NSW POLICE FORCE HEALTH STANDARD AND DIRECTION FOR …€¦ · health standard and direction for health assessment requirements structure of the standard .....8 the fitness-for-duties

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NSW POLICE FORCE

HEALTH STANDARD AND DIRECTION FOR

HEALTH ASSESSMENT REQUIREMENTS STRUCTURE OF THE STANDARD .................................................................................................. 8

THE FITNESS-FOR-DUTIES DECISION PROCESS ...................................................................... 8

THE ROLE OF THE SENIOR POLICE MEDICAL OFFICER ........................................................................... 8 THE ROLE OF THE CLEARING MEDICAL PRACTITIONER........................................................................... 8 THE ROLE OF THE ASSESSING MEDICAL PRACTITIONER .......................................................................... 8 APPEAL PROCESS .................................................................................................................................. 8

AVAILABLE INFORMATION RESOURCES .................................................................................. 9

THE MANUAL ........................................................................................................................................ 9 THE INFORMATION BASE....................................................................................................................... 9

GENERAL NOTES ................................................................................................................................ 9

TIMING OF MEDICALS ............................................................................................................................ 9 REASSESSMENT AFTER EXPIRATION OF MEDICAL ASSESSMENT CURRENCY ........................................... 9 PROFESSIONAL INTEGRITY .................................................................................................................... 9 MEDICAL PRACTITIONER RESPONSIBLE FOR MEDICAL EXAMINATION .................................................. 10 COST OF FURTHER OPINIONS OR INVESTIGATIONS ............................................................................... 10 PRESCRIBED FORMS ............................................................................................................................. 10 PRACTICAL TESTS ................................................................................................................................ 10 CONFIDENTIALITY ............................................................................................................................... 11 RETENTION OF MEDICAL DOCUMENTATION ......................................................................................... 11 INDEMNITY .......................................................................................................................................... 11 EQUIPMENT ......................................................................................................................................... 11 QUALITY ASSURANCE ......................................................................................................................... 11 REVIEW OF THIS GUIDELINE ................................................................................................................ 11

VISION .................................................................................................................................................. 12

MONOCULAR VISION ........................................................................................................................... 13 Qualifying standard to be reached or required response or action to be taken ............................. 13 Relevant comments, guidance or supplementary responses, requirements or actions ................... 13 Evidentiary Basis ............................................................................................................................ 13 Discussion ...................................................................................................................................... 14

BINOCULAR ACUITY – DISTANT ........................................................................................................... 14 Qualifying standard to be reached or required response or action to be taken ............................. 14 Relevant comments, guidance or supplementary responses, requirements or actions ................... 14 Evidentiary Basis ............................................................................................................................ 14 Discussion ...................................................................................................................................... 14

BINOCULAR ACUITY – NEAR ................................................................................................................ 15 Qualifying standard to be reached or required response or action to be taken ............................. 15 Relevant comments, guidance or supplementary responses, requirements or actions ................... 15 Evidentiary Basis ............................................................................................................................ 15

COLOUR VISION ................................................................................................................................... 15 Qualifying standard to be reached or required response or action to be taken ............................. 15 Relevant comments, guidance or supplementary responses, requirements or actions ................... 15 Evidentiary Basis ............................................................................................................................ 15 Discussion ...................................................................................................................................... 15

PERIPHERAL VISION ............................................................................................................................ 16 Qualifying standard to be reached or required response or action to be taken ............................. 16 Relevant comments, guidance or supplementary responses, requirements or actions ................... 16 Evidentiary Basis ............................................................................................................................ 16 Discussion ...................................................................................................................................... 16

STEREOPSIS ......................................................................................................................................... 17 Qualifying standard to be reached or required response or action to be taken ............................. 17

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Relevant comments, guidance or supplementary responses, requirements or actions ................... 17 Evidentiary Basis ............................................................................................................................ 17 Discussion ...................................................................................................................................... 17

DARK ADAPTATION ............................................................................................................................. 17 Qualifying standard to be reached or required response or action to be taken ............................. 17 Relevant comments, guidance or supplementary responses, requirements or actions ................... 17 Evidentiary Basis ............................................................................................................................ 18 Discussion ...................................................................................................................................... 18

OTHER EYE CONDITIONS INCLUDING ACUITY CORRECTIVE SURGERY .................................................. 18 Qualifying standard to be reached or required response or action to be taken ............................. 18 Relevant comments, guidance or supplementary responses, requirements or actions ................... 18 Evidentiary Basis ............................................................................................................................ 18 Discussion ...................................................................................................................................... 18

HEARING ............................................................................................................................................. 19

AUDIOMETRY ...................................................................................................................................... 20 Qualifying standard to be reached or required response or action to be taken ............................. 20 Relevant comments, guidance or supplementary responses, requirements or actions ................... 20 Evidentiary Basis ............................................................................................................................ 20 Discussion ...................................................................................................................................... 20

RETROCOCHLEAR CONDITIONS ............................................................................................................ 21 Qualifying standard to be reached or required response or action to be taken ............................. 21 Relevant comments, guidance or supplementary responses, requirements or actions ................... 21 Evidentiary Basis ............................................................................................................................ 21 Discussion ...................................................................................................................................... 21

SIGNIFICANT HEARING LOSS, TINNITUS, EAR OR BALANCE CONDITIONS .............................................. 21 Qualifying standard to be reached or required response or action to be taken ............................. 21 Relevant comments, guidance or supplementary responses, requirements or actions ................... 21 Evidentiary Basis ............................................................................................................................ 21 Discussion ...................................................................................................................................... 22

HEARING LOSS GREATER THAN THE PRESCRIBED WORKERS COMPENSATION THRESHOLD ................... 22 Qualifying standard to be reached or required response or action to be taken ............................. 22 Relevant comments, guidance or supplementary responses, requirements or actions ................... 22 Evidentiary Basis ............................................................................................................................ 22 Discussion ...................................................................................................................................... 22

VESTIBULAR ...................................................................................................................................... 23

DISORDERS OF BALANCE ..................................................................................................................... 23 Qualifying standard to be reached or required response or action to be taken ............................. 23 Relevant comments, guidance or supplementary responses, requirements or actions ................... 23 Evidentiary Basis ............................................................................................................................ 23 Discussion ...................................................................................................................................... 23

DRUG/MEDICATIONS/OVER-THE-COUNTER ITEMS ............................................................. 24

DRUG TESTING .................................................................................................................................... 24 Qualifying standard to be reached or required response or action to be taken ............................. 24 Relevant comments, guidance or supplementary responses, requirements or actions ................... 24 Evidentiary Basis ............................................................................................................................ 24 Discussion ...................................................................................................................................... 25

ILLICIT, PROHIBITED, RECREATIONAL OR ILLICIT RECREATIONAL DRUG USE ....................................... 25 Qualifying standard to be reached or required response or action to be taken ............................. 25 Relevant comments, guidance or supplementary responses, requirements or actions ................... 25 Evidentiary Basis ............................................................................................................................ 25 Discussion ...................................................................................................................................... 25

DIABETES – NON-INSULIN TREATED TYPE 2 AND OTHER ENDOCRINE DISORDERS 26

STABILITY OF THE DISORDER ............................................................................................................... 26 DISTURBANCE OF CONSCIOUSNESS ...................................................................................................... 26 ABILITY TO ACCESS REGULAR OR EMERGENCY MEDICATION .............................................................. 26 ABILITY TO RESPOND IN THE CASE OF A PRIORITY OR EMERGENCY ..................................................... 26

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Qualifying standard to be reached or required response or action to be taken ............................. 26 Relevant comments, guidance or supplementary responses, requirements or actions ................... 27 Evidentiary Basis ............................................................................................................................ 27 Discussion ...................................................................................................................................... 27

REGULAR REVIEW AND REPORTING ..................................................................................................... 28 Qualifying standard to be reached or required response or action to be taken ............................. 28 Relevant comments, guidance or supplementary responses, requirements or actions ................... 28 Evidentiary Basis ............................................................................................................................ 28 Discussion ...................................................................................................................................... 28

DIABETES – INSULIN DEPENDENT .............................................................................................. 29

DIABETES MELLITUS THAT REQUIRES INSULIN FOR APPROPRIATE GLYCAEMIC CONTROL ................... 29 Qualifying standard to be reached or required response or action to be taken ............................. 29 Relevant comments, guidance or supplementary responses, requirements or actions ................... 29 Evidentiary Basis ............................................................................................................................ 30 Discussion ...................................................................................................................................... 30

EPILEPSY ............................................................................................................................................ 31

STABILITY OF THE DISORDER ............................................................................................................... 31 ABILITY TO RESPOND IN THE CASE OF A PRIORITY OR EMERGENCY ..................................................... 31



CEREBROVASCULAR CONDITIONS – STABLE WITH LOW RISK OF RECURRENCE ... 34

MEDICAL REPORT FROM THE TREATING SPECIALIST ............................................................................ 34 ABILITY TO RESPOND IN THE CASE OF A PRIORITY OR EMERGENCY ..................................................... 34 ASSESSMENT OF NEUROLOGICAL DEFICIT ............................................................................................ 34



CEREBROVASCULAR CONDITIONS – UNSTABLE, DEVELOPING, RESOLVING ............ 37

CEREBROVASCULAR CONDITIONS – UNSTABLE, DEVELOPING, RESOLVING .......................................... 37 Qualifying standard to be reached or required response or action to be taken ............................. 37 Relevant comments, guidance or supplementary responses, requirements or actions ................... 37 Evidentiary Basis ............................................................................................................................ 37 Discussion ...................................................................................................................................... 37

OTHER NEUROLOGICAL CONDITIONS ..................................................................................... 38

MEDICAL REPORT FROM THE TREATING SPECIALIST ............................................................................ 38 ABILITY TO RESPOND IN THE CASE OF A PRIORITY OR EMERGENCY ..................................................... 38 ASSESSMENT OF NEUROLOGICAL DEFICIT ............................................................................................ 38


REGULAR REVIEW AND REPORTING ..................................................................................................... 39

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CARDIAC RISK ASSESSMENT AGE < 40 YEARS ....................................................................... 41

SMOKER IN THE LAST 4 YEARS OR FOR GREATER THAN 5 YEARS ......................................................... 41 DIAGNOSED WITH HYPERLIPIDAEMIA, DIABETES, HYPERTENSION ....................................................... 41 FAMILY HISTORY HYPERLIPIDAEMIA, DIABETES, HYPERTENSION ....................................................... 41 FAMILY HISTORY OF CARDIAC CONDITION .......................................................................................... 41


BMI > 30 ............................................................................................................................................. 42 Qualifying standard to be reached or required response or action to be taken ............................. 42 Relevant comments, guidance or supplementary responses, requirements or actions ................... 42 Evidentiary Basis ............................................................................................................................ 42 Discussion ...................................................................................................................................... 42

CARDIAC RISK ASSESSMENT AGE >= 40 YEARS ..................................................................... 43

AGE >=40 BUT < 45 ............................................................................................................................. 43 Qualifying standard to be reached or required response or action to be taken ............................. 43 Relevant comments, guidance or supplementary responses, requirements or actions ................... 43 Evidentiary Basis ............................................................................................................................ 43 Discussion ...................................................................................................................................... 43

AGE >=45 ............................................................................................................................................ 44 Qualifying standard to be reached or required response or action to be taken ............................. 44 Relevant comments, guidance or supplementary responses, requirements or actions ................... 44 Evidentiary Basis ............................................................................................................................ 44 Discussion ...................................................................................................................................... 44

BLOOD PRESSURE ............................................................................................................................ 45

SYSTOLIC BLOOD PRESSURE ................................................................................................................ 45 DIASTOLIC BLOOD PRESSURE .............................................................................................................. 45



CARDIAC MURMURS OR ABNORMAL CARDIAC SOUNDS ................................................... 47

CARDIAC MURMURS OR ABNORMAL CARDIAC SOUNDS ....................................................................... 47 Qualifying standard to be reached or required response or action to be taken ............................. 47 Relevant comments, guidance or supplementary responses, requirements or actions ................... 47 Evidentiary Basis ............................................................................................................................ 47 Discussion ...................................................................................................................................... 47

CARDIAC RHYTHM DISTURBANCES .......................................................................................... 48

STABILITY OF THE DISORDER ............................................................................................................... 48 ABILITY TO RESPOND IN THE CASE OF A PRIORITY OR EMERGENCY ..................................................... 48


REGULAR REVIEW AND REPORTING ..................................................................................................... 49

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PACEMAKER ...................................................................................................................................... 50

STABILITY OF THE UNDERLYING DISORDER ......................................................................................... 50 ABILITY TO RESPOND IN THE CASE OF A PRIORITY OR EMERGENCY ..................................................... 50



OTHER CARDIO-VASCULAR DISEASE AND DISORDERS ..................................................... 52

MEDICAL CLEARANCE ......................................................................................................................... 52 ABILITY TO RESPOND IN THE CASE OF A PRIORITY OR EMERGENCY ..................................................... 52


PHYSICAL CAPACITY ........................................................................................................................... 53 Qualifying standard to be reached or required response or action to be taken ............................. 53 Relevant comments, guidance or supplementary responses, requirements or actions ................... 53 Evidentiary Basis ............................................................................................................................ 53 Discussion ...................................................................................................................................... 53


MOOD DISORDERS ........................................................................................................................... 55

MAJOR MOOD DISORDERS.................................................................................................................... 55 ADJUSTMENT DISORDERS, OTHER MOOD DISTURBANCES AND PERSONALITY VARIANTS ..................... 55 ABILITY TO RESPOND IN THE CASE OF A PRIORITY OR EMERGENCY. .................................................... 55

Qualifying standard to be reached or required response or action to be taken ............................. 55 Relevant comments, guidance or supplementary responses, requirements or actions ................... 55 Evidentiary Basis ............................................................................................................................ 55 Discussion ...................................................................................................................................... 56 Qualifying standard to be reached or required response or action to be taken ............................. 56 Relevant comments, guidance or supplementary responses, requirements or actions ................... 56 Evidentiary Basis ............................................................................................................................ 56 Discussion ...................................................................................................................................... 56

PSYCHOTIC ILLNESS....................................................................................................................... 57

ESTABLISHED PSYCHOTIC ILLNESS ...................................................................................................... 57 Qualifying standard to be reached or required response or action to be taken ............................. 57 Relevant comments, guidance or supplementary responses, requirements or actions ................... 57 Evidentiary Basis ............................................................................................................................ 57 Discussion ...................................................................................................................................... 57

SLEEP DISORDERS ........................................................................................................................... 58

NARCOLEPSY AND SLEEP APNOEA ....................................................................................................... 58 Qualifying standard to be reached or required response or action to be taken ............................. 58 Relevant comments, guidance or supplementary responses, requirements or actions ................... 58

