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Item C07
BOARD OF COUNTY COMMISSIONERS AGENDA ITEM SUMMARY Meeting Date: October 17, 2012 Division: Employee Services Bulk Item: Yes X No _ Department: Human Resources Staff Contact Person: Pamela Pumar X4459 AGENDA ITEM WORDING: Approval to amend contract with Dr. Samess, M.D. to provide employment physical services , to add Fishermen's Hospital as a party to the agreement. ITEM BACKGROUND: On or about July 1, 2012, Dr. Samess became an employee of Fishermen's Hospital in Marathon, Florida. An amendment to the current contract is required in order to add the name of Fishermen's Hospital since the invoices will now be issued under the name of Fishermen's Hospital, Inc. All other terms and conditions of the Agreement remain in full force. PREVIOUS REVELANT BOCC ACTION: On April 20, 2011, the BOCC approved the contract with Dr. Samess for a three year period. The bid for services was advertised in December, 2010. CONTRACT/AGREEMENT CHANGES: Adding the name of Fishermen's Hospital, Inc. STAFF RECOMMENDATIONS: Approval. approx TOTAL COST: $4,500 yr INDIRECT COST: BUDGETED: Yes X No approx COST TO COUNTY: $4,500 yr SOURCE OF FUNDS: Ad Valorem REVENUE PRODUCING: Yes No X A OUNT PER MONTH Year APPROVED BY: County Atty"" OMB/Purc asing _ Risk Management DOCUMENTATION: DISPOSITION: Revised 2/27/01 Included X To Follow Not Required AGENDA ITEM # MONROE COUNTY BOARD OF COUNTY COMMISSIONERS CONTRACT SUMMARY Contract with: Dr. Samess (Fishermen's) Contract # Effective Date: July 1, 2012 Expiration Date: Contract Purpose/Description: April 20, 2014 Provider to render employment physical services Contract Manager: Pamela Pumar 4458 Employee Services #1 (Name) (Ext.) (Department/Stop #) for BOCC meeting on 10-17-2012 Agenda Deadline: 10-2-2012 CONTRACT COSTS Total Dollar Value of Contract: $ approx Current Year Portion: $ $4,095.00 Budgeted? Yes® Grant: $ County Match: $ No ❑ Estimated Ongoing Costs: $_ (Not included in dollar value above 4,500 yr Account Codes: 001-06500-510-316- ADDITIONAL COSTS /yr For: (eg. maintenance, CONTRACT REVIEW lities, janitorial, salaries, etc. Changes Date Out Date In Needed Reviewer Division Director- Yes❑ NoNh ] D- 1.12 Risk Manager nt L v i A Yes❑ Noo/ C) O.M.B./Purc asing ---Ov Yes[:] No❑x ~�� 10 Z - IL County Attorney j2 Yes❑ No� ► t Zt7/-v Comments: vivili i Uiiii i"cvlJcu L/L //V 1 lvll,r ffL AMENDMENT TO CONTRACT FOR EMPLOYMENT PHYSICAL SERVICES This is an amendment ("Amendment") to the Contract for Employment Physical Services ("Agreement') by and between Monroe County ("County") and Ronald R. Samess, M.D. ("Dr. Samess" or "Contractor") made and entered into by the County and Dr. Samess on April 20, 2011. WHEREAS, the County and Contractor entered into an Agreement on April 20, 2011, whereby Dr. Samess agreed to furnish employment physical services; and WHEREAS, on or about July 1, 2012, Dr. Samess became an employee of Fishermen's Hospital in Marathon, Florida; and WHEREAS, the County continues to need the services listed in the Agreement; and WHEREAS, it is necessary to amend the Agreement in order to add the name of Fishermen's Hospital because all invoices for services provided under the Agreement will now be issued under the name of Fisherman's Hospital, Inc. ; NOW THEREFORE, for good and valuable consideration, the parties agree to the terms and conditions set forth below. 1. Fishermen's Hospital, Inc.., 1st Professional Centre, 5701 Overseas Highway, Ste. 17, Marathon FL 33050 is added as a party to the Agreement. 2. By executing this Amendment, Fisherman's Hospital indicates its consent to be bound by the terms and conditions of the Agreement, as amended hereto, and Dr. Samess and the County indicate their consent to the addition of Fishermen's Hospital as a party. 3. The person signing below on behalf of Fishermen's Hospital warrants that he has all necessary authority to execute this Amendment on behalf of Fishermen's Hospital and to bind Fishermen's Hospital to the terms and conditions of the Agreement and this Amendment. 4. This Amendment is made retroactive to July 1 2012. 5. All other terms and conditions of the Agreement remain in full force and effect. IN WITNESS WHEREOF, the parties hereto have caused this Amendment to be executed the day and year first above written. (SEAL) Attest: Danny L. Kolhage, Clerk Deputy Clerk 2 Board of County Commissioners of Monroe County Mayor/Chairman Fishermen's Hospital, Inc. Hal W. Lef�, DBA, FACHE Chief Ex utive Officer Ronald . Samess, M.D. Ronald R. Samess AARO E COUNTY ATTORNEY V D AS 0 FOMYNTHIA L. AL'NTS O ANTATTORNEY ®-ate CONTRACTMONROE COUNTY FOR a s r THIS AGREEMENT CAggreemenV) is made and entered into this 20tlh day cf Apra 2Q11, by MONROE COUNTY ('COUNTY"), a political subdivision of the State of Florida, whose address is 1100 Simonton Street; Key West, Florida 33040 and Ronald R. Samess. M.D. ("CONTRACTOR"), whose address is 1$t Professional Centre 5701 Overseas Highway, STE. 17, Marathon, FL 33050. Section 1. SCOPE OF SERVICES CONTRACTOR shalldo, 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. 1st Professional Centre ,- 5701 Overseas Highway, STE. 17 ---. Marathon, FL 33{}50 Phone; 305-743-2253 Fax, 305-743-5383 D. All urine screens will conform with the standard chain of custody proto.colso mandated by state and federal regulations. N += E. The Contractor will have an employee designated as coordinatgr rst r facilitator to assist in the communications with the Monroe Countq ECCtsa primary contact personnel. F. Appointments will be available throughout the business hours of the facility: Monday - Friday 9:00 a.m. - 5: 0 p.m. Closed 12-1:30 for Lunen 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. N. The Contractor will provide the County with at least a 4 -- 48 hour 2 turnaround time for the receipt of any drug or physical results. 1. The Medical Review Off€cer ,:vill be availablta for contact by [tie Monroe County BOCC or its employees to answer questions about the effect of prescribed drugs. Vart ol`the: ietluiretttt:tats set fiOrth by the State €il' Vloridat drug free workplace policy. which Monroe C'€Minty has adopted. and Ifie Department nt cat" i rciiasportaticsn. the County must have a cluMilied kledicaal Rey icw Officer er `'1,iTRU perform dru<-, s,creenia -services, °the ,lRO r€:c:civc; lab reports li-om the laboratcar r (its "OVCaccyNIILIIatttts); lab report,s lZir integrity, authenticity, take nt�atives, and fldse posilivt°s; interprets, lab results, including veriheati€ n of1,d) positives; w-po►is lab relit rt,+to the zitalilc�yc:r {ats cic:tiite:tl ley rules aarttl rtF�alaaticatas}_: T 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 shalt be fully qualified, and, if required, to be authorized or permitted Lander State and local law to perform such services. Section 2. QUALIFICATIONS NECESSARY OF CONTRACTOR The CONTRACTOR must certify at least annually that all staff members, independent contractors, subcontracted work, if any, all service providers it uses, engages or manages, comply with Health Insurance Portability and Accountability Act (HIPAA) privacy and security rules. Physical examinations will be conducted by, or under the direct supervision, of a physician or medical doctor currently licensed and practicing general medicine in the State of Florida. The examining physician may employ assistants property licensed and trained, as necessary, to perform laboratory tests and/or assist in all phases of the examination 3A Provide all best available information as to the COUNTY'S requirements for the Scope of Services described in Section. One to this ;Agreement. 3.2 Designate in writing a person with authority to act on the COUNTY'S behalf on all matters concerning said services. Section 4. TERM OF AGREEMENT 4.1 The initial Agreement term will be for one (1) year beginning the 20th day of Apr 201land renewable at the Co nty`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 S. COMPENSATION Compensation to CONTRACTOR is outlined in the Scope of Services — Section One. Section 6. PAYMENT TO CONTRACTOR 6.1 Payment will be made according to the Florida Local Government Prompt Payment Act. Any request for payment must be in a form satisfactory to the Clerk of Courts for Monroe County (Clerk). The request must describe in detail the services performed and the payment amount requested. The CONTRACTOR must submit invoices to the appropriate offices marked Human Resources. The respective office supervisor and the Administrator of Human Resources, who will review the request, note his/her approval on the request and forward it to the Clerk for payment. 6.2 Continuation of this Agreement is contingent upon annual appropriation by Monroe County Board of County Commissioners. Section 7. CONTRACT TERMINATION Either party may terminate this Agreement because of the failure of the other party to perform its obligations under the Agreement. COUNTY may terminate this Agreement with or without cause upon thirty (30) days notice to the CONTRACTOR. COUNTY shall pay CONTRACTOR for work performed through the date of termination. Section 8. CONTRACTOR'S ACCEPTANCE OF CONDITIONS A. CONTRACTOR hereby agrees that he has carefully examined the RFP, his response, and this Agreement and has made a determination that he/she has the personnel, equipment, and other requirements suitable to perform this work and assumes full responsibility therefore. The provisions of the Agreement shall control any inconsistent provisions contained in the specifications. All specifications have been read and carefully considered by CONTRACTOR, who understands the same and agrees to their sufficiency for the work to be done. Under no circumstances, conditions, or situations shall this Agreement be more strongly construed against COUNTY than against CONTRACTOR. B. Any ambiguity or uncertainty in the specifications shall be interpreted and construed by COUNTY, and its decision shall be final and binding upon all parties, C. The passing, approval, and/or acceptance by COUNTY of any of the services furnished by CONTRACTOR shall not operate as a waiver by COUNTY of strict compliance with the terms of this Agreement, and specifications covering the services. D. CONTRACTOR agrees that County Administrator or his designated representatives may visit CONTRACTOR'S facility (jes) periodically to conduct random evaluations of services during CONTRACTOR'S normal business hours. E. CONTRACTOR has, and shall maintain throughout the term of this Agreement, appropriate licenses and approvals required to conduct its business, and that it will at all times conduct its business activities in a, reputable manner. Proof of such licenses and approvals shall be submitted to COUNTY upon request. 4 Any notice required or permitted under this agreement shall be in writing and hand delivered or mailed, postage prepaid, to the other party by certified mail, returned receipt requested, to the following: To the COUNTY- Human Resources Administrator 1100 Simonton Street, Suite 2-268 Key West, Florida 33040 To the CONTRACTOR: Ronald R. Samess, M.D. ls' Professional Center 5701 Overseas Hwy, STE. 17 Marathon, FL 33050 CONTRACTOR shall maintain all books, records, and documents directly pertinent to performance under this Agreement in accordance with generally accepted accounting principles consistently applied. Each party to this Agreement or their authorized representatives shall have reasonable and timely access to such records. of each other party to this Agreement for public records purposes during the term of the agreement and for four years following the termination of this Agreement. If an auditor employed by the COUNTY or Clerk determines that monies paid to CONTRACTOR pursuant to this Agreement were spent for purposes not authorized by this Agreement, the CONTRACTOR shall repay the monies together with interest calculated pursuant to Section 55.03 of the Florida Statutes, running from the date the monies were paid to CONTRACTOR. Section 11. EMPLOYEES SUBJECT TO COUNTY ORDINANCE NOS, 010 AND 020-1990 The CONTRACTOR warrants that it has not employed, retained or otherwise had act on its behalf any former County officer or employee subject to the prohibition of Section 2 of Ordinance No. 010-1990 or any County officer or employee in violation of Section 3 of Ordinance No. 020-1990. For breach or violation of this provision the COUNTY may, in its discretion, terminate this agreement without liability and may also, in its discretion, deduct from the agreement or purchase price, or otherwise recover the full amount of any fee, commission, percentage, gift, or consideration paid to the former County officer or employee. Section 12. CONVICTED VENDOR A person or affiliate who has been placed on the convicted vendor list following a conviction for public entity crime may not submit a bid on a Agreement with a public entity for the construction or repair of a public building or public work, may not perform work as a CONTRACTOR, supplier, subcontractor, or CONTRACTOR under Agreement with any public entity, and may not transact business with any public entity in excess of the threshold amount provided in Section 287.017 of the Florida Statutes, for the Category Two for a period of 36 months from the date of being placed on the convicted vendor list. 91 This Agreement shall be governed by and construed in accordance with the laws of the State of Florida applicable.to Agreements; made and to be performed entirely in the State. In the event that any cause: of action or administrative proceeding is instituted for the enforcement or interpretation of this Agreement, the COUNTY and CONTRACTOR agree that venue shall lie in the appropriate court or before the appropriate administrative body in Monroe County, Florida, Section 14. SEVERABILITY If any term; covenant, condition or provision of this Agreement (or the application thereof to any circumstance or person) shall be declared invalid or unenforceable to any extent by acourt 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. The COUNTY and CONTRACTOR agree that in the event any cause of action; or administrative proceeding is initiated or defended by any party relative to the enforcement or interpretation of this Agreement, the prevailing, party shall be entitled to reasonable attorney's fees, and court costs, as an award against the non -prevailing party. Mediation proceedings initiated and conducted pursuant to this Agreement shall be in accordance with the Florida Rules of Civil Procedure and usual and customary procedures required by the Circuit Court of Monroe County. Section 16. BINDING EFFECT The terms, covenants, conditions, and provisions of this Agreement shall bind and inure to the benefit of the COUNTY and CONTRACTOR and their respective legal representatives, successors, and assigns. Section 17. AUTHORITY Each party represents and warrants to the other that the execution, delivery and performance of this Agreement have been duly authorized by all necessary County and corporate action, as required by law. Section 18. ADJUDICATION OF DISPUTES OR DISAGREEMENTS COUNTY and CONTRACTOR agree that all disputes anddisagreementsshall 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 shalt 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. 0 In the event any administrative or legal proceeding is instituted against either party relating to the formation, execution, performance, or breach of this Agreement, COUNTY and CONTRACTOR agree to participate, to the extent required by the other party, in all proceedings, hearings, processes, meetings,; and other activities related to the substance of this Agreement or provision of the services under this Agreement. COUNTY and CONTRACTOR specifically agree that no party to this .Agreement shall be required to enter into any arbitration> proceedings related to this Agreement: 11Y i 0, 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 Vll 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 USG ss. 1681 1683, and 1685-1686), which prohibits discrimination on the basis of sex; 3) Section 504 of the Rehabilitation Act of 197 „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-) as amended, relating to confidentiality of alcohol and drug abuse patient records; 8) Title Vill of the Civil Rights Act of 1968 (42 USC ss. 3661 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 A 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 statee statutes which may apply to the parties to, or the subject matter of, this Agreement. 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. 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 lino; ether than . a bonafide employee working solely for it, any fee, commission, percentage, gift, or other consideration contingent upon or resulting from the award or slaking 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 otherwiserecover, the fall amount of such fee, commission, percentage,: gift, or consideration. The COUNTY and CONTRACTOR shall alloy 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 919, 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_ 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 focal government liability` insurance pool coverage snail 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. 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 there, of this Agreement to enforce or attempt to enforce any third -party claim or entitlement to or benefit of any service or 8 program contemplated hereunder, and the COUNTY and the CONTRACTOR agree that neither the COUNTY nor the CONTRACTOR or any agent, officer, or employee of either shall have the authority to inform, counsel, or otherwise indicate that any Darticular 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 -Coll usion Agreement. 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 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 a 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 reinstatedor 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 CONTRACTOWs 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 subjecttocancellation, non -renewal, material change, or reduction in coverage unless,a minimum of thirty (30) days prior notification is given to the County by the insurer. The acceptance and/or approval of the Contractor's insurance shall not be construed as relieving the Contractor from any liability or obligation assumed under this contract or imposed by law. The Monroe County Board of County Commissioners, its employees and officials will be included as "Additional Insured" on general liability policies. 33.2 General Liability Insurance Requirements For Contract Between County And Contractor 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: If split limits are provided, the minimum limits acceptable shall be: $200,000 per Person $300,000 per • 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 requirernents. 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 findthe CONTRACTOR or any of his/her employees, contractors; servants or agents to be employees of the Board of County Commissioners for Monroe County. As an independent contractor the CONTRACTOR shall provide independent,. professional judgment and comply with all federal, state, and local statutes, ordinances, rules and regulations applicable to the services to be provided. The CONTRACTOR shall be responsible for the completeness and accuracy of its work, plan, supporting data, and other documents prepared or compiled under its obligation for this project, and shall correct at its expense all significant errors or omissions therein which may: be disclosed. The cost of the work necessary to correct those errors attributable to the CONTRACTOR and any damage incurred by the COUNTY as a result of additional casts 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. TNESS WHERE F; the parties hereto have caused these presents to be executed on the of►. Deputy Clem (CORPORATE SEAL) ATTEST: By 12 RONALD R. SAMESS, M.D. by \\--- I ti40IN'R F_ COUNTY ATTORNEY AP �iONN/ AS T � R ASSIS ri'/,s�. "IJ Y ATTC3�iNEY `s i t ............. .ice 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 resultswillinclude: • 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 can 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) 14 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 *MRCS review) 5 panel will be either scheduled or drone on a $35.00 Department of walk-in basis. Transportation Leguirement *MRCS REVIEW Drug screens will be forwarded to ILIA Dr. Burton for MRO review. Dr. Burton will bill Dr. Samess directly for p4ent of MRO review. BLOOD ALCOHOL When requested, Blood Alcohol (Collection, Lab, M R O 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 ertarmed. 13 If Physician wishes to propose either means of screening method, please provide testing method explanation and accuracy. A testing facility must be available 4 hours a day, 7 days a week for past accident, random, and reasonable suspicion alcohol screening, PPD-``iB 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 performed by the Combined physician during the facility's normal with lousiness hours. Diphtheria below:• DIPHTHERIA When requested, a Diphtheria inoculation will be scheduled and N/A performed by the physician during the facilit Is normal business hours. DOT PHYSICAL, When requested, a DOT physical will (SEE ATTACHMENT be scheduled and performed by the "tB" 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 performedin conjunction with a post -offer physical. Thereafter, only a DOT physical is performed by the physician.. Physician may also perform a urine drug screen of requested se aratel by El Monroe County BOCC. POST -OFFER When requested, a past -offer physical PHYSICAL.: will be scheduled and performed by the $70.00 (SEE ATTACHMENT" physician during the facility's normal "A" to be completed by business hours. Includes exam and employee and physician) physician review of employee health history and job description. Physician may also perform a urine drug screen if requested separately by Monroe County BOCC. FIREFIGHTER, When requested,_ Firefighter physical PHYSICAL (SEE will be scheduledand performed by the ATTACHMENTS "E" to physician during the facility's normal` 7 -00 be completed by employee business hours. Includes exam and *Fee Also and physician). physician review of employee health includes history and job description. Respirator Physician may also perform a urine Physical at; drug screen if requested' separately by no additional Monroe County BOCC. Charge. Also required. EKG, Chest X-ray, Sptrometry, HearinglAudiogra , Stress Test; PPD-T$ screen. FITNESS FOR DUTY When requested, a Fitness for Duty $70.00 PHYSICAL (SEE Physical may be requested at any time XTTACHMENT "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 i history, exam, review of.job duties and medical regards if necessary. Physician may also perform a urine drug screen if requested` separately by { Monroe County BOCC. RESPIRATOR When requested, a Respirator physical *S80 PHYSICAL. (SEE: will be scheduled and performed by the ATTACHMENTS "C" physician during the facility's normal PART I & II to be business hours. Includes exam and completed by employee physician review of employee health and physician) history and job description. Physician may also perform a urine drug screen if requested separately by Monroe County BOCC. Also required; Chest X-ray and Sprirometry. *See Fire latex= Eli sicul EKG Normally done in conjunction with the S80.00 Firefiyjiter physical. 15 CHEST_ X RAY Chest X Ray is normally done in Physician conjunction with.lhe New Hirt' provides Firefighter and Respirator physical if order to Key there is an issue with the EKG or Wilt spirometry results. Diagnostics, Key West Diagnostics twills County directly (S75,00) SPIROMETRY Normally done in conjunction with the Respirator physical. All Firefighters and employees who use a respirator will S20.00 have a Soirometry when hired.. Nonnally done in conjunction with the H ARING/A.UDIOGRAM appropriate physical. May be requested S30.00 separately by Monroe County BOC;C. STRESS TEST (SEE Normally done in conjunction with the physician ATTACHMENT "U for new hire Firefighter physical. provides explanation of services to Performed thereafter for firefighters as order to Dr. be performed by needed. Bards. Ear. physician) Boros schedules test with Firefighter. Boros provides results and bill (S200) to HR with copy of results to Samess, Samess sends results via fax to HR. CHEMICAL Tests Glucose (sugar), kidneys; liver (I Fee included PANEUCMP tube of bland drawn). in Firefighter Normally done in conjunction with the physical ... _.... ..... Fired r iter Physical. ... _.._ Y.. CI C 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 Firefi x ter Physical. LIPIDS Tests good cholesterol and bad S55.00 (CHOLESTEROL,) cholesterol ( one of the tubes of bleat drawn) Normally done in Lon)unction with the 16 Firef ter Physical. t1A SIP Normally done in conjunction with the *Included in DOT physical Physical fee CIA W ITH M fC RO 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 Cleric, the State Auditor general, and agents thereof shall have access to Contractor's books, records, and documents required by this contract for the purposes of inspection or audit during normal business hours, at the Contractor's place(s) of. business. 17 9WORN STATEM ENT UNDER ORDINANCE NO.t ! ..i MONROE COUNTY,FLORIDA ETHICS CLAUSE "...warrants that he/it has not employed, retained or otherwise had act on his/her behalf any farmer County officer or employee in violation of Section 2of 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 farmer County officer or employee." (Signature} Date: d (/ STATE OF: COUNTY OF: QAAAL— Subscribed and sworn: to (car affirmed) before me on MaVQIA (date) by (names of'affrant). He/She is r personally known to me or has produced (type of identification) as identification. NOTARY PUBLIC My Commission O ��`Public ` Slate u{ Florida CWW % �committer1..t�No NON-COLLUSIONAFFIDAVIT i, of the city of according to law on my oath, and under penalty of perjury, depose and say that 1. I am of the firm 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 persona partnership or corporation to submit, or not to submit, a bid for the purpose of restricting competition;, and 5, The statements contained in this affidavit are true and correct, and made with full knowledge that Monroe County relies upon the truth of the statements contained in this affidavit in awarding contracts for said project. (Signature) Date: STATE OF: COUNTY OF: Subscribed and sworn to (or affirmed) before me can awl (date) by �- - ,�; ' _.. (name of affiant). He/She is personally known to me or has produced (type of identification) as identification. NOTARY PUBLIC spyy� itfft3ttf i}P.V Pry �� My Commission EXpf *_ � `:: et��i�e`�� f7AlifG.i.AL PUMAR Notarx avbttc .sate of i'iorida t '= +ia1-Expires Noy 27, 2011 +%; C,,WSatcn #1 00 737309 'mot Bided ihrmo National Notary Awn. 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 underbida 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 terms of the statement and will notify the employer of any conviction of, or plea of guilty or noio contendere to, any violation of Chapter 893 (Florida Statutes) or of any controlled substance law of the United States or any state, for a violation occurring in the workplace no later than five (5) days after such conviction. 5. Imposes a sanction on, or require the satisfactory participation in a drug abuse assistance or rehabilitation program if such is available in the employee's community;; or any employee who is so convicted. 6. Makes a good faith effort to continue to maintain. a drug -free workplace: through implementation of this section. As the person authorized to sign the statement, I certify that this firm complies fully with the above requirements. (Signature) Date: STATE OF: if l l<l COUNTY OF Subscribed and sworn to (or affirmed) before me on (date) by !t MAY If i . (name of affiant). t e/She is personally known to me or has produced (type of identification) as identification. NOTARY PUBLIC My Commission Expires. """"y.`"-'""®.�...R�..`,"►". �r"p MEGA G. PUMAR a1110111 Notary Public State of Florida } ' = my Commission Expire$ NOY 27, 2t011 -' .,, Commission # DID 737309 :t`F. `B9ndedThroughNationaftlaryAssn PUBLIC ENTITY CRIME STATEMENT "A person or affiliate who has been placed on the convicted vendor list following a conviction for public entity crime may not submit a bid on a contract to provide any goods or services to a public entity, may not submit a bid on a contract with a public entity for the construction or repair of a public building or public work, may not submit bids on leases of real property to public entity, may not be awarded or perform work as a contractor, supplier, subcontractor, or CONTRACTOR under a contract with any public entity, and may not transact business with any public entity in excess of the threshold amount provided in Section 287.017, Florida Statutes, for CATEGORY TWO for a period of 86 months from the date of being placed on the convicted vendor list." I have read the above and state that neither Renate! R. Sam+essM.D. (Contractor's name) nor any Affiliate has been placed on the convicted vendor list within the last 36 months; (Signature) Date: STATE OR pj�IL COUNTY OF:01)hVVL Subscribed and sworn to (or affirmed) before. me on x) (date) by&&%(name of;affiant). He/She is personally known to me or has produced (type of identification) as identification. NOTARY PUBLIC My Commission Expires 21 i4 ......... p.%f,,. PAFAEtAI. t'U�fAR Notary Public - State 4t Florida MYCam M" Expires Nov 27, 2d11 Commission # Ott 137309 MONROE COUNTY,FLORIDA RISK MANAGEMENT POLICY AND PROCEDURES a- A 4 rf Indemnification and Hold Harmless For Other Contractors and Subcontractors The Contractor covenants and agrees to indemnify and hold harmless Monroe County Board of County Commissioners from any and all claims for bodily injury (including death), personal injury, and property damage (including property owned by Monroe County) and any other lasses, damages, and expenses (including attorney's fees) which arise out of, in connection with, or by reason of services provided by the Contractor or any of its Subcontractor(s) in any tier, occasioned by negligence, errors, or other wrongful act of omission of the Contractor or its. Subcontractors in any tier, their employees, or agents. In the event the completion of the project (to include the work of others) is delayed or 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 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: It too 11 011 Coverage shall be maintained throughout the entire term of the contract. Coverage shall be provided by a company or companies authorized to transact business in the state of Florida. If the Contractor has been approved by the Florida's Department of Labor, as an authorized self -insurer, the County shall recognize and honor the Contractor's status. The Contractor may be required to submit a Letter of Authorization issued by the Department of Labor and a Certificate of Insurance, providing details on the Contractor's Excess Insurance Program. If the Contractor participates in a self-insurance fund, A Certificate of Insurance will be required. In addition, the Contractor may be required to submit updated financial statements from the fund upon request from the County. 