NFPA 1582 Standard on Comprehensive Occupational Medical Programs for Fire Departments 2003-2007 Editions Sandy Bogucki, MD, PhD Branford Fire Department

NFPA 1582NFPA 1582

Standard on Comprehensive Standard on Comprehensive Occupational Medical Programs Occupational Medical Programs

for Fire Departmentsfor Fire Departments

2003-2007 Editions2003-2007 Editions

Sandy Bogucki, MD, PhDSandy Bogucki, MD, PhD

Branford Fire DepartmentBranford Fire Department

Section of Emergency MedicineSection of Emergency Medicine

Yale University School of MedicineYale University School of Medicine

NFPA 1582NFPA 1582(1992 Edition)(1992 Edition)

• Medical Requirements for Medical Requirements for FirefightersFirefighters

• Consensus standard Consensus standard processprocess– Not law or regulationNot law or regulation– Took 4 years to develop Took 4 years to develop

from NFPA 1001from NFPA 1001

• Prescribed medical Prescribed medical evaluation and tests to be evaluation and tests to be performed on firefighters to performed on firefighters to determine fitness for dutydetermine fitness for duty

• Divided medical conditions Divided medical conditions into Category A and into Category A and Category BCategory B– Few similar standardsFew similar standards

• Described roles and Described roles and qualifications for FD qualifications for FD PhysiciansPhysicians


• Few analogous documentsFew analogous documents– Pilots, CDL’s: RegulationsPilots, CDL’s: Regulations– Law enforcement, HAZMAT, EMS have no Law enforcement, HAZMAT, EMS have no

consensus medical standardconsensus medical standard– Results in frequent inappropriate use of 1582.Results in frequent inappropriate use of 1582.

NFPA 1582NFPA 15821997, 2000 Editions1997, 2000 Editions

• Incorporated medical progress (PTCA Incorporated medical progress (PTCA stenting)stenting)

• Expanded instructions for physicians to Expanded instructions for physicians to enhance understanding of FF demandsenhance understanding of FF demands

• Largely eliminated Category A due to Largely eliminated Category A due to ADA concernsADA concerns

Problems with 1582, 2000 ed.Problems with 1582, 2000 ed.• Not affecting non-traumatic L-O-D death ratesNot affecting non-traumatic L-O-D death rates• Inadequate science to support requirementsInadequate science to support requirements• Not being used to full benefitNot being used to full benefit

– Doc’s only read Chapter 3Doc’s only read Chapter 3• Majority don’t understand demands of fire fightingMajority don’t understand demands of fire fighting• Majority don’t get involved in FD Health & Safety roles Majority don’t get involved in FD Health & Safety roles

– Incompatible with real world practiceIncompatible with real world practice• Especially with respect to incumbent medical conditionsEspecially with respect to incumbent medical conditions

– Ambiguity of Category BAmbiguity of Category B• Equivocal standards due to ADA concernsEquivocal standards due to ADA concerns

• Not consistent with OSHA requirements, Not consistent with OSHA requirements, recommendations of 1583 and Labor-Management recommendations of 1583 and Labor-Management fitness/wellness initiativefitness/wellness initiative

Line of Duty Death and InjuryLine of Duty Death and Injury

• Per fire, increasingPer fire, increasing• Cardiovascular causes Cardiovascular causes

still most commonstill most common• Operations-related Operations-related

trauma, asphyxiation trauma, asphyxiation increasingincreasing– Investigations focus on Investigations focus on

operational issuesoperational issues– Contribution from Contribution from

medical issues unknownmedical issues unknown

Line of Duty Cardiovascular Line of Duty Cardiovascular Death InvestigationsDeath Investigations

• Cardiac risk factors and/or cardiac Cardiac risk factors and/or cardiac disease frequently knowndisease frequently known

• No FD medical requirementsNo FD medical requirements• Medical evaluations performed by Medical evaluations performed by

physicians not familiar with FF demandsphysicians not familiar with FF demands• Increased proportion of volunteersIncreased proportion of volunteers• No fitness/wellness programs or No fitness/wellness programs or

requirementsrequirements


– Expanded scope of Expanded scope of medical evaluation to medical evaluation to detect conditions for detect conditions for which FF’s are at which FF’s are at increased risk.increased risk.

• Made yearly medical Made yearly medical evaluation mandatoryevaluation mandatory

– Developed model list of Developed model list of EJT’s of FF’s upon EJT’s of FF’s upon which medical which medical requirements are based.requirements are based.

• Require FD’s to supply Require FD’s to supply FD Physicians with list of FD Physicians with list of local EJT’s or formal local EJT’s or formal validation of the model list validation of the model list in NFPA 1582in NFPA 1582


– Category A and Category B Category A and Category B medical conditions updatedmedical conditions updated

• Now apply only to candidatesNow apply only to candidates

– Incumbents are restricted by Incumbents are restricted by FD Physician from specific job FD Physician from specific job tasks when medically tasks when medically indicatedindicated

• FD determines to what extent FD determines to what extent restrictions can be restrictions can be accommodated: Light duty, accommodated: Light duty, change in job description, change in job description, retirement, etc.retirement, etc.