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Evidentiary Basis ............................................................................................................................ 58 Discussion ...................................................................................................................................... 58

SKIN DISORDERS .............................................................................................................................. 59

SKIN INFECTIONS ................................................................................................................................. 59 Qualifying standard to be reached or required response or action to be taken ............................. 59 Relevant comments, guidance or supplementary responses, requirements or actions ................... 59 Evidentiary Basis ............................................................................................................................ 59 Discussion ...................................................................................................................................... 59

OTHER SKIN DISORDERS ...................................................................................................................... 60 Qualifying standard to be reached or required response or action to be taken ............................. 60 Relevant comments, guidance or supplementary responses, requirements or actions ................... 60 Evidentiary Basis ............................................................................................................................ 60 Discussion ...................................................................................................................................... 60

RESPIRATORY ................................................................................................................................... 61

RESPIRATORY ASSESSMENT ................................................................................................................. 62 Qualifying standard to be reached or required response or action to be taken ............................. 62 Relevant comments, guidance or supplementary responses, requirements or actions ................... 62 Evidentiary Basis ............................................................................................................................ 62 Discussion ...................................................................................................................................... 62

PAST OR CURRENT HISTORY OF ASTHMA ............................................................................................. 62 Qualifying standard to be reached or required response or action to be taken ............................. 62 Relevant comments, guidance or supplementary responses, requirements or actions ................... 62 Evidentiary Basis ............................................................................................................................ 62 Discussion ...................................................................................................................................... 63

OTHER RESPIRATORY DISEASE ............................................................................................................ 63 Qualifying standard to be reached or required response or action to be taken ............................. 63 Relevant comments, guidance or supplementary responses, requirements or actions ................... 63 Evidentiary Basis ............................................................................................................................ 63

EXERCISE CAPACITY ............................................................................................................................ 63 Qualifying standard to be reached or required response or action to be taken ............................. 63 Relevant comments, guidance or supplementary responses, requirements or actions ................... 63 Evidentiary Basis ............................................................................................................................ 64

ABILITY TO RESPOND IN THE CASE OF A PRIORITY OR EMERGENCY ..................................................... 64 Qualifying standard to be reached or required response or action to be taken ............................. 64 Relevant comments, guidance or supplementary responses, requirements or actions ................... 64 Evidentiary Basis ............................................................................................................................ 64 Discussion ...................................................................................................................................... 64

INFECTIOUS DISEASES ................................................................................................................... 65

HEPATITIS B ........................................................................................................................................ 65 Qualifying standard to be reached or required response or action to be taken ............................. 65 Relevant comments, guidance or supplementary responses, requirements or actions ................... 65 Evidentiary Basis ............................................................................................................................ 65

HEPATITIS A ........................................................................................................................................ 65 Qualifying standard to be reached or required response or action to be taken ............................. 65 Evidentiary Basis ............................................................................................................................ 65

HIV-AIDS .......................................................................................................................................... 65 Qualifying standard to be reached or required response or action to be taken ............................. 65 Relevant comments, guidance or supplementary responses, requirements or actions ................... 66 Evidentiary Basis ............................................................................................................................ 66 Discussion .........................................................................................Error! Bookmark not defined.

MEDICATION ..................................................................................................................................... 67

PRESCRIBED MEDICATION ................................................................................................................... 67 Qualifying standard to be reached or required response or action to be taken ............................. 67 Relevant comments, guidance or supplementary responses, requirements or actions ................... 67 Evidentiary Basis ............................................................................................................................ 68 Discussion ...................................................................................................................................... 68

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OVER-THE-COUNTER MEDICATION ...................................................................................................... 68 Qualifying standard to be reached or required response or action to be taken ............................. 68 Relevant comments, guidance or supplementary responses, requirements or actions ................... 69 The clearing doctor should consider advice or restrictions as appropriate with particular

attention to the reason the preparation is being taken. Review and report by the applicants

treating general practitioner may be required ............................................................................... 69 Evidentiary Basis ............................................................................................................................ 69 Discussion ...................................................................................................................................... 69

VITAMINS, HERBAL PREPARATIONS, ALTERNATIVE AND COMPLEMENTARY MEDICINES. ..................... 69 Qualifying standard to be reached or required response or action to be taken ............................. 69 Relevant comments, guidance or supplementary responses, requirements or actions ................... 69 Evidentiary Basis ............................................................................................................................ 69 MIMS Annual – June 2006 – CMPMedica Australia Pty Limited – www.mims.com.au Discussion

........................................................................................................................................................ 69 ABILITY TO RESPOND IN THE CASE OF A PRIORITY OR EMERGENCY ..................................................... 70


SIDE-EFFECTS ...................................................................................................................................... 70 Qualifying standard to be reached or required response or action to be taken ............................. 70 Relevant comments, guidance or supplementary responses, requirements or actions ................... 70 Evidentiary Basis ............................................................................................................................ 70 Discussion ...................................................................................................................................... 70

MUSCULO-SKELETAL ..................................................................................................................... 71

MUSCULO-SKELETAL HISTORY ............................................................................................................ 71 Qualifying standard to be reached or required response or action to be taken ............................. 71 Relevant comments, guidance or supplementary responses, requirements or actions ................... 71 Evidentiary Basis ............................................................................................................................ 71 Discussion ...................................................................................................................................... 71

OBESITY .............................................................................................................................................. 72

OBESITY .............................................................................................................................................. 72 Qualifying standard to be reached or required response or action to be taken ............................. 72 Relevant comments, guidance or supplementary responses, requirements or actions ................... 72 Discussion ...................................................................................................................................... 72

VACCINATIONS ................................................................................................................................. 73

VACCINATIONS.................................................................................................................................... 73 Qualifying standard to be reached or required response or action to be taken ............................. 73 Relevant comments, guidance or supplementary responses, requirements or actions ................... 73 Evidentiary Basis ............................................................................................................................ 73 Discussion ...................................................................................................................................... 73

ATTENTION DEFICIT [HYPERACTIVITY] DISORDER ........................................................... 74

ATTENTION-DEFICIT DISORDER .......................................................................................................... 74 Qualifying standard to be reached or required response or action to be taken ............................. 74 Relevant comments, guidance or supplementary responses, requirements or actions ................... 74 Evidentiary Basis ............................................................................................................................ 75 Discussion ...................................................................................................................................... 75

ATTENTION-DEFICIT HYPERACTIVITY DISORDER ............................................................................... 75 Qualifying standard to be reached or required response or action to be taken ............................. 75 Relevant comments, guidance or supplementary responses, requirements or actions ................... 75 Evidentiary Basis ............................................................................................................................ 75 Discussion ...................................................................................................................................... 75

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STRUCTURE OF THE STANDARD The standard is structured in line with the inherent requirements of the position being sought. In

general the requirements will apply to front line policing – general duties. A national listing of the

inherent requirements of policing has been agreed to by Commissioners.

Where an applicant does not meet the standard, their case must be risk assessed on an individual

basis. If the requirements of this standard are too onerous, but a case exists for a variation, then

the requirements of the standard can be varied on a case-by-case basis by the clause that allows

review and variation by the Senior Police Medical Officer or delegate. Acceptance will probably

be on a conditional basis.

If a person is to be recruited for a specialised task, has a medical condition or performs a task that has

specific legal requirements for medical assessment then these requirements will be in addition to the

requirements of this standard. Where such requirements are found to be in conflict, the requirement that

presents the lower risk will be adopted. Cases of doubt will be referred to the Senior Police Medical

Officer or delegate.

In general, recruitment will be for admission into the training at the Police College. Here applicants are

not employed by the NSW Police Force but are students of the University contracted to run the

institution. No guarantees are given or implied by acceptance into the College that the applicant will be

attested or later confirmed to become a police officer.

THE FITNESS-FOR-DUTIES DECISION PROCESS The role of the Senior Police Medical Officer The Senior Police Medical Officer (SPMO) is an occupational physician with the responsibility of

advising NSW Police Force (NSWPF) in medical matters including recruitment fitness-for-work

decisions. All questions concerning fitness-for-work that come from this guideline should be initially

referred to the SPMO. In cases where the guideline requires referral to the SPMO, an occupational

physician or other suitable health professional may be delegated by the SPMO to perform such tasks

and make recommendation to the NSWPF.

The role of the clearing medical practitioner The clearing medical officer is a senior practitioner who has responsibility for, and seniority in respect

to, the assessing medical officers of their organisation. It is the clearing medical officer’s role to act as

the final arbiter for their organisation in respect to a medical file and to act as a quality control monitor

for the medical assessments done.

The role of the assessing medical practitioner The assessing medical officer is the medical practitioner who conducts the medical assessment, makes

the initial assessment for fitness if they are able to, and has responsibility for the review and decision

making in respect to the input of other health professionals.

Appeal Process Where an applicant does not meet the standard required for admission to the College, an appeal may be

made. An appeal against the decision of the clearing medical practitioner must be in writing, and

addressed to the SPMO. The appeal should highlight the grounds of appeal and should contain

supporting documentation. The decision of the SPMO is binding. In the event of a real or perceived

conflict of interest, the General Manager Health and Wellbeing will manage the appeal.

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AVAILABLE INFORMATION RESOURCES

The Manual This manual is a document that details the applicable medical standards. It includes details of reference

material supporting the standards. It includes discussion of relevant matters underlying the reasons for

decision making as required by this Standard.

The Information Base The information base represents the documents that underpin the evidence used to compile the manual

and hence the guidelines. It is maintained by the Senior Police Medical Officer and, except for material

that is confidential to policing operations, is available to practitioners who require access to

information for a better understanding of the issues in conducting the medical assessments under this

standard.

GENERAL NOTES Timing of medicals A medical assessment must be completed and cleared by the SPMO or person delegated by the General

Manager Health and Wellbeing to perform this function.

The period of currency for such a clearance will be:

For applicants aged 40 years and older at the time of the assessment – 180 days

For other applicants – 365 days

For any applicant, irrespective of age, if a change in medical status is notified to the Manager

Recruitment or delegate, or the Manager Recruitment or delegate becomes aware of such

change the period will be zero days. Any such change in medical status must be notified to the

Manager Recruitment or delegate as soon as possible.

On presenting for any subsequent assessment an applicant may be required to fill out further medical

questionnaires. Should medical (including psychological) issues be identified then the case will be

referred to the SPMO or delegate for advice. Typically such questionnaire will be part of physical and

psychological testing.

Reassessment after expiration of medical assessment currency If the period from the previous medical assessment is greater two (2) years then a repeat full medical

assessment will be required.

In all other cases a questionnaire similar to that used at the initial assessment will be administered and

any changes in health or psychological status will require a new medical assessment. If in the opinion

of the Manager Recruitment or delegate, usually supported by certification by the treating medical

practitioner such changes are of a minor nature, then this requirement can be waived. This will usually

be after consultation with the PMO.

Professional integrity Police officers operate in an environment of the utmost integrity. For an applicant, being viewed as a

future police officer, it will be considered a serious breach of integrity and therefore reflect poorly on

their professional suitability if:

a medical condition is not disclosed

the extent of a medical condition is not disclosed

a misleading impression is created (or attempted to be created) by the omission of facts, the

statement of false facts, or otherwise

a misleading impression is created (or attempted to be created) by any other means

the true nature of a medical condition is misrepresented by the taking of a substance, the

omission of the taking of a substance, the change in the prescribed dose of a substance or by

any other method that involves a non prescribed change in therapy.

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Additionally it must be noted by applicants that insurance and disability coverage arrangements can be

affected by such non-disclosure

Medical practitioner responsible for medical examination Medical examinations must be performed under the direct control of a fully qualified and Australian

registered medical practitioner. The assessment and recommendations must then be cleared by a

medical practitioner who is experienced in policing occupational health issues. They should be either

an occupational physician or a medical practitioner with equivalent current experience. This clearing

medical practitioner must be independent of any recent past, present, or foreseeable future treating role

for the individual concerned.

A treating general practitioner and treating specialist are qualified medical practitioners with current

HIC provider numbers who are engaged in the current ongoing medical support of the applicant's

condition. A trainee registrar general practitioner and trainee registrar specialist under suitable

supervision are equivalent respectively to the treating general practitioner and treating specialist.

An occupational physician is a Fellow in good standing of the Australasian Faculty of Occupational

Medicine of the Royal Australian College of Physicians. To be in good standing the Fellow must be

current with their continuing medical education. Confirmation of this can be requested from them.

In all cases the opinions of treating general practitioners, treating specialists and other health

professionals will be taken into consideration by the medical practitioner who completes the medical

assessment. Such information is taken as advice and interpreted in the context of the health and safety

of performing the designated role. Such opinions of other health professionals will usually, but may not

necessarily, be accepted or acted on.

During the assessment it may be determined, whether specifically stated in the standard or otherwise,

that further investigation, general practitioner report or clearance or specialist report or clearance is

needed. The assessment will not be considered complete until this is available. Interim telephone

advice is not acceptable. Faxed material signed and on letterhead as well as email communications may

be accepted by the assessing or clearing health professional at their discretion.

Cost of further opinions or investigations Payment for the costs of tests and examinations needed for the completion of the assessment will not be

the responsibility of the assessing or clearing medical practitioner or the medical service performing the

assessment. In most cases such further specialist opinion and/or investigation is not claimable under

Medicare - it is an offence for the doctor or the applicant to attempt to do this.

Prescribed forms Where the words "prescribed form" are used then a form approved by the NSW Police Force is referred

to and forms part of the appendix to this document. An alternative form, possibly electronic, may be

used but it must seek the same minimum information as the approved form, be agreed to by NSW

Recruitment, the Senior Police Medical Officer and be capable of readily transferring the required

minimum information to NSW Police Recruitment Branch.

Practical tests Practical testing may in some circumstances be used and consists of a typical set of tasks that represent

the most difficult of safety-critical tasks required for the efficient, safe and effective conduct of the

position being sought. Such tests will comply with anti-discrimination laws where there may be a

medical restriction applicable. An example is an OSTU assessment for the hand function to use a

firearm.

Use of other standards

Currently there does not exist a national medical recruiting or policing health standard. When there

does, and it is agreed to by the NSW Police Commissioner, then conflict between the two standards will

be resolved by referring to the criteria that leads to the lower risk determined by a Risk Assessment

Committee on a case by case basis. Such a decision will be made by the Senior Police Medical Officer

or delegate.

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There are fitness standards for other occupations such as rail-worker, commercial drivers and airplane

pilots. Caution is advised in referring to such material because of the peculiarities of policing. Police

will often and regularly: have to move from relatively sedentary activity to full mental and physical

alertness and strenuous exertion; face individuals intent on harming them with and without weapons;

have to face emotionally distressing situations where they have little or no control; participate in the

recording and removal of the remains of horrific incidents/accidents; be required to cope with domestic

situations regularly when they will themselves have their own domestic situations both large and small;

be required to act outside of normal legal constraints with higher risk to themselves, their partner(s) and

the public such as with firearm use in public, detention, vehicle pursuit, crowd control, riot situations.