23 GENERAL LIABILITY INSURANCE REQUIREMENTS FOR 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; # 11 0 it J! # - * is - # If split limits are provided, the minimum limits acceptable shall be: 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 Worker's Compensation $jOO 000 Bodily Injury by Acc. $_500 000 Bodily Inj. by Disease, policy Imts 100.000 Bodily Inj, by Disease, each emp. General Liability, including $ 300,000 Combined Single Limit Premises Operation Products and Completed Operations Blanket Contractual Liability Personal Injury Liability Expanded Definition of Property Damage Professional Liability $250,000 per Occurrence and Including errors and omissions $750,000 Aggregate The Monroe County Board of County Commissioners shall be named as Additional insured on general liability policy. 25 EMPLOYMENT P14YStCALSE-RVICES AFIACHMENT MEDICAL RECORD rS Informallon IS for A. i NAME OF PATIENT test, f;tsf. &77 aJ PMA gTREET ADDRESS •Stfeet cr REPORT OF MEDICAL HISTORY ENTI11CA-VON NUMBER tj Position 7 sT At EME NT OF PATENT'S PRESENT HEALTH AND MEDICATIONS CURRENTLY USED {010, AdiAifto—1 P40S J ntc"340Y) CURRENT DiCATIOU---.. REGULAR OR INTERIM. C. AILLERGI ES fyncludg fns*cr bi7fv!Phn9$ and c0fAroo" "06JV Id, f4Ei(iKT Wklu" I ;ell' PATIENT'S OCCUPA rION LED RIGHT HANDED LEFT HANDED 10. PASTICURRENT MENCAL HISTORY CHECK EACH r I EM YES NO 040 N T KNOW CHECK EACH ITEM YES NO IN DO't KNOW CHECX EACH ITEM KNOW Household CanIaCt w1f, anyone Will% kubef';;'tosis Shortness of breath Bono, laint orailre defatmly pilm or pressure 'n chest Lass of finge? or too T"belc4osts at VaSrwe 1`0 test oodai tosputum of hen rougtnrg at det,lal -ark Chronic cough at poundimo heal. Mean Itoubt gh of low blood pwalwe I'Antol m *Ifick' thouldet or. elbow 04,curten, back pain a( any. back �njury Cramps'". your legs, 'Tick' of locked Ito" su.vfiv Attempt a, pfsn's f(.4vent 4"Gosimm Fool itoabtvr SIf'.v-W*.g Stomach, Imet ofmlesafmal Ktoqbl Nerve m�y Wear Gait bladder lfo�bl* of galmones pestys's N'cw�'v ialantife) _7 Epilepsy or seiztga LJc% VVItOn 10 ellhat *V* Javod+ca oy h"Amis C 44. train, .6a at at sockoesi Weer a 1'xeaftnq md afoItt'n. bones Frequent -trouble strtpknq $t utter or st;mfoff Adverse reaction ro,awkit 'won I Depression or "C*4vV* .0"Y West a bract a, back �jrvort .jii;- 1'c fftof Swollen Of pmolut pwnls Frequent Of severe headaches '.rl'r,'ess a, tmm'N saeft e trouble clear 09 — -- Rmmem car mfrtuora ;Foec or 00quent tofdg 5averc tooth or p:x+t trouble • Skin disaas as T.mt' 9tavAk Cyst. comet HemJa Hemattho,ds of ferlal flisease F,eWa-t at pehA unnat,on Red well,N s.Ke Aqv 12 K,dnsy 51*n* or blo*d,n ur,na sugar of Altusnan . vf"'d I Se.uAlly Tfammfed &srfascs I Recent qmn 0, togs of we,gjt 41,ng disorder lanw*a'A buhMr *' 41C.) ButVI"1,ifads.bmances Thvfo!d u"bitaf 94.1ar ----i Loss of memory of amnesia Nelv.us trouble of any so rt— Perfods ol wworAv—s(1033 Pa(enus,bl,A9 -flhdiabetes, cancef, sitoke a, htrast 6geass, 3 x ray Or other rad,'avon the apy I Asbestos onto ,c hermcat —4.---,-4— dp i-mle, Pitt Of Pad In any bone totd to cut $a—, 0, to, ate.hrI 60 tray (ever. or alre'sc " lht's Head mIfv Awma --- 'Ised Tobacco vWI?"m Na-N ;Ijuu I —.. I , ' . — pleyloos Psicitlatcl by ICM;4.IGSA FIRMR 141 CFRt .01 9 202 1 -7ro—a--T lox CHECK EACH ITEM Yes i NO Kit Ow 1PEF 7,—..I.d fat a lernee Otiorder NIA anqq in Menstrual Patton, Lt�i- ----CHECX EACH ITEM. IF 'YE- EXPLAIN IN 13LANK iEM YES q N 12 Have you boon refused *rMloytnent or teen idgibls to held a tob or I ,,tay in sohoot because of a. Sensitivity to IhOt'ncals, dust, Suf0iotil, OM' b inability to pit,foun curtain motions. , I—hdey to assume certain 00.0tios's, ill. Other medical reasons W yes. qive mosons-i 1. 13, Have you ever heart, IrAmild lot a Memel conditicril Ift Yes. wheo. whete, mod give dtimifsl 14 Have you ov#t been damed 1,14 trimUrs"; fit Vat, S(At# '#&S4n And I S. Nave you tied. or rAv" you been advised to riave, any operate., If Y"' d&jcAb# and give age he which occurfed.1 113 Have vowtiver It~ a PAIM.1 in any type "T flog ll 0 tayes. S'p#c'fY when, here, IW, name o or doctor and compMto address of Aosptaiit) 11, Have you conWled *I been treated by Clinics, OW3iciam. hilaals- or other preclittaners wwwri the past S VASIA, lot What than fitinor Arranges I fit Yes, 0'a, conweir aditnis.1 of doctof; hospital, cOric, and do (ads, j I a H4.0 you ever too rejected in, noldary service bKauaa physical, Mental, at oltief reason I W Yes. 9;ve dole and moselt for T-L--11001 -- 19. Have you ever bggnj.,cnar,;ed tiom Milhri service because of I ti*J'f.Lss or uriiU(WiAry'l Td-, Have Ott over facolved, is Itlers "n d in 9 a r have you over applict for ponsiann of to 586 ii for .isting disability 7 (if yes, specity What Aind, or— byw am, atilt whet Omoaat' when. -1114 222 Have you ever been (OAVased with a tommIng di2abriety? fit Yes. 9wo type. where,. e,,d he- d4goosed I !GRAM N/A NIA N/ak ro RIGHT, LIST EXPLANATION Oy 11 LM NUMMt' dg,,glep by mff'oew any addfifterw MO&CIP, -Itrslioty dtorried mWorfigol, and record any TI-01"V5 r""" 93 iniv i rtl'POr Mk �x'�8} i t 38 27 2& Z5_ 2A 23 44 i!Ek5 T t�} c. 'a; ur+s�.=='. j4)WCROSCOPIC �y �y 8UMfN .,� f RGAR. ;,uERLX.OGY fspdea�'<"em4"o O EKG ®LiN S FACTOR , 4 N S N. 75 40-00,634.401lS 36-t25: „—l""d a?J+9'OSN4r;es 3'eA iSR=:.✓lr4•?R. Aa. pi ®EtEC'S5 AND DSEASES F L 2. Zt 2E3... Y4 wD Si Q cm EST )(..AAY OR. PPD (Pk m... ctiate:-Ian a,,mawr ar4 re=s+,dt CIA PE ANp OTHER TESTS 32}+ P. 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Q o Rj Q E b �c c � U e n. 6, E o 4 0 ?A �,:, S�.�.z c* Z Li a� & < 94w P rxi J, cm 1 0 me Z f1 . r lD SP I -, 2 J. v cc O }g FG :s tt5 Ck ^ Ci liQ-Va 5b Cc PC a+— ii wccn 0'` Eccq uwi' t° Y E = m vo x a w . xr.'Ci y mi 000 s e7n o �y .� a-e m zm's<Q, C. 'i m E r "'S am N p It oSmuCp ��.�p C pt? Eha� p E�•�L � C�s � u os + o�cr) wys�x»nsi °44) a o: ,a w m q Fa OLOYMENT PHYSICAL SERVICES ATTACHMENT � 0 Ouesfionnah J 111-a Age {to nearest year}, Job "title. *x (t:he (k:ttne) U klule C Feirtate slate: Height: feet.__ sax hrx, Weights, lam. Check the type of respiratoryou will use (you An th4, k 1ttore t One c,,ategory): Phone number where you can be neiwited by the health U N, CL or P disposable arcl+iirator (filter-mas , care person who reviews this (iax;luile ar€a�t tu1t+)i tort-c-artriti type, <enly). `Me best untie to call you at t" number. a. U Othe r type (forexample, half, or full -fat etp#eCe type,, rx)w.ered-air purifying,. supplied-.tir, self-t:onLjrwd Has your employer told you how to contact the health rare breathing apparatus). person who will review #his (check +.,)nt-) G3 Yes u *.o have You wom a: respirator.. Q Yt-4 U No If ,ytsj,, what type(s)r _...... �___._:___.... Part A -- C tion 2 (Mandatmy) Qupstieans I thmugh 9 bolow must he answpTed by A-vrry emplr€ye e whcs hoes hmn-selected to ussw any t%p of ", pirator (pleas t•het k .,yes„ or "nd'). I. Do. Von currently smoke tobacco, or have you smoked tobacco in the last month? ......... .> ..:..., J yi-, U Nc.) t Have you ever had Any of the following conditions a. Seizaams (fits). .... h. ........ ...... ........... ................... U Yc s Diabetes (sugar disease):.......> ......... NO A`, ....... U Yes rltierrir aeat.tions that interfere with breathing .................... Q J. ......... Q Yes. Claustmphobia (fear of c-Icir: ed-in piacAkc):..,:.. . ................ U NO c;, . ,. ........Cl Yes rrutahlet smAing to ors ......... 3 S3ig i es .3. Have you ever had any of the following pulmonary or lung problems? I a:t+erttsi :... h. sthaYra......................:.........:..........:............... :..... ....., .,,..,... ... a Yes*; :. No A: C>hronit hrnnic-hitis. ............:.............. d. .... ...,...,. ..,.....,: ....,.,::. ....,.3Yt—, m physt inn . ........... ....,..,.,. .......... 'J No t'. ......: ............ Yt-, Vneut7atttna:- "................ .,....... ..l No f. ....................... ......... ....3 Yts; rubt>n tait,& ......... ...... A Nil __...;...,....,..,.:.: ......... = Yt»: ..... i : € KPtiet€tnothora,- ...l ytq (G 441.11"ieti 11111g) .,.................. ..... J No ...... ... _.... Yt`s l N€3 i� Broken .... ........ ................ -1l (-% .a %tI .... .,. ... ars torsi 1at'St €t ajar€t,%or mat r}�/�f€t'!: ......... .. ..... 1. \ny t.{.ht•r 1tt€'I. problvill that ti ttaE'tr itt�'#a ttelAl atu=*at° '-1 N.G) 2 : - No WVI An 3 VICA ixt 30MA t* easy4.2W 4. Do you feaa ntly have any of the following symptoms of pulmonary or lung; illness? J. "altt}rtiat '; of breath, :.,.. <.,.........: .............. .......... h. ` hortna+s-_c+f breath when wolkin}, fast on level ground or walking, up a %light hill or teat line:....:..... ��� Yo4, °. ',,ii t , Shoriru w of breaths when wslking 3Lith other r44,rlt` at An ordinary pj%ce on It-tri ground: .,;...,:. 1y Yc`�, QNoel. I lave to stop for bwaltll i'Yhi-n-w,dkinly aat:.your own pat a" i)a"5 1E'VE>I.}s2'flfaill�t . .:....... ...::;.... .,>.,.....,,a e+. Shortne of breath wht-n washing or cln,�4int; tt>ua� t`I( .;: .... ........ ... ......... ....::... a Y,,,s .1 No f: Shortne*'N t,l hmath that inte'rfen-s With vour joh. ........... ,.::.,:. ... ;—..... ........ ' ,,....... Ye`s fa No gF. coughing that pmducej Phlegm (thee k sputum): . ........ Q Yeas J No h. Coug;hing, that wakes you early in they morning;..... ... ......... .. ... . .. ......... :.,1:3 Yees J No i. (.ctug,liing; that#xvurs mtrttly wht>n cYu �ia+tviref;eltY� n-- ................... --.... ......... a Yes- �a No ("c++agrhiiag, up bltxid in the last month: ...... .:......_ .......... ....... .......... ,..,...... U No k. k1Vhtv,-A1g. ........... ...... ...................... ... ... - _ � Yew Q Nca I. Whe o/ing; that interfe" with ytaurlEais:..,,. .................. ..... fQ Yes Q No m. Ctwst pain when you lare4the deeply. ... .., .....>. ... ... .. Q No n, Any rather symptoms that you think may be related to hang, p E+lems.. 5; Have you everhad any of the following cardiovascular or heart problems? a. Hurt aitt at k......... ......... ....... •• ....... Q Yes Nob. stmke: C. Ang ura..... .................... , ...... ...... ................. Q Yc3s Q rsb J. Heart fu ure ...... .. Q Yaas. Q No ea. Swelling in your legs or feet (not c•atmml by wbalking). ;....... .... ......,......... ;„:.:.. ......... Q. Yew Q N f. Heart auThythrnfa (heart heating irrtag ul arly). . ....... ..................... ......... ......... Q Yes U No g. High blood pre --sure: .......................... .,......... ....... 0 Y€mi U NO h, Any rather heart problem that you' ue been told about : ... ......... ,........... . Q Yes Q No #. 1-lave you ever had any of the followingf, cariliovasciuUr or heart symptoms? J. h. Frequent pairs or fightrmm in your chest :.. ........................ .... ........... .......... ......... ......,.........:..... Pain Q Yeas Q No .. or tightnessin your chest during physical activity.... ......... ........ ....... ......,.. Q Yk,S Q NO c Pain or tightne pie your cl"t that inte?rfores with your job ......... ........... ............ . ........ .:.....:. Q Yew Q No d. In the Past two years, have you ntati" your heart skirping, or missingr, a befit ::....... ......... Q YE i Q No e. Hearthurn or indigestion that is not tvIdtei to eating ........ ...... .• ..... ....... ........ aYt� Q No... f. Any other symptoms that you think may he Mated to heart or 'ireulatidn ptx)bk' xt.s. .. . ................. 0 Yes Q No 7 Do you curmntly take inectkatfon forany of the following problems? a. Breathing or lungs pwbleems .. h. Heart txtsu(*Ie.................................. . .... ..... Q Ycya C� .No Q Yew Q NO C. slomj pn`ssure}; ..................... ................. .......... . ......... tl, Q Y'a Seairun-i (fit_:,): ........ ....... .. , es iNo S. If'you've w4ed a respirator, have you ever had any of the following pvoble ? llf t°tYe 'vv iievor w;vd a revirator go to cluetition' ) a. Eyv irritaation :Q Yam J N+a I*. %in ,illvrg,ia-; or re* lxt s. ....... j t`,ua J No ka><. ei lather rn)t�h,nv that interfert-, sloth Wspiratcar MCA VV1819MI 0x*&*8-XM 9, would you like to talk to the health vAr-e professional who will review this questionnaire About your .11-t5vvi,rs to ...... ... -- ... .......... JY"t'-; j No Qut-,tim-L4 Wto 0 Mow tilust Lxloxi-wewd by vvvry employev who ha%N4-ti s0vamt to uNevitlwra hill-f4lollietv rv%pirttor or a rMWEIrl tit, Lhk-Atlui-Stion5isvoluntarv. 10. * lave you everlost vision in either eye (temporArity or pernumently),., ............ -- ............. Yip; .3 No 11. C)o you currently have any of the following vision problems? a. Vvvor k ortatt ...................... ....... .......... — . . ........ - . .......... .............. ......... .............. --a Yvs, Q No h. Vvvar Joassos. ..... .................... ... ---- ...... --- ............. . ... .............. I ...... ...................... 1 � YvS Q No 4'. Color bhnd:.. ........... -- ....... -- .... ...... -- ................... .. I......- .......................... ............... - ....... ........ ....... Q yt.-S U No J. Otlier eye or vision probluix- ..... . ...... ..... .......... ;.." .. ...... —.-- ............... . .. 1— ... I ... — ---11. : I-- U YOS U No 12. Have you everhAd an injury to our ears, including a broken car dxuxn.,.. ........ -A ................ .................... C1 Yes UNo M Do you currently have Any of the foHowing heating problems? a. Difficulty healing . ..... t- ........... ...... . ..... .......................... - ........................ ...................... .. . ........ . . ....... U Yes U No b. Wear dhintringail!.:...... .................. ............... - ......... - ................ ................ I ..... . . ...... .......... Q yes U No c. Any other hearing or ear ............ .................... - ..... ................... ...... . ...... I ......... U yes U i%'o 14. Have you ever had a back injury: . ........ . .... ................. ................. ................ ................................ ......... _ ..... (a Yt"s U NO 15. Vo you currently have any of the f6flowing musculloakeletal problems? a. Weaknv% in any of your Arms, hands, legs, or fet4: ................ ........................................... A ................ Q Y(-, UNo b. Back paim....- .. . ....... . ...... -- ........... . .......... ........ ................ . .. ..... .... .......................... -..- ......... ......... U Yip U No C. Difficulty fully moving your arms anti lvgp: ........... .............. ...... .............................. . ....... ................ (3 yes (3 NO d. Pain or stiffrwss when you lean forwarclter backward at the waist . .............. ..... -11 ... —1.1. ...... . ........ . .. a Yes U NO e. i)iffic-ulty faUy moving your head up or down: ... ....................... ...... ... -- ... ..... ... -- ... . - U Y(,-,, U NO f. DiffiLulty fully moving your head side to side . .............. ....... ............... . ............................................. Q Yes U No I,. Difficulty Nnding At your krwes: .............. ................... ......... ..................................... ...... ........ - 0 Yes U No h. Dtfilculty squatting to the ground: ..... -- ...... ................. ............................................... .......... ............ . Q Yes U No i. Climbinga flight of stairs or` 4 IdddercarTyine, more than 25 Ihs.: .................... ............. ......... ............. Q Yes U No i. Any other mu. -A le or skektal prutlem that interferers with using a ".. pirator ....................... ....... - U Yes U No PM1t 8 AnV of the following qut-'tions' and other questioms tiot Lst*-d, niay be added to the questionnaire at the Jist retion of tht! health t are rrofessivmd wlic) % ill w-view the qu*-,tionnaire. 1. In your present job, Are you working At high Altitudes (overSAM feet) or in 4 place that leas lower than 1X)rm4I'%1i1ot111ts of oxv)eti: .. ........ ........................ ...... 'Jhas (if 4.Alu'r -q mplutil'; -'OU-n you're, working under these t tared itioris.................... - ....... -- ........ ...........',J Yos �-J No 2. At work or At hOnte, have you ever been exposed to hazAWoussolvents, hazardows airborne chemicAls (v,g),,,ies, fttoir%, t Yriust), i }r lui v(- Y-Ou t oinv into k in t t mtat t %% ith hi I ivnuc.Js:-- ... . ............... ,,, J'lfati J No RESPIRATOR USE PHYSICAL Name --- Age — Sex Home Address "Telephone Occupation Length of Employment I agree to the release of this infbnnation for State and Federal regulatory purposes to the extent provided by applicable laws, DATE SIGNED nFollow-up Medical Evaluation Physical EMPLOYER Required. (Positive response — Question 1-8). Post -Offer Physical: Medical. Evaluation Physical Required. `. Would you Like to talk to the he tlth iaie pmfessior d who avx11 review this questionnaire about your an.-WeVsto this,�uestionnAft •.:..:::...................... .- . No Quc- ti<rtl"_ 10to 15 E'Mow M uit t"A* J"6w(!rvJ ily crtivu rti� employe e who hay�•��t�t''i to u�c: �ikhr>r a FuII-I �ci �icY�e� t+ sP« Itot-,ar a ti �tf i cutt.tinc cl l� �sr•,thinf, ar to {SCB ). 'Foren5rhot e(-s wK) tuve btvn sekaed to i > ar cvcrin(; tht-w questioris �vo1lu tttary, use oi?:r tic ; of r »; �catt)r: (U. Have you ever lost vision in erither eye (temporarily intE orxril or e nruneY): .... .... ., .Q Yt s �3 No 11. DO you currently have any of the following vision problems? a. tYrrar ez,�,t�;t texx�� I% Wear t l m : ..,..,.,. Y q o {, Color Wind: ...0 Yes Q �fus d. Other eye or s 7 at�n probli.-m: Ci Y 0 No .. .. . ............................. ..... .C.3 WS U No U l- Ave you ever had An injury to your eass, including ai broken eardrum :.:_ .... 1100 you cuxnnoly have any of the fallowing hearing problems? a., L3iffi+-vrtty hu�arrng' hs 4Year a hearint; Aid,......... .....I. ........0 Yes Q No ........ ...... C. Any other IIV trim; or ear problem: ............ .......• ''7'j Yes(C^;'I No '14. Have you everhad d back injury:....................... 15. 00 you cu =mdy have any of the toiim ring mu-scuioskeletal problems? a. Weakness in any of your Arats�, hdnds, legs, or Net _ .......................... ...,,,. ,.«. .............................,....a Yes c.•�� Difficultyiry guy moving your � and legs a No , . •.... ......... ....... ......... QYES d. Pain or stiffness when you lean forward or backward at the waist; UNO e. Difficulty fully moving your head u dowm .i� Y C3 No or F Difficulty fully moving your head side to side,.—,.... .0 Yes Q No g: Difficulty bending at your kzlees Q Yes Q NO h= Difficulty squatting to the groune#, ...................................................,...,...........,..,�! Yt,, `� No i, Cylimml nga flightofst s vca bdder carrying raying, than 25 tbs. ............ ......0Yes more ...,.,.. j. Any other musc:leorskeletal problem that interferes with using...0 yes a ru�spirator:. 0 NNo CJ No o ..................Q Yes Jo part Any of the following questions, and other questions not listen cnav ba.s added to the qut�ironrvur2 at tl� duscxr txc�n of the l�e� th care professional whO will review the questionnaire. t, (n your pment jol',_am You Wozk'"g at high altitudes (over5,l D fees) or in a place auk has lower than nor=raal aanounts of oxygen . car othersyrnptoms w hen you're working under tht.�se conditrorus; Ci Yc�U NO ........ ................, .. C3 Yes i3 io Z Atwork orat home, lave you ever beers exposed to hazardous solvetab, teazuafoul airborne clseetirals (e-* $ses, fumes, andust), or have you come into skirt contact wvyttt laarslous eheatticals- ........, yes No with any of the UuterLds,ormnder any of themnditinns, lis - 4. List any second jobs orside busbaesses you have- 5List your previous occupations: 7Have you been an the naftaxy services? -°-Yes UN()u-Ye�'we�you to omdnq�u�a�n�n�dh�bmba���or`----~~^~~ ~~ S. Have you evorworiced'n a HAZNIAT teaml____ 9. Other than medkations forbreathing And&mg Problems, head6mubleo blood pressum, and Seizures mentioned eartier in this questionnaire, am you talking any other medicahons for any reason (indudin bp ° name the medications if you know them, - ---`',--~----`~~--''~^--.------'°~~--^- - -_,016s C�No10- Will YOU be Using Any of the follow r - -- ~~....... .................................... aS []No 11. How often am you expeoed to use the ^' E-%,apevnly (no pescuoy,^,,^~_'_-'--'— -.'-~^- }� �y��mnb=�-~____`-__-------~----`--`~^~---_`--'~_~'-c�y�' [�No c �����������____~----'------'—~—~'—^---Io1� �� d. Le�/�ao2hours ��l�:._,^_____~,, --'.................-- -----'----~-0�� [ky�` e4 Jto�6o�sper ' _ -_,._,_____--~----~'-- ~_ [�y�» 1[ {�mr 4�*�sper . ____,_~.._,-'----^~---�-~-- ~-'--....... -....... Qrm 0mm NICK I t- *4U Dac iivain I z Vurin& the reriod you ux. using the re pirator(s}, is V,,, work effort a. I il;ht (tees thaat txi k,-al f*c=r Inc ur}.,. ,:.,.,. F ' how Icxn .., y, % t, dezei: this pe�rica<.t_last during titer Average shift '., ... hm ...mjns....• If „ E,xjmITlt'S e}fa lii,ht ,.i,)rk Offcart are• acting whclex writints typsnt, draftmn r or pe rfe)r7ttintr,; light as"A'nibly work, car stattclirtt3 s l2ele n} etratint, tdnll prt,-.s (!.j €bs.) c�recrntcx>Iliim ng Itin« I,. %lodc�rate t-AX) to 330 ke d per hourk ... If " yvs," how Ic,119 dtWs this pvriod last durxuig the= ivt raj,,,e s atilt Examrlc� Of medc�rate work offort'are or sitting; while! r1aalin f� � lye � marts n uri~•+n tr.eff�.; +t.tttuine�;v�hilc �,lrill:ns nsiltn • b iis,� clrit.•inl;.a truckcar buss irti ` IxTrf��mtiral; aa*emt,ly wi�rle, or traa�sfcrrM a ntcscl"rate I"d Olx)ut 35 Ili;.} at trunk Iey"eI; walkiN.On a lee,•el surf we ibout ) mph or down a 3-c ege e grade A-43ut .3 m&. or pushing a;whe oburr sw with a heuvy jo.ea (shout tt3tl (E, ::) on a le eI surf*e. c'. t-Ir.:tvy ON)VI-= 33l ktal per hour} mina. J Y+% If "yc�,', how longdoes this. period fast during the avge shett. hrs< ,,...,.. l-,xamplc5 Of heavy work u-,. lifting, heavy load (aix)ut30 lhs.) f ,c , the ,()Or to your waist or, Shouleler, working can ,x Ittaeiing elmk, sh' ovealing; stand g while bric:lci ayin or chippingcastint s, w-"king up an t3-,.Ie9ake trick=,about ? mph; climbing stairs with a heave load (about 30 tbs.). 13. t} H you be wea g pmt"vo clothingand/oregWl?wentt (Othe, tin the resp rataz) when you're using your m-spiratnn............. . . If .,.y(--;,- dc--A:nbe this prulft4ve dOthing and/or a qu pment... ......0 Yes t3Via. 11 WM YOU be Working under hot conditions (temper exceed' F�........ ....... ......................... ...C! Yes 0 P%Ia a 'WiU you be working under huaaaid conditionx .... .. ........ ........................................................,.Ci Yes- C,I Na 17 Describe any special or haz antovs co"timaaa YOU miagttt eirs ouaaterwrhet you'ae usist your respica#or(s) (for example, confined spaces, l ife tlueatening gases A Provide the following informAtiom if you know it, for each toxic substance &A you'ii bye eNpused to when you're~ easing your respirator{s),. Marne of the first toxic sub ..,tArwe. lrsiimateul maxinium ex Piasvte leve i per shut MCA InNL- WAIT c if"2M Duration of�-ifxx un> pt rshift Marne of the stvona toxic �iubg5 ux&- Estimated m iximum exposure It el Fvrshift: Duration of exposure per sh. fC I? dme of the third toxic suEastuxe. Estimatedcaaxitzsum a pu sure .level. per sha- Duration of exposure per shift The name of other toxic su`Easb1mes that yo `ll be exposed to while using your respirator. 19 . Des<xibe zr�spvezvrbiliiies you" have whine use'ng your pimtor jsj dLat maiy of ed the safety and welt -being of Bathers (#cec ngie, nasrues sec,urity� K'Iwjk"Rv,* employe+, Name: job title. Date of this fouow-up. , ReAsons forfoilow.up, A4tio Medical Examinatiorl, Copy of twotr metal i ion riven to employee? Q Yes C) `Ita Rt*4:c)uinwndalicin;s abouE cart ployae useof the mspinutor: utnitations• Neftt for fOROW-up mWical evaluations - Dam signedL, bate give= RESPIRATOR )aA PHYSICAL See Attached .Job Description NAME AGE SEX HOME ADDRESS TELEPHONE OCCUPATION LENGTH OF EIN PLOYNIENT 1 agree to the release of this i formration for State and Federal regulcrtMpurposes DATE SIGNED ol 112I , 4 I 1. HEIGHT WEIGHT 2. HEART. Murmers: Rate Rhythm Enlargement 3 LUNGS. Pulmonary Function Within Normal Limits Outside Normal limits 4. PA CHEST X-RAY- Within Normal Limits Outside Normal Limits 5. RECON2VI NDATIONS: It is ray opinion that the above named patient is is not qualified( to wear a Respirator in the performance of his/her duties. PHYSICIAN medically C(j/ EMPLOYMENT PHYSK,4L SERVICES B82-t yright4 2000. NEI' 1. All Rights Reserved. NFPA 1582° Standard on Medical Requirements for Flue Fighters and Infomation for Fire Department physicians 2000 Edition This edition of NFP4k 1582Standard am ,Medical Requr'rements farFzrai:ghtert.snd fn,�mmadim jarFim DeitrurtRscrtt i7eysieians, was pregartd by the. Technical Corittnittee on Fire Service Occu- pational Medical and Health. and acted on by the National Fire Protection Association. Inc., at its November, Meeting held November 14 -17. 1999. in New Orleans, LA- It was issued by the Standards Council on January 1 #, 2000. with an effective date February 11, 2000. and supersedes all previous editions. This edition of NFPA 1582 was approved as an American National Standard on February 11. 2000, Origin and Development of NFPA 1582 A joint task force of members representing both the Technical Committees on Fire Service Occupational Safety and Health and Fire Fighter Professional. Q* ialtftcatiom began addre.w iug medical requirements for fire fighters in March 1988, A standing subcommittee on Med- ical/ Physical Requirements for Fire Fighters was created under the Fist Service Occupational Safety and Health Committee in 19% and was responsible for the development of NMk 1382: This new document covered the medical requirements necessary for persons who perform fire -fighting tasks. Medical requirements that were previously contained in Section 2:2 of NFPA 1001, Sf4ndard jr r Fret F?ghkrPmf nd Qualific4liam, applied only to the entry level. They were deleted from NFPA 1001. Legal opinion and federal taws shove that requirements set for a position must apply to anyone who would be or is in that position. `these medical requirements are therefore intended to apply to candidates as well as to current fire fighters. Two categories of medical conditions were created, Categories A. and B. Category A repre- sented conditions that, if they exist in the candidate or current fire fighter, would not allow this person to perform fire -fighting operations. Category R conditions trust be evaluated on a casc-by-casa basis so that the fire department physician can determine if the medical condi- tion in a particular candidate or current fire fighter would prevent that person from perfortnm ing fire -fighting operations, Medical evaluations, medical examinations, record keeping, and confidentiality were addressed in Chapter 2. Chapter 3 contained the actual medical conditions that comprise the requirements, Extensive advisory and informational material was developed in the appendixes to aid fire department administrators and fire department physicians. The committee completed its work in January 1992, and rite first edition was presented to the Association membership at the 1992 Annual Meeting in New Orleans, Louisiana; The second edition of this siwulard reflected the numerous changes in medical technol- ogy that have impacted atnrctural fire fighters. The technical committee was assisted by phy- sician-3 whose expertise covered the areas of emergency medicine, vision: hearing; and cardiac, pulmonary, neurological. and metabolic conditions; The technical committer endeavored to update six critical areas and moved some of the pre riots Category A text to Category & They then enhanced some of the Category A raterial, that would prohibit an individual from being hired or to continue as a fire fighter. The com- mittee also added additional appendix text in the arem of ADA requirements, explanatory material for both fire department administrators and Eire department physicians, and sample physician checklist forms, Additional explanatory material was added or enhanced to provide the user with addi- tional. information regarding medical conditions whose categories were changed. These included a number of cardiac conditions. diabetic conditions. seizure disorders. asthma. and therapeutic and -coagulation. 1582-2 vlECtlt�ti,itkQUIRE.MENI'S FOR FIREFIGHTERS AND INFOO(ATION, FOR FIRE DEP,ARTMEXT PiiYSlt»Ir 1!S The 2000 edition of this standard reflects (1) the technical committee's recognition that medical technology is continually changing and (2) the committee's effort to incorporate those medical technology changes within the standard. just as the committee recognizes med- ical technology advances. i t is incumben t on the Fire department to communicate with the fire t department physician changes in the essential functions) the fire department performs. Conversely. the fire department physician moist keep the fire department updated` on the lat- est changes in the medical field: Fire department physicians are the primary users of t tFF:k 1582. Committee members feel that allowing the fire department physician more latitude in determination of a member s ability to perform essential functions will assist users in enforcing the standard. Therefore, the s committee has changed the title of the standard to uEl?4 1582 St+an&vd on Medkot Aejuiw- mmu for Rm Fxg'hun and Information for Fire Dtpartmeni Aytirians. The topicof incident scene rchabititadon and accountability are included in this edition, since the fire department physician may provide ,guidance or assistance at the rehabilitation unit. In addition, specific areas concerning the following conditions were etaritied or expanded. cardiac, vision, hearing, neurological, and metabolic. An appendix was added to this edition comparing the requirements of this standard with those of 29 CFR 1910.134. the OSKX respiratory protection regulation. There are many users of both documents; and this appendix clarifies the companion areas ofeach. 