NFPA 1582 and the Training Officer

By: John K. Murphy JD, MS, PA-C, EFO

A question for training officers and chief officers – do you have a medical/physical evaluation program and a physical abilities test in your department providing bi-annual (or annual) testing for your firefighters? If not, why not? Almost 50% of firefighter deaths are caused by a preventable disease such as heart disease and cardiac arrest. Is this one of the responsibilities of the Training Division or department to implement and manage? What do your firefighters do on a daily basis and how do you test their capacity for doing work? Using your department’s job description, job analysis and essential elements of the job is the foundation for continuing medical evaluations and abilities testing. There are two distinct processes in play to determine the fitness of your firefighters. The first is the entry standards of a CPAT and using the NFPA 1582 guidelines as a basis for new entry level firefighters. The second, for your established firefighters or one returning from an injury or disability is an entirely different process which we will discuss later in this article. Entry Level Firefighters – Preplacement. There are usually no issues with a Physical Abilities test for entry level firefighters as it is generally a pass/fail proposition and the Training Division may administer this portion of the entry test in some form or fashion. Many fire departments are now using the CPAT testing model with good results. If not using the CPAT, then your physical abilities test should test the essential functions of the job and not use a Combat Challenge or other similar competitive process. Failure of this physical abilities test automatically disqualifies the candidate. Candidate Medical Physical - After the offer of employment by the department, the candidate is sent to a qualified medical practitioner for a complete and thorough medical examination. Again, many departments use the NFPA 1582 as a guideline for the components of the medical/physical evaluation with a physician or other qualified health care practitioner fully versed in what the fire department actually does on a day to day basis. The NFPA 1582 are guidelines for your use unless adopted by your State or your department in their entirety then become the regulation which departments must follow. If there are medical issues discovered during the candidate medical/physical, you may want to dig a little deeper with additional medical testing with a specialist to see if the medical condition actually disqualifies this candidate. You also need to closely read and understand the categories “A” disqualifiers and the “B” allowances for all medical conditions to make sure your candidate is either qualified or unqualified due to a limiting medical condition. I have sent candidate firefighters to specialists for further evaluation as there was some abnormality on the EKG, Pulmonary Function Test or the blood tests. If they return from these specialists with a clearance to continue, then the candidate can proceed in the process to hopefully the ultimate hire. Existing Firefighters - This is where the Training Division/Officer comes into the picture. It is my learned opinion that the Training Officer and Training Division evaluates, teaching and trains your firefighters more than other officers in your department. You observe their ability to work at high levels of performance and can determine if a firefighter is poorly conditioned, deconditioned or in general, is a hazard to himself/herself and others. These are the ones that should be identified as high risk and sent for medical evaluations and many times these are your existing long term firefighters showing signs of a critical medical condition. I highly recommend that your department have an annual or bi-annual medical/physical examination program in place for all firefighters and possibly a for-cause medical testing for firefighters showing signs of a condition preventing them from working at 100% of capacity. For those firefighters with a possible critical medical condition (hypertension, hypercholesterolemia, coronary artery disease or diabetes to name a few) discovered in the physical, the department must have a policy and program to allow the firefighter to find a medical solution to the discovered medical issue. What should be (at a minimum) included in a periodic medical standard is: basic questions about current health history, current immunizations with the addition of specific blood work to include liver function, cholesterol, blood glucose level, a CBC (complete blood count), your immunity to Hepatitis B, chest x-ray or PPD, hearing testing, pulmonary function testing, mask fit testing and other testing as determined by your health care provider based on your job description or job analysis. For male firefighters a PSA to detect possible prostate cancer. There are a number of blood tests to detect certain cancers however those tests have some false positive results. They should be used judiciously by your health care provider during the physical examination. It is developing technology that will make our firefighters healthier. For those of you on the Haz/Mat team, include baseline testing for the most common heavy metals to include lead, mercury, arsenic, cadmium, copper and zinc. All firefighters should be examined for developing skin or throat cancers. These tests are closely correlated with your job description, job analysis and essential functions of the job. What is very important, is the resting EKG and stress treadmill testing to ensure cardiovascular health and the results evaluated by a cardiologist. Injured Firefighters – Return to work independent medical examinations (IME) Using the NFPA 1582 as a return-to-work standard is the wrong standard to utilize when returning an injured or disabled firefighter to work. The NFPA 1582 guidelines have been designed as an entry level standard for firefighters and there are certain medical elements contained within that document that would disqualify an injured firefighter (or some existing firefighter if tested) seeking to return to work. My suggestion is to have an IME predicated on the actual functions of the job performed by a qualified physician. For example a firefighter out with a rotator cuff repair, an orthopedist should perform the IME using the essential functions of the job and a job analysis. There are a number of firefighters successfully returning to work after a heart attack, rotator cuff repair, spinal disk repair, hip or knee replacement surgery and other medical conditions. Finally - As an attorney and health care practitioner, I have toss in this little nugget - you may have to make reasonable accommodations under the ADA rules and regulation for firefighters that cannot pass the medical/physical or physical ability test. Under the law (eeoc.gov), Title I of the ADA requires an employer to provide reasonable accommodation to qualified individuals with disabilities who are employees or applicants for employment, except when such accommodation would cause an undue hardship on the employer. As this is a complex issue, I suggest employers look at the EEOC website and discuss this issue with your HR director and the department’s attorney for guidance. Our responsibilities as Training Officers is safety on the training grounds. Ensuring your firefighters are healthy enough to participate in training activities is also your responsibility.