Confidentiality The results of the medical assessment remain medical-in-confidence. The content of the medical

assessment, in whole or in part, cannot be released to a third party beyond the assessing and clearing

health professionals and their relevant support staff without the written consent of the applicant to

whom such content pertains. Where a risk to the health of the applicant might exist, the results of the

medical will be released to a treating doctor nominated by the applicant.

Retention of medical documentation A record of the assessment must be retained in the files of the assessing health professional under the

same conditions as those rules that apply, by law, to a medical practitioner in NSW and pertain to

medical information. Such a record must contain, at minimum, the information contained in the

prescribed medical assessment form. The original documentation completed for the medical

assessment, or its electronic or other equivalent, will be sent to the NSW Police Recruitment Branch

within seven days.

Indemnity All health practitioners performing assessments in connection with this standard must carry the

indemnity insurance required for their profession. A health service or organisation that performs these

services must have public and professional liability insurance to cover accidental injury or other

incidents that might occur during and in connection with the medical assessment. Additionally the

health service must either indemnify any health professional working for them or confirm the

indemnity status of the professional.

Equipment All equipment used in medical and physical assessments must have its calibration current. Any

electrical equipment must have a current inspection tag from a qualified electrician.

Quality Assurance Preference for service providers will be given to organisations that are ISO 9000 series certified.

Review of this Guideline This guideline will be reviewed every five (5) years by the Senior PMO or his delegate.

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VISION

Eyesight Qualifying standard to be reached or required

response or action to be taken

Relevant comments, guidance or

supplementary responses, requirements or

actions

Monocular vision Visual acuity greater than or equal to 6/9 in the

better eye, with correction if needed; must meet

the visual field standard of 70 degrees either side

of the meridian; plus report from a specialist.

Visual fields of 50 degrees either side of the

meridian will allow front-line policing but the

officer will be restricted from holding a silver

NSW driving certification (and above).

All spectacles must be poly carbonate plastic;

spherical power -4 to +5 D; cylindrical power

<=3D.

Contact lenses must be certified by an

ophthalmologist or optometrist to be able to have

been worn constantly for 12 hours per day

without problems, especially irritation.

Each case will be referred to the SPMO for

individual assessment.

The presence of peripheral vision can be critical

to safety. The assessing or clearing physician

must exercise risk based judgement depending on

the particular position. The above standard is for

general duties frontline policing.

Binocular acuity -

distant

Visual acuity of 6/9 monocularly and 6/6

binocularly, with correction if necessary.

The visual correction must either be contact

lenses or poly carbonate lens glasses.

Where contact lens are used they must be able to

be worn a full shift without problems. Back-up

glasses are required.

Binocular acuity -

near

Near visual acuity equal to or better than N9 with

visual correction if necessary.

The visual correction must either be contact

lenses or poly carbonate lens glasses.

Where contact lens are used they must be able to

be worn a full shift without problems. Back-up

glasses are required .

Colour vision Colour vision anomaly is screened for by greater

than 4 errors on a 24 Ishihara plate test as a

screen.

A medical practitioner or optometrist report is

required to confirm the nature of the condition. A

standard Farnsworth Munsell D15 test is to be

performed as a minimum. The colour vision

standard is met if this test is passed on two or

more of three runs. If the test is borderline then a

practical test will be performed by the SPMO.

Room lighting should be Illuminant C or

daylight.

Colour correction contact lenses are not

permitted.

Peripheral vision Greater than 70 degrees either side of the

meridian horizontally and greater than 20 degrees

vertically above and below the horizontal.

An individual with greater than 50 degrees or

more but less than 70 degrees can be cleared with

a restriction not to hold a “silver level” driving

certification or higher.

In case of failure, the cause and stability of the

underlying condition must be assessed and the

opinion of an ophthalmologist sought in the

prescribed format.

Such cases need to be referred to the SPMO for

assessment when this material is available.

Stereopsis Minimum degree of binocular fusion and

stereopsis must be 40 seconds of an arc on a

screening test.

If the individual does not meet the standard then

they can be assessed by an ophthalmologist for

cause and possible correction.

Should no cause be found and an ophthalmologist

report is available on the prescribed form

recommending that the inherent requirements of

policing can be achieved then the candidate can

13

proceed to commence training conditionally. The

condition is that performance in relevant practical

tasks are not impaired by visual problems and

must be agreed to in writing.

Amblyopia See the discussion in monocular vision

Diplopia See the discussion in stereopsis.

Night vision –

dark adaptation

A negative response must be obtained to a

question asked concerning any difficulties with

adaptation to the dark, night blindness or night

vision.

All candidates proceed to commence their

training on the understanding that a test for dark

adaptation occurs at the College. Failure will be

considered as not to meet the standard.

If the individual does not meet the standard then

they can be assessed by an ophthalmologist for

cause.

Should no cause be found and an ophthalmologist

report is available on the prescribed form

recommending that the inherent requirements of

policing can be achieved then the candidate can

proceed to commence training conditionally.

The condition is that performance in relevant

practical tasks is not impaired by visual

problems. The condition must be agreed to in

writing.

Other eye

conditions

including acuity

corrective surgery

Report from an ophthalmologist, treating doctor

or other suitably qualified medical practitioner is

needed

The case will have to be referred to the SPMO

when such reports are available.

If an ophthalmologist report is available on the

prescribed form recommending that the inherent

requirements of policing can be achieved then, if

the SPMO agrees, the candidate can proceed to

commence training conditionally.

The condition is that performance in relevant

practical tasks is not impaired by visual

problems. The condition must be agreed to in

writing.

Monocular Vision

Qualifying standard to be reached or required response or action to be taken

Visual acuity greater than or equal to 6/9 in the better eye, with correction if needed; must meet the

visual field standard of 70 degrees either side of the meridian; plus the report from a specialist.

Visual fields of 50 degrees either side of the meridian will allow front-line policing but the officer will

be restricted from holding a silver NSW driving certification (and above).

All spectacles must be poly carbonate plastic; spherical power -4 to +5 D; cylindrical power <=3D.

Contact lenses must be certified by an ophthalmologist or optometrist to be able to have been worn

constantly for 12 hours per day without problems, especially irritation.

Each case will be referred to the SPMO for individual assessment.

Relevant comments, guidance or supplementary responses, requirements or actions

The presence of peripheral vision can be critical to safety. The assessing or clearing physician must

exercise risk based judgement depending on the particular position. The above standard is for general

duties frontline policing.

Evidentiary Basis

Assessing Fitness to Drive AUSTROADS September 2003 – National Road Transport Commission

Commercial Drivers

14

Australian Optometrical Association – Eyesight Guidelines for Recruit Level Entry to the Police

Service – October 1995 sections 1, 5

National Standard for Health Assessment of Rail Safety Workers – NTC Australia 2004 section 22

Medical Screening Manual – California Commission on Peace Officer Standards and Training –

Vision Guidelines: section XI

Discussion

Persons suffering from amblyopia will usually have appropriate peripheral vision but a one sided

central scotoma. They are not monocular in the sense of this criterion. Their evaluation will be in terms

of their corrected distance vision, their visual fields and the acuity in their better eye. Each case will

need to be assessed by an ophthalmologist on the prescribed form.

Binocular acuity – distant


Visual acuity of 6/9 monocularly and 6/6 binocularly, with correction if necessary.

Power is to be limited to: spherical -4D to +5D; cylindrical <3D; equivalent anisometropia <3D.


The visual correction must either be contact lenses or poly carbonate lens glasses.

Where contact lens are used they must be able to be worn a full shift without problems. Back-up

glasses are needed.

Evidentiary Basis


Commercial Drivers

Australian Optometrical Association – Eyesight Guidelines for Recruit Level Entry to the police

Service – October 1995 sections 2


Medical Screening Manual – California Commission on Peace Officer Standards and Training – Vision

Guidelines: section XI

Discussion

A minimum visual standard of 6/12 in either eye has been argued for on the grounds that altercations

are frequent in front-line policing and an officer may have to use their firearm in the situation where the

visual correction is lost. This is likely to be at close range for self protection.

Experience so far has not shown this to be an issue so this minimum has not been supported.

15

Binocular acuity – near


Near visual acuity equal to or better than N9 with visual correction if necessary.


The visual correction must either be contact lenses or poly carbonate lens glasses.

Where contact lens are used they must be able to be worn a full shift without problems. Back-up

glasses are required.

Evidentiary Basis

The near vision test is a practical test for the reading task. Reading is a requirement that underlies many

inherent requirements for Policing.

The N9 standard equates to the smaller writing that is to be found in documents and paperwork.

Colour vision


Colour vision anomaly is screened for by greater than 4 errors on a 24 Ishihara plate test as a screen.

In the case of such anomaly, a medical practitioner or optometrist report is required to confirm the

nature of the condition. A standard Farnsworth Munsell D15 test is to be performed as a minimum. The

colour vision standard is met if this test is passed on two or more of three runs. If the test is borderline

then a practical test will be performed by the SPMO.


Room lighting should be Illuminant C or daylight.

Colour correction contact lenses are not permitted.

Evidentiary Basis

Ishihara Tests for Colour-Blindness – 24 plate edition – 1995. Kanehara & Co Ltd




Medical Screening Manual – California n Commission on Peace Officer Standards and Training –

Vision Guidelines: section XI

Discussion

1) Victoria Police, subsequent to an antidiscrimination case, obtained consensus advice from the

experts on both sides. This advice is the basis of this standard and in general is not inconsistent with

that in the reference material for other safety-critical occupations.

16

2) The need for acceptable colour vision relates to an ability to accurately give evidence and to be able

to identify and act on colour related information. In general, the colours for testing are selected for

diagnostic purposes in the formal medical testing. A battery of colours was obtained from a survey of

clothes and cars and forms the basis of the SPMO practical test. The results have proven to correlate

highly with the D15 and have the advantage of illustrating the issues to the applicant.

Peripheral Vision


Greater than 70 degrees either side of the meridian horizontally and greater than 20 degrees vertically

above and below the horizontal and with no significant scotoma

An individual with greater than 50 degrees or more but less than 70 degrees can be cleared with a

restriction not to hold a silver level driving qualification or higher.


In case of failure, the cause and stability of the underlying condition needs to be assessed and the

opinion of an ophthalmologist sought in the prescribed format.

Such cases need to be referred to the SPMO for assessment when this material is available.

Evidentiary Basis


Commercial Drivers.





Guidelines: section XI

Discussion

Research has shown peripheral vision to be an important criterion for policing (Medical Screening

Manual - Californian Commission on Police Officer Standards and Training – Vision Guidelines:

section XI).

Simple confrontation test is adequate for screening but assessment by an optometrist is needed if the

visual fields are not 85 degrees either side of the meridian unless physical features make the cause

obvious. In cases where the visual fields are limited a cause must be established and a report from an

ophthalmologist on the prescribed form may be needed.

17

Stereopsis


Minimum degree of binocular fusion and stereopsis needs to be 40 seconds of an arc on a screening

test.


If the individual does not meet the standard then they can be assessed by an ophthalmologist for cause

and possible correction.

Should no cause be found and an ophthalmologist report is available on the prescribed form

recommending that the inherent requirements of policing can be achieved then the candidate can


The condition is that performance in relevant practical tasks is not impaired by visual problems. The

condition must be agreed to in writing.

Evidentiary Basis


Guidelines: section XI.

Discussion

1) Individuals with fusion problems use a range of other cues to compensate and can usually perform

adequately. Their ability to use such cue in emergency and life threatening situations is not established.

2) Diplopia is a condition that is incompatible with front line policing.

Dark adaptation


A negative response must be obtained to a question which must be asked concerning any difficulties

with adaptation to the dark, night blindness or night vision.

All candidates proceed to commence their training on the understanding that a test for dark adaptation

occurs at the College. Failure in this test will be considered as not meeting the standard.


If the individual does not meet the standard then they can be assessed by an ophthalmologist for cause.

Should no cause be found and an ophthalmologist report is available on the prescribed form

recommending that the inherent requirements of policing can be achieved then the candidate can




18

Evidentiary Basis

Medical Screening Manual - California Commission on Peace Officer Standards and Training – Vision

Guidelines: section XI.


Commercial Drivers.


Discussion

Research has shown dark adaptation to be an important criterion for policing (Medical Screening

Manual - California Commission on Police Officer Standards and Training – Vision Guidelines:

section XI).

Dark adaptation testing is not usually available from the general practice optometrist.

Other eye conditions including acuity corrective surgery


Report from an ophthalmologist, treating doctor or other suitably qualified medical practitioner is

needed.

The case will have to be referred to the SPMO when such reports are available.


If an ophthalmologist report is available on the prescribed form recommending that the inherent

requirements of policing can be achieved then, if the SPMO agrees, the candidate can proceed to

commence training conditionally.



Evidentiary Basis

Medical Screening Manual – California n Commission on Peace Officer Standards and Training –

Vision Guidelines: section XI.


Commercial Drivers.


Discussion

Each case will have to be assessed on its merits.

The above documentation relating to policing and other safety critical employment can be used as a

resource and guide to decision making.

19

HEARING

Hearing Qualifying standard to be reached or required

response or action to be taken

Relevant comments, guidance or supplementary

responses, requirements or actions

Audiometry Pure tone thresholds <= 20db in both ears at

500Hz, 1KHz, 2KHz, 3KHz, 4KHz. This must

be achieved without hearing aid.

Supplementary unaided criteria

If the standard is not met an unaided qualifying

standard is all of:

pure tone thresholds in each ear averaging <=

25db for 500Hz, 1KHz, 2KHz, 3KHz

pure tone thresholds in each ear <= 35db for

500Hz, 1KHz, 2KHz, 3KHz

pure tone thresholds in each ear <=35db at

4KHz

a speech discrimination test performed in the

prescribed manner that is >=90% correct

responses in the quiet in each ear at 50 db HL

and >= 70% correct responses with

background noise at +5db signal-to-noise ratio

performed binaurally.

Supplementary aided criteria

If the standard is not met an aided qualifying

standard is all of:

narrow band or warble tone monaural

thresholds with the unaided ear plugged or

masked

an average threshold <= 25db for 500Hz,

1KHz, 2KHz, 3KHz for each ear

a threshold <= 35db for 500Hz, 1KHz, 2KHz,

3KHz for each ear

a threshold <=45db at 4KHz

a speech discrimination test performed in the

prescribed manner that is >=90% correct

responses in the quiet in each ear at 50 db HL

and >= 70% correct responses with

background noise at +5db signal-to-noise ratio

performed binaurally.