2 .i Eften CQ'RI;3Ri'1`LE PERSONNEL Technical Committee on pore Service Occupational j4(edi%aE and Health Hurrey L Lo#6n Chair Virginia. Reach Ftre Dept, VA (VI Rep, NFVA Fire Service Section D-i4f J Barillo, U- S, Army (nit. of Surgical Research. TX (SE) KimberlyS. Bevhm 6iay.CAre.,il [SE[ Paut "Shoo" Blake, City of Baytown Fire Rescue Services. ( t I Rep. Industrisi Emergency Resppome Working Group Mary S. Bog-W, Ya€C University, CT:ISE) Anthony L Clark. Kenton County .kirport Board. OH (Uj Thomas]. Cuff,; jr., Firemem Assn. of the State of iew York. NY CU t Tammy DiA,nda, Reno Fire Dept;. RiV [Uj . John i. Folaa, Northside Medical Amc., NY jSEj Ricbasd D. Ceri€in, jr., Good Samaricatt Hoapitali Phoenix Fire Dept.. AZ (EI Juan.Gotssalvx. Medfle :The Exercise Ssiencc Inst., W- Lvvy Ketmey. Penn State University, P.A. [RTj Rep. Lindy Jacobs &Assoc. Sandra Kirkwood, Las Vegas Fire DepL, +"Y [itl Frank P, Mirwo. Now York. City Fire Dept., NY [Uj Garr L Neilsess,Truckee Meadows Fire Prorection Disiriet. xv(U) Rep; Fire Dept. Safety Officem Asset' Alternates Davief W. Dedsan, Loveland Fire Dept., CO (Ul (Al,- to G. L Neilson) W,b.l$. Gray, Virginia Beach Fire DepL, VA (Ul (AIL to M. E. Lotlin) Stephaa N. Putty, NFPA Staff Liaison Deborah L» Pritehett, Lawrence Township Fire Dept., 1,4 (i;j Rep. Indianapolis Metropolitan Protesxional Fire Fighttrs Linton GoPdon M. Sachs, tor-W Emergency Services Group, P_k [SEj Rep. Fairfield Community Fire Co., lnt, 7DaWel G. Sam*. EYH -OMEGA. IL (SEj James Sewell, Seattle rice Dept.. W:k (Lt Rep. lnt'I.%sn. of Fire Chiefs Philip G. Stinleburg. L.&xrge fire Dept. WI (L) Rep. Nat'l Volunteer Firr Council Rohert,Nf- Soratrnan. West Metro Fire Protection Dutriet. CO CRT] Rep. Metropolitan State College of Denver body C. Teeter, Tulsa Fire Dept., OK [Uj' Rep. Intl Fire Service Training Assn. KAby'r'm os. Cooperative Personnel Services: CA (SE; `Caress Warm, Santa Ana College, CA ISE] Do* N. t+1}tiWAer. Loekhced-Martin Idaho Technologies ..ID [Ii Decker Williams, Phoenix Fire Dept,. (El Thomas R.. Luby, New York City Fire DCpL, NY (Ul (AIL to F. P. Nimto) Sriass Y, Moire, Phoenix Fire Dept., AZ (El (Alt, to D. Williams) This Gast r eran the mersrbrrshilr at t&e €tears Of Committer was ietiatsd ore awplat test of thfs rditim. Suer that time, chal%Vs in the membership may hour orcumik A Aq to rGusVicatimu ir, found at the dark of the doctiatent.. NOTE- Membership on a committeeshaii not in and Of itselfconsdrute an endorsement of the Association or any, document developed by the committee an which the member serves. (Gmnk xee scope: This Committee shall have primary responsibility for documents on occupational medi- cine and health in the working environment of the fire service. 20M E&Vdn REQIQULVIENTS FOR FIRE FIGHTERS 1*4FOWMATION FOR FIRE DEPARTMENT Pfn`li:1,t%S Contents Chapter I Administration . , � .... 1-4.1 ....... 1582- 5 1-1 Scope - - ... 1582-_5 1-2 Purpose '.1,1" 1582. 5 1.3 Implementation 1582- 5. 14 Definitions:... : � I ............. 1582_ 5 Chapter 2 Medical Process 1582- 6 2-1 Medical Evaluation Process ............ 1582- 6 �-2 Fire Department Roles... : 4, . , : ... _., 1582- is 2-3 Preplacement Medical Evaluation.. 1382- 6 2-4 Periodic Medical Evaluation , , , . , . 1582- 7 2-5 EvWuation, 1582- 7 24 Medical Evaluarion Records, Results, Reporting, and ConfidenEiatity ISS:!- 7 Chapter 3 Category A and Category B Medical Conditions ..... 1582- 8 3.1 tiledical Conditions Affecting Ability to Perform ..... :**,,* ..... **** .... 1582- 8 3-2 Head and Neck_ ....... 1582- 9 3-3 Eyes and Vision.. ............ ...... 1582- 8 34 Fars and Heating . ... _... 1582- 8 3-3 Dental .... - ........ ...... ........ 1582- 8 3-6 Nose, Orophar) nx, Trachea. Esophagus. and Larynx ................ 1582- 3 3-7 Lungs and ,Chest Wall. , 15$2- 0 " Helmand Vascular System 1582- 9 3-9 Abdominal Organs and Cutrointestinal System .... ....... 1582- 9 'Llo Genkourinarysystern ................. 1582- 9 3-11 Spine. Scapulae, Ribs, and Sacroiliac joints ... ....... 1582-10 3-12 Extremities .................. __ _ 1582_10 3-13 Neurological Disorders . .. ...... IsS2_10 3-14 Skin . . ................. ...... 1582_10 345 Blood and Blood-Fortning organs ....... 1582-10 3 16 Endocrine and Membolic Disorders......1582-10 3-17 Systemic Disease: and Miscellaneous Conditions.. ,, ,, 1582-10 20M Ed000 3-18 Tumors and Malignant Diseases_ 1582-10 3-19 Psychiatric Conditions::. .......... 1582_ 11 " 20. Chemicals. Drugs, and Medications_...... 1582»1 1 Chapter 4 Infectious Disease Program 1582-11 4-1 Infection Control Program. __.1582-11 4-2 Exposure Incidents. 158211 +3 Tuberculosis ............ 1582-11 -" Immunizations ....... Im-11 Chapter 5 Incident Scene Rehabilitation and ' Medical Treatment . . : . . . . . ..... 1582-11 34 IncidentScene Rehabilitation .. : ........ f 592-11 5-2 Incident Scene Safety and Health ........ 1582-11 5-3, Evaluation and Triage of Member Injuries .......... .......... 1582-11 54 Incident Scene Rehabilimdon Tactical Uvtl Management Component ........... .... 158241 Chapter 6 Referenced Publications, .. . .......... 1582-12 Appendix A Explanatoxy Material . ...... 1582-w12 Appendix 8 Information for Fire Department Phy3id2W . . . ...... ........... 1582-21 Appendix C Essential Structural Fire -Fighting Functions ........ .......... _1582-26 Appendix D Guide for Fire DeparttrrCot Administrators........ ......... 1582-26 Appendix E Sample Forms.... ........ _,IS82-33 APPendixF Referenced Publications ........... 1582-33 tndex_____ ..... ........... ........ 1582_.4.8 I 0 WNW IXI.5TR.t ru).*4 153,2- i NFPA M12 Standard on Medical Requirements for Fire Fighters and Informal on for Fire; Department Physicians .ttlfitt Edits -on 'OTICE: :act oicrisk t •} foildwitil, the nuinber ur letter des. iynutng I Paragraph iudicater that cxplattanxry ttia rnAl_ntt. the p.iragralsh can he6wiid in .ipptiidix A. tnformation on referenced pteblicauons can ate found in Chapter is and .Appendix F. Chapter I Administration 1-1 Stoke, 1-1.t This standard shall contain medical requirements for members. including ful"me or part-time employees and paid or unpaid volunteers. It also shall provide information for phy- sicians regarding other areas of fire department medicine, including infection control and fireground rehabilitation. 14.2 These requirements are applicable to ptablic. go-,vrnmen- ral, military. prit ate and industrial Ere department organi=tiotts providing rescue, fire suppression, emergency medical services, hazanlous materials mitigation. special operations, and other emergency services. 1-1.3 This standard shall not apply to industrial fire brigades that also can be known as emergency brigades; emergency response teams, fire teams. plant emergency organizations, or mine emergency response teams. 1-2 Purpose. 1-2.1 The purpose of this standard shall be to specify mini- mum medical requirements for candidates and current mem. bens- It also shall provide other information regarding Are department activities that assist the department physician in. providing proper medical support for members. 1-2.2` The implementation of the medical requirements out fitted in this standard shall help ensure that candidates and current members are medically capable of performing their required duties and shalt help to reduce the risk of oecupa- tional injuries and illnesses. 1.2,3 Nothing herein shall be intended to restrict anyjurisdic titan from exceeding these minimum requirements. 1-3 Implementations. 1.3.1 For candidates, the medical requirements of this Bran- dard shall be implemented when this standard is adopted by an authority having jurisdiction. on an effective date specified by the authority having jurisdiction. 1-3.2• When this standard is adopted by a jurisdiction. the authority haling jurisdiction shall set a date or dates for cur- rent members to achieve compliance with the requirements of this standard and shall be permitted to establish a phase - in schedule for compliance withspecific requirements of this standard in order to minimize personal and departmental disruption, 14 N lien 6dns. 14.11 Approved. A%ceptable to the atithoritv having jalris diction. 1 4.2* Authority Having jurisdiction. The ors anixadon, ")thee; or indisiitual responsible for approkin,; equtpment, m.tterials. an installation or i procedure. 14:3* Candidate, A person who has made :application it, commcnce performance as a mrmher. 14.4 CategoryA Medical Condition. A medical F:ondipon that would preclude a person from perforning as a member in a training or emergency operationat entirtmment by presenting .s siymificant risk to the safety and health o€the penon or others. 1-4.3 Category Medical Condition. rl medical condition that. based on its severity or degree, could preclude a person from performing :is a member in a utuning or emergency operational environment by presenting a si,tttificant risk to the safety and health of the person or others. 14.6 Drug. Any substance. chemical, over-the-t:ounter medi- canon. or prescribed medication that could affect the perfor- mance of the member. 14.7 Essentiat Job Function. Task or assigned duty that is critical to successful performance of the job. 14.3 Evaluation. Ste Medical Evaluation. 14.9 Fxposure Incident A speck eye, mouth. or other mucous membrane, non -intact skin, or parenteral contact with blood. body fluids, or other potentially infectious mamri- als, or inhalation of airborne pathogens, ingestion of food - borne pathogens or tocins. 1 4.10 Fire Department, Physician. The licensed doctor of medicine orosteopathy who has, been designated by the fern department to provide professional expertise in the areas of occupational safety and health.as they relate to emergency services. 1-4.11. Functional Capacity Evaluation. An assessment of the correlation bttween that individual's capabilities and the essential job functions. 14.12 Health and Fitness Coordinator. The person who, andtr the supervision of the fire department physician, has been dmig- nated by the department to coordinate and be responsible for the health and tintless programs of the department. I4.t.3 Health and Safety Officer, The member of the fire department assigned and authorized by the lire chief as the manager of the safety and health program and who performs the duties and responsibilities specified in this standard. This individual can be the incident safety officer or that can also be a Separate function. 14.14 Infection Control Officer. The person or persons within the fire department who"Are responsible for managing the department infection control program and for coordinat- ing efforts surrounding the investigation of as exposure. t4.1 "s infection Control Program. Tht fire department's for- mal program relating to the control of infectious and commu- nicable disease hazards where employees, patients. or the general public could be exposer to blood, body fluids, or other potentially infectious materials in the fire department work environment. This program includes. but is not limited to, implementation ofwritten policies and standard operating procedures regarding exposure follow-up measures, tmtnuni- rations, members' health screening programs. and educa- tional programs. !3%3'3=ti titFfJtt t,C, tZi+tiL'ift£�f iS FOR FIRE f[c:Fi€Eit3 A*ND MFr}RtA'%TION FOR FIRE QEP:kRft1E�T Pfi eSfi>f.> ;S 1416 Medical Eva uadon. The analysis of inf rmation for the purpose of making a determinaril*rn of medical certifica t:on„'fedical evaluation can include a medical ev.4minatiun. 14-17 Medical Examination, An examination performed or directed by the fire. department physician, 1438 Medical Services, Emergency. The provision of treat. went ---itch as first aid, cardiopulmonary resuscitation, basic life support, advanced life support. and otIher pre -hospital pro- cedures including ambulance transportation--tripauenis. 14-19 Stec[IcailY Certified. A determination by the fire dep3a. went physician that the candidate or cut:ent Member meets the medical requirements of this standard. I-1:20* Member- A person involved in performing the ducats and responsibilities of,a fire department, under the auspices of the organization. A fire department member can be a full. time or part -tune employee or a paid or unpaid volunteer, can occupy any position or rank within the fire department, and can engage in emergency opemdom 143 20,1 Member, Currettt- A'person who is already a me in. ber and whose duties require the performance o£ essential fire -fighting functions_ 14.21 Shall. Indicates a mandatory requirement: I4-22 Should. Indicates a recommendation or that which is advised but.not required, 14.23 Standard. A_document. the main text of which con.. tains only mandatory provisions using the word "shall" to indi. cate requirements and which is in a form general[ysuitable for mandatory reference by another standard or code or for ado p- lion into law. l+lonmandatory provisions shall be located in an append ox, footnote:. or fine -print note and are not to be can. sidered a part of the requirements of standard. 14.24 'Tactical Level: Mpnagement Component (TL,N(C3: A. management unit identified in the incident management sys tem commonly known as "division. "group." or "sector." Chapter 2 Medical Procew 2.1 Medical Evaluation Process, 2•1.1" The fire department shall establish and implement a niedical evaluation process for candidates and current members. 2-I.2 The medical evaluation process shall include preplace- meat medical evaluations, periodic medical evaluations, and return-to-dutymedical evaluations. 2.1-3 The fire department shalt ensure that the medical eval. uation process and all medical evaluations meet all of the requirements of Section 24. 2.1.4 Each candidate or current member shall cooperate. par- cicipate and comply with the medical evaluation process and shall provide complete and accurate information to the fire department physician, 2-1.5* Each candidate or current member shall report, on a timely brsis. tothe fire department physician any exposure or medical condition that could interfere with the ability of the individual to perform as a member. 2.1.6 The medical evaluation shall be at no cost to the candi- date. current member- or other member. 2000 E44ih9rt -2 Eire Department Roles. 2.2.1 The fire department Shall have an Officially desiilnated physician who shalt be responsible for Viiding. dtret ring, and advising the members with regard to their health, fitness, and suitability for duty as regtired by NFP.k Lille}, Stesn.Gsrrl nn F1 , i ,parrn nt Orcufpato'nal Srtjny an.t Hynith Piir rum. 4.2* The fire department physician shalt be a licensed doc, to r u£ medicine or osteopadry: 2-2.3' For the purpose of conducting medical evaluations, the fire department physician shalt understand the physiotog: ical and psychtrlssgieal demands placed on members and shall understand the environmental conditions under which mem• bers must perform. The fire department shall provide thc.fire department physician with a current job description for all tire. department pOitions and rams. 22.4 The fire department shalt require that the fire depart• ment health and safety officer and the health and fitness ccror• dinator maintain a liaison with the fire department physician to ensure that the health maintenance process for the fire department is maintained. 2.2.5 Fire Departmetat Physician Roles. 22.5.1 The fire department physician shall evaluate the per: sort to ascertain the presence of any medical conditions listed in this standard. 2.2.i.2 When medical evaluations are conducted bua physician other than the fire department physician.. the eva[ttationshall be reviewed and approved by the fire department physician. 2.3* Preplacemeut Medical EvAuation. 2.3.1 The candidate shall be certified by the fire department physician as meeting the medical requirentertts of Chapter 9 of this standard prior to entering into a training program to become a member or performing in an emergency opera.. tonal environment as a member. 2-3.2 The candidate shall be evaluated according to the teed ical requirements of Chapter 3 of this standard to assess the effect of medical conditions on the candidate's ability to per. form as a member. 23.3 A candidate shalt not be certified as meeting the medi- cal requirements.of this standard if the fire deputatent physi- cian determines that the candidate has any Category A medical condition as specified in Chapter 3 of this standard. 2-3.44 Pt candidate shalt not be certified as meeting the med- ical requirements of this standard if the fire department phy- sician dctermines that the candidate has a Category B medical condition as specified in Chapter 3 of this standard that is of sufficient severity to prevent the candidate from performing, with or without reasonable accommodation. the essential functions of a member without posing a sigitificans risk to the safety and health of the candidate or others. 2-3.4.1 The determination. of whether a reasonable accom- modation shall be made by the authority having jurisdiction its conjunction with the fire department physician: 2-3.5 If the candidate presents with an acute medical problem or newly acquired chronic medical condition that interferes with the candidate's ability to perform the functions ON mem- btr, medical certification shall be postponed until that person has recovered trom this condition and presents to the tire department for review. 2-4* Petiiodic,Mcdiicat Evaluation. 24,1 The current member shall be certified anniialiv,_or at the request of etcher the lire department or the member, by the tire department physician as meeting the medical require. merits ofCh.ipter 3otthis standard in fader to determine that member's medical .tbiliry to contint; a p:trticipaung in a train - in; or rmer erity iaper-atiomal snvironmtrit is a member, Aiii• applicable OSK. standards, such as 21) a-S 1910.i20. "14.14- ardous W.t to Operations and Emergency Response." `_r'? CFI? 191 i).134.'Respiratory Protection,' 27 t FCt 11)10.95.-0ccupa- U6nal Noise Exposure,' and 29 iT-,R 131t).1-+l`W, `Bloodbtrtne Pathogens,' shall be followed. 2 4.1.1 The components of the annual medical evaluation as apvcitied in ` 4-1 2 shall be permitted to be performed by qualified personnel as authorized by the fire department physician. When other qualified personnel are used. the fire department physician shall review the data gathered during the evaluation. 24 l.'2 The annual medical evahtauon shall consist of the ftil- lowin (1) ekninterval medical history (2) An interval occupational history, including significant exposures (3) Height and weight (4) Blood pressure (5) Heart rate and rhythm 24. LP 1n addition to the annual medical evaluation. the fire department shall include a medical examination according; to the following schedule- (1) Ages 29 and under —at least every 3 years (2) ages 1 to 39—at least emery 2 years (3) Ages 40 and above -- every year 2..1.4* The medical examination shall include examination of the following components: (1). Vital signs — namely, pulse, respiration, blood pressure, and; if indicated, temperature (2) Dermatological system (3) Eams eyes, nose, mouth, throat (4) Cardiovascular system - (5) Respimtorysyatem (6) Gastrointestinal system (7) Genitourinary s}stem (3) Endocrine and metabolic systems (9) M- uscuteskeleta system ( ill) Neurological system (11) Audiometry (12) Visual acuity and peripheral vision testing (0) Pulmonary function testing (14) Laboratory testing, if indicated (15) Diagnostic imaging, if indicated ( it)) Electrocardiography. if indicated 24.2 A current member shall not be certified as, meeting the medical requirements of this standard if the fire department physician determines that the member has any Category A medieai condition specified in. Chapter 3 of this standard. 24 3• A current member shall not be certified as meeting the medical requirements of this standard if the tire department physician determines cleft the member h.ts t Cate oc7, S con, dition aperaiied in Chapter 3 of this stait,iard th.tt is of �utli- cientseverity to prevent the member fr im.perfo mint,•, with or without reasonable aecommoda€inn. the essential functions rr f a member without posing a scariiiic.tnt rill: 1u the aafety and health; of the member or others;. 24.3.1 The 'demrminatinn of reasonable acc«mmotiauon shall be made by the Stith+hits ht.Mng jurisdiction in conjunc. tion with the tare department ph4sicitin. 2- A If the current member presents with an acute illness or recently acquired chronic medical condition. the.evalua- tion whall be deferred until the member has recovered from the condition ind presents to the Lire department to return to duty. 2r5 Aemm-ter-Dury Medical Evadttation. 2-3• 1 • A current member who has been ab ent from ditty for a medical condition of a nature or duration that could alect performance as a member shall be evaluated by the lire department physician before returning to duct. 2.3.2 The fire department physician shall not medically cer. tify the current member for return to dutyifany Category.#. medical condition specified in Chapter 3 of this standard is present 2-5.3* The fire department physician shall riot medically cer- tify the current member for return to duty if any Category a medical condition specified in Chapter :3 of this standard is present that is determined to be severe enough to affect the members performance as a member. The fire department physician. in conjunction with the authority having jurisdit Lion, shall take into account the member's currentduty assign - men t and alternative duty assignments or other programs that would allow a member to gradually return to full duty. 2.5.4• The department shall provide guidance, opportunity, and encouragement to the member so as to expedite his safe return to full duty. 2.6 Medical Evaluation Records, Results, Reporting, and Confidentiality. 2-6.1 All medical information collected as part of a medical evaluation shall be considered confidential medical informa- tion and shall be released by the fire department physician only with the specific written consent of the candidate or cur- rent member: 2-6.2 the fire department physician shall report the results of the medical evaluation to the candidate or current member, including any medical condition (s) disclosed during the med- ical evaluation, and the recomtnendation as to whether the candidate or current member is medically certified to perform as a member. 2-6.3 The fire department physician shall inform the fire department lire chief or designee only as to whether or not the candidate or current member is medicaRy certified to per- form as a member. The specific written consent of the candi- date or current member shall be required in order to release confidential medical information regarding this condition to the fire department 2.6.4 All medical record keeping shall comply with the, requirements of29 t:FR 191€1,20, -Medical Recordkeeping:" 20M edtacn 1582-5 MEDICAL REQUMEME.VfS FOR FIRE fic,147ERS040 NFORNUTION FOR FtPE DEP.*'wr%tEyr Chapter 3 Category A and Cate -gory B Medic Coaditions; 3-1 Medical Conditions Affecting Ability to Perform. Cam - gory A and Category B medical conditions shall help the examiner understand the type of condition that could result in rejcctiort or acceptance. The medical conditions listed act organized by organ system, In the corresponding Appendix A explanatory material, a diagnostic example is often included. with the list. In addition, the rationale for the rejection is pre- sented in terms of the effect of the medical condition on the capability of the person to perform as a member. 3-2 Head and Neck. 1-2.1 Head. 3.2.1.1 There shall be no Category A medical conditions. 3-2.1.2* Category B medical conditions shall include the fol. lowing- (1) Deformities of the skull such as depressions or evxcstoses (2) Deformities of the skull associated with evidence of dis- ease of the brain, spinal cord, or peripheral nerves - (3) Loss or congenital absence of the bony substance of the skull (4) Any other head condition that results in a person not being able to performas a member 3-24 Neck. 3-2-2.1 There shalt be no Category A medical conditions. 3-2.2,2* Category B medical conditions shall include the fol- lowing. (1) Thoracic outlet syndrome (2) Congenital cysts, chronic draining fistulas, or similar lesions (3) Conn -action of neck muscles (4) Any other neck condition that results in a person not being able to perform as 2 member 3-3 Eyes and Vlisiom I 3-3. V Category A medical conditions shalt include the fol, lowing: (a) far visual amirf. Far visual acuity shall be at least 20/30 binocular. corrected with contact lenses or spectacles. Far visual acuity uncorrected shall beat least 20/ 100 binocular for wearers of hard contacts or spectacles. (b) FeriPherat uisim Visual field performance without cor- rection shall be 140 degrees in the horizontal meridian in each eye. 3-3.2* Category B medical conditions shall include the fol. lowing: (1) Diseases Of the eye such as retinal detachment, progres• sive retinopathy, or optic neuritis (2) 00thalmOlOgicAl procedures such as radial keratotomy or repair of retinal detachment (3) AnyoEher eye condition that results in a person not being able to perform as a member ZM ediffon 34 Ears and Hearing. 3-4.1 There shall be no Category A medical conditions. 34.2* Category 8 medical conditions shall include the fol- lowing (a) Hearing deficit in the pure tone thresholds in the unaided worst ear that is (1) Greater than 25 dB in three of the four frequencies a. 500 Hz b. 1000 Hz c. 2000 Hz d, 3,000 Hz 01Z (2) Greater than 30 dB in any one of the three frequencies a. 500 Hz b. 1000 Hz Ir c. 2000 Hz AUND (3) In addition averages greater than 30.dB for the four &e- quencies a. 500 Hz b. 1000 Hx c. 2000 Hz & 3000 Hz (b) Unequal, hearing loss (c) Atresia, severe stenosis. or tumor of die auditory canal (d) Severe external odds (c) Severe agene3is or traumatic deformity of the auricle M Severe mastoiditis orsuriocal deformiryofthe mastoid (g) Men iere's syndrome or labyrinthitis (h) Otitis media 0) Any other ear. condition. that results in a person not being able co perform as a member and results in a person being unable to pass ajob-specific functional heating task test ors heazi ng in noise test. 3-5 Dental- 34. I There shall be no Category A medical conditions 3.5-2* Category B medical conditions shall include the fol- lowing- (1) Diseases of the jaws or associated tissues (2) Orthodontic appliances (3) Oral tissues, extensive loss (4) Relatiortship bevween the Mandibleand maxillaEhatpre. cludes satisfactory postorthodonEic replacement or abil- ity to use protective equipment (5) Any other dental condition that results in a person not being able to perform as a member 3-4 Nose, Oropfiarr=� Trachea. Esophagus, and Luy=. 34.1 * Category A medical conditions shall include the fol- lowing, (1) Trachcostomy (2) Aphonia 3-ti.2* Category B medical conditions shall include the f61. lowing-. (1) Congenital or acquired deformity (2) Allergic respiratory disorder CkTECOKY:A ANO G3TECORY 0 MED(CAL CONDITIONS 1582-9 (3) Sinusitis; recurrent (4) Dysphonia (5)Anosmia (6) Any other nose. oropharynx; trachea, esophagus, or lar- ynx condition that results in a person not being able to perform as a member or to communicate effectively 3.7 Lunp aril Chest Wag. 7.1" Category.A medical conditions shall include the fol- lowing: (1) Active hemoptysis (2) Empyema (3) Pulmonary hypertension (4) Active tuberculosis 3-1.21 Category 8 medical conditions shalt include the fol- lowing: (1) Pulmonary resectional surgery, chest wall surgery, pneu; mothorart (2) Bronchial asthma or reactive airways disease (3) Fibrotftetrax. chest wall deformity, diaphragm abnormalities (4) Chronic obstructive airways disease (5) Hypoxemic disorders (6) Interstitial lung diseases (7) Pulmonary vascular diseases, pulmonary embolism. (8) Bronchieetasis (9) Infectious diseases of the lung or pleural space (10) Any other pulmonary condition that results in a person not being able to. perform as a member M Heart and Vascular System, 3.8.1 Rears. 3.8.1.1' Category A medical conditions shall include the fob lowing: (1) Angina pectoris. current (2) Heart failure.; current. (3) Acute pericardids, endocarditis, or myoacarditis (4) Syncope, recurrent (5) Automatic implantable cardiac defibrillator 3=8.1.2, Category $ medical conditiorts,shall include the fol- lowing- (1) Significant valvular lesions of the heart. including pros- thetic valves (2) Coronary artery disease, including history of myocardial infarction, coronary artery bypass surgery, or coronary angioplasty, and similar procedures (3) Atrial tachycardia, flutter; or fibrillation (1) Left bundle branch block, second. and third-degree ath- oventritular block (5) Ventricular tachycardia (6) Hypertrophy of the heart (f) Pecurrent paroxysmal tachycardia (8) History of a congenital abnormality (9) Chronic pericarditis. endocarditis, or myoearditis (10) Cardiac pacemaker (11) Coronary artery'vasospasrn ( l2) Arty outer cardiac condition that results in a person not being able to perform as a member 34.2 'Vascular System. 3-8-2.1 There shalt be no Category A medical conditions: 38.2.2" Category B medical conditions shall include the fol. lowing• (1) Hypertension ("_) Ptr pheral, vascular disease such as iavnaud's phenome non (3) Recurrent thrombophlebitis (4) Chronic lymphederna due to lymphadenopathy or severe venous valvular incompetency (5) Congenital or acquired lesions: of the aorta or major Yes. sell. (6) Marked circulatory instability as indicated by orthosrrtit hypotension, persistent tachycardia, and severe periph. et -al vasomotor disturbances (7) Aneurysm of the heart or major vessel (8) Any oihervascular condition that results in a person not being able to perform as a member 3-9 Abdominal Organs and Gastrointestinal $"tem. 3-91 There shall be no Category A conditions. 3.9.2' Category 8 medical conditions shall include the fol- lowing { 1) +Chotec7ntits M Gastritis (3) GI bleeding (4) Acute hepatitis (5) Hemia (6) Inflammatory bowel disease (7) Intestinal obstruction (8) Pancreatids (9) Resection, bowel (10) Ulcer, gastrointestinal (11) Cirrhosis. hepatic or biliary (12) Chronic active hepatitis (13) Any other gastrointestinal condition that results in a per- son not being able to perform the duties of member 340 Genitouas"asrysystem. 3-10.1 Reprodt ed". 3.14.1.1 there shall be no Category A medical conditions 3-14.1.8"' Category B medical conditions shall include the fol- lowing. (1) Pregnancy, for its duration (2) Dysmmorrhea (3) Endornetriosis, ovarian cysts; or other gynecologic con- ditions (4) Testicular orepididymalmais (5) Any other genital condition that results in a person not lacing able to perform as a member 3.10.2 UrinairySystem. 3-14.23 There shall be no Category A medical conditions. 3.10.2.2; Category R medical conditions shall include the fol- lowing (1) Diseases of the kidney (2) Diseases of the ureter, bladder, or prostate (3) Any other urinary condition that results in a person not being able to perform as a member 20W Edition 1.573''.—t+) 11ED:t x[ iEk i iKEttEN,iS FOR FIRE FIGHTi N,i`` AND tNfOR.