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2nd Amendment 03/19/2014 AMY HEAVILIN, CPA • CLERK OF CIRCUIT COURT & COMPTROLLER MONROE COUNTY,FLORIDA DATE: April 16, 2014 TO: Pam Pumar, Administrator Human Resources Division FROM: Vitia Fernandez, D.C. At the March 19, 2014, Board of County Commissioner's meeting the Board granted approval and execution of Item C22 Amend the Contract with Dr. Samess, M.D. and Fishermen's Hospital to provide employment physical services. Attached is a duplicate original of the above-mentioned for your handling. Should you have any questions please do not hesitate to contact this office. cc: County Attorney (electronic copy) Finance (electronic copy) File 500 Whitehead Street Suite 101,PO Box 1980,Key West,FL 33040 Phone:305-295-3130 Fox:305-295-3663 3117 Overseas Highway,Marathon,FL 33050 Phone:305-289-6027 Fax:305-289-6025 88820 Overseas Highway,Plantation Key,FL 33070 Phone'852-7145 Fax'305-852-7146 SECOND AMENDMENT TO CONTRACT FOR EMPLOYMENT PHYSICAL SERVICES This amendment ("Amendment") dated March 19, 2014 is entered into by and between Monroe County("County"), Fisherman's Hospital, Inc. ("Hospital") and Ronald R. Samess, M.D. ("Dr. Samess") (collectively, Hospital and Samess are referred to as 'Contractor"). WHEREAS,the County and Samess entered into a Contract for Employment Physical Services ("Agreement") on April 20, 2011, whereby Dr. Samess agreed to furnish employment physical services; and WHEREAS, on October 17, 2012 the Agreement was amended in order to add the name of Fishermen's Hospital because on or about July 1, 2012, Dr. Samess became an employee of Fishermen's Hospital in Marathon, Florida and all invoices for services provided under the Agreement would be issued under the name of Fishermen's Hospital, Inc.; and WHEREAS, the current contract expires on April 20, 2014 and the County continues to need the services listed in the Agreement; and WHEREAS, Florida Statutes section 119.0701(2) provides that"each public agency contract for services must include a provision that requires the contractor to comply with public records law"; NOW THEREFORE, in consideration of the mutual covenants contained herein the parties agree to amend Sections 4, 7 and 8 of Agreement as follows: 1. Paragraph 4.2 of the Agreement is revised to read as follows: Following the expiration of the initial term and any subsequent terms listed in paragraph 4.1, this Agreement shall automatically renew for successive one- year terms unless and until either party gives the other notice of cancellations in accordance with the terms set forth in paragraph 7, below. 2. Section 7, CONTRACT TERMINATION, in the Agreement is revised to read as follows: Either party may terminate this Agreement because of the failure of the other party to perform its obligations under the Agreement. Either party may also i terminate this Agreement without cause, on sixty(60)days' written notice to the other party in accordance with Section 9 of this Agreement. The COUNTY shall pay contractor for all work performed through the date of termination. 3. A new paragraph (F) is added to Section 8 of the Agreement (CONTRACTOR'S ACCEPTANCE OF CONDITIONS), as follows: F. Pursuant to Florida Statute§119.0701, Contractor and its subcontractors shall comply with all public records laws of the State of Florida, specifically to: i. Keep and maintain public records that ordinarily and necessarily would be required by Monroe County in the performance of this Agreement. ii. Provide the public with access to public records on the same terms and conditions that Monroe County would provide the records and at a cost that does not exceed the cost provided in Florida Statutes, Chapter 119 or as otherwise provided by law. iii. Ensure that public records that are exempt or confidential and exempt from public records disclosure requirements are not disclosed except as authorized by law. iv. Meet all requirements for retaining public records and transfer, at no cost, to Monroe County all public records in possession of the contractor upon termination of this Agreement and destroy any duplicate public records that are exempt or confidential and exempt from public records disclosure requirements. All records stored electronically must be provided to Monroe County in a format that is compatible with the information technology systems of Monroe County. 4. All other terms and conditions of the Agreement remain in full force and effect. [THE REMAINDER OF THIS PAGE INTENTIONALLY LEFT BLANK] 2 IN WITNESS WHEREOF, the parties hereto have caused this Amendment to be executed the day and year first above written. e,i.,:;L) Board of County Commissioners y Heavilin, Clerk of Monroe County *l eputy Clerk 1 ayor/Chairman (CORPORATE SEAL) Fishermen's Hospital, Inc. Attest: vie By. B �1 Avi� Secretary Hal W.v 'ch Chief :t :native Officer z e) c Ronald R. Samess, M.D. Y C d dr C %O v� S — By: Ronald R. Samess 121 MONROE COUNTY ATTORNEY ROVED?{T{,OF.RM: NTHIA L. HALL ASSIS ANI COUNTY ATTORNEY Date 0--J- 8V I f 3 - I . ' AMENDMENT TO CONTRACT FOR EMPLOYMENT PHYSICAL SERVICES ThIs is an amendment("Amendment)to the Contract for Employment Servioes;('AgreemM�e by end b tyreen Monroe County('County')and Ronald Samess Sammie.D. ('Dr. Sam or'Contactor')made and entered Into by the Cou and Dr. Sammie on April 20, 2011. WHEREAS,the County and Contractor entered into an Agreement on Apra 20, 2011,whereby Dr. Samosa agreed to furnish employment physical services; and ! Ii* 1 . WeEE11LASr on 4r about July 1,2012, Dr. Samna became an emplopesoc FNhennen's Hospital In Marathon, Florida; and , F I WHEREAS,the County continues to need the services listed in the Agreement; and r WHEREAS, it is necessary to amend the Agreement in order to add the of Fishermen's Hospital because all Invoices for services provided under the will now be issued under the name of Fisherman's Hospital, Inc. ; 1 _ NOW THEREFORE,for good and valuable consideration, the parties agree to the terms and conditions set forth below. 1 r 1. Fishermen's Hospital, Inc., 1m Professslonal Centre, 5701 Overseas Highway, Ste. 17, Marathon FL 33050 is added as a party to the Agreement. i 2. By executing this Amendment, Fisherman's Hospital indicates its I sent ' terms to be bound by the and conditions of the Agreement, as emended hereto, . _ Dr. and 1heCounty Indkrete theta consent to the addition ofllehermen sH3 *' `: at a party. 3. The person signing below on behalf of Fishermen's Hospital that he has all necessary authority to execute this Amendment on behalf of Fia ill - Hospital and to bind Fishermen's Hospital to the terms and conditions of the Ag nt and this Amendment. 4. This Amendment is made retroactive to July 1, 2012. 5. M other terms and conditions of the Agreement remain in full force mnd effect 1 IN WITNESS WHEREOF, the parties hereto have caused this Amendmet$t to be vtQF�the day and year first above written. 1 , Ler Board of County Commissioners .l,; . Kolhage, Clerk of Monroe County Deputy Clerk /p/,i//,2 Mayor/Chairman 1 I Fishermen's Hospital, Inc. I i Hal W. , DBA, FACHE i Chief Officer Ronald R. Samess, M.D. ,,ors��..y.' M J R R. iG at—. 1 U � L'•— K Irc j o I MO OUNTY ATTORNEY , witgeil O yg xw c E C ,r J r,. "A ASSI8T NT C UNTY—U TvoRNEY Dots lf+- 0- 's+� I 1 2 I MONROE COUNTY CONTRACT FOR EMPLOYMENT PHYSICAL SERVICES THIS AGREEMENT("Agreemenr)is made and entered into this 2,ft day of April.2011, by MONROE COUNTY(-COUNTY'), a political subdivision of the State of Florida,whose address Is 1100 Simonton Street, Key West, Florida 33040 and Jtonald R. Samess.M.D. ('CONTRACTOR'),whose address is 1st Professional Centre.5701 Overseas Hlahwar.STE 17. Marathon,FL 33050. Section 1. SCOPE OF SERVICES CONTRACTOR shall do, perform and carry out in a professional and proper manner certain duties as described in the Scope of Services-Section One-which is attached hereto and made a part of this agreement. CONTRACTOR shall provide the scope of services in Section One for COUNTY. CONTRACTOR warrants that It is authorized by law to engage in the performance of the activities herein described, subject to the terms and conditions set forth In these Agreement documents. The CONTRACTOR shall at all times exercise independent, professional judgment and shall assume professional responsibility for the services to be provided. Contractor shall provide services using the following standards, as a minimum requirement: A. The CONTRACTOR shall maintain adequate staffing levels to provide the services required under the Agreement. B. The contractor is responsible for obtaining proper releases from the employee or prospective employee in order to discuss the results with Monroe County BOCC. C. The contractor will provide the required services at the location of: Ronald R. Samess, M.D. 1•t Professional Centre 5701 Overseas Highway, STE. 17 Marathon, FL 33050 Phone: 305-743-2253 < Fax: 305-743-5383 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 coordinatdrodt• r 0 facilitator to assist in the communications with the Monroe County ElkkOss primary contact personnel. F. Appointments will be available throughout the business hours of the facility: Monday-Friday 9:00 a.m. -5:00 p.m. Closed 12.1:30 for Lunch Fridays: Physician leaves at noon. Facility open until 3:00 p.m. for procedures, such as drug screens,which do not require a physician be present. Walk-ins will also be accepted if an appointment cannot be reasonably scheduled. G. Appointments will be seen by the contractor in a reasonable and timely fashion. H. The Contractor will provide the County with at least a 24-48 hour 2 turnaround time for the receipt of any drug or physical results. I. The Medical Review Officer will be 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 firth by the State of Florida drug free workplace policy, which Monroe County has adopted,and the Department of Transportation.the County must have a qualifiedMedical Review Officer"MRO" perfomr drug screening sen ices. The .MRO receives lab reports from the laboratory(as governed by regulations); Reviews lab reports For integrity,authenticity, false negatives, ;Ind tiilse positives; interprets lab results. including verification of lab positives; reports lab reports to the employer(as defined by ndes and regulations). J. The personnel shall not be employees of or have any contractual relationship with the County. To the extent that Contractor uses subcontractors or independent contractors, this Agreement specifically requires that subcontractors and independent contractors shall not be an employee of or have any contractual relationship with County. K. All personnel engaged In performing services under this Agreement shall be fully qualified,and, If required,to be authorized or permitted under State and local law to perform such services. Section 2.QUALIFICATIONS NECESSARY OF CONTRACTOR The CONTRACTOR must certify at least annually that all staff members, independent contractors, subcontracted work, if any, all service providers it uses, engages or manages, comply with Health Insurance Portability and Accountability Act(HIPAA)privacy and security rules. Physical examinations will be conducted by, or under the direct supervision, of a physician or medical doctor currently licensed and practicing general medicine in the Slate of Florida. The examining physician may employ assistants properly licensed and trained, as necessary, to perform laboratory tests and/or assist in all phases of the examination. Section 3. COUNTY'S RESPONSIBILITIES 3.1 Provide all best available Information as to the COUNTY'S requirements for the Scope of Services described in Section One to this AgreemenL 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.i The initial Agreement term will be for one(1)year beginning the 2r day of April, au7 and renewable at the County s option for two(2)additional consecutive one year terms. 4.2 The terms of this Agreement shall be from the effective date hereof and continue for a period of one year. This Agreement shall be automatically renewed for successive one- year periods until either party gives the other notice of cancellation in accordance with the terms set forth below. The Contractor must provide the Contractor with at least thirty(30) days notice of intent to terminate. If either party desires to modify this Agreement, it shall notify the other in writing at least thirty(30)days prior to the effective date of such modification. In the case of proposed modification the party receiving the notification of the 3 proposed modification shall Itself notify the other party within ten (10)days after receipt of notice of its agreement to the proposed modification. Failure to do so shall terminate this Agreement. Section 8. 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. My request for payment must be in a form satisfactory to the Clerk of Courts for Monroe County (Clerk). The request must describe in detail the services performed and the payment amount requested. The CONTRACTOR must submit invoices to the appropriate offices marked Human Resources. The respective office supervisor and the Administrator of Human Resources, who will review the request, note his/her approval on the request and forward it to the Clerk for payment. 6.2 Continuation of this Agreement is contingent upon annual appropriation by Monroe County Board of County Commissioners. Section 7. CONTRACT TERMINATION Either party may terminate this Agreement because of the failure of the other party to perform Its obligations under the Agreement COUNTY may terminate this Agreement with or without cause upon thirty(30) days notice to the CONTRACTOR. COUNTY shall pay CONTRACTOR for work performed through the date of termination. Section 8. CONTRACTOR'S ACCEPTANCE OF CONDITIONS A. CONTRACTOR hereby agrees that he has carefully examined the REP, 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 (les) periodically to conduct random evaluations of services during CONTRACTORS 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 shah be submitted to COUNTY upon request. 4 Section 9. NOTICES Any notice required or permitted under this agreement shall be in writing and hand delivered or mailed, postage prepaid,to the other party by certified mail, returned receipt requested, to the following: To the COUNTY: Human Resources Administrator 1100 Simonton Street, Suite 2-268 Key West, Florida 33040 To the CONTRACTOR: Ronald R. Samosa, M.D. 1e Professional Center 5701 Overseas Hwy, STE. 17 Marathon, FL 33050 Section 10. RECORDS CONTRACTOR shall maintain all books, records, and documents directly pertinent to performance under this Agreement in accordance with generally accepted accounting principles consistently applied. Each party to this Agreement or their authorized representatives shall have reasonable and timely access to such records of each other party to this Agreement for public records purposes during the term of the agreement and for four years following the termination of this Agreement. If an auditor employed by the COUNTY or Clerk determines that monies paid to CONTRACTOR pursuant to this Agreement were spent for purposes not authorized by this Agreement, the CONTRACTOR shall repay the monies together with interest calculated pursuant to Section 55.03 of the Florida Statutes, running from the date the monies were paid to CONTRACTOR. Section 11. EMPLOYEES SUBJECT TO COUNTY ORDINANCE NOS.010 AND 020-1990 The CONTRACTOR warrants that it has not employed, retained or otherwise had act on its behalf any loner County officer or employee subject to the prohibition of Section 2 of Ordinance No. 010-1990 or any County officer or employee in violation of Section 3 of Ordinance No. 020-1990. For breach or violation of this provision the COUNTY may, in its discretion, terminate this agreement without liability and may also, in its discretion, deduct from the agreement or purchase price, or otherwise recover the full amount of any fee, commission, percentage, gift, or consideration paid to the former County officer or employee. Section 12. CONVICTED VENDOR A person or affiliate who has been placed on the convicted vendor list following a conviction for public entity crime may not submit a bid on a Agreement with a public entity for the construction or repair of a public building or public work, may not perform work 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 38 months from the date of being placed on the convicted vendor list 5 Section 13. GOVERNING LAW,VENUE,INTERPRETATION, COSTS AND FEES This Agreement shall be governed by and construed in accordance with the laws of the State of Florida applicable to Agreements made and to be performed 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. SEVERABIUTY 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 attorneys fees, and court costs, as en 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 18. BINDING EFFECT The terms, covenants, conditions, and provisions of this Agreement shall bind and inure to the benefit of the COUNTY and CONTRACTOR and their respective legal representatives, successors, and assigns. Section 17. AUTHORITY Each party represents and warrants to the other that the execution, delivery and performance of this Agreement have been duly authorized by all necessary County and corporate action, as required by law. Section 18. ADJUDICATION OF DISPUTES OR DISAGREEMENTS COUNTY and CONTRACTOR agree that all disputes and disagreements shall be attempted to be resolved by meet and confer sessions between representatives of each of the parties. If the Issue or issues are still not resolved to the satisfaction of the parties, then any party shall have the right to seek such relief or remedy as may be provided by this Agreement or by Florida law. This Agreement shall not be subject to arbitration. 6 Section 19. COOPERATION In the event any administrative or legal proceeding is instituted against either party relating to the formation, execution, performance, or breath of this Agreement, COUNTY and CONTRACTOR agree to participate, to the extent required by the other party, in all proceedings, hearings, processes, meetings, and other activities related to the substance of this Agreement or provision of the services under this Agreement COUNTY and CONTRACTOR specifically agree that no party to this Agreement shall be required to enter into any arbitration proceedings related to this Agreement. Section 20. NONDISCRIMINATION COUNTY and CONTRACTOR agree that there will be no discrimination against any person, and it is expressly understood that upon a determination by a court of competent jurisdiction that discrimination has occurred, this Agreement automatically terminates without any further action on the part of any party, effective the date of the court order. The parties agree to comply with all Federal and Florida statutes, and all local ordinances, as applicable, relating to nondiscrimination. These include but are not limited to: 1) 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 drug abuse patient records; 8)Title VIII of the Civil Rights Act of 1968(42 USC ss. 3601 et seq.), as amended, relating to nondiscrimination in the sale, rental or financing of housing; 9) The Americans with Disabilities Act of 1990 (42 USC s. 1201), as may be amended from time to time, relating to nondiscrimination on the basis of disability, 10) Monroe County Code Chapter 13, Article VI, which prohibits discrimination on the basis of race, color, sex, religion, national origin, ancestry, sexual orientation,gender identity or expression,familial status or age; and 11) any other nondiscrimination provisions in any Federal or slate statutes which may apply to the parties to, or the subject matter of, this Agreement. Section 21. COVENANT OF NO INTEREST COUNTY and CONTRACTOR covenant that neither presently has any interest, and shall not acquire any interest,which would conflict In any manner or degree with its performance under this Agreement, and that only interest of each is to perform and receive benefits as recited in this Agreement. Section 22. CODE OF ETHICS COUNTY agrees that officers and employees of the COUNTY recognize and will be required to comply with the standards of conduct for public officers and employees as delineated in Section 112.313, Florida Statutes, regarding, but not limited to, solicitation or acceptance of gifts; doing business with one's agency; unauthorized compensation; misuse of public position, conflicting employment or contractual relationship; and disclosure or use of certain information. 7 • Section 23. NO SOLICITATION/PAYMENT The COUNTY and CONTRACTOR warrant that, in respect to itself, It has neither employed nor retained any company or person, other than a bona fide employee working solely for it, to solicit or secure this Agreement and that it has not paid or agreed to pay any person, company, corporation, individual, or firm, other than a bonafide employee working solely for it, any fee, commission, percentage,gift or other consideration contingent upon or resulting from the award or making of this Agreement For the breach or violation of the provision, the CONTRACTOR agrees that the COUNTY shall have the right to terminate this Agreement without liability and, at its discretion, to offset from monies owed, or otherwise recover, the full amount of such fee, commission, percentage,gift, or consideration. Section 24. PUBLIC ACCESS The COUNTY and CONTRACTOR shall allow and permit reasonable access to, and inspection of, all documents, papers, letters or other materials In Its possession or under its control subject to the provisions of Chapter 119, Florida Statutes, and made or received by the COUNTY and CONTRACTOR in conjunction with this Agreement; and the COUNTY shall have the right to unilaterally cancel this Agreement upon violation of this provision by CONTRACTOR. Section 25. NON-WAIVER OF IMMUNITY Notwithstanding the provisions of Sec. 768.28, Florida Statutes, the participation of the COUNTY and the CONTRACTOR in this Agreement and the acquisition of any commercial liability insurance coverage, self-insurance coverage, or local government liability insurance pool coverage shall not be deemed a waiver of immunity to the extent of liability coverage, nor shall-any Agreement entered into by the COUNTY be required to contain any provision for waiver. Section 26. PRIVILEGES AND IMMUNITIES All of the privileges and immunities from liability, exemptions from laws, ordinances, and rules and pensions and relief, disability, workers'compensation, and other benefits which apply to the activity of officers, agents, or employees of any public agents or employees of the COUNTY, when performing their respective functions under this Agreement within the territorial limits of the COUNTY shall apply to the same degree and extent to the performance of such functions and duties of such officers, agents, volunteers, or employees outside the territorial limits of the COUNTY. Section 27. LEGAL OBLIGATIONS AND RESPONSIBILITIES Non-Delegation of Constitutional or Statutory Duties. This Agreement Is not intended to, nor shall it be construed as, relieving any participating entity from any obligation or responsibility imposed upon the entity by law except to the extent of actual and timely performance thereof by any participating entity, in which case the performance may be offered in satisfaction of the obligation or responsibility. Further, this Agreement Is not intended to, nor shall it be construed as, authorizing the delegation of the constitutional or statutory duties of the COUNTY, except to the extent permitted by the Florida constitution, state statute, and case law. Section 28. NON-RELIANCE BY NON-PARTIES No person or entity shall be entitled to rely upon the terms, or any of them,of this Agreement to enforce or attempt to enforce any third-party claim or entitlement to or benefit of any service or 8 I _ program contemplated hereunder,and the COUNTY and the CONTRACTOR agree that neither the COUNTY nor the CONTRACTOR or any agent,officer,or employee of either shall have the authority to inform, counsel,or otherwise indicate that any particular individual or group of individuals, entity or entities, have entitlements or benefits under this Agreement separate and apart,inferior to,or superior to the community in general or for the purposes contemplated in this Agreement. Section 29. ATTESTATIONS CONTRACTOR agrees to execute such documents as the COUNTY may reasonably require, including, but not being limited to, a Public Entity Crime Statement, an Ethics Statement, and a Drug-Free Workplace Statement, Lobbying and Conflict of Interest Clause, and Non-Collusion Agreement. Section 30. NO PERSONAL LIABILITY No covenant or agreement contained herein shall be deemed to be a covenant or agreement of any member, officer, agent or employee of Monroe County in his or her Individual capacity, and no member, officer, agent or employee of Monroe County shall be liable personally on this Agreement or be subject to any personal liability or accountability by reason of the execution of this Agreement. Section 31. EXECUTION IN COUNTERPARTS This Agreement may be executed in any number of counterparts, each of which shall be regarded as an original, all of which taken together shall constitute one and the same instrument and any of the parties hereto may execute this Agreement by signing any such counterpart. Section 32. SECTION HEADINGS Section headings have been inserted in this Agreement as a matter of convenience of reference only, and it is agreed that such section headings are not a part of this Agreement and will not be used in the interpretation of any provision of this Agreement. Section 33. INSURANCE POLICIES 33.1 General Insurance Requirements for Other Contractors and Subcontractors. As a pre-requisite of the work governed, the CONTRACTOR shall obtain, at his/her own expense, insurance as specified in any attached schedules, which are made part of this contract. The CONTRACTOR will ensure that the insurance obtained will extend protection to all Subcontractors engaged by the CONTRACTOR. As an 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 9 it 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 bei, included as"Additional Insured"on general liability policies. 