction? ❑ ❑ Cotton,flax,or hemp mill? ❑ ❑ Electronics plant? ❑ ❑ Farm? ❑ ❑ Foundry? ❑ ❑ NFPA MedkM EXOMI adon Form(9 o/12) 2000 Edition I Yrt.�U///rylllP011O/�I II APPENDIX F 1582-45 FIGURE E-2 (Continued) Health History Yes No If"Yes,"Give Details. Hazardous waste industry? ❑ ❑ Hospital? ❑ ❑ Lumber mill? ❑ ❑ Metal production? ❑ ❑ Mine? ❑ ❑ Nuclear industry? ❑ ❑ Paper mill? ❑ ❑ Pharmaceutical? ❑ ❑ Plastic production? ❑ ❑ Pottery mill? ❑ ❑ Refinery? ❑ ❑ Rubber processing plant? ❑ ❑ Sand pit or quarry? ❑ ❑ 'Service station? ❑ ❑ Shipyard? _.. ❑ ❑ Smelter? ❑ ❑ Have You Ever Worked With or Been Exposed To: Aldrin? ❑ ❑ Arsenic? ❑ ❑ Asbestos? ❑ ❑ ,Penzene? ❑ ❑ Benzidine? ❑ ❑ Beryllium? ❑ ❑ BIS chlonnethyl ether? ❑ Cadmium? ❑ ❑ Carbon disulfide? " Carbon tetrachloride? ❑ Chlorine? ❑ ❑ Chlorodane? ❑ ❑ Chloroform? ❑ ❑ NFPA IUbteal Eramin�tlan Form(10 of 12) 2000 Man 7 p1 6 .......... 1582-46 MEDICAL REQUIRE"IENTS FOR FIRE FIGHTERS AND INFORMATION FOR FIRE DEPARTbIENT P FIYS[CL4YS FIGURE E-2 (Coy= ) I Health History Yes No If"Yes,"Give Details. Chloroprene? ❑ ❑ Chromates? ❑ ❑ Chromic acid mist? ❑ ❑ Cutting oils? ❑ ❑ P DDT? Dieldrin? ❑ ❑ Dioxin? ❑ ❑ Dust,coal? Dust,sandblasting? ❑ ❑ Dust,other? ❑ ❑ _ Ethyl dibromide? ❑ ❑ Ethylene oxide? ❑ ❑ Extreme heat or cold? ❑ ❑ Heptachlor? ❑ ❑ Hexachlotvbenzene? ❑ ❑ Isocyanates(TDI,MDI)? ❑ ❑ �,_ Loud or continuous noise? ❑ ❑ Mercury? ❑ ❑ Methylene chloride? ❑ ❑ Microwaves,lasers? ❑ ❑ Nickel? ❑ ❑ PCBs? Pesticides,herbicides? ❑ ❑ ❑ ❑ Phenois? Phosgene? ❑ ❑ Plastics? ❑ ❑ ` Radioactive materials? ❑ ❑ Roofing materials? ❑ ❑ Rubber? ❑ ❑ Silica? ❑ ❑ ------------ NFPA'0"'=--MlnOdan Fain(I I of 12) 2000 Editlan � ,..,^,_,M...�mioiuwwramculN oaioieiF!/FlNffWl Jr J APPENDVC F 1582-47 FIGURE E.2 (Cor�) Health History Yes No If"Yes,"Give Details. Solvents/degreasers? 17 Soots and tars? ❑ ❑ Spray painting? ❑ ❑ YTRYPER chloroethylene? Vinyl chloride? ❑ ❑ List any toxinskhemicaLWbiological hazards you might currently be exposed to: Work History Iv. Jobs—Start with the Most Recent. Date(Year to Year) Compa°y Position Any Wont Hazards --------------- -------------- I certify that the above information is true and complete to the best of my knowledge.I hereby give Permission to release work-related information to the proper authorities Of my employer or the company for which I am a job applicant Date: Signature: Examiner. NFPA M4dko aumineftn Form(12 of 12) 2000 Wden ��r�uu•�w.u�x JId4(Wl4%l,%%/��i��J��1!! 1582-4.9 MEDICAL REQUIREMENTS FOR FIRE FIGliTERS AND INFORMATION FOR FIRE DEPARTMENT pM ICiANS Index I, The copyright in this index is separate and�nattonal Fire from the copyright Association.All Rights Reserved. PY^B document are not applicable to this index.This index may not be reproduced in whole or in art t pyright in the document that it indexes.The licensing provisions set forth for the mission of the National Fire Protection Association,Inc. P by any means without the express written per. organs... -F- Administrators,guide for fire department.............3-9,A3 9.2 Fire department Advanced life supportt (ALS) APP•D Guide for administrators . ................5 2.2,A5-1.1.A 5.2.Y A +. ti•di,aimination laws.. Members.. pp.D Approved(definition) ............................ D-1.2 Fire department physician..... -.A-2-2; e 14o see Members Asthma.... .............. 1-4.1.A1-4.1 .......A 2-2;see alto Medical evaluations Audiometry•..........................................B-3.2 Choosing ............................... AuthorityDefinition............................ 2-2.2.A 2-2.2,D.2 �BJurisd►ction(definition) .B-Y.3.2.4 ............ Immunizations,responsibility •.. 4-4 • .10 ••••••••.1-4.Y,A-1.4.Y Ponsibiliry for....... . � Incident scene treatment,role in.. .5-3.2, -5-1.1 to A 5-1 2 'r-B- A-5-3.2 A ' Basic life support(BLS)... Infection disease control,role in.Blood and blood-forming organs .......... 