%L"'S' ON FOR FIRE UePARTMENT PMJt(,LA-N5 ---------------------------- 3• t 1 Spine, Scapulae, Ribs; and Sacroiliac joint,. 3-1 t.t There shall be no Category medical conditions 3-111• Category it. medical conditions shall include the rol- Driving: (1) ,arthritis (2) Structural abriormatity, fracture, or dislocation (3) Nuclrais putposus. herniation of. or history of laminec- to y discectomv or fusion (4): AnkslossngspondyiiUs (3) Any other spinal condition that results in a person not being able to perform as a member 3.12" E'xerenties. 3-1 ` 4 'There shall bents Category A medical conditions; 3-1' 2* Category B medical conditions shall include the fol. lotvjtg (1) Limitation of motion ofa joint (2) ;imputation or deformity of a joint or timb (3) Dislocation of a joint (4) Joint reconsmruction, ligamentous instability, or joint. replacement (5) Chronic osteoarthritis or traumatic arthritis (6) Inflammatory art hritis (7) Anyother extremity condition that results in a person not being able to perform as a member 3-13 Neurological Disorders. 3431* Category A medical conditions shall include the fol- lowing: (1) Ataxias of heredo-degenerative type (2) Cerebral arteriosclerosis as evidenced by documented episodes of neurological imP21rment (3) Multiple sclerosis with activity or evidence of progression within previous three years. (4) Progressive muscular dystrophyor atrophy (5) All epileptic conditions to include simple partial, complex partial, generalized, and psychomotor seizure disorders other than those with complete control during previous five years. normal neurological examination, and defini- tive statement from qualified neurological specialist 343.2 If an epileptic member experiences a fiveyearseizure- free interval resulting from a change in the medical regimen, that individual shall not be cleared for return to Fire -fighting duty until he or she has completed five years without a seizure on the new regimen. 3-13.3* Category B medical conditions shall include the fol- lowing- (1) Congenital; malformations (2) Migraine (3) Clinical disorders with paresis, paralysis, _dyscoordina-- Lion. deformity, abnormal motor activity, abnormality of sensation, or complaint of pain (4) Subarachnoid or intraccrebral hemorrhage (5) Abnormalities from recent head injury such as severe cerebra€ contusion or concussion (6) Anyother neurological condition that results in a person not being able to perform as a member 200 edtt.an 3.14 Skin, 3.14.1 There shall be no Category A medical conditions. 344.2* Category a medical conditions shall include the fal. lowing: a) Acne or inflammatory skin disease (2) Eczema (3) Any other dermatologic condid6n that results in site per- son not lacing able to perform as a. member 3-15 Stood aid S%o&Fucminq OrSam. 3.15.1* .Category medical conditions shall include the fol- lowing. (1) Hemorrhagc: sates ; requiring replacement therapy (2) Sickle cell disease (homorgous) 3.112• Category B medical conditions shalt include the fol. towing: (1) Anemia (2) Leukopenia (3) Polvcythemia vary (4) Splenomegaly (5) History of thromb sembolic disease (6) Any other hematological condition that results in a per- son not being able to perform as a member 3-16 Endocrine and Metabolic Disorders. 1• Diabetes mellitus, which is treated with insulin or an oral hypoglycemic agent and where an individual has a history of one or more episodes of incapacitating hypoglycem la, shall be a Category A. medical condition. 3.16.2" Category B medical conditions shall include the fol- lowing- (1) Diseases of the adrenal gland, pituitary Stand, parathy. raid gland, or thyroid gland of clinical significance (2) lVutritionail deficiency disease or metabolic disorder (3) Diabetes mellitus requiring treatment wM insulin or oral hypoglycemic agent without a history of incapacitating hypoglycemia (4) Any other endocrine or metabolic condition that results in a person not being able to perform as: a member 3-17 Systemic diseases and Miscellaneous conditions. 3-17.1 There shalt be no Category A medical conditions, 3-17.r Category B medical conditions shall include the fol- lowing: l ). Connective tissue disease, such as derrnatomycisids, lupus crythematosus, scleroderma. and rheumatoid arthritis (2) Residuals from past therma€,ii€jury (1) Documented evidence of predisposition to heat stress with recurrent episodes or resulting residual injury (4) Any other systemic condition that results in a person not being able to perform as a member 3-18 Tumors and Maligiaant diseases. 348.1 There shall be no CategoryA medical conditions. 3-18.2• Category B medical conditions shall include the fol- lowing. (1) Malignant disease that is newly diagnosed.. untreated, or currently being created'. INCADE.NT SCE\E REf lA31Lf"r.t"flt3\ .14C3 YEtlf(:.%L Tftf art1EvT 158 t-1 a. Candidates shall be subject to the pro+aisr.sn ,3f ).}.5 of this standard. b. Current members shall be subject to the pr.)vist`ous of 2-4.4 of this standard, (2) Treated malignant disease that is etaluated on the basis of an individuals current physical condition and on the likcliho:)d of the disease to recur or progress. i, a,3vother tumor Orsimtiarcon dit`sonthat results inaper. . son not bring able to perform as a imember, 3-19 Psychiatric Conditions. 19.1 There shall be no Category A medical conditions. 3-19.20 Cat —,Orr'- B medical conditions shall include the fol- lowing: (1) A historts of psxchiatric €andiron or substance_ abuse problem t^) Any other psychiatric condition that results in a person not bring able to perform as a member 3-19.3 Candidates and current members shall be evaluated based on the individual"s current condition, 3-24 Chemicals, Drugs, and ifedicatiom. 3-20:1 There shalt be no Category A medical conditions. 3-20.2" Category B medical conditions shalt include the use of the following- (1) Anticoagulant agents (1) Cardiovascular agents (3) Narcotics (4) Sedatime-hypnotics (5) Stimulants, (6) Psychoactive agents (7) Steroids (8) Any other chemical. drug. or medication that results in a person not being able to performs as a member Chapter 4 Wecti us Disease Program 4-1 Infection Control Program. 4•i:•t The fire department shalt maintain infection control programs as delineated in NFPA 1331, .Strandard ern fir, 0tpar€- meat In fikdan Contra! Nrans 44.2 The fire departrmenr physician shall maintain a liaison with the infection control officer as specified in NFPA 1581. 4.2 evosure tacidenta. 4-2,1" All blood and/or body fluid exposures shall be reported immediately, and medical assessment shall be pro- vidcd within n hours of cxposure. Medical assessment shall conform to current CDC guidelines. 4-2.2* All other exposure incidents shall be reported and assessment provided within 24 hours ,ofexposure, 4-3 Tuberculosis. 4-3.2* The fire department. shall pro idea tuberculosis mon- itoring.prograrn that will test members at lr„mot annually and as indicated by CDC guidelines. Tuberculosis (T8) testing inter- vals shall conform to current CDC guidelines. 4.3:24 sill members $hail lrr: ctaluated according to current CDC guideliltes follot"ing ant, tuberculosis exposure. These results shall be communicated to and retictyed by the fire dcPUtment ph sician. 4-4' lit —la tixaciot s- -Ui members shall he rmmuniZcd "Vint infectlOus disc' as required by the authority booing jurisdiction and by "J (TR I}It3Ir).lrl "8koflborne Path,- gens." The lire department physician shall cmure that, all members are offered currendv re'comntended ill' Mu airations, Chapter 5 Incident Scene Rehabilitation and &Iedical "Treatment 5-1 Incident Scene Rehabilitation. 5.1.1' The fire department shall develop standard operating procedures that outline a systematit approach for the rehabit- itatian of members operating at incidents. Protisivns addressed in these procedures shall include medical cvalua- Lion and treatment, food and fluid replenishment, crety rota- lion, and relief from extreme climatic conditions. 5-I.2' The incident commander shall consider the circum- stances of each incident and initiate rest and rehabilitation of members in accordance with the fire department's standard Operating procedures and with NFPA 156t, Standard on Egw, gency :Syr -.rites Incident Management .System. 5-2 Incident Scene Safety and Health. 5-2.1 The incident safety officer shaltensurethat theincident commander establishes an incident scene rehabilitation tacd-< cat level management component during emcrgcn.c opera- tions as required by ciFt' 152I..5tun:lard jorFnrQcpartmmt S�z�c ty iT/jeer 5-2.2" Transport capable emergency medical services (E.MS) shall be available in the incident scene rehabilitation tactical. level management component for et-4luation and treatment of members. Basic life support (R S) shall be the minimum level of available care. Advanced life support (ALS) care is preferable where it is available. 5-3 Evaluation and Triage of :.Member Injuries. 5-3.1 In the event of an injury to a member during emergency operations, EMS personnel shall assess and treat the injury based on local EMS protocol and fire department standard operating procedures. 5.3.2" Protocols and procedures _Ividing EMS pro,iders car• ing for ill or injured members during emergency operations shall be developed by the EMS medical director in collabora- tion with the fire department physician and chief. .. 5-4 Incident Scene Rebabi0tatlon Tactical Level Management Component, 5-4.1 The rehabilitation tactical level management comps, nent shall be designated per department standard operat- ing procedures, such as large-scale incidents. long -duration incidents„ or those associated with significant temperature extremes. 5A2 The rehabilitation tactical level management compo- nent shall be established in a safe environment away from the hazardous area of the incident. 2000 edtion 133"_1" ttt:i W N1.6tt.<,`+,UIRD ENT5 FOR FIRL FIGIJ CERS,k:r) t:vPOR-NIX `10N FOR FIRE DEPAR.TNIUNT Pt€e"SW'L1.` i 54.31 The restittrces needed at the rehabilitation tactical level management component shall include an environment to limit tempenture stress. medical equipment, and adequate medicat ,calf. 5- 4_4• Mvinbers shall be ;tssigned to rehabilitation as pre- scrthed by departmental standard operating procedures. Unusual circumstances: such a,"long,lur: tion incidents, citua- tions requiring hcavv exertion, or severe weather extremes shall retlttire an alteration to procedures. 54.3" Members arnvitttg at rehabilitation shall be bnerly alucstioned by medical staff about any symptoms of dchFdra• (ion, hest stress. cold Stress, physical e`haostion, and:'or car• dt,`spulmon:try abnormalities.:Vav member ltavirtar, ,igniticant svmptoms shalt be moved to an area where as :ssment by advance lift: support personnel can be perforated. 54.6 Members assigned to rehabilitation shall be encouraged to add, remove clothing to regain norma€ bodv temperitttre. drink tltat`ds (water. eleetrolvte replacement drinks). and rest; 54.7 No member shall he reassigned to return to dun until medical evaluation and hydration has occurred for at least 11) minutes in rehatbilitadonand after being clearest by nicdical staff. 5-4.8 .U1 members entering and leaving rehabilitation shall be proptriv assigned by the incident management system and be tracked through the personnel accountability wstem. Chapter 6 Referenced Publications ti-1 The, following documents or portions thereof are refer, enced within this standardas mandatory requirements and shall be considered part of the requirements of this standard. The edition indicated for each referenced mandatory docu- ment is the current edition as of the da to of the NFPA issuance of this standard. Some of these mandatory documents rnighE also be referencedin this standard for specific informational purposes and, therefore, are also listed in Appendix F. 6.1.1 NT'PAPublications. National Fire Protection Associa- Bost. I Batterymarch Park, P.p, Box 9101. Quincy. ILA 42,369- 91GI. NFPA 1500. Standrtrd on Ftsa Dt t+artmeni Occupaturartl Safety and Health P" %gram, 1997 edition. NFPA 1321, .Slandard forge Department Safety Officer, 1997 edition. NFPA kart!, SinndarV an Em, gmry "irnice; incident ,ttantige. enent .System, '21000 edition. .%'FP,k 1331, .Standlard on Fire DI. artment Prtfection Contrail Pro- 3"nam, 2wQ edition. 6-1.2 V. S. Covernnient Publicadons. US. t~. wernment Print- ingOdice, Washington, DC20401. Title 21), CvaleofFedrrol Regrtt.atrmtt, Part 19tn.124),'Hward- ous Waste Operations and Emergency Response,- 1986 Title 29, Coat of Fed real i?rc ttCutrons Part 19I'M 34. `Respita- tort' Protection," 1998. Title 29, Code of F,,drrtd Rri teJatemtr Part 19Io.9:i: 'Ot.cupa- donal Noise Exposure;- 1980, Title 29. Culp of Firma Rerr dnuuns, Part 1910,2a), Milt;dical Reeordkeeping," 19941. Title 29.. Code of Federal Rkgul tonne. Pict 1910 100, 'Blood - borne Pathogens,' 1715. 2000 541.0n Appendi c A Explanatory Material 3pP,em tx A u not at part of rite rrrlrtirrn!rrttt of thu , TRA ;Cart• ."I but it tr 4wicil fair inf'annartronal +ptsrPgseat urt€y. Tha tfJfirr fix , ;*rams exf &tn,ttory m,ttemd, numberd to ronvipond with the appli. "true text parggrapE s. A-1-21 9 There is a direct relationship berveen the medical requirements and the job descripuion of members. The pr b descrsption,hoold include all essential,lob funcuons of tnem= burs. both emergency andnonemergency. Members perform a variety of emergency operations including sire Fighting; emcrgeri v medical care. hazardous materials miti1ption, and Special operations. Nonemergenr_yduties can include, and are not limited to. training,, station and vehicle maintenance, and Physical fitness. Each fire department needs to identify and develop a written job description for members. Appendix C. Essential Fire -Fighting Functions, provides an example of easental job functions for members. The specific determination of the authority having jurisdiction depends on the mechanism under which this start. dard is adopted and enforced. 'Where this standard is adopted voluntarily by a particular fire department for its own ttse, the authority having jurisdiction should be the fire chief or the political entity that is responsible for the operation of the fire department. Where this standard is legally adopted and enforced by a body having regulatory authorityy over a fire department, such as federal. state, or local government or political subdivision, this body is responsible for making those determinations as the authority having, jurisdiction. The coin• phance program should take into account the services the fire department is required to provide, the financial resources x4labla to the fire department, the availability of personnel, the availability of trainers, and such other factors as will affect the fire department's ability to achieve compliance, r1r14.1 Approved. The National Fire Protection Msociation does not approve. inspect, or certify any instillations, prose dures, equipment, or materials: nor does itapprove or evatu- ate testing laboratories., In determining the acceptability of ins Wladons, procedures. equipment, or materials, the author- ity having jurisdiction may base acceptancee on compliance %rich `FPA, or other appropriate standards. In the absence of such standards; said authority may require evidence of proper installation, procedure, or use. The authority having jurisdic- uon may also refer to the listings: or labeling practices of an organization that is concerned with product evaluations and is thus in a position to determine compliance with appropriate standards for the current production of lasted items. ,1-14.2 Authority Having jurisdkdon. The phrase "authority having jurisdiction' is used in NTPA documents in a broad manner; since jurisdictions and approval agencies vary, as do their responsibilities. Where public iafety is primary. the authority having jurisdiction rnav be a federal. state. local, or other regional department or individual such as a fire chief; fire marshal; chief of a fire prevention bureats, labnr depart• rnent, or health department; building official: electrical inspector or others having statutory authority_ For insurance purposes. an insurance inspection department, rating bureau. or other insurance company representative maybetheauthor- itv having_ jurisdiction. In many circumstances, the property owner or his or her designated agent assumes the role of the authority having jurisdiction; at government installations, the commanding otlicer or departmental otficiit mat be site authority having jtirisdiction. A-14.3 Candidate- In an empl.avrne st context, the Anieri canswithDisabihuesAi t(discussedinfurtherdetailin.Appen- dix Di regttires that any medical examination to be condticted rake place after an offer of employment is made and prior to the commencement of dudes..Therefore, in the emphit -me conotxt, the definition of the terra ccxmluhsle .hould be .tpplied soisto be consistent with that 'regtiire ent. Volunteer members have been deemed to be emplocees in some states or jarudictions. Volunteer fire departments should seek legal counsel as to theiricgal responsibilities in. these matters: A-14.20 Member. See Appendix C. Essential Strucuirsl fire- fihting Functions'. A•2.1.1 See Append: D. Guide for Fire Deparuriet%(Adminis� trator$.. A-2.1.3 Exposures and medical conditions that should be reported if they can interfere with the ability of the indhidual to perfsirtn as a member include, but are riot limited to, the following: 11) Exposures to hazardous materials or toxic substances- 12) Exposure to infectious or contagious diseases (3) Illness or injury (4) Use of prescription or nonprescription drugs (S). Pregnancy A-2-2 2 See Appendix U. Section D-2. Choosing a Fire Depart- ment Physician. A-2-t3 See Appendix B. information for Fire Department Physicians. Appendix C, Essential stntcturti Fire -Fighting Functions provides a generic description of job -asks per. formed by members. A fire deparunent needs to provide the fire department physician with a job description of all pQsi. Lions and minks so that the fire department physician can understand the physical and mental demands placed upon all members regardless of position or rank. Appendix D. Guide for Fire Department Administrators, also provides guidance. for ensuring that the fire department physician is provided with this information. A-2-3 See Appendix B. Section B-3. Guidance for Medical Evaluations; A4-1.4 See Appendix D, Section D.I. Legal Considerations in Applying the Standard: A-g-d See Appendix B, Section W. Guidance for Ntedical Evaluations. A 2.4.1.3 At the discretion of the fire department physician, an examination can be performed sooner than would be expected from the schedulegiven in 24.1.3. Current medical conditions and coronary risk factors could mandate more fre- quent medical examinations. A-24.1.4 See Appendix B, Guide for ;"ire Department Phy- sicians. A-2 1.3 See Appendix p, Section 0-1. legal Considerations in Applying the Standard. Ai.-2-5.1 A department should set protocols regarding length of time absent from duty and/or medical conditions that require the department physician to evaluate a member. A-2.3.3 See Appendix 0. Section'0-1. Legal Consklerations in Applying the Standard A,1-34 Phviicai thertpv, strength training uork hardening functional capacity ecaltlations. andalterriite dutx are all actt`v- ittes that can be helpful, A-34.1.2 C;attS4ory 8 medical condition, of The head include the follosvintr, it) Deformities of the skull. such is depressions or exos< toles, ofa degree that interferes with the use of protec. the equipment, Deformities of the skull can result in the member's inability to properly wear protective equipmenc. (2) Deforrnitirs •af the skull -Associated w" evidence of dis- ea,5e of the brain, spinal cord, or peripheral nerves. These deformities can result in the potential for sudden Inca. pacitation. the inability to properly wear protective equipment. and the inability to commtinicate effectively dtte to oropharynsgeaf dysfunction, (3) Loss ofor congenital absence of the bony substance of the skult (if associated with disease interfering, with prrfor mance or ifapproprrate protection cannot be provided for the area without interfering with protectise equipment acid iision). Loss of or congenital absence of the bony • sub• stance of the skull can result in the inability to properly wear protective equipment and the inability to comet uni- cam effectively due to oropharyngeal dss£unctiom (4) Aray other head condition that results in a person not being able to perform as a member. A-3.2.2 » Category B medical conditions of the neck include the following' (1) "Thoracic outlet syndrome (symptomatic). Thoracic out- let syndrome can result in frequent episodes of pain or inability to perform work. (2) Congenital cysts, chronic draining fistulas. or similar lesions (if lesionsor underlying disease interferes with performance). Congenital cysts, chronic draining fistu. las,'or similar lesions can result in the inability to properly wear protective equipment, and the inability to. comma. nicate effectively due to oropharyngeal dysfunction. (3) Contraction of neckmuseles (if it interferes with wearing of protective equipment or ability to perform duties). The contraction of neck muscles can result in the inabil- ity to properly wear protective equipment, and the inabil- iiy to perform functions as a member due to limitation of flexibility (41 Any other neck condition that results in a person not being able to perform as.a member. A-3.3.1Category A medical conditions of the eyes and vision include The following. (1) far uisual ae-sity. Far lisual acuity is at least 20/30 binocu- Aar corrected with contact lenses or spectacles, far visual acuity uncorrected is at least 20,1100 binocular for wear• ers of hard contacts or spectacles. Successful long-term soft contact lens wearers(thatis, six months without a problem) are not subject to the uncorrected standard. Inadequate far visual acuity can result in the failure ro be able to read placards and street. signs or to see and respond 'txi imminently hazardous situations. l 2l fersphend noon. v"isual field performance without correc- tion is 140 degrees in the horizontal meridian in each eye, (dfembers cannot have just mottotutar yi5i+sn,) ljki'—i •l etCl>ts . RE42LIIREME.N fS FI)t;, R FI;;I ITtuita kND tM QRNt 1['UM FOP FIRL 0Ll',tRT%1I,'_NT Ptn-'1q;kLJ Monocular vision can result in sudden incapacication when debri- is lodged in one eve. Inadetluate or cutnpro. mtscd peripheral riion can result in tite t'ollowin.': z. Failure to perfonninb duties and maintain visual con- tact with a partner- b Inability to maintain safety near moving objects c. Poor balance an uncven surfaces d. l:nsuccebeftrl perfuzmance in envirmtricnzs uticre- vtsttal cues are critical to personal safety A-3-3.2 Carenoty B medical conditions of the eves and vision include the follovrizrg;: (1)' Diseases of the eve such as retinal detachment. peogres. stye rednopathy, or Optic neuritis (severe or progresive): These diseases of the eye can resultn the faiture to read placards and ;erect signs or to sec and respond to immi- nently hazardous situations. (") ophthalmological procedure: such as radial karatot- omy and repair of retinal detachment. With retinal detachment, suffl6cm: time (l-2 wecks.for radial'kcm- tonnmy and t asik-type surgeries; three months for rcti- nal detachment) must have passed to allow smbiliradon Of visual acuity .and to ensure that there are no poststtr gical complications, These ophthalmological prbcc dares may result in the failure to be able to read placards and street signs or to see and respond to inuni nentty hazardous situations; (3) Any other eye condition that results in person not being able to perform as a member, Persons with severe color vision loss will likely fail the acuity requirement.. Formerly, color vision deficiency was listed as a Cate- gory B medical condition. However, it is left that within most cases this condition will not affect the ability of a member to perform the essential functions of his or her job. The lire service ph7sician should consider the color vision deficiency of the individual and consider the color vision requirements of the member's job and reach an individual determination. (€)i Savere external outis, that is, rc:ctwi-c t leek of hearing can re4tilt to the inability to hear sounds of low intensity or ti> disun;,*ttish voice from backyrotind m>i,c, leading' to failure to respond'to imminently hazardous situauoits. (c) Severc a;encsis or traumatic dcfurmiry of the auricle can result in the inabilin, to property wear protective equip - merit and the inability to !tear sounds of Bier intensity or to dis. tint uish voice from background noise, leading to £s lure to respond to imminently hazardous utuatiuns, 4ti) Severe ni tstgidits pr surmcal dcfcrrtxiiy oaf thz mastoid can result in the inability to properiv wear protective equip mcnt and the inability to hear sounds of low intensity or to dis- un�p fish voice from background noise. leading to failure. to respond to muninendy hazardous situations. (e) M<nicrc`s S- drO me or severe labyrinth€tis mav result in the potential for sudden incapacitation and die inability to perfortn job functions due to limitations of balance; (f) Oritis media tchronic) can result in frequcntepisodes of pain or the inability to perform work and the inability to hear sounds of low intensity or to disun;,naish voice from back- ground noise. leading to failure to respond to imminently haz• ardous situations. (g) Any other ear condition that results in a person not being able to perform as a member can be classified as -a Cat- egory B medical condition of hearing. A-3-B.2 Category B dental medical conditions include the fol- lowing: (1) Diseases of the jaws or associated tissues ( those that are incapacitating or preclude ability to use protective equipment). diseases of die jaws or associated tissues can result in the inability to property wear protective equipment: (2) A-3-4.2 There are currently no hearing tests that will allow the (3) fire deparunem physician to accurately predict whether the firefighter will adequately be able to perform cssenclal. job denies. Job -specific hearing testa should he individualized for each department and its specific jssb functions. The following list of heating -specific tasks can assist to direct development of (4) hearing protocols. (l) Understanding spoken commands, both over the radio and white wearing SCBA (2) Rearing alarm signals. includingbuilding evacuation, lowair signal tin the SCE, and PASS alarms (3) Hearing and locating the source of calls for assistance (5) from victims or other fire fighters .-lit of the above tasks will need to beperformed with rea. sonably simulated incident scene back grottnd noise and SC& noise: The inability to hear sounds of low intensity or to dlstinr grrish voice from background noise can lead to failure to respond to imminently hazardoussftuations. (See air.)(j4 5J Category S medical conditions of hearing include the fol- lowing- (al Unequal heating can result in the inability to localize sounds, Leading to failure in the ability to perform search and rescue and other localization tasks. .:CW 52etfoll Orthodontic appliances (those that preclude the ability to use protective equipment). The :nearing ofotthodon. tic appliances can result in the inability to property wear protecuvc equipment. Oral tissues; extensive toss (that which precludes sadsfac- gory postorthodontic replacement or ability to use pro- tective equipment). Extensive toss of oral tissues may result in the inability to property wear protective equip mentand the inability to communicate effectively due to oropharyngeal dysfunction. Relationship between the mandible and maxilla that pre- cludes satisfactory postorthodontic replacement or abil- ity to use protective equipment. This condition can result in the inability to property wear protective equipment and the inability to communicart effectively, due to uropharyngeal dysfunction. Any other dental condition that results in a person not being able to perform as a member. A-3-6. t Category A medical conditions of the nose, orophar- ynx, trachea, csophagus, and larynx include the following: (1) Tracheostomg A tracheostomy can result in the inability to property wear protective equipment, the inability to perform job functions due to limitations of endurance, and the inability to communicate effectively due to oropharyngeal dysfunction. (") Aphonia, rcg4rdless of cause. Aphonia can result in the inability to communicate effectively due to oropharyn- Beal dysfunction. .�ti'1'E ti DtX .{ 1382..I;i 3 8.2 Categn- 13 medical conditions of the nose, orophur. trachea, esophagus. and larynx include the following: Congenital or acquired deformity that interferes with the ability to use protective: equiprnenr. A congenital or acquired deformity can result in the inability to properly wear protective equipment. +llergtc respiratory disorder (uncontrolled), Allergy c res pirazorr disorder can result to frequent episodes of pain, the inability to perform work. and the inability to perform functions as.a rncmber due to limitations of endurance. Sinusitis, recurrent (severe, requiring repeated hospital-, ta €uons or causing impairment). Recurrent sinusitis can; result in frequent episodes of pain and the inability to perform work. Dysphonia {severe}, Severe dssphonia can result in the inability to communicatc ed'ectively due to oropharyn- geal dvifunction Any Ocher nose, oropharmr. trachea. esophagus. or Eat- c ox condition that results in a person not being able to perfo€ m as a member or to communicate efi`ectfvelz A 3�-7.1 Catrgoty-A medical conditions of the lungs and chest wall include active hemoptysis,, empyema. pulmonary h"per• tension. and active tuberculosis: These conditions can result in the inability, to perform functions as a member due to liiml. tations of endurance. A-3-7,2 Category B medical conditions of the lungs and chest wall include the following: (I. (`i") (3) NE Pulmonary resectional surgery, chest wall surgery; pneu- mothOmx (that is, history of recurrent spontaneous pneumoshorae). These conditions can result in the inability to perform functions as a member due to limita- tions of strength or endurance and may result in: the potential for sudden incapacitation. Bronchial asthma or reactive airways disease (frequent medication use or symptoms caused by exposures to exec. tson. heat and cold, or products of combustion and other irritant inhalation). Bronchial asthma or reactive airways disease can result in frequent episodes of pain or the inability to perform work the potential for sudden inca- pacitation, and the inability to perform functions as a member due to limitations of endurance, brothorax, chest wall deformity, diaphragm abniinnall- ties. Pibrothomx, chest wall deformity, and diaphragms abnormalities can result in the inability to perform func Lions as a member due to limitations of endurance; Chronic obstructive airways disease, Chronic obstructive airways disease can result in the inability to perform func- tions as a member due to limitations of endurance. Pivpoxemic disorders. Hypoxemic disorders can result in the inability to perform functions as a member due to limitations of endurance, interstitial lung diseases. Interstitial lung diseases can result in the inability to perform functions as a member due to limitations of endurance. Pulmonary vascular diseases, pulmonary embolism. Pul- monary vascular diseases and pulmonary embolism can result in frequent episodes of pain and the inability to perform functions.. as a member due to limitations of endurance. Sronchiectasis with significant residual impairment of pulmonary function or requiring frequent therapy. $ron. chiectazsis can result in the inability. to perform functions as a member due to limitations of endurance. (9) Infectious diseases ofthe lung -or pleural space. (10) :Inv other pulmonary condition that results in a pees m not being able to perform as a member. 