33.2 General Liability Insurance Requirements For Contract Between County And Contractor Prior to the commencement of work governed by this contract, the CONTRACTOR shall obtain General Liability Insurance. Coverage shall be maintained throughout the life of the contract and include, as a minimum: • Premises Operations • Bodily Injury Liability • Expanded Definition of Property Damage The minimum limits acceptable shall be: - _ _---$300,000 Combined Single Limit(CSL) If split limits are provided,the minimum limits acceptable shall be: $200,000 per Person $300.000 per Occurrence $50.000 Property Damage An Occurrence Form policy is preferred. If coverage Is provided on a Claims Made policy, its provisions should include coverage for claims filed on or after the effective date of this contract 10 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 advise or services of a professional nature, the Contractor shall purchase and maintain, throughout the life of the contract, Professional Liability Insurance which will respond to damages resulting from any claim arising out of the performance of professional services or any error or omission of the Contractor arising out of work governed by this contract The minimum limits of liability shall be: $250,000 per occurrence and$750,000 aggregate Section 34. INDEMNIFICATION The CONTRACTOR does hereby consent and agree to indemnify and hold harmless the COUNTY, its Mayor, the Board of County Commissioners, appointed Boards and Commissions, Officers, and the Employees, and any other agents, individually and collectively, from all fines, suits, claims,demands, actions, costs, obligations, attorneys fees, or liability of any kind arising out of the sole negligent actions of the CONTRACTOR or substantial and unnecessary delay caused by the willful nonperformance of the CONTRACTOR and shall be solely responsible and answerable for any and all accidents or injuries to persons or property arising out of its performance of this contract. The amount and type of insurance coverage requirements set forth hereunder shall in no way be construed as limiting the scope of Indemnity set forth in this paragraph. Further the CONTRACTOR agrees to defend and pay all legal costs attendant to acts attributable to the sole negligent act of the CONTRACTOR. At all times and for all purposes hereunder, the CONTRACTOR is an independent contractor and not an employee of the Board of County Commissioners. No statement contained in this 11 agreement shall be construed so as to find the CONTRACTOR or any of his/her employees, contractors, servants or agents to be employees of the Board of County Commissioners for Monroe County. As an independent contractor the CONTRACTOR shall provide independent, professional judgment and comply with aft federal, state, and local statutes, ordinances, rules and regulations applicable to the services to be provided. The CONTRACTOR shall be responsible for the completeness and accuracy of its work, plan, supporting data, and other documents prepared or compiled under its obligation for this project, and shall correct at its expense all significant errors or omissions therein which may be disclosed. The cost of the work necessary to correct those errors attributable to the CONTRACTOR and any damage incurred by the COUNTY as a result of additional costs caused by such errors shall be chargeable to the CONTRACTOR.This provision shall not apply to any maps, official records, contracts, or other data that may be provided by the COUNTY or other public or semi-public agencies. The CONTRACTOR agrees that no charges or claims for damages shall be made by it for any delays or hindrances attributable to the COUNTY during the progress of any portion of the services specified in this contract. Such delays or hindrances, if any, shall be compensated for by the COUNTY by an extension of time for a reasonable period for the CONTRACTOR to complete the work schedule. Such an agreement shall be made between the parties. N TRESS WHERE F, the parties hereto have caused these presents to be executed on the of 011 ? ? r�`� BOARD OF COUNTY COMMISSIONERS 'AI � L KOLHAGE, CLERK Y'� �.NROE COUNTY, FLORIDA w✓= by Deputy Clerk ayor/Chaimran (CORPORATE SEAL) RONALD R. SAMESS, M.D. ATTEST: By by Title: MONK E COUNTY ATTORNEY AP OV AST F R ASSIST(•1 r C:;RTV nTTORNEY OgtP_ od 12 SECTION ONE SCOPE OF SERVICES EMPLOYMENT PHYSICAL SERVICES The scope of services to be provided on an as needed basis by the Provider and may include, but not be limited to, the following. The forms to be reviewed and completed by the Contractor are attached to this agreement(Attachments A- E). All results will include: • Written interpretation of test results in common terms and written explanation of the significance of each abnormality or written explanation of those results which are outside the normal range. • Examining physician's written recommendation concerning future action on any condition considered outside the normal range. • Written recommendation of specific reasonable accommodations in accordance with the ADA. SERVICE FEE DRUG SCREEN: When requested, a drug screen will (Collection,and Lab, be performed by the physician and *MRO review) 10 panel will be either scheduled or done on a $35.00 State Requirement walk-in basis. DRUG SCREEN: When requested,a drug screen will (Collection and Lab, be performed by the physician and *MRO review)5 panel will be either scheduled or done on a $35.00 Department of walk-in basis. Transportation Requirement *MRO REVIEW Drug screens will be forwarded to N/A Dr. Burton for MRO review. Dr. Burton will bill Dr. Samess directly for payment of MRO review. BLOOD ALCOHOL When requested, Blood Alcohol (Collection, Lab, M RO Screens will be performed by the review) physician and will be either N/A scheduled or done on a walk-in basis. A testing facility must be available 24 hours a day, 7 days a week for post accident, random, and reasonable suspicion alcohol screening. BREATH ALCOHOL(if When requested,may be used for available) screening. If breath alcohol screen is positive,a blood screen will be N/A performed. 13 • If Physician wishes to propose other means of screening method,please provide testing method explanation and accuracy. A testing facility must be available 24 hours a day, 7 days a week for post accident, random, and reasonable suspicion alcohol screening. PPD-TB screen When requested,a PPD-TB screen will be scheduled and performed by the physician during the facility's normal $30.00 business hours. A PPD-TB screen will be performed with the new hire Firefighter physical. HEPATITIS A When requested,a Hepatitis A inoculation will be scheduled and performed by the physician during the N/A facility's normal business hours. HEPATITIS B When requested,a Hepatitis B inoculation(s)will be scheduled and N/A performed by the physician during the facility's normal business hours. TYPHOID When requested,a Typhoid inoculation will be scheduled and performed by the physician during the facility's normal N/A business hours. TETANUS When requested,a Tetanus inoculation will be scheduled and perfomred by the Combined physician during the facility's normal with business hours. Diphtheria below: DIPHTHERIA When requested,a Diphtheria inoculation will be scheduled and N/A performed by the physician during the facih 's normal business bouts. DOT PHYSICAL: When requested,a DOT physical will (SEE ATTACHMENT be scheduled and performed by the "B"to be completed by physician during the facility's normal $95.00 employee and physician) business hours. Includes exam and physician review of employee health history and job description. The DOT physical is initially performed in conjunction with a post-offer physical.Thereafter,only a DOT physical is performed by the physician. Physician may also perform a urine drug screen if requested separately by 14 Monroe County BOCC. POST-OFFER When requested,a post-offer physical PHYSICAL: will be scheduled and performed by the $70.00 (SEE ATTACHMENT physician during the facility's normal "A"to be completed by business hours. Includes exam and employee and physician) physician review of employee health history and job description. Physician may also perform a urine drug screen if requested separately by Monroe County BOCC. FIREFIGHTER When requested,Firefighter physical PHYSICAL(SEE will be scheduled and performed by the ATTACHMENTS"E"to physician during the facility's normal $75.00 be completed by employee business hours. Includes exam and *Fee Also and physician). physician review of employee health includes history and job description. Respirator Physician may also perform a urine Physical at drug screen if requested separately by no additional Monroe County BOCC. charge. Also required:EKG, Chest X-ray, Spirometry, Hearing/Audiogram, Stress Test, PPD-TB screen. FITNESS FOR DUTY When requested,a Fitness for Duty $70.00 PHYSICAL(SEE Physical may be requested at any time ATTACHMENT"A"to be by the employer in the employee's completed by employee respective area of work. The exam will and physician) be scheduled during the facility's normal business hours. Includes physician review of employee health history,exam,review of job duties and medical records if necessary. Physician may also perform a urine drug screen if requested separately by Monroe County BOCC. RESPIRATOR When requested,a Respirator physical *$80 PHYSICAL(SEE will be scheduled and performed by the ATTACHMENTS"C" physician during the facility's normal PART 1&II to be business hours. Includes exam and completed by employee physician review of employee health and physician) history and job description. Physician may also perform a urine drug screen if requested separately by Monroe County BOCC. Also required: Chest X-ray and Sprirometry. *See Fire Ater Ph ical EKG Normally done in conjunction with the $80.00 Firefighter physical. 15 CHEST X RAY Chest X Ray is normally done in Physician conjunction with the New Hire provides Firefighter and Respirator physical if order to Key there is an issue with the EKG or West spirometry results. Diagnostics. Key West Diagnostics bills County directly ($75.00) SPIROMETRY Normally done in conjunction with the Respirator physical. All Firefighters and employees who use a respirator will S20.00 have a Spirometry when hired. Normally done in conjunction with the HEARING/AUD(OGRAM appropriate physical. May be requested S30.00 separately by Monroe County BOCC. STRESS TEST(SEE Normally done in conjunction with the Physician ATTACHMENT"D"for new hire Firefighter physical. provides explanation of services to Performed thereafter for firefighters as order to Dr. be performed by needed. Boros. Dr. physician) Bores schedules test with Firefighter. Boros provides results and bill($200)to HR with copy of results to Samess. Samess sends results via fax to HR. CHEMICAL Tests Glucose(sugar),kidneys, liver(1 Fee included PANEUCMP tube of blood drawn). in Firefighter Normally done in conjunction with the physical Firefighter Physical. CBC Test to see if Anemic;if any infections Fee included within the body;if dehydrated(test in Firefighter from I of the tubes of blood drawn). physical Normally done in conjunction with the Firefighter Physical. LIPIDS Tests good cholesterol and bad $55.00 (CHOLESTEROL) cholesterol( one of the tubes of blood drawn) Normally done in conjunction with the 16 Firefighter Physical. UA DIP Normally done in conjunction with the *Included in DOT physical physical fee UA WITH MICRO Normally done in conjunction with the *Included in Firefighter Physical physical fee • The Contractor shall retain all records pertaining to this contract for a period of four(4) years after the termination of this contract. • The County, the Clerk, the State Auditor General, and agents thereof shall have access to Contractor's books, records, and documents required by this contract for the purposes of inspection or audit during normal business hours, at the Contractor's placa(s)of business. 17 SECTION ONE: COUNTY FORMS AND INSURANCE FORMS LOBBYING AND CONFLICT OF INTEREST CLAUSE SWORN STATEMENT UNDER ORDINANCE NO.010-1990 MONROE COUNTY, FLORIDA ETHICS CLAUSE "RONALD R.SAMESS.M,D" (Company) °...warrants that heAt has not employed, retained or otherwise had act on his/her behalf any former County officer or employee in violation of Section 2 of Ordinance No. 010-1990 or any County officer or employee In violation of Section 3 of Ordinance No. 010-1990. For breach or violation of this provision the County may, in its discretion, terminate this Agreement without liability and may also, in its discretion, deduct from the Agreement or purchase price, or otherwise recover, the full amount of any fee, commission, percentage, gift, or consideration paid to the former County officer or employee? (Signature Date: '3/d$/ao// STATE OF: COUNTY OF: �'1 1 1UAL Subscribed and sworn to(or affirmed)before me on enligeln aD (nI (date)by 'R 6nA1& K. csinumM.A. (name of affiant). He/She is personally known to me or has produced (type of identification)as identification. Qum k Rona/ NOTARY PUBLIC My Commission •• PR/Wt.— tTt+'�1'y1,. NNrry P,a1 • �ecoarantorIMrn,kr 18 +tC,� MCm7oP Seem* hweNu r NON-COLLUSION AFFIDAVIT 1, of the city of according to law on my oath, and under penalty of perjury,depose and say that 1. I am of the fine of the bidder making the Proposal for the project described in the Request for Proposals for and that I executed the said proposal with full authority to do so; 2. The prices in this bid have been arrived at independently without collusion, consultation, communication or agreement for the purpose of restricting competition, as to any matter relating to such prices with any other bidder or with any competitor, 3. Unless otherwise required by law, the prices which have been quoted in this bid have not been knowingly disclosed by the bidder and will not knowingly be disclosed by the bidder prior to bid opening, directly or indirectly, to any other bidder or to any competitor; and 4. No attempt has been made or will be made by the bidder to Induce any other person,partnership or corporation to submit,or not to submit, a bid for the purpose of restricting competition;and 5. The statements contained in this affidavit are true and correct,and made with full knowledge that Monroe County relies upon the truth of the statements contained in this affidavit in awarding contracts for said project. (Signature) I '1 Date: �\��\\) STATE OF: 4kujO a COUNTY OF: 11 \6IIMKL Subscribed and sworn to(or affirmed)before me on My \ a3\ , mit p l� p (date)by 'W1 L 5� r(, _ • `"•U• (name of affiant). ILI She Is m personally known tome or has produced (type of identification)as identification. Ph Oa tea/ NOTARY PUBLIC n#MaAI.WwR My Commission Exp �.y+._. Dom PSI.•Stole of n m 19yy,7 C�. w rw.++w 0 DO MOO DRUG-FREE WORKPLACE FORM The undersigned vendor in accordance with Florida Statutes Section 287.087 hereby certifies that: RONALD R.SAMESS. M.D. (Name of Business) 1. Publishes a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance Is prohibited In the workplace and specifying the actions that will be taken against employees for violations of such prohibition. 2. Informs employees about the dangers of drug abuse in the workplace, the business' policy of maintaining a drug-free workplace,any available drug counseling, rehabilitation. and employee assistance programs, and the penalties that may be imposed upon employees for drug abuse violations. 3. Gives each employee engaged in providing the commodities or contractual services that are under bid a copy of the statement specified in subsection (1). 4. In the statement specified in subsection (1), notifies the employees that, as a condition of working on the commodities or contractual services that are under bid, the employee will abide by the terms of the statement and will notify the employer of any conviction of, or plea of guilty or nob contendere to. any violation of Chapter 893(Florida Statutes)or of any controlled substance law of the United States or any state, for a violation occurring in the workplace no later than five(5)days after such conviction. 5. Imposes a sanction on, or require the satisfactory participation in a drug abuse assistance or rehabilitation program if such is available in the employee's community, or any employee who Is so convicted. 6. Makes a good faith effort to continue to maintain a drug-free workplace through implementation of this section. As the person authorized to sign the statement, I certify at this firm complies fully with the above requirements. (Signature) Date: --Thk- �\ STATE OF: 'T*DijkIk. COUNTY OF: 'Alai Subscribed and sworn to(or affirmed)before me on Prl-/I0 I) (date)by E7f1.E'(A IC JaMUM N.d' (name of affiant). He/She is personally known to me or has produced (type`� of aide iflcatlon)as identification. 11.1A\-4\ 1 )Wie NOTARY PUBLIC My Commission Expires: - MEU L.PUMAR :.,reWarpPu. w Pubic anaWE 20 • ercas4Ew.M.n.mrr •S- .. ria.EMM„ree inns EMM.lM.pi Mains MaayAnn 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 pudic work, may not submit bids on leases of real property to public entity, may not be awarded or perform work as a contractor, supplier, subcontractor, or CONTRACTOR under a contract with any public entity, and may not transact business with any public entity in excess of the threshold amount provided in Section 287.017, Florida Statutes,for CATEGORY TWO for a period of 36 months from the date of being placed on the convicted vendor list? I have read the above and state that neither Ronald R. Samos.MA (Contractors name)nor any Affiliate has been placed on the convicted vendor list within the last 36 months. (Signal e) 1 yyI Date: \AA\ • STATE OF: M""l(MVALIS& 11 1. COUNTY OF: 1 Subscribed n_d^sworn to(or affirmed)before me on 3 r/-) I (date)by ZD6 & d cluxue (name of affiant). He/She is personally known to me or has produced (type of identification)as identification. '1 "4�, YN11 � 'I�Y�II✓ NOTARY PUBLIC My Commission Expires: MUM-PUNAR istpTve Rohr Public•Slats of PIPS 34'fa mreceesagithogneantami lalsdrottONallonaINctrevAson 21 MONROE COUNTY, FLORIDA RISK MANAGEMENT POLICY AND PROCEDURES CONTRACT ADMINISTRATION MANUAL Indemnification and Hold Harmless For Other Contractors and Subcontractors The Contractor covenants and agrees to indemnify and hold harmless Monroe County Board of County Commissioners from any and all claims for bodily injury (including death), personal injury, and properly damage (Including property owned by Monroe County) and any other losses, damages, and expenses (including attorneys fees) which arise out of, in connection with, or by reason of services provided by the Contractor or any of its Subcontractor(s) in any tier, occasioned by negligence, errors, or other wrongful act of omission of the Contractor or its Subcontractors in any tier, their employees, or agents. In the event the completion of the project (to include the work of others) is delayed or suspended as a result of the Contractor's failure to purchase or maintain the required insurance, the Contractor shall indemnify the County from any and all increased expenses resulting from such delay. The first ten dollars ($10.00) of remuneration paid to the Contractor is for the indemnification provided for above. The extent of liability Is in no way limited to, reduced,or lessened by the insurance requirements contained elsewhere within this agreement. 22 WORKERS' COMPENSATION INSURANCE REQUIREMENTS FOR EMPLOYMENT PHYSICAL SERVICES BETWEEN MONROE COUNTY, FLORIDA AND RONALD R. SAMESS, M.D. Prior to the commencement of work governed by this contract, the Contractor shall obtain Workers' Compensation Insurance with limits sufficient to respond to the applicable state statutes. In addition,the Contractor shall obtain Employers' Liability Insurance with limits of not less than: $100,000 Bodily Injury by Accident $500,000 Bodily Injury by Disease, policy limits $100,000 Bodily Injury by Disease, each employee Coverage shall be maintained throughout the entire term of the contract Coverage shall be provided by a company or companies authorized to transact business in the state of Florida. If the Contractor has been approved by the Florida's Department of Labor, as an authorized self-insurer, the County shall recognize and honor the Contractors 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 Contractors 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 II GENERAL LIABILITY INSURANCE REQUIREMENTS FOR EMPLOYMENT PHYSICAL SERVICES BETWEEN MONROE COUNTY, FLORIDA AND RONALD R. SAMESS, M.D. Prior to the commencement of work governed by this contract, the Contractor shall obtain General Liability insurance.Coverage shall be maintained throughout the life of the contract and include, as a minimum: • 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 $ 100.000 Bodily Injury by Asc. $ 500.030 Bodily Inj. by Disease, policy Imts $ 100.030 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 $750,000 Aggregate The Monroe County Board of County Commissioners shall be named as Additional insured on general liability policy. 25 • EMPLOYMENT PHYSICAL SERVICES A!IACHMENTA NO OF AT/ACHED SHEETS FtOF EXAM MEDICAL RECORD I REPORT OF MEDICAL HISTORY LI NOTE. This Intention Is a*MIN and Rocker cwtdsmW us*only all a not be Mlmssd to unauthorised potions I liAME Of PATIENT C....ter.emN l IENTItICE[ON NUMRR ;T Posit ion No OME STREET ADDRESS•star at ND,Car of roan SHIM.and PIP Code/ 5 E•Mayo]FACILITY JO Clfv We STATI II CODE N PURPOSE OF EFAMMA ION T STATEMENT OF PATIENT 5 PRESENT HEALTH Al Mt MENTIONS CURRENTLY USED NM 4g4rJ pans A.rneuryl . 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S/'^ 33 CCCQVPRYNSh&WJ.MMW N MII IPERICEPTLON 1$( cowmen 0 O ��`LLS... LOT RraMr NREw Ei N MOLT N5IMOISMyy W,nAI 51 MO LOIS TEETIYHA RK30 .mAcuLAR ONSICN R/IA T LEFT 0/MARINO NI A wAO C4CNI N PSVCM L L CA APOPSYCIOIOTM 4 YW IR &tivwl l ROM,wV ISM .IS SY 50S IM 2 LNIRRO 80120 MO �1A NS SO10N NP 25Y an ,« LIDS ArTWV IAMy M5 �� 42 NOTES ICans nC POcICJM 0 IMfRVALNSTCRY ILMsy,NaaN,_.TARS] 43 SUMMARY OF CLRCTS LNDOIAOCSLS t.cPqus2VNrsmn&My 4 RLCWMOWnOO.RIIMLPS EOAtlSTE\MSMAnOP ROCATLO ISVLM •Sl ROOMS PROLL P V L I AR L S • exam.,(OWN • o oMILIFLO FOR In accordance with attached Job .SR PHYSICAL CATEGORY e LMOT ounIJSCFw description o IFNOT OIAVPLO,1ST OWOVPMW arEQS Iv in./R}INN A B c L a fvrto w PW lI0 44m.CITHYSICIAN LYIMawe a nap OR mwrto wMLa *SK.wl ,Own.L 4 rT.LD on mlMID ma 040001ST OR PMncrnl lMzieM,oll 50M4Tun Si ME°OR MWILO NMR pRVIWN2 CFPKTR OR APPRomm AVRNWTV NOIAM STANMRO BOMA of R. 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Io the employee:Can you mill 6 k one)' ........ .. ..... ................................ ...]Yes No lour empbger must allow you to answer the.ym.tunraln•Junng normal working hours,ur al a tome and plat that et .umine•nt toy Oar. Fe maintain your amf.kT4Whly,your Pmpk.ynr or supervisor must not look at or minim your answers, and your employer mum tell you hew to Wiser or wild this mistionuame to the health a are professional who will n iew it. fhe following information must be pnnlaid by...cry employee who has been wits lid hi rw any type of respirator (please punt) Name: - .—_ Job Title:___.. _. Aye nearest year): Sex(a he;k eve) O Male O Female Date. Height feet Weight-_lbs. Check the type of sesphata.you.will use(you can the.) more than one category) Phone m.mberwhere you can be reached by lb.health a. O N.R or Pdisposable respirator(fker-ma care person who teviews this(include area cat). non-cartridge type only). The best tlme to call you at this numbest a. ❑Other type(for example,half-or full-faceprece type,powered-air purifying,supplied-air,selfsontaimd breathing apparatus). Hu your employer told bow to contact the health cast personreview will lew MY(chck%akaYea ONo Unto soma respirator: OYw UNo If"yea,"what tyre(sk Part A— Section 2(hfardafuy) QMeah.ns I though 9 below must be answered by every empk.y a who has her sekr led to use any type of respirator (pksrwcIwk5 s"or"m") I.Do you cuantiy smoke tobacco,or have you smoked tobacco in the last month? .................................0 Yes 0 No 2.Have you ever had any of the following conditions? a. Seizures(frisk ❑W. ❑No b. Diabetes(sugar disease). O Yes No e. Allergic matinee awl interfere with breathing 0 Yes 0 No J. Claustuphobk(far of timed-In places)' O Yes O No trouble stalling odors:. ]Yes 0No d Have you net had any of the following pulmonary or lung problems? a. A hums: 0 Yea 0 No b. Asthma U Yes a Nn .. . Chrona boa hlis: ... .. .. ...]Ks ']N.. .1. Fmpbyw•ma: _... ...... .. .....7 Yes ]No e. rnamena: ....__..................._...__.__....... ..... ...... ... . .... ..... ....... 'Yes J No I Follett ufw.: ... ................. .. ... .. .... ...,... .....JYrs J\o p ash was: ... .. ....... ........ .... ........ .. ..... ... ....... ... . . . . . .1Yrs JNo h. Pik thorax 6'dinned lung): .. .... . . ....... ... ales 'J•Vo I. I ulnteara er: • . ..... ._. . . ... .. . . . .. .. Jye. J\u broken nos: . . . . .]Yes J\o \Ilk 41.04'Num.or surgeries: ._. ._. . .. .. . . Joe. allo I. kr,'.4 by-lung rmhfsn that y.ede,.bs.n 6,1.1 abut: . . ... JYr. Jxar tl .3 \CA Mt atm' tart t Do you cuneMly have my of the following symptoms of pulmonary orlung illness? h. 'bonne.,of breath whim walking fag on{mil ground or walking up a slight lull or int line: ., Yes -I No Shortness of breath when walking with Sher people at an ordinary pme on Imo! 'J NII 4. I law tu skip for breath when walking at your own pail,Im level go lllll J. a Yrs No e. Shininess of breath when wa.hing or tInsomp,yourself J Yes allo f. Shortness bruath that interferes with your mb. 'J a Nu gr. Coughing that involutes phlegm(tint k sputum). r.1 trs 4 No h. Coughing that wakes you early in the mornmg. 43 Yes j No i. Coughing Mat um mostly when you am lying down: LPN.