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Running head: ANNUAL MEDICAL EVALUATIONS AT THE ABERDEEN FIRE 1
Annual Medical Evaluations at the Aberdeen Fire Department - Reducing the Risk of Heart
Attack
Thomas D. Hubbard
Aberdeen Fire Department
Aberdeen, Washington
ANNUAL MEDICAL EVALUATIONS AT THE ABERDEEN FIRE 2
CERTIFICATION STATEMENT
I hereby certify that this paper constitutes my own product, that where the language of others is
set forth, quotation marks so indicate, and that appropriate credit is given where I have used the
language, ideas, expressions, or writings of another.
Signed: ______________________________
Thomas D. Hubbard
ANNUAL MEDICAL EVALUATIONS AT THE ABERDEEN FIRE 3
Abstract
The number one cause of firefighter line of duty death each year is heart attack and has been so
for the past twenty years. The problem was the Aberdeen Fire Department (AFD) did not have a
system in place that indentified or monitored firefighters at increased risk for cardiovascular
disease. The purpose of this research was to identify viable methods by which the AFD and
local fire departments could reduce the incidence of heart attack by identifying and reducing
cardiac risk factors among firefighters. Descriptive research utilizing internal and external
questionnaires and personal interviews was used to answer the research questions to (a)
determine if the firefighters included in the research had taken steps to indentify and reduce their
risk of heart attack; (b) identify the personal and organizational barriers preventing firefighters
from improving their cardiovascular health; (c) identify cardiac screening programs that would
result in cardiac risk reduction for firefighters, and (d) assess if physical fitness was an
organizational priority for the fire departments included in this research.
The results indicated that none of the fire departments required incumbent firefighters to
undergo annual medical evaluations; that nearly half of the firefighters surveyed could be at
increased risk of heart attack due to undiagnosed and untreated cardiac risk factors, and that
financial costs, staffing issues, lack of organizational prioritization, and personal choice were the
primary barriers preventing firefighters from obtaining medical evaluations and improving their
overall physical fitness.
It was recommended that the fire departments utilize NFPA 1582, The Fire Service Joint
Labor Management Wellness-Fitness Initiative, and the Health and Wellness Guide for the
Volunteer Fire and Emergency Services to develop mandatory cardiac screening programs
designed to identify and treat firefighters with elevated cardiac risk factors.
ANNUAL MEDICAL EVALUATIONS AT THE ABERDEEN FIRE 4
Table of Contents
Abstract…………………………………………………………………………….............page 3
Table of Contents………………………………………………………………………..…page 4
Introduction……………………………………………………………………………..….page 5
Background and Significance………………………………………………………….…...page 6
Literature Review……………………………………………………………………….….page 10
Procedures………………………………………………………………………………….page 18
Results……………………………………………………………………………………...page 29
Discussion………………………………………………………………………………….page 43
Recommendations……………………………………………………………………….…page 48
Reference List……………………………………………………………………………....page 51
Appendices
Appendix A……………………………………………………………………………...…page 55
Appendix B………………………………………………………………………………...page 56
Appendix C…………………………………………………………………………….......page 57
Appendix D………………………………………………………………………………...page 59
Appendix E………………………………………………………………………………....page 60
Appendix F………………………………………………………………………………....page 62
Appendix G………………………………………………………………………………...page 63
Appendix H………………………………………………………………………………...page 66
Appendix I……………………………………………………………………………...…..page 69
Appendix J……………………………………………………………………………….…page 71
ANNUAL MEDICAL EVALUATIONS AT THE ABERDEEN FIRE 5
Introduction
In its annual report titled Firefighter Fatalities in the United States in 2008, the United
States Fire Administration reported that 45 firefighters died in 2008 from heart attacks and that
“firefighting is extremely strenuous physical work and is likely one of the most physically
demanding activities the human body performs” (United States Fire Administration [USFA],
2009a, p. 22). Basri and Bergman (2009a) note that with the exception of September 11, 2001,
over the past 20 years the number one cause of firefighter line of duty deaths was attributed to
heart attacks, with 50% of all line of duty firefighter deaths resulting from cardiovascular
disease. The authors note that during the same time period heart attacks accounted for 22% of
the line of duty deaths of police officers and that the occupational national average was 15%.
Because firefighter’s death from cardiovascular disease is well documented, the National
Institute for Occupational Safety and Health is one of several agencies that recommend that fire
departments “provide mandatory annual medical evaluations to ensure members are capable of
performing job tasks with minimal risk of sudden incapacitation” (National Institute for
Occupational Health and Safety [NIOSH], 2007, p. 16).