Retrocochlear

conditions

These applicants are required to pass the

audiometry standard as above and a speech

discrimination test.

This includes any condition proximal to the ear

including conditions related to cerebral functions,

cognition and thought processing. Of particular

note are:

Past moderate-to-severe head trauma

History of stroke

History of ADD

Learned English as a teenager or later

Significant hearing

loss, tinnitus, ear or

balance conditions

A hearing loss that shows a noise induced

hearing loss pattern requires that the applicant be

issued a hearing conservation advice on the

prescribed form.

Hearing loss in excess of the prescribed workers

compensation threshold (6% at the time of

writing) requires that the applicant be issued a

hearing conservation advice on the prescribed

form.

If there is a history or tinnitus, hearing

conditions or balance conditions then the

applicant be issued a hearing conservation advice

on the prescribed form.

Hearing loss greater

than the prescribed

workers

compensation

threshold

The NSWPF must be notified on the prescribed

form with copies of the audiograms.

20

Audiometry


Pure tone thresholds <= 20db in both ears at 500Hz, 1KHz, 2KHz, 3KHz, 4KHz. This must be

achieved without hearing aid.


Supplementary unaided criteria

If the standard is not met an unaided qualifying standard is all of:

pure tone thresholds in each ear averaging <= 25db for 500Hz, 1KHz, 2KHz, 3KHz

pure tone thresholds in each ear <= 35db for 500Hz, 1KHz, 2KHz, 3KHz

pure tone thresholds in each ear <=35db at 4KHz

a speech discrimination test performed in the prescribed manner (Appendix A) that is >=90%

correct responses in the quiet in each ear at 50 db HL and >= 70% correct responses with

background noise at +5db signal-to-noise ratio performed binaurally.

Supplementary aided criteria [see also recommendation under “notes” attached]

If the standard is not met an aided qualifying standard is all of

narrow band or warble tone monaural thresholds with the unaided ear plugged or masked

an average threshold <=25db for 500Hz, 1KHz, 2KHz, 3KHz for each ear

a threshold <=35db for 500Hz, 1KHz, 2KHz, 3KHz for each ear

a threshold <=45db at 4KHz

a speech discrimination test performed in the prescribed manner (Appendix A) that is >=90%

correct responses in the quiet in each ear at 50db HL and >=70% correct responses with

background noise at +5db signal-to-noise ratio performed binaurally.

Evidentiary Basis

Development of a Hearing Performance Standard for Law Enforcement Officers J American Academy

of Audiology vol7 number 2 April 1996

Medical Screening Manual - California Commission on Peace Officer Standards and Training –

Hearing Guidelines: section XI1

Discussion

The prescribed form (Appendix A) has the relevant instructions for the audiologist performing the

speech discrimination test. Testing that does not conform to these instructions will not be accepted. It

should be noted that the word list should be supplied annotated with the correct and incorrect

responses.

Any audiogram that has significantly different responses in the two ears, has not had this

investigated in the past, has tinnitus in that ear and especially if there is evidence that it has

developed recently without cause, then the applicant must be referred to their treating doctor

with a letter that indicates the possibility of an acoustic neuroma and recommends ENT referral.

21

Retrocochlear conditions


These applicants are required to pass the audiometry standard as above and a speech discrimination

test.


This includes any condition proximal to the ear including conditions related to cerebral functions,

cognition and thought processing. Of particular note are:

Past moderate-to-severe head trauma

History of stroke

History of ADD

Learned English as a teenager or later

Evidentiary Basis


Hearing Guidelines: section XI1

Discussion

This group of conditions takes account of the speech recognition, interpretation and processing by the

brain. While not considered a pathology, learning English as a second language after the age of 14 can

have a significant effect in higher signal-to-noise ratio environments.

Significant hearing loss, tinnitus, ear or balance conditions


A hearing loss that shows a noise induced hearing loss pattern requires that the applicant be issued a

hearing conservation advice on the prescribed form (Appendix B).

Hearing loss in excess of the prescribed workers compensation threshold (6% at the time of writing)

requires that the applicant be issued a hearing conservation advice on the prescribed form (Appendix

B).

If there is a history or tinnitus, hearing conditions or balance conditions then the applicant be issued a

hearing conservation advice on the prescribed form (Appendix B).


None

Evidentiary Basis

NH&MRC guide to the calculation of hearing loss

ANZSA NIHL Management Plan

22

Discussion

The purpose of this criterion is to present the prospective candidate with information concerning NIHL

and to counsel them as appropriate

Hearing loss greater than the prescribed workers compensation threshold


The NSWPF must be notified on the prescribed form with copies of the audiograms.


None

Evidentiary Basis

NH&MRC guide to the calculation of hearing loss

NSW Workers compensation Act and Regulations

Discussion

The purpose of this criterion is to document any prior NIHL above the statutory threshold, 6% at the

time of writing.

The prescribed form will contain the required information and the address for notification of the

hearing loss.

The NSWPF will insist that a claim for compensation be made against a previous employer before the

applicant can be engaged by the NSWPF Department

23

VESTIBULAR

Vestibular Qualifying standard to be reached or

required response or action to be taken


supplementary responses,

requirements or actions

Disorders of

balance

There is an absence of uncontrolled vertigo

or other disturbance of balance for 3 months

or an ENT surgeon’s report that clears the

applicant on the basis of a diagnosis and the

natural history of the disorder.

The stability of the condition will need

to be assessed by a report from the

treating specialist with a particular

statement as to the frequency, severity

and suddenness of the episodes.

Disorders of balance


There is an absence of uncontrolled vertigo or other disturbance of balance for 12 3 months or an ENT

surgeon’s report that clears the applicant on the basis of a diagnosis and the natural history of the

disorder.


The stability of the condition will need to be assessed by a report from the treating specialist with a

particular statement as to the frequency, severity and suddenness of the episodes.

Evidentiary Basis


Commercial Drivers.


Discussion

The examination should include a Rhomberg test. Nystagmus should not affect visual functions.

Any vestibular condition that causes unheralded vertigo and is not effectively treated will not be

acceptable.

24

DRUG/MEDICATIONS/OVER-THE-COUNTER ITEMS

Drug/medications/

over the counter

items

Qualifying standard to be reached

or required response or action to

be taken




Drug testing The testing for recreational drugs and

alcohol is not a medical assessment

criterion.

The testing for recreational drugs and

alcohol can be performed as a service

on the grounds of organisational

efficiency but the policy and actions

that pertain to it are separate from the

medical fitness-to-work decision.

Prescribed medications Where the medication is used under

valid medical supervision see

Medication elsewhere in this

document otherwise treat the use as

recreational.

Over the counter

medications (OTC)

Where the OTC is used under valid

medical supervision, or in the

opinion of the assessment medical

officer is used for valid medically

justified reasons, see Medication

elsewhere in this document otherwise

treat the use as recreational.

Illicit, prohibited,

recreational or illicit

recreational drug use

There is no place in the NSW Police

Force for people who illicitly use

substances.

As part of the medical assessment

this must be asked as a question and

the reply recorded.

An affirmative response to the

consumption of these substances should

lead to:

1) A warning that they are tested for

regularly and can lead to significant

employment implications. The

individual should be referred to the

AOD policy.

2) Sufficient counselling must be

performed to ensure that usage is not

self-medication for an underlying

psychological disorder.

3) Self-harm screening must be

performed.

Drug Testing

There is no place in the NSW Police Force for people who illicitly use substances.


The testing for recreational drugs and alcohol is not a medical assessment criterion.


The testing for recreational drugs and alcohol can be performed as a service on the grounds of

organisational efficiency but the policy and actions that pertain to it are separate from the medical

fitness-to-work decision.

Evidentiary Basis

NSWPF Drug and Alcohol Policy

25

Discussion

The participation in the use of recreational drugs is a legal matter rather than a medical issue in most

cases. Where it represents self-medication for an underlying disorder this is to be taken up in the

relevant medical section of this document.

The testing for alcohol serves to discover those individuals who are so addicted that they cannot stop

even for a pre-employment medical. The consequences of this should be taken up as a

psychological/psychiatric/substance abuse issue.

The use of illicit drugs or steroids, by serving police officers is unacceptable and the procedures to be

followed on the establishment of a positive test are set down in the NSW Police AOD Policy. In

general an applicant returning a confirmed positive test will have their application withdrawn. If it can

be established that the medication was taken to treat a significant underlying psychological/psychiatric

disorder then the issue can be considered under that section of this standard.

Illicit, prohibited, recreational or illicit recreational drug use

There is no place in the NSW Police Force for people who illicitly use substances.


As part of the medical assessment this must be asked as a question and the reply recorded.


An affirmative response to the consumption of these substances should lead to the following actions:

1) A warning will be given that the substances are tested for regularly and can lead to significant

employment implications. The individual should be referred to the AOD policy.

2) Sufficient counselling must be performed to ensure that usage is not self-medication for an

underlying psychological/psychiatric disorder.

3) Self-harm screening must be performed.

Evidentiary Basis

NSWPF Drug and Alcohol Policy

Discussion

The participation in the use of recreational drugs is a legal matter rather than a medical issue in most

cases. Where it represents self-medication for an underlying disorder this is to be taken up in the

relevant medical section of this document.

The testing for alcohol serves to discover those individuals who are so addicted that they cannot stop

even for a pre-employment medical. The consequences of this should be taken up as a

psychological/psychiatric/substance abuse issue.

The use of Illicit drugs or steroids, by serving police officers is unacceptable and the purpose of this

section is to warn clearly those who partake for enjoyment and also to identify and if necessary defer

the application pending further investigation and treatment, for those who use these substance for self-

medication of an underlying disorder.

26

DIABETES – NON-INSULIN TREATED TYPE 2 AND OTHER ENDOCRINE DISORDERS

Non-insulin

treated type 2

diabetes and

other endocrine

disorders

Qualifying standard to be reached or





Stability of the

disorder

The stability of the disorder must be

evaluated. A written agreement on the

prescribed form must be obtained

confirming continued medical review and

compliance with medication.

The report must be on the prescribed

form and a decision made on a risk

assessment basis taking account of the

probability of the occurrence of a

disturbance of the applicant's conscious

state and/or judgement and the

seriousness of the consequences.

In general, if there is a history of

hypoglycaemia that is not unique to a

particular clinical situation, the case

should be treated as an IDDM and

referred to the SPMO.

Disturbance of

consciousness

Disturbance of consciousness is a major

determining factor for qualifying as being

of acceptable risk for front line policing.

A report from the treating specialist

indicating knowledge of the inherent

requirements of front line policing must

be obtained.

Ability to access

regular or

emergency

medication

Medication must be safely accessible in

both the regular treatment cycle and in

times of emergency. To attain both

situations a condition may be necessary -

commonly this will be “to not work

alone”.

Ability to respond

in the case of a

priority or

emergency

The applicant must be able to respond

immediately in an emergency or priority

situation. The effect of shift work of up to

12 hours, lack of sleep, missed meals,

medication or time for medication to act

needs to be risk assessed.

Regular review

and reporting

A review by the treating endocrinologist

with report will be required to be issued

at an interval set at this assessment.

The report will be on the prescribed

form.

Stability of the disorder Disturbance of consciousness Ability to access regular or emergency medication Ability to respond in the case of a priority or emergency


The stability of the disorder must be evaluated. A written agreement on the prescribed form must be

obtained confirming continued medical review and compliance with medication.

Disturbance of consciousness is a major determining factor for qualifying as being of acceptable risk

for front line policing. A report from the treating specialist indicating knowledge of the inherent

requirements of front line policing must be obtained.

Medication must be safely accessible in both the regular treatment cycle and in times of emergency. To

attain both situations conditional employment restriction may be necessary - commonly this will be not

to work alone.

27


The report must be on the prescribed form (Appendix A) and a decision made on a risk assessment

basis taking account of the probability of the occurrence of a disturbance of the applicant's conscious

state and/or judgement and the seriousness of the consequences.

In general, if there is a history of hypoglycaemia that is not unique to a particular clinical situation, the

case should be treated as an IDDM and referred to the SPMO.

Evidentiary Basis


Endocrine: section II.


Commercial Drivers.


Discussion

Endocrine disorders generally

Although the following focuses on diabetes, the principles in relation to optimal therapeutic control and

the maintenance of normal conscious state are the key to risk assessment and decision making.

If there is any doubt as to fitness for front-line policing then the case should be referred to the

SPMO for review.

Diabetes

There are two major competing issues with respect to diabetics and front line policing:

The maintenance of optimal blood sugar levels that predisposes to hypoglycaemic episodes.

The risk of end-organ damage from sub-optimal blood sugar control in order to avoid

hypoglycaemia.

From an operational perspective the avoidance of disturbance of consciousness events is mandatory but

equally the NSWPF cannot either directly or indirectly influence a person to jeopardise their health in

order to gain or retain employment. The disturbance of consciousness can at times be accompanied by

aggressive attitude and an individual may have no recollection of events during the period of low blood

sugar. Combine this with access to a firearm in public and a need for a disciplined approach in a

confrontational situation and it adds a further dimension to the risk beyond the simple inability to

function experienced with other disturbance of consciousness health issues such as cardiovascular

events and epilepsy.

In the past a considerable emphasis has been placed on the ability for high speed driving but this is only

one, and probably a minor, issue in respect to the issue of diabetes and front-line policing. The key

issue is the ability of a police officer to be in control of their conscious state. On a day-to-day basis, for

much of their working time as a police officer, routine will be regular enough that they will be able to

have regular dosing with medication and the consumption of appropriate available meals. However,

there is a regular need for police officers to act precipitously because of emergencies, rendering the

probability high in the long term that they will be subjected to an insulin/food intake imbalance and be

at risk of hypoglycaemia. Such an event may occur in circumstance where they are unable, may be

sufficiently distracted that they forget, or do not perceive the warning signs because of the heightened

physiological state, to take emergency sugar. In general the type 2, non-insulin dependent diabetic will

not be so critically affected by the lowness of their blood sugar troughs that disturbance of

consciousness is an issue.

If there is any doubt as to an applicant’s fitness for front-line policing, if there is a need for

insulin or any there is a history of hypoglycaemia outside of a situation that will not occur while

28

on duty, the case should be referred to the SPMO for review. In taking account of a history

indicating no hypoglycaemic episodes, an normal HbA1c within the optimal range is needed. If

the HbA1c shows poor control, then the applicant should be deferred, not because of the poor

control, but because the response to treatment to attain normal blood sugar levels is unknown.

Regular review and reporting


A review by the treating endocrinologist with report will be required to be issued at an interval set at

this assessment.


The report will be on the prescribed form.