* 7 No 1. Coughing up Houil the last month: UYes a No k. lArbeenng: 13 Yes 0 No I. Wheering that Werfens with your itile 'ayes )No in. Oast pain wlwn you boodle(Wyly: 7 Yes cJNo it Any other symptoms that you think may be reLMJ to lung problemspniblems DV1. U No 5.Have you ever had any of the following ranllovastdar wheat problems? a. Heart attack: U Yes 17 No b. Stroke. Dyes GI No CI Yes 0 No J. Whin fdiltur 0 Yes CI No Sweling in your leper feet(not 4:4ILIMIlly walldn) Cl YI•5 U No I. Heart arrhythmia(Wait beating inegularlY) CI Yes CI No Hieh blood possum CI Yes 0 No h. Any other heart problem that you've been told about: CI Yes CI No 6.Have you ever had any of the followlmgrazdiovamidar or head symptoms? a. Frequent pain or tightness In your chest 0 Yes CI No • b. Pain or tightness in your chest dwing physical activity- 0 Yes CI No c. Pain or tightness in your sheet that interferes with your ph CI Yrs 0 No J. En t/w pest two yeam have you noted your heart skipping or missing a beat: CI Yes CI No e. Heartburn or intligtsbrin that is not related to eating' CI yes CI No L. Any other symptions that you think may be related to heart ur tin-dation problenss CI Yes 17 No 7.Do you nomad,take medkatlan for any of the tones/beg problems? a. Breathing or lung prolskims:. ayes ON° b. Wart trouble. CI Yes 7 No thud prevails- CI Yes No J. Seizures(Cas) Dyes 2Nn S.If you've used a impbator,have you ever liad my at the fallowing Nobler& kit you've-n."41 used a nwprator go to quemtan 4) a. E.r u.ntation: ciYes 7 Ni. 11. skin atingle%or ra•hrs. ..'a Y. J k• MMOV... .1)0.1 7No J. Ca.neral lllll kiess or fatigue: . . . . J NO e Other problem that loterfen-.. ith%.t'or wsptralor ow:... . .• . . -3 • mcA bat 09331 Wal 9.Would you like to talk to the health can professional who will'veiny this questionnaire about your „uvewore le this gurus penury- LI No Questains Ill to 15 Ishwe mud be answered by.Wry timpkiee whim has hall why it'd to use either a foll-fk *pus ti respirati or a miffs ontamed breathing apparatus(SCB.i).For empks wilt II hale toe°wits led lir use whit b.pc,of reepiran answering thew questions is voluntary. 10.Have you ever lost vision in either eye(temporarily or pernunendy) 3 Yes 3 No Do you cunently have any of the following vision problem? Yes UN411 h. Wow glasses: 3 Yes UN° ... Color bhal: CI Yes CI No tl. Other eye or vision problem' CI Yes 13 No 12.Have you ever had an*wry to your east inchicling a broken ear daunt CI Yes CI No U.Do you rumen"have any of the following hearing peoblernst a. Diffkulty Seeing: 0 Yes 0 No b. Wear a hearing at CI Yes CI No c. Any other hearing or ear problem. 0 Yes 0 No 14.Have you ever had a back Warr CI Yvs CI No 15.Do you comely have any of dee following antsculosheletal problemet a. Weakness in any of your arms,hands,lep. fret 0 Yes 0 No b. Back matt 0I Yes 0 No . Difficulty fully creasing your arms and km: CI Yes CI No d. Pain or stiffness when you lean foment or ha behind at the waist. CI Ylb 0 No e. Difficulty fully moving your head up or dower CI Yes CI No • I. Difficulty fully mining your head side to silts 0 Yes CI No g. Ddficully Minting at your knees:. 13 Yes CI No h. Difficulty squatting to the mound: 0 Yes 0 No Climbing a flight of stain or a ladder carrying mom then 25 lbs• 0 Yes 0 No Any other must le or skeletal proMiim that interferes with using a aspirator 0 Yes 0 No Past B Any of thi.following questions,and other yuenions not ksted,may tie added to the questionruue at the dm ninon of the health •are pnefessiond who null whew the yuestioneumm. 1.In your present job,an you worlds,*at high Alludes(over 5000 feet)or in a place that has lower than normal amounts id loygen 21 Ni, ,.rotbvrmptoms when you're working under these‘4111{1dItifei:. LI Yes J Nil 2..%i work oral honer,have you ever been reposed to hot/4111110W soh onto,har.uslous eirbonte i heroical, • loin,,,•w&lug),•or lune)ou 41444/0'nit'skill• mutt.I‘•oth haiarals no..hem x.16... . ‘1." RESPIRATOR USE PHYSICAL Name Age Sex Home Address Telephone Occupation Length of Employment I agree to the release of this information for State and Federal regulatory purposes to the extent provided by applicable laws. DATE SIGNED ❑Follow-up Medical Evaluation Physical EMPLOYER Required. (Positive response—Question 1-8). ❑ Post-Offer Physical: Medical Evaluation Physical Required. 9.Would you like to talk to the health cue professional who vial review this questionnaire about your PR SWPCS t 0 this questionnaire- 3 Yie O No °Antonio 10 to 13 below must be unwcred by every employ'',who has been wk..byl to 11.*valor a full.fasepicae noputator or wil-sont.nned breathing app.iratus(KBA).Foc ompka)vex who hoe been seletted to Wit.COLT qr.%or wsreatcts..inswenng 1 thew yurshonsi.vialuntary. W.Have you ever lost vision in either eye(temporal/Sly or perratuarntlfr 0 Ws Q It Do you currently have any of the following unionproblems? a. Wear contate knees: 0 Yin 0 Mu h. Wear gLzses.. 0 Yc CM0 Color 0 Ws 0 No d. Other eye or basun pmblem: 0 Yes ONo 12 Have you ever had an balmy to your earn Including a broken eardrum Ci Ws CI No la Do you tumidly have any of the following hearing problems? a. Difficulty Emmy 0 Yes No b. Weara heating aid: 0 Yea 0 No c. Any other hearing or ear problem: 0 Yes 0 No It Have you ever had a back MO:Jr 0 Yes 0 No 13.Da you murnaily have any of the following muandorikeletal rabies*? a. Weakness in any of your arms.heal*kV,dt•ket 0 Yea 0 No b. Back putt CYn ONo c Difbalky fully moving your annoand legs Oita ONo ..1. Pain or stifintso when you lean forward or badavard at the waist Cl Yes 0 No e, Dificadty fully moving your lued up or dome 0 Yes 0 No Difficulty fully moving your head side to side. UYss 0 No g. Difficulty bending at your knees: OVa 0 No Dafficulty squatting to the ground:.. 0 Yes ONo I. Climbing a flight of stairs or a ladder carrying more than 23 Ibt Was ONo 1 Any titter muscle orskeletelploblem that inlets with uSng 4 ropirator Ci Yes Onto Pait Any of the&allawing questioin and other questions not listed.may be added to the questionnaire at the disintion of the health care professional who will review the qumbonnaire. 1.Its yowl/urgent job,are you wodring a high altitudes(over 5,13.10 feet)or in a place that has lower than normal amounts of oxygen OVa 0 No or other symptoms when you're working under thew conditions 0 Yes 0 No t At work ant boson have you ever been exposed to haulms solvents,hazardous airbotne chnnirab O.&pees,fumes,or dust),or have yea come into skin contact with hazaidane chenileales U Yes ONo • .. • •. • L — - me.thes•TAU hot PYLIII0 3,Have you ever worked with any of the nutria or under any of the conditions,Hated below: 4. .AN1whitIV " 0 No h. Ms a toil. s.tn.1141‘tina ay... 0 No • Tunipten/whalt(1.4 iyondintor troldannthts outiri.4 Yes No • etwyllturnt 7 Yes 3>4o p. Aluminum' 7 tes '7 No f. COJI(Ayr twunrls.,mininit) 7 los 0 No Nom 7 Yes 0 No h. Till: UYs 3 No I. Dusty envenments: 7 Yos 0 No • 1. °Ulm Facetious c.pusust QYos 0 No • If"yet.-Jambe tlwse e‘pusures: d.Litany second jobs or side businesses you have 5.List your preview occupations 6.List yew nuient and previous hobbies: 7.Have you been lithe mills,services? 0 Yes U No If-yes,"were you exposed b biologic:dor denical agents(eTher in uairU.gwcomb.4 CI Yes CI No S.Have you ever wodied ono HALMAT temd Dyes ONo 9.Other than medications for breathing and king problems,heart troub(e,blood plenum and seizures mentioned eadier in this questionnaire.am you taking any ether medications for any season (inducting overthe-munter medications): a y CJ No If"yes."rum*the inedittitions if you know them: 10.Will you be using any of the following dents with younespiratods)? 4. NEPA Filters UYe C1No b. Camsters dor exarol0a gss mesidk 0 Yes 0 No C. C.utrulges U Yes U No 11.How often a.you expected la we the tespiratorisy: a. Escape only(no cost.-se 0 i'. UNo b. Emergency rescue only OW" ON° Less than 5 hours pm week: 0 Yes 0 No J. lass than 2 hours per day. ayet ONo e. 2 to.'how,pee day: 0•40 ONo Over 4 hours per der °Yes ON° - - MCS ha-teat Coe unite a' During the period you an using the respirator(s),is your wed(effort J. LI6ht(hSIthJ11 Flt hour). It, UN0 If")rs"haw long dote this period Lot dunrig the aterage shift hn. MUM Exampke of a light ttorkeffirit are titling while wntins tyre drafting or performing light stonily work or 5/411.thIl1;‘.huk irsiting a drill press(1.1 lbs.)or controlling MJ.11111111. S.ItIdiTSP tu 350 kcal cur bluish Otte 0 No If"ye-how long dote this proud Lot dunng&average skit: hrs. mine Examples of modems work effort ant sating while nolingor(dug drtvmg a truth or bus In urban traffic standing while aniline,noltris performing assembly work or transfaring a moderate had(about 33 Its)•11 trunk Ind;walkingOil a Iota surface about 2 mph or down 54egee grade about 3 mea or pushing a whiwItmeow with a heavy load(about It1)lbs.)on a level surface. c. Heavy(above 150 kcal per hour). 0 IA'S CI No If"yes,"how long does the period lastduring theaverage shift—hes_mins. Examplo of hoavy work are lifting a heavy load(about 50 N.)hoot the Boor to your want or shouldec w0rk10g0n4 Wiling Judi;shoveling standing while bricklaying or chippingcastin walking up an 8-degree grade about 2 mph;ilicabingstairs with a heavy had(about 50 lbs.). 11 Will you be wearing protective clothing and/or equipment(other than the reopbaton when you're using your tespuldoo 0 Yes 0 No if"yes,"Jambe this protativeduthing and/or equipment it Will yen be working tinder hot conditions gemperanne exceeding 77PFh. 0 Yes CI No is.Will you be working under htunidconditIont 0 Yes CI No 17.Describe any epeeist or hatardoss conditions you might encounterwhen you're using yollt reepiratorieg Vox example,confined span lifetueatening pseeh it Provide the following inhoznation,if you know It for each toxic substance that you'll be exposed to when you're ming your nigh:nov(5) N4=of the lint 1.13XiCsulenance: Estimated MaillItlER nposure hue)per shift a=mug gee eglee Ourn wn of Irvpwwt per shift Hama of the second tuxr.substance Estemst•d maximum exposure level pershdt Dorton of expoyme payshaft Name of the third toxic substunr. Eatimot ed maximum exposure level per shill Dumtlon of exposure per shift The name of other toxicsdwtmub that youll be exposed to while using your respirator. 19.Describe any special resposgtgtln you'll have while using yoursnpimor(s)that may affect the safety and well-being of other(ferexample,rescue,s.v udyk • •It %CUN.YW DM beL`t0 PLHCP Follow-Up Medical Examination imploy«N.mn: Copy of eecommendatlongiven to employee?OYMONo Job title: Raoo:menaLM.ns about employee iaeo(die nspmab+r L.miratmn+ Dab of this follow-up: Rea ons forfoULaw-up III Actions Need for foiowwp medical evaluations Dab signet* Signet* Date given RESPIRATOR USE PHYSICAL See Attached lob Description NAME AGE__ SEX_ HOME ADDRESS TELEPHONE OCCUPATION LENGTH OF EMPLOYMENT I agree to the release ofth6 Information for State and Federal regulatory purposes DATE SIGNED CARDIOPULMONARY EXAMINATION I. HEIGHT WEIGHT 2. HEART: Manners: Rate_ Rhythm Enlargement 3. LUNGS Pulmonary Fimcdon Within Normal Limits__ Ohmide Normal Limits A PA CHEST X-RAY: Within Normal Limits Outsides NonW Limit_ 3. RECOMMENDATIONS: It is my opinion that the above named patient is Is not medically qunDBed to wear a Respirator in the performance of hie/her duties. PHYSICIAN • EMPLOYMENT PHYSICAL SERWCES li 15.112.1 at i ACHMEIIT mght O 2000 NFPA.ALI Right Reserved NITA IS02 Standard on Medical Requirements for Fire Fighters and Informadon for Fire Department Physicians 2000 Edition This edition of NEPA I501.Stallard en Melina aensemena Rn Rgeset and/nJamatan lie For Drumm PApmam.wprepredby the Inimical Committee on Fire Silence Occu piebald Medical and Halt and acted on by the Madam'Ere Protection Association.Inc., at irs November Meeting held November 14-17.1999.in New Orleans,LA.It cot issued by the Standards Council on January lf,20N1.with an effective date of February I I.2000.and supersedes all previous edidom Thie edition of NM BSI was approved as an American National Standard on Fantasy 11.2000. Origin and Oeedopmrnt olNFPA 1582 Ajont ask force of memben representing both the Technical Committees on Fire Service Occupational Safety and Health and Fire fighter Pmfeoional Quali&adom began address- ing medical eequiremena for Are lighten in Much 1900.A standing subcommittee on Med- lol Physical Requirement,for FireFighten was created under the Fire Service Occupational S�and Health Committee in 1990 and wasrmpoSble for the development of NFPA This new document covered the metal requirements necessary Sr persons who perform hajhdag tads.Medical requirements that were only confined in Section 2-2 of .S NEPA t001. .Wd fir ROM,e RO Rtykr Qudjlatiauaa applied only to the enter Ind. Th./were deleted from NPPA 1001.Legal opinloa and federal lam show that requirements set for a position must apply is anymm who would be or b in that position.These medal requirements ate therefore intended to apply to candidates I.well as to current Om Aghen Two categories of medical condition were created,Categories A and R.Camper*more. sented conditions th*if they exist in the candidate or current fire lighter,would not allow this penal to reknit&c-%hdng operations.Greaoq R candidons mot be evaluated on a castrate basis o that the Ore department phyrlldd ,can determine if the medical condi. don In a paNmisr candidate or anent Am fighter would prevent the person from perform. in;1re5gluing condone. Medical ewilmadore. medical ea.Madmu. record keeping. and confidentiality were addreeed in Chaptert Chapter 5contained the arum'medical conditions that comprise the regtdremenn [Menthe adwory and idornational material was developed in the appendixes to aid Are department adminlaeaon and fire department physician. The committee completed its west inJaomry 1991.and the ant edition w presented to the Amodadan membership atthe 1992Anntal Meeting in New Orleans,Louisiana. The second edition of this standard reflected the numerous changes in medical technol. calf that have impacted atnurwal fire lighten The technical committee was aniseed by phy- sicians whose experdse covered the areas of emergency medicine; "'lion: hdadng and cardiac,pulmonary,neurological.and metabolic coadidom The technical committee endeavored to update six critical area and moved some of the pentom CategoryA mawOeeaoryR They den enhanced some of else Category A matted than would prohibit an Individual from being hired or o conuaue es a are fighter m.The com- mittee mitee also added additional appendix ea in the areas of ADA requirement explanatory aerial Car both Are department administtaon and are department pitniciame.and sample phyla=chamist from. Addidonal explanatory material w added or enhanced to provide the user with addi- tional information regarding medical condition.whose categoric'were changed. These included a number of cardiac conditio.w diabetic condition seizure disorders.asthma.and therapeutic aodsoagulaaoo. ISE2-9 MEDICAL REQUIRLML.YMS FOR FIRE FIGHTERS MID INFORMATION FOR FIRM DEPARTMENT PHYSICIANS The 2000 edition of this standard reflects(I)the tedsnical committees recognition that medical technology h continually changing and (2)the committee's eHon to incoepornn those medical technology changes within the standard.Juries the commutes recognizes meth dal technologyadvancer.it is incumbent on the fire department tocommunicate with the Ore department physician changes in the menial function(*) the lire&me.r., t performs. Contently.the fire department physIdan mtm keep the fire deparunent updated on the at atchsns i the medial held. The department physicians are the primary reersof:FTA 15ST.Candidate member feel Out allowing the lire depamment physician more latitude N determination of a members ab'Wy to perlpmessendalhmcdom will assist users In enfornng thesundatd.Therefore,the ,r committee ha changed the tide of the standard to NITA ISSS.Standard on Mead Aram aunt.far mnwfgAnn and fnkrnatunfor An D4ertmm PAJwam The topic of incident scene nlubilltadon and accountability are included in this edidon, rime the fire department physician may provide guidance or assistance st the rehabilitation unit. In addition. specific areas concerning the f09owng conditions mire clarified or expanded:cardiac.nsion.hearing,neurological,and metabolic. c •• M appendix was added to this edition comparing the requirements of Odsaundard with those ofl9 Q111910.131,the OSHA mpbatoey prediction regulation.There an many men of both documents,and this appendix deifies the companion area of each. • 3000 Eaten COMMOTLE PERSONNEL 15E2_3 TesaaliCal Commien o.Fit Service Occupational Medical and Health teem E.Lab,Qer• Wrenn lath Fire Dept.VA(UI Rep NMI IkeSmr Semen Dowel.Roan.,US Mole Ina of Surreal Research, DeberaR L Naha{e.n«e Township Fire Dept., TX[SKI IN ILI Rlaberle S aael"Mo see,MI(WI Rep.Ind:anop rSear traleuln:W Fire M P 'Mum'Mae Ory ofIgmwn Fire h Reacue Senates. erns Unlon Metropolitan TN(LI Gorden M.Sedm IOCAD Geapem Senors Cwup. Ile Iodueud lmerpmq Repave Waking Group PA ISCI Mae M Eloped.Yale Winona CT(SC Rep.fated&d Gmmump fire Ce.Inc. Anew GAP.. het Amite.ite C n Jan akopc.t Bea OH IUI DDanielaOMEGA.G.Se .INN� IL ISEI It a S..a ,Seattle like Dept..WA ILI New York ISEI Rep. MatChudsTwee MA &Rem Fa Dept.NV IU Philip GSthdieis Leeg Fire Dept.WI ILI pat Ma Nnide Medical Arose•NY mahadD.Ge.tl.,Ir.GeodSmunam Heepdr Mann" Rep.Nall Volunteer Fire Canal M Dep..A21CI Co(R M.Sva uaa West Metre rrsDanae h<PuDanaJ Gensler.Medea:The lame Piece Init. CO MITI ra n(RTI Rep.Metropolitan State College ofDearer W.Laq Rare,Penn San Unrmry.PA(ATI Andy lean.Tub etc Deg.,OK lul Sa.M Lanela Las Vega AM«. Dept. Rep.Intl Eke Sent Taman Assn. Pemb P.Mr.,New York w e tan NUi Tenesar Sams Ar. Rule CA ISEIaa,GlSEj p in Prect.NIt ede DonN.Waa Soo Arne NV Garr L ibea Trochee Meaaoghe Mteadr Durrett Don SmiWw.L«bhrsd-0I.van Idaho Tahnobgiea .W eta De.,10IEI Rep Fire Dept Skryomten An Deebr WRnemoM«sirs Fire D opt.Az(El Alternate raw W.Deenaa Loveland fire Deg.,CO IUI ThsaaL Lay New York Cln Eke Dept.NY(UI (Mt toG.L swoon) (Alt a P.P.Mina bnral S.Gear VI°Inia leech fire Dept.vA(UI Rehm V.Moon,Phoenix Fire Drp..A2(El (Alta M.L Goole/ (Mt to D.Wlwa) Stephen elide.NITA Sod Lialwan This t.�she as e «tip to Sink Genet MU based en weal e y ta w.rotor.San m.:.&— Mal AIM card.A ee a tk.vW+lrn albs d re tieryr.a mint NOTL Menehnab:p en acemmitteeshall not In and olirrten.awu r endorsement dre Aaeeladon or any documemaeadepl by die emetics on which the member senea Ceslta Scopes Tile Committee slue have primary reepewiMin We document,on occupational mod: erne and health in the we.Mngataimlmena of the are rote. 2030 Eden ' 1512a SIEDIC L REQUIREMENTS FOR FIRE FIGHTERS AND INFORMATION FOR FIRE DEPARTMENT PIDSh1LO3 Contents i Chapter l Adnb6mdne . .. .... ...... . ISl2- S 118 Tumors and Malignant Diseases 15/1-10 14 Scope 158E- 5 M9 Prychuuic Conditions. ... . ._. .....I312-11 12 Purpose ... 1512- 5 1?0 Chemicak,Drugs.and Medications. . 1582-11 15 Implementation.. 1582- 5 14 Definuam... 1381- 5 Chapter a Infecd.se Dbes Program ... ... . . 1582-1I Cbptr Y d18did Prorm .. .. ISg1- 8 it Infection Control Program .. .1582-11 42 Exposure Incidents.. ...... .. 1562-11 21 Medkal fialuaden Process 1582- 8 43 Tuberculosis 151E-11 1.2 Flrc Department Roles. . 1582- 6 24 Preplacemcuc Medal Evaluation.. ... Mgt- d 14 Immuniuuon+.... ...... .I582-11 241 Penodic Medical Evaluation . . ... ... 1382- 7 2-5 Retumno-Duty Medical Evaluation ... . 1582- 7 C1aPrr S inviting Mate Helabillatiae - 2E Medical Evaluation Records.Results and Medical Treatment 1582-11 • Reporting,and Confidentiality 1512- 7 54 Incident Scene Rehabllludon 1582-11 5-2 Incident Scene Safety and Health ..... 1582-11 Qrapier 3 C HSerr A sad Cas.pq I 13 Evaluauon and Triage of Medical Conditions 1582- 5 Member I surir 1332-11 11 Medical Conditions Affecting Minty 54 Incident Scene Rehabilitation Tactical Len' to Pasterns 1582- 8 Management Component 15112-1l 12 Strad and Neck " MID- a 3-3 Eyes and Vision 1582- $ Chaptrs Referem.dpbbcadm. 158E-12 N Ears and Heating 1582• $ 1582- 8 Appendix Explicatory MUSH 158E-12 56 Nose,Oropharym,Trachea.Esophagus. and Larynx 1582- 8 3.7 Lungs arid Orr Wall. 158E- 9 App.dixI Inlam.Sa foe The D.pamant 54 Heart and Vascular System 1582- 9 Phyllis' I5BYS1 ~ 19 Abdominal Organs and Gmoinmsdnal Sntem Isis Appmdi*C Etsmdal Structural T.•FigtWg MO Genitourinary System 1582- 9 Ian 15e1-21 341 Spine.Scapulae.Rib.and Sacroiliac Joints 188E-10 Appendix D Guide fir Tire Deportment 3-12 Eaeemides 1582-10 Adativbnrata 158L16 345 Neurological Dhorden 158E-10 Me Skin 1582.10 Ag_SZ SaPio Tetra 1552-33 115 8load aad EbobFomting Orgasm1582-10 138 Endocrine and Metabolic Disorders. .... 1552-10 APpwS*F RfhloilN pWodam 158E-33 Sly Systemic Diseases and Miscellaneous Conditions 1582-10 Index 158E 48 . soap Emir .1/40V1NMTgt now 1362_i NEPA 1582 14 DeMidons. 14.1' Approved. Acceptable to the tinhorn having pins- Standardco diction. LJ.2• Authority Having Jurisdiction. The organization. Medical Requirements for Fare Fighters and office. or Individual resp ns hk fir appnw,ng equipment. Information for Fire Department Physicians matenab.an us•nation.or a procedure WD• Canidata. A person who ha made application to 2000 Edition commence performance a a member 1-1.4 Cater-rya Medical Coalition. A maximal ondmwm that NOTICE an ale.uk TO fnlln.unp hbe numbnw letter dray would preclude a person from per roune as a member a a sgna erg a paragraph indicates dhar caplairnanw maenal on training or emergence operauonal a niom tat by praenung the paragraph ran be hard in Appmahs a. a dgnikant osk to the safety and health tithe person aotsen. Informamn on refeanceI pumwation tan br found m WS Category E Medical Cand idon A medical Condition Chapter b one appen,ba F. that.based on Its amenity or degree.could preclude a person from performing as a member in a training or emergency Chapter I Administration operational environment by presenting a significant nsk to the safety and health of di.person or when I-I Scope. 14.6 Dray. Any substance.chemical.mer4he<ounter medi- 1-1.1 This standard shall contain medical requiremenu for ration orprescnbed medication thatcould effect the perfor- members,includinghd.0ms or parhume employees and paid mane of the member. or unpaid volunteers.It also shall provide information for Ow t{y Ea.Wal Job flmdon. Task or assigned duty that is scans regaling other areas of fire department medicine, critical to suaesaful performance of(Isaiah including infection control and fireground rehabilitation. I-I.3 Evaluadom See Medical Evaluation. I.1.!These re"dremenu are applicable to pubic.gotemmen- 14.9 Exposure laddma A spec eye, mouth, or other el militarn prim...and industrial fire depumnent orpdadon maim membrane, no intact skin. or parcnteral contact prodding recce.fire suppression,emergency medical amces. weth blood,body fluids.or other potentially infectious mated- hazanbm materials mtogadon.special operations and other cis.or inhalation of airborne pathogens,ingestion of food- emeIgengamces borne pathogen or toxins. 1-1.3 This standard shall not apply to industrial fire brigades 1410 /be Department?Stelae. The licensed doctor of that also can be known a emergency brigades.emergency medicine or osteopathy who has been designated by the fire response teams.Pre teams.plant emergency organizations,or department to provide professional expertise in the area of mine emergency response teams, occupational safety and health as they relate to emergency 14 Porpc te. 14.11 Fusidoa4 Capacity Evauadon. An assessment of the 14.1 The purpose of this standard shall be to apecdy mini- correlation between that individuate capabilities and the mum medical requirements for candidata and current mem- audaldob funcuatt. ben. It also shall provide other information rcprding Pre 1412 Hdiedplm._Cocedieator.The person who.under department activities that assist the department phy.ician in the supervision of the fire degsunent physician.has been dodgy providing proper medical support for members. nated by the deparment to coordinate and be reponsible for 1-2!4 The implementation of die medical requirements nut- the health and limes programs af the department !hied in this standard shall help ensure that candidates and I{13 Health and Safe"Offfce-The member Of the nee • • current members are medically capable of perfuming their depannient assigned and authorized by the fire chief as die required dude.and shall help to redure die risk of occupa- manager of the safety and health Porn and who performs atonal Injuries and illnesses, the duties and respomibilities specified in this standard.This individual Can be the incidentsafety officer or that can also be 1-2.3 Nothing herein shall be intended to restrict arryjundu- a separae fmcuon, don from exceeding these minimum requirements. 14.14 Infection Control Officer. The penes@ or persons I-I tmpkst-nudon. within the fire department who'ne responsible for managing I-f.l For candidates.the medical requirements of this sum the department infecuan control program and for coordinate 9uireme'hlag efforu surrounding the mve.tipuon of an exposure. dad shall be implemented when this standard is adopted try 14.I5 Infection' Cenmal The fircde tsfor- anauhorityhavingdurisdicuon,on an effective date specified math program relating to coloruhkcuowpanimNcommu- by the audanty havingjddicdon IJ. • When this standard is adopted mcable disease hazards where employees, patents. or the 1-3.2* h o rd sadopt d dateb a dates a general public could be exposed to blood, body fluids, or authority gipother paternally infectious materials in the fire department rent members to achieve compliance with the requirements work environment.This program includes,bus is not limited of this standard and shall be permitted to establish a phase- to,implementation of mitten policaesand standard upenung in schedule for compliance with specific requirements of this procedures regarding exposure fdiownp measures Immm: • sundad in order to minimize penonal and departmental rations. members' health screening program. and educe- disruption tional programa 2000 Edition IS8241 Mroiral.nth.MLNENTS FOE F111E rroHtL1aASOINFONMATION FOR FIRE DEP Wf\ENT PIOSKt1M 14 16 Medical Evaluation. The anyeru of inhamwon for 24 Phe Deparmwna Roles. the purpose of making a detenninadnn of medical certifier'. bil The fire department shall have an otficulb designated eon.Medical cwlnauon can Include a medical exam,nam,n' physician who shall a responsible for Y^ated I{I) Medical Exaninnatlo's. An examinationperformed or p W guiding.directing.and • directedtheal fired intent advising the members*nth regard to their health,[knees.and byepar phrrician. tuiablm for duty as required by NIPA 1300.Swndow(en Fin 14.13 Medical Services.Emmgeoa. The prowuon of treat. plan/Eon Dfmph"41347ual Yniit p"M'u^ mein—vmh as rest,aid.<ardwpWmonan rnh,vuaufm.bout =•L2• The fire department physician shag be a licensed doe. life support advanced life support and osherpre.ospw pro (orMmeainne or amo cedurn including ambulance vansporudan—w pagans. pathv 14.19 Medim4F Certified. A detennireon by the fire depart. 