The problem addressed by this research is that the Aberdeen Fire Department (AFD) does
not have a system in place to assess or monitor the cardiovascular fitness of its incumbent
firefighters which places the mission of the fire department and the health of the individual
firefighter at risk for heart attack. The purpose of this research is to identify methods for
assessing and improving the cardiovascular fitness of firefighters at the AFD. Descriptive
research utilizing internal and external questionnaires and personal interviews were used to
address the following research questions: (a) Have the fire departments and firefighters included
in this research taken steps to identify and reduce the risk of heart attack, (b) what are the
ANNUAL MEDICAL EVALUATIONS AT THE ABERDEEN FIRE 6
barriers preventing firefighters from improving their cardiovascular health, (c) what are the
options available to the AFD for providing annual medical evaluations, and (d) is physical fitness
an organizational priority for the fire departments included in this research.
Background and Significance
Cardiovascular disease is not just isolated to the fire service but rather afflicts a
significant cross section of the adult population of the United States. Data released by the
American Heart Association (AHA) in their Heart Disease and Stroke Statistics 2010 Update
indicate that in 2006 one out of every six deaths was from coronary artery disease and that an
estimated 785,000 people will have a new coronary attack in 2010 (Lloyd-Jones et al., 2009, p.
e2). According to data from the Centers for Disease Control and Prevention “heart disease is the
leading cause of death in the United States and is a major cause of disability. The most common
heart disease in the United States is coronary heart disease, which often appears as a heart
attack.” (Centers for Disease Control and Prevention [CDC], 2010, para. 1). This correlates with
the results of a ten year retrospective study of firefighter deaths from 1990 to 2000 by the
TriData Corporation that found “heart attacks were the leading cause of firefighter deaths,
accounting for 44% of the total cause of firefighter deaths” (USFA, 2002, p. 23).
The AFD is a municipal fire department staffed by 33 career firefighters who provide fire
protection and ALS and BLS ambulance transport to a population of 25,000 people. The AFD
operates with an eight man minimum that staff one ladder truck, one engine, one ambulance, and
one command unit per 24 hour shift. The AFD operates on a 24 hour on-duty 48 hour off-duty
schedule with overtime call back of personnel for greater alarm structure fires and for inter-
facility transport of patients to definitive care hospitals. To gain employment with the AFD,
candidates must pass a pre-employment medical evaluation that is compliant with the criteria
ANNUAL MEDICAL EVALUATIONS AT THE ABERDEEN FIRE 7
contained in NFPA 1582 (see Appendix A). Once hired however, firefighters are not required to
undergo medical evaluations to maintain their position with the department. There are two
exceptions and they are: (a) when an employee is absent from work for more than one week due
to medical reasons they must present a signed physician release prior to returning to work; or (b)
if they miss 90 days or more of work they may be required to submit to a fit for duty examination
prior to resuming their duties (Aberdeen Fire Department [AFD], 2010).
The issue of health and fitness for the members of the AFD has been addressed through
policies; however, the policies primarily delineate the steps a firefighter must take to return to
work after an illness or injury occurs. Section 1.0 of the Health and Wellness section of the fire
department’s Safety and Accident Prevention Program states “the Aberdeen Fire Department
shall ensure that members with fit for duty job requirements are fit for duty” (Aberdeen Fire
Department [AFD], 2004, p. 1) and defines fit for duty as “the state of physical conditioning,
mental and medical health that allows the member to safely perform the essential functions of the
job. Fit for Duty is determined by the City of Aberdeen’s physician or licensed health care
provider” (AFD, 2004, p. 2). The City of Aberdeen’s Personnel Policies, Section 9.10 Health
and Fitness state:
Each Employee is expected to maintain physical and mental health fitness necessary to
effectively and efficiently perform the duties of his or her position. When the health of
an employee becomes a hazard to other persons or property, or prevents the employee
from effectively performing the duties of the assigned position, the employee may be
required by the department head to undergo a health examination. When so required, the
employee will be paid for the time required for the examination and for the cost of the
examination itself if it exceeds insurance benefits. Correction or treatment of conditions
ANNUAL MEDICAL EVALUATIONS AT THE ABERDEEN FIRE 8
diagnosed during this health examination will be the responsibility of the employee (City
of Aberdeen, 2003, p. 33).
Additionally, the State of Washington mandates through the Washington Administrative
Code (WAC) 296-305, Safety Standards for Firefighters, Section 296-305-01509, Management’s
Responsibility, that “the employer shall assure that employees who are expecting to do interior
structural firefighting are physically capable of performing duties that may be assigned to them
during emergencies” (Washington State Safety Standards for Firefighters, 1997).