Evidentiary Basis


Endocrine: section II


Commercial Drivers.


Discussion

The NSWPF needs to maintain a current risk assessment for any officer who has a medical condition

that affects, or may affect their ability discharge their duties. To achieve this, the NSWPF will review

the health status of an officer if they suffer from an endocrine disorder. The review must be on a

prescribed form as part of the medical surveillance program for operational police officers.

At the recruitment stage it is necessary to inform the applicant that, should their application be

accepted, then it will be a condition of their engagement as a student and as an officer if attested and

confirmed that they:

Maintain the recommended medical follow-up

Engage in such treatment and medication as is recommended

Inform the NSWPF if there is a change in their health, treatment, medical condition or any

matter in relation to their condition that is pertinent to policing duties

Supply a report from their treating specialist on a prescribed form at regular intervals.

In general the regular reporting will be in the form of a certification to the Local Area Commander that

the above issues are under control and the officer is fit for duties. If a condition requires confidentiality

as a matter of necessity, for example HIV, then the certification can be made via the SPMO.

29

DIABETES – INSULIN DEPENDENT

Insulin dependent diabetes

Qualifying standard to be

reached or required response or

action to be taken




Diabetes Mellitus that

requires insulin for

appropriate glycaemic

control

HbA1c in the range of 6.1 – 8.0

for a period of twelve months

(measured three-monthly) prior to

entry.

Statutory declaration regarding

hypoglycaemic history whilst

well-controlled.

The qualifying standard will not

be met if HbA1c is greater than

8.0, or history of hypoglycaemia

shows evidence of disturbance of

consciousness.

Other parts of this assessment should

be completed but any investigations

and testing should be deferred. An

initial report from their treating

endocrinologist on the prescribed

form can be requested on behalf of

the SPMO to assist.

HbA1c In the range 6.1 – 8.0 for twelve

months prior to joining training

program

Standard is not met if HbA1c is

higher than 8.0

Conscious state A hypoglycaemic episode in the

context of the discussion in this

document is any blood sugar

level, which for a particular

individual, will cause:

loss of consciousness;

disturbance of consciousness;

disturbance of judgement;

loss of attention, memory or

insight;

(or allow) inappropriate

agitation or anxiety state; or

disturbance of ingrained

training protocols)

Standard is not met if an instance of a

hypoglycaemic episode in previous

twelve months whilst in well-

controlled state

Diabetes Mellitus that requires insulin for appropriate glycaemic control


HbA1c in the range of 6.1 – 8.0 for a period of twelve months (measured three-monthly) prior to entry.

Statutory declaration regarding hypoglycaemic history whilst well-controlled.

The qualifying standard will not be met if HbA1c is greater than 8.0, or history of hypoglycaemia

shows evidence of disturbance of consciousness.


Other parts of this assessment should be completed but any investigations and testing should be

deferred. An initial report from their treating endocrinologist on the prescribed form can be requested

on behalf of the SPMO to assist.

30

Evidentiary Basis


Endocrine: section II


Commercial Drivers


Discussion

There are two major competing issues with respect to diabetics and front line policing:

The maintenance of optimal blood sugar levels that predisposes to hypoglycaemic episodes.

The risk of end-organ damage from sub-optimal blood sugar control in order to avoid

hypoglycaemia.

From an operational perspective the avoidance of disturbance of consciousness events is mandatory but

equally the NSWPF cannot either directly or indirectly influence a person to jeopardise their health in

order to gain or retain employment. The disturbance of consciousness can at times be accompanied by

aggressive attitude and an individual may have no recollection of events during the period of low blood

sugar. Combine this with access to a firearm in public and a need for a disciplined approach in a

confrontational situation and it adds a further dimension to the risk beyond the simple inability to

function experienced with other disturbance of consciousness health issues such as cardiovascular

events and epilepsy.

In the past a considerable emphasis has been placed on the ability for high speed driving but this is only

one, and probably a minor, issue in respect to the issue of diabetes and front-line policing. The key

issue is the ability of a police officer to be in control of their conscious state. On a day-to-day basis, for

much of their working time as a police officer, routine will be regular enough that they will be able to

have regular dosing with medication and the consumption of appropriate available meals. However,

there is a regular need for police officers to act precipitously because of emergencies, rendering the

probability high in the long term that they will be subjected to an insulin/food intake imbalance and be

at risk of hypoglycaemia. Such an event may occur in circumstance where they are unable, may be

sufficiently distracted that they forget, or do not perceive the warning signs because of the heightened

physiological state, to take emergency sugar.

In general, a person treated with insulin will not achieve the level of risk management with respect to

loss of consciousness. The risk level of 5% chance of a disturbance of consciousness event in 5 years is

compatible with cardiovascular end epileptic conditions and is used as a standard here.

If an individual’s diabetes and/or mechanism of control is such that their application is accepted, either

conditionally or without restriction, then the NSWPF needs to maintain a current risk assessment for

any officer who has a medical condition that affects, or may affect their ability discharge their duties.

To achieve this, the NSWPF will review the health status of an officer if they suffer from an endocrine

disorder. The review must be on a prescribed form as part of the medical surveillance program for

operational police officers.









In general, the regular reporting will be in the form of a certification to the Local Area Commander that



31

EPILEPSY

Epilepsy Qualifying standard to be reached or

required response or action to be

taken




Stability of the disorder Normally a period of 24 months free of

seizures is required. This can be varied

depending on the diagnosis, known

triggering factors and the results of

MRI and EEG investigations by the

clearing medical officer.

The report must be on the

prescribed form, stating knowledge

of the inherent requirements of

policing, completed by a treating

general practitioner or neurologist

and giving such additional

information as required by the

assessing health professional.

The clearance decision is to be

made on a risk assessment basis

taking account of the probability of

occurrence and the seriousness of

the consequences. In general an

applicant with single unprovoked

seizure, normal EEG and is

compliant on medication, and 24

months without seizure can be

cleared on the information

available. Other applicants with

epilepsy should be referred to the

SPMO for review of the case and

clearance.

Ability to respond in the

case of a priority or

emergency.

The applicant must be able to respond

immediately in an emergency or

priority situation. The effect of shift

work of up to 12 hours, lack of sleep,

missed meals, medication or time for

medication to act needs to be risk

assessed.

Regular review and

reporting

A review by the treating neurologist

with report will be required to be issued

at an interval set at this assessment

The report must be on the

prescribed form.

Stability of the disorder Ability to respond in the case of a priority or emergency


Normally a period of 24 months free of seizures is required. This can be varied depending on the

diagnosis, known triggering factors and the results of MRI and EEG investigations by the clearing

medical officer.

The applicant must be able to respond immediately in an emergency or priority situation. The effect of

shift work of up to 12 hours, lack of sleep, missed meals, medication or time for medication to act



The report must be on the prescribed form, stating knowledge of the inherent requirements of policing,

completed by a treating general practitioner or neurologist and giving such additional information as

required by the assessing health professional.

The clearance decision is to be made on a risk assessment basis taking account of the probability of

occurrence and the seriousness of the consequences. In general an applicant with single unprovoked

seizure, normal EEG and is compliant on medication, and 24 months without seizure can be cleared on

the information available. Other applicants with epilepsy should be referred to the SPMO for review of

the case and clearance.

32

Evidentiary Basis


Neurology: section XI.


Commercial Drivers

National Standard for Health Assessment of Rail Safety Workers – NTC Australia 2004 section 22.

Waterfall report

Discussion

The major issue with epilepsy is disturbance of the conscious state. Work done by Hauser that is

quoted in Medical Screening Manual - California Commission on Peace Officer Standards and

Training – Endocrine would indicate low risk of recurrent seizure for individuals with single

unprovoked seizure, normal EEG is compliant on medication, and 24 months without seizure. A 5%

chance of event occurrence in 5 years appears to be a quantitative level acceptable for safety critical

work (see cardiovascular risk assessment in National Standard for Health Assessment of Rail Safety

Workers – NTC Australia 2004 and the report from the Waterfall Commission of Enquiry in NSW).

The Hauser data indicate that the above criteria will be less than this level.

For other cases the more detailed guidelines in the Assessing Fitness to Drive AUSTROADS September

2003 – National Road Transport Commission Commercial Drivers and National Standard for Health

Assessment of Rail Safety Workers – NTC Australia 2004 (essentially the same) should be used as a

minimum for the risk assessment of an individual. This will be done by the SPMO or an occupational

physician delegated by the SPMO.

A model analogous to the CASA cardiovascular risk assessment used in National Standard for Health

Assessment of Rail Safety Workers – NTC Australia 2004 that is proposed by Chadwick, 1993

Prognostic index for recurrence of seizure after remission of epilepsy BMJ 306:1374-1378 is being

considered for future individual assessments of risk on the broader group of epileptics than those with

the criteria stated above.



A review by the treating neurologist with report will be required annually in a stable situation and in

the absence of seizures Any change in medication or significant inter-current illness constitutes an

“unstable” situation.



Evidentiary Basis


Neurology: section XI.

33


Commercial Drivers.


Discussion



the health status of an officer if they suffer from an epileptic disorder. The review must be on a













34

CEREBROVASCULAR CONDITIONS – STABLE WITH LOW RISK OF RECURRENCE

Cerebrovascular

conditions – stable with

low risk of recurrence



action to be taken




Medical report from the

treating specialist

A medical report supporting the

ability to perform the inherent

requirements of policing will be

required from the treating

specialist.


form, stating knowledge of the

inherent requirements of policing, by

a treating general practitioner or

specialist with such additional


assessing health professional. The

clearance decision is to be made on a

risk assessment basis taking account

of the probability of occurrence and

the seriousness of the consequences.

The workplace implications of a

neurological deficit will require

assessment by an occupational

physician who will need to be

supplied with reports from the

treating specialist(s). Such report

must is to be on the prescribed form.

In particular attention must be paid to

eyesight, cognitive functioning, gross

and fine motor skills and

psychological stability. A functional

capacity assessment from an

occupational therapist may be

required.



emergency

The applicant must be able to

respond immediately in an

emergency or priority situation.

The effect of shift work of up to

12 hours, lack of sleep, missed

meals, medication or time for

medication to act needs to be risk

assessed.

Assessment of neurological

deficit

Any neurological deficit will have

to be assessed in relation to the

body functions that are affected.

The fitness-for-work evaluation

will be determined by the relevant

section of this guideline.

An assessment and report from an

adult educational

psychologist/neuropsychologist

will usually be required in any

case of possible cognitive

impairment

Regular review and

reporting

If there is ongoing treatment, a

review by the treating neurologist

with report will be required to be

issued at an interval set at this

assessment.


form.

Medical report from the treating specialist Ability to respond in the case of a priority or emergency Assessment of neurological deficit


A medical report supporting the ability to perform the inherent requirements of policing will be

required from the treating specialist.




Any neurological deficit will have to be assessed in relation to the body functions that are affected. The

fitness-for-work evaluation will be determined by the relevant section of this guideline.

35



by a treating general practitioner or specialist with such additional information as required by the

assessing health professional. The clearance decision is to be made on a risk assessment basis taking

account of the probability of occurrence and the seriousness of the consequences.

The workplace implications of a neurological deficit will require assessment by an occupational

physician who must be supplied with reports from the treating specialist(s). Such report is to be on the

prescribed form. In particular attention must be paid to eyesight, cognitive functioning, gross and fine

motor skills and psychological stability. A functional capacity assessment from an occupational

therapist may be required.

Evidentiary Basis


Commercial Drivers.


Discussion

A stable cerebrovascular condition is one that will be unlikely to recur and has functional consequences

that are also stable. The applicant should be assessed to record these functional consequences, both

physical and psychological and then they are to be assessed under the respective section dealing with

those areas. The final risk assessment will be the accumulation of the respective risks individually and

together.



If there is ongoing treatment, a review by the treating neurologist with report may be required to be

issued at an interval set at this assessment.



Evidentiary Basis


Commercial Drivers.


Discussion



the health status of an officer if they have ongoing treatment. The review will be on a prescribed form

as part of the medical surveillance program for operational police officers.

36












For those applicants without ongoing treatment, if engaged, their ability to perform the inherent

requirements of the position will be judged on a performance basis.

37

CEREBROVASCULAR CONDITIONS – UNSTABLE, DEVELOPING, RESOLVING

Cerebrovascular

conditions – unstable,

developing, resolving


or required response or action to be

taken

Relevant comments, guidance

or supplementary responses,


A cerebrovascular condition

that is still evolving

Each case of a developing CVA must

be referred to the SPMO for

consideration.

Other parts of this assessment

should be completed but any

investigations and testing should

be deferred. An initial report

from their treating specialist on

the prescribed form can be

requested on behalf of the

SPMO to assist.

Cerebrovascular conditions – unstable, developing, resolving


If there is ongoing treatment, a review by the treating neurologist with report may be required to be

issued at an interval set at this assessment.


Each case of a developing CVA must be referred to the SPMO for consideration.

Evidentiary Basis


Commercial Drivers


Discussion

The risks associated with unstable cerebrovascular conditions relate mostly to the possibility of

syncopal episodes. The material in the section on insulin dependent diabetics can be used as a guide.

In general an applicant that has an unstable cerebrovascular condition will have their application

deferred until it becomes stable, either through treatment or the natural history of the condition.

38

OTHER NEUROLOGICAL CONDITIONS

Other neurological

conditions



action to be taken




Medical report from the

treating specialist

A medical report supporting the

ability to perform the inherent

requirements of policing will be

required from the treating

specialist.


form, stating knowledge of the inherent

requirements of policing, by a treating

specialist with such additional


assessing health professional. The

clearance decision is to be made on a

risk assessment basis taking account of

the probability of occurrence and the


The stability of the condition will be an

important consideration with

disturbance of consciousness a key

determinant in the risk assessment.

The workplace implications of a

neurological deficit will require

assessment by an occupational

physician who will need to be supplied

with reports from the treating

specialist(s). Such report must is to be

on the prescribed form. In particular

attention must be paid to eyesight,

cognitive functioning, gross and fine

motor skills and psychological stability.

A functional capacity assessment from

an occupational therapist may be

required.



emergency




The effect of shift work of up to 12

hours, lack of sleep, missed meals,

medication or time for medication

to act needs to be risk assessed.

Assessment of

neurological deficit

Any neurological deficit will have

to be assessed in relation to the

body functions that are affected.

The fitness-for-work evaluation

will be determined by the relevant

section of this guideline.

An examination and report from an

adult educational

psychologist/neuropsychologist

will usually be required in any case

of possible cognitive impairment

Regular review and

reporting

If there is ongoing treatment, a

review by the treating neurologist

with report maybe required at an

interval set at this assessment.


form.

Medical report from the treating specialist Ability to respond in the case of a priority or emergency Assessment of neurological deficit


A medical report supporting the ability to perform the inherent requirements of policing will be

required from the treating specialist.