2.tfireFor the purpose of conducting medial evaluations& men,pbtik,antiattite andidme or current member meets the der plasicianshallundersumdthephvsiolog- medicalretpnremenoofthisstandard nal and psychological demands placed on members and shall I4.20• Member. A person imolvad,n performing the dues understand the environmentalmeannessunder which mem. and embers Shred ben must patent The fire department shall provide the Are respo eparmmnt.under the asthma" depanmemphskunwth actinen,lobdescnpnon for all fire of the organauon.A fire department member can be a full- department pos,tiom and ranks. um*orpaname employee or a pad or unpaid volunteer.can occupy any position or rank within the the department and 2-2.4 The fire department shall require that the fire depart- can engage in emergency operations, matt health and safety officer and the health and fitness won. 1 Minter mammal a liaison with the Are department hysician t{E0.1 Member, m E A penon who is already a memP ber and whose duties require the performance of mutual to tame that the health maintenance process for the are Are.ighung frcuc,p department Is maintained. 1{21 Shall Indicates a mandatory requirement. 2.23 Fire Department Physician Rules. 1{r Should. Indicates a recommendation or that which u 2.2.3.1 The fire deparment physician shall evaluate the per advised but not required son to ascertain the presence of any medial conditions listed la.23 Seradaad A document.the main tat of which con. in this standard. tvnsWan Ymdacory Provisions hal o using the rd'sr w ball- 2JS.2 When medalalu eadons are conductedbva physician requirementsrate and'Akins in a Conn genea W lly, oble for other than the fire depatnnem physician.die evdua Mall mandatory reference by anothersandasd or code or foradop be reviewed and approved by the fire department physician. ton into law Nonmadaory prorldons shall be Incased in an appendix•f000lore,or Oneida'note and ae not to be sun 2J• Pteplacemam Medical Ewehudenk ',tiered a pat of die requirements of a standard. , • 1{M Tactical lewd Management Carrot f1131Ci. A SJ.I Thecandidate shall be certified by the fire department anagement uni"denufied in the incident moagemm,le. phpkian a meeting the medical requirements of Chapter 3 hem commonly known a'div4wn.•group:or-sector." become is andedber orr entering inaai emergency programw a member or performing in an emergency opera- tional environment as a member. Chapter 2 Medial Process 2-3.2 The candidate shall be evaluated according to the med- ical requirements of Chapter 3 of that standard to assess the 2-I Medial EvtSoe Piecsa effect of medical conditions on the candidate's ability to pert 2.2.1• The fire department shall establish and implement farm asa member. a medical evaluaoon process for candidates and current 24.3 A candidate'hall not be coed a meeting the media members. cal requirements of thissanda d if the fire deparment physi. 21.2 Tice medical evaluation preemie shall include pteplxe i ad determine, that the cancIda a has any Category A men,medial evaluations.periodic medical evaluations.and medlol condition as specified in Chapter S of that standard. returns duy medical evaluations. 24J• A candidate shall not be certified as meeting the meth• LIS The fire department shall ensure that the medical rat. icy reguirementsetthisesandard ifthe fire department pby- uaoen proses and all medical evaluations meet all of the sic" min determines that die ca^didam ha a Cetera" R r<gartmmuofSection Y 1. medical condition as specified In Chapter 2 of this standard that n of sufficient severity to prevent the candidate front LI.e Each candidate orcurtent member shall cooperate.par. performing.with or without reasonable accommodation.the m'pate.and comply with the medical evaluation procr and essential functions of a member without posing a significant shall provde complete and accurate information to the fire risk to the safety and health of die candidate or others. department physician. 2.3.4.1 The detenniadon of whether a reasonable accmm 2-1.3• Each candidate or current member shall report,on a madation shall be madebethe authonyhavingturidicuonm timely basis,to rice fire deparunent physician any exposure or co juncrn with the fire department physician. medical condition that could interfere with the abdiry W the YJ.s candidate ndidate with individual to perform asamember. newlyacquired chronic medicalindividindividual an acute medical problem condition that interferes or 2.1.6 The medical evaluation shag be at no cost to the candi. with dhe c acquired sabilitywperformthefunctionsofamem- date,current member,or other member her,medical certification shall be postponed until that person MOO Fawn fill tenet AL PRU'Eba 1532-7 ha recovered trnm this condition anti presents to the lire phyucun determines that the member has a Catc;tor.Bcum department for review down specified in Chapter 3 of tha sumfasd that is of two. Y-k• Periodic Medical Evaluation. cuntweeny m prevent the member from pent mmq.with ter without reasonable accomm,daunn,the ennead lunation.N 24.1 The current member shall be certified anntulh,or al a member without posing a agndic.int chic to the afeq and the request of either the lire department or the member.by health of the member or others the tire department Oarsman as meeting the medical requite- 2A.3.1 The determmaunn of reasonable acwmmadati0n menu afClupter 3 alibis smdaed m order to determine that be made br the authnnry havmglurtvhmnn In cranium. members medical abdie to continue paruapaung m s tram. tun with the foe depammmt ph.uaan mg or merman operational environment as a member.tiro applicable OSHA iundar s.such a 29 CfR 1910 120.•Hai- 24.4 if the current member prevent with an acute illness ardow W.nte()pennons and Emergency Response:29(JR or chromic recently acquired chnic medical condition.the 191011a.'Respiratory Pmmctwn;29 CR 1910 95.-Occupa- win.hall be deferred until the member has recovered from nunal gwue Exposure;and 29 C FR 1910 1030.-Bkndbsme the condition and present.to the tire department to return Pathogens:shall be followed. to duty 24.1.1 Thecomponents of the annual medical evaluation as 2d Reuwt.Buq Medical Evalwation. 'rolled In 2-1.1 2 shall be permitted to be performed by qualified personnel as authorued by the lire department 23.1• A current member who has been abtrnt from dna for phystetan.When other quahfied personnel are used.the lire a medical condition Ma nature or duntnn that could affect department physican shall review the data gathered during performance as a member shall be evaluated by the fire the evaluation. department physician before retuning to duty, 24.1 2 The annual medical enluauon shall consist of the fol- 23.! The fire department phyrian shall not medically car- bong ay the current member for return to duty if any Category A (I) An mteml medical him., medical condition specified in Chapter 3 of this iandard is li (2) An interval occupational history, including significant Present. exposures 21.34 The fire department physician shall not medically cec. 13) Height and weight tify the current member fin return to duty if any Category B (4) Blood pressure medical condition specified in Chapter 3 of thu standard is (5) Heart rate and rhythm present that Is determined to be:.ere enough to affect the 24.1.36 In addition to the annul medial evaluation.the fire members petformanee a a member.The fire deparment department,hall include a medid eumnamn according to physician.in conjunction with the authority having jurtsdlc- the f Rowing schedule. on,shall take into account the memberscuneat duty reign- ment(1) Ages 29 and under-at least every]yean woudaal nd membauver to gradualy temm alignments or m Wv ins rAat (2) Ages30 ton—at least every2 yeah 13) Ages 40 and above—every fear 2-I.43 The department than preside guidance,opportunity. S41A• The medical examination shall include enminatlon reand encouragement to the member was to expedite his safe of the following components rem to up duty. (I) vital signs—namely.pulse.respiration,blood pressure. 24 Medial Erduadon Record.,Resides,Reporting,and and.if indicated.temperature Coa6dntlaUq. 12) Denm(ologlW yam 26.1 AR medical information collected a part of a medical (3) Ean,eyes,nose,mouth,throat enluauon shall be considered confidential medical Informs pl Cardiovascular system- uon and shall be released by the fire department physician 13) Respirateryrpicm only arida the specific written consent ache candidate or cur. 16) Gastrantesdnal system rent member (7) OcnitouMary system (3) EMoctine and metabolicsystems 2E.2 The fire department physician shall report the results of (9) Musculcskeleal yam the medical evaluation to the candidate or current member. (to)Neurological system includingny medical condition(%)disclosed dung the med- (11)Audiontet.y ,cal evaluation.and the recantlitendauon as to whether the 12)Visual acuity and peripheral norm testing candidate orcurrent member 6 medially certified to perform I L3)Pulmonary function testing as a member 211)Laboratory testing if indicated SdS The fire de t (13)Diagnostic imaging.if indicated Panmm designee physician shall inform the free Elearxmdiognphy.if indicated department lire thief er only as to whether or not (1ti) the candidate or current member is medially certified to per. requnt member shall not be candied as meeting the candi- medicalform asa member The speak brerunconsent of the requlremena of this standardif the fire department t date or fatten(member shall be required in order to release physician dearmtnpe that die member has any Category A confidential medical information resardmg this condition to medical condition specified in Chapter 3 Nthis standard. the fire department_ 2-1.30 A martin member shall net be certified as meeting the 26.4 All medical record keeping shall comply with the medical requirements of this standard if the Ore deparment requirements of29 CFR 191920.-Medical Recordkeepmg- ma tatW L __ 1582-5 MEDICAL REQUIREMENTS FOR FIRE FIGHTERS ANO INFORMATION FOR FIRE DtI ?TMENY NO3ICIANS Chapter S Category A and Categoq B 14 Lan ad Healing. Medical Conditions 3-4_1 There shall be no Category A medical conditions. 11 Medial Conditions greeding muskyio pee rm. Cate• 5.1.2• Category 5 medical conditions shall include the fol. gory A and Caugo7 B medical conditions shall help the lowng: cosigner understand the wipe of condiuon that could mull (al Hearing deficit in the pure mare thresholds in the In rejection or acceptance.The medical conditions Listed are unaided worst ear that is organstd by organ svuem.In the corresponding AppeeduA 1) Greater than 25 dB in three of the four frequencies nplanatory maenal.a diagnostic example b often included with die Inc.In addition.the ntionak for the rejection Is pro a. 500 Hz seined S.teams tithe effect of the medial condition on the b. 1000 Hz capability of the person to perform as a member. a 2000 Hs d. 3000 Ha 3A Had and Neck. O0. Mil Bead. (2) Greater than 30 dB in any one of the dine frequencies _ a. lit 3-L1.1 That shall be no Gregory A medial conditions. b. 00 1000 He 1L1.2v Category B medical conditions shall include the fol- c. Y000 Hz lowing: AND (II Manama of the skull such ode rchalonsoramwn (3) In addldan avenges greater than 20 dB fordo four fro quendra (2) Delta iaes of the skull associated with evidence of dm aseo(the brag..spinal cord,or peripheral Pen a 500 Hz b. 1000 Hz (3) Loss or congenital absence of the bony subsmnce of the c. 2000 Ha skull d. 3000 Fla (4) MY other head condition that(multi M a potion not (b) Unequal hearing bit being able wperform as a member Icl Atieda.aevere'tenons.or tom(of the auditory canal 112 Neck. (d) Seven external odds 1L11 There shall boon CategoryAmedicY conditions. le) Severe agenesis or eaumdc deformity of the auricle (B Severe nnatoidls or surgical deformity of the mastoid 12.12e Category B medical conditions than include theft. Iv Menlerek syndrome(labminthlds lowing Ih) Odds media 117 Thoracic cutesyndrome (i) My(her ear condition that results in a person not being able to perform as a member and reeds in a person (2) Congenital cysts. chronic draining fistulas. or similar being unable to pan ajob-pecl0c functional hearing tuft ten Imam or a heating in noise is (3) Convaoon of neck muscle 13 Distal (4) My other neck condition that resign In a person not being able to perform as a member 34.t There shall be no CategoryA medical conditions. 3-2 Ems and Vision. 3-L2e Category B medical conditions shall include the fol. tarring: 3-.11° Category Amedical conditions shall include the fol- (I) Diseases of thejaws or associated sissies lowing: (2) Orthodontic appliances ve (s) Fuoindnon a Far visual acuity shall beat eat 20/30 (3) Orldaue..a tweneen s binocular. corcected with contact lenses or spectacles pat 111 Ldad(tihiDbbetweendiemandibleandmuJlathalpre- visual acuity uncorrected shall be at lean20/100 binocular for dudes saGfacwtypnswrthodontic replacement rabll- wearers of ha contacts or spectacles, try tome proud(equipment d IbIP w.Visual Oeld performance without con (5) Any other dental condition diat raid*in a person not etphnoi w per bemg able to perform as a member reason Pall be 140 degrees in the horizontal meridian in each eye. 3-4 Nose.O.ephvyna.Than.Esophagus,and Larynx. 13 Es Category B medical conditions shall include the Fed- 3-IAe CategoryA medical conditions shell include the fol- lowing • II) Doran of die eye such as retinal detachment proems- (I I T htnamT sive reunopadm or optic neund. (2) Aphasia (2) Ophthalmological procedures such as ndhl ketamnomy M.r Category■medical conditions shall include the Pal- er repurof retinal detachment lowing: (3) M1oOter eye condition that result,in a person nocbemg (1) Congenial or acquired defomdry able to perform as a member (2) Allergic respiratory disorder .- 2000 Edam C tECoRY A AND CATEGORY 2 MEDICAL CONDITIONS 15g=A (3) Sinus.recurrent 34.2 Vascular System (<) DrPhonu 30.L1 There shall no l he CategoryA medical conditions. (5) Manua (6) My other nose.ocephuynn,trachea.esophagus.or lam- 10.2.2• Category 8 medical condmons shall include the fob yna condition that results in a person not being able to lowiag perform as a member or to communicateeffectively (I) Hypertension 17 Loop ad aim Wall (3) Pcnphen ma mm l macular disease such as Ravnaud's phenue. non 17.1• Category A medial conditions shall include the fol- (3) Recurrent thrombophlebins lowing: (4) Chronic hmphedema due to lymphadenopathy orsevere (1III Active hemoprysy venom seamier incompetency 1 Ampyeh (5) bgenital or acquired lessons of the soma or mayor vs. (Si Rdmonary hypertension (6) Marked circulatory instability as indicated by othosatic (a) Active cubercubsb hyporension,penistent tachycardia.and severe periph- eral Categoryeral vasomotor disturbances lowing: 8 medical conditions shall include the lob (7) Aneurysm of the heart or major vemel (0) Any other sascnla condition that results in a person not (1) Pulmonary resectional'urger):chest wall surgery,pries- being able to perform as a member mothorax (2) Bronclual asthmatic reacdveainniMeuse 34 AbelomiW Corpus soul Gastrointestinal System (3) Fthmttiona.cllem wall deformintdiaphragutabnatvuliaa 3-9.1 There shall be no Category A conditions. (4) Chrome obstrucda airway disease (3) Hypoxemk disorders IS Category B medical conditions shall include the fob (6) Intendaal lung diseases lowng (7) Pulmonary vascular diseases,pulmonary embolism 2) Chol<c( (0 ta) 8ronchieu °-) Camillassdds (9) Infectious d'ueans of the lung or pleuralspace (3)4 GI bAcutleeding (101 other (5) Hemia hepatitis My pulmonary rmasa member results ins person (5) Hemb nos being able to perform as a member (6) Inflammatory bowel disease SS Han and Vowels/System Intestinal obtasstim (8) Prncreatids 34.1 Hear (9) Resection,bowel al 12.1.10 Category A medical conditions shall include the fob (I0)Cirrhosis, iUlr hoot.r. hepatic or lowing (12)Chthals,hepatic aiii. (13)Chro other *care Irepolntti u (1) Anginaiectoris.ure.cu anent (1]7 My not rgmbet erf rm the ddetresmlts emb a per (2) Hew failure.cumin: son tom being able to perform the duaeadmtsnbar (3) Acute pesiardids,endocardhu,or myocardids 110 GedemuisWy Speaa. (4) Syncope,retuiTen) (51 Automatic implantable cardiac defibrillator 3-10.1 Rep•odeedw. 34.1.2• Category B medical conditions shag include tine fob 110.1.1 There shall be no Category A medical condidom. toning 340.1.2° Category 8 medical conditions shall include the fob (I) Significant Hinder lesions of the heart including pros. Imdnr thedc Antis (I) Pregnuscy,for in duration (2) Coronary artery disease,including history of myocardial (2) Dpmennorthea infarction.coronary artery bypass sorgerp or coronary (31 Endomerriosis,ovarian cysts.or other gynecologic eon. angioplasty.and dtntlar procedures ditiom (3) Aural tachycardia.flutter.or fibrillation 14) Testicular or<piddymal mats (4) Lee bundle branch block second-and third-degree aim- (5) Any other genital condition that results m a person not o.entacular block being able to perform as a member ((5) Venncubr tachycardia 110.2 Urinary Spann. 6) Hypertrophy of the heart (7) Recurrent paroxysmal tachycardia 3-10.2.1 There shall be no Category A medical conditions (0) Hiuonofa congenital aboxurmalry 110.22• Category B medical conditions shag include the fob (9) Chronic pericarditis.endocarditb,or myocardial lowing (10)Cardiac pacemaker (I) Disease of the kidney (II)Coronary artery sompasm (2) Diseases of the ureter bladdenor. prostate (12)Any other cardiac condition that results in a person not (3) My other urinary condition that results in a person not being able to perform as a member being able to perform as a member fern tom 1382-1) MEDICAL REQUIREMENTS FOR TIRE FIGHTERS AND INFORMATION roR FIRE DEP tItT31ENT al1{IcL'NS 111 Spine,Scapulae,Ribs,ad Sacroiliac Joints. 3.14 Skin. 111.1 There shall be no Category A medical condition: 114.1 There stall be no Category A medical condiuons. 311.26 Category B medical condtoem shah include the fob 114.2• Category B medical condition shall Include the foL Lnrny Mmng (I) Anhnns (I) Acne or inflammatory skin disease (2) Structural abnormahry.fracture.or diskaSion 121 Eczema (31 Nucleus Wpm,.herniation of.or baton of lamnec- 13) Anyother d<muwbgre condition that rauln in the per. tomsdAcectemvorfuion son not being able toperform as a member (41 Motoring spondyliw 3-13 Blood and Bleefloning Organs. CS) My other spinal<ondmon that mini in a person not I•45.IS. medical conditions shall include the feL being able to perfrm as a member } Category A me loader 342 Esnemidn. (II Hemorrhagic ates moulting replacement therapy 112.1 There shall be no Category A medial mndiuoru 121 Stride cell deease Ihomos satin - 112.2• Category 5 medical condition:shah include the fel- NBS• Category B medial conditions shall include the foL e lowing: lowing I/ Anem <I) Limitation of motion ofajotm (21 Leuhnepenia 12) Amputation ordefonniry Ma joint or limb (31 PWltytllemuven (3) Dukcation of'joint (4) Spknomegaly (4) Joint reconawcuan, ligaanensow ImtabBlte ac pint (5) Hhoty ofthrombaembolic disease replacement (6) Any other hematolopal condition that resins in a per- CM Chronic osteaaMrirk or traumatic arthritis son not being able to?edema a member (6) !Minimum"arthritis 116 Eadectine awl Mrsabelle Disorders. (7) Myotser warm*condition Nat ratan in apemen not being able to pMonn as a member 43-11.1• Diabetes mellitus.which is treated with insulin or an 113N Disorders ral hypoglycemic agent and Mitre a individual has history Neurological of one or more episodes of incapacitating hypoglycemia.shall • 113.1• Category A medical candidata shall include the Cot- be a Category Ametcal condition. loMing 3-16.2• Category B medical conditions shall include the fol (I) Amdaofheredodegeneradve type MMng' (2) Cerebral aneriaseMeh as evidenced by documented (I) Diseases of the adrenal gland pituitary gland,panty. epoodeofneurologicalimpairment reid gland,or thyroid gland admiral significance (3) Muldpk sclera*with salary or evidence of progression (2) Nutritional deficiency disease or metabolic disorder within previous three years (31 Diabetes mellitus requtinguenmentMth Inseam or oral (4) Progtemlve muscular dystrophy or atrophy hypoglycemic agent without a history of incapacitating (3) All epileptic conditions to Include simple partial,complex hypoglycemia partial.generalized,and psychomotor sebum duorde (4) My other endocrine or meabolic condition that results other tun those with complete control during previous in a person not being able to perform as a member flte years.normal neurological enatlm,anddegni- 117 Satanic Diann n Dwn and hWB aMM anea COoee `live statement from qualified neurdogid speulbt. 113.2Ifanepileptic member experiences afire-year sdaum 347.1 Theta shall bno CaryoryA medial condition.free interval resulting from a change in the medial regimen, 3.17.2° Category B medical conditions shall inhale the fol- that individual shall not be cleared for noun so Breaghdng lowing duty until he Of she has completed Om yearswithowa seine (1) Connective tissue disease,such asdenseemywids,lupus on the new regimen. eryxhematew,cleradenna Ind rheumatoid arthritis 113.3• Category I medical conditions shah include the Mi. (2) Residuals from past thermalisjury lowing; (3) Docawnted evidence of a predisposition to hew soar l I) Congenital malformations with recommt episode or resulting residual injury R (O My other systemic condition that results in a peon not - 12) Migrant being able to perform as a member (31 Clinical dborde with paresis. paralysis, dyscoordina- son.deformity,abnormal moor acclaim abnormality of 118 Tumors ad Malignant Dianna sensation,or compksnt of pain 118.1 There shall be no G (4) Soharecindd or intncerebral hemorrhage Category Amedkal condition (3) Abnormalities from recent head injury such as severe 118.2e Category B medical conditions shall mdude the fd- cerebral contusion orconcussion 10i41311' 16) My other neurological condition that results in a person (I) Malignant disease that is needy diagnosed,unwted,or not being able to perform as a member currently being vested. 2000 Oman • INCIDENT SCENE ItEr133ILIT I.TION molt NEoICLL TAL\TsuENT 1382d1 a. Candidates shall be subject to the provisions nl 2,13 43.2• All members shall be evaluated accoMmq co current of this standard. CDC guidelines following any tuberculous csposurc. These ' b. Current member shall be subject to the provisions of results shall be communicated to and rescued by the fire 24 a of this standard. dcparment physician. Cl Treated malignant divau that is evaluated on the basis 44• Imwmhaden. All members shall he immunised of an indbdual's current phvnal condmon and on the aynint infectious di ays u required be the authunry havin likelihood of the Minxto recur or progress- g II Ms other tumor or similar condition this results in a per- lumdicmn and by 29 CfR 1910 ,an -8knM6nme hth& son not being abl<mperWm as a member gen.- The fire department phvacan stun ensure that all tnmben arc offered currently recommended unmumuuom. 119 Prydiavic Cenddoes 119.1 There shall be no Categnot A medical conthuiin> Chapter S Incident Scene Rebabuitadon 119.2• Category B medical mndiuon shill include the Soh and Medical Treatment Wwing 11 Incident Scene Rehabtiudon. ID A history of pnmhutnc conthtinn or substance abuse SL1• The fire d< a tmmt shall develop problem procedures that outline asntematc apprach fstanor theprch p oeratinl- C) Any other puchuuhc condition that results in a person nation of memben npcndng at incident,. Pronrun not being able to perform as a member addressed in these procedures shall include medical molar 1195 Candidates and current members shall be evaluated non and ueaunent food and fluid replenishment.crew rota- based on the tndnidual's current condition. uan.and relief from extreme climatic conditions. 120 Chemicals,Drys,and 5kdication& 54.2• The incident commander shall consider the°rot m- srnces ofeach incident sod initiate ten and rehabiliutsen of 120-1 There shall be no Category A medical conditions member,in accordance with the fire departments standard 120.Y• Gregory S medical conditions shall include the use operating procedures and with NIPA 1561,Stendad a Ease d the following' grnq Semen/widen AWg nrvnt Spine 111 Anticoagulant agenn 11 laddent San Safety and Health. (2) Cardiovascular agents SLI The Incident safety offMr shall enure than the incident Q1 Narcotics commander e,t.bliahes an incident scene rehalaliataon t.cd- (4) Sdatsve-hypnodcs cal level management component during emergency opera- (5) Stimulant. tons as required by NEPA 1521.Standard fee For&partmeu (6) Psychoacum agents WRY Officer (1) Steroids (8) Any other chemical,dnsg.or medicadon that results ma SLY• irarupon capable emergency medical semen(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 Infedmss Disease Program level ofavailable Advancedre.Adnced life support(AIS) care is preferable where it is available. 44 Iafsctia Coned Program. 5.3 Evaluation ad triage of Member Injuries. 41.1 The fire department shall maintain infection control SS.I In the event of an in)unto a member during emergeny program as delineated in NIPA 1581,Standard on fin Dyer- operations, EMS penonael shall assess and treat the injury mew Wanes ~ °' based on lot EMS protocol and fire department standard 41.2 The fire department phpkian shall maintain a liaison uperaung procedures. with the infection control officer as specified in NFPA f581. 