A challenge that must be addressed by the AFD is the financial impact of implementing
any new program. The City of Aberdeen has been faced with significant financial hardship. The
county’s unemployment rate of 14.9%, economic stagnation and rising employee costs are all
negatively impacting the general budget. According to the Finance Director for the City of
Aberdeen the general budget is derived primarily from sales tax revenue which has declined 20%
since 2006. This revenue decrease is further impacted by a 21% increase in employee benefit
costs and a 5% increase in salaries since 2007. Even capital improvements to city facilities and
infrastructure have been non-existent in recent years unless they can be funded by state or federal
grants (K. Skolrood, personal communication, March 15, 2010). In discussing budgetary
concerns with the fire chief of the AFD, he reported that employee costs accounted for 90% of
the fire department’s budget with the remainder allocated to supplies, operating costs, vehicle
maintenance and mandated training. Programs such as fire prevention in the schools and
hazardous material teams have been eliminated due to lack of funding (D. Carlberg, personal
communication, January 11, 2010).
The significance of this applied research paper is that the AFD needs to develop a
medical screening program that would improve the health of its firefighters by identifying
ANNUAL MEDICAL EVALUATIONS AT THE ABERDEEN FIRE 9
and addressing health issues before they result in a disability or a line of duty death. Two goals
of this research paper are to educate firefighters about the significant risk of cardiovascular
disease in the fire service and to identify medical screening programs that would be effective,
economically feasible, and acceptable to both the firefighters and management. The lack of a
health screening program at the AFD was brought to the forefront when a 39 year-old member of
the fire department suffered a heart attack in 2009. The impact this event had on the fire
department was a catalyst for choosing this topic for the applied research project. To protect his
privacy, the firefighter will be referred to as FF#1 and his personal observations will be cited as
anonymous.
The topic addressed by this research project supports the USFA operational objective of
improving the fire and emergency services’ capability for response to and recovery from all
hazards, specifically, Objective 3.2 which advocates a culture of health, fitness, and behavior that
enhances emergency responder safety and survival (USFA Strategic Plan-Fiscal Years 2009-
2013, p. 9). This topic also reflects upon curriculum contained within the Executive
Development course at the National Fire Academy. Two of the objectives contained within Unit
7, Organizational Culture and Change are: (a) “recognize the indicators that point to a legitimate
need for an organization’s culture to change”, and (b) “recognize that the Executive Fire Officer
should be an agent of cultural organizational change” (Federal Emergency Management Agency
[FEMA], 2006, p. SM 7-1). The implementation of annual medical evaluations would be
an adaptive challenge for management as well as the firefighters at the AFD. Heifetz and Linsky
(2002) suggest that adaptive challenges require a change of culture, attitudes, values and beliefs
and that such challenges cannot be made by implementation of policy alone but require
acceptance and endorsement by the entire organization.
ANNUAL MEDICAL EVALUATIONS AT THE ABERDEEN FIRE 10
Literature Review
Because heart disease is not only the leading cause of line of duty death in the fire service
but is also the leading cause of death among the general U.S. adult population, significant
research has been directed towards reducing its impact (CDC, 2010). The AHA has identified
nine risk factors that contribute to coronary heart disease, six of which have been determined to
be modifiable through lifestyle changes and medical treatment. The modifiable risk factors
include tobacco use, high blood cholesterol, high blood pressure, physical inactivity, obesity and
diabetes mellitus (American Heart Association [AHA], 2008). The AHA lists the three non-
modifiable risk factors as increasing age, gender, with males being at higher risk, and heredity
and makes clear that those with a strong family history of heart disease are especially at risk
(AHA, 2008). The prevalence of hypertension, high cholesterol and obesity in the U.S. are
addressed by the CDC in a series of data briefs utilizing data from the National Health and
Nutrition Examination Survey (National Health and Nutrition Examination Survey [NHANES]
n.d.). In 2008 the National Center for Health Statistics released its findings regarding
hypertension utilizing data from the 2005-2006 survey. It was found that 29% of the U.S. adult
population ≥ 18 years of age had hypertension defined as systolic blood pressure ≥ 140 mmHg
and that 28% had pre-hypertension defined as systolic blood pressure ranging from 120 –
130mmHg (Ostchega, Yoon, Hughes, & Louis, 2008). A separate NHANES study found that
16% of the U.S. adult population ≥ 20 years old had total serum cholesterol levels of ≥ 240 mg/dl
placing them at significant risk for heart disease (Schober, Carroll, Lacher, & Hirsch, 2007).
Data obtained from the NHANES study for the years 2005-2006 was not encouraging when
assessing obesity in the U.S. with over one-third of the population registering as obese. For the
study, obesity was defined as anyone with a body mass index (BMI) ≥ 30.0 and was calculated
ANNUAL MEDICAL EVALUATIONS AT THE ABERDEEN FIRE 11
by dividing a person’s weight in kilograms by their height in meters squared. In comparing
obesity data from 1980 to 2007 it was noted that the adult population of the U.S. was becoming
heavier (Ogden, Carroll, McDowell, & Flegal, 2007).