Full Service Training

By: Jake Barnes

As fire instructors, all too often we focus on the immediate dangers of firefighting and the corresponding training. We constantly train on air management, R.I.T. teams, Maydays, and more. While this is important, I believe we should also work harder and teach the more chronic aspect of firefighting; the health and wellness portion of the fire service. We are losing brothers and sisters to heart attacks and cancer in alarming numbers. The worst part is we usually have all the equipment to combat this but often we don’t emphasize enough the importance of using the tools and having the knowledge to keep us alive and well into our golden years. There are many ways we can help our own out when it comes to staying healthy, such as mandatory exercise programs, nutritional education, respiratory programs, and gear washing policies and procedures. With these valuable tools, we can arm our firefighters in the battle for their own health. What I am proposing is a culture change, and I know as well as anyone that change is a nasty word in the fire service. There is nothing more dynamic than the fire service and nothing more static than the firefighter. So how do we create a revolution around health and wellness in the fire service? The same way we eat an elephant; one bite at a time. Start by designing exercise programs that replicate what we do and how we do it. A program like this would be heavily influenced by cardio. Contact local fitness trainers, or even better, get trained as IAFF Peer Fitness Trainers. Take your workout plan to the doctors that oversee your department physicals and have them review it for recommendations or changes. Also, knowing what your departments are planning to do will help the doctors and their staff conduct a better physical. I wouldn’t attach anything punitive to this part of the process yet. If this is new to the department and firefighters have been “allowed” to get sedentary and overweight then we should allow a reasonable time to get the weight off and build up the needed energy level. While we support our firefighters to lose weight and become more efficient in their jobs, we can start to build in nutritional education. Yes, this is likely to be met with MUCH resistance and venom. Mess with a firefighters meals and we’re treading in dangerous waters! When I first became the Training Officer in my department, I had a nutritionist come to the fire department and actually cook healthy meals and provide some much-needed education of fats, carbs, and calories. Although the group wouldn’t admit it, several firefighters really enjoyed it and tried to apply what they learned. That’s how a revolution starts, with just a few people. The modern firefighter is attacked every day at fires by more and more chemicals. Because of this, we need a solid and dynamic respiratory program. This should include wearing our SCBA’s during overhauls and monitoring the air for as many chemicals as we can. By wearing our SCBA’s longer we need to ensure our SCBA’s are comfortable. Yes, the newer SCBA’s are designed with comfort in mind and can make a huge difference when wearing them for a long time. Of course, if we are making our firefighters wear the SCBA’s for extended periods of time then we need a better plan for rehab. This is often seen as Snickers and Gatorade but we need to see this for what it is really designed to do, rehab our firefighters. Have fans, pop-up tents and plenty of water and EMS for vitals. The suggestions we have talked about so far take time, yet they’re solid investments with astronomical returns. In addition, there is one activity we can incorporate right away to decrease the odds of our rank-and-file from developing cancer: gear washing. The days of wearing your filth as a badge of honor are over; dirty gear now looks like a sign of ignorance. We need to use specialized gear washers and dryers to keep contaminants away from us. Having a second set of turnout gear for our people can be a HUGE step! There is also a current push in the fire service for field decon, which can be done quickly at the scene as companies prepare to leave. It can be as simple as a booster line and dedicated truck brush to quickly knock off any particulates prior to getting in the truck. Firefighters should have extra gloves and hoods to change at the scene when they change bottles. If the department is lucky enough to have spare gear, then we should have a way to get that gear to the scene after the fire, collect the dirty gear, and have it cleaned with a certified gear washer and dryer. We should have procedures in place so that decon is as expected as picking up hose and filling air bottles so we NEVER let a company go in quarters until they are deconned at the scene. Like any important change in the fire service we have to start at the top. The chief and his staff need to draft new policies and procedures on all of these programs. We don’t need to reinvent the wheel. A few phone calls and emails to local departments that have implemented similar procedures will net great success. We must train our people on these policies and set reachable goals and expectations. And we must have a disciplinary policy in place in the event that departments don’t meet the expected goals. Most importantly, all the chiefs and the staff should lead by example. The administration should be up-front and center leading the charge. I realize as an administrator that our eight-hour days have 10 hours’ worth of work. Still, we have to make time for us and for them. We must be vigilant in advocating for firefighter health and wellness.