11.24 Protocols and procedures guiding EMS providers cat 4-2 Exposure bidden. mg for ill or injured members dunng emergency operations shall be developed by the EMS medical director m mnabon- 4LI• NI blood and/at body fluid exposures shall be uon mth the fire department physician and chief reported immediately.and medical assessment shall be pro- vided within 2 hour'of exposure. Medial assessment shall 54 IncideuuScae RehabilitateTacdtal Level Maagement confirm to current CDC guidelines Csanpaenu 4d.26 All other cepowre incidents shall be reported and 54.1 The rehabilitation tactical level management comps assessment provided within 24 hours of exposure. e eat shall be designated per department standardstandardoperat- rocedures,such as large•scaleincidents.Wngdurnwn 43 Tuberculosis. incidents.or those associated with significant temperature 45.1• The fire department shall provide a tuberculosis m extremes nna program that toll test members at least annually and as 54.2 The rehabilitation tactical level management comp& indicated by CDC guidelines.Tuberculosis 1TS)testing inter- nein shall be established In a safe environment away from the yak shall conform to current CDC guidelines. handers area of the incident Inn Damn I561-I2 %EDIritt.RtQL IRE31E615 FOR FIRE EWA I ruts tin INFOSst\tIDN FOR FIRE Of r'RTMCNT elnhwILWr 54.3• The resources needed at the rchabil,utmn tactical Appendix A Explanatory Material Ih el management component shall include an environment to limit temperature urets medical equipment.and adequate ,app,Ax A u w a pm of At n p us umna o/Iku 1FP.3 teen medical sad "All bid atMIle fear uya .ammd peepno onh Thu apprndu 54.4' Slemben shall be assigned to rehabiiuuan as pre e.Ietm tyrant on n„avi,d nu,nband to tamped with shrapp. scribed by depatunend standard npenung procedures. n Ale teapu,y sphL Unusual arcumuanccs such as long-duration incdenu,w,m. eons requiring heave eaenson.ar there weather c.memes .41!.Y There is a direct relationship between the medical ,lull require an alteration in procedures. rapircmenu and the job dump on of members.The Job description shook'include all essentialjob functions of men. 5M.3' Slemben amvmsg at rehabilitation shall be bneth ben.both emergency and nnnemcgenw Members perform 'presumed In medical traf"hoot any svmpmma o[*huh. nnen of emergence openuam mdwlin9 Ore fightlng, wan.heat suers.cold stress,physical enhauvlson.and.Or can eaurgenc medical care.hanrdaua matenals mmgman.and dnpnhuman abnormblnles.Lty member having ugndkant special npenoons Nonemergent,teen can endue.and are vmpmms shall be moved to an area whet c assessment b' not limited to.training.liaison and vehkk maintenance,and advance lie support personnel can be performed. ph.dcal fitness.leis trc departsnent need n identify and S-k6 Members assigned to rehablitauon shall be encouraged derv<Wp a wnum jab darnpum for members..\pp<ndia C. to add.remove clothing to regain normal body temperature. Essential Fire Fi hung Functions. prmdes an example of Meal Bends Mane electrolyte rcpuementdnnLsl.and mt. etemuljob function for members 54.7 No member shill he reassigned to return to dun until A-1-32 The specific determination of the authority having medical evaluation and hydration has occurred far at least junsduuan depends an die mechanism underwheh this sun. 10 minutes in rehabilitation and after being cleared by darduadopted and enforced.Where this standard is adopted medical staff mlununh hr a pNcular fire depatment for its ovn use,the S•1.8 All membenenre and leasing rehabilitation shall be authority haing jurisdiction should be the five chief or the tar me ed W the incident management and be political entry tsar b respmsable for the operation of the fire proper assigned depuunenL Where this standard n. legdW adopted and tracked through the personnel accountability mtent enforced by a body having regdasary authority over a Ore department. such as federal.state or local government or ter Mlerenced Publications political subroson,this body is responsible for making those �P dererminatiom asthe authority hayingjuttdicdoa The cot' pllance Program should take into account the semces the fire Si The following documents ar pardons thereof are refer. department is required to pronde. the financial resources emcee]within this standard as mandatory regtmhnenu andavailable la the fire department.the availability of?enamel, shall be considered pan oft.reqiIrernenis of this standard. the availability duainen,and such other futon as will affect The edition indicated far each referenced mandatory dote• the the department's ability to achieve compliance. mem is the current edition asof the date of the NEPA issuance of this standard.Some of these mandatory documents might .414.1 Approved The National Fee Protection Aasacsauon also be referenced in this standard for specific infermauonal does not approve.Inspect or certify any installations.prate purposes and,therefore.are also hued in Appendix F. duress equipment m materiab:not doe it approve or eNu Sit NAA Publkatem. National Fire Protection ,Wecia ate tens' hbonrona. In determining the acceptability of oars l Banerymarch Park,P.O.Baa 9101 Quiwy.M.102269. inadlations.procedures,equtpmem.ormaterhls.theauthory 9101. ity haring funsdicdon may base acceptance on compliance NFPA 13M.Scanlon'ow Fin hpsnaw Oaupa,md Safety with NFPA or other appropnate standards In the absence of and 1Nana 300.&a 1997 edition. such standards.said authonry may require evidence of proper c. NEPA 1521.Standard for Fin Oepmsnna Safety Offing 1997 Iion mayllan al procedure.or use.The authority ha dices ofan edition. ton may also refer to the listings or labeling practices an NFPA 1551.SmdeN on E Sewn(reuLea,Stu oryhnintinn that is concerned with product evaluations and is Emergency ter thus in a positron to determine compliance with appropriate stem Ana 9000 edition. standards for the current production of listed Haas. NFPA 1381.SranLmf n Fire t palsmmt Infection Gels pre qmw.2000 edman. A1-1.2 Atelier'',HavbgJuruAedon. The phrase'audience 64.2 ti.S.Oorernsemr Publications. E'S finemmem Pant- ing Ofike,Washngton DC 20401. manner,smcejurudworo and approval agencies vary.as de -Tide_9,foJ.o/fdnv<W)n.Wsms,Part 1910120.'Hazard' their respanubdioe. Where public safety Primary, the sea Waste O and Emergencyautismry kmngpmdmnon may be a federal.see,local.or Operations Response.'1966 other regional department or individual such a a Ore chief ous Cher g•FattraiRegubw,mt Part 1910.134.-Respire' fire manhole chief of a fire prevention burcai.hbor depart- tort Fe19.Cc;1996. met or health Cepartmenu bolding rity official: elerascal Tide29.Code of£dmd Regu(asv,Pan 191095.'OccupJ. inspector;or others having summit autoriry itirirouranre man Noe Exposure.'1960 purposes an insurance inspection department rating bureau. Tide2n. Cod of Fdmi ReeuLmw,Pan 1910.90,'Medical or other Insurance company representative maybe the author Rec dkeepng:19811 n having junsdicuon. In maw stances.the property Tide 29.Coder/Federal Regrdwm o .Pan 1910 1030.-Blond. owner or his or her designated agentgent assumes the role of the • borne Pathogens, 1095 aurhonn hanng jaridituan.at government lmulhtian4 the sow Sawn ra'r(Yfl\ 1 t 8 -lS commanding officer or departmental official ram he the AI-SA See Appendix D.Section 0-I.Legal Considerationstn atithonn hanngpiridiction Applying the Standard. 4141.3 Candidate. In an emplmment context. the .M,en• At-5 4 labiate] therapy. strength training.work hardening. cans with DeabJtun.Avu(discussed in furtherdemd inAppea- functional apacmevaluatmu.and alternate dun are all um. dix DI requites thaswr medical examination co be conducted mew that can he helpftd take place after an offer of emplmment IImade and pnor to ,4k2.1.2 6g B medicalconditionsof the head includeth commencement of dutan.Therefore.in the emplo•went e2nrY context the definition of the term candidate;Mudd be applied the followimy w x to be comment with that requirement. t I) Deformities of the skull. such m .deprentom or e.oVolunteer members have been deemed to be emploseea tines,of a degree that interferes with the use of protect I In some sums or jurodicnans,Volunteer fire depanmenu nee equipment. Deformities of the skull can result in should seek legal counsel as to their legal respumibilina in the member, inability to pmperb wear protttuse these mourn equipment. AlJ.tO Member. See Appendix C.Esuntal Summed Fire- (2) Deformities of the skull matured with evidence of di,- erne of penph<ral nerves These Fi;hung Functions. deformities can result in the potential for sudden Ina. A-2.1.1 See Appendix D.Garde for Fire Department Admtiue penman. the inability to properly wear protective 'aalorsequipment.and the inability to communicate electively M21.S Exposures and medical conduom that ahosdd he due toorophanngeal dsfunction. A.24.5 Exosresnnterfen onabons ofWmdmd he (]I Lon oforcongemtal absence ofrhe boavmbatance of the to pedants as a member include.but am not limited to.the mall e o moruted with dtsecu inan a with Ped(for following. the sea Jappropvse edn with cannot be provided for the area without interfering with p equipment (1) Exposures to hazardous materials or toxic whinnies andcbmn).Lou of or congenital ateerace nce of of the bonysub- t2) Exposure to Infectious or contagmw diseases stance of the skull can result in the inability to properly 1]) nines or injury wear protective equipment and the inability tocommwi. (4) Use of prescription or nonprennpuon drugs caw eg<ersely due to oropharyngealdiYunction 0) Flys..sc., N) Any other head condition that rewlu in a pawn nog .422.2 See Appendix D.Section D2_.Choosing a fire Depart- ment Physician. A33.2.2 Category B medical candiuom of the neck include .4 ] See Appendix B. Information far Fin Department the following 22 Physicians. Appendix C Essential structural lre.Fighung 11) Thoracic owlet syndrome (symptomatic).Thwack out- Function, provides a ge'enc description of job cvks per- formed by members.A fire deparment needs to provide W inabiliryto perform work fire department physician with ajob description of all pas;. In_) Congenital cysts, chronic draining fistulas. or similar dons and ranks so that the fire deprtn ent physkian can lesions (if lesions or underlying disease interferes with understand he phsscal and mend demands placed upon all performance).Congenital cysu.chronic draining fistu. members reprdlen of position or rank.Appendix D.Guide km.orsimibs lesions can result in the inability to properly for Fire Department Mminbmtors.also pro ides guidance wear protective equipment and he inability to commu- ter ensuring that the fire department physkhn is provided nicate e(fecdvely due to aropharyngeal dysfunction. with chi,information. (3) Contraction of neck muscles(lit interfere,with weanng ASJ SeeAppends B. Sttuon 6]. Guidance for Medical of protective equipment or ability to perform duties). El aluauatu The contraction of neck muscles thecan result ininabi4 In to properly wear protective equipment.and the unabd- A-2.2.4 SeeAppend=D.Section Psis lepl Considerations in icy to perform functions as a member due to limitation of Applying the Standard flexibility. (Al Any other neck condition that results in a person not A2-1 See Appendix B. Section W. Guidance for Medical Ewluatiwms being able inperformasa member. AI�.I] At the discretion of die fire department AS].l Category A medical condition,of the eves and vision par physician, include the fallowing: I an examination can be performed sooner than would be expected from the schedule given in 24 I 3.Current medical II) Far ewd amly Far visual acuity is at least 20/30binocu- conditions and coronary nsk factors could mandate more frc rat.corrected with contact lenses or spectacles far visual guent medical examinations. acuity uncorrected is at least 20.'100 binocular for war A4.{.IA SeeAppendix B.Gard<for Fire pie en of hard contain or spectacles.Successful long-term uciam payment ally- soft contact lens wearers (that is. ax month,without a problem) are not subject to the uncorrected standard. ntaom In Inadequate far visual acuity can result in the Callum to be A-24.3 See Appendix O.Section D.1.Legal Commde Applying the Standard able to read placards and street signs or to see and respond to imminendy hazardous situwons A.2.S.1 A department should set protocols regarding length (?) Pmphmm mice Visual field performance without correc- of time absent from duty and/or medical conditions that ten is 140 degrees in the horizontal meridian in each require die department physician to evaluate a member eye. (Members cannot have just monocular wren.) Nor Ea4on l 312-II )ICInCkt.Ii gUIR2nt-Te FOn rutE HbIttl0.t 1)OH IK)lVn)u POk Stet OLP LRT'ItNT PHYSIC!\b Mbmoeular wmm can result in sudden mzapaciuuon lb/ Semrc<eternal own.that is.recurrent Fos of hearing when daub is kicked'one rye.Inadequate or coinpro can remit in the malnlit to hear wools ofIwo intensity or to msed penplieml vision can result in the following. d+vonghosh voice from background Rime.leasing to failure to a. Failure to perumhlob dudes and maintain visual cnro ropnrM to Imminency haaardotn nuutiong tact with a partner (c) Score agents or traumatic defunnln'of the auncle b Inabibn to maintain Laren near moving objects CAA remit m the mobhhn to propery wear protective equip c. Pour balance on uneven wrfxn mentand the inability to hear sounds of low'town sir to diw d. UnwuceaBA performance in enurement, where wwe(sum backgnund noise,leading to failure to surd cues are mescal to pen nil mien respond to imminently hazardous wtuaauna A51° B medical conditions of the eyes and vi.mn r (ill Swett ntaamidiut or surgical deformity'tribe mastoid m13.2 Category B can remit in the inability to properly wear protective equip g meat and the inability to hear sounds of low intenatvor to din I If Ducasea of the eve such as retinal detachment.progre ung+nsh voice front background node.leading to failure to nnpthy,or optic nelsons(uwre or pntgrnwrel espond to imminently hazarAmu notations. These diseases of the eyc can result n the failure to read le) Stemmer androme or inert labcintfiw may result placard%and Street signs or to are and respond to nom in the potenual for sudden incapacitation and the inability to bendy hazardous unudom. perfonnjob(moons due to limitation.of balance. (2I Ophthalmological procedures Rich as radial keratot. 10 Onus maim(chronic)can result in frequent episodes ono and repair of retinal detachment. With retinal of pain or the inability to perfonn work and the inability to detachment.sufficient time (14 weeks for radial ken. hear sounds of low intenum or toduungwah voice from b.ck- tonainy and Laokepe'urgeriei,three months for red- ground noise.leading to failure to respond to'momently haz- nal detachment)must have passed to allowmbdiaoon ardeus nsuaaons. of visual acuity and to ensure that there are no penult. lip Any other ear condition that multi in a person not final complications. These ophthalmological proce- being able in perform as a member can be classified a a Cab duos may revolt In the failure to be able to read cgory B medical condition of hearing, placards and sweet signs or to see and respond to Mow nendv hazardous situations. A34.2 Category B denial medical conditions include the fol. (3) Anyot ereye condition that results In a penon not being lowing able to perform as a member.Persons with severe color 1 p Diseases of the jaws or associated tines(those that re vision Ion will likely foil the acuity reprhrcment incapadtadng or preclude ability to use protective formerly.color vision deficiency was listed as a Cate- equipment).Diseases of the jaws or associated dawn gory B medical condition.However,it a felt that within can result in the inability to properly wear protective most taus this condition vnll not affect the abibry of a equipment. member to perform the essential functions of his or her i2) Orthodontic appliances(those that preclude the ability job. senateThe fire senate physician should consider the color m tau proudv ce equipment.The wearing of onh m odo vision deficiency of the indwidual and consider the color tic appliances can result in the inability to properly wen vision requiremenu of the member's lob and reach an protective equipment. individual determination. (11 Oral dames.extensive loss(thatwlhich precludes ntslae A.112 There are cumndy no hearngteststhat will avow the tory pwmModontic replacement or ability to use pro- fire department physician to accurately predict whether the teedve eguipm<ntl. Extensive Ices of oral mow may fire lighter will adequately be able to perform essential job result in the inability to properly wear protective equip- duties.job-specific hearing tests should be individualized for meat and the uabdiry to communicate effectively due to cacti department and its specific job huwtons.The following oropharyngeal dysfunction. list of hearingspccigc tasks can amino direct development of (II Relationship between the mandible and maxilla that pre. hearing protocols. eludes satisfactory postotdodontic replacement or abik III Understanding spoken commands.both over the radio try to use protecuveequipment This condiuoncen result and while wearing SCBA in the inability to properly wear pmtenive equipment 12) Hearing alarm signals, including building evacuation. and do inability to communicate effectively due to low airsignal on the SCB m A,and PASS alau oropharyngeal dysfunction. (3) Hearing and locaung the source of calls for assistance lit My other dental condition that results in a person not from victims or other fire lighten being able to perform asa member. All Of to above tasks will need to be performed with yea. A.3-4.I Category A medical conditions of the nice.orophan tonally simulated incident scene background noiseand SCBA yaX inchea,esophagw.and larynx include the fallowing noise.She inability to hear sounds°flow Intermit,or to Won. III Tnchemremy Aoxhewmmy can result the inability gunk voice from background noise can lead to failure toro Pmperly wear protective equipment.the inability to respond to ummhnendy hazardous dmations.(Ser elseM al perform job functions due in limitations of endurance. Category B medical conditions of heating include the fob and the inability to communicate eg<cowly due to lowing oropharyngeal dysfunction. sat Unequal hearing can result in the inability m localize (21 Aphonia.regardless of cause Aphasia can result Lit the womb.leading to failure in the ability to perform search and inability to communicate etemvely due to oropharym rescue and other localization tasks. Beal dysfunction MOO Edwin APPENDIX A 1582-13 A-14.1 Category B medical conditions of the nose.oroplur (9) Infectious diseases of the lung or pleural space. nx.trachea.esophagus.and lame Include the following: (10)Any other pulmonary condition that results m a penasn (l) Congenital or acquired deformity teat mterkns with the not being able to perform as a member. ability to the protecate equipment. A congenital or A-341.1 CategoryAmedicalcondmonsofdieheartandna- acquired defomuty can result in the inabdity to properly <War dawns include the following: wear protean equipment tl) Affirm'pecrom.current.Mgma pistons can result in r_1 prawAllergns respineoe disorderM (mane frequent episodes ders ens frequent episodes of pain or inability to perform work,themets.to pefr nnoshmndthility to .faunn. ve illness leadingw funmonil impairment.and I 0etmbdiaa member worn lnetti limitations ofendurarform ate pommel for sudden tcapaumoan. Pane gaunt re a meat(severe, to li hung r of endurance.hap. (2) glean radar. current. Hem failure on result in fru fll damns recurrent(oven,eni) Sec repeated damns an quent episodes of pro or inability m perform work.pm, remit or g empades in and nrainmtm can gmsle diners leading to functional impairment.and the perform e frequent episodes of pain and she wabkr NIP potential foe sudden incapacitation. 1a1 Dysphmia(revere);Severe derphmia can result in the (3) Acute pericardloa endocarditis. or mvoarditis. Then inability to communicate efectuely due to orophatyn. conditions an result in frequent episodes of pain or the gal dvrfuncvon. inability to perform work. (3) Am„her nost oropharenu trachea,esophagus.or kr, (4) Syncope,recurrent.Recurrent syncope can result in the otential for redden tnca iatim. • per smasamdayer or maten rotbeing able m i3) Automatic ins lanabk rd4ac defdbnllator An a perform as member or to communicate erceuveh ' P 'a' 417.1 Category A ndedial conditions of the lungsand chat 'mama implantable onude n cardiac des don. can result m the wall include move hmwprysia empyenu.pulmonaryM1.pery pomade'for sudden iaapaiatlon. tendon.and active suherculosis.These condduam can result A'38.I.2 Category B medical condioom of the hem and vs in the inability to perloem(masons aamember due to lln.i- chief slit"'Include the totlowmp utions of endurance. (l) Significant valvular lesions of the heart,including pros. AS7.2 Category B medical condiaom of the lungs and chest deck valves.Specific recommendation,include the fa- ' wall include the following: lowing: a. Mend rand Mitral stenosis is acceptable if in sinus(I) Pulmonary resecdonal stollens w ens chestall surgery.pnete rhythm aid moods is meld.that it salve areas l.3 cat modsorax (due is. history of recurrent spontaneous or pulmonary artery s niolic pressure<33 men Hg. pnmmothmal. These conditions can result in the b. Muralintu�Jb'ms}Mail insufficiency is acceptable it inability toperfo perform as a member due to limier. in sines rhythm with normal left ventricular site and dons of strength endurance and may result In the funcmn potential for sudden rapae aim c. Aortic detrain Aortic stenosis is acceptable if steak (P) m Bronchial asthma or reactive abway disease (frequent mild.that k,mean sonic valvular pressure graa- meedkaaonmeorgtmpromcaused by eepoounon d nen Is <20mm Hg. Son,hntand<on)or onchmasusma aim airo her as d AwMM dvpgtaIa garde regurgleadon b acceptable if irritant inhalation) Bronchial asthma or reactive airway leftvenuictat sue is normal or slightly increased and disease can result in frequent episodes pain or the systolic lurctun b nonnil. "nabliry to perform work the to e for sudden inca. ts a e. RmMk tuba Prostihetic valve are acceptable unless pacitaebn,and the inability perform functions a a andco member due co full limiadons of endurance ag'daim is in effect (a) ties.Fierax,chest il deformity,dbphrand abphr,ili, le-1 Coronary array disease.including history of mcorydial ea Fibwdwra.chest wall deformity, and diaphragm infarction. coronary artery bypass surgery, coronary u abnormalities can result In the inabiryea perform func. angloplastli and similar procedures. Persons at mildlyadue dons a member limiradons increased of endurance. ncreased risk for sudden incapacitation are acceptable (4) Chronic obstructive airways disease.Chronic obmd<me for fire figtong.Mildly increased risk b defused by the airway disease rub in the Inability to perform tun. presence a each of the following: dons a a member due to liminuons&endurance a, formal left ventricular ejection fraction (5) Moos mu disorders.mfuncmiceis a mcan result in b, Normal exermehdmnce.att metabolic egulwktm the inability a perform function as a member due to (blence hmniudon,of endurance. c. Absence oof erdteenducedudtmib ban vet toting (6) Interstitial in l lung diseases. rn fun lung diseases can d Absence of exereumnduced complex vermicular resuk in the inanlity to perform Maroons as a member arrhythmia due to lanadom ofeneurance. e. Absence ofnemodynamkally percent unions on all i 7) Pulmonary vascular disease,pulmonary embolism.Pub major coronary attune l(era my Percent lumen diameter monary vascular diseases and pulmonary embolism can narrowing).or successful myocardial m armlanadon result in frequent episodes of pain the inability tr (3) Aent aAyordu.Burr.or on rm perfo functions as a member duee go limitations of lal Left bundle branch, and ih second"and thdNdegne auioven- endutane. 