As a group, firefighters must understand that they are included in these worrisome
statistics and that they in fact face a significantly higher risk of cardiovascular disease due to
their occupation. Referring again to the ten year retrospective study of firefighter deaths from
1990 to 2000 by the TriData Corporation, heart attacks were the number one cause of line of
duty firefighter deaths in the United States (USFA, 2002).
According to Scanlon and Ablah (2008) the modifiable risk factors, if not managed, are
associated with a high degree of morbidity and mortality and recommend firefighters control
them through proper diet, exercise, lifestyle changes, and physician intervention. In their study
of heart disease among firefighters Kales, Soteriades, Christophi, and Christiani (2007) indicated
that firefighters were at the greatest risk of heart attack during fire suppression activities because
many have undiagnosed coronary heart disease that has not been treated. The study further
revealed that this problem is exacerbated by the fact that nearly 75% of all United States fire
departments do not have programs designed to address the health and fitness issues affecting
firefighters. The study also concluded that responding to emergency alarms and physical
training in the form of physical fitness, live fire training and search and rescue drills, because of
the associated increases in cardiac demand, accounted for the next highest incidence of heart
attack in firefighters. In another study of firefighter deaths Kales, Soteriades, Christoudias, and
Christiani (2003) reported that heart attacks were the result of several work related stressors.
The stressors included periods of inactivity followed by heavy physical demands, working at or
near maximal heart rates for extended periods of time, reacting immediately to alarms, which
ANNUAL MEDICAL EVALUATIONS AT THE ABERDEEN FIRE 12
resulted in increased heart rates, and exposure to heat stress and dehydration which all placed a
strain on the cardiovascular system. The study examined 52 firefighter deaths and found that
over 25% of the firefighters had pre-existing arterial disease and that high blood pressure and
high cholesterol levels were common among the group. It was also determined that the majority
had not had an adequate medical evaluation during the two years preceding their death. Kales et
al. (2003) concluded that since the firefighter deaths were predominantly linked to pre-existing
cardiovascular conditions, improving the fire service’s attention to fitness and implementing
medical screening would greatly reduce the incidences of premature death from cardiovascular
disease. A study conducted in California that spanned 17 years and involved 71 male firefighters
from a career fire department concluded that as a whole, the group had better physical fitness
than a comparable male reference group (Davis, Jankovitz, & Rein, 2002). Importantly,
however, the study also documented that as part of the normal aging process both groups
experienced an increase in their cardiac risk factors in the form of increased total serum
cholesterol, increased BMI, and elevated blood pressures which reinforced their recommendation
that firefighters should be obtaining medical evaluations to manage those changes in a proactive
and preventative manner.
In a series of articles written to focus firefighter’s attention on their risk of heart attacks,
Basri and Bergman (2009b, 2009c, 2010) discussed the implementation of medical evaluations
as a way to identify firefighters with elevated cardiac risk factors. The authors stated that
firefighters who have unidentified and untreated cardiac risk factors are at the greatest risk of
dying on the job. They recommended that annual medical examinations be mandatory for
firefighters and that the examinations include screening for high blood pressure, high cholesterol,
diabetes, signs of cardiovascular disease, and BMI analysis. They also recommended that at the
ANNUAL MEDICAL EVALUATIONS AT THE ABERDEEN FIRE 13
time of the examination, physicians should be counseling firefighters about ways to reduce their
cardiac risk factors through lifestyle changes which included improving dietary intake and the
importance of obtaining 30 minutes of aerobic exercise four times per week. Loy (2001a) in
discussing cardiac risk factors reported that people are classified as being at moderate risk for
heart disease if they are male over the age of 45 or female over the age of 55 and have two or
more cardiac risk factors.
Published by the National Fire Protection Association, NFPA 1582 titled Standard on
Comprehensive Occupational Medical Program for Fire Departments specifically addresses the
requirements for annual medical evaluations for firefighters. It must be noted that since NFPA is
not a government agency, fire departments are not required to abide by the recommendations
unless the state or jurisdiction they are in adopts the standard as law. First published in 1992, the
standard was developed to address the medical requirements for firefighters and its most recent
edition in 2007 continues to promote health in the fire service. Within the standard, fire
departments and physicians will find the recommended criteria to be included in firefighter
medical evaluations as well as criteria that would preclude a firefighter from continuing in the
fire service (National Fire Protection Association, [NFPA], 2007). It is this exclusionary criteria
listed within the standard that may be the largest stumbling block preventing some fire
departments from adopting NFPA 1582. According to Basri and Bergman (2010) both career
and volunteer firefighters may view medical screening programs as a direct threat to their ability
to remain in the fire service. In answer to this the authors stated that fire departments should
make it clear that the purpose of the medical screening programs are to improve the firefighter’s
total overall health throughout their career and to ultimately prevent them from dying on the job.