Any neurological deficit will have to be assessed in relation to the body functions that are affected. The

fitness-for-work evaluation will be determined by the relevant section of this guideline.

39



by a treating specialist with such additional information as required by the assessing health

professional. The clearance decision is to be made on a risk assessment basis taking account of the

probability of occurrence and the seriousness of the consequences.

The stability of the condition will be an important consideration with disturbance of consciousness a

key determinant in the risk assessment.

The workplace implications of a neurological deficit will require assessment by an occupational

physician who will need to be supplied with reports from the treating specialist(s). Such report must be

on the prescribed form. Particular attention must be paid to eyesight, cognitive functioning, gross and

fine motor skills and psychological stability. A functional capacity assessment from an occupational

therapist may be required.

Evidentiary Basis


Neurology: section XI


Commercial Drivers


Discussion

The applicant should be assessed to record the functional consequences, both physical and

psychological of the neurological condition as they stand at the time of the assessment. The question of

future deterioration is a difficult issue to factor into the overall risk assessment. As an applicant must

complete their time at the College, be confirmed and then work a minimum of three years in general

duties, it is reasonable to consider that there will not be significant deterioration in five years, thus

allowing the applicant time to achieve the practical exposure to be an experience officer and time to

seek appointment to a position suitable for there career aspirations and any pending restrictions. Any

deficits that need to be assessed should be dealt with under the respective section dealing with those

areas. The final risk assessment will be the accumulation of the risks individually and together.



If there is ongoing treatment, a review by the treating neurologist with report maybe required at an



The report must be on the prescribed form.

Evidentiary Basis


Neurology: section XI

40


Commercial Drivers


Discussion



the health status of an officer if they have ongoing treatment. The review must be on a prescribed form

as part of the medical surveillance program for operational police officers.














41

CARDIAC RISK ASSESSMENT AGE < 40 YEARS

Cardiac risk assessment age

< 40 years


reached or required response

or action to be taken




Smoker in the last 4 years or

for greater than 5 years.

Diagnosed with

hyperlipidaemia, diabetes,

hypertension.

Family history

hyperlipidaemia, diabetes,

hypertension.

Family history of a familial

cardiac condition.

Require a formal cardiac risk

assessment and risk level of 15

or less.

The protocol for the cardiac risk

assessment in Appendix A is to be

followed.

BMI > 30 Irrespective of other history

these applicants require a formal

cardiac risk assessment and risk

level of 15 or less..



followed.

Smoker in the last 4 years or for greater than 5 years Diagnosed with hyperlipidaemia, diabetes, hypertension Family history hyperlipidaemia, diabetes, hypertension Family history of cardiac condition


Require a formal cardiac risk assessment and risk level of 15 or less.


The protocol for the cardiac risk assessment in Appendix A is to be followed.

Evidentiary Basis


Cardiovascular: section I.


Commercial Drivers.


CASA cardiac risk assessment tools reference

Discussion

Applicants are required to pass a strenuous physical testing regime before acceptance into the College.

While there, engagement in a continuous physical fitness program is mandatory. The conditions at the

College can vary depending on the time of year, the summer months being especially challenging.

Physical fitness is vital for the effective discharge of the duties of a front line police officer. As well as

concerns for physical fitness and capacity to perform strenuous exercise in, for example pursuit,

detention and/or self defence, an officer cannot be at an unacceptable risk of experiencing disturbance

of consciousness from an infarct or other cardiac condition.

42

The aim of this criterion is to screen subgroups of applicants that may have cardiac risk factors and

have them formally assessed.

BMI > 30


Irrespective of other history these applicants require a formal cardiac risk assessment and risk level of

15 or less..



Evidentiary Basis




Commercial Drivers


CASA cardiac risk assessment tools reference.

Discussion

A BMI >30 is not in itself a criterion for exclusion from the College but it is considered to be correlated

with poor physical and possibly poor cardio-vascular fitness. There will be some individuals who have

a BMI >30 due to muscular development and the performance of the risk assessment would be

expected to result in an acceptable risk level. An assessment of sum-of-skin-folds or of body fat

percentage may be required in such cases.


concerns for physical fitness and capacity to perform strenuous exercise in, for example pursuits, an

officer cannot be at an unacceptable risk of experiencing disturbance of consciousness from an infarct

or other cardiac condition.


While there engagement in a continuous physical fitness program is mandatory. The conditions at the




43

CARDIAC RISK ASSESSMENT AGE >= 40 YEARS

Cardiac risk assessment

age >= 40 years



be taken




Age >=40 but < 45 Require a formal cardiac risk

assessment and risk level of 15 or

less.

Require a negative ECG reported by

a cardiologist.



followed.

Age >= 45 Require a formal cardiac risk

assessment and risk level of 15 or

less.

Require a negative stress ECG

reported by a cardiologist.

Age >=40 but < 45



Require a negative ECG reported by a cardiologist.



Evidentiary Basis


Cardiovascular: section I


Commercial Drivers.



Discussion

The 40 and 45 year break-points were chosen empirically based on experience in sub-maximal exercise

testing of coal industry underground and open-cut mines rescue personal for over ten years.




44


concerns for physical fitness and capacity to perform strenuous exercise in, for example pursuits, an

officer cannot be at an unacceptable risk of experiencing disturbance of consciousness from an infarct

or other cardiac condition.



Age >=45



Require a negative stress ECG reported by a cardiologist.



Evidentiary Basis




Commercial Drivers.



Discussion

The 40 and 45 year break-points were chosen empirically based on experience in sub-maximal exercise

testing of coal industry underground and open-cut mines rescue personal for over ten years.





concerns for physical fitness and capacity to perform strenuous exercise in, for example pursuit,

detention and/or self defence, an officer cannot be at an unacceptable risk of experiencing disturbance

of consciousness from an infarct or other cardiac condition.



45

BLOOD PRESSURE

Blood pressure Qualifying standard to be

reached or required response

or action to be taken


supplementary responses, requirements

or actions

Systolic blood pressure A systolic blood pressure,

measured according to a

recognised protocol, which is

greater than 140mmHg must be

referred to a treating general

practitioner for assessment and a

report is obtained. Confirmed

systolic hypertension needs

cardiologist review.

A report from the treating general

practitioner will be required. Confirmed

hypertension requires cardiologist review.

The requirement for general practitioner

review and report may be waived by the

assessing health professional if, in their

opinion, it is due to the circumstances of the

medical assessment.

Diastolic blood

pressure

A diastolic blood pressure

measured according to a

recognised protocol that is

greater than 90mmHg needs to

be referred to a treating general

practitioner for assessment and a

report is obtained.

Confirmed diastolic

hypertension requires


Systolic blood pressure Diastolic blood pressure


A systolic blood pressure, measured according to a recognised protocol, which is greater than

140mmHg needs to be referred to a treating general practitioner for assessment and a report is obtained.

Confirmed systolic hypertension requires cardiologist review.

A diastolic blood pressure measured according to a recognised protocol that is greater than 90mmHg

needs to be referred to a treating general practitioner for assessment and a report is obtained.

Confirmed diastolic hypertension requires cardiologist review.


A report from the treating general practitioner will be required. Confirmed hypertension requires


The requirement for general practitioner review and report may be waived by the assessing health

professional if, in their opinion, it is due to the circumstances of the medical assessment.

Evidentiary Basis




Commercial Drivers



46

Discussion

This section is provided for the circumstance where hypertension is found at examination. If the

examiner is convinced that the hypertension is due to anxiety at the time, white-coat hypertension, then

they can waive the requirement for further review.

Applicants with treated hypertension should be referred back to their GP if the readings are abnormal.

An applicant with adequately treated hypertension must have their cardiac risk assessed as in the

relevant section of this document.



If there is ongoing treatment of hypertension, a review by the treating general practitioner must be

performed at an interval set at this assessment.



Evidentiary Basis




Commercial Drivers


Discussion


that affects, or may affect their ability discharge their duties. To achieve this, the NSWPF will need to

review the health status of an officer if they have ongoing treatment. The review must be on a















47

CARDIAC MURMURS OR ABNORMAL CARDIAC SOUNDS

Cardiac murmurs or

abnormal cardiac

sounds



action to be taken




Any murmur or

abnormal cardiac sound

These are documented and a letter

of advice, in which there is a

request for diagnosis, issued to the

treating general practitioner. If a

diagnosis is not available in

writing from the general

practitioner, then an echo-

cardiogram and report by a

cardiologist is required.

An echo-cardiogram diagnosis and if

appropriate, measurement of cardiac

function is required. If there is any

dysfunction then a cardiologist report is

required on the prescribed form.

Cardiac murmurs or abnormal cardiac sounds


These are documented and a letter of advice, in which there is a request for diagnosis, issued to the

treating general practitioner. If a diagnosis is not available in writing from the general practitioner, then

an echo-cardiogram and report by a cardiologist is required.


An echo-cardiogram diagnosis and if appropriate, measurement of cardiac function is required. If there

is any dysfunction then a cardiologist report is required on the prescribed form.

Evidentiary Basis




Commercial Drivers.


Discussion

A cardiac murmur is not it itself a medical problem that could lead to rejection of an application.

Important is the underlying cardiac condition and whether this might lead to exercise limitation or an

unacceptable possibility of loss of consciousness.

48

CARDIAC RHYTHM DISTURBANCES

Cardiac rhythm

disturbances



be taken




Stability of the disorder An assessment of the probability of a

syncopal attack or other

incapacitating event must be

evaluated and a report from the

treating cardiologist obtained on the

prescribed form.



requirements of policing, completed by


cardiologist and giving such additional



The clearance decision is to be made on

a risk assessment basis taking account

of the probability of occurrence and the


Ability to respond in

the case of a priority or

emergency



emergency or priority situation. The

effect of shift work of up to 12 hours,

lack of sleep, missed meals,

medication or time for medication to

act needs to be risk assessed.

Regular review and

reporting

A review by the treating cardiologist

with report may be required to be

issued at an interval set at this

assessment.


form.

Stability of the disorder Ability to respond in the case of a priority or emergency


An assessment of the probability of a syncopal attack or other incapacitating event must be evaluated

and a report from the treating cardiologist obtained on the prescribed form.





Evidentiary Basis




Commercial Drivers.


Discussion

The major issue with a cardiac rhythm disturbance is the possibility of a disturbance of consciousness.

Because of the suddenness of this happening the risk must be low. Refer to the discussion in the

sections relating to cardiac risk assessment, epilepsy and insulin dependent type 1 diabetes.

49

The risk of an arrhythmia producing a disturbance of consciousness should be no greater than 5% in 5

years given suitable treatment and mandatory compliance.

No specific investigations have been specified, the actual investigations are left to the treating and

assessing medical practitioners. The only qualification is that such investigations are done as are

appropriate for the assessment of the risk.

If disturbance of consciousness is not an issue but other effects of the arrhythmia exist, then the case

should be referred to the Senior Police Medical Officer.



A review by the treating cardiologist with report may be required to be issued at an interval set at this

assessment.



Evidentiary Basis




Commercial Drivers.


Discussion



review the health status of an officer if they have ongoing treatment. The report following the review

must be on a prescribed form as part of the medical surveillance program for operational police

officers.

In general review will be required if the condition is not stable, if there is medical treatment, a

pacemaker is used or if the assessing or clearing medical officer considers regular testing is required.














50

PACEMAKER Pacemaker Qualifying standard to be reached


be taken




Stability of the

underlying disorder

An assessment of the probability of a

syncopal attack or other

incapacitating event must be

evaluated. A report from the treating

cardiologist will be required.














emergency.







act must be risk assessed.

Regular review and

reporting

A review by the treating cardiologist

with report may be required to be

issued to the employer at an interval

set at this assessment.

The report must will be on the

prescribed form.

Stability of the underlying disorder Ability to respond in the case of a priority or emergency


An assessment of the probability of a syncopal attack or other incapacitating event must be evaluated.

A report from the treating cardiologist will be required.



completed by a treating general practitioner or cardiologist and giving such additional information as



occurrence and the seriousness of the consequences.

Evidentiary Basis




Commercial Drivers.


Discussion

The major issue with a cardiac rhythm disturbance is the possibility of a disturbance of consciousness.

Because of the suddenness of this happening the risk must be low. Refer to the discussion in the

sections relating to cardiac risk assessment, epilepsy and insulin dependent type 1 diabetes.

51

The risk of an arrhythmia producing a disturbance of consciousness should be no greater risk level than

5% in 5 years given that here is suitable treatment and mandatory compliance.

No specific investigations have been specified, the actual investigations are left to the treating and

assessing medical practitioners. The only qualification is that such investigations are done as are

appropriate for the assessment of the risk.

If disturbance of consciousness is not an issue but other effects of the arrhythmia exist, then the case

should be referred to the Senior Police Medical Officer.



A review by the treating cardiologist with report may be required to be issued at an interval set at this

assessment.



Evidentiary Basis




Commercial Drivers.


page 30.

Discussion





officers.

In general review will be required if the condition is not stable, if there is medical treatment, a

pacemaker is used or if the assessing or clearing medical officer considers regular testing is required..














52

OTHER CARDIO-VASCULAR DISEASE AND DISORDERS

Other cardio-vascular

disease and disorders



be taken




Medical clearance A medical report on the prescribed

form will be required from the

treating cardiologist.












Disturbance of consciousness, the

stability of the condition and exercise

capacity are important.



emergency.







act needs to be risk assessed.

Physical capacity The cardio-vascular capacity to

perform physical maximal work

without a significant risk of causing,

exacerbating or precipitating a

cardiac event must be evaluated.

This will usually require the results of

an exercise ECG or the equivalent to be

performed.

Regular review and

reporting

If there is ongoing treatment or the

condition may change, a review by

the treating cardiologist with report

maybe required to be issued at an



form.

Medical clearance Ability to respond in the case of a priority or emergency


A medical report on the prescribed form will be required from the treating cardiologist.






completed by a treating general practitioner or cardiologist and giving such additional information as



occurrence and the seriousness of the consequences. Disturbance of consciousness, the stability of the

condition and exercise capacity are important.

53

Evidentiary Basis




Commercial Drivers


Discussion

This catch-all section for cardio vascular conditions includes, but is not limited to, myocardial

insufficiency syndromes and infarcts, major vessel aneurysms, cardio-vascular operations and

procedures, varicose veins, vasculitic conditions, conduction abnormalities, ECG abnormalities, heart

failure, cardiomyopathy, pulmonary embolism and valvular disease.