38,P-1 Category A medical conditions of the heart and spa, cular system include the: following: t 1) Angina la,.ctor'ss. current. Angina pectoris can result in frequent episodes of pain or inability to perform work progressive illness leading to functional impairment. and the powntal for sudden incapacitation. (") Heart tailure. cutrent. Heart failure can result in fre, quent episodes of pain or inability to perform work, prra- gressive illness leading to functional impairment, and the potential for sudden incapacitation. (3) acute pericarditis, endocarditis, or msocardids. These conditions can result in frequent episodes of pain or the inability to perform work. (4). Syncope, recurrent, Recurrent svncope canresult in the potential .for sudden i-ncapacitation. (5) Automatic implantable cardiac defibrillator An auto. rnatic implantable cardiac defibrillator can result in the potential forsudden incapacitation. A 3.8.1.2 Category B medical conditions of the heart and vats. culat system include the following: (1) Signif€cant.valvular lesions of the heart; including pros €hetic valves. Specificrecommendations include the f il- lowing: a. tV1i1r0i T&-n0=. htirtal stenosis is acceptable if in sinus rhythm and stenosis is mild. that is, valve area > 1.5 cm* or pulmonary artery systolic pressure a 335 mitt Hg. b..WjMl imsuj Lacy. Mitml insufficiency is acceptable if in sinus rhythm with normal left ventricular size and function. c. Aortic stenviis. Aortic, stenosis is acceptable if stenosis is mild. that is, mean aortic valvular pressure gmdi- ent< 20inm14g... d. Aortic m9urg;Worn. Aortic regurgitation isacceptable if left ventricular size is normal or slightly increased and systolic function is normal. e. Prosrhedcvalvess prosthetic valves are acceptable unless full anticoagulation is in effect. (2) Coronary artery disease; including history of myocardial infarctiom coronary artery bypass surgery, coronary angioplasty, and similar procedures. Persons at mildly increased risk for sudden incapacitation are acceptable for dire fighting. Mildly increased risk is defined by the presence of each of the following. - a, NOMal left ventricular ejection fraction b. Normal exercise tolerance. > 10 metabolic equivalents c. Absence ofexercisetnduced ischemia by exercise testing d. Absence of exercise -induced complex ventricular arrhythmias e, Absence of hemodynatnically significant stenosis on all major coronary arteries (250 percent lumen diameter narrowing), or successful myocardial revascufatization (3) Atrial tachycardia, flutter, or fibrillation (4) Left bundle branch, second- and: third-degree arsioven> tricular block. These blocks will result in disqualification unless exercisecan be performed with an adequate heart rate response. "whey can result in frequent episodes of pairs, the inability to perform work, and have the poten- tial for sudden incapacitation. 20W t Coon 1582-14 ttF;DlCAL tt£t>(: tltP;,MENTS MR FIRE F<)1t ME DEV NltrLlE T 1'tt` 1(:LVNS la) Verstricular tachycardia. 'Ventricular tachycardia can, result in the potential for sudden incapacivatiort anti the inability to laerfotm job functions due to limitations of strength or endurance. (6) H pertropity of the heart. H pertrephy of the heart can result in the potential forsadden:incapacitation and the inability to perform job functions date to limitations of endurance. (3) Recurrent paro�smal tachycardia. Recurrent pars>vm' mal ta, hvcardia can result in, the potential for sudden incapacitation and the inability to perfortn job functions due to limitations of strength or endurance.. () Kistory ofa congenital abnormality that has been treated by surgery but with residual complications or that has not been treated by surgery leaving residuals or complica- tions, A congenital .abnormality can result in frequent episodes oe pain or inability to. perform wvrl: Arid the potential for sudden incapacitation. (9) Chronic pericarditis, er ducarditis. or myocardius. These conditions can result in the inability to perform job func. lions due to limitations of endurance, (10)'Ca.rdiac pacemaker. If the person is pacemaker-deperi- dent.rthen the risk for sudden failure duc to trauma is not acceptable. Those with cardiac pacemakerscanhave the potential for sudden incapacitation. (11) Coronary artery vasaspasm. Those with cardiac artery vasospasm can have the potential for sudden incapaci- ta€ion. (12) .any other cardiac condition that results 'in a person not being able to perform as a member, A4.8.2.2 Category 8 medical conditions of the vascular sys- tem include the following: (1) Hypertension that is uncontrolled, poorly controlled. or requires medication likely to interfere with the perfor mance of duties, Acceptable hypertension isa blood prc$w sure less than 130j100 and no target organ damage. Hypertension is progressive illness leading to functional impairmentwith the potential for sudden incapacitation. (`?) Peripheral vascular disease, such as Rayttaud's phenome- non, that interferes with performance of duties or makes the individual likely to have significant risk of severe injury,. Peripheral vascular disease can result in frequent episodes of pain or the inability to perform work and the inability to perform frrnrtions as a member due to limita- tions of endurance. (3) Recurrent thrombophlebitis. Recurrent thrombephlebi- tis can result in frequent episodes of pain or the inability to perform work and the inability to perform functions as a member due to limitations of endurance. (41 Chronic lvmphedcrna due to lyrnphopathy or severe venous valvular incompetency. Chronic lymphedema can result in the inability to perform functions as a member due to limitations of endurance. (5) Congenital or acquired lesions of the aorta or ma r Yes - sell. for example, syphilitic aortitis, demonstrable athero- sclerosis that interferes with circulation. and congenital acquired dilatation of the aorta. Congenital or acquired lesions of the aorta or major vessels can result in the potential for .sudden incapacitation and the inability to perform jots functions due to limitations of endurance. (6) Marked circulatory instability. -xi indicated by orthostatic hypotension, persistent tachycardia, and severe periph- eral vasomotor disturbances -Marked circulatory instabsl- itycan result in the inability to perform job functions due 20co Edition to limitation.,; of en€ umnce and the inability to perfoirm lob functions due to limitations vt balance.; t f) Aneurysm of the heart or maj.ir vessel, c+in;,enual: or acquired..AYn aneurysm of the heart or major vcascl can result in frequent episodes of pain, the inability to per- form wvork: and the potential for sudden incapaeiratinn. i 6) Any other vascular.condition that results in a person;tvt being able to perform as member. A-3-9.2 Category 8 medical conditions of. the abdominal organs aradfastrointestfnal system include the following: t l j C.holecysci6s ( that which causes frequent pain due to stones or infection) . Cholecystitis can result in frequent episodes of pain or the inability to perform work. (2) Gastrids (that which cause recurrent pain and impair.< ment). Gastritis can result in frequent episodes of pain or the inability to perform work. (3) CI'bleeding can cause fatigue, and or hemodynamic instability resulting in inability to perform work. (1) Acute hepatitis (until resolution of acute hepatitis as determined by clinical examination and appropriate lab- oratory testing). Acute hepatitis can result in frequent episodes of pain or the inabiliry to perform work. (5) Hernia (unrepaired inguinal or abdominal hernia that could obstruct during duty). A hernia can result in the potential for sudden incapacitation. (6) Inflammatory bowel disease (that which causes disabling pain or diarrhea) . Inflammatory bowel disease can result in frequent episodes of pain or the inability to perform work. It is a progressive illness leading to functional impairment. (7) Intestinal obstruction (that is, recent obstruction with impairment), An intestinal obstruction can:result in fre- quent episodes of pain. the inability to perform work.. and the potential for sudden incapacitation. (8) Panereadds (that is, chronic or recurrent +rich impair- ment). panrreatitis can result: in frequent episodes of pain or the inability to perform work. (9) Resection. bowel (if frequent diarrhea precludes perfor- mance ofduty). A bowel resection can result in frequent episodes of pain or the inability to perform work. (10) Clcer, gastrointestinal (where symptorns are uncon- trolled by drugs or surgery). rat gastrointestinal ulcer can result in frequent episodes of pain or the inability to per - farm work. ( 1 l) Cirrhosis. hepatic or biliary (that which is symptomatic or in danger of bleeding). Cirrhosis can result in frequent episodes of pain or the inability to perform work. (12)'Chronic active hepatitis. Chronic, active hepatitis, can result in frequent episodes of stain or the inability to per- form work. (13) Any other gastrointestinal eo onion that results in a per- son not being able to perform as a member. i-3-ltl.L2 Category 8 medical conditions of the reproductive organs include the following- (1) Pregnancy. Pregnancy can result in frequent episodes of pain or the inability to perform work, progressive inabil- ity to perform workdue to limitations ofendurance, fle.K- ibiliiy or strength, and the inability to properly wear protective equipment. (Sw &4• 4, Rep"luctnw,) (2) Oysmcnorirhea that leads to recurrent incapacitation. Dysmenorrhea can result in frequent episodes of pain or the inability to perform work. (3) Endorretriosis,ovarian cysts, orodiargynecolog,ic conf€- uvns licvere,' leading to recurrent incapacitation).. Endometriosas, ovarian cysts. and s)ther )pnccologic con- ditions can result in frequent episodes of pain sir the inahilim to perform work; (i)- Testicular or epididrmat mass (that which requires medi- cal tyvaluation)_ A testicular or epididymal m ,s can result in frequent episodes of pain or the inabiliy, to perfi)rm worst,: Thisisa pro57ressive illness leading to functionaal impairr;tent, (5) Any other genital condition that results in a person ntst being able to perform as a member. Category B medical conditions of the urinary ,ss- tetra include the following: (I) Diseases Of the kidnev, requiring dialysis. Diseases of the kidney can result in frequent- episodes of pain or Elie inability to perform stork. Kidney disease is a progressive illness leading to Functional impairment: (2) Diseases of the iueter. bladder, or prostate that require frequent or prolonged treatment. These disexzes can result in frequent episodes of pain or the inabiliry to per, form work. () Any other urinary condition that results in a person not being, able to perform as a member. A-3.111 Category 8 medical conditions of the spinc, scapu. lae, ribs. and sacroiliac joints include the following._ (1); Arthritis that results in progressive impairment Or limita- tion of m,avement_ Arthritis is a progressive illness that Ieads to functional irnpairmcm, Arthritis can result in the inability to perform functions asa member due to limita. lions of endurance or flexibility. (2) Structtti a€ abnormality, fracture, or dislocation that is a pn>gressive or recurrent impairment. These conditions are progfressive illnesses leaning tofunctional impair ment._T'hese illnesses can result in the inability to per, form functions as a member due to limitations of strength or flexibility. (3} Nucleus pulposus, herniation of, or history of lsminec• corny. discectomy, or fusion. These conditions are pro- gressive illnesses leading to functional impairment and the inability to properly wear protective equipment. (4) Ankylosing spondylitis. ibis condition can result in the inability to perform functions as a memberdue to limita- tions of'endurance or llexibi€icy: (5) Any Other spinal condition that results in a person not being able to perform as member A3-12.2 Category 8 medical conditions of the extremities include the €allowing:- (l) Limitation of motion of a joint of a degree to interfere -Kith successful and safe performance of fare -lighting duties. The limitation of motion of a joint can result in the inability to perform functions as a member due to limitation of flexibility (2) Amputation ordefarmityofainintorlimmbofadegree to interfere with successful and safe performance of tire. fighting duties, the amp utation or deformim, ofa joint or limb can result in the mnability to perform functions as a. member slue to limitations ofstrength and/or balance. (3) Dislocation of a joint. Recurrent dislocation of a)ointor dislocation with residual limitation cif motion ofa degree to interfere with successfut and soft performance of fist fighting duties successful surgery for recurrent shoulder di location. if ringe of mots:sia, 6 intact, would- n"t exclude a pertion. Distocauort ,t,,i; jarit3t =,an result in the inability to perform functions as a meirtberdate to lirnra. titans of itrcngth or d,±xihality (+) Joint recon,trvKtioi4. liilamcntou.s instahilim, or joint replacement. In cases where recurrent or with residual limitation of moci+an of a de:grce to insert=:re with success- ful and sate perf.w manse ,it tirt-ti-hung duties, surgery for a torn, anterior cniciate l tmrr#t,c+7uld d€sr;taalifv it quadricep<strengilt=is not nor mil or if the knee is [ax or derelops pain Or-s+,s 1 n;< vheo stresicd. These condi- tions of tite-unit can result in the inability to perform. functions as a member due to limitations Of strength „r Elextbt[in: ia€ (;hronic osteoaidiritis or traurn:atie arthritis tin cases wticre recurrent exacerbations leads to impairment), Chronic osteiiarthrit)s or traumatic arthritis ran resul t in frequent episodes of pain, the inability to perform work. :and the inability to'perform functions as a member due to limitations of strength. endurance: or flexibility (6) Inflammatory arthritis (it' caseswhereitis severely recur. rent or a' -progressive illness or%ith deformity or timita- tiOn of range of motion of -a: degree to interfere .with saiccessftrl and safe performance of tire -fighting duties}, Inflammatory arthritis can result in frequent episodes of pain, the inability to perform work, .and the inability to perform functions as a member 'due to limitations of strength, endurance, or tlexibilim (r ) Arty other extremity condition that results in a person not being able to perf»rm as a member. A-3-111 Category A- medical conditions of a neurological nature includ+_ the following:. (a) Ataxias of the her edo-+degenerative ripe. Ataxias of the heredo-degenerative tt°pe can result in the inability to perform functions as a member due to limitations of balance. (b)•, Cerebra! arteriosclerosis as evidenced by documented episodes of neurological impairment. Cerebral arteriosriero- xis can resultin the inability to perform functions asa member due to limitations of strength and/or balance. (c) Progressive multiple sclerosis or multiptescierosissrith evidence-ofprogression within previous three years, 4luldple sclerosis can result in the inability to perform functions as a member dose to limirations of strength or flexibility. (d) Progressive mitsculardi strtaphe oratrophy.Th s condi- don can result in the inability to perform functions as a mem- ber titre to limitations of strength and' tar balance. (e) Epileptic conditions; After a provoked seizure. with the precipitant identified and alleviated, with subsequent normal CT or •NIRI scan, normal EEC. nefrmal neurological exam, free of rccurrence %vithout medicatiori for one year, and with defin- itive statement from a qualified neurological specialist, a mem. bar can be cleared to return to duty: •3 13 3 Category B, medical. conditions of a neurological stature include the follvwinq� (a) Congenital malformations (that is, severe.ascutarMal. formations that interfere with the ability to wear protective equipment) Congenital _malfirmarions can result in the inability sea properly Wear protective equipment (b) 'Migraine (that is. recurrent, with impairment uncon- trolled). Migraines can result in frequent cpisorics of pain or the inability to perform work, jar? kd'"M 1532-13 ti€ri7tf?.tl. KEt_) €RENtENTS FOR FIRE ft<:€€MS ,k. •D €'+ F+a€ttt.oi'€ON F(Itt Hoot t)ViII t€tMENT MN'S€4rLINS (c) Clitucal disorders with paresis. paralvais. d%scnordim- Lion. deformity: abnormal motor activity. abnormality ofsensa- tion, or complaint of pain (progressive or severe). These disorders ace progressive illnesses leading to functional' €inpairment. They can result in the inability to perform funs- bons as a member due to limitations of strength, flexibility, or balance, td) Subas-achnoid or intraccrebrA hemorrhage, verified tither clinit.alty or by ittboratoryStudies. except for those cor- rected with verificatton by lahoratory studies and report of treating physician. Subarachnaid or intrtcerelral hem,>r rhage is a progresmve illness ie;uting to functional impair- inent. This illness can result in the potential for sudden incapacitation. te) Abnormalities from recent head injury, such as severe cerebral contusion or concussion. The abnormalities can result in the potential for sudden incapacitation. (t) .sny lather neuroloSicat condition that results in a per- son not being able to perform as a member. <044.2 Category 9 medicalconditionsof the skin include the following: (a) kcne or intlammatory skin disease (if condition pre- cludes ,good fit of protective equipmens such u.SCSA £ace piece, or prevenu shaving). Acne or inflammatory skin disease'. can result in the inability to properiywear protective equipment. (b) 'Eczema (if broken skin results in impairment from infections or pain or interferes with seal Between skin and per- sonat prmtecti•,e equipment). Eczema can result in frequent episodes of pain or the inability to perform work. (c) .any other dermatologic condition that results in. the person not being able to perform as a member. A- -15.1 Category A medical conditions of blood and blood forming organs includes the following (a) Hemorrhagic states requiring replacement therapy (for example. von Willebmad's disease, thrombaeytoprnisa, hemophilia). These hemorrhagic states can result in episodes of pain or the inability to perform work. (b) Sickle cell disease (homozygous). Sickle cell disease can result in frequent episodes of pain or the inability to per- form worst and the potential for sudden incapacitation. A-145.2 Category 13 medical conditions of blood and -blood- Forming organs include the following: (a) Anemia (in cases that require regular transfusions). Anemia can: resultin frequent episodes of pain or the inability to perform work. Anemia is a progreuive illness leading; to functional impairment. fb) teukopenia (where chronic and indicative of serious illness). Leukopenia is a progressive illness leading to func- uonal impairment (c) Folycythem a vera (where severe. requiring treat- rnrnt) Polycythemia vera can result in frequent episodes of pain or the inability to perform work and the potential for €ud- Ylen incapacitation. (d) Splenomegaty (where the spleen is susceptible to tup- ture from blunt trauma). Splenomegaly can result in the potenual for sudden incapacitation; (e) History of thronil o<mboliic disease (that is, more than one episode or an underlying condition). A history of thromboembolic disease can result in the potential for sud- den incapacitation. M any other hcmarulo.gcal condition that results in x person not being able to perform as a member. A 3-16A Category A medical. conditions of cndocrine and metabolic. disorders include diabetes mellitus that is treated with insulin or an oral hyp glycemic scent and that includes a history of one or more episodes of incapacitating hvpoglree. mia, Diabetes mellitus can result in the potential for sudden incapacitation. A�3-16.2 G.tte nrr 8 medical conditions of endocrine a:nd metabolic disorders incltirics the following- (a) Diseases of the adrenal gland, pituitary .;land, paradiv. chid gland. or thvroid gland of clinical significance (that is, symptomatic and poorly controllyd).'x hese diseases can result in frequent episodes of pain, the inability to perform work, and the potential for sudden incapacitation. (b) Ntttritionat deticiency disease or metabolic disorder (where clinically siytriihranc and nor correctable by replace- ment therapy or either medication). Nutritionai deficiency dis- ease or metabolic disorder can result in freeloent episodes of pain or the inability to perform work. (c) Diabetes tedious requiringtreatment with insulin: or oral hypoglycemic agent. Diabetes metlitus can result in epi. sodes of pain or inability to perform work. It is a progressive illness leading to functional impairment and can result in the potential forsudden incapacitation. (d) Any other endocrine or metabolic condition that results in a person not being able to perform as a member. ?i-3-17.2 Category 8 medical conditions of systemic diseases and miscellaneous conditions include the following: (a) Connective tissue disease, such as dermatomyositis. Iupus erythematpsus, scieroderms. and rheumatoid arthri- tis (where manifested by systemic impairment or limitations of motion). `these connective tissue diseases are progressive illnesses leading to functional impairment and the inability to function as a member due to limitations of strength or flexibility. (b) Residuals from put thermal injury (for example, frost- bite resulting in significant symptomatic discomfort). Residu- als from past thermal injury may result in the inability to perform functions as a member due to limitations of strength, endurance, or flexibility.. (c) Documented evidence of a predisposition to heat stress with recurrent episodes or resulting residual injury. A predisposition to heat stress can: result in the potential for sud- den incapacitation and the. inability to perform functions as a member due to limitations of endurance. (d) Any other systemic conditisn that results in a person not being able to perform as a member. ti-3.18.2 Category 11 medical conditions of tumors and malig- nant diseases can include the following: - (a) The medical evaluation of any person with malignant disease that is newly diagnosed, untreated or currently being treated will be deferred; Any person with treated malignant disease should be evalu- ated based on that person's current phrical condition and on the likelihood of that person's disease to recur or progress, (b) Any other tumor or similar condition that results in a person not being able to perform as.a member: APPENI)tX ak 1333 —1q A,349.2 Category B medical conditions of a psychiatric nature include thefollowingz (4) Any person, with a history of a psychiatric condition or substance abuse problem should be evaluated based on that person's current condition Psychiatric conditions and sub• stance abuse problems can result in frequent episodes of pain or the inability to perform work and the potential for sudden incapacitation. These conditions are progressiveillnesses lead- ing to functiOnal impairrnen (b) -Any other psychiatric condition that results in a person not beingablc to perform as a member_ A-3-20.2 Category B medical conditions concerning chemi- cals, drugs, and medications include the following- Andcoagulantagents such as coumadin can be permit, ted if the anticoaglilated state is, controlled such that the pre" thrombin time. or INR has been in the therapeutic range on a stable medical regimen for at least one month and that no other coexisting conditions would either contribute to a bleeding diathesis or by themselves preclude certification for full duty. Anticoagulant agents can result in frequent episodes ofpain or the inability to perform work,, as well as the potential` for sudden incapacitation. (b) Cardiovascular agents (for example, anuhypertensives) can result in frequent episodes of pairs or the inability to per- form work; as well as the potential for sudden incapacitation. (c) The use of narcotics can result in frequent episodes of pain or the inability to perform work. as well as the potential for sudden incapacitation. (d) The use of.seladve-hypnotics can result in frequent episodes ofpain or the inability to perform work, as well as the potential for sudden incapacitation. (e) The use Of stimulants can result in frequent episodes ofpain or the inabiliryto perform work, as well as the potential for sudden incapacitation. (f) The use of psychoactive agents can result in frequent episodes ofpain or the inability to perform work, as well as the potential for sudden incapacitation. (g)The use of steroids can result in frequent episodes of pain or the. inability to perform work, (h) Any other chemical. drug. or medication that results in at person not being able to perform as a member is included lit this group. A-4-2.1 Physicians who care for members need to be familiar and keep Up-to-date with the most current recommendations for post -exposure prophylaxis (PEP) for bloodborne panto• gen (BBP) exposures. Also there should be a written protocol for dealing with members who present with SSP exposures. This should be based on the following elements; (1) Fact sheet that explains in lay language the risks of infec- Lion, the various prophylactic and therapeutic options. the testing and follow-up that will be needed and recom. mendations for personal behavior (i.e.. safe sex; blood donation, and so forth) following an exposure. (2) Classification table to determine the exposure type and recommendation for prophylaxis. Current recommenda- (ions of U.& Department of Health and Human Services, Centers for Disease Control and Prevention, and Public Health Services: (:3) Listing of testing to be clone on exposed member, includ- ing the following; a. HIV b. Hepatitis B surface Antibody (1-184 b), if not previ• atrsly known to be positive c. Hepatitis B surface Antigen (K B.wig), if not previously known to be positive HOSAII d. Hepatitis C•'mtibody (HCAb) el If HIV prophylaxis is to be given. the following tests- should be done.'. I. CBC ?. Clucose, renal and hepatic chemical function 3. Pregnancy test for females (4) Listing of testing to be done on source patient, including the following: a. HIV b, H&Ag . c, HCA,b (3) If source is available, interview for HIV, HepB. and HepC ride; statius. N Determination of risk and need for PEP (7) Member counseling regarding PEP medication(s) and. side effects of treatment, A printed Fact sheet should be available for the member to review. (8) If PEP prophylaxis is to be given, it should be done as soon as possible after the incident, preferably within 2' hours. (9) Members an prophylaxis need to be followed (preferably by an ID specialist) for the duration of their treatment. (10) -Amessmcnt of tetanus scam and adminiscmdon of dT booster, if appropriate (1 I) assess HepB status a- If previously immunized with a positive post -immuni- zation titer, no further treatment is needed, b. If previously immunized. titer was negative, and source is HBsAg positive or high risk, give Hepatitis B Immune Globulin (HBIG) as soon as possible - pref erably within 24 hours - and a dose of Hepatitis B vaccine. c. If previously immunized and titer is unknown, draw Lim I. If titer is positive, no further treatment is needed. 2. If titer is negative and source is HBaXg positive or high risk, then give Hepatitis B Immune Globulin (HBIG) as soon as passible - preferably within 24 hours - and a dose of Hepatitis B vaccine. d. If previously immunized with negative titer and rcvac- . cinated with a negative titer, give HBIG immediately and a second dose I month later. e: If never immunized. give HBIG and begin Hepatitis B vaccine series. (I2) Follow-up instructions should include the following: A. Adverse events and side eli'ects of PEP b. Signs and symptoms of recrovirah illness (fever, aden- apathy, rash) c, Appointments for follow-up blood work, including the following: t. HrVat 5 weeks, 3 months. and 6 months 2. i tiaA b and/or HCAb at tl weeks; 3 months. and 6 months, if source is HepB and/or HepC positive 3. Every other week CBC, renal and liver function, if receiving PEP 20M Eotton 1532-20 M WCAL Rt gt4tFl tE`T5 FOR FIRE FICHTERS AND UNTO RtCU10N FOR itRk. L7i:6 AAA tF_.