NFPA 1582 addresses this topic by stating that firefighters should be considered the most
ANNUAL MEDICAL EVALUATIONS AT THE ABERDEEN FIRE 14
important resource at a fire department and that the implementation of NFPA 1582 should be
done in such a way that it improves firefighter health and wellness (NFPA, 2007).
The Fire Service Joint Labor Management Wellness-Fitness Initiative created by the
International Association of Fire Chiefs and the International Association of Firefighters define
the role union firefighters should take with respect to health and wellness. In the introduction to
the initiative it states that union leadership must work with management to ensure that the health
and safety of its members is an organizational priority and that fire departments should ensure
that each member is physically, mentally and spiritually capable of performing their duties to the
best of their ability (International Association of Firefighters, 2008). The initiative also states
that the program should be positive in nature and non-punitive with the improvement of the
individual’s health as the ultimate goal. Likewise, the USFA along with the National Volunteer
Fire Council (NVFC) has published guidelines for the volunteer fire and emergency services
(United States Fire Administration, 2009b). One of the goals of the publication is to provide a
foundation upon which volunteer fire departments can build their own health and wellness
programs. In 2003, 16 volunteer fire departments were identified that had viable health and
wellness programs and those programs were followed to determine what worked and what did
not work. Three common roadblocks were identified and they were funding issues, lack of well
defined program elements, and the difficulty in keeping the firefighters motivated to sustain the
programs (USFA, 2009b).
Of particular interest to this research was an article describing the preliminary results of a
2008 study conducted on 300 firefighters from the Gwinnett County (GA) Fire and Emergency
Services (Ward, 2009). During the initial medical screening process to identify cardiovascular
risk factors in firefighters, three members of the fire department were identified as requiring
ANNUAL MEDICAL EVALUATIONS AT THE ABERDEEN FIRE 15
immediate surgical intervention to save their lives. The author unequivocally stated that three
firefighter deaths were prevented that day by the timely medical evaluations. Preliminary results
from that research indicated that firefighters are at a 300% greater risk of developing
cardiovascular disease than the average citizen and that the increased risk is due to the inherent
physiological and emotional stressors of the job. The study also indicated that those stressors
coupled with poor dietary intake and lack of physical conditioning resulted in otherwise healthy
firefighters displaying increased risk for heart attack. The author concluded his article with this
advice, “Take care of yourself. Start with a checkup. Eat healthy and work out a little. That’s
not asking too much” (Ward, 2009, p. 84).
As referenced previously, a member of the AFD suffered a heart attack in 2009. The
heart attack occurred twenty-one hours after getting off work from what would be described as a
typical shift of responding to emergency medical calls, daily training, apparatus maintenance,
and station up-keep. Upon interviewing FF#1 regarding his cardiac risk factors it was
determined that he had a family history of cardiovascular disease, was being treated for
borderline hypertension and had a BMI > 30.0. He had also been treated in the past for elevated
cholesterol levels. He stated that his lifestyle would not have been classified as sedentary but
that he was not obtaining 30 minutes of aerobic exercise four times per week. FF#1 stated that
during his emergent cardiac angioplasty it was discovered that two of his coronary arteries were
severely occluded by cholesterol plaque. He conceded that the occlusions did not occur
overnight and that in retrospect he had experienced vague warning signs in the form of increased
fatigue and unexplained transient back pain brought on by exertion. FF#1 was candid in stating
that the two months he spent off work undergoing cardiac rehabilitation following his coronary
angioplasty was an extremely stressful time for both he and his family. He also stressed that
ANNUAL MEDICAL EVALUATIONS AT THE ABERDEEN FIRE 16
firefighters must pay attention to the signs and symptoms they are experiencing and to not
discount them as trivial. As of March 2010, his medical bills had totaled one hundred thousand
dollars and the determination as to whether his heart attack would be covered as a work related
presumptive cardiac illness under Washington State Labor and Industries Law was still pending.
His message to firefighters is very straightforward; he realizes he has been given a second
chance to continue working in the profession he loves and he wanted other firefighter to realize
that heart attacks can happen to them and that the identification and reduction of cardiac risk
factors should be the goal of every firefighter (Anonymous, personal communication, March 21,
2010). FF #1 missed two months of work due to his heart attack and AFD payroll records
obtained from the Administrative Assistant to the fire chief indicated that the fire department
spent $7,200 dollars in overtime costs to fill his vacancy in order to maintain a minimum staffing
level of eight firefighters. Had his absence from work occurred during the summer months,
when the fire department routinely operates at an eight man minimum due to scheduled
vacations, the overtime cost could have reached as high as $17,500 dollars (S. Johnson, personal
communication, March, 2010).