One Size Never Fits All - Positive Pressure Attack

One size fits all, an iconic statement that the American fire service tends to apply to a very dynamic event. Unfortunately, the environment that we respond to and are expected to provide a service in does not fit into a “one size fits all” category. We as a fire service have become a utilitarian service that is expected to utilize a variety of task, tactical and strategic operations to accomplish our mission. Like all tactics, we as firefighters have an emotional connection to the effects of the tactic. That emotional connection can sometimes blind us on the true benefits or the appropriate use of a tactic. As the American Fire Service continues to evolve through technology, the complexity of the environment that we work in does not afford us the opportunity to have emotional connections to tactics, science and facts; thus the title of this article, “One Size Never Fits All” is a more accurate definition. Go to almost any fire station in America and you will find a gas powered positive pressure fan either on the engine or the truck. The evolution of the “fan” over the last twenty years has grown past the use of just a ventilation tool. Vent for life was our motto; the use of the fan was one functional tool in the vent for life motto. The challenge with vent for life is COORDINATION. Since the beginning, the application of water in a coordinated attack was critical for the vent process. Failure to have coordinated attack on the fire when venting causes rapid fire growth that jeopardizes the safety of the fire fighters and the victims still inside. We know for a fact that the failure to apply water along with ventilation creates a very dangerous environment. The first order of business is to identify and define Positive Pressure Attack (PPA) versus Positive Pressure Ventilation (PPV). PPA is defined as the use of the mechanical positive pressure fan in a coordinated initial attack into a compartment fire with the fan being used as an aid in the suppression process. PPV has an accepted definition of the use of the mechanical fan for the sole purpose in assisting in ventilation post knock down or fire control. Positive Pressure Attack originated as a means to ventilate a structure after the fire was knocked down. Over the years the use of a positive pressure fan has evolved into using the fan to assist in the extinguishment process. Experts like Kris Garcia and Reinhard Kauffmann and Ray Schelble developed tactical operations that include the use of a coordinated attack with the use of the positive pressure fan. The fan was placed in the intake (airflow) of the structure to provide pressure into the compartment with an exhaust created allowing the super-heated gasses to vent out the exhaust as the fire fighters in a coordinated effort stretched an attack line from the clean air side of the flow path advancing towards the seat of the fire. The concept was that properly used PPA allows firefighters great control over the interior environment of a fire building, and provides for increased ventilation (cool fresh air) for potential victims and better visibility for the firefighter to attack the fire. Positive Pressure Ventilation is the tactical use again of a mechanical fan to assist in venting the structure post fire control. The need for a single intake, flow path and then an exhaust are used in conjunction with the fan to aid in the removal of the super-heated gasses. Over the last twenty years, PPA has become a valuable tool that most organizations use consistently for residential structure fires. Over the last ten years some organizations have developed larger truck mounted and elevated fans for the use in commercial and multi-story buildings. Recently, Underwriters Laboratory conducted research and testing on the benefits and disadvantages of the use of PPA. I was fortunate enough to sit on that committee along with PPA experts from around the world. Kris Garcia, one of the most prominent PPA experts is also on the committee. Information listed in this article is documented tests through KTF and NIST. The Tactic: The use of a PPA fan positioned in the inlet of a structure, positioned to maximize the creation of a flow path from the unburned side of the structure to the fire compartment then vented out an exhaust. Crews are to identify the air intake; traditionally the front door, then an exhaust opening must be created. This is traditionally done by taking a window or opening a door closest to the fire. Once the exhaust is established crews will then move back to the inlet and make their initial attack with the fan blowing at their backs. The Goal: The goal of the fan blowing at your back is to clear a path through the structure to the seat of the fire and out the exhaust. The concept is the fan clears all the super-heated gasses out of the structure and out the exhaust providing for better visibility and patient survivability. In addition, the thought was it would provide for less thermal insult on fire fighters as the advance through the structure. The Challenge: One of the critical challenges of PPA is creating the appropriate and effective sized exhaust outlet; the “book” says 2 ½ times the inlet size. With the modern fuels high energy release and expansion rate we are finding that we struggle to create a large enough exhaust to move the volume of super-heated gasses out of the structure fast enough must be accomplished with a larger exhaust. Inaccurately identifying where the fire is located causing fire extension into non fire compartments causing more damage. The use of PPA is dependent on the following items: 1. The fire occupancy can be identified and is compartmentalized. 2. A large enough exhaust can be created. 3. The fire is compartmentalized and located near an exterior wall 4. Exhaust vent and fire are located on the same floor 5. The occupant and fan position are not impacted by wind speed or direction. The use of PPA is another tool for our tool box, Yes, I know that is cliché but it’s true we are a dynamic organization that must have multiple tactical options to safely provide the expected service to our community. Aggressive tactical operations that are performed by skilled firefighters under the direction of educated company officer that use tactical knowledge to best provide service is critical. In all cases tactical operations should not delay the application of water. Water in all cases provided for improved conditions for patient survivability and improved conditions for interior fire operations. The result from the UL PPA study will impact how and when PPA is applied, however it will not be eliminated it from our tool box. Bottom line is that it all depends; there are conditions and situations for each tactic.