'titular Mock These blocks will result in dequaligwoon (a) Iltioncpulmonary decwis with significant rnWual impairment of unites exeewan be pe ormednchan adequate heart pulmonary function or reguiemgfreguent therapy Um- ran response They can result in frequent episodes of as a men can result in the inability to perform functions pain,the inability to perform work,and lave the pour as a member due ro limitations of endurance. nal for sudden incapacitation. mob Fetes 1342-I6 tD(rAE HEW.1Rl#IENTYfOn RRE PHnfhR.it SO lNFOtL%rum re im FIRE DEP'RT)IENT PI rtlio IUS 3) Venmadar uchrcardu. Ventricular ncha+Mn can to limitations of endurance and the inability to perform mud'in the potential for sudden mcapxaeoon and the Job functions due to limttanom of balance. inability to perform Job functions due to limitations M 17) .tneurysm of the heart or mayor veil. congennal or strength or endurance. acquired.An aneurysm of the heart or maim veael can (6) Hvpertrophv of the heart Hypcnraphy of the heart can result in frequent episodes of pain.the inability to per result in the potential for mdilen incapacitation and the form wark and the potential for sudden incapactutinn. inability to perform Job functions due to limitations of !El Mir other vascular condition that results ins person net endurance. bang able in perfom as a member IT) Recurrent paroasanal tinthetachycardia. ectnent pudden ,t-19.2 Category R medical conditions of the abdominal ai tuh cards can result in the potential for sudden and S l.stem include the following:due to and the inability to penbnceMfunctmns otvn. Rao g duenn limitations of strength or endurance. ill atelecoaaas (that which muses frequent pain due to (8) Hhrugery congenital abnormality that ha been treated emnes or infection)orChdttnatis can result in frequent beergerybut withrgery.lavingrauans or that ha not episodes of pain or the inability to perform work. been treated by surgery.leaving residuals or o t (2) Camels(that which cause recurrent pain and mins. a congenial abnormality can rc ark in frequentn menu.Cant can midi hequnc<pnadnMpam or episodes of pain or inability to perform work and the the inability to perform work potential for sudden incapacitation. fill CI bleedanginstability re can roue fatigue, and or mark. vNc (9) Chronic pencardtu,einduardius.or perfordinsltiese nsesWong In inability to perform mark. conditions can resultn the Inability to perfotmphfune- ( Acute hepatitis (until xamnum of acute hepatitis as tons due to limitations of endurance. determined by clinical examination anresppropnae lab (10)Cardiac pacemaker. If the person is due ais en- oratory of pain Acute hepatitis can result in frequent dent then the risk for'cardiac failure due to cad dhave not a ofpain or the inability to perform wart acceptable.Thou bid'cardiac pacemakers can have the (31 Hernia(onrepadred inguinal or abdominal henna that potential for sudden incapacitation.pasm. could obstruct during dug). A hernia can result in the (Ill Coronary arteryve .Those with cardiac artery potential forsuddel incapacitation VZIO1ration tram can have the potential for sudden mcapaci- (6) Inflammatory bowel disease(dens which causesdtabbng I I21 Any other cardiac condition chat results in a person not pain or diarrhea).Inflammatory bowel disease can result being able to aerie n as a member. in frequent episodes of pain or the inability to perform work. It ls a progress a Illness leading to bnctional Ad41.2.2 Category k medical conditions of die vascular sty- impairment tern include the following: (7) Intestinal obstruction (that is, recent obstruction with III Hypertension that is uncontrolled,poorly controlled a impairment).An nmdnal obstruction can result in lm- requires mediation likely to interfere with the pear- and episodes of pain, the inability to perfann work. requires of dudes Acceptable hypertension is a bland pres- surelen than igp/Iao and no target organ damage. (8) Pancreatids (that is chronic or recurrent with impair- Hypertension b a progressive Illness leading to Functional ment) Pancreadds can result In frequent episodes of impairment with the potential for sudden incapadtadon. pain or the inability to perform work. 12) Penphnl vascular disease,such as Raynads phenome- (9) Raccoon.bowel(if frequent diarrhea precludes perfor- non,that Interferes with performance of dunes or makes mance of duty).A bowel resection can result in frequent the individual likely to have significant risk of severe episodes of pain or the inability to perform work iiytry.Peripheral vaxular disease can result in frequent (to)Ulcer. gavointestinal (where rympoms are WCOM episodes of pain or the inability to perform work and the trolled by drip or surgery).Agatroinewiul ulcer can inability to perform functions as a member due to limits result in frequent episodes of pain or the inability to per mans of endurance. form work. (Si Recurrent thrombophlebitis Recurrent thrombophlebi- (il)Cirrhosis.hepatic or billary(that which is anpomadc or tit can result in frequent episodes of pain or the inability in danger of bleeding).Onhosis can rant in frequent to perform work and the inability to perform&sections as episodes of pain or the inability to perform wort a member due to limitations ofendurance (121 Chronic active hepatitis. Chronic. active hepatitis can (al Chronic lymphedema due o Ilmphopathy Or severe result in frequent episodes of pin nr the inability to per venous valvular Incompetency.Chronic lymphedema can form wad. result in the inability to perform functions as a member (IS)Another gastrointestinal condition that results in a per- due to limitations of endurance. son not being able to perform as a member. (5) Congenital or acquired lesions of the aorta or map.Yes- A110.1.2 Category 6 medical conditions of the reproductive eta.fore.ample.syphiliticaormhs demuiutrable athero- sclerosis negaa lack."the fdlomng that interfere with circulation.and congenital acquired ddmatien of the aura.Congenital or acquired (II Pregnancy Pregnancy can result in frequent episodes of lesions of the aorta or major vessels can murk in the pain or the inability to perform work;progressive inabil- potential for sudden Incapacitation and the inability to ay to perform work due to limitations of endurance.deo perfomaph function,due to limitations of endurane cbiliry, Of strength; and the inability m properly wear (6) Marked circulator,instability as indicated by oMostat protective equipment(Srr&e 4.Rtpmduimw.) hypotension. persistent tachycardia,and severe peripb (1) Dywncnonhea that leads to recurrent incapacitation. nil vasomotor disturbances.Marked circulatorywtabis Dymenontes can result in frequent episodes ofpain or try can result in the inability to pert gab fumdons due the inability to perform work. 200o Emm O rE}DIX h 1 iy±.17 3) Endomemons,ovanan am,or ther gynecologic condw didnaumn. it huge of more n mitt. would not mans (severe. leading to recurrent mapattatinnl exclude a peon. Dislocation of a pant an molt n the Endomnnoia.woman cysts,and other gynecologic mry inabilin 10 perYarm functions as a member due to lime,.dmons can result in frequent episodes of pain of the mom of strength or Ilevhdty inability to perform work. If) Joint recon,m¢uon, ligamentous amiability. or (11 Tesuaular or epidsd.mal map(that which requires medik replacement, in cases where recurrent or with pant cal naluauon) A testicular ore didnnal mass can resultn resulml pful and safe numnman.,. glee w moms with success- in m frequent.Thisepisodes es pain or the inability to tbwm for at „tee enamor ete tire-lightingen Amex surgery impairment. me w a progressive illn<a leading to functional for a cep ant<nor cools iecould Ia, it imp other genial strength a not normal or if the knee is lax or RI Any other genial condition that mules in a person not de chips pain or ,welling when stressed These condo being able to perform as a member cloth of die joint can molt in the inability to perform A 40 2: Category B medical conditions of the'mnary sin functions11a member due to limitations of in tern include the following- llexibibn 111 Dusan of the kidney requiting dialmn.Diseases of the t3i Chronic mteomthnm or tnumauc arthritis On cases kidneyueas can result in frequent a soles of or the where recurrent exacerbation. leads to impaument) kid pu wfrk. sn Kidney disease o pain the Chronic wumntriva or traumatic anbnm.an result in frequent episodes of pain.the inability to perform work. illness leading to functional Impairment andthe inabt is to perform Mamoru as a member due 12) Diseases of the ureter, bladder,or prostate that require to limitations of strength,endurance,or taobilty frequent or prolonged treatment. These disease] can (fit Inflammatory arth (in cases where ius merely recur result frequentepisodes of pain or the mabdrn to per- form work. rent nr a rangeprogressiveof linen or'nthl deebrmry or limita. with 3) .ant other unitary condition that rcwlts in a pencxt not oon of of motion of a degree to interfere with successful and safe performance of fi duties). beingable to perform as a member InflammInflammatoryanhnm can result infrequentequent episodes of A-111 2 Category B medical conditions of the spine,sapu- pain, the inability to perform work,and the inability to be,nbs and sacroiliac joints include the following perform functions as a member due to limitations of (11 .Artnus that results In progressive impairment or limits- me endurance,or❑eaibilha non of movement Arthnds is progrcalive illness that Cr) thcI Any other extreme condition that result,in a person not Leads w[uncuonal impairmenLArthnus can result in the being able to perform as a member inability to perform functions as a member due to lima- A3•13.1 Category A medical condmons of a neurological Lions of endurance or flexibility nature include the following: (2) 5uucmnal abnormally fixture.or dislocation that is a progressive or recurrent impairment These conditions (a) Ataxia of the heredod<generatire type.AULas of the are progressive illnesses leading to functional impair- heredodegeneraove ape can result in the inability toperfonn ment.These Illnesses can result in the Inability to per- functions M a member due to limitations of balance. form functions as a member due to limitations of Ibl Cerebral artenosclemh as evidenced by documented strength or fle:ibiliy, episodes of neurological impaiment,Cerebral arterioscieta (31 Nucleus pulposus, herniation of.or binary of laminee his can result in the inability to perform functions as a member wary.discectomp or fusion.These conditions are pro due to limitations of strength and/or balance. gnaw Illnesses leading to functional impairment and lc) Progressive multiple sclem,u a multiple sclerosis with the inability to properly wear protective equipment. evidence of progression within previous three yeata Multiple (4) Ankylming spondylius.This condition can result in the sclerosis can result in the inabilityn to perform functions as a • inability to perform[unctions as a member due to limits member due to limitations of strength or flexibility. dons of endumae or flexibility. (d) Progrcmve muscular dystrophy or atrophy This condi- IS) AnY other spinal condition that resuln in a Perm('not Lion can result in die inabdity to perform functions asamem- being able to perform as a member. ber due to limitations of strength and/or balance. M3•133 Category B medical conditions of the extremities (el Epileptic conditions.,Vtera provoked seizure,with the include the Eollavnng: Prove e precipitant n andalleviated.weusubsequent tmornv l (q limitationof motion of a of a degree to interfere ofTorRLcM.normal G, gmordlnnndogkilefree dsttsuccml and n of n 11( ecureaee"dim°mclicvwrifoonadwieldefi - The bmmtifnof motion of ajoint result in Kim statement from aquabfl<d neurological ypec. isc.a mem- ber can be cleared to return to dunthe inability to perform functions as member due to limitation of flexibility A.S10.3 Cate B medical conditions of a neurological (2) Amputation ordeformity of a joint or limb cif degree to nature include the cousin/ interfere with successful and safe performance of tire. tlghung dudes The amputation or defennitv of slant or (a) Congenital malformations(that is.severe vascular nab limb can moron the inability to perform functions asa formations that interfere with the ability le wear protective member due to limitation ofWength and/or balance. equipment) Congenital malfmmauom can result in the (3) Dulaaunn of aloint.Recurrent dislocation of almnt or inability to properly wear protective equipment. dislocation with residual limitation of motion afa degree (b) Migraine(that is.recurrent,with impairment uncen. to interfere with successful and safe performance of fire. trolled).Migraines can result n frequent episodic of pans lighting duties.successful surgery for recurrent shoulder the inability to perform work moo EO ee 13.92_I.i urnicu.REAL IREME'TS FOR!IRE fie IITElb SO INFORYIATK19 FOR FIRE 0e1'tit lNI vT rtnSI<LP, (c Chuual disorders with paresis.paralysis.dncnordina. 10 Any other hemaiulugmal condition tint rs'sulo in a ton.deformity.abnormal motor acuity.abnunnalm of setts perm not brine able to perform as a member. ton. tar complaint of pain fpragremse or severe) Thee ASb6.1 Category A medical conditions of end cone and disorders programme illnesses leading to functional 8^ry im^mn<nr.The can result in the inabiln to perbnn fine- metabolic disorders include diabetes mellitus that is Wcued aamember due to Initiations of strength.llexbltn,or with insulin curonoral hypoglycemic agent and this includes a balance history done or more episodes of inapaciuung hspoghce. Id) Subanchnoid or mo-uerebral hemorrhage,vended mu Diabetes"limn can molt in the potential for sudden either climcallvor by laboratory studies.except for Nose cnr mcapatiman reeled with vendeaum by laboratory studies and report of 43-16.2 Category B medical conditions of endocnne and treating physician. Suhar+chnoid or inmacerebnl hemnr- meubolic disorders includes the falbmng rage is a propel ve illness leading to fancuonal impair. tnent. Thu illness on result in the potential for sudden (a) Diseases of the adrenal gland.pituitary gland parades incapacitation. rind gland.or thyroid gland of clinical abnu6eance(Nat is, tel .Abnmmaliun front recent head Injury.such as imere P mauc and pooch controlled) These disrasescan result cerebral contusion or concussion. The abnormalities can in frequent episode.of pan, the Mobile/io perform work, result in the potential for sudden incapacitation. and the potential for udd<n incapacitation. 10 Any other neurological condition that results In a per (hi Nu Muonsl deficiency disease or metabolic disorder son not being able to perform as a member (where clinically significant and not correctable by replace. A-}Ii.2 Category B medical conditions of the skin include ment therapy or other medication) Nuunonaldelkiencydis the following ease or metabolic disorder can result in frequent episodes of pain or the inability to perform work. lal Acne or mfmmatory itin disease (if condition pre- (c) Diabetes mellitus requiring treatment with insulin or eludes good Sc of promyue equipment. such as SCBA face oral hypoglycemic agent Diabetes melting can result in tot- piece.or presents shaving).Acne or inflammatory skin disease sods of pain or inability to perform work.It is a progressive can resultin the inability to properlywr pmtecte equipment. illness leading to functional impairment and can result in the Ibl Eczema (if broken skin results in impairment from potential for sudden incapacitation. infections or pain or interferes with seal between skin and per- (dl Any other endocrine or metabolic condition that sonal protect'e equipnentl. Eczema can result in frequent results in a person not being able to perform as a member episodes of pain or the Inabdiry to perform work. ic) Any other denvmbgic condition that result,in the 43-17.2 Category 8 medical conditions of systemk diseases person not being able to perform as a member. and miscellaneous conditions includeNc following: b}lS.l Category A medical conditions of blood and blond (al Connective tissue disease,such as dermatomyositis. funning organs includes the following lupus eryrhematssus,scieroderma,and rheumatoid artist as(where manifested by systemic impairment or limitations (a) Hemorrhagic stain requiring replacement thenpy of morionl_These connective tissue diseases are progressive (for example. son Willebnnd's disease, thrombocyropema. Illnesses leading to functional impairment and the inability hemophilia).These hemorrhagic states can result in frequent to function as a member due to limitations of strength or episodes of pain or the inability to perform work. flexibility. (b) Sickle cell disease (homorygaml. Sickle cell disease (b) Residuals from past thennalinjury(for example.fran- ca result in frequentepisndel of pain or the inability to per bite resulting in significant symptomatic discomfonl.Reddy- form work and the potenual for sudden incapacitation. as from past themul injury may result in the inability to A-I-15.2 Category 8 medical conditions of blood and blood- Perform functions as s mentherdue to limitations of strength, forming organs include the following endurance.or flexibility. (al Anemia (in cases that require regular transfusions). (r) Documented evidence of a predisposition to heat Anemia can result in frequent episodes of pain or the mabihry stress with recurrent episodes or resulting residual inury.A to perform work.Anemia k a progressive illnm reading to predisposition to heat stress can result in the potential for sud- functional impairment den incapacitation and the mnabdhy to perform Rin<tions as a CIOLeukopenla(where chronic and indicative of senora member due to timiuuon of endurance. illness). Leukopenia is a progressive illness leading to font- (d) My other systemic condition that results in a person uonal impairment not being able to perform as a member. (cl Polyrnhema wen (when severe. requiring °ea,- A-3-18.2 Category 8 medicalcmdiuons ofnmon and malig tom( Solycytemu visa can result In frequent episode*of nant diseases can include the following pain or the inability to perform work and the potential forsud- •len Incapacitation (al The medical evaluation of any person with malignant (d) Splenomegaly(Mere the spleen is susceptible to nip- disease that is newly diagnosed.untreated or currently being tore from Hunt trauma) gplenomegaly an result in the treated will be deferred. potential for sudden mcapaciuuon. Any person with treated malignant disease should be enlu- (e) History of thromboembolic disease (that u. man aced based on that penunb current phi-dial condition and on than one episode or an underlying condition) A history of the likelihood of that person's disease to recur or progress. Nromboembolic disease can result in the potential for sud- (b) My other tumor or similar condition that results in a den incapacitation. person not being able to perform as a member. 2000 Gann AlKwbi't A 1562-19 A.119.2 Category B medical conditions of a unchains a. HIV nature include thefollowing b. Hepatitis B surface Antibody (Hisab).if not pens (a) My person wilt a hewn of apwchiatric condmun or ously known to be pmiux substance abuse problem should be ealuaed bad on that c. Hepatic Bsurface Antigen(HOMg).ifna previously persons current condition. Prychumc conditions and sub- known to be puma HBaAb >ance abuse problems can result in frequem episodes of pain d. Hepaum C Antibody(HCkb) or the imbdiw to peefotan work and the poundal Far sudden e If HIV prophyiaai>n to be given,the following ma imapantalan.Thee conditions ore progressive Illnesses lead- should be done ing to functional impairment. 1 CBC lb) Another pschiauic condition that restate in apeman 2. Qucose.renal and hepatic chemical function not being able to perform as a member. S Pregnancy test for females M120.= Category B medical condition concerning chem. dal Loring dusting to be dote on source patient,Including cals,drugs.and medicationsinclude the following theg la) Muccogulantagent such as m ca n n be permit- a. NN ted if the'amen/viand state is conoolled such that the pro- b ffgwtg ' thrombin time of INR ha been in to therapeutic range on a C. HCAb 1 amble medical regimen for at least one month and that no Q) If source is available,interview for HIV.Hepi,and HepC other coexisting conditions would either contribute to a risk/sans bleeding diathesis or by themselves preclude unification for 16) DetenWnadon of cbk and need for PEP full dun Mdcoagda t agents can result in frequent episodes lid Member counseling regarding PEP medications) and of pain or the inability to perform work,a well a the potennal side effects of natment A printed fact duet should be For sudden incapacitation. - available for the member to review (b) Ca,db armta scab Hoc example.antihypertesuivn) (8) If PEP pmphy4vb is to be given,it should be done as on result in frequent episode of pain or the ioabign to per- soon a possible after the incident.preferably within 2 form mt,a well ache ptendsi ler sudden isicapacimoon. hours • (c) The use ofna<odes can result in Bwmnt episodes of 19) Memberson prophylnb neal m be followed(preferably pain or the inability to perform wort a well as the potential by an ID specialist)for the daemon of dial treatment for sudden incapacindon. 110)Assessment of eons seam and adminbmdon of AT (d)The use of.Madve•hypnoda can result in frequent booster,if appropriare episodes of pan or the babikty m perform met.a well a the (Li)Area HepB status poundal for sudden incapacitation. a. If previously Immunized with a positive poHmmuni- 1e) The use of stimulants can result in frequent episodes radon der,no further treatment Is needed of pain or the inabilltyco perform work,a well as thepotendal b. If previously immunized, the ma nepdve. and for sudden incapaltalon. source is HB.Ag porithn or high risk,give Hepatitis B lD The uae of psychoactive gents ran result in frequent Immune Globulin lHBIG)as Men le passible—prat epbadeso(minor theinabifn m pastime work.as well ads< etably within St lours—and a dose of Hepatitis potential for sudden iseapadadon. racing. (g) The use of steroids can mutt in frequent episodes of c If previously immunized and titer is unknown.dery pain or the inability to performs wort Y1' Ih)Amoeba ductal.drug or medication Outranks in I. If titer is Fondue,no fuller treatment Is needed. a person not being able to perform as a member is included S. if titer is nepdse and source is HBMg positive or in this group. high salt then give Hepatitis B Immune Globulin A1S.l Physicians who can for mmMsncN to be familiar • 24{HMG) a soon as possible—preferably within cine. and keep p-todate with the coon current recommendations evooun—aunz Mthnegpeddsaradm for post-exposure prophylaxls (PEP) for bloodborne to d If previously t a neptive ended with eve HBIGtive immer ediately d iately gen(BBP)exposures.rue there should be a written protocol and as with a titer,giro immediareFr for dealing with member who present with BB?exosures and a second dose I month We. This should be based on the billowing elements vaccine If never immunized.girt HMG and begin Hepatitis B accin series. It) fact sheet that explains in lay language the raiser inks- (ISO Fallowup instnations should include the following: don. the various prophylacrk and dseapeuuk options. a. Adverse aeon and side effect of PEP the tearing and follow-up that will be needed and mom- mendadons for personal behavior(i.e.safe sty, blood b. Signs and symptoms of reuonrd illness(fever.adew domuon,and so fort)following an exposure. opathy.rash) (2) QasiBcaden tale to determine the exposure type and c. Apponunents for follownp blood work,including the recommendation(or prophylaxis Current recommend a- tions of l B.Department of Health and Human Bent., 1. HIV at 6 weeks,3 months.and 6 months Censers forManse Control and Prevention,sad Public S. 149Mb and/or HCAb at 6 weds,S months and6 Health Semen months.if source b HepB and/or HepC peals. 131 4sung of taws m be done on exposed member.incbd- 3. Everyother week CBC,renal and liver function.if ing the following receiving PEP anti 6eaen 1532=0 'IEDICM.RGQCIQ)IENTS FOR FIRE FICHTERs tADI\FORMN'In6 FON FIRE DEP 1RiM1NT Pi n5iM NS A-14.2 Pouexpnure praphyla<u may also be mdkated tee or long-duration Incident.Medial evaluation and veamtenI the foOmnng dix.ues' in the omcene rehabilitation area should be conducted (11 Duphthena according toemergencprotocolsemer1ev medical smoke (Eb161protocols 121 Hepatitis developed by the fire department in ronwlation with the fire (J) Metonymdepartment plowman and the EMS medial director. if (1) Perms advanced ld<nlppan lASS)penonnelare available.ohs level (il Rabies of EMS ore is preferred. (6) vance0a Soler 1.3l3 Seemlier facion donna emergency incidents can 449.1 Mmnual TB program should include tll<fall rung: impact sererek on the safety and health of members,who are apeman,damns extremes of heat or row.where mete fat. (11 Documentation of a two-step punned protein demamc ton combine wadi lontdurauon anodenu or situations that ;PPD)pnor to this PPD or a 0-mm PPD within the pa require heavy exertion.the milk to members increase rapidly. wear The tire department should develop procedures.in consuls (2) Placement of PPD and reading by a trained.deugnaaed ton with the Are department physician.to prone relief from reader within ad hours to DE hours of placement.Mem- adverse climatic conditions- ben with a history of posiive PPD should fill out a riot- The following are typical rehabilitation considerations for tIOnnawe, operations during hotweather extremes: (3) PPD rends mould bedacumenwd at milhmeten lmm). (I) Moving tangoed or unassigned members away Rom the A test with nu skin reaction should be recorded as 0 dim hazardous area of the incident (a) APPD skin testwili beconuderedpoidve tithe following (2t Renown co^diaons are present. Renown; pen protective equipment a. Greater than 5 mm m someone who is tmmunmu (5) Ensuing that person el are out of direct sunlight pressed p- (a) Ensuring that there a adequate at movement over per. b Greater than 10 mm in someone with a normal so^ne6 either naturally or mechanically U) Providing members win fluid replenishment,especially immune system who is at tut foram/talon due to an water exposure 16) Punting medical evaluation for personnel shoring c. Greater than 10 nun increase from previous reading signs or symptoms of heat exhaustion or heat stroke (3) If PPD u positive(conversion).the fmbwingeteps should The following are typical rehabilitation considenhons for be taken: opendons during cold weather extremes: a Fill out questionnaire b. Obtain chat i-rev (I) Moving fatigued of unassigned members away from the C. Evaluate for sears disease (2) area of the incident (2) Presiding shelter from wind and temperaturenmmel d. Evaluate for prevenative therapy (3) Providing members with fluid replenishment,especially (6) If active disease is diagnosed the member has to be aver removed from any duty until she/he has been deter NI Providing medical evaluation for mbenshowing signs mined to be noninfectious Thisthe will occur when ades or symptoms of frostbite, hypoermia or ether cold- quite therapy has been instituted, the cough has related injury resolved.and 3 consecutive sputum smear for addtat AS2.2 The assignment of an ambulance or other sit rt bacillus(AM different days arc nepave. P crew to the rehabilitation function is<am let doling lonong- AiJ.R In the event of an exposure to TB.the following steps duration or heabyexenion incident operations.ass.This crew can should be taken: assist with medial talon functions as well as be awlah&to (I). Member should receive a PPD within la days of« provide immediate basic life support needs for memben. sure.Members with a history of positive PPD should roc. Advanced life to be (paramedic) kv<I of croon and out a TB questionnaire mamimt has be available quickly.however,to insure the el of care. (2) Repeat PPD or questionnaire should be done 6 weeks to p`or e mr vedialstiff has m have an assigned medical director. 