A portion of this research paper must focus on the benefits of physical exercise since it is
inherently linked to cardiovascular fitness. Heiden, Testa, and Musolf (2008) succinctly
described the benefits of regular aerobic exercise as training the lungs to breathe more effectively
and improving the hearts ability to pump blood throughout the body. The authors claim that
regular aerobic exercise results in thinner blood which improves oxygen transport to the cells,
helps keep the arteries clear of blockages, and results in a more efficient vascular system. The
overall effect is a reduction in blood pressure, lower cholesterol levels, and a reduction in cardiac
diseases including coronary artery disease and congestive heart failure. To measure a person’s
ANNUAL MEDICAL EVALUATIONS AT THE ABERDEEN FIRE 17
fitness level, Heiden et al. (2008) described the benefits of usingVO2 max testing as a tool to
indicate how efficiently a person’s heart, lungs, and blood are delivering oxygen to working
muscles. VO2 max is a measurement used to assesses an individual’s cardio-respiratory system
and ultimately their fitness level. Loy (2001b) reported that the Los Angeles Fire Department
uses a submaximal bench step test to obtain the VO2 max measurement of its firefighters on an
annual basis. The author reports that the fire department uses the bench step test because it is
easily administered at each fire station. An alternative VO2 max test referred to by the author, as
well as endorsed by The Joint Labor Management Wellness-Fitness Initiative, is a submaximal
treadmill test which utilizes the Gerkin Test Protocol. According to Loy (2001b) obtaining an
actual VO2 max value would require that firefighters be tested at an exercise physiology
laboratory but that the submaximal tests available, such as the bench step test or the treadmill test
are logistically more realistic for firefighters and fire departments. Loy (2001b) stated that at a
minimum, firefighters should be able to obtain VO2 max scores between 45 and 49 ml/kg/min
during the testing procedure. In assessing VO2 max scores the higher the value the more
physically fit someone is considered to be. Loy (2001b) adds that to become physically fit a
person must exercise at more than 70% of their age predicted maximum heart rate as part of a
regular exercise regimen.
In summary, the literature review indicated that firefighters are needlessly dying from
heart attacks at an alarming rate. The number of line of duty deaths from heart attacks has
remained at or near 50% per year for the past 20 years (Basri & Bergman, 2009a). There has
been medical research, legislation, and standards developed to address the issue but to date there
has not been a widespread cultural change in how fire departments operate or how firefighters
themselves view the issue. There are some bright spots however, with programs such as The
ANNUAL MEDICAL EVALUATIONS AT THE ABERDEEN FIRE 18
Joint Labor Management Fitness-Wellness Initiative and the Health and Wellness Guide
sponsored by the USFA and the National Volunteer Fire Council which have proven effective in
improving the health and wellness of firefighters. However, with only 25% of the U.S. fire
departments reporting that they have some form of health and wellness program in place,
undiagnosed cardiovascular disease will continue to threaten the lives of firefighters.
Improving firefighter physical fitness is also of paramount importance if the fire service
is to reduce the incidence of line of duty deaths from heart attacks. Basri (2005) is of the opinion
that firefighters must view themselves as occupational athletes and train their minds and bodies
accordingly. He stated that firefighters work at maximum physical and emotional extremes that
place a severe strain on the body and if they are not physically prepared the end result could be
their death.
The impact of the literature review on this research paper was significant. The reason
why firefighters should be obtaining annual medical evaluations became readily apparent early
on in the research process. This author realized that if this project was to have significance
within his own organization and the surrounding fire departments, this paper would need to
identify and present solutions to the barriers that were preventing local fire departments from
developing effective cardiac screening programs that identified and reduced cardiac risk factors.
Procedures
Descriptive research utilizing questionnaires was used to determine if the fire
departments and firefighters included in this research had taken steps to identify and reduce the
effects of cardiovascular disease in their organizations, assess perceived barriers preventing
firefighters from improving their health, and had the firefighters rate their overall physical
fitness. Three questionnaires were developed to obtain information specific to each target
ANNUAL MEDICAL EVALUATIONS AT THE ABERDEEN FIRE 19
population. The questions were developed by this author and reviewed for clarity and content by
the assistant chief and the training officer of the AFD. The external firefighter questionnaire was
developed to assess the firefighters of three surrounding mutual aid fire departments. The fire
chiefs of each of these departments and the AFD were also given a questionnaire to assess their
views on cardiovascular disease and physical fitness within their departments and to compare the
chiefs’ responses with the firefighters they supervise. A third questionnaire was developed to
solicit information from the members of the AFD. The three questionnaires are discussed in the
following sections.