%T Pjrf7 rt.L A-4-2.2 Fist -exposure prophvtax6 may also be indicated tir the following diseases- 41) Diphtheria (2): Hepatitis. (3) `teningiuz, (t)- pertussis_ (5) tlabies (6) Lancella Zoster A-1-3.1 :An annual T3 program should include the fallowing: (1) 0-cuimcntati m of a ttvo-step purified protein denva ive (PPD) prior to this PPD or a 0-men FPO within the pait I year. (2) Placement of PPD acid reading by.a trained. designated° reader within 4 hours to 72 hours of placement.. Mem- bers with a history of positive PPD should fill out a goer tionnaire; (3) PPO results should be documented in millimeters mm). A test with no skin reaction should be recorded as 0 men. (.l) A PPD skin test twill be considered positive if the following conditions are present. a. Greater than 5 mm in someone who is immunosup- pressed b. Greater than 10 mm in someone with a normal immune system who is at risk for conversion due to an exposure c. Greater than 10 mm increase from previous reading (3) If PPD is positive (conversion), the following steps should be taken. a. Fill out questionnaire b. obtain chest x-ray c. Evaluate for active disease d. Evaluate for preventative therapy (fi) If active disease is diagnosed, the member has to be removed from any duty until she/he has been deter mined to be noninfectious. This will occur when ade, quatc therapy has been instituted, the cough has resolved, and 3 consecutive sputum smears for acid.fast bacillus (riFFA) on different days are negative. A4-3.2 In the event of an exposure to TS. the following steps should be taken: (1)� Member should receive a PPD within 14 days of expo. sure. Members with a history of positive PPD should fill. out a T6 questionnaire. (2) Repeat PPD orquestionneire should be done 6 weeks to. 12 weeks after the first. (3) If PPD is positive (conversion) or questionnaire is posi- tive, proceed as per (5) and (6) ofA+3:1. A-44 29 C fR 1910.1030 requires that members be offered Hep. atius B immunization at no cost to the member. islembers who choose to decline the offerof this immunization are required to sign a written declination. The declination becomes part of a member's confidential health data base as specified in 'Section 8-4 of NFPA 1500, S4ind4rd on Ftrr, t1<yictrrratavt1 t?rctapatrmrat 5etfetp and Hratfh Pwgrran Members are allowed to recast at any time and receive offered immunizations. A-5-1.1 Having a preplanned rehabilitation program that is applicable to most incident tapes is essential for the health and safety of anembers: This program should outline an ongoing rehabilitation for simple or short -duration incidents as well as a process to transition into the rehabilitation needs ofa large ZCt�O Ea�tton •.,r long -duration incident. Medical evaluation and treatment in the oft -scene rehabilitation area ! Fhould be conducted' according to emergency medical service (EMS) protocols developed by the fire department in consultationwith the fire department phvsician and the EIS medical director, if advanced life support (ALS) personnel are available, this level of EMS care is preferred A-5-1_2 Weather factors during emergency incidents can cmp.tet severely on the safety and health of members. who aCe operating during: extremes of heat or cold- Where these fac. tors combine with lonsl�iuration incidents or situations that require heavy exertion. the risks tomembers increase rapidly. The fire department should develop procedures, in consulta- tion with the fire department physician. to provide relief from adverse climatic conditions. The following are typical rehabilitation considerations for operations during hot weather extremes: (l l ht<atizng fatigued or unassigrtcd members away from the hazardous area of the incident (2) Removing personal protective equipment (3) Ensuring that, personnel are out of direct sunlight (4) Ensuring that there is adequate air movement over per- sonnel, either naturally or mechanically (5) Providing members with fluid replenishment, especially water i(S) Providing medicalevaluation for personnel showing sivni or symptoms of heat exhaustion or heat stroke The fallowing are typical rehabilitation considerations for operations during cold weather extremes: (1) Moving fatigued or unassigned members away from the hazardous area of the incident (2) Providing shelter from wind and temperature extremes' (3) Providing members with fluid: replenishment, especially water (4) Providing medical evaluation for members showing signs or symptoms of frostbite, hypothermia, or other cold related injury A 5.2.2 The assignment of an ambulance or other support crew to the rehabilitation function is essential during long. duration or heavy -exertion incident: operations. Thiscrewcan assist with rehabilitation functions as welt as be available to provide immediate basic life support steeds for members. rtdya. ced life support (paramedic) level of evacuation and treatment has to be available quickly, however. to ensure the proper level of care: The medical staff has to have an assigned medical director. This can be an on -scene physician such as'a fire department physician, a remote physician at a base hospital, or a central medical direction facility, A-5-3.2 For major incidents or escalating incidents, medical control can be established by the fire department physician or medical director at the incident scene. Burn fajury. When a member suffers a berm; injury, he or she should be evaluated as to the extent of injury. First -degree burets can treated on scene, and the member may continue duty. Second-degree burets should be evaluated by a physician familiar with burets. such as an emergency department physi- cian, a member ofa burn unit, or a fire department physician. Second-degree bums and Higher are conditions that demand that the member be removed. from emergency response duty. After the burns have healed to the extent that there is minimal risk forentryintothe member sbodyofbodyEluidsandchem- .si•cENUIX l) fail. ` l icals encountered duriniar replar duties, he or ,he can return to full duty. The American Barn A.,socation has criteria f,sr rel'erratl to a burn center. They an: second- and third degr e burns with chatactertticsas f0lliiw4 11) Exceeding ` 0 percent, bud! surfcire area (BSAj { `_I) Exceeding 10 Percetnt BS,3 for age under 10 :5r over 50 i.F) Any third-degree bairn over 5 percent BSA () Invoking hawts, feet. face. perineum.:�enitalia, of inaj+ir joints ta) Circumfereridal involving extremities or chest f 6) t act.sed by contact with Chemicals. electricity, or lighming (~) Coupled with smoke inhalation injury (i) :lasociatrd with tmiltiple trauma I') lnvolvin3 patients with _pre-existing signittcant medical. illness LT asra?nxkztrtal Sprains. Strains and :sprains are xrn+anti the most common member injuntm When they occur during peri= ods.when circulating riatecholamines are high, such as on the fireground, the injured member might underestimate the severity of the injury, Under such conditions, he� or she might continue working and worsen the injury. Evaluation of these type of injuries nn the ficeigrczuntl can be difficult The injury might sworsen with time due co swelling. muscle spasm, and increased pain perception after the emer- genet/ call is over. ikny acute injury that leads to swelling or results in more than a trivial limitation of motion should prob- ably be evaluated by a physician.. .1vtoke Irthaataatiord Smoke inhalation is fortunately becom ing less common, due to the use .ofself-contained breathing appa- ratus. Amember with smoke inhalation should be treated with 100 percent oxygen and transported to an emergency depart nrcnt~ Burns involving greater than 15 percent ofbody surface area, facial bums, singed hair; and airway soot are associated with more severe airway burros. Lower wrNaiy injury can. be associated with carbonaceous sputum; wheezing, rates, rhon- chi, and chest pain, Pulmonary function tests can reveal, a decrease in forced expiratory volume in one second CFEVII. A Chest radiograph may disclose infiirsates or acciecsasia. Hypoxemia may be seen on arteriat blond gas_ana.lysis, A nor - mat chest radiograph and normal arterial blood pas results do not, however, tole out significant smoke inhalation injury. Endotmcheal incubation should be performed if there is central nervous system. suidor, h}130xemia (POD less than 60). hvpercarbia (PCO., greater than 50),, full -thickness bums of the Face or neck. airway or puimonary edema, or inability, to handle secretions. Positive end expiratory pressure (PEEP) should be used if hvpoxemia persists despite inntbarion and. administration of li)o percent oxygen. Inhaled betas -agonises and anticholinertlt'cs can be used for bronchospasm. Systemic corUccisteroids are not recommended for pneumonitis or put- monary edema. A,ntibiocics mac be needed if sputum Strain stain and culture with fever and lcukoeytosis suggest the pre$- ence of a bacterial pneumonia. Oriiirn Xtrin6er Certainly the scenario involving the discovery of an- unconscious member is one that is difficult to manage, given the psvcholo.Tcal responses of all involved. Of course, the fast priority is the safe removal of the victim from the haz- ardous area. Then the AirAgv. Bleeding, Cardiac (ABC"%) are carried out :and a secondary survey performed. Transport to a hospital should be expedited. Any unconscious member should be treated with (tiff per - Cent oxYgen, since carbon monoxide poisoning is common and cytnidc POisoninil possible as secondary eifects of $mokc inhalation. At the enter. ency departinetit. the victim sh,,,1ttt have an arterial: carbwxvhemugl,rbiu detcrrninet.i and shrauild be evaluated for pras,,iblet,-vanide toxictcv if cvaniile pqis,sning is suspected, treatment with a �, anide antiduce kit;ihould he, initiated. Since intiticintl methemoglo6inemia in a. patient with an elevated carbcat-sheni.ialssliin level m.iv further impair osvgen delivtrv, only srrtlieam thiosnlfate slimildbe ; iven in; tually, If treatment with hyperbaric oxygen 6 aarleti: nitrite, may he stied. A-54,3 Items that can assist in limiting temperature stress in c6111 Miionments include heat, I blank, tts. grid protection from thy: wind. For lu,t weather: items hould include aderivate shade, ('am. air-�Ondidoning, and misting, iviteins. Food and hvdraiian needs include water and oral duvU, food, broth. and Emit, ,,%0, for hydratiou> a 5t)"50 mixture of :.cater and an electrolyte replacement drink can be provided, Medical equipment should include blood presuire culfs. stethoscopes. oxvgrn, cardiac monitors. thennumecers, and intrasen6m fluid mid supplies. :%54.4 The incident commander should consider the cir eumstances cif each incident and make suitable provisions for rest and rehabilitation of members operating at die incident scene. For example, when members consurne air, from two SC BA air cylinders ft'.vo-cylinder rule), they should be assigned to rehab.. A.i.-t.a' The measurement of the pulse rate has been used by some fire departments in assessing members during rehabilita- lion. ?t persistently elevated pulse could be a sign of excessive stress on the body due to dehydration, heat stress. exhaustion, or cardiopulmonary disease. The use of a pulse rate has not been studied its a manner chatallows sit--tct medical protocol to be recommended. The pulse rate combined with the remain- der of the clinical evaluation of the member may be used to determine if the member can return to operations. Appendix S Information for Fire Department Physicianx That appendix is not apart of the requirements of lftu A�T'i doe- ument but is indUd ed far infatrmatiaiiat purposes only, tl-t 0cmisational Safety and Health problems for Mernbeas. B-1.1 General. Fire fighting and emergency response are very diiiculc jobs: People in these jobs perform functions that are physically and psychologically very demanding.. These functions are often performed under very difficult conditions- (.Srr Appertdix C.) 1.2 Physical Load. Studies have shown that fire•iighting functions require working at neat; rn-Wmal hears rates for pro- longed periods of time. Heavy prbteccivc equipment (includ- ing respirators) and the heat from the fire contribute to this physical laud. B-1-3 Toxic Substances. Members and emergency response personnel also are exposed to many toxic substances during their work. Carbon monoxide is the most common conxmmi- nan t; studies have shown individual exposures that are as high as 5000 ppm during actual fires. Other significant exposures common during fires include c+anide. acrolein, hydrogen chloride. nitrogen dioxide, and benzene.'rhe burning ofplas- tics and other synthetic materials can expo-ie members to other toxic materials, such as isocyanates and niirosamines. flazardous materials incidents can inv,>Ive exposures to many 2W Edition L53;!-'-`.' tii.i3V_iL t+E t.'ii't[.,"� ENT_i FOR RRE Ftl'. HT[P.a.tNtT 9` t'1)(i}t \Ctt1V Fou 1^tRE i 1 t':L tititk.:T t ltr tt:.l:1ti t other toNti materials. ,Adthough the use of respir-.at9rs helps to reduce exposures: mechattical, env ronmental. and behav- ioral factors can limit their ta,t during all phases of a tire. The avtitable health data on members are limited. W*lule the protection for members )tits improved over the last several nears: exposures might be changing due to the introduction of more wridietic materials. Given the delay between expontre. and ,onset, r that is, latencv? of many occupational illnesses: current or p;sst health itudics:aif members might not rettt:ct. future health risks. Theselimitations should be recogni ed when reviewing the available studies. B-1_4 Increased Risk of Injury and Disease. Available data indicate that members have increased risk for injuries, pul- monary diae.tsc, cardiovascular disease, cancer, and noise - induced hearing loa s. Thtt increased risk for injuries is expected. given the demands anal circumstances of this tvorl:. F.italitits and serious injuries from burns or other fire scene ha Lards can occur. The risk for respiratory disease occurs due to the respir-x- €orn damage caused by many of the components of tiro smoke (.for example, particulate, acrolein, nitrogen oludes, and so on.) Acute reductions in pulmonary function and even hvpvx emia are not uncommon after fees, even in asymptomatic members. Permanent damage from smoke inhalation bas also been reported. Studies of chronic pulmonary changes from ere fighting, have not had consistent results. Some follow-up studies have shown a greater rate of decline in pulmonary function among members over time. while others have not been able to detect this change. Increased use of protective equipment and job selection ftrtcirs till members transferring to other dudes) could account for these inconsistent findings. The strenuous work demands of fire fighting combined with exposures to carbon monoxide and other toxic sub- stances can increase the risk for cardiovascular disease among members. Acute respiratory changes also can stress the cardiovascular system. This increased cardiovascular dis- ease risk has been documented even in some mortality stud- ies, despite the job selection factors that tend to mask any increase when compared to the general population, {ether studies have not detected this risk. Certainly, the combina- tion of the physical stress of fire fighting and exposures for a person with preexisting coronary heart disease would be expected to increase the risk of a myocardial ittfa:rction or other acute event. However, the degree ofchis acute risk and whether fire fighting also contributes to the development of coronary heart disease is uncertain, increased cancer risk for members has been found in sev- eral recent studies. Wide not totally consistent, these studies genemily showan increased risk of brain cancer, igastrointes- anal caa<ersi colon cancer_ prostate cancer, lymphoma, and leukemia amcing members in many different parts of the world. Increased incidence of other cancer sites has also been shown in some studies. Several studies art currently under way to further evacuate this risk. Noise -induced hearing loss has now been documented in several studies of members. Members. might also be at risk from other specific exposures including infectious diseases and liver, kidney, or neurological damage from exposure to specific chemicals: 2000 Ectst.en 1'•° Guidance for Medical Evaluations. lz^'_>.l f replacemant said Baseline ifedical Evaluations;, ?replacement medical tvaluations isscss: sit individval's health status before assignment to positron. The prtrpaase of tfie eva(uanon is to ascertain whether the individual has anti health condition that prevents him oc her fr+ ni pc -forming tilt ob. inctuditi.; the ability: to wear protecuv�e egmpmcn€ required for the jaib. The evatuati,)n should also identify anv health problems that could be substantially aggravated by the phvsical demands and workinc; conditions. $incline medical information concerning the applicants health status can then be compared to :subscttueist evaluation results for the purpose of determining whether the individual h x anv sip iFcant health treads that can be occupationalty related. Two rmpes of information are essenual for a medical prc- ptacernrrit cvatraation of those performin,.- member duties. First, cite physician most understand the working conditions and ph,�sical demands of this occupation. appendix C pro aides a list of the environmental factors encountered in fire fighting and emergency response. The physician also should obtain additional informadoa" from the fire department reprd'ing specific job duties and task lists (if the fire depart- ment has conducted a -validation study or job anaG-.is) and should be familiar with the organization of the fire depart- ment. For the evaluation o€some medical conditions, the phy. sician-wilt need to obtain further information about specific job duties in order to nuke a determination. This might require on- ite. inspections and consultation with fire depart. went personnel. Second, the physician needs to have accurate information about the person's disease or medical condition. the func- tional limitations associated with that condition. and an understanding of how physical demands and working condi. Lions would impact on thattcondition, .Axt accurate diagnosis is often the key factor in determining the person% capabilicv. For example. different skits diseases can have similar clinical appearances but can markedly differ in their response to envi- ronmental exposures. The physician should also recognize that individual variability can exist between persons with. the same clinical condition. Upon completion of the examination, the physician should `inform the authority having3ucisdiction whether the applicant is medically qualified to perform as a member. 8,-2.2 Periodic Medical Evaluations. The periodic medical evaluation is designed to evaluate the person's continued abil- ity to perform his or her nudes and to detect any other signif leant changes in the condition of his or her health. The tatter includes possible job -related changes or abnormalities. Every year, each member will be medically csa Euated by the Lire department physician. This niedical evaluation ineludes- an update on the member's medical history, including any sig- nificant. ch3ago, a brief review of symptoms; and a report on any significant jab -related exposures experienced during the past year. Height, weight, visual acuity, and blood pressure are measured and recorded. The extent of the medical evaluation and additional testing will depend on the members medical condition, Amore thorough evaluation. including a medical examina- tion, is conducted an a periodic basis. For individuals less than 31) years of age, the medical evaluation and examination is conduc fed at least every three rears; for those 30 to 39 years of age. at least every two years; and for those 40 years of age or over, every year: This evaluation should include an updated Af'I'E:' OIX a medical tnd interval historv, complete phy-icai examinatiom, vi ion testing, audionmctry. putmonary function testing: and a CBC, urinalysis. gltrcuse, Bt N'j creatmine. liver funcuon tests. and tipid profile The use of chest x.rays in surveillance activities in the absence of significant expo-res. symptoms, or mcdicul find- mis his not been shown to reduce respiratory or other health impairment. Therefore. only prep tacement cheat --rays are recommended.. No firm Tudelines for stress electrocardiography inset: iP. tomatie individuals have been developed. There have been problems with false -positive results from this testing. (-specialty in younger age groups and in women. In those with one or more risk £actors for coronary artery disease, there is probably justification for performing the testis ..Ai well, strews tests'ar more important in those whose work deals with public safety: ? Stress tests can be: pear(`ormed using a ireadirmill, bicvele, or stair climber, as long as the protocol being used gradually increases in workload metabolic egiiicaient of resting ener, expenditure: (..MET$). A su smaximal test, with the endpoint being the; attainment of 95 percent of predicted maximal heart rate (P`tlklii), may .be-petfbi-red. Additional informa- tion gained by performing a maximalsymptorn-limitcd test might not be worth the additional time, effort, cost, and risk. A reasonable approach is. to star,, periodic treadmill testing on members at age +l. In those with one or more coronary artervdisease risk factors [premature family history (less than age 55), hypertension. diabetes mellitus, cigareite smoking, And hYWCholesterolemia (total cholesterol greater than nZ. or HDLcholeuerol less than 35)], testing should be started by. age 35. The frequency of testing should increase with age, but at the minimum the test should be done at least every-rao; years. Testing can also be done as indicated for those with symptoms suggestive of coronary artery disease. as reported in their yearly medical histories or interim reports. Conversely, it is known that even maxima[ stress testing fre- qucndy misses cardiac abnormalities seen during actual fire- fighting duties. < B-2.3 Content of the Medical Evaluation, 8-2.3.1 Medical and € ccupational history. The medical his. tory should cover the person's known health problems, such as major illnesses, surgeries, medication use, allergies, and so forth. Symptom review,is also important for detecting early signs of illness. In addition, a comprehensive medical history should include a personal health history, a family health his- tory. a health habit history, an immunization history, and a reproductive history. An occupational history should also be obtained to collect information about the penon's past occu- pational and environmental exposure& &2.3.2 Medical Examination The medical examination includes the following organ systems and tests: (1) trial signs, such as pulse, respiration, blood pressure, and. if indicated. temperature (2) Dermatologicat (3) Ears, eyes, nvsc. mouth. throat (4) Cardiovascular (5) Respiratory 05) Gastroin€estinal. (7) Genitourinary (S) Endocrine and metabolic (9)- Musculaskelctal (10) Neurological 01) Audiometry C 2) Visual acuity and peripheral vision testing (I3) Pulmonary function testing 0-0 Laboratorytestint;. if indicated (13) Diagnostic imaging, if indicated C l 6) Electroc.-irdio4mphv, if indicated'. 15$2-2:i &2.3.21.l i-aboratary, Tests. CSC. biochemical test battery; urinalysis. glucose. BUN, creatininc, liter function rests. and tipid profile. sho;ild be conducted for detecting specific ill. nesses ;is well as developing a baseline for later comparison Sys. A baxellne chest x-rev can be helpful for individuals with:a hi5tor3 of respiratory health problems or symptoms. for fathers it can be usefut for later comparison. B-2.3.2.3 P=rizrrortrary t unetiot T+sr ig. Pulmonary function testing can be Helpful for individuals with a history of respira- tory health problems and as a baseline for lacer 5:omparison. A baseline test should be administered by an experienced per- son. Only a spirogr-am that is technically acceptable and dem- onstr-ates the best etTdrts by an individual should be used to caiculute the forced vital capacity (FVC) andforced expiratory volume in one second (FEV I)_ B4.3.2.4 Audiometry. iudiograms should be performed in an AWNS -approved soundproof booth (ANSI 53.1..'€ Maximum Permiuib&,,irrrbirnr MSise .t meh or, adionwric Test ia'uumS) with equipment calibrated to ANSI standards (_A.NSI 53 6. Spedyfcu tiorr frrtudrr+mkrs). If a booth is unavailable. the test room sound pressure levels should not exceed those specifited in the federal OSHA noise regulations (29 t:F1t 1910.95). 8-2.3.2.5 Electrocardiography Baseline electrocardiography should be conducted. (Periodic resting electrocardiogruns. have not been shown to be useful, but may be reasonable as a. members age increases.) B-2.4 Reporting the Results of the Medical Evaluations. All individuals participating in a medical evaluation should be informed ahead of time about the purpose of the: medical evaluation and the content of the exam. The results of any medical evaluation are considered to be confidential medi- cal information, subject to customary patient.physician cixn- ficientiality restrictions. tender most circumstances, results and recommendations arising from the evaluation should be expressed in general terms without specific diagnostic infor- mation. In cases where more specific information is needed in order to make a decisions on the status of a candidate or member. a specific consent form releasing that information should be obtained from the candidame or member. Blanket or general "release of medical information" forms should not be used. In most cases, a simple statenient like one of the following will suffice: (a) Based on the results of the preplacement medical eval- uation of December 10, 1996,,jane Doe is (or is NOT) meth- eallycertified to engage in training and emergency operations for Anytown Fire Department. (b) Based tin the results of the preplacement medical eval- uation of December to, 1996,Johrt Doe is NOT medically cer- tified to engage in training and emergency operations for Anvcown fire Departrrient.. He has been advised of the medical reasons for this recommendation avid of the policies and pro- cedures available to him it he disagrees with the results of the medical evatuation. MEDWt kt. REQ MENIENTS FOR FIRE Ftf;11'TatZS A.40INFOR,`-L ` ON FOR FIKt".DEi'.titib ENT Nn wl.iNS B-2.5 Second Opinions. Fire department policies and proce- dures should allow for a medical second opinion when a candi- date or member disagrees with the results or recommendations of a medic" examination conducted by the fire dcpartmeni physician or +vlien the lire department physician is uncertain abotitthe limitauonsorproposis of the individual's c€ rt liuon. Often other physicians will not be familiar with the duties and demands of tire f4liting and eme%aniy response. When pow. We. the fire department physician should help educate the other physictain about how the individu:al's condition caulti ati'ect or be affected by fire fighting, if there is still d6agrecment about the condition or placement recommcnd;ttion, a third physician (acceptable to bath the fire department and the can. didatc) can be consulted. 111-2-6 Musculosk+eletal System:, Some of the injuries or prob• lams encountered in this system will need functional capacity evaluation to determine fitness for duty: Physical therapy pro. eiders often design tests for employers to determine ability to perform tasks similar to those required as part of their essen• vial job functions. These tests should be based on direct mea surements of the Actual job functions. These functional capacity evaluauotts can be especially useful when a member has been cleared for full duty by a physician who is not familiar with the essential;ob function$ of a member: 8-3 Spe6fic Medical Conditions. B-3.1 Diabetes Mcliltus, The major concern for diabetic members is the risk; of becoming hypoglycemic during 6re- ground operations or other emergency responses. Both exog- enous insulin and oral hypoglycerruc agents can be associated with episodes of hypoglycemia that can rapidly progress from impaired judgment to unconsciousness. The most reliable predictor of hypoglycemia is a history of it. In one study of insulin -dependent adolescents conducted at the Joslin Clinic (Bhatia and Wolfsdorf 1991). all 196 patients experienced hypoglycemia at least once during the two-year observation period. Of these, 15 percent were classified as severe, based on loss of consciousness, seizure. or the clinical need for thera- peutic glucagon or intravenous glucose. It was particularly concerning that 24 percent of hypoglycemic episodes detected by blood glucose monitoring were inapparent to the. patients. The probable causes of hypoglycemia were identified in 71 percent of cases, and the most common were strenuous ex,ircise and skipped meals or snacks. Both of these precipi- tants are likely to occur in emergency responders, especially fire service personnel. In addition to accelerating glucose utl- lization, strenuous exercise increases insulin sensitivity {Wasserman and Sinman 1994). With the tighter glycemie control that is now known to decrease and delay onset ofdia- betic complications. there is a concomitantly increased likeli- hood of cxercise-induced hypoglycemia (Wasserman and Sinman 1994). Insulin is clearly associated with a much higher risk of symptomatic hypoglycemia than are oral agents. In: the absence of a history of incapacitating hypoglycemic episodes, and with close medical monitoring, there is probably no rea- son to exclude members who are taking oral hypoglycemic agents, as long as they have stable weights, diets, and renal function. Although the Americans with Disabilities Act (Public Law 101.336 10)) does not appear to require each diabetic patient to be evaluated for fitness for duty individually. there issome case law that disallowed blanket exclusion of insulin - dependent diabetics from public safety positions (Fire & Police Personnel Rrp€arre£ t994), The Fcderal Aviation sovo 5diit n .administratton (I i CFR 67,1:316 1993) docs not grant medical certificates to diabetics treated with imtilin anti scverely limits those yin orut hypoglycemic agents.. B-3.2 Asthma and Reactive Airways Disease. Fhc diagnosis of asthma and related airway hyperactivity disorderx is often - c€>nfoitnded by definitional. issues, For the purposes of member certification. avariety of airw3v disorders that meet the following criteria can be inctuiied. A3thma is a chronic nfi,immatury disorder of the airwav& to suscepti• bie individuals, this inflammation causes symptoms that are usually' associated with widespread but variable airflow obstruction that is often reversible, either spontaneously or with treatment, and causes an associated increase in airway responsiveness to a variety of stimuli. Since asthma is a highly prevalent disease, a number of member applicants will require special evaluation. CombusLL Lion products, exercise, and. cold air are all puent provokers of an asthma attack. Some of these exposures are unavoidable. even with SCBA use. If a candidate has a diagnosis or symp. tams consistent with an asthma -like disease; manic factors will treed to be considered: An asthma attack during a suppression activity could Harm the member, his fellow members. or a member of the public. The fyllowiog factors can be used to help in certification: (1) Persistence of airway obstruction between attacks (as measured by spiromerry) (`?) heed and frequency of steroid and bronchodilator use (frequent bronchodilator use suggests persistent airway hyperactivity) (3) Usual type of triggers in the applicant (allergic, ini'ec- tious, exercise -induced, etc.) (4) History of hospitalization, emergency room, or urgent treatment: (5) Length of time between attacks (6) Nocturnal symptoms and other estimates of airway insta. bility Moderate asthma or worse could disqualify an individual for member duties. Unknown factors such as the suppression of airway hyperactivity with anti-inflammatory medications to reduce the possibility of a sudden or severe attack arc under investigation and could modify' current suggestions. B-3.3 Heart Disease. The medical conditions relating to the cardiovascular xvstem have been reviewed since the previous edition (1997) of this document. The task forces at the Bethesda Conference published recommendations for ath- letes competing with cardiovasculardisease its the journal of the Amoiean Ca&gge of Cardi€rloo in October 1994. The analysis used by the task force has relevance to the evaluation of mem- bees with cardiovascular disease. Firc.fighting activities have a. high static component (i.e., inducing predominantly an increase in blood pressure) and a moderate to high dynamic component (i.e., inducing predominantly an increase in heart rate), Sports with a similar set of demand& include wrestling, body building, and boxing. Recommendations made by the task force'with respect to atlsletic activities that have these physical demands (high static, moderate dynamic) have been followed in this document. 