• FD Physicians do not make FD Physicians do not make hiring/firing decisionshiring/firing decisions

– FD Physicians are required to FD Physicians are required to monitor for health trends, monitor for health trends, participate in safety divisions participate in safety divisions and supervise health & and supervise health & wellness programswellness programs

Medical requirements must be Medical requirements must be based on essential job tasksbased on essential job tasks

• Interior structural firefightingInterior structural firefighting

• Wildland, ARFF, ShipboardWildland, ARFF, Shipboard

• Driver-OperatorDriver-Operator

• HazMat, Technical RescueHazMat, Technical Rescue

• Rescue, EMSRescue, EMS

Essential job tasksEssential job tasks(1) Performing firefighting tasks (1) Performing firefighting tasks

(e.g. hose line operations, (e.g. hose line operations, extensive crawling, lifting and extensive crawling, lifting and carrying heavy objects, carrying heavy objects, ventilating roofs or walls using ventilating roofs or walls using power or hand tools, forcible power or hand tools, forcible entry, etc), rescue operations entry, etc), rescue operations and other emergency response and other emergency response actions under stressful actions under stressful conditions, while wearing conditions, while wearing personal protective ensembles personal protective ensembles and SCBA, including working in and SCBA, including working in extremely hot or cold extremely hot or cold environments for prolonged environments for prolonged time periods. time periods.

Essential job tasksEssential job tasks• (2) Wearing a self-(2) Wearing a self-

contained breathing contained breathing apparatus, which apparatus, which includes a demand includes a demand valve-type positive valve-type positive pressure face piece or pressure face piece or HEPA filter masks which HEPA filter masks which requires the ability to requires the ability to tolerate increased tolerate increased respiratory workloadsrespiratory workloads

Essential job tasksEssential job tasks

• (3) Exposure to toxic (3) Exposure to toxic fumes, irritants, particulates, fumes, irritants, particulates, biological (infectious) and biological (infectious) and non-biological hazards, non-biological hazards, and/or heated gases, and/or heated gases, despite the use of personal despite the use of personal protective ensemble protective ensemble including self-contained including self-contained breathing apparatus. breathing apparatus.


• (4) Depending on (4) Depending on the local jurisdiction, the local jurisdiction, climbing 6 or more climbing 6 or more flights of stairs while flights of stairs while wearing fire protective wearing fire protective ensemble weighing at ensemble weighing at least 50 pounds and least 50 pounds and equipment/tools equipment/tools weighing an additional weighing an additional 20 to 40 pounds.20 to 40 pounds.

Essential job tasksEssential job tasks• (5) Wearing fire (5) Wearing fire

protective ensemble that protective ensemble that is encapsulating and is encapsulating and insulated. Wearing this insulated. Wearing this clothing will result in clothing will result in significant fluid loss that significant fluid loss that frequently progresses to frequently progresses to clinical dehydration and clinical dehydration and can elevate core can elevate core temperature to levels temperature to levels exceeding 39 degrees C.exceeding 39 degrees C.

Essential job tasksEssential job tasks• (6) Searching, finding, and rescue-dragging or (6) Searching, finding, and rescue-dragging or

carrying victims ranging from newborns up to adults carrying victims ranging from newborns up to adults weighing over 200 pounds to safety despite weighing over 200 pounds to safety despite hazardous conditions and low visibility. hazardous conditions and low visibility.


• (7) Advancing water-(7) Advancing water-filled hoselines up to 2.5” filled hoselines up to 2.5” in diameter from fire in diameter from fire apparatus to occupancy apparatus to occupancy (approximately 150 ft); (approximately 150 ft); may involve negotiating may involve negotiating multiple flights of stairs, multiple flights of stairs, ladders and other ladders and other obstacles.obstacles.


• (8) Climbing ladders, operating from heights, (8) Climbing ladders, operating from heights, walking or crawling in the dark along narrow walking or crawling in the dark along narrow and uneven surfaces, operating in proximity to and uneven surfaces, operating in proximity to electrical power lines and other hazards.electrical power lines and other hazards.


• (9) Unpredictable (9) Unpredictable emergency emergency requirements for requirements for prolonged periods of prolonged periods of extreme physical extreme physical exertion without exertion without benefit of warm-up, benefit of warm-up, scheduled rest scheduled rest periods, meals, periods, meals, access to medication access to medication or hydration. or hydration.


• (10) Operating (10) Operating fire apparatus or fire apparatus or other vehicles in other vehicles in an emergency an emergency mode with mode with emergency lights emergency lights and sirens.and sirens.