The major issue with a cardiac condition is the possibility of a disturbance of consciousness through

arrhythmia or the chance of precipitating a significant cardiac event such as an infarct. Because of the

suddenness of this happening the risk must be low. Refer to the discussion in the sections relating to

cardiac risk assessment, epilepsy and insulin dependent type 1 diabetes. The risk level disturbance of

consciousness or infarct should be no greater risk level than 5% in 5 years given that here is suitable

treatment and mandatory compliance with this prescribed treatment.

If there is any doubt concerning the risk assessment then the case should be referred to the Senior

Police Medical Officer.

Physical capacity


The cardio-vascular capacity to perform physical maximal work without a significant risk of causing,

exacerbating or precipitating a cardiac event must be evaluated.


This will usually require the results of an exercise ECG or the equivalent to be performed.

Evidentiary Basis




Commercial Drivers.


Recruitment Physical Testing Guidelines.

Discussion

An applicant has to perform strenuous physical testing before their application is accepted and then

ongoing physical fitness activity during their training. This section is included to ensure that the

applicant has the cardiovascular capacity to undergo such physical activities.

54

As an operational police officer the need for physical activity is variable with much time spent in

relatively sedentary activities. But regularly an officer will be required to pursue a person of interest,

detain them and/or defend themselves or members of the public. This need to move from sedentary to

high physical exertion needs to be borne in mind when risk decisions are made in respect to cardiac

issues.



If there is ongoing treatment or the condition may change, a review by the treating cardiologist with

report may be required at an interval set at this assessment.



Evidentiary Basis




Commercial Drivers.


Discussion





officers.

In general review will be needed if the condition is not stable, if there is medical treatment, a

pacemaker is used or if the assessing or clearing medical officer considers regular testing is needed.














55

MOOD DISORDERS

Mood disorders Qualifying standard to be reached


be taken




Major mood disorders Major mood disorders: a report from

a treating psychiatrist is required.

The report must include a statement in

relation to self-harm, impulsivity and

attention span. The report must also

note the medication, dose and any side-

effects.

Generally an applicant will need to be

symptom-free for two years and not

requiring any medication.

A history of recurrence will increase

the risk and make the deferral longer.

Adjustment disorders,

other mood disturbances

and personality variants

A report from the treating general

practitioner is required. A report

from a psychiatrist may be required

by the assessing or clearing

practitioner.



emergency.

The applicant must be able to cope

with the psychological impact of

front line policing including fatigue,

aggressive behaviour against them

and personal attack both verbal and

physical

Psychometric testing A result from a K10, DAS21/42 or

other instrument recommended by a

clinical psychologist should fall

within the normal range.

A K10, DAS21/42 or other instrument

recommended by a clinical

psychologist should be administered as

part of the medical assessment. A

report from a treating psychiatrist will

be required on the prescribed form.

Major mood disorders Adjustment disorders, other mood disturbances and personality variants Ability to respond in the case of a priority or emergency.


Major mood disorders require a report by a treating psychiatrist.

The applicant must be able to cope with the psychological impact of front line policing including

fatigue, aggressive behaviour against them and personal attack both verbal and physical

The applicant must be able to cope with the psychological impact of front line policing including

fatigue, aggressive behaviour against them and personal attack both verbal and physical


The report must include a statement in relation to self-harm, impulsively and attention span. The report

must also note the medication, dose and any side-effects.

Generally an applicant will need to be symptom-free for two years and not requiring any medication.

A history of recurrence will increase the risk and make the deferral longer.

Evidentiary Basis


Commercial Drivers.


56

Discussion

Policing is a psychologically demanding profession as is evidenced by the high rate of psychological

injury and the specialised psychological assessment services within the NSWPF. The carrying of a

firearm in public needs a stable mental state and clear sensorium. Any impairment of reality testing is

not acceptable.

Individuals with recurrent mood disturbance, especially if it is not reactive to a stressor, are at risk of

exacerbation by the demands of policing. The use of anti-depressant medication, although it comes

with warnings inconsistent with firearm use, has not been shown to be an issue with policing as long as

there are no side-effects. The reason for insisting a student is medically certified as no longer requiring

medication is that an applicant should either be fully recovered from an episode and off medication, or

they have an underlying psychological disorder which would be likely to make the possession of a

firearm an unpredictable risk.

It should be noted that people in these categories are not refused entry into the NSWPF, they are

deferred until they have recovered.

Psychometric testing


A result from a K10, DAS21/42 or other instrument recommended by a clinical psychologist should

fall within the normal range.


A K10, DAS21/42 or other instrument recommended by a clinical psychologist should be administered

as part of the medical assessment. If the result indicates possible underlying psychological issues then a

report from a treating psychiatrist will be required on the prescribed form.

Evidentiary Basis


Commercial Drivers


Australian Police research Psychological Document

Discussion

Psychometric testing varies widely in its complexity and it is impractical to have the more advanced

test during the pre-employment assessment. All applicants have a MMPI-2 administered while at the

College and psychiatric follow-up if appropriate. The purpose of the current testing is to screen for

disorders at an early stage and to arrange psychiatric assessment as soon as possible if indicated.

57

PSYCHOTIC ILLNESS

Psychotic illness Qualifying standard to be reached


be taken




Established psychotic

illness

Established psychotic illness is

incompatible with front-line policing

and such applicants will be

considered as not meeting the

required standard.

A person with a brief psychotic

episode, defined precipitating cause, a

short period and rapid response to

treatment can be referred to the SPMO

for review of the case.

Established psychotic illness


Established psychotic illness is incompatible with front-line policing and such applicants will be

considered as not meeting the required standard..


A person with a brief psychotic episode, defined precipitating cause, a short period and rapid response

to treatment can be referred to the SPMO for review of the case.

Evidentiary Basis


Commercial Drivers.


Australian Police research Psychological Document

Discussion

Policing is a psychologically demanding profession as is evidenced by the high rate of psychological

injury and the specialised psychological assessment services within the NSWPF. The carrying of a

firearm in public needs a stable mental state and clear sensorium. Any impairment of reality testing is

not acceptable..

58

SLEEP DISORDERS

Sleep disorders Qualifying standard to be


action to be taken




Narcolepsy and sleep

apnoea

Inadequately treated narcolepsy or

sleep apnoea is incompatible with

front line policing. The applicant

will be deferred until the condition

is adequately treated. A report will

be required from the treating

specialist

An Epworth Sleepiness Scale or the

equivalent validated instrument must be

administered as part of the medical

assessment.

Sleep apnoea that is mild may be cleared

on the basis of a general practitioner

report. The opinion and report of a sleep

physician will be required other cases of

sleep apnoea and cases of narcolepsy.

Narcolepsy and sleep apnoea


Inadequately treated narcolepsy or sleep apnoea is incompatible with front line policing. The applicant

will be deferred until the condition is adequately treated. A report will be required from the treating

specialist


An Epworth Sleepiness Scale or the equivalent validated instrument must be administered as part of the

medical assessment.

Sleep apnoea that is mild may be cleared on the basis of a general practitioner report. The opinion and

report of a sleep physician will be required in other cases of sleep apnoea and cases of narcolepsy.

Evidentiary Basis


Commercial Drivers.


Discussion

Alertness and resistance to sleep pattern changes are important for policing because of periods of

inactivity interspersed with unpredictable demands for responses when the officer must be fully

mentally functional. Patrol work in a vehicle and night driving have been reported by sleep apnoea

affected officers to be particularly problematic.

A case of narcolepsy treated with an amphetamine class medication must be referred to the SPMO.

59

SKIN DISORDERS Skin disorders Qualifying standard to be


action to be taken




Skin infections A report from a treating general

practitioner or specialist is

required. Each case will be

assessed on an individual basis.

A report from a treating general

practitioner or specialist on the prescribed

form is required.

Other skin disorders The capacity of the skin to act as a

barrier must be assessed. If suitable

protection cannot be achieved then

restrictions are needed and may

make the person incompatible with

front line policing duties.

A report from a treating general

practitioner, and in severe cases a treating

dermatologist may be needed. This must

be on the prescribed form.

Skin infections


A report from a treating general practitioner or specialist is required. Each case will be assessed on an

individual basis.


A report from a treating general practitioner or specialist on the prescribed form is required.

Evidentiary Basis


Dermatology: section II

Discussion

Skin infections are a concern in respect to their capacity to spread an infective agent and/or allow a

mode of inoculation by another infective agent because of the loss of the skin protective barrier.

As most skin infections are temporary, the applicant should be deferred until the condition has

resolved. If there is recurrence due to an underlying condition, refer to the general dermatological

section below.

60

Other skin disorders

Skin disorders may be primarily a skin disease or may be a manifestation of systemic disease, in which

case the effect of that systemic disease on the applicant’s ability to perform safely the Inherent

Requirements of a Front Line Police Officer will be the determining issue.


The capacity of the skin to act as a barrier must be assessed. If suitable protection cannot be achieved

then restrictions are needed and may make the person incompatible with front line policing duties.


A report from a treating general practitioner, and in severe cases a treating dermatologist will may be

needed. This must be on the prescribed form.

Evidentiary Basis


Dermatology: section II.

Discussion

The two issues that would impact on an applicant’s capacity to perform their duties as a police officer

relate to the integrity of the skin as a barrier to infection (e.g. hepatitis B, C, HIV) during a body fluid

incident and comfort matters if the affected areas do not allow for ease of sitting and moving.

Often conditions are relapsing and recurring and the final decision will be determined by the frequency

with which these two criteria can be fulfilled and the effectiveness of protective dressings during an

exacerbation.

61

RESPIRATORY

Respiratory Qualifying standard to be


action to be taken




Respiratory assessment The WorkCover respiratory

questionnaire and spirometry

according to their methodology

must be completed. FEV1/FVC

>=75% and FVC >=80% predicted

value is required.

Clinical judgement may be used if the

assessment indicates measurement

problems as the cause of the abnormal

spirometry. A detailed history and

examination will be needed, including

sporting/ recreational history, in order

to support this clinical judgement.

Past or current history of

asthma

Each case needs to be assessed on

the history, examination and

spirometry results. A past history

of hospital admission for severe

asthma is significant If there is

doubt as to suitability then a report

from a respiratory physician is

needed with a eucapnoeic

hyperventilation test for exercise

induced asthma and saline

challenge testing [or equivalent]..

The issue is rarely one of the

applicant's ability to perform their work

on a daily basis. Important is their

ability to withstand the use of

incapacitating chemical agents used for

self-defence, their ability to withstand

adverse weather conditions such as

cold and fog or in dusty and pollen

laden air, in particular during an

emergency situation. These criteria

must be conveyed to the respiratory

physician when the report is requested.

The treating specialist must complete a

report on a prescribed form stating

knowledge of the inherent requirements

of policing.

Other respiratory disease A report from a respiratory

specialist is required.

Important is their ability to withstand

the use of incapacitating chemical

agents used for self-defence, their

ability to withstand adverse weather

conditions such as cold and fog or in

dusty and pollen laden air, in particular

during an emergency situation. These

criteria must be conveyed to the

respiratory physician when the report is

requested. The treating specialist must

complete a report on a prescribed form

stating knowledge of the inherent

requirements of policing.

Exercise capacity The applicant will need to be able

to pass the physical testing

schedule for recruitment.

This level of fitness is tested by a

shuttle run. The exercise capacity for

front line policing is considered to be

equivalent to 40 ml O2/kg/min.



emergency




The effect of shift work of up to 12

hours, lack of sleep, missed meals,

medication or time for medication

to act needs to be risk assessed.

This criterion needs to be considered

when referring the applicant for an

opinion and in clearing them to proceed

to training

62

Respiratory assessment


The WorkCover respiratory questionnaire and spirometry according to their methodology must be

completed. FEV1/FVC >=75% and FVC >=80% predicted value is required.


Clinical judgement may be used if the assessment indicates measurement problems as the cause of the

abnormal spirometry. A detailed history and examination will be required, including sporting/

recreational history, in order to support this clinical judgement.

Evidentiary Basis


Respiratory: section X.


Commercial Drivers.


Discussion

The history, examination and spirometry are used as the screening tests for lung function sufficient to

sustain the required exercise capacity. Such capacity may be limited by cardiac or physical fitness

issues and these are covered in the relevant sections. In the absence of such other causative factors,

clear history, examination and spirometry will correlate highly with the required exercise capacity and

the applicant can safely proceed to the physical testing.

If the applicant is an asthmatic on medication or has a history of asthma, even if they have a normal

lung function test, they will require formal testing for irritable airways as in the next section.

Past or current history of asthma


Past or current history of asthma


The issue is rarely one of the applicant's ability to perform their work on a daily basis. Important is

their ability to withstand the use of incapacitating chemical agents used for self-defence during an

emergency situation. This criterion must be conveyed to the respiratory physician when the report is

requested. The treating specialist must complete a report on a prescribed form stating knowledge of the

inherent requirements of policing.

Evidentiary Basis


Respiratory: section X

63


Commercial Drivers


Discussion

An applicant should be able to achieve the same results as a member of the normal population so that

their risk to bronchospasm when exposed to irritating combative spray, adverse weather conditions

such as cold and fog and to dusty or pollen laden air is acceptable. They can continue to use such

medication as is needed. It will be a condition of their employment that they continue to take treatment

as prescribed by their treating practitioner.

Other respiratory disease


A report from a respiratory specialist is required.


Important is their ability to withstand the use of incapacitating chemical agents used for self-defence,

adverse weather conditions such as cold and fog, dusty or pollen laden air particularly during an

emergency situation. These criteria must be conveyed to the respiratory physician when the report is

requested. The treating specialist must complete a report on a prescribed form stating knowledge of the


Evidentiary Basis




Commercial Drivers


Exercise capacity


The applicant must pass the physical testing schedule for recruitment.


This level of fitness is tested by a shuttle run. The exercise capacity for front line policing is considered

to be equivalent to 40 ml O2/kg/min.

64

Evidentiary Basis




Commercial Drivers.


Ability to respond in the case of a priority or emergency






These is criteria needs to be considered when referring the applicant for an opinion and in clearing

them to proceed to training.

Evidentiary Basis


Respiratory: section X


Commercial Drivers.


Discussion

With the exception of oral corticosteroids, asthma which is optimally controlled on medication will

generally be acceptable. Applicants who have required treatment with corticosteroids for only a short

time should be referred to the SPMO for opinion.

65

INFECTIOUS DISEASES

Infectious disease Qualifying standard to be reached


be taken




Hepatitis B Blood test must show immunity

Hepatitis A Nil for recruitment Applicant should be aware that immunity

will be required for certain specialist roles

within the organisation

HIV-AIDS Viral load negative

Hepatitis B


Blood test must show immunity


Evidentiary Basis

NSW Police Force Policy – Infection Control v2 2008


Commercial Drivers

National Standard for Health Assessment of Rail Safety Workers – NTC Australia 2004 section 7 46.