12 weeks after the fins Thm can be an on-scene pysic hian such as a fin dearent 131 If PPD is positive(conversion) or questionnaire is poshP departmentdye,proceed as per IS) and(6)ofAi3.1. Physician,a remote .an at-a pave hospital.or a central medial direction facility. A. $ 29 CM 191010Nl requires that Members be offered Hep- 4132 Form 'aim B immunization at no cost to the member Member,who year fished or ewe depa Inoidenm medical choose to decline she offeror this immunaadon am required w control can be esablie by the fin department physician or sags a watts declination.The declination becomes pan of a medial director at the incident acne, members confidential health dam base as specified in Secoon bum fiiJt When a member suffers a bum injury,he or tit of NFPA 1500.SmmWe.dmfindpemmn OraupasxtdS•/dY she should be evaluated as to the extent of injury nmdegr<e and Papua Memben me allowed to recant at any one bumacan be veaudonacne.and the member may conww and receive offered immunizations. dun Secondd m egree bus should be evaluated by a phyfcian familiar with burls,such as an emergency department phni A-6.1.1 Havana a preplanned rehabilitation program that is cun.a member of a bum unit,or a fire department physician. applicable to most incident npea is essential for the health and Second-degree bums and higher are conditions that demand safety of numbers,This program should outline an ongoing that the member be removed from emergency response duty. rehabilitation forsimple or short-duration incidents as well as After thebunu have healed to the extent that there is minimal a procea to transition into the rehabilitation needs of a large nil(Oh entry into the member''s body of body muds and chem- M00Eown treewix n I3h2t1 weir encountered dunng regular dune,he or she Can return inhalation..kt the emergency deparunent.the namm'honk' to full dun. have an scrams]carhoehemordobsir detnnnned and should The Amencan Wen Aaocudun has cnena Inc reran)to he<valuated for portable a-antde toxscm if eamde poisoning a burn center They are second-and thuddryrte burns with ri suspected.treatment malt a nanide antidote kg should be chaactnutia as follows: initiated. Since inducing methemoglobrnemu in a patient (I) Exceeding 20 percent both surface area l BSA, with melnatrd nrbnavhemeglohnhnel me.further 12) Exceeding 10 percent BSA for ye under In or met i0 oxygen delivers.only sodium thew?ate should be,green mw 1J1 Any thirddrgrce burn over 3 perem BSA nails. If treatment with hvperbanc oaagen a tuned, nitrite NI Involving hands.feet.face.penneum genmba,or mapr mar he wed. joints Adil Items that an aunt in limiting temperature stress in 151 Circumferential involving extremities or cheat coil environments include heat.blankets,and pmwcdon from In1 Caused In contactwsdl chemicals.electrician or lightning the wind.for hot weather.nem Would include adequate bade, (l Coupled with smoke mhaLicion injury sate,atrcondtommng,and maang menu.Food and Incitation IS) Assonared with nulldp4 trauma needs include water and.sal Hurds.food.broth.and thin Also, (91 Involving patients with prewnwing significant medical foe h dtawW. a 50.30 mlxude of water and an eketrohce illnm replacement dnnl can be premded Medical equipment Would ,Alwrulaafvkxal Serena Strains and sprvm are among the Include blood prea^Ie cula. snthtascopes. oxygen. cardiac oscommon membertjunes.When theyoccur dunng pen tiw^son.thennumeun,and intrxemwu fluid and supplies.moda when circulating areebSammas are high.such as on the A31 a The incident commander should consider the ten fireground. the injured member might underestimate the cumsmnces ofeach incident and make suitable mansions for seventy of ate Mince Under loch condition&he or might rest and rehabilitation of members operating at the incdem continue working and worsen the injure. scene. For example, when members consume air from rwo Exaluanon of there rype of injunes on the fireground an SCBA air °guiders (two-cylinder mile). the should be be difficult The i jury might worsen with.me due to swelling. assigned to rehab. muscle spasm,and increased pain perception after the emer- gency call u over.Any acute injury that leads to swelling or b3-15 The measurement of the eds.tee has been mod by mulls in more than acting limitation ofmodon should prob. soma fire depammen°in asresung memben dunng rehabdim ably be evaluated he a physician. don.A persistently ekmted pulse could be a sin of excessive Nob fnadatw Smoke inhalation is fortunately becoming sneer on the both due to dehldlamh heat mess,exhatndon, less common,due to these ofxg<ontaned breathing app. or ardlopulmonary Hint The use or a prise rate has not ntus.A member with smoke inhalation should be treated with been studied in a manner that allow strict medical Protocol to win percent oxygen and"asthma to an enseerrggeania depart- be recommended.The pulse rate combined with the remain- • meet.Bums lnvolvinggmter than 15 percentofbodr surface der of die clinical evahudon of the member may be used to area.facial bums,staged haw,and airway soot are associated determine if the member an reran to operations. with more severe airway buns. Lower airway injury can be associated with carbonaceous sputum.wheezing.mks,then- chi. sad chest pain, Pulmonary lunettes tem can reveal a Appendix! laformadon for decrease in forced expiratory volume in one second 1FEY1). The Department Physician A chest radiograph may disclose infiltrates or atekcals. Hypoxemu may be teen on arterial blood gas analysis Anon This appendix h not a port of Mr'guaranies of An A.P.l dao ' nS chest radiograph and nonnalanmal Mood gas reloW do menu bus or minder for tyunnnaslaliWpost nfy. nor,however.retie out significant smoke inhalation Injury. Bd Occupational Safely and HWth Problems for Heathen. Endotracheal incubation should be performed if there is central nervous system.suidor.hypoxemia(POs lets than k0). B•l.l Cewal. Fire fighting and emergency response are huperarbia(PCO2 grater than 50), full-thickness bums of wry difficult jobs.People in theejobs perform functions that the face or neck,siren or pulmonary edema,or inability to are physically and psychologically very demanding These handle semuem. Positive end-expiratory pressure (PEEPI functions are often performed under very difficult conditions. should be used if hypoxemia persists despua intubanon and (fire Apposes C) adminhtnoon of 100 percent oxygen.Inhaled beeagomstsan T-IS I ad Studies have shown that fimf htin ddaa�dcholinergia can be wed for beonchorpmm.5ntemtc functions require� working at seas maximal heart rams or pro old are not recommended forpneuinxnia or put- longed periods of rime. Heavy prbrecne equipment linclud. uoin WWI nary edema.Amid/sueAmid/sueten be needed sputum gram mg mptntors) and the heat from the fire contribute to this and culture wi fever and leukogcods suggest the bins- h al load. en e nia r<of pneumo P Pk -- -pwn.Nneber Cenasnly the scenario involving the discovery 61.3 Teak Substances. Members and emergency reppone of an uncomnous member is one that is difficult to manage personnel also are exposed to mans toxic rbsuncea dung given the pgchologtal responses of all involved Of coune. their wort.Carbon monoxide is the most common conrami- die fiat pnentv u the sale removal of We victim from the hat- nanpmdie have shown indmdual exposures that areas high ardour area Then the ajar,Blending,Cardiac(ABC)are as 5000 ppm dunng actual fires.Other signtficant e.pmWei tamed out a secondary lurey performed Transport to a common dunng fires include cyanide. acrolein, hydCro�vggenm hospital should be expedited. <blonde.nitrogen dioxide,and benzene.The bumingofphe .ante unconscious member should be treated with 100 per- tics and other synthetic materials can expose members to cent oxygen,since carbon monoxide poisoning u common other toxic materiah.such as truejamm and muosamine& and cyanide poisoning pnuthle as secondary diem of smoke hazardous mvmab incidents bin invoke exposures to many 1000 Eebi 1582-23 YCDICAL PEQ:INENbT)fl)It FULFlGNTM OA rettntalt[ION Fnx FIRE UCP UxTVt\T P1 p10.1]1. other toms materials.Although the use of respirators help.to B! Guidance for Medical Evakadua. r<du« exposures meehvmal. <mimnmenul, and behay- 621 Replacement and Baseline Medial Evaluations. howl futon can lima their the dung all phases of a lire The amiable health thuson members art limited MalikPreplxement medical mahatma, trice ant tndmduaCt the prasetaun for members has impnnedaver the W al health swat before assignment e a position The purpose of an magnu<s might be changing due to the introduction of heamalanunnh t primun bun or htheim pe11rlax any ant hetic matertab.Given the delay between Ire ;ob.health udingn he premns Wm of hertmInpexhrmwgthe more. ^ne req, including the Then iI wear prwttu.e dentpanany and 'nit' past e.tatenwl os members occ fight di elied health for the that The<Manota shouldlI .Uwe tied by am fcuture or pa health sa edli of ions Mold bet ec mach phstsc 1problem.demands shet could be conditions aggnine by the when emehealth inhe. These la to dies should be remenucd p forma and working asp lca t hen Baseline n then when mamng the mailable studies minrmadwmcnncemm•{.h<appWanu health w.wnntMn be compared to subsequent evaluation results far Ow purpose 5-1.4 Increased Risk of Injury and Disease. Mailable data of determining whether the individual has any significant indicate that members have increased risk for injunec.pun health trends that can beoccupauonalls related. monary disease. cardiovascular disease, cancer, and m Two oyes of mlonnation are essential for a medical pre- indu«d heanng loss. The Increased risk for tnjuncs u placement evaluation of thine performing member dune,. expected„given the demands and nrcunutance ofthu wort. First the physician must understand the working conditions Fatalities and seronu'apnea from burns or other frc,cene and minute'demands of this occupation. Appendix C pro- hazards can occur .ides a list of the en.ironmental titan encountered in the The rnA for respirators,disease occur sue to the respire- lighting and emergency response.The physician also should Cory damage caused b many of the coin s of lire smoke obtaing additional information from the file department example.particulate.entreat nitrogenratme hla conductedspecific jabduties and taskt lea to the fire u) and p nd eve and ox sum.has rwith a validation or zauo anfire eaderid e omil not reductions M pulmonary fires, function, emnndemnom u c should be a evaluation dothe oreamnum of the f e the li ink are uncommon after fm, sum in atimpwmatic moat.For need to afwte medical conditions, chv- e been en Permanent of from smokepulmo inhalation n has also moan mil need io obtainto a information about sp fight rereported. aStudies chronic pWmunary meng<lfrom pab doom in order to make an determinationonwithThis epart- stre fighting ham not had consistentritof results Some fellow-up onay mem personnel.lnapehom and comulution fir<depan- j nndko ham shown a errs or r ti . whi he s haven tmSc and. functionn among e members over tine, while others have not Second, ersonbd<i needs to have accurate information. the fbc- eq si meabln to detect this ion fact r Increased be of protective demng about the person i disease or medical condition. the hsan other dute)coulecco tfor ell membersantnsfemgs. undo tandinlimitatiuos associated withethat condition. and n to otherdutieslcould account for theseincamuum findings. tonswundingochaw hatcoYd<maMh and wardag The strenuous work demands of fire fighting combined condi- tions wouldkimpacty(war r in d condition.the xmntediapaorku with exposure, ro arbon monoxide and other taxic sub- Fore am kn facee in ki ndis ieg a e sim aplinical increase the risk for cardiovascular disease appearFor example.different skindiseases cateansse toinical tong members.Acute respiratory changes abo can stress ronmevt<e,bpscat markedly. pyicerinthril response to B tha indul exposures. Thecan physician weenld also swih recognize thecardiovasculars system This inarcasededkvasculasud- that cdlyintoiliq exist between persons with the ev<nak has been documented even in some morality stud- sine clinical condition hes. despite the jab selection factors that tend to mask any Upon completion of the examination,the physician should increase when compared to the genera population. Other infant theautwrity haying jurisdiction whether the applk ant studies have not detected this risk,Certainly.the combine- a medically qualified to perform as a member. lion of the physical stress of fire fighting and exposures fora bi.i psaiadic MedkY Eva ii.. . The oak medical person with preexisting coronary heart disease would beperi expected to increase the risk of a myocardial infarction or mluatim nMignh weyaluat<the penon'uonmued abi4 fry to perform his or her duties and to detect any other d if- otherxme event.However,the degree of this acute risk and gat whether fire fighting also contributes to the development of includesnges in the condition of his or her health The latter coronary heart disease is uncertain pa r.each b<elved changes or abnormalities. Enryyear,each member will be medically evaluated by the Increased cancer Wsk far members has been found m the fire department physician, This Medical evaluation include, eeal recent studies.While not totally consistent,these studies an update on the members medical huwn,mdudin am sir generally show an increased ink of brain cancer, grit m& es ant chang a bnef renew of symptoms,and a repon on tins•cancers,colon cancer,prostate cancer,lymphoma,and any year. cntjoh•eight exposures,and during the leukemia among members in many different pans of the past year.Height. eight usual taws.and blood pressure are world.Increased incidence of other cancer sites has also been measured and recotded.The extent of the medical evaluation shown in some studies.Several undies are cuendy under way and additional testing will depend on the members,medical to further emlate this nsk condition Nouo-mdoced hearing loss has now been documented in A more thorough evaluation,includinga medical eeatwa- .eel studies of members. Members might also be at risk 34)um.is conducted 4F on a e evaluationc blsat For Ind exacb less than from other specific exposures including i fecmus diseases conducteddean age, the medical and 0to man n and liver.kidney.or neurological damagegfrom eto , la at least even oyear's; years:for theme yesn 39 man of +pectic chemicals. qca exposure a e,at ve ear. ties yen:and she those*Man of age Or mil,every yeti. This ealuauan should include an updated MOO fawn NTLW It B 1532 9T medical and intend hutorr.complete phytical nomination. I111 Audiometry orlon«rung.audiometry.pulmonary function testing.and a (12)%usual acuity and penphenl coon wane CRC,unnalvYs.glucoae.BUY.creaunme,liver function ten. 031 Pulmonary function testing and lipid profile (Hl Laboratory feting,if indicated The use of chest •nvs in surredlance activities in the absence of significant espoora symptom.,or medical find- 1131 Duynmuc imaupnq.dmdiotd nags has not been shown to reduce rnptnton or other health (IA)Ekevavdhogmphr hf indicated lmpanment Therefore.only prepizement cheat anus are B-2.3.2.1 labontua Two- CBC. biochemical tat beatem recommended. unalsa.gbsose.BCN,creaunme.liter function tesic,and 4 No fun midehnes for Wear electrocardiography den asvnhp lipid profile.should be conducted for detecting specific ill. tomauc indaduah have been developed. There have been moan as well as developing a baseline for toter cumpanaon. problems wish fake pduve results from this rating,spaulh' 62.5.2.2 lam% A buebae chest rrwv Can be helpful for younger age group and in women.In throe with one or individuals with a hmtory of respirator/health problems or more k lama for coronary erten disease,there b probably symptoms Fur others itcan be efulfor latera morei titan for performingsewthe none As well,stress tan are pfuncts more important in those whole work deals with publiccle.o tesong.3 PWmmufu for n Thecae Testing. Pulmonary function s1i 'Stress teen can be performed using a reeadnne bicycle,or hung can be helpful for md'niduLs with a hnfory of respire- adr climber, as long as the protocol being used granualh nary health problems and as a baseline for tar to experienced n.A increases In workload metabolic equivalent of reseg emerge baseline ten should be ered by an experienced per- being e(ME 1. A abmaamn test,with the endpoint son Only a best elf that a technically datable and den' beingthe attainment of 95 percent of prednd maximal °nit ates the best efforts br an md-mdual should be used to heart rate(PMHR),may be performed.Additional inforoe- calculate the forced viol capacity(FV'C)and forced expiratory non pined by performing a maximal arnpromimn rat volume in oneV1 second(FE . worth might not be the addiri al rime,effort,cosst,and mat A reasonable approach Is to Mari periodic treadmillnting 62.3.2.4 Aprasedry.Audio should be performed in on members at age M.In those with one or more coronary an ANStopproved soundproof booth (ANSI 53.1..5/asssus nay disease nsk facto„(premature family stir?(lea than Pm:iam Antolini Nov Leven far Test Ragas) with age 551. hypertension,diabetes mellitus.cigarette smoking• equipnen huo tcalibrated to ANSI standards(ANSI S3.6,Spmo and hvpeahole terse is(rod cholesterol greater than e ce for s Adw ud Ifisml. a booth unavailable,the test room or HUL cholesterol Its than 35)Ihnlyshould be sorted by sound pressure levels should not exceed those spaded in the age 35.The hryueucyaaxingsMWd increase with age,but federal OSHA noshes rcguldom 129 Cal 1910.%). at the minimum the tot should be done at least every no spans meevovdiognphy. Baseline electrocardiograph, yean Testing an also be done as indicated for those with should be conducted. (Periodic resting electrocardiograms snptonu cygestive a corona/artery disease.a reported1n have not been shown to be useful.but may be reasonable asa their yearly medical histories or interim report. members age increases) Conversely.it is blown that even mammal sties teeing fre- quently mists cardiac abaci-indium seen during actual fire- 62.4 Reporting the Resets of the Medical iVa aadoa. All fighdng dude E individuals participating in a medical evaluation should be 62.2 Contest of the Medial Cralustlom informed ahead of time about the purpose of the medical evaluation and the content of the esam.The results of any 62.2.1 Medal and Ocaprbas History. The medical his. medial evaluation are considered to be confidential medi- tory should cover the persons known health problem,such cal informadon.abject to customary patient-phnician con- as major illnesses,surgeries.mediation use,afegies,and so fidentiatity restrictions. Under most circumstances, results Birth.6maptom review is also important for detecting early and recommendation arising from the evalauon should be signs of llama In addition.a comprehensive medical history expressed in general tens without specific diagnostic into" should include a penonal health hurom,a family health his- mation.In cases where more specific information is needed nary. a health habit history.an immunization history,and a in order to mate a decision on the status of a candidate or reproductive hntory.An occupational history should also be member,a specific consent Lon releasing that Information obtained to collect information about the peen i pat anal- should be obtained from the candidate or member.Blanket national and environmental exposures or general -releaso of medical infonadon- fora should not be used. 6 d 2.3.2 Meal!Junkman. The medical examination In most case.a simple stamdenc like one of the following includes the following organ sysiema and rests: will satfier. IU Viol signs, inch as pulse. respiration. blood pressure, (a) Basede the results of the preplacemenc medical evil- _ and.if indicated.temperature canon of December 10.1996.Jane Doe if for is NOT)mdr • (21 Dermatologcal catty certified to engage in riming and emergencyoperations (3) Eon,eyes.none,mou&throat for Annowrh Fire ttepanmenc (11 Cardiovascular (b) Based on the results of the preptxemsnt medical eval- 151 Respiratory anon of December 10.19%.John Doe u NOT medicallycer- (6) Casoonnunal u0ed to engage in training and emergency °pennons for 171 femmunnary Amtown Fire Department,He has been advised arthe medical (91 Endocrine and metabolic reasons for this recommendation and of the policies and pro- (91 Musculoskeletal cedun andable to him if he disagree with the results of the NO)Neurological medical ealauon. 2&C Foam 1322-7.1 'IEDn:µ&tQL IRL IE`TS FOR FIRE FIGHTEIU X1D INFOthalloni IOR toff Ott,sarstChr tingles%no 62.5 Second Opinions. fare department p hcia and prime. Administration(I I CFR67 I3101995)does not anent medical dares should allow for a medical second oilman when a candi Certificates to dssbeues treated with insulin andx+<reb limit dateor member Malmo with the resultsorrecommendations those on oral hvpglnemu agents f a medical e<amrnawn conducted M She rue depvuna n 63.E Asthma and Retake Airways Disease. The diagnosis physician or what the firedepartment ph.ua.tn us uncertain or mthma and related awas lisperacntsty disorders often about the lim,auons or prognosis of the,ndnd,al s condition. confounded by definitional mots Fur the purpose. Often other phcum of n wig nor fi be ml4ar with the dunes and member certification. a ranee of airway dirdrs that demands of tire lighting and emergency response.When pass meet the following criteria can be included. Asthma ua We. the Ste dep nment physaoam should ISAp d«ate tic g other phynaan about Mow the mdindwl'a condition could chronic inflammatory disorder of the airs's, rn ruuepri. affect or be affected byline fighting!khan s lull disagreement Isle individuals.associated this inflammation susst variablems the are 'bow Jae cendiuun err placement rccommcndawn, a IhNusually associated with wide.yread but airflow bstruction that is often reversible,ethers spontaneously or physician(aneptsse a both the fire deprmientano tie cam with arearment and causes an associated increase in airway gdate)awn be consulted rerSmee a neu to a variety of stimuli. ems Muuntend i d Swam Same of the injuries or prob. Since asthma u a highly prurient disease, a number of eels encountered in this mum toll need functional capacity member applicants will require special evaluation.Combos <iden of Mdetesmene fitness for dun Phsucal therapy pro- non products agnate,and cold air are all potent provaben sinters often design testa for employersto determine ability toow of an asthma'text-Some of theseemprc wtav s areoadable, perform tasks similar to Nose required as pan of their enSCAMwith SC use. If a candidate has a diagnosis«temp gal job functions.These tests should be based on directt m men tarns consistent with an asthma-like disease,many heron will Kimmins of the actual jai functions. These amemnal need to be harmd.An asthma attack apprellan capacity cleared can be especially useful when member activity could harm the member. his fellow members,or a has been cleared for full dun bra physician who isnotfamiliar member ember of the public. with the essential job functions of a member. The following factors can be used to help in ration: 63 Specific Medial Candidate. (1) Persistence of airway obsreucuan between attacks (as 61.1 Diabem Maims. The major concern for diabetic measured by frequencysp of members n the Ask of becoming hypoglycemic during sire 1') Need and of steroid and bronchodelaror use ground operations or other emergency responses.Roth nog. hype(freq cis bron<hodilror use suggests persistent airwn ) e insulin and oral hypoglycemic agents can be associated usual t psi o with episodes of hypoglycemia that case rapidly progress from (SI Usualneehei nigger,inthe applicant lilkrgk, infer. impaired judgment to unconsciousness. The most reliable hew,y of ho,tad«ed,etc.). e predictor of hypoglycemia s a history of it In one study of 141 History of bespidiatiw, emergent mom,or urgent insulinelependenr adolescents conducted at the Jaslin Clink treatment (Shack and Wolhdorf 19911. all 196 poems eapedenced (5) Length or time between stacks hypoglycemia at least one during the twoyear summon IS) Yecareal rympmms and other estimates of vrwy inns period.Of these.lS percent were dassied as severe.based an bilhy loss of conscioushess seizure,or the clinical need for them Moderate asthma or won.could disqualify an individual peuw gluagon or intravenous glucose. It was particularly for member dude.Unknown futon such as the suppression concerning that 24 percent of hypoglycemic episodes of airway hypenNNry with anti-inflammatory medicatiomto detected by blood glucose monitoring were inapparent to the reduce the potability of a sudden or severe stack are under patients.The probable ream of hypoglycemiawereidentifed rnsaipuen and could modify current suggestions. in cases, n]I percent of and the most were common wo srenwus 1S.3 Heart Disease. The medical conditions rera ig Co the exercise and skipped meals or snacks Both of these p cippi cardiovascular Nun have been renewed since the previous anti are likely to occur in emergency responders.especially edition (19971 of this document. The task fortes at the fire'enticesszen personnel.�rca ikwmuce accelerating gnucos ado- BethesdaConference published recommendations for ails liato , uaua increases insulin sens)tiviry lens coin un with cardiovascular disease in the mnf tlr (Wwerman and Sinman 1994). With the tighter glycemk fK ggauge J01 ai control that 6 now known to decrease and delay onset of dim .need by the task yCmditkC. in October 1994.Theamtysla bew complications.there a a concomitantly increased likeli seed by th<evk force has relevance to the evaluation of mein. head of <aurscinducd hypoglcems IWa enaan and ben with cardiovascular disease.fire-fighting activities have a Smman 1994) high static component Ise, inducing predominantly an Insulinn ckuly associated with a much higher task of component in blood pressure) and a moderate to high dynamic symptomatic hypoglycemia than an I agent In she component 0 e. similaria setomieaanysrmcraumh<an absence of a history of incapacitating hypoglycemic episodes body building,lrn w and a set demenda include debiting, and with close medical monitoring.there n probably no rem bodynee respect boxing d Recommendations nude by the son to exclude members who an asking oral hypoglycemic task tone with s(h to athkoc me des m have b them agent,,as long as they have stabk weighs diets and renal ptyncal in manN Iurmnauc.madmen dMaw<)fan been function Although the Amenans with Dlsbdina Act(Public followed in this document Law 101J96 19901 does not appear to require each diabetic 71.3A Reproductive. Exposures m the !relighting ennron patient to be evaluated for fitness for dun individually,there advent reproductive effects for bah males some case has that disallowed blanket exclusion of insulin. merit Medical evidence emus to indicate that chemical dendent diabetics from public safety potations (Fin it exposure.heat.noise,and physical exerden can affect venom Police Personnel Reporter 1994) The Federal Amnon endpoints of reproductive health including„misty,fed loss. Moo damn trrpalln u I393+4u and growth parameter.of the offspring All candidate nil reactive wxone that cut be attributed to a nvenUde.under.. members should be educated about time mks and+lie it de ing prenpunc.These circumstances glu not nuccranly repre- need to tale appropnate steps to limit thar exposures sent n ongoing rick nl',rlikn onprnbtuhlc incapacitation of Ale, there could be some slummns when a male or a member If.a member has a Angle mutt a clear prectpunt ,ensile member,,attempting to convene a child and n haonq not ..asted with tenrnl nervous,stem damage a identified ddfictlm In thesa situations...herca complete medical milli. and Unmated and the mmbdual has no muirence user the anon has not'delimiied mother cur for ten mfcndrv,ter wig year then he or.he is p UAW not more likely to lure prom aognment on a«stunt-.Isms so alternator dun ors ensuing roue than die re l of the general p'pulation ISp.n Ito ofabence Mould be considered. Ler l•t)5i %Lot fire department phi cues well want qualified Med.ala'dence exists that certain toxic ub✓ances or eon- nnunlnynu to cent.that an mdtadual with a history((.courts dmons din are present in the hre4'ighung ennronment arc dna not in tact.have epilepsy dangerous to the rake and well-bane tad the tam.Tlereimre. Epilepiv I. du;nn..l In the present e of unprovoked. important to educate all membenaouhese riotd the recurrent stoma nt sece -proaamal Euorden of the central net..ho reasons for recommending that pregnant member, restrwt mus ooem cluracienred by an abnormal cerebral neuronal their fire.uppreasean acunue,.For example.there,s grad at. discharge with or indium loss al mnaimsme.; ICaciie dente that the fetus is especially amour to carbon monoxide. ttrH1 Treatment of patents with cpdepu is only nnabl.sue. a known sgm0cant component of tile mmke .Although the rental.mth mughly al percent ofpaucntsattaininq remission use of SCBA ts =timed to be protecute. sometimes cinch m .nW Moaner onnt therapy and Hesdonfer 11Jo equipment is not used throughout a fire aippesuon or hat- Spencer Ea93) Remss,mn h detined as Ike .an without ardaus marenals incident The toe of such equipment oho recurrence rence of seuti run ty mty (Anne-fen. Hamer.and Else- increases heat. otherfedsermon.such as exertion and h .Other back fimss- 1979) Further complicating the ehn issue duty issrs concern,arc those msolnng physical work.Pminnged stand. the fact that only A)percent of patients who achieve remission Sus.heavy lifting.and eapoura to temperature enamel and do .o mthou toxic ode diem of the anucomdsant thug humidity have been related to an increase of preetm and low lCaicmo 19941. birth weight infants. 