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NFPA 1582

NFPA 1582. Standard on Comprehensive Occupational Medical Programs for Fire Departments 2003-2007 Editions. Sandy Bogucki, MD, PhD Branford Fire Department Section of Emergency Medicine Yale University School of Medicine. NFPA 1582 (1992 Edition). Medical Requirements for Firefighters

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NFPA 1582

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  1. NFPA 1582 Standard on Comprehensive Occupational Medical Programs for Fire Departments 2003-2007 Editions Sandy Bogucki, MD, PhD Branford Fire Department Section of Emergency Medicine Yale University School of Medicine

  2. NFPA 1582(1992 Edition) • Medical Requirements for Firefighters • Consensus standard process • Not law or regulation • Took 4 years to develop from NFPA 1001 • Prescribed medical evaluation and tests to be performed on firefighters to determine fitness for duty • Divided medical conditions into Category A and Category B • Few similar standards • Described roles and qualifications for FD Physicians

  3. NFPA 1582(1992 Edition) • Few analogous documents • Pilots, CDL’s: Regulations • Law enforcement, HAZMAT, EMS have no consensus medical standard • Results in frequent inappropriate use of 1582.

  4. NFPA 15821997, 2000 Editions • Incorporated medical progress (PTCA stenting) • Expanded instructions for physicians to enhance understanding of FF demands • Largely eliminated Category A due to ADA concerns

  5. Problems with 1582, 2000 ed. • Not affecting non-traumatic L-O-D death rates • Inadequate science to support requirements • Not being used to full benefit • Doc’s only read Chapter 3 • Majority don’t understand demands of fire fighting • Majority don’t get involved in FD Health & Safety roles • Incompatible with real world practice • Especially with respect to incumbent medical conditions • Ambiguity of Category B • Equivocal standards due to ADA concerns • Not consistent with OSHA requirements, recommendations of 1583 and Labor-Management fitness/wellness initiative

  6. Line of Duty Death and Injury • Per fire, increasing • Cardiovascular causes still most common • Operations-related trauma, asphyxiation increasing • Investigations focus on operational issues • Contribution from medical issues unknown

  7. Line of Duty Cardiovascular Death Investigations • Cardiac risk factors and/or cardiac disease frequently known • No FD medical requirements • Medical evaluations performed by physicians not familiar with FF demands • Increased proportion of volunteers • No fitness/wellness programs or requirements

  8. NFPA 1582(2003 Edition) • Expanded scope of medical evaluation to detect conditions for which FF’s are at increased risk. • Made yearly medical evaluation mandatory • Developed model list of EJT’s of FF’s upon which medical requirements are based. • Require FD’s to supply FD Physicians with list of local EJT’s or formal validation of the model list in NFPA 1582

  9. NFPA 1582(2003 Edition) • Category A and Category B medical conditions updated • Now apply only to candidates • Incumbents are restricted by FD Physician from specific job tasks when medically indicated • FD determines to what extent restrictions can be accommodated: Light duty, change in job description, retirement, etc. • FD Physicians do not make hiring/firing decisions • FD Physicians are required to monitor for health trends, participate in safety divisions and supervise health & wellness programs

  10. Medical requirements must be based on essential job tasks • Interior structural firefighting • Wildland, ARFF, Shipboard • Driver-Operator • HazMat, Technical Rescue • Rescue, EMS

  11. Essential job tasks (1)     Performing firefighting tasks (e.g. hose line operations, extensive crawling, lifting and carrying heavy objects, ventilating roofs or walls using power or hand tools, forcible entry, etc), rescue operations and other emergency response actions under stressful conditions, while wearing personal protective ensembles and SCBA, including working in extremely hot or cold environments for prolonged time periods.

  12. Essential job tasks • (2)     Wearing a self-contained breathing apparatus, which includes a demand valve-type positive pressure face piece or HEPA filter masks which requires the ability to tolerate increased respiratory workloads

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

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

  15. Essential job tasks • (5)     Wearing fire protective ensemble that is encapsulating and insulated. Wearing this clothing will result in significant fluid loss that frequently progresses to clinical dehydration and can elevate core temperature to levels exceeding 39 degrees C.

  16. Essential job tasks • (6)     Searching, finding, and rescue-dragging or carrying victims ranging from newborns up to adults weighing over 200 pounds to safety despite hazardous conditions and low visibility.

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

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

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

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

  21. Essential job tasks • (11) Critical, time sensitive, complex problem solving during physical exertion in stressful, hazardous environments (including hot, dark, tightly enclosed spaces) further aggravated by fatigue, flashing lights, sirens and other distractions.

  22. Essential job tasks • (12) Ability to communicate (give and comprehend verbal orders) while wearing protective ensemble and self-contained breathing apparatus under conditions of high background noise, poor visibility, and drenching from hose lines and/or fixed protection systems (sprinklers).

  23. Essential job tasks • (13) Functioning as an integral component of a team, where sudden incapacitation of a member may result in mission failure or in risk of injury or death to other team members (e.g. two in, two out as described in NFPA 1500).

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

  25. NFPA 1582 Requirements Changes- 2003 • Occupational Medical Program Customized to Local FD’s • FD’s have to tell MD’s what their FF’s do • MD’s have to understand what FF’s do • MD’s have to look for and evaluate morbidity/mortality trends in their FD’s • Includes fitness/wellness component • MD’s don’t hire/fire

  26. NFPA 1582 Requirements Changes-2003 • Category A and B applies only to candidates; assumes all 13 EJT’s (Interior structural FF, Driver Operator) • Category A • Heart & cardiovascular disease • Smoking • Asthma • Diabetes • Epilepsy • Vision, hearing • Certain medications

  27. NFPA 1582 Requirements Changes-2003 • Incumbents undergo full medical evaluation yearly • Preventive cardiology • Screening for conditions with known excess morbidity in FF’s • Data trending • Workplace intervention

  28. NFPA 1582 Requirements Changes-2003 • Incumbents are restricted from performing various duties in the presence of certain medical conditions • FD’s determine whether/how restrictions can be accommodated

  29. NFPA 1582 Requirements Changes-2007 • Diabetes Mellitus • Category A but with exceptions • Asthma • New testing parameters • Seizure Disorders • Evaluation and requirements amended in 2003 edition • Coronary Artery Disease • Evaluation and requirements amended in 2003 edition

  30. Sneak Preview - 2010 • Prosthetics? • Hearing aids?

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