9-3.4 Reproductive. Exposures in the hre-fighbrig environs merit can cause adverse reproductive effects for both males and females. Siedical cvidencc exists to indicate that chemical exposure, heat, noise; and physical exertion can affect various endpoints of reproductive health including fertility, fetal toss. and growth paramett:rs of the eiti' pring 'ill..cantlidate ;ati,j mernbrra shoWd be educated about thv.it risk9 and alkx{t the nt�cd to mk.: appraipriate step; to circuit their expti3lares. also, there could be Stunt sittaMons whs rt: a male or ftnialt member ii ,#cterstpttn, to cone€ve .t child and is h.icing <hfficuirv,.Inthese ituations.i.hereacompletemedicalevatit^ ation has not tdentificd anothcr cause for thal inferulirr: tem- pomry .tssignmen( on a v=sluntim h.tsis to alwi-natice deity ,)r a le the of abNence shtatild he cbrn detearl. .Medical nider cc exists that tert-aIn toxic substances ter cxan. dluons thnrare present in the firc,fi, hunt/ env rnnm nt-a are dangerous to the safety and well-being of the fettrs. Tlierefrire, It Is tttaptarta,ut to educate all membersaboeit theac risks „t%d file rc:Utans forrecommending that pregnant rnem4crs re!�tric ( their firentippression acts€.sues. for example, there is ;+xc rt eetr deuce that the fetus is especialtysensitite to t:arbon monoxide: a known siPiticant comp€anent of fire smoke, Although the use of St:$.k is assumed to be protective. somelilties +etch equipment is not toed throughout afire suppression or liaz• ardous materials incident. Tile use of such equipment also increases other fetal strecsors. such as exertion and h rit. I:)ther concerns are those involving phvsicat work. Prolonged stand. ing. heavy lifting, and exposures to temperature extremes and humidity have been related to an increase of preterm and tovv birth weight infancy. Se€•a€ue the fetus should be protected from these exposures at the earliest possible time, the member who might be pregnant should obtain tarty, pregnancy testing.. Reco,pizing potential risks to the fetus from the. rirc-fightin, environment is a relatively recent dent. and many tnembets might nor. be %vire of these risks. Based on a recent U.S. Supreme Court decision £Interna- tional Union et al. v.,johnson Controls, inc..59I .S.L-'W 4209. March 20, 1991). the ability,tas: perform ass member is to be the basis for the- mrtlicat certification without comiderauon of health risks to the fetus. Ho',vcvcr. the pregnant member should be counseled on the potential risks to her fetus due to her exposures during'fire-fighrang duties. .any rtyember who becomes pregnant should be cal%red: afic opportunity at any time during the pregnancy to be voluntar ity removed from fire -fighting duties and from other duties involving; the hazards or physical stress that might endanger the fetus. If practical. the member should be offered voluntacV reassignmentto an alternative position. At such time as the (afrgnant member cats no longer bemedicallycertified as being capable of performingfire•fighting duties. the member should be reassigned to other duties. At such limit as the meat- her is no longer pregnant. the member should be reinstated to the position held prior to being pregnant. Nursing mem hers should also be advised about the potential exposures to their infants. B-3.3 Noise -induced HeattiAg Lass. This category can ptrse difftculucs. because a high percentage of current members have noise-indtired hearing loss due to their exposures as members. Implementation of hearing conservation programs and programs to reduce noise exposures should lead its a decrease in. the prevalence of this condition in the Riture. 3-3.6 Seizures and Epilepsy. It, is important to distinguish between a history of seizures and epilepsy, As much as It) per- cent of the population will experience at least one seizure in a lifetime, whereas ;ess than t percent of the population quatielec: for a diagnosis ofepitepsy(Hauser and Hcsdortfer 1 ), Manv conditions producing srlxurcs in the pediatric age group are kno<rn to remit prior to adulthotsd: and many adults sustain a reactive-ivirt.mc that e:Itt he au:-tiiutctt t+) a r€:verstlslc, tentlerli-. inq precipitatit. These circumstatlaes tit) not II'-CC-.Narity reps w WrIc an'ungoin„risk tif,tr€ deft; unprs•hctahlc incapacitaljon ,, f a member. If .t menther li to a jln;tr icittriv a clear precipitant Ant 3,r),oclotcd with central nelVtiel) systtm +lam.rgt is identititd .tnd eliminated. and the inttividttal ll.L� Ito recurrence:twer the ensutn - vear: then he oe vhe is probably not more likety b,) h.rve .motherieizure than dte rest if the general p ipldation i5pen. aver 19951 ito,t fire deparuttent phvstci ttts will avant a iittatititd neur•flog st To verifc that act indicidiiat with.a histoty of 3ciz(ires dales not. in last, have tpitepv. Epilepsy is dia;ntrwd by the presence of -unprovoked, rrctirredt sci�utes par,)x*-smA di3ortfe€S of the central ncr. vous , item clturactery.rd by an abnormal ctrebrat neuronai dischar;r with or withotit toss of cotvxiotisnem' :(Cascitrta 1994). Treatment cif patients with epilepiv is onfy variabiv stir• cessful.withr<aughty40percentofpatients attalnin rcmissiott On an(i.;onttilsrnt therapy (l imier and Hcad€irtfer 1'.190; Spencer la9i1. Remissirsn is defined .is face gears withotit rectirrcace of seizure acriviry t.annegers, Hauser. and Elve. back lai79). Ftirther complicating the htness.for-dun: iss€ie is the fact that only AO percent of patients who achieve retttissiiin do ,o withotit toxic side effects of the anti-convulsant drag lC.ucino 1994), partial. simple epilepsy, or recurrent. seizures that do not impair. consciousness, are felt to be a disqualifving condition because of the uncertainty regarding how much of the brain might be involved. and the risk of propagation to other re;glans of the brain, particularly in the highly cpilcptogenic environment of the frrcground (Spencer E99:iF: This standard is somewhat more liberal than that protnul- gated by the federal' Aviadon Administration of the IJ:S.. Department of Transportation for aircraft pilots (14 CFR 67.1316 1995). All epileptics. re-gardless of therapeutic success are denied first-. second-. or third-class medical certificates. except under the provisions of 14 -CFR (i7. 191, `Special Issue of Medical C e.rdficates.' 34 References.. Anne 5crs. J F.. W. A. Hauser. and 1.. R. Elveback, 1979, "Remission cif Seizures and Relapse in Patients with Epilepsy. Epi&pxin 2M, r -'9. Bhatia, V_ and J. 1, Wolfsdorf. 1991. "Severe Hypt-Ityccmia in Y43uth with Insulin -Dependent Diabetes 4iellitus: Fre quenty and.Causative Factors" Pe,latria 88:113f, Brunacini, Alan. Fir and C omniranti. Nation -it Fire Protec- tion Association. 1985, Cassino, G. D, V9034. E,GAlpiy: Contemparuryt Pertprctivcs an Fat;.ztuuti- and Treatmrrrt.', lavo Clinic Proceedings 69.1199. `Emergencv Incident Rehabilitation.' United States fire' administration tF.-X#I 121), Fire & Pharr P?sortnet fie'lr:rrlrr; Novernber 1994. p. 169, Hauser, t'4' A., and D.,C. Hesdorffer, 1990. "Epilepsy: Fre. quency. Cau.,es and Consequences." New Y,)rk: Demos, i�atitiital Fire Incident Reporting System lvF1y data base.: NFPA 1121. Stetadrtnl for Fi- Pjairtment .5aply Qfrjr,,r, 1997 edition, Public Law 10-1-336. 1991), Tide I » Emplovmcnt; "Spencer. S.- personal Communication, 1995. {Spencer is professor of neurology and director of the Clinical Epilepsy and Elertrophysiolog c Monitoring ;Services at Yate University Schoen tifMedicine.) Title 14, Code fir Firirr4z tr?rgu&:Ilans, part 191U.ti)t} , Suh> parts 13-16. -Air Contaminants. 2Gt}ia Edition 1 i3'2 �e3 FOR FIREFIGi4TcVSAN'3INFORMATION Ft)ittlRCsli»hARIMCNTPffs tt:f.14� "`l'uxic imoke itilialation: Cyanide pnisoning in fire ; c- tams.- lone3, J: et at:. irnr"Can Jonmut of Emery nvy .t "44ine Wasserman, D. U.. and B.Sinman. Mt.-Exercisein'indi- vidiials wrath IDD11.' Drabrar Cam 1,:'#.:14. .itppendi-t C Essendal Saucy." Fire -Fighting Functions Thts z fsp zi:iix it rta,t a p,arc ,) f the fer irements = f tfits .VMP A .Ili.; - is vt,na &.,it is in, larle4 far inf)rm,xriA snl �}srr�N sea nra6v c•i The medical requirements in this standard were based=in in-depth consideration of essential structural t re-fiaghang functions. Thesc essential functions arc what members are ex pccted to perform at emergency incidents and art derived from the performance objectives stated in NfPA 1001. -Si an- Lardliiri ire F`itO&y unlii iattiarts. E,,isennai functions ire perfrarmed in and; at ettec# br the following environmental factors: (1) Oper3dng both as a member of a team and indepen- dendy at incidents of uncertain duration (`2) Spending extensive time outside exposed to the elements (3) Tolerating extreme fluctuations in temperature white per- formingrJudes; fire fighters are required to perform phvs. ica.11y dcmanding,sork in hot (up to )°F), Humid (up to. 1 t)() percent) atmospheres white wearing equipment that significantly impairs body -cooling mechanisms. (4) Experiencing frequent transition from hot to cold and from humid to dry aunospheres (a) Working in wet, iq/ or muddy areas (fi) Performing a variety of tasks on slippery, hazardous iur- faces such as on rooftops or from ladders (7) Working in areas where sustaining traumatic or thermal injuries is possible (d) Facing cxposure`to carcinogenic dusts such as asbestos, toxic substances such as hydrogen, cyanide, acids, carbon monoxide, ororganic solvents, either through inhalation sir skin contact (9) Facing exposure to infectious agents such as Hepatitis S or id1Y (101, Wearing personal protective equipment that weighs approximately 50 lb while performing fire -fighting tasks (1 I) Performing physically demanding work while wearing pos- itive -pressure breathing equipment with 15 in of seater column resistance to exhalation at a flow of 40 L-/min (12) Ferforming complex tasks during life -threatening emergencies (13) Working for long periods of time, requiring sustained physicat activirr and intense concentration { t }) facing life-or-sieath decisions during emergency conditions (15) Being exposed to grotesque sights and smells associated - with major crautna and burn victims (16) Vaking_rapid u-muitions from rest to near -maximal exer- tion without warm-up periods (17). ). Operating in environments of high liaise. poor visibility. limited mobility; at heights. and in enclosed or confined spaces (t8) lasing manual axed power toots in the performance ofdudes t 19) ttetving on sensesof sight, hearing, smclt, and touch to help determine the nature ref the emergency. to maintain personat safety, and to make critical decisicns in a con- fused, chaotic, and potentially life -threatening ens^iron- mcnt throughout the duration cif tyre operation 24CC EctEa°aM :AppendLx 3 wide for Eire DepattmentAdn-Lin sfrators nu silap .nx is not rt fxirt of the reluirnnen 4c ,)f :has `4'PA 4,, rt.�'mentbut is inamited f»r inform atiOnatPsa'r)ir4..:.arii : it-1 Legit ctmsiderations in .appl*g the Standard. Tlic con. sideraat?n of an application or con tinutd emotm-Ment of a mein- ber based on medical or ph}sical perioim=c' e, tluactons m%ol ex a determination chat is nut without 1c;al implications. Tu dt6 end, pnor it) making an .ttlserw. emplrwnient de iafon ba.Ned on der f6m4nin,y,Standard; the authorirs with jurisdiction n€tyt t evish to consult with counsel:, D-L IIndividuals with Handicaps or Disabilities- The lteha- bilitadon Act of l,ril as amended; T) l-S.£. 91 et seq., and implementing regulauoni, prohibit discrimination atpinst thou with handicaps or disabilities under any program receiv- ing financial assistance from the federal government. The inencans with Duabilitics ,-kct of tt3",lt}, 42 U.S.C. 4 12101, et seq.. also prohibits employment discrimination by certain pri- vate emptovers a€,ainst individuals t tth disabilities. In addition, many states have enacted tc risladott prohibiting discrimination .igainst those with handicaps or disabilities. These laws prevent the exclusion, denial ofbenefits, refusal to hire or promote. or other discriminatory conduct against an individual based on a handicap or disability, where the individual involved can, with or without reasonable accommodation. perform the essental functions of the job without creating undue hardship on the employer or program involved. Application of this .standard should be undertaken with these issues in mind. The -medical requirements ofthe 1°.y}i edition of this stan- dard were initially developed and found to be job -related by a subcommittee comprised of medical doctors. physiological specialises; and fire service professionals. as processed through the NFPA consensus standards -making system. Changes for the current edition have been proposed by a task group com- prised of similar expertise. The standard provides, to the extent feasible, that decisions concerning candidates and cur- rent members with medical ailments, handicaps, or disabilities be made after case -by -case medical_ evatuadons. Thus, most medical conditions have been assigned to Category B. The medical requiremcnEs in this edition of the standard' were revised based on the essential functions contained in Appendix C. It is recognized that some fire -fighting functions and tasks can vary from location to location due to differences in department size, functional and organizational differences, geography, level of urbanization, equipment utilized. and other factors. Therefore; it is the rmponsibithy of each individ- ual fire department to document, through jab analysis, that the essential functions performed in the local jurisdictionare substantially similar to those contained in Appendix C. There are a wide variety of job analytic techniques available to document the essential functions of the jrrb of a member. However, at a minimum, any method utilized should be cur: rent, in writing, and meet the provisions ofthe.'imencans with Disabilities Act ()iFRi53t3.`?(n)(:3);.Jobdescriptionsshould focus on critical and important work .behaviors and specific tasks and functions. The frequency andlcrrduratiatt of task per- formance, and the consequences of failure to perform the task should be specified. The working conditions and eniironmen- tal Nuards in which the work is performed should be described. The job description should bemadeavailable to the fire service physician for use during the preplacement medical examination for the individual determination of the medical suitability of :applicants for member. APPE.Notx D' D-1.2 An -Discrirninatiofl t..aws. Finally, users of this stan- dard should be aware that. while courts are likely to give co€s- sidenble weight to the existence of a nationally recognized standard such as NFRA 1aL`2, Stfianrksrd onMedici d Rc+�ritrrnrrrits for Fire PgAitert and ::Information for Fire. Do Phvsirifanz ,tinker a Sioux 6,alruta'V fire D"Partmeni. 4137 ;+M'_'d 138 t 1993). reliance on the standard alone could be Insufficient to widwand a challenge under the and -discrimination laws. Even in the case of f ategoro A medical conditions, courts can ;tall require additional expert evidence concerning an individ- ual candidate" or member's inability to perform the essential functions ofthe job. Until the courts:provide further guidance in this developing area of law, some uncertaittry as to the. degree and nature of the evidence required to establish com- pliance with the antWiscrimination laws will remain. -0 Individuals Who Are lfembeirs of Protected Clasers (R.ace, Sex, Color, Religion or National Origin), `title leaf of the. Civil Rights let of 1964. as amended, 42 U.S C . 20110e, and implementing regulations by the Equal Employment C3pporni- nity Commission ('EEOC) prohibit discrimination in emplox* mesh on the basis of race, sex, color. religion, or national origin protected classes). tinder Title 421, an `employer" is defined. generally, to mean a person with 15 or more empl®y ees for each working clay in each of 20 or more calendar weeks` in the current or preceding calendar year. (42 U3 S.(; Vt)t1e) Several federal jurisdictions have held that unpaid volunteers are not considered to be "employees" under Title tit. Additionally.. many states, cities; and localities have adopted similar legislation. Generally; physical performance or other requirements thatresult in "adverse impact' on mem- bers of a protected class (e.g., on the basis .of gender) are required to be validated through. a study in accordance with EEOC guidelines, if such requirements are to be relied on in making employment decisions. Under EECSC- guidelines, a study validating employment standards in one jurisclictlon can be transportable to another jurisdiction (and therefore used in lieu of conducting a separate study). However. specific pre- conditions must be met in this: regard, and Else authority hav- ing jurisdiction should seek the advice of counsel before relying on a transported validation study. D-1.4 Preguancy and Reproductive. Federal regulations, as +,•`rely as many court decisions. including the U.S. Supreme Court's decision in Inttemaiiamd t,'ision, er al. a, fohnson Controls, Inc. (499 U.S. 187. 111 S.Cc 1196 (1991)1. have interpreted, the requirements of Title Vit'with respect to pregnancy and reproduction. The authority having jurisdiction should seek the advice of counsel in resolving specific questions concern- ing these requirements as well as other requirements that can be imposed by state or local laws. D-2 Choosing a Eire Department Physician, Several factors should be considered in chotrsing a fire depantrment physician: There are relatively few phytit:ians with formal residency train- ing and certification in occupational medicine, The fare depart mcnt physician needs to be qualified to provide professional e?tprtvse in nce areas of occupational safety and; health as these areas relate to emergency services. For the purpose ofconduct- ing medical evaluations, the fire department physician needs to understand the physiological and psychological demands- placed on members and needs to understand the environmen• sal conditions under which members have to perform. Therefore. phlsicians with specialties other €lian occupa. tionai need to be considered. as well as the phvsician's back- ground and expenence: lurowledge .af occupational medicine and experience with occupational health programs. ob,vIously, would be helpful. The physician has to be committed to meeting the rrgtrirr menm of the program. including appropriate record keeping His or her willingness to work with the: department to contin' ually improve the program is aleo irnpormn . Finally. his or her concern and interest in the proKram and in the individuals in the department is.vital. There are many<,apdons for obtaining phvsician services. (a) Physicians could be paid on a service basis or through a contractual arrangement. (bl For volunteer departments. local plivsicians crinld be willing to volunteer their services for the progrram. with addi- tional member arrangements for plivrieni of laboratory test- ing, x-rays, and so forth. (c) Some departments could utilize a local health care facility for medical tare. However, in that case, the department should be sure to have one individual physician responsible for the program. record keeping, and so forth. (d) In some cases, it could be possible to have the medical examination by the fire department physician. while some of the associated costs could be defrayed by the member's olvn health `insurance. For example, the health insurance provider could .allow the member to have a yearly physical. normally performed by the member's personal physician. The health care insurance provider could allow, that physical to be per- formed by the fire department physician with some degree of reimbursement. D-3 Coordinating the Uedical Evaluation Progr=. An indi. vidual from within tiie department should be assigned the responsibility for managing the health and fitness program, including the coordination and scheduling of evaluations and examinations. This person should also act as liaison beewcen the department and the physician to make sure that each has the information necessary for decisions about placement, scheduling appointments, and so Earth. Confidentiality of all medical data is critical to the success of the program. &Iembers need to feet assured that the infor- mation provided to the physician will not be inappropriately shared. No fire department supervisor or manager should have access to medical records without the express written consent of the member. 'There are occasions, however, when specific medical information is needed to make a decision about placement. return to wtigk. and so forth. and a fire department. manager trust have more medical information for decision making. In thatsituation, written medical consent` should be obtained from the individual to release the specific information necessary for that decision. Budgetary coostramts can affect the medical program. Therefore, it is important that components of the program be prioritized such that essential elements are nodose. %+rich addi- tional funding, other programs or testing can be added to enhance the program. i7ial,Table 0-4 represents a comparison between `iFPA 1582 and OSKA 29 CFR 1'1310,134. 2000 Fd"n 15,42-2.1 xtEDttw.tt. Rust,?t:tRLNlEN"fS FoR FIRE. �i.ttt'i`kE`at k'k4`�kCirL S 'I"aisle D-4 Comparison of OS `'29 CFR, Parts 11M. €34, "Medical Requiftments" an<i NF'PA 1582, Stairdard on Xledirat R,v,im mts for Fir+r Fiyh&ers and Infarrrratioir far Fire Deparflrrtmt Physierans, 2000 Edition N'FPA 1582 OSHA 1910.134 2.1 titedicai Evaluation Process. The employer must establish and implement it those elements of the written respiratory pro- 2.1 1 `The tire department shall establish and iimplemcnt a MiAical eva€ua- tecu to program necessary to ensure that any tip>n process for candidates and current members, empIovee using a respirator voluntarily is med- iCal€v able to use that respirator, and that the respirator is cleaned stored and maintained },;o that its use doesnotpresent a hazard to the ; Wer. Exception:: Employers are not required.to i include in a written respiratory protection prey mm those employees whose anly use of respt- 3ratorsinvolves thevoluntary use of filtering face pieces ( dust masks) . Appendix D-3 Coordinatingthe'Nledical Evaluation Proyrram. An individual 1(3) The employer shall designate a program from within the department should be assigned the responsibility for man- administrator who is qualified by appropriate aTng the health and fitness program, including the coordination and se eduling of evaluations and c�tamtnations. This person should also act as training or experience that is commensurate svitlt the complexity of the program to admin- liaison between the department and the physician to make sure that each for decisions ister or oversee the respiratory protection pro - and condu, the rerluiree! evaluations has tine information necessary about placement, scheduling gram -of appoinunents, and so forth. the program effectiveness. Confidentiality of al€ medical data is critical to the success of the program. :4tembers must feet assured that the information provided to the physic€sn will not be inappropriately shared. No fire department supervisor ar man- ager should have access to medical records without the express written con- scnt of the member. There are occasions when specific medical information is needed to make a decision about placement, return to work, and so forth, and a fire department manager must have more medical information. in that sinaation; written medical consent should be obtained from the individ- ual to release the speck information_ necessary for that decision. budgetary constraints can affect the medical program Therefore, itis impportant that components of the program be prioritized such that essen- last funding, tial elements are not With additional other programs or test. ing can be added to enhance the program. 2-i,2 The medicalevaluation process shall include limplacerrient medical (1) General. The employer shall provide a evaluations, periodic medical evaluations, and return-to-dutymedical evalu- medical evaluation to determine the ations. ern ployee`s abi€ii to use a respirator, before is fit to the employee tested or required use the respirator in the workplace. The employer innay discontinue are employee's medical evalu- no longer I required to use a repirator. fshrtt t of if Table D-4 Comparison of OSHA 29 CFX Parts 1910,134, 'Medical Requirements" and NF PA 1582, Standard an Mediral R+equirerricn#s fm Fitt Fi-ghu's aad fnfa m stionfir Firs De frartrne»t Phjticz mr 2000 Edition 1Coodinuedj N FP:% 1582 .1.3 The fire department .shalt ensue that the medical e%aluation process and all medical evaluauons tmeet a1'l of the requirement ofSecuon 2.1. OSHA 1910.1.3.4 i i(3`s follow-up medical examination. ? li) The -employer Shall ensure that s follow-up medical examination is provided for an i employee who gives a positive response to any gitewon among questions I through 8 in Sec- tion ?. Part A of Appendix C or whose initial medical etaminsuon demonstrates the need for.follow-tip medical examinations. tii) The follow-up medical examination shaft include anv medical tests, consultations. or !diagnostic procedures that the plivsician or ilicenwrl health care professional (PLHM 'deems necessary to make a final detetmina- don, n.1.4 Each candidate or current lire lighter shall coo elate. participate, and t :) Additional medical evaluations.:lt a mini- €iamplywith the medical evaluation process and shall provide complete and mum, the employer shalt provide additional accurate information to the fire departiaentphysi€ian. medical evaluations that: comply with the 2-t:5" Each candidate or current lire fighter shall, an a timely basis, report requirements of this section if - to the fire department phyysician any exposure or medical condition that t`i) An employee reports medical signs or could interfere with,the bHim of the individual to perform as a fire fighter. symptoms that are related to ability to use a , 24.1.1 The component% of the annual medical evaluation specified .in respirator, 2-4.11 of this section shall be permitted to be performed by qualified per- (ii) A PLHCP, supervisor, or the. respirator Co. sonnel as authorized by the fire department physician. When other quali- gravel administrator informs the -employer that Pied personnel are used. the fire department physician shall review the viola an.employee needs to be re-evaluated ;gathered during the evaluation. (iii) Information from the respiratory protee- Lion program, including observations made during fic cesdnsg and program evaluation, indicates a needfor employee re-evaluaton or (iv} A change occurs in workplace conditions (e.g., physical work effort, protective clothing, temperature) that may result in a substantial increase in the physiological burden placed on an employee_ r`Shat 2 of S) Zti00 ewson 1582-30 N,EDWA.i. REQUIREME` TS FOR FIRS FIGHTERS AND INFEiRNLi iTON FOR. SRE DEFARTMENT i MSICiANS Table " Comparison of OSHA 29 CFF Parts 1010.134, `Medical ltegttirernciaW and N"A 1582, Standard an ,Liedical Aequ rrms%ft it Fire lrivf &n and In ormation far Am Depart bent Physician;, 2000 Edition (C'andmmd) N E X 1582 OS*U 1910.114 2-2 Fire Depa.risnent Roles; (2) Itedical evaluation procedures. 2.2.1 The fire department shall have an olTicially designated physician who (i) The employer shalt identify a physician or other licensed health care professional shall be responsible for guiding. di and and advising the members with regard to their health, fitness, and suetabiliry for duty as required by . iFP.k (PL14CP) to perform medical questionnaire 1500. Standta dl m Pim Di p x meat Occupational Safel and Heallh Psssr�ti m that obtains: or an me i n Medical as the medtionical the same. information as the medical qucstian- 2-2•2 The fire depariment physician shall be a licensedd doctor of medicine. naiXe: or osteopaths (ii) The medical evaluation shall obtain the 0-2 Choosing a Eire Department Physician. Several factors should be consid. informationre nested by the questionnaire in Sections 1 and , Part A of Appendix C of this ercd in choosing a Fire department physician.' There are relatively few physi- section. cians with formal residency training and certification in occupaaonal medicine. The Fire department physician shall he qualified to provide pro- fessional expertise in the arras ofoccupadonai safety and health as they relate to emergency services. For the purpose of conducting medical evalua- tions. the Fire department physician shall understand the physiological and psychological demands placed on fire fighters and shall undicruaind the environmental conditions under which fire fighters must perform. 