5•:.2.A-5-2.2 ................4-1.2.A- -2.1 3-15,A 3.15 Information for... Blood atpoaures......... .................. Record keeping .'.••its of...........••..•.••.•"'App.B Bloodborne path 4-2.1,A-4-2.l and repo . 2-6 Pr'oP�u+s f� .Pnstw o Functional capacity evaluation..... B 2.6 Body fluid exposures. A-1-2.1 Definition................... ...................... Bu 4-2.1.A•4-2.1 r°IDja'ry.............. ................. .................I-l.11 ....A-5 9.2 -G -C- Gastrointestinal systems . Cancer risk ...... Genitourinary systems....•••.••••••••.••••••.•..." ,A 3.9.2 ............. Candidates ........................&1.4 ...............3-10.A-3.10,BS.4,D-1.4 Definition.............. .g- Medical evaluation. ........ .1, .. _2 1.4.3,A 1-4.3 Read........... 2-1,2-3,A 2-1.1.A 2-1.5,A 2-3 Health and fitness coo•••. •• •5.2.1,A•3•2.1.2 Category A medical condition .. ..ate Medical conditions Definition.. ..... to •............. •2-2.4 Category B medical condition .............smMedical con 1-4.12 conditions Health Chemicals...... and safety officer............................... 3.20,A Chest wall ..........'... 3.20.2 Definition..... ••••••••••2-Y.4 •. •. Chest wall .........................................3.7,A 3.7 Hearing ..................................... 1-4.13 ty,medical evaluations...... ' ..•'• •••••......3.4,A-3-4-Z B-1.4,B•2.3.2.4,B•3.5 Heatitis B Y2-6 Heart s 3 ga l a A 3-0.1,&1.2,&1.4,B-2.1 to B-2.2,B-2.3.2.5.B-3.3 -G p immunisations.... Dental ........ A-4-4 Diabetes mellitus.. 3.5,A 9 5.2 -I Disabled persons.......................................B-3.1 Immunisations.. Down member........... D•1.1 Implementation of standard.• 9-4,A-4-4 Drugs.. A-5.3.2 Incident commander,, 1-3, -3.2 . A 1 treatment 3_0.A-3.20.2 Iaddeat safetyofficer 5-1.2.5•2.1.A 3.4.4 Definition. ...... ... ............... 1-4.6 Incident scene rehabilitation and medical tre t .....Chap.•. -5 A Infection control officer .. a ....Chap.53 Ears Definition.......... •••- 4-1.2 Infection control 1414 Electrocardiography...............................3�4,A-3�f.2 Program(infectious and eommuaicable.... Emergency medical services ..............B-2.2,B-2.3.2.5 disease control)..................... ..Chap.4.A-4 A5.2.2,A-5.3.2 (EMS)..............5-2.2.5-3.A5.1.1 Definition.............. Definition ................ ............... 1-4.15 Endocrine disorder..... 1-4.18 -L- Epilepsy.. 316,A 3.16 Laboratory tesb......... Esophagus h...........................................B$.6 Larynx .. 8-2.3.2.1 Essential cab (Structural M.A 3-6 Legal considerations. M.A 3-6 j functions(strtscnsr+i fire fightia .D•1 Definition.................................................... App.C Lungs ....'t............... ......3.7.A 3-7,B•2.3.2.3.B-3.2 Evaluations. ............ 1.4.7 Medical i'••• see Functional capacity evaluation;evaluations -M. Exposure ioeidents........ Malignant diseases,. Definition.......................................4.2.A-4-2 Medical conditions 3-18,A 3.18.2 Extremities ............. ............................ 1-4.9 CamgoryA.. g 3-12.A-3.12.2 and conditions Chap.3.A-3:see also specific body parts Yca. ............ .............................3.3.A3.3 Definition...... 2000 Edition ...................................1-4.4 _. z i INDEX 1582-.4g Category B............. ....Cha 3, Parts and conditions P A-9;sa alro specific body Definition p Specific ........................................ 1-1.5 Physical load, accountability system......................... .5-;cad,of tiee`fighdng fimcdom.. -8 Medical evaivadone ..... &9 Physician...... &1.2 Content of.. P ''.......•••..Fer Fire department physician Coordination of program............ &2.3 pr<grrraa��sure ProPhYlaais .....................A-l-Y.1 to A4-2.2 Definition .............. D-3 Protected classes.. &5.4,D-1.4 Guidance for.... I-LI6 Psychiatric condition D-1.3 ..............'