6erause the fetus should be protected Partial,simple epilepsy.or recurrent seizures that do not from theeexposure at the earliest possible time.the member impar curiousness.are felt to be a disqualifying condition who might be pregnant should obtain early pregnancy testing because of the uncertainty regarding how much of the brain Recognizing potential mks to the few from the 6refighung might be involved. and the risk of propagation to other mnwronmene is a(namely recent event and man,members regions of the brim.particularly in the highly epleptogemc ight not be aware of these risks. ennron men'of the,,reground(Spencer I995). Based on a recent U.S.Supreme Court decision(Interne. This standard is somewhat more bbenl than that promul- -uonal Union et aka.Johnson Controls.Inc.59C 5.LW 41919, gated by the Federal Aviauon Administration of the US March 20.1991).the ability to perform as a member is to be Department of Tnmponadrn for aircraft pants (14 CM the Insister the medicalcerd6cmion without considerwon et 67.13161995).All epil<Ptia.regardless ofthenpeuue iceem health nob to the fetus. However, the pegnau member are dented fiat-,second.or third-class medical ceruficaes, should be counseled on the poenOal risks to Pier km,due to except under the provisions of 14 CFR 67 19.'Special Issue of her exposures dunng Bre-fighting duties. Medical Certi6omx' Any member who becomes pregnant should be offered the 8-1 Referee's. opportunity at arty brie during the pregnancy to be voluntar Annegers.J.F..W.A Hauser.and L IL Elveback 1999. ily removed from firefighting dunes and from other dunes 'Remission of Seizure'and Relapse in Padents with Epilepsy.' in.oMng the hazards or physical stress that might endanger Epsilon 20:799. the(eon.If pncucai the memberahould be offered voluntary Sham V..and J.I.Wollidorf 1991 'Severe Hypoglycemia reassignment to an alemauve petition.At such time as the in Youth with Insulin-Dependent Diabetes Mellitus: Fre- pregnant member can no longer be medically certified as inseam and Causative Facrorsl Acetones BS:1197. being capable of performing firefighting duties.the member Srunacim.Alan.hummed bmmond National Fire Protec- should be reassigned to other duties Ai such time as the mem a on Association.l985. ber is no longer pregnant.the member should be reinstated Cascino. G. D 1•994. E Curs sneer:to the positron held pnor to being pregnant.NursingPerry C: uyeean g, era on 9. hen should also be advised about the potential expure,to Ewibwin r and I emnt Mayo Clinic n.' nite Stat s Fire their infants. 'Emergence Incident Rehabihuwn: United Stases Fire .elminutntmn IF.Aa1191. • • 65.5 Noisebadueed Hearth(Lea This category on pee Fri ypi(hrr fenmhnd Reports,N(.emher 199E p.Ig9 dif6culaes because a high percentage of current members Hauser.W A.,and D C. Hedonhr. 1990 'Eplep.r ire hair noisecndwed hearing loss due to their ex ma as quenv NationalCa Fire and Incident Consequences•dew York Demos. members.Implementation of heanng conservation programs Reporting System IYi1R51 data and pragratu to reduce noise expmures should lead ro to a bre. 1:51, render edition. in the prevalence of thm ndiuon in the hoard- edition. DrFT/Drponmma Solos Officer. 1997 63.6 Seruns and Epilepsy. It u important to duungutsh Public Law 1O1.396,199O.Tube I-Employment. between a history of serum and eplepre.As much a 10 per Spencer.S. Personal Communicauon, 1995 Spenceris cent of the phptladon veil enpenence at Least one secure in a professor of neurology and director of the Cloned Epilepsy bkume.whereas lea than l percent of the population qualities and Electrophystologie Monitoring Senders at Yale University for a diagnossofepdepy(Hauser and Hesdnl c 199O) Marry School of Medicine) conditions producing seizure in the pediarr age group are Tide 14. Carr Fir Fniecl Revilerwu Part 1910 1000.Sub- known to remit prior to adulthood.and ma addu swum a parts U-Ib.'Air Contaminants lace fawn 13S2-20i gC01CLL XEIIt IREHENT3 FOR FIRE FlGHTER5 tND INFORAVIO.'rot FIRE Orr W T\ICht PIp<IOLt' 'lode smoke inhalations Cvande poisoning in Are vac- Appendix Guide for fire DepartmentAdosiniuwalon tams.-James.J et at. Seeman Juamd of Estero?.L(.darne 3 317.19H7 Thu=p =u rent a pin of Mr wgrunmmu of Au.7P1 Apr. Wasserman,D H.and IL Sinman 1931 'Exercise in lndr umae 6ar a mdmWpw inb .tcionulpurpnes ann ndoalt with IDDM.'Wdarw Can,17 021. Cal Legal Candderadatu in Applying the Standard. The con. ud di<G Essential Fit-ego/hung mon of ans appbcaoun orcanenuemplwmentofamem- A Ppe^ o/h g be based on manioc plansal perfonnancennlaiaminsimokes Fuaebom a dnennnaaun that u not without Mal a p6mab.To no and. Thu appmka a nru a pats rgeti mpa.mmn of this NFPA der prior m mob d an dame emplmment demon bated•n the uwni bide Ir m ladestforu iJ.manmatpurport anh corgmslg ttsou r4 the aduhantr wMJumNeoa ntiymt widh m couernrmh sccavuel. C-I The medical requirements in this standard were baedon rota r^dieid.I.with Hmdieepr de Dinbiuts< The Reiss in-depth consideration of essential structural flrefghong brlitaan Act of 1973,a amended.29 L'S.C.791 et seq..and functions These essential functions are what members are ex- pected to perform at emergency modem and are derived implementing regulations. prohibit dummmwon aging froth the okeaves slated in NEPA 1001. Sian- mg with handicaps or dnahbues underam program room ran;prhe performance fight,Propsurecnal Qwe ted hng financial assistance from the fedenl government The Essential mnctlom an in and affected be the Liman.with Disabilities Act of 1990.42 L'S.C.g 12101,et following annrocionsanl performedctors: seq..abo pmhsbns employment ducommation by certain pn ware empbver,against mdlnduals huh disabibem.In addition, 111 Openung both as a member of mans and indepen- many states hate enacted lesbiaaon prohibitingdsmminadon dentiv at incidents of uncerasn duration against those with handicaps of disabrfiues These laws prevent (21 Spending ecten s=time outside reposed to the element the exclusion.denial of benefit,refusal to hire or promote.or (3n Toleradng extreme flucmadom m tempemm=while per- other diunntinaton conduct ageinn an individual based on forming d oes;fire lighten a re requited to perform pin handicap or dabllim.where the individual invoked can,with dcJh denuding work in hot(up to.WPF),humid(up to or without reasonable accommadadon.perform the enendal Ion penal atmosphem while wearing equipment that hancoons of the job without creating undue hardship on the aigmfio slv impairs bodvemlingmechaoisms. employer or pogrom vwol'N, Applicator.of this standard 141 Expenencmg frequent transition from hot to cold and should be undertaken with these issues in mind. from humid to dry atmosphem The medical requirements of the 1•m edition M this scut. (31 Working in wet.ich or muddy areas dard were initially developed and found to bejobrehted by (ST-Performing a variety of tasks an sfippery,haardou.sus subcommittee comprised of medical doctors. physiological faces such as on rooftops or from ladders speaamo,and fin service professionah.as pmceted through - I it Workng in areas Men sustaining traumatic or thermal the NFPA consensus staedardwmaking mtem. Changes for injunes is possible the current edition have been proposed by a task group corn- (d) Facing exposure to carcinogenic dust such as asbestos. prised of similar expertise. The standard provide', to the tone subsianca suck as hydrogen cyanide,ands,carbon extent feasible,that decisions concerning candidates and cur- monoxede,or organic solvent.either through inhalation rent memberswith medical ailment.handicap,ordisabrhties or skin contact be made after care-by'case medical enladons.Thus, most (0) Racingeaposure to infectious agent such as Hepatitis g medical candidata have been assigned to Category g. or HIV The medical requirements in this edition of the standard (101 Wearing personal protective equipment that weigh were revised based on the essential functions contained in approximately M Ih while perfuming firefighting tasks Appendix G It is recognized that tome firefighting functions (II)Performing physically demanding work while westing pow and cab can vary from location to button due to differences rtivepresure breathing equipment with 13 in.of water in department um.functional and organizational differences. column resistance to exhaladon at flow of e0 L/min geography, level of urbanisation. equipment utilized. and 21 Performing complex tasks during Unthreatening other=ttom Therefore.itb the mpmubi4gof each mend- emergencies ual fire department to documenr,through job analysis.that (131 Working for long periods of mate,requiring sustained the essential functions performed in the local jun./beton are phmical acuity and intense concenmuon subtanually similar to those contained In Appendix • 1141 Facing life-Pdeath decisions dating emergency canddam There are a wide sanely offnb apahuc redmpun available (IS)gang exposed to grotesque sight and smells associated to document the mental functions of the job of a member with major trauma and bur muds However.at a mrmimum,any method Wised should be cur- (I61 Making vapid transitions from rest to near-maximal exer- rent in writing,and meet the pro slat of the Amencans with ton without wanwnp periods Disabihnes Act(29(.R 1630.2_Inl(3)I Job descriptions should I7)Operating in unman menu of high noise,poor visibthm focus on critical and imporant work behnion aml specific limited mobility,at hagha,and in enclosed or confined tasks andfiimtios.The frequencyand/ordundon avast per Mares romance.and the consequences of halite to perform the task I(S) Lungmanrd and power mob in the performance ofduces should be specified The worbn condition.and enuronmen- III Relying on soma of sight.hearing.smell.and touch to al hazards in which the wort isperformed should be descnbed. help delemune the nature erne emergency,to maintain The job description should be made available to the fire personal afem and to make entrcal decisions in a con. service physician for use during the preplacement medical fused,chaotic.and potentially lift-threatening ennroro examination for the individual determination of the medical mentthrougbmt the duration of the operation suitability of applicant'for member a000 Form .vrtiOn cD 13e2-97 0.1.5 enbahstnSnWw Ian. Ftnalh. uses of the sun- Therefore. phnxim with specialties other than occupy dard should be aware that.while courts are likely to we win- (mint need to be considered.a well as the plantain back- enterable weight to the exigence of a nationally recognized ground and expenence.h:not4edge of occupational medicine standard such se NIPA I S&'S,Sather a Unite Reptovw and expenence with occupational health program..obviously. J r fin Ferret end Woman o n Jo'Fin prrtmmr Armen. would be helpful. le q. Xida u Slag Getman For Dip nmmt 497 Nth fid 218 The plivunn ha to be committed to meeting the repute- 1'993i;.reliance on the standard alone could be innilTxxnt mean of the program.including appmpnate record keeping to vaulted a challenge under the and-discrimination lava His or her willingness to work with the department to cons Even in the case of Category Amedical conditions.courts can tallympeeve the program is aba important,Final)...his or her stall require additional evert evidence concerningan mdmd- concern and interest in the program and in the individuals in seal candidates or membeh inability to perform the mental the department is reat functions oftheaob.Until thecom provide further guidance There are manyi h cry. sii the developing area of law. some uncertainty a to the 'options tinafter obuinin q Mancini seance. degree and nature at the evidence required CO esnblnh corm (a) Mancini*could be paid tin a service bin or themthrough pbance with the anud.cnminauon laws will remain a contractual arrangement. 0.4.5 todviduah Who Are Member of Protected Classes (bl For volunteer department local physicians could be lRaee,Stir,Calm,Rehgiam,er Mama Origb).Tine VII of willing to volunteer their sancta for the program,with addi- the Cie''bgha Act s1964.as amended 42 C'S.C.10d0e,and tonal member arrangements for patment oflaloramrvtest- mpkmenmigregulnons by the Equal Employment Oppomw mg.ran.and to forth nay Commmon I EEOC) prohibit dbenmmarton In employ (c) Some deparamena could utilize a local health care n on the ban Bence.sex,cokr-religion,ornaunnalongrn yaigty for medical Care.Howmr,in that ease.the depaaanent i.e.. protected dial. Under lide VU. n -employer is ahotf be sure to have one individual phyician responsible defined generally,s men a Pemba with or more emp10 for the program.retard keepint and so forth. tea for each working day in each of 20 or more calendar seeks in the current or preceding calendar year:lei US.C.2OO'kl ail In some cases.it could be possible to have the medical Several federal Ndadktione have held that unpaid volunteers examination by the fire department phnien.while some of are otcem,dered to be-employeei under Title VFl. the associated costs could be defrayed by the members own health insurance.For example,the health insurance provider Additionally. many uata cities. and locates have could allow the member to have a yearly physical.normally adopted similar legislation.Generally.phntcal petfonnance performed by the member i penonal phnomn.The health tar otherrequiremenu that rest-akin'adverse impact on mein- care insurance prodder could allow that physical to be per- ben of a propped clap (e.g.. on the bat of gender) are formed by the fire department physician with tome degree of required to be validated through a study in,ecotone with relmbmaement. EEOC guideline.if such requircmena art to be relied on in making employment demons. Under EEOC guidelines. a 0.5 Coordinating the Medical Evaluation Program. An iML study validating employment standard in one jurisdiction can ideal from within die department should be assigned the be transportable to anotherjndsdxtion land therefore used responsibility for managtag the health and fitness program. in lieu cif conducting a separate study).However,specific gin including thecaordinadon and scheduling of evaluations and condition must be met in this regard,and the authority haw- examinations.This person should Leo act as liaison between ing jurisdiction should seek the advice of counsel before the department nd the physician to make sure that each ha relying on a transported validation study. the infamadon netesary for decisions about placement scheduling appointment.and so forth. 0.1.4 regency ad R.prodsyvs. Federal rep/axiom. as Confidentiality of all medical daub critical to the success veil a many cowl decblom, Including the US-Supreme of the program.Members need to feel assured that the infer- Cowie decision InMte'gWnal Union n aL aJolwn fanner, nation provided o the physician will not be inappropriately Inc (499 US. IS?.III S.O. 11%(1991)1.have interpreted shared. No fire department supervisor or manager should the requirement,of Tide VIt with respect o pregnancy and have aces to medical records without the express written reproduction.The authority having jurisdiction should seek consent of the member.There are occasions,however,when the advice of counsel in resolving specific questions concern- specific medical information Is needed to make a decision ing these requirements as well a other requirement,that can about placement. return to wek, and so forth.and a fire be imposed by state or local laws. department manager mint have more medical mformadon for decision making.In thawmaon,written medal corium PR Choosing a Fire Departments Physician. Several factors should be obtained from the individual to release the specific should be considered In choosing a fire deparmiem physician. infomauon necessary for that decision. There are relatveh few phmc ans with formal residency thin- Budgetary contain can affect the medical program. mg ndceribovon in occupational medicine-The dm depsn- Therefore.it is important that componnn oldie program be mnt physician needs to be qualified to provide professional espervsein the area ofocctipadonal safety and health as that pnondzedsuch thmr program grelemrn son are ca be With d o area relate to emergency senate For the purpose ofcond u- enb n e theme piper pragrvns w „song can added to mg medical evaluations.the fire department physician needs to program' understand the physiological and psychological demands the Table D-4 represents a companion between NFPA 1S8Y placed on membersand needs to undenwnd die endrommeth and OSHA 29 CfR 1910134. sal coadunn under which memben hue to perform. Yoe Sewn I582-2I MEOIC,.LL REQC(RENCNTSFOR FIRE NCI INFOR]IAflQN FOR LIRE OCCtRfMENT PinstMs.S Table D4 Comparison of OSHA 29 C[R.farts 1910 134,-Medical Regt*n nu^and NIPA 1S82,Seceded in Medial Rigdnwen fr fire/lean and byk.ssmf w/r Iin Dspanaese Meyifneac 2000[tides NIPA 1302 OSHA 1910.134 2.l Nedcal Evaluation Process The employer must establish and implement those elements ridge mitten respirator)pm Sd.1 y The fire department shall establish and smpiemenr a medial enlua- tecunn program necessary to mare that arty non process for candidates and current members. employeeQum a aspirator valummnly is med- ically able to sue that respirator.and that the respirator is cleaned.stored.and maintained so that m use does not praens a hazard to the uses. If iceman:Employee are not required to include in a written respirators protection p . gram three employees whore only used maw ratan invokes the volunun use of fikenne face pieces(dust masks) 1 Appendix 63 Coordinating the Medical Evaluation Program An tndindual 131 The employer shall designate a program from within the department should be assigned the responsubdir for map- administrator who is qualified by appropriate aging the health and fitness program.including the coordination and mining or expenence that is commensurate scheduling of evaluations and esaminadons.Thu person should also act at Mth the compleairy of the program to admin liaison between the department and the physician to make sure that each islet or oversee the respiratory protection pro ha the information necessary for demons about placement.scheduling gram and conduct the required ev$uadonad appointments.and so forth. the program effectiveness. Coaidentiality dad medical data is critical to the success of the program. Memben must feel assured that the infonmaon provided to the physician will not be inappropriately shared.No fire department supervtmr 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 atom to work.and so forth, and a fire department manager must have more medial infonnadon.In that situation.Witten medical consent should be obtained Dom the individ- ual to release the specific informadon necessary foe that decision • Budgetary constraints an affect the medical program Therefore,It is omporant that component.of the gram been ridded such that eaten- af elements are not lac With additional funding.other programs or test. ing can be added to enhance the program. 2.1.2 The medical eyaitadon process shall include preplacement medical (I)General.The employer shall provide a enluadans.penadk medical emluadons,and reosrnHodury medical male- medical valuation to determine the adorns. employees ability to tires a respirator,before the employee is fit tested or required to use the respirator in the workplace.The employer may discontinue an employees medical at arsons when the employee is no longer required to use a respiraior. • dike 0) stem Farm i1 FISHER/ OP ID: LD ACORO CERTIFICATE OF LIABILITY INSURANCE D T/1/20W14 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(Ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Phone:407513-365 NAME T Mc307 Park Inc. Fax:407-423-4648 wrap FM: (NC Nol: Orlando,Park Lake Circle EXAM. FL 32803 ADDRESS: MCNeary,lna.-Flodda INSURER(S)AFFORDING COVERAGE NAICY INSURER A:Zurich American Insurance INSURED Fishermen's Hospital INSURER B: Hal Leftwich 3301 Overseas Hwy INSURER C: Marathon,FL 33050-2329 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OP INSURANCE MI Aux-SUM POLICYEFF POLICY EXP LIMITS LIX RISE WWI POLICY NUMBER IMDDNYYY1 1MMNOIYYYY1 GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 HPC 5761329 00 07/01/2013 07/01/2010 DAMMGL TO RENTED 50,000 A X COMMERCIAL GENERAL LIABILITY X PREMISES(Ea occurrence) $ X CLAIMS-MADE OCCUR MED EXP(My one person) $ 5.000 PERSONAL&ADV INJURY $ 1,000.000 7ISK AGEMENTGENERAL AGGREGATE S 3,000,000 GEML AGGREGATE LIMIT APPL^IES PER: '/ PRODUCTS-COMP/OP AGG $ 3,000,000 Poucv iET LOc BY1 'Y`' COMBINED swGLE LIMIT $AUTOMOBILE LIABILm DAJ - l (Ea accident) ' ANY AUTO WAIVER W V/S_ BODILY INJURY(Per person) s ALL OWNED SCHEDULED •AUTOS AUTOS BODILY INJURY(Per accident) S NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) S UMBRELLA MAR OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS UM X CLAIMS-MADE HPC 5761330 L0 07/01/2013 07/01/2014 AGGREGATE S 5,000,000 DED RETENTION$ S WORKERS COMPENSATOR WC STATU- OTH- AND EMPLOYERS'LMBILITY YIN TORY LIMITS ER ANY PROPRIETORIPARTNER,EXECUI1VE NIA E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED (Mandatory In NH) E L DISEASE-EA EMPLOYEE S If yes,describe under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ A Professional HPC 5761329-00 07/01/2013 07/01/2014 Ea Incid 1,000,000 Aggregate 3,000,000 I DESCRIPTOR OF OPERATIONS/LOCATIONS I VEHICLES IARech AGGRO 101,Additional Remarks Schedule,H more space Is required) email: dims-chriatine@monroecounty-FL.goy CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Monroe County Board ACCORDANCE WITH THE POLICY PROVISIONS. of Commissioners AUTHORIZED REPRESENTATIVE Christine Diaz ,(� a1 1100 Simonton St. 1-. tym - �al «= ,Key West.FL 33040 A ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD A`O a CERTIFICATE OF LIABILITY INSURANCE DAo4i`enDa THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the farms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NA MCGRIFF,SEIBELS S WILLIAMS,INC. P.O.Box 10285 PWC HONE 800<]R-2211 FAX Al 35202 Ed1AILo Ent): (Ac,No): ADDRESS: INSURER(S)AFFORDING COVERAGE NAIL e INSURER A:Zenlih Insurance Company 13269 INSURED Fishermen's Hospital INSURER e: 3301 Overseas Highway INSURER C: Marathon,FL 33050 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:9TYFYTA9 REVISION NUMBER: ' THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTMTHSTANDI NG ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTRR ATYPE OF INSURANCE INSR WVO POLICY NUMBER POLICVEFF MMIODYEXP IMOUCYEFF (POUCT EXP LIMITS GENERAL IIASIUTT EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISESSO(Ea oc PEN currence) $ CLAIMS-MADE n OCCUR MED EXP(My one person) $ PERSONAL B AW INJURY $ AP••ell FBy CEMENT GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: BY / I - PRODUCTS-COMP/OP AGG $ 7 POLICY LOC $ G AUTOMOBILE UABIUTY DATE _ I �—` COMBI(Ea NED SINGLE LIMB ident} $ ANY AUTO WAIVER WAVES_ BODILY INJURY(Per Peron) $ ALL OWNED —SCHEDULED AUTOS AUTOS BODILY INJURY{Per e¢bMn $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS (Per accident) S $ UMBRELLA LIAR _ OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTIONS $ A WORKERS COMPENSATOR 2126562401 04/01/2014 04/01/2015 wcSTATU- OTH- ANYE PLOYERS LIABILITYOPRIETOP/mRTNER/ Y/N X TORN LIMITS FR ANY PROPRIETOR/FARTNER/E%ECUTIVE EL EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? NIA i (Mandatory In NH) E.L.DISEASE-EA EMPL 500,000 II ye descnbe under S DESCRIPTION OF OPERATIONS below E.L. L.DISEASE-POLICY LIMIT $ 500,000 $ $ $ $ DESCRIPTOR OF OPERATIONS/LOCATONS/VEHICLES (Attach ACORO 101,Additional Rom mks Schedule,II mop opus Is required) CERTIFICATE HOLDER CANCELLATION • SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Monroe County Board of County Commissioners AUTHORIZED REPRESENTATNE 1100 Simonton Street Key Wes[,FL 33040 .Ef a,,poJ:.Q Page 1 of 1 ©1988-2010 ACORD CORPORATION. All rights reserved. Endorsement#11 0 Additional Insured - Designated Person or ZURICH� Organization Policy No. Eff.Date of Pol. Exp.Date of Pol. Eff.Date of End. Producer Add!Prem. Return Prem. HPC 576132900 07/01/2013 07/01/2014 04/11/2014 48854000 $0.00 $0.00 Named Insured and Mailing Address: Producer: Fishermen's Hospital. Inc. McNeary, Inc. 3301 Overseas Hwy 307 Park Lake Circle Marathon, FL 33050-2329 Orlando, FL 32803-3923 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: Commercial General Liability Coverage Part Health Care Professional Liability-Claims Made Coverage Part Section II — WHO IS AN INSURED of the attached Coverage Parts is amended to include the person or organization shown below as an Additional Insured, but only with respect to liabilities arising out of his, her or its operations performed by or for the Named Insured. This endorsement provides no coverage to the Additional Insured for liabilities arising out of the claimed negligence of the Additional Insured, or out of the negligence of parties other than that of the Named Insured. Name of Person or Organization(Additional Insured): Retroactive Date: Monroe County Board of County Commissioners 04/11/2014 ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED. U-HCU-641-B CW (02/10) Page l of 1 Includes copyrighted material of Insurance Services Office,Inc.,with its permission.