MIMS Annual – June 2006 – CMPMedica Australia Pty Limited – www.mims.com.au

Hepatitis A


Nil for recruitment, but applicant to be aware that immunity will be required for certain specialist roles

within the organisation.

Evidentiary Basis



Commercial Drivers.

National Standard for Health Assessment of Rail Safety Workers – NTC Australia 2004 section

7.MIMS Annual – June 2006 – CMPMedica Australia Pty Limited – www.mims.com.au

HIV-AIDS


Viral-load negative

66

Reporting requirements


Evidentiary Basis



Commercial Drivers



http://www.mims.com.au/

67

MEDICATION

Medication Qualifying standard to be reached


be taken




Prescribed medication A report must be available from a

medical practitioner.

The requirement for a treating medical

practitioner report may be waived by the

assessing or clearing medical practitioner

if, in their opinion, the nature of the

medication and the medical disorder do

not warrant this advice.

The applicant must be advised to

familiarise themselves with the consumer

medical information now mandated to be

available for all prescribed medications,

noting in particular any warnings in

relation to driving, machinery and

alertness.

Over-the-counter

medication

The applicant is required to list such

medication and state the reason for

taking it.

The clearing doctor should consider

advice or restrictions as appropriate with

particular attention to the reason the

preparation is being taken. Review and

report by the applicants treating general

practitioner may be required.

Vitamins, herbal

preparations,

alternative and

complementary

medicines

The applicant is required to list such

preparations and state the reason for

taking them.

The clearing doctor should consider

advice, or restrictions as appropriate, with

particular attention to the reason the

preparation is being taken. Review and

report by the applicants treating general

practitioner may be needed.



emergency




Medication/preparation/formulation

or time for these to act needs to be

risk assessed.

The treating doctor/specialist must

complete a report on a prescribed form

stating knowledge of the inherent


Side-effects The existence of the side-effects of

any medication, remedy or

preparation must be evaluated and

cleared.

Review and report by the applicants

treating general practitioner may be

needed. The need will depend on the

medication and judgement should be

exercised by the assessing and clearing

doctors.

Prescribed medication


A report must be available from a medical practitioner.


The requirement for a treating medical practitioner report may be waived by the assessing or clearing

medical practitioner if, in their opinion, the nature of the medication and the medical disorder do not

warrant this advice.

68

The applicant must be advised to familiarise themselves with the consumer medical information now

mandated to be available for all prescribed medications, noting in particular any warnings in relation to

driving, machinery and alertness.

Evidentiary Basis


Commercial Drivers

National Standard for Health Assessment of Rail Safety Workers – NTC Australia 2004 section 7 46.


Discussion

There is such a wide range of medication available that prescribed rules are not feasible. A risk based

approach must be taken in respect to the possibility of a disturbance of consciousness and/or a

disturbance of judgement. A too cautious approach will force individuals to discontinue medication too

early in order to have their application accepted when they would be safer on the medication and

appropriately monitored. The discussion of disturbed consciousness in the sections on epilepsy and

insulin dependent diabetes is a guide to the level of acceptable risk which should be assessed as

“remote’ if the standard is to be met.

The use of psychoactive medication, in particular anti-depressants and sedatives is not uncommon in

employed police officers. The use of these medications is not in itself a reason for the rejection of an

application; it is the fact that their use indicates existing and currently active psychological conditions

that result in a decision to defer until the underlying issues are resolved.

In general, an applicant and an assessing and clearing doctor should be cognisant of, and guided by, the

consumer medical information now legally required to be available for all prescription medication.

A police officer is required to be available for duty at all reasonable times unless restricted. If an officer

has a medical condition that requires medication and agrees to take the medication (or other treatment)

in order to be accepted for training, participate in training and be fully operational, then it is an integrity

issue that they conform to the prescribed treatment or inform their Commander (or delegate) or in

exceptional circumstance the SPMO. This responsibility must be conveyed to any applicant taking

medication. It is considered an act of dishonesty for an officer to manipulate medication to the

detriment of their health, without supporting medical advice and the agreement of the NSWPF, in order

to remain operational. The same opinion is held for applicants who do, or have, done. this to have their

application accepted.

A change in the status of medication (type, dose, frequency, formulation) should be discussed with the

treating doctor and any significant risk of a change in their workplace performance should be

communicated to the Commander who would usually discuss this with the SPMO. This responsibility

must be conveyed to any applicant taking medication.

Over-the-counter medication


The applicant is required to list such medication and state the reason for taking it.

69


The clearing doctor should consider advice or restrictions as appropriate with particular attention to the

reason the preparation is being taken. Review and report by the applicants treating general practitioner

may be required

Evidentiary Basis


Commercial Drivers.

National Standard for Health Assessment of Rail Safety Workers – NTC Australia 2004 section

7.MIMS Annual – June 2006 – CMPMedica Australia Pty Limited – www.mims.com.au

Discussion

It is wrong to believe that unless a formulation is prescribed, it is harmless and does not require of

careful consideration. The comments made under the section of prescribed medication are equally

applicable here. In particular formulations such as St Johns Wort , used for depression, codeine

containing formulations (for example Panadeine, Panadeine 15, Panamax co, Nurofen Plus, Dymadon

co) and other analgesics containing narcotics or the equivalent (Mersyndol, Digesic, Capadex) should

be evaluated with caution. The issues are twofold: is the underlying condition for which the

medication is taken and the possible need for deferral until this is addressed, and the possibility of

impairment of performance due to the medication itself. A key factor in the risk assessment is the

frequency of use and reliance for dealing with particular medical situations.

Vitamins, herbal preparations, alternative and complementary medicines.


The applicant is required to list such preparations and state the reason for taking them.


The clearing doctor should consider advice, or restrictions as appropriate, with particular attention to

the reason the preparation is being taken. Review and report by the applicants treating general

practitioner may be required..

Evidentiary Basis


Commercial Drivers


MIMS Annual – June 2006 – CMPMedica Australia Pty Limited – www.mims.com.au Discussion

A major factor with this group is the actual active components of the formulation, the consistency of

the formulation and the possibility of contamination. The comments in respect to prescribed medication

and OTC formulations is a guide but this group should be viewed with suspicion and the exact product,

supplier and reason for use carefully considered..

http://www.mims.com.au/

70

Ability to respond in the case of a priority or emergency


The applicant must be able to respond immediately in an emergency or priority situation.

Medication/preparation/formulation or time for these to act must be risk assessed.


The treating specialist must complete a report on a prescribed form stating knowledge of the inherent


Evidentiary Basis


Commercial Drivers.



Discussion

The assessing Doctor should exercise judgement as to when a report is required for a medication or

other formulation in respect to the officer’s capacity to respond in an emergency.

Side-effects


The existence of the side-effects of any medication, remedy, formulation or preparation must be

evaluated and cleared.


Review and report by the applicant’s treating general practitioner may be required. This will depend on

the medication and judgement should be exercised by the assessing and clearing doctors.

Evidentiary Basis


Commercial Drivers.



Discussion

The assessing Doctor should exercise judgement as to when a report is required to determine whether

or not taking medication or other formulation is relevant to the officer’s capacity to respond in an

emergency.

71

MUSCULO-SKELETAL

Musculo-skeletal Qualifying standard to be reached or





Musculo-skeletal

history

The applicant must complete a history on

the prescribed form for any musculo-

skeletal injury or illness and the assessing

health professional must comment on all

positive responses. Where an issue is

identified by the assessing health

professional further questioning and

medical report may be needed.


perform the physical needs of the


They will undergo a maximal

exercise test and other functional

assessment. The major focus of the

current clearance is to certify them fit

for such testing.

Musculo-skeletal

examination

The applicant must complete a screening

examination of the musculo-skeletal

system, recorded on the prescribed form

by the assessing health professional.

Where an issue is identified by the

assessing health professional further

questioning and medical report may be

required.

Musculo-skeletal history


The applicant must complete a history on the prescribed form for any musculo-skeletal injury or illness

and the assessing health professional must comment on all positive responses. Where an issue is

identified by the assessing health professional further questioning and medical report may be required..

The applicant must complete a screening examination of the musculo-skeletal system, recorded on the

prescribed form by the assessing health professional. Where an issue is identified by the assessing

health professional further questioning and medical report may be required..


The applicant must be able to perform the physical needs of the inherent requirements of policing.

They will undergo a maximal exercise test and other functional assessment. The major focus of the

current clearance is to certify them fit for such testing.

Evidentiary Basis

Medical Screening Manual - California Commission on Peace Officer Standards and Training – section

VIII

NSWPF information sheet for applicants: PHYSICAL CAPACITY TESTING

Discussion

The aim of the medical assessment is to ensure the applicant can participate in the practical physical

testing that is part of the recruiting process. There are requirements under the cardiovascular and

respiratory sections and this section aims to ensure musculo-skeletal function and integrity.

Broadly the application must have a full range-of-movement, normal tone, normal coordination and

normal power to be able to be cleared.

For those applicants with significant disabilities a practical assessment by the Operational Safety and

Training Unit is possible by arrangement with the SPMO.

72

OBESITY

Obesity Qualifying standard to be reached or


taken




Obesity as measured by body mass

index (BMI), waist/abdomen/hip

circumference or skin-fold thickness

and is not, in itself. a criterion for

exclusion.

Measurements of obesity are

recommended but the result must be

interpreted by the assessing and

clearing health professional based on

the overall capacity of the applicant to

perform the job.

Obesity


Obesity as measured by body mass index (BMI), waist/abdomen/hip circumference or skin-fold

thickness is not, in itself, a criterion for exclusion.


Measurements of obesity are recommended but the result must be interpreted by the assessing and

clearing health professional based on the overall capacity of the applicant to perform the job.

Discussion

Obesity is correlated with lack of physical, cardio-vascular and general fitness as well as decreased

exercise tolerance. There are some cases where a BMI can be misleading.

In general, the tests for body fat should be performed and used to initiate cardiac, general or specific

fitness evaluation. Tests of obesity are not, in themselves, criteria for failing or deferring a candidate.

73

VACCINATIONS

Vaccinations Qualifying standard to be reached


be taken




Document

vaccinations

The applicant must either be able to

establish their hepatitis B and tetanus

immunity, sign a declaration of

conscientious objection or sign an

acknowledgement of their lack of

response to vaccination.

Vaccination for tetanus, hepatitis B

should be documented as a minimum. If

vaccination is complete then hepatitis

antibody status should be supplied.

Individuals are advised to have hepatitis

B vaccination as a public health measure.

Vaccinations


The applicant must either be able to establish their hepatitis B and tetanus immunity, sign a declaration

of conscientious objection or sign an acknowledgement of their lack of response to vaccination,

preferably supported by certification by a treating doctor.


Vaccination for tetanus, hepatitis B should be documented as a minimum. If vaccination is complete

then hepatitis antibody status should be supplied.

Individuals are advised to have hepatitis B vaccination as a public health measure.

Evidentiary Basis

NH&MRC Guidelines for Immunisation

Discussion

Police regularly deal with a stratum of society that is at risk of a range of infectious diseases. This

contact is often adversarial and the possibility of body fluid exchange is ever present. Where possible

standard precautions should be applied but in the urgency of some situations is not possible. Hepatitis

B and tetanus are preventable by vaccination (except for 4% for hepatitis B) and applicants should be

strongly urged to receive relevant immunisation. Because of the non-responder rate for hepatitis B,

antibody status checking is strongly advised. [reviewer’s note: to say that in “many situations” the

exercise of standard precautions “is not possible”, in my view, places NSWP at risk. Even substituting

“some” for “many” is not ideal. Reference to Personal Protection equipment and training should,

perhaps be included]

74

ATTENTION DEFICIT [HYPERACTIVITY] DISORDER

ADD Qualifying standard to be reached or


taken




A diagnosis of ADD

at any time

A report from an independent

psychiatrist specialising in this disorder

is required

This disorder must be differentiated

form ADHD

Learning difficulties There will need to be a clearance from

an appropriately qualified clinical

psychologist knowledgeable in

educational assessments.

Although the assessments instruments

will be largely a decision of the

assessing psychologist, there will be a

set that will be required to be

administered as set out in the appendix.

Medication All medication must be ceased for a

period of 12 months before any

assessment

Of particular concern is the use of

amphetamine based medications.

ADHD Qualifying standard to be reached or


taken




A diagnosis of

ADHD at any time

A report from an independent

psychiatrist specialising in this disorder

is required

This disorder must be differentiated

form ADD

Learning difficulties There will need to be a clearance from

an appropriately qualified clinical

psychologist knowledgeable in

educational assessments.

Assessment instruments will be largely

the decision of an assessing

psychologist or neuropsychologist. ,

The appendix will detail specific

instruments to be applied..

Impulsive behaviour Each case of ADHD must be referred

to the SPMO for clearance

Each will be considered on its merits

but any form of impulsive behaviour is

an unacceptable risk to firearms access

Medication All medication must be ceased for a

period of 12 months before any

assessment

Of particular concern is the use of

amphetamine based medications.

Attention-Deficit Disorder


A report from an independent psychiatrist specialising in this disorder is required

There will need to be a clearance from an appropriately qualified clinical

psychologist/neuropsychologist knowledgeable in educational assessments.

All medication must be ceased for a period of 12 months before any assessment


This disorder must be differentiated form ADHD

Assessment instruments will be largely a decision of an assessing psychologist or neuropsychologist.,

The appendix will detail specific instruments to be applied.

Of particular concern is the use of amphetamine based medications.

75

Evidentiary Basis

DSM-IV

Discussion

The major issue with ADD is its association with learning difficulties. Applicants with ADD should be

aware that their acceptance into the College will mean that they are required to perform tasks that can

require high levels of concentration and they may be found unsuitable subsequent to starting.

Attention-Deficit Hyperactivity Disorder


A report from an independent psychiatrist specialising in this disorder is required

There will need to be an opinion from an appropriately qualified clinical psychologist knowledgeable

in educational assessments.

Each case of ADHD must be referred to the SPMO for clearance

All medication must be ceased for a period of 12 months before any assessment


This disorder must be differentiated form ADHD

Assessment instruments will be largely a decision of an assessing psychologist or neuropsychologist ,

The appendix will detail specific instruments to be applied.

Each case will be considered on its merits but any form of impulsive behaviour is an unacceptable risk.

Of particular concern is the use of amphetamine based medications.

Evidentiary Basis

DSM-IV

Discussion

The major issue with ADHD is its association with impulsivity. Each case will be assessed on history

and period since any symptoms. Any past evidence of behaviour incompatible with firearms use will

result in rejection.

Every case must be referred to the SPMO for opinion.

Documents

NSW POLICE FORCE HEALTH STANDARD AND DIRECTION FOR …€¦ · health standard and direction for health assessment requirements structure of the standard .....8 the fitness-for-duties