External Firefighter Questionnaire
The three fire departments that participated in this research were selected because they
provide mutual aid response to the AFD for greater alarm fires and medical calls and therefore
work closely with the AFD at emergency incidents. The departments surveyed consist of two
that are staffed by a combination of career and volunteer firefighters and one that is staffed
exclusively by career firefighters. The career firefighters of the three departments are
represented by the IAFF for contractual items that address wages, hours and working conditions
and the volunteer firefighters are represented by their respective volunteer associations. Prior to
delivering the questionnaires the fire chief of each department and the union president of each
local bargaining unit were contacted by this author to determine if they would agree to
participate in the research project. All parties contacted expressed interest in participating in the
research. A cover letter (see Appendix B) was included with each external questionnaire which
explained the purpose of the questionnaire and the goal of the research. The letter also stated
that all information gathered would remain anonymous with respect to respondent identity and
that completion of the questionnaire was on a voluntary basis.
ANNUAL MEDICAL EVALUATIONS AT THE ABERDEEN FIRE 20
The external firefighter questionnaires (see appendix C) were delivered to the
participating fire departments on January 15, 2010 and retrieved on February 5, 2010, which
allowed the respondents 22 days to complete the questions. During the initial telephone contact
with the fire chief of each department it was determined that there were a total of 116 firefighters
in the external firefighter population. A total of 62 completed questionnaires were returned
resulting in a 53.4% return rate.
The following section provides an overview of the questions contained within
the external firefighter questionnaire along with the rationale for their inclusion. Question
number one of the questionnaire was used to determine the demographics of age, number of
years served in the fire service and the respondent’s career or volunteer status. Age and number
of years in the fire service were considered important data to collect as the literature review
indicated that as age and length of time in the fire service increased, so did the firefighters
inherent risk of cardiovascular disease. The respondent’s employment status of career or
volunteer was collected in order to compare response commonalities and differences between the
career and volunteer firefighters. Questions two and three assessed the respondent’s knowledge
of their organization’s current practice of providing pre-employment and incumbent firefighter
medical evaluations. If the respondent indicated that their organization provided annual medical
evaluations they were directed to skip to question number six, but if their organization did not
provide annual medical evaluations they were directed to continue on to question four. Question
four had the respondent indicate whether they obtained annual medical evaluations on their own
initiative. If the respondent answered no, question five provided selections for the respondent to
indicate why they did not obtain annual medical evaluations. The four answers provided were
identified during the literature review as being the most common reasons firefighters were not
ANNUAL MEDICAL EVALUATIONS AT THE ABERDEEN FIRE 21
obtaining annual medical evaluations. The respondent was also given the opportunity to list their
own reason for not obtaining annual medical evaluations should the four prepared responses not
accurately reflect their opinion. Question six asked that the respondent indicate whether they felt
that annual medical evaluations should be mandatory, voluntary or allowed them to provide their
own answer with explanation. Information gained from the literature review recommended that
medical evaluations should be a mandatory requirement for firefighters in order to identify and
treat life threatening conditions before they resulted in career ending disability or line of duty
death. Question seven was used to assess if the respondent was aware that heart attacks had been
the leading cause of firefighter line of duty deaths for the past five years. This question was
asked to determine if the heart attack line of duty death statistics and case studies published by
organizations such as the USFA, IAFF, IAFC and NIOSH were being reviewed by the
firefighters included in this research. This question was important because if firefighters are not
aware of the information contained in these reports they are not adequately informed about the
risk of cardiovascular disease in the fire service. Question eight was used to determine if the
respondent’s department had a policy in place regarding firefighter physical fitness and question
nine asked the respondent to indicate how often they exercised to improve their cardiovascular
fitness level. Both of these questions were used to ascertain if physical fitness was an
organizational and personal priority since increasing physical activity is one of the six modifiable
risk factors identified by the AHA. Question ten and eleven were used to determine the
respondent’s self-reported fitness level and required the respondent to indicate how they
determined their fitness level. The three responses available to the respondent were
medical/physical testing, comparison to others, or that they rated their cardiovascular fitness
subjectively. Question eleven was written to emphasize that without quantitative measurable
ANNUAL MEDICAL EVALUATIONS AT THE ABERDEEN FIRE 22
data in the form of lab work and medical screening, the respondent’s self assessment was purely
subjective and could result in undiagnosed and untreated cardiovascular disease. Questions
twelve and thirteen were used to assess the organizational culture of the respondent’s fire
department. The questions asked if the respondent felt that physical fitness was a priority for
their organization and then asked the respondent to select from a list of barriers they felt may be
preventing firefighters in their organization from maintaining a physically fit state.