'Therefore, physicians with other specialties need to be considered. The background and experience of the physician should be considered. Knowl- edge of occupational medicine and experience with occupational health programs obviously would be helpful the physician must be committed to meeting the requirements of the pro- gram including appropriate record keeping. His/her willingness to work with the department to continually improve the program is also important; Finally, his/her concern and inter" in the, program and in the individuals in the department is vital. "There are many options for obtaining physician services.'They could be paid on a service basis or through a eontmcruai arrangement. Eorvolunteer departments, local physicians might be willing to volunteer their services for the program with additional arrangements to pay for laboratory testing, x- rays, and so forth. Some departments might want to utilize a local health care facility for their cart. However, in that case, the department should be sure to have one individual physician responsible for the program, record keeping, and so forth. In some cases it could be possible to have the medical examination by the Fire department physician, while some of the associated costs could be defrayed by the fire fighter's own health insurance. For exam pie, the health insurance provider might allow the Fire fighter to have a yearly physical, normally performed by the fire fighter`s personal physician. the health care insurance provider can allow that physical to be performed by the fire department physician with some degree of reimbursement. ($IueR .i Of T), E0600 1582-31 Table D-i Comparison of OSHA 29 CFS, Farts 1910.134. -Medical Ret}uirements" and. NFPA 1582, Staxdarrt onMedical Requinwents far Fire Footers and fnfnrm h- furl jrt f?e}iari -nA Ph)o ioam. 2000 Edition Wontirtucd) NFP:a 1582 j 2-2.3"' For the purpose of conducting medical evaluations, the fire depart mcni physician shall understated the physiological and psychological. demands placed on members and shalt understand theenvironmental con-ditions under which members must pert'orm. The lire depsruneru shall pro - the tire; department physician with a current job description for all Eire deparurtcrit positions and ranks. B-1 Occupational Safety and Health Problems for Fire Fi%hters. Fire righting and emcr,;cricy response are very difficult jobs. ?copte in these jobs per- form functions that are phvaically and psychoiogicaliy very demanding. jThese functions are often performed under vent difficult conditions. (See 'Appendix C.) Studies have shown that fire -fighting functions require work- ing at near maximal extort rates for prolonged periods of orate. Heavy pro- tective equipment (including respirators) and the heat from the Ore contribute to this physical load. Fire fig hters and emergency response personnel also are exposed to many toxic substances during their work.. Carbon monoxide is the most common contaminant. studies have shown indMdual exposures as high as 5000 ppm in actual tires. Gather significant exposures common in fires include cya- nide, acrolein. hydrogen chloride, nitrogen dioxide, and benzene. The burning of plastics and other synthetic materials can expose tire fighters to other toxic materials such as isocya raates and nitrosam'rnes. Hazardous mate- rials incidents can involve exposures to many other toxic materials. White the uae of respirators helps to reduce expowres, mechanical, 4cmitonmen- mL and behavior.-J factors can limit their use during all phases ofa fire. f3SIU 1910.134 Medical evaluation. Usingarespitatormay :e a physiolo�te or''cal bvrdcn on, employees vant:s With, thpc of respiratorw9rn: the rd the Workplace conditions in which the nrator is used. and the medical status of employee. Accordingly, this paragraph .ities the miteimum'regtairemenes for midi _+valuation that employers must implement cterm ne the employee°s ability to rise a 15) Supplemental information for the PLHCP.. I (i) The following information must be pro- vided to the PL14CP before the PLHCP makes a recommendation concerting art employee's ability to use a respirator: (A) The q?c and weight of the respirator to be used by the employee. (ia) The duration and frequency of respirator use (including ttse for rescue and escape); (C) The expected physical work effort; (D) Additional protective clothing and equip - men t to be worn: and (L)'remperature and humidity extremes that be encountered. (i) Any supplemental'tnfonnation provided previously to the PLHCP regarding an employee need not bie provided forsubse- tluent medical evaluation if the'` information and the PLHCP remain the same. (itt) The employer shall provide the PLHCP with a copy of the written resppiratory protec- tion program and a copy of this section. Note to paragraph (e) (5)(iii): Wthen the employer replaces a PLEiQ the employer must ensure that the new PLHCP obtains this information, either by gWAding the docu menu directly to the i'LttCP or having the documents transferred £tom the former PLHCP to the new PLHCP. however, OSHA does not expect empioyers to have employees medically re-evaluated solely because a new PLHCP has been setecicd. 2000 Editmn 1382-3: MEDICAL RD i iR ME"r'i'S FOR FIRE Ftt;,H`Ci;MANO INFOR:st-MON:FOR FIRE OEPAR7atENT Pti}-,ir:t %N5 Table D-t Comparison of OSHA 29 CM Parts 11 IC13.t, ""sled€,cal Requirtrrtents" atad !`1kFA. 1582, Siamkrrlun,btedized Requimmumt fiar Finn F ghucrr and tnfirrmat on for Kira tigwm *wt PA)wirimu, 200 Edition (Continued) `TPA:1582 OSHA 1910.134 i 2-t. t The current member shall be certified annually, or at the request of (it) Medica€ determination. In determining either the fire department or the member. by the Fire department physician the employee's ability to use a respirator, the as meeting the medical requirements of Chapter 3 of this standard in order employer shalt to determine that member's medical ability to continue participating in a training or cmergengtoperational environment as a membi:r. Any appl€ca > 0) Obtain a written recom icndation regard- t31e t BEih standards, such as29 €ultl.t2€1, tt tzardoui i "ante Opera."ng the erne€ovec's ability to use the respirator tuons and Emer- gency Response," ?4 1910.134. "Respiratory Protection,' provide the PLHtoP. The recommendation shalt provide only the following information. 29 t.:FR 1410.95,'Occupational Noise Exposure,' anti 29 CFR 1910.1030. 48loodborne Pathogens:shall:be followed. (A) Any limitations onrespirator use related to the medical condition of the employee; or relating to the workplace conditions to which the respirator will. be used, includingg whether car not the employee is medically abte to use l the respirator.; I (8) The need, if any, for follow-up medical evaivadons; and (C) A statement that the PUICP has provided the employee with: a copy of the PL14CP's writ- ten recommendation. 00 If the respirator is negative a pressure res. pirawr and the'PU4CP fiinrls a. medical condi- tion that tray place the employee's health at "increased risk if the respirator is used. the employer shall provide a PAPR if the PLHCP`s medical etialuanon finds that the employee can use such a respirator. if a subsequent m ed- ical cvaluation finds that the employee is med ically able to fur a. negative pressure respirator,then the employer is no longer required to provide a PAM (4) Administration of the medical question- naire and examinations. (i) The medical questionnaire and cxamina: tionsshall be administered confidentially dear- in$ the employees normal working hours or at a time and place convenient to the employee. The medical questionnaire shaft be adminis- toed in a manner that; ensures that the employee understands its content, (4) The employer shalt rovide the employee with an opportunity to discuss the question- naire and the examination results with the (Shaer S o(JJ 2000 Edston ArPE,Neat:,: F Appendix E Sample Fomu This dPPe<ndix is not 4 pet» of the requirements of this N" 1 doc- ument but is included for infyrmadonai puurpora only. E-% Physical Exam Summary. The fire department physician can report results of the periodic medical evaluation, which is designed to evaluate a member"s continued ability to perform his or her duties and to detect any significant changes in the condition of his or her health, on a form like the Physical Exam Summary. (•Set rigure�,E 1.) &Z Medical Examination Report The fare department physi- cian can record information froth the medical cxatmnadon on a form like the Medical Examination ReporL (See, rigum E•2,) Appendix p Referenced Publications F 1 The following documents or portions thereof are refer- enceti within this standard for informational purposes only and are thus not considered part of the requirements or this standard unless also listed in Chapter & The edition indicated here for each reference is the current edition as of'the date of the vFPA issuance of this standard. F-L t t*tFPA Publications. National fire Protection Associa- tions l Satterymarch Park, P.O. Box 9101, Quincy, 4tA 01269. 91£l 1. NFPA 1001. Standard for fire Fz7ghte r Am essionaf Qunlift,-a- ttom. 199, .edition.- F-t 2 V45I Publications. American National Standards lnsd- tute, lnc:, 11 Nest 42nd Street. 13th floor, New York. ZW 1'ta036t ANSI $3.1, At= mum PermausibleAmbientX#istLevels forAudi- omttric Test Room, 11 edition. .ANSI S3.6, Specif A- Lion for Audiomttrn; 1936 edition. EMPLOYMENT PHYSICAL SERVICES i5dz-34 N1EDIC.kt; REQUIREMEN-TS FOR FIRE FTGHTERx AND INFOR..GETiON FOR FIRE DEPARTMENT PM3tC'Li.YS PiGUIRE Est Form for fire department physician's repat't Physical Exam Summary Employer, Employee's Name: Position Tile: Lute of Exam- Examining Physician: Components Performed 44ithttt i'Normat Limits Abnormal, Able to Perform Job Tasks Abnormal, Unable to Perform Job Tasks Significant Chang" ;Voted from Previous,. Exam (if applicable) r7l Physical exam 7 Audiograrn ` 0 Pulmonary function l3 Treadmill stress a EKO-12lead 0 Chest:t-ray CI Nfarnmogtam D Pelvic/Pv Laboratory tests Other Explanation of Abnormal Results7SigniftcantChanges'. Ii 0 Medically cleared to perform job tasks Q denied medical clearance for current job tasks MMA "SkO Exam Srrtmmwy It at FIGL`itE`F.-I JContt»uaC) H of RL: 'vtXAfs. is a y o. Fire Fighter Police Officer with the depaswcnt, The purpose of this annual physical is to establish fitnessfor the continuation of those duties. Hetshe has enjoyed good health. MrjNtrs, vgiced fire fallow n;,questaons Vl dical History Surgical History Medications — i}.K ® Orthopedic HTY _ . ENT — CVD Optho — Asthma , Other Allergies Social History ROS Smoke Gl, PP[3 Hematochezia — Quit Stool caliber ... ...... .... ,...... . _ ..... ..... .V.... ..... Exercise Alcohol G.U, Amount' __ stones Frequency Hematuria CV Guest pain —SOB. Rasp. Cough T,,,, 4�'iue2es _ _ SO8 FH Physical Audio — DM insent physical here —RFM ........» HTN ..,„_ Speech range — CVD Vision Slood — Far — Target ,NBC. .,.._ Corrected — Ltterp Glu Stool 08 — Stage achieved Chol �,. Positive Ptilm RDL Negative FVC Rat;P - Risk tfk `ao PXed _ Siood FEVL. LFPss SCOT_ _ Pmtesri `$ Pred SGPT_ _ Glucose Other ZM EdWn I582-36 MEDICAL REQUIREMENTS fop FIRE FIGHTERS AND INFOKMATION FOP FIRE DFP..A r*ME;VT i''461CL-\°NS: FIGURE S2 Medical e-twW radon report farm. 1. NAME (Last) Medical Examination (First) (Middle)I SEX 3. DATE OF F-XANiINATION 4. PLANT Ott DIVISION 15. St7C. SEC. OR EMPLOYEE NO 6. OCCUPA7TON 7. DATE' LAST E,+G4WNAnE N 8, REASON FOR PRESENT EXAMINATION C3 PRE-PLACENAENT 0 D,OT, 0 SURVEILLANCE 0_ E:vlti10PA'Y'ION Q FLT 9. TEMP. 10. PuLSE 111,I)LOODPRESSURE, 12: NEIGHT Fr IN. u tAr'Elow t4. TTi'; us SNELLWO 11. VISION DISTAN-r LINCORRECITID CORRECTED K COLOR "VISION (Use Code)" RE 201 BOTH LE 101 n 201 8E3TH LE 201 `)EAR RE 201 BOTH LE I(V RE 201 BOTH ELE201 17. PERIPHERAL Clinical Evaluation Area Examined ' Use Code Remarks (Describe all "Code Is" in deiail) 19. head and neck 19. Thyroid Lymph nodes 20. Eyes Fundi 21. Ears 21. dose and sinuses 23 Mouth and throat 24. Teeth 25: Chest and lungs Breast 26. Heart 27. Abdomen 2& Inguinal. e.g., hernia E-91 LG�enitalia • Code: 0 -- Within normal limits i — Signiflcandy abnormal X -- Notexamined x ut wasrE e�ms"..aon Para;t err tx1 2fk3tl ache n 4- APPENDIX E 1582-37` FIGLIM E-2 fC4nthmed.) 30. Pelvis 31. Anus and rectum -. l . _m_ ---- Prostate Proetoscopic -.---1 ...... 31 Spine 33. Skin 34, Ames - Hands -------_--- 35, 36. Legs Feet Peripheral -Vascular .... 37. Neurologic 38. Emotional status 19, Other 44. Urine dip: Glucoset albumins S,G.; Hettx: Leukocyte -Esterase: Other 41. Flex 41 Step test 14IR 43. Body Pat t4IPe 44, PFr 45.?ludio 46. Chest x-ray (use 0. t, or X) 47. EKG (use 0. 1, or X) and specify test used 49, Hemocult NIR 49. Back evah i Sri. Tetanus 51, PPP3 32. Srxtss test ° ode; 0 -- Within normal limits I — Signi5candy abnormal X -- Not examined NFFR Modica estnuiM form (2 of 12) 1582— 8 MEDICAL REQUMEME`TS FOR FIRE FtGFifERS AND i4FC YNATYON FOR FM DEPARTMENT Pt(Y'S[CLQNS FIGURE i.2 Wantinw&) 53. Other x-ray or laboratory findings 54. Physician's summary, rcrriarks, and diagnoses, inclu4ing: recommendations made to patiem (include code numbers for diagnoses and conditions found) 55. Recommendations/Restrictions 5& R-N. signature Q 0 57. Physician's signature; 0 yy 59. Patient's signature 59. Work qualification. 60. Contact person: 5 t. Date: 62, Initiat: Coals: 4 --- WAWR nprmal limits ! --Significantly abnormal X -Prot examined NB * Mvdkaa aet fwM (a a+e9) 2wo Ediean APPENDIX F 1582-39 FIGURE E-2 (Continua) Health History Yes NO If "Yet, Give Details. HaveYou Had Any$urgerleSlOperations: On your back, arm. leg. or knee? ❑ n To treat a hemia? 0 0 VXicose veins? 0 0 Otheroperations? M Cl Have you ever been hospitalized? 0 Allergy — Have You Ever Had or Do You Currently Have: Serious allergy? 13 0 Bad rmaction to -any medication? Q Advised not to take any medication (e.g.. aspirin)?00 Skin — Have You Ever Had or Do You Currently Have. Hivesieczerna or rash? 0 Chmm c skirt problems (e.g., cuts slaw to [� heal)? Excessive skin dryness? t...l 0' Problems with "easy bruising"? 00 "! Chemical or jewelry rashtsensitivicy? 0 0 Neura —Have You Ever Hadar Coo You Currently Have, A psychiatric or emotional problem? 0 Numbness/weakness/paralysis? Cl 0 Dizziness or fainting spells? 0 0 Severe/fragtcnt or migraine headaches? Q n Head injury. concussion. or skull fracture? 0 0 Neurological disorders? Q Seizures or blackouts? Stroke? 0 EyewlEara --- Have You Ever Had or Do You Currently Have* Hearing loss? 0 ❑ Fmquent Gar infections? low e~ 1332-40 NIEDIC.1L, #tEQUIRE.MENTS FOR FIRE FIGHT£" ' A..140 INF0 R,%t N rION FOR FIRE DECAXV61ENT Ptn- RCLiNS IiTCUPLE E-2IContinurd ) Health History Yes No It "Yeas," Give Details. Ringing in ears? ❑ Q Other ear probtems? Glaucoma or cataracts? � I�TJ Red eyes? #j§�-1 Eye .injury/vision .loss? ❑ Other eye problems (e.g., strain, from ii OT' use)? ® #I—_i! i�_—ti Glasseslcontacts? Date of last vision screen [E�1 Head/Neck — Have You Ever Had at Do You Currently Have; Dw of last dental,exarm Recent problems with teeth/dentures? n Frequent mouth ulcerslinftetions? E Sinus or hay fever? Q El Frequent sore : throats? .. F 0 _. Frequent nose bleeds? 0 0 Trouble with thyroid (e.g.. taking thyroid L Cl medication)? Problem requiring radiation treatment to C1 El the neck area? t Lungs -- Have You Ever Had or Der You Currently Have. Asthma orwheezing' 0 t-I [0_! Co shed up any blood? Cl Shortness of breath without apparent reason? TS or positive skin test forTH? Pneumonia or pleurisy? 0 11 Do you couple every day, especially in the morning? Pain or rightness in chest? 0 L t .-ore than three episodes of bronchitis in [� . one year? Ever stroked tobacco in any form? 0 Fiona tong. Yrs. Packs per day: When quit. - Had a chest x ray? Q Last time: " pA U*dkm Eratl Moon Parer Is or 12) Y t A.PFENDIN F FIGVRE &Z (C*P6Pu*Z) Health History Yes No it -Yes,, Glve Details. Heart — HaveYou Ever Had or oo You Currently Have: Rheumatic fever or heart Murmur? M 11 Re,trt disease? 0 11 Treated for heart condition? n 0 Unusually cold or bluish -colored hands F1 F1 or feet? High blood pressure. It -Yes," how is it 0 Medicine 0 Diet Q Exercise treateV Do you have a history of elevated cholesterol? M_ 0_1 Avernia or any blood disease? CI Cl Phlebitis. varicose veins, or blood clorst poorcirculation? Chest pain with activity? El G1 — Have You ever Had or Oo You Currently Have'. Ulcers? Maw hernitk? C1 El Indigestion, pain, or unusual burning in stomach? F1 0 Vomiting,of blood? 13 1:1 B loodyltarry bowel movements? 0 Colitis or nervous stomach? Yellow jaundice or hepatitis? 0 Problems with your pancreas? 13 0 Gallbladder disease? 11 11 Kldneys — Have You Ever Had or Do You Currently Have: Bladder or kidney inftctiors? F1 Kidney stones! 0 ❑ Burning or discomfort on urination, or frequent urination? 11 Cl Hernia? 0 0 Blood in urine? F1 0 N,FPA Oodlem EXOM11todon ftm (tat 'M I 2W E&J*ff 1582-42 MEDICAL REQUIREMENTS FOR FIRE FIGHTERS ANa r-4foR-MATION FOR FIRE DEPARTMENT PHYSICLAVS FIGVU fl-2 (Cmqi-) Health History Yes No it "Yes," dive Details. Miscellaneous — Have You Ever Had or Do You Currently Have: Diabetes or sugar in your blood or urine? Cmccr of any kind? 0 MuscleoSkeletal — Have You Ever Had or Do You Currently Have: Arthritis. rheumatism, neck. back, or spine injury or disease? Been treated for a back problem? Recurrent stiffness or back pain? Bursitis. tendonids? Recurrent pulW muscles or sprains? Hand or wrist injury or problem? Hip or knee injury or problem? AnWe or foot injury or problem? Frostbite? Job requiring heavy Wng or standing, or Sitting for long period$ of time? Any broken bones? For Females Only.— HaveYou Ever Had or Do You Currently Have: MensmW irregularities? 0 n Recurrent problems of the female organs? El Breast masses or lumps? Do you practice monthly breast self -exam? Have you ever W a marrunogram, Dam of tag pap smear. For Mates Only — Have You. Ever Had or Do You Currently Have - Prostate or testicular problems? Breast tenderness, swelling, or lumps? El Do you practice monthly testicular sclf-exam? ?4"% N*ft* LW*ff4WR Orom 17 of in 2000 E*ftn N APPEl4laix p 1582-43 FIGURE lit (Carainued} General t,ifealyte 1. (Clwk the amwer that hest ditcHbes you.) General health a PDX 0 Fair Q Good 0 Excellent % Seatbelt use 0 11=24% Q 25-49% 0 50-74% 0 75--100% Daily stress 0 Low: 0 Moderate Q high Average hours sleep 0 6 hours or less Q 7-9 hours 0 9 hours or more Average meals daily 0 1 meal 0 2 meals Ci 3 or more 'Member of eggs per week 0 071 Q' 2 Q 3 or more Average number red moat, mews per week C] 0-1 Q 2--3 0 3 or more Average number of alcoholic beverageAcers 0 0.5 0 6-14 Q 15 or more per week Yes N*- It "Yes," Give Details. Ego you exercise there times per week? 30-40 minutes each time? Identify types of exercise.. Are you more than 30% above your ideal ❑ weight? Have you received a tetanus booster in the last 10 years? � © __ Have you been immunized against hepatitis B? ® Year immunized: Do you take any prescription medication? t❑-7 ❑ ❑ Do you take nonprescription medication (or ovemhe- Later drug) on a regular basis? Cl El General Uf"tyle it. Do you participate ina, workplace weilaesst ❑ ❑ "help promotion program, Whicb of the following would you like to sec offered and would you participate in? Cholesterol screen ❑ ❑ Blood pressure screen ❑ ❑ Weight loss C3 ❑ Nutrition7. program ❑ Stress management Cl . _._. . (�J❑t�.,.`� Smoking cessation ❑ ❑ CPR L...3 C1 NFPA axwWra on ram to at Is) IS8 —44 MEDICAL REQUIREMENTS FOR FIRE FIGHTERS AND IvFf fUV,,TtOr4 FOR FIRE DEN;ti.RTMENT Pt-NS(CLNNS FIGURE E,1 (Condnaed.) Health His# Blood drive Health risk appraisal SelfAirected exercise Health education program Women's health Yes No if "Yee," Give L_,.l Cl_ Cl ❑ _... Work History 1: Have you ever: $ten restricted in your work or given "fight health duty"because of your or injury? ❑ ❑ Left mots because of health problems? Cl Cl Been injured on the job and treated by doctor? ❑ ❑ Received compensation for an industrial injury or illness? ❑ FD Are you receiving any health cane treatment {e.g:, physical therapy, chiropractic,. ❑ acupuncture, medical, etc.)? Been hospitalized in the last five yeas? Have you hail any illness or injury that we have not asked you about?. ❑ Cl Work History 0: Do you have hobbies. such as furniture refin- ishing, painting. hunting, shooting, or model building? ❑ Cl 7o you moonlight or have a second job? ❑ ❑ 1. Work History Ill. Exposures -- have You Ever Worked Around the Following: Chemical plant?: ❑ ❑ Coke oven? ❑ ❑ Construction'. ❑ Cotton, flax, or hemp mill? ❑ ❑ Electronics plant? ❑ ❑ Farts? ❑ ❑ Foundry? ❑ HFPA Wdfcal UwMns"an fares (9 of 12) 2000 Edition L APPENDIX F 1582-45 FIGURE E-2 (Cart6nued.) Health History Yes No if "Yes," Give Details. Hazardous waste industry? Hospital? C1 Lumber mill'-' Meta) production'? 0 Cl Mine? Nuclear industry? 0 13 Paper mill? El C1 Pharmaceutical? 0 Cl Plastic production? 0 1:1 Pottery mill? El Cl - Refinery?' E] M Pubber processing plant? 11 Cl Sand pit orquarry' M ri Service station? Shipyard" Smelter? Have You Ever Worked With arften ExposedTw Aldrin? Cl Cl Arsenic? n Cl Asbestos? n Cl 'Penzenal F-1 Benzidine? 0 Beryllium?, Cl Cl BIS cCfdormethyl ether? 0 Cl Cadmium? 0 Cl Carbon disulfide? ri n Carbon tetrachloride? 0 El Chlorine? Cl 11 Chlorodane? ❑ Cl Chloroform? F1 1582--t6 REQutREmEh4'rs Fok Fiat£ FjrHTEPS.1,,ND INFORYLA IION FOR FIRE DEPARTMENT PM51CW43 F'tGir'3i;Ir E-2 (Gantttmtcd..) Health History Yes No It "Yes," Give details. Chloroptene? 0 Cl Chromates? ❑ 0 Chromic acid mist?Cl Cl Gutting oils? Cl DDT? Cl Cl Dietdrin? Dio un?` Dust, coal? t__t Dust, sandblasting? Cl Dist. othor2 ❑ Cl_. Ethyl dihrotmde? L__.I Cl Ethylene oxide? L ..l Extrerne heat or Gold? n _ F1 Hcpmchlor? Cl 1 _I Hexachiorokertxene? ❑, isocyanates (TDL MDIV ❑, Loud or continuous noise? n,Cl Mercury:' n,Cl Methylene chloride? C1 Cl Microwaves. lasers? C1 t l Nickel? Cl PCBs? Cl Cl Pesticides. herbicides? Cl Phenois? (F1 i..i 0 Phosgene? F—I Cl Plastics? n 11 Radioactive materials? Cl Cl Roofing materials? Q Rubber? n Cl Silica? N"A Meoca Ewmtn m Fw" ill of-rx) S.. APPENDIX F 1582--47 RGURE E-2 (Cma* w 4) Health History Xis No 1t "Yes," Give Details. Sot+rencsidt:gt�ass? Snots and taus? 13 Spray painting? 1l TRYPER chltaroethytene? Cl Vinyl chloride? ❑ n List any wxinstchemicalsibiologicat hazards you might currently be exposed w Work History N, Jobs — Start with than Most Recent* Date (Year to Year) Company Position Any Work Hazards I certify that the above information is true and complete to the best of my knowledge. t hereby give permission to release work -related information to the proper authorities of my employer or the company for which I am a job applicant. Date' Signature- Examiner iNFVA t"*Wt ,td to IT- 1 SA2:-49 MEDICAL R.EQUIREh1LNTS FOR FIRE FIGIiTERS &ND INFONSIATtON FOR FIRE DEP;ART5IEN'17 F SICV045 irides :12m National Fire Protection Association. Alt Rights Re cmd. The copyright in this index is sepirate and distinct front, the copyright in the document that it indexes. The licensing provisions set forth for the document arc not applicable to this index. This index may not be rtproduced in whole or in part by any means without the express written per. mission of the National Fire Protection Association; Inc. :A- Abdominal organs.. 3.9. A>3.9:2 Administrators, guide for fire department.. .. App. D- AAvznt-, d life support (.US) ............. . .. 5-2.2. 00 4.I. A 5-12' .4n"iscriminAdoa Taws . : . : ...:..:......:.:........ , ....1361.2 Approved (definidon) .... . .......... . ..... . ......1-4.1. A 1-4.1 Asdunst ..... ..---- ......... --- .............. ... .'?.. Audiometry .. .... 8-2,31A Authority leaving jutisd .ction (del7aidon) . . ........... 1-4.2. A-14:2 .B. Basic life support tBLS) .... , .... , .. , , ..... , ......5-t2. A-5- 2 Blood and blood -forming ergans ; ...........3-15. A3-15 819od exposures.... € 2.1, A 3F .1 Sloodboroe pathogen eVosure*, post-eag oxure prophylatatfor........ ......... --- ...... A-4-2A Body fluid ctposusxt . J-2.I, A-+2. i Burn injury ..... .C- Cancer risk ........._ ................... _, ............ S-IA Candidates Definition . ....... .. .. .1-4.3. A-1-4.3 Medical evaluation ......... .. 24. 2=3,.A 2.1,1. A-24.3. A•2.3 Category medical condition . ua Medical conditiotu Category B medical condition ........ , .. sm Medical conditions Chemicals .............. . .. _ .... ............. $-20, A•3-20.2 Cbest wsS ... , . > ................ ... ................3-7. A-3-7 Coafidentla{ity, medical evAuadom.......................... 24 .D- Dental ...... . ........ . ......................... 3 5. A-3-5.2 Diabetes median.. ...... .. _ 9 3.l Disa lsled persons. ... .. , ....... ....... .. .....19 1. l Down member..................... ......... ......... A-5-'S.2 Drsip.............. Dcfenition ............ ............................ 14;6 _E. Eases :. , ....:: _. ...... . , ... 54, A-S-t g F.lec%r"Cardfagraphy .. _ , .. .................... 8-2.2. 8-2.5.2.5 Errr"r cy medical services (H.'4L ). .. . .......... 5-2.2. 5-3. A-5-1.1 A-5-2.2. A-5-3:2 Definition .. ... . . . ............... ......... Endocrine disorders. ...... ... .3-16. A:3.16 Epilepsy ... ...... . .............................. .84,6 Esopltagras ......... .......... ....... , ..34, A-3-6 Emwntiat)ob fustctloas (structural fire -tuning ........... App: C Definition . -.............. ..................... 1-4.7 Evaluations .................. wFunctionalcapacicycvaluation; Medical evaluations Exposure incidents. . . ........... , , .............. <4-2; AA-2 DcOnition . , ............ , 1-4.4 fxtren'Ades. ; ......... , .. ... , ... 3-12, A-3-12:2 Eyes ...... ...... , .... . _ ... ..3.3, h-3.3 »ODp Edition .F. Fwt department Guide for adrninisstrators::, .. App. D LicmTers::.....................,....,.,.,...srrilembers Fire department physician, .,, ..2-2. A-2.2. ser a4a Medical evaluations Choosing ......... ................>..... 2.2.1.A-2.2.2,D-2 Definition.. Imchunimdons. responsibility for........ ..... 4-4 Incident scene treatment, role in..... 5.3.2,A-5-LI to.A-5-I.:: A4-3,2 Infection disease tontro4. role in 4-1:2. A-4 2.t Information tar ... ...B !Record keeping and reportsof., .. 2-6 Ftmcdonal rapacity evaluaioa : .. . .. ....... .8-216 Definition...........................................IAA! C- +Gamointerdnid "ems .................... . . ... .3-9, A•3-9.2 Genitourivary r)staema...... . : .. .......3.10. A-3-10. B-3.4. D-1:4 4U. Head ......... . .... , ; ......... ; + - . ....... ;3-2.1. A-3=2:1.2 Health and Oment cootdiivator. . . . .. .... . .... . . . .. .2.2.4 Defin cion. ... .... . .. .... .......1-4.12 Health and safety officer....... ...................... . .. . 2-2.4 Definition ...... ....... .............. ........ .......II-3.13 Hearing.... . 34. A-341.2. &IA S-2;31A. 8-3.5 Heam... - . 3.8.1, A,M,I. &1;2. B-1A4 S-2.1 to 8-2.2.8-Z3.2.5. S-3.3 Hepatitis 0 immi ntt . . ............ . ....... . ... . .. . .A44' .[ immuvizations.... ..... ... . 4-4. A44 irapteaaeatatloo of statadard .... ._..1-3; A•1:3.2 Incident commander- , . ........ S.1:2- 5-2.1. A-544 lacsdeut safety officer ................ ." I T=Went scene rehabilitation and mad" treatment . , ..Chap. 5. A 5 Infecdon control officer, ................ .... : ... . ... ..i-1.2 Definition. .. ...... 1-4.14 Infection cattarrol program (fnfecdous and communicable disease control) ......... Chap. 4.A-4 Definition........ ..... ...1-4.15 .L 2sboratury testa.... .. B 2 3.2.1 Larynx_ . < ...... .. . .. . ........... Legal coasidemdo s .. ...... D•1 Luogs ....... . . . . ...................3.7, A-3-7, 3-2 3.2,3. 8.3:3 bt- 3isf 9naat disease:; ..... . . ... ........... . ....1-1f1„,A.-3-18.5 Medical coadidona Category A ... , .. Chap. 3, A-st are aisa specific body parts and conditions Definition ......................................1-4.4 INDEX: 1582-49 CategorYB . , , . . : , ,Chap 3_A-3sserafro spedflc body parts and conditions Definition ......... ...... ........ 1-4.5 Specific ............. ...... ....... &3 Ned" evaluations Content of.... ....... B-2.3 Coordination of program, D-3 Definition ......... ..... ... ...... 14.16 ('.uid`lnce 66f. .... .... .. ........ ft-2 Incident scene. . ... __ ................ 5_31.k.5.3.2 OSHA 1910.134 compared ........ .. Table D-4 periodic. . . . . . _ , . ....... ..... � 2A�2. 24. A-2-4, 11,2.2 PfcPllcement and bast line. ........... 2-L2. 2-3.A-2-3.1343 Process..:.:.. ....A-2-1-5 ,.Records, Mult3, reporting. ant( confidentiality ._ 24. 8-2.4 Sample forms, medical examinations.... ._ App_F_ Retutn,to.dury ......... .... 2-1.2. 2-5.A-2,53. A2-5,3 to A-2-5.4 Tactical level management component (TL%lr-),... 54.5 54.7, A-5-4.6 MvelicA elt3Anin3tious , . t - . ,.. . . ., - . , - _w aWMedictil evaluations Components of.. ..... ........ Definition .... .......... ...... ------- ...... 1.4.17 Sample forms. .... ......... ......... > App, E MedIvA history . , . , , ... ...... B•jjj. Medical Process ........... ......... Chap. 2. A-2 Medical services, taserl"Cr $0 Emergency medical services M5) Medically cerdfied Derwition ....... .............. ........ ......... 1419 Periodic medical evaluation... ___ ......... 2-4.A.24 Preplacement medical evaivation ................ _ . . 2-3, A-2-3 Reports:. .. ....................... 2-0.2 to 2-5.3 Return-to-ducy medical evaluation . ........ 2-5.2 to 25.3, A-2-5.3 Medication. � ......... _ ........ .......... Members Current Det"it4c'n .................. ....... ......... 14 203 Medical evaluations .......... .2,1, 24, A-2.1.1. A_2_1.5, A-24 Der""itiOn ......... ......................14.M A-14.20 Down..... ............................. Incident scene rehabilitation and medical treatment ..... .............. -Chap. S. A-5 Infection control program ................... _ . Chap, 4, A4 Occupational Wiry and health problems .......... 3-1. Table 0-4 Metabolic disorders .... ............ Mu"WONktie"I system - - ............ .... A-5-3.2. 3-2.6 ....... 3-2.t A-3-2,21 Neurological disorders 3-13. A-3-13 t4osa ........... __ __ ....... � "34. A.34 ocruputiocial history ........ ....... MA Occupadisasil Sta" and Health Axiministradgs (OSUM t910.134 comparison ... ...... Table D.4 Occupadonal safety andbealth problems:........... B.I. ThT,, D4 .P. Personnel accountability syst'ras ....... Physicsill load, of ffi-e-fighting functions. ...... ...... &L2 ftyliciall ...... let Fire department Ph."10.3n Post-expow" prophylaxis .......... 1 ....... A-4-2.1 tok_4_2_2 .............. EIr-14.0-1,4 Protected dass" . .................. Piychiscric condition* ............ ........... .. 3-19, A44 9,2 Pulmonary function tesd . ..... 8-2.3,2.3 Purpose of standard _R_ Reactive arv'mP "ease ....... ........ &12 Referenced pablitAtions .......... Chap, 6. 84. App. F Reports and records EXPORIM incidents ....... ........ 4-2, 4-3.2. A-+2_N-4-3,2 Immunization rccords.. ...... . - . . . ., A-4-4 Medical evaluations. ..... Sample forms, medical examinations. . App. E Reproductive srKens ... AS-10-1. A4-10.1.2, B-3.4, D-1_4 Respiratory disease risis.. 8-1.4. &12 RL-OM . . . ... 1.1A''11'.' . . . . . . . . . . . . . . 3-1 L A-3-11.2 Ri* increased ................ ...... _ B-IA -5. SaCro'liatJOWts ........ Sample to. ......... App. E Scapulae ...... .......... ...... 3.11, A-3-11,2 Scope of standard .... I ...... 1-1 SftOdd opinions ...... ...... _ ........... 3.2,5 Seizures........,:;: ....... 8.3.6 ShaU (definition) .......... ......... ................ 14,21 Sbould (delinitim) ....... ........... ....... 1,4.22 SWA- .. - ................ 3-14. A-3-M2 SmQkw UA"dAdAM - ......................... - . . _ A-5-3.2 SOUt ....... ... ...... ....... . - . -, 3-11. A-3-11.2 Stwdud (definition), ....... __....................14.23 Stress temd-5 .... B-21 Systemic diseas". ...... _ ............. 3-I6 A,,3-17.2 _T_ Tuticw level ma na emeet Component (Tutc) ........ _ 54 A-54.3 to A-54.5 Derinition. . ..... _ ...... ...... ........ 1-4,24 Thiek =hxtwcvss ........................... 94,3. &IA 8-3.4 Trachea, � ......... - ...... Thage, incident scene ....................... TubtrcssloAs ....... _ ... , ........ Tumors. . . . ........ ......... I 1 ..1' .V� V4*ArY systern ...... .............. &1(),2. A-3-10,22 Valgilar system. ......... . 34,Z A,". 84.4. &3,3 Vision . . . ...... ....... X2.2. X21,21 CQWw 2OW Editon