.... . &2 Pulmonary function testing............... 3.19,A-3-19.2 OSHA 1910.134 compared ....... ......''''..5-3,A 5-3.2 Purpose of standard .............................. &2.3.2.3 Periodic... ............. .Table D4 1-2,A(-2.2 Preplacement and 2-1.2,2.4,A 2.4,&2,2 -A- base line..... 2-1.2,2-3,A 2-3, Reactive airways diaeax Process... ........ &2.I ..... ............ . 2-1,A Y-1.I,A-2-1.5 Referenced publiwdom. &3.2 Records,results,reporting,and confidentiality.........26,&2.4 Repot and records • Sample forms, Chap.6,B-4,App,F P Ly.. medical examinations., Exposure incidents . Return-1O duty............. ,, 1,A- ,..•, A 2- E Immuniza ............'• 4-2,4-3.2.A-4-2,A-4-3.2 .2-1.2,Y-5,A-2-5.1,A 2-5.9 to A-2-5.4 lion records., Tactical level management component(TLMC), Medical evaluations.. A-4-4 5.4.7,A 5.4.5 5.45 Sample forms, 26 Medical examination.. P rrris,medical examinations... ...... ... afro Medical evaluations Reproductive system. .••• ••• 'ADP'E Components of.............. Respiratory disease risk..................,A 3-I0.1.2,&3.4,D I.4 Definition . ...................... 8�2.3.2 .................... &1.4,&2.9.2.5,&S.2 Sample forms ...................................... 1.4.I7 Ribs...................................... -2.3- .3-I1.2 Medical history.. ............................. App.lt Ruk,iacreascd....................................., • &1.4 Medical process...................................... B-2.3.1 Medical services, .........Chap.Y,A 2 S- medialserne�E � ......—Emergency Sseroiliae joints .................... Medically certified Sample forms.................. 3-11,A 3.11.2 Definition ...... Scapulae.............. App.E Periodic medical evaluation. 1419 Scope of standard ..........................'... 5-11,A&11.2 . e 2-4.A 2-1 Second opinions.. .'........ 1-1 Preplacement medial evaluation. ........... eizurs,,................................................................. . &2.5 Reports 2-3,A 2-S S ... Return-todury medial eves! •'''''.•2.6.2 to 26.3 Shall(definition) .............................. B-3.6 Medications. evaluation .........2-5.2 to 2-5.3.A Y-5.3 Should(definition) ........................ 1.4.2I 1-4.22 Members .........S•20,A 3.20.Y Smoke iohaladoa. 3.14,A S-I4.2 Current Spine... ....................................A-&3.2 Definition... Standard(demon... 3 I I,A-3 I1.2 Medical evaluations ............ .1,2-4. -2.1. ..Ir-20.1 Stem� )...................................I-t23 Definition ...... 2-1,2�,A-Y-1.I.A 2-1.5.A 2�k Systemic diseases...... ...... ..'.. ...•. &2.Y Down -1-4.20,A1�120 ....•...................�3-16.A-3-17.2 .......... Incident scene rehabilitation and ... A-5-3.2 -T medical treatment. Tactical level management component(TLM Infection control program.....,.•......... Chap.5.A-5 A-5�4.3 to A-5■i.5 ..............5-4 problems .....,,..,,Chap.4,A-4 Definition....................... Occupational safety and health problems...... ......................... Metabolic ....&1,Table D-4 Tbidc substances ....... ....... 1 .24 Mn+culoskeletal system........ ......3-I6,A 3-16 Triage, ........................... &1.3.&I.4.&3.4 ....,..A-5-3.2,B-2.6 Triage,incident scene ... .......3-6•A 36 Tuberculosis.. ........... 5-3.A-5.3.2 -N- Tumor. ........ .4-3,A-." Neck.... .. ....... 3-2.2,A-3.2.2.2 3-I8,A 3-18.2 Neurological disorder.. .................. .. Nacre............ 3-13,A 3.13 ........36,A 36 Urinary system.............................. 3-10.2,A 3.10.2.2 -O- Occupational history . -V Vascular ascular arm.. 3 8.2,A OccuPadoaal Weg9 O I34 cc m�tradim vision . 3.8.&1.4.&3.3 (OSOcor+patioml safe Parison...............Table D•4 ...........................3-3,A 3-3 ry and health problem.. OropbarTu.......... &1,Table D•4 -X-.........................36,A-3.6 X-rays ................ ....................... &2.2,B-2.3.2.2 Coutw 2000 Edition