Essential job tasksEssential job tasks• (11) Critical, time sensitive, complex problem (11) Critical, time sensitive, complex problem

solving during physical exertion in stressful, solving during physical exertion in stressful, hazardous environments (including hot, dark, hazardous environments (including hot, dark, tightly enclosed spaces) further aggravated tightly enclosed spaces) further aggravated by fatigue, flashing lights, sirens and other by fatigue, flashing lights, sirens and other distractionsdistractions..

Essential job tasksEssential job tasks• (12) Ability to (12) Ability to

communicate (give and communicate (give and comprehend verbal orders) comprehend verbal orders) while wearing protective while wearing protective ensemble and self-ensemble and self-contained breathing contained breathing apparatus under apparatus under conditions of high conditions of high background noise, poor background noise, poor visibility, and drenching visibility, and drenching from hose lines and/or from hose lines and/or fixed protection systems fixed protection systems (sprinklers)(sprinklers)..

Essential job tasksEssential job tasks• (13) Functioning as an (13) Functioning as an

integral component of a integral component of a team, where sudden team, where sudden incapacitation of a incapacitation of a member may result in member may result in mission failure or in risk mission failure or in risk of injury or death to of injury or death to other team members other team members (e.g. two in, two out as (e.g. two in, two out as described in NFPA described in NFPA 1500).1500).

Essential Job TasksEssential Job Tasks• In addition to general firefighting In addition to general firefighting

duties (as listed above) members duties (as listed above) members of specialized teams such as of specialized teams such as hazardous materials units, hazardous materials units, SCUBA teams, technical rescue SCUBA teams, technical rescue teams, EMS teams, or units teams, EMS teams, or units supporting tactical law supporting tactical law enforcement operations may be enforcement operations may be required to perform additional required to perform additional tasks not specified above. These tasks not specified above. These tasks require members to wear tasks require members to wear or utilize specialized PPE that or utilize specialized PPE that may increase weight, may increase weight, environmental isolation, sensory environmental isolation, sensory deprivation and/or dehydration deprivation and/or dehydration potential above levels potential above levels experienced with standard fire experienced with standard fire suppression PPE. They also may suppression PPE. They also may include additional medical and/or include additional medical and/or physical requirements that shall physical requirements that shall not be enumerated in this not be enumerated in this standard.standard.

NFPA 1582 Requirements NFPA 1582 Requirements Changes- 2003Changes- 2003

• Occupational Medical Occupational Medical Program Customized to Program Customized to Local FD’sLocal FD’s– FD’s have to tell MD’s what FD’s have to tell MD’s what

their FF’s dotheir FF’s do– MD’s have to understand MD’s have to understand

what FF’s dowhat FF’s do– MD’s have to look for and MD’s have to look for and

evaluate morbidity/mortality evaluate morbidity/mortality trends in their FD’strends in their FD’s

– Includes fitness/wellness Includes fitness/wellness componentcomponent

– MD’s don’t hire/fireMD’s don’t hire/fire

• Category A and B applies only to Category A and B applies only to candidates; assumes all 13 EJT’s candidates; assumes all 13 EJT’s (Interior structural FF, Driver (Interior structural FF, Driver Operator)Operator)

• Category A Category A – Heart & cardiovascular diseaseHeart & cardiovascular disease– SmokingSmoking– AsthmaAsthma– DiabetesDiabetes– EpilepsyEpilepsy– Vision, hearing Vision, hearing – Certain medicationsCertain medications

NFPA 1582 Requirements NFPA 1582 Requirements Changes-2003Changes-2003

• Incumbents undergo full Incumbents undergo full medical evaluation medical evaluation yearlyyearly– Preventive cardiologyPreventive cardiology– Screening for conditions Screening for conditions

with known excess with known excess morbidity in FF’smorbidity in FF’s

– Data trendingData trending– Workplace interventionWorkplace intervention


• Incumbents are Incumbents are restricted from restricted from performing various performing various duties in the presence duties in the presence of certain medical of certain medical conditionsconditions

• FD’s determine FD’s determine whether/how whether/how restrictions can be restrictions can be accommodatedaccommodated


• Diabetes MellitusDiabetes Mellitus– Category A but with Category A but with

exceptionsexceptions

• AsthmaAsthma– New testing parametersNew testing parameters

• Seizure DisordersSeizure Disorders– Evaluation and requirements Evaluation and requirements

amended in 2003 edition amended in 2003 edition

• Coronary Artery DiseaseCoronary Artery Disease– Evaluation and requirements Evaluation and requirements

amended in 2003 editionamended in 2003 edition


• Prosthetics?Prosthetics?• Hearing aids?Hearing aids?

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NFPA 1582 Standard on Comprehensive Occupational Medical Programs for Fire Departments 2003-2007 Editions Sandy Bogucki, MD, PhD Branford Fire Department