The following limitations are noted for the external firefighter survey. First, prior to
dissemination to the research group, the questionnaire was not tested on a sample population to
screen for ambiguous questions. Therefore, some of the questions may have allowed for
individual interpretation not intended by this author. Specifically, questions nine through twelve
of the questionnaire allowed for subjective interpretation and therefore the results, although
informative, should not be used to rate the firefighters as fit or not fit. It is, however, a
contention of this research paper that unless firefighters undergo medical and physical testing
they are not able to accurately determine their cardiovascular fitness level. This concept is
emphasized by question number eleven which asked the respondent to rate their cardiovascular
fitness level. It is this author’s contention that only the respondents who had undergone
medical/physical testing could accurately answer this question. The second identified limitation
was an error contained in the cover letter attached to the questionnaire. The definition for
medical evaluation, line f. cardiovascular/aerobic testing, should have listed spirometry as the
diagnostic procedure to be used and not treadmill/Stairmaster. This author does not believe that
this error had a negative impact on the results of the questionnaire but is noted here for
clarification. The last identified limitation is that this author did not contact the leadership of
each volunteer association prior to delivery of the questionnaire as was done with the fire chiefs
ANNUAL MEDICAL EVALUATIONS AT THE ABERDEEN FIRE 23
and union presidents. This failure to adequately inform the volunteer leadership as to the
purpose of the research may have accounted for the 36.6% return rate from the volunteer
firefighters as compared to the 94.1% return rate from the career firefighters.
Fire Chief Questionnaire
The fire chiefs of the three external fire departments included in this research project as
well as the fire chief of the AFD were provided with an explanatory cover letter and
questionnaire during the same 22 day period as the firefighters (see Appendices D and E). All
four questionnaires were returned for a 100% return rate. The purpose of these questionnaires
was to determine management’s stance on annual medical evaluations, gain insight into the
organizational culture of each organization regarding medical and physical fitness testing, and to
compare the fire chiefs’ responses with the responses given by their firefighters. Included with
the questionnaire were pages 1582-16 to 1582-17 of NFPA 1582 which lists the required
elements of a firefighter medical evaluation.
The following section provides an overview of the questions contained within the fire
chief questionnaire along with the rationale for their inclusion. Question number one was used
to determine if the fire departments the fire chiefs represented required a candidate firefighter to
successfully pass a medical evaluation prior to employment. Question number two was used to
determine if their fire department required its incumbent firefighters to undergo annual medical
evaluations. Both questions listed NFPA 1582 as the required medical evaluation standard and
both questions applied to career and volunteer firefighters. Question number three asked if their
fire department had developed essential job tasks as described in NFPA 1582 for each position in
the fire department. Essential job tasks are a key component of NFPA 1582 when determining
firefighter fitness for duty issues. Question number four was used to ascertain whether the
ANNUAL MEDICAL EVALUATIONS AT THE ABERDEEN FIRE 24
employee’s medical health plan would cover the financial cost of providing annual medical
evaluations for the department’s firefighters regardless of their career or volunteers status. This
question was important as the financial burden, whether born by the organization or by the
individual firefighter, could be a significant barrier to implementing annual medical evaluations.
Question number five was used to determine if in the past five years a member of their fire
department had lost time from work due to a cardiovascular condition. The term cardiovascular
condition was defined as cardiac arrest, myocardial infarction, coronary artery disease, angina
pectoris, cardiac arrhythmia and hypertension. This question was used to determine if there was
a history of cardiovascular disease among the fire department’s members that had impacted their
fire department. Questions six and seven were used to determine if the fire departments had
policies in place that delineated medical and physical fitness standards, whether their firefighters
were compliant with the existing policies, and if the organizational culture of their fire
department promoted physical fitness as a priority. Question number eight requested that the fire
chiefs list the three most significant barriers they felt would inhibit them from implementing
annual medical evaluations for their firefighters. This question was important because, without
identifying those barriers, developing solutions would not be possible.
A limitation of the fire chief’s questionnaire was that it was only distributed to four fire
chiefs and therefore did not represent widespread management input as opposed to the 93
questionnaires received from the combined firefighter group. Another limitation was that the
questionnaire did not seek to determine if the fire chiefs had identified solutions to the barriers
they identified in question number eight regarding the implementation of annual medical
evaluations in their organizations. The solutions they proposed would have been a key
component to this research and was an oversight by this author.
ANNUAL MEDICAL EVALUATIONS AT THE ABERDEEN FIRE 25
Aberdeen Firefighter Questionnaire
An explanatory cover letter and questionnaire (see Appendices F and G) were delivered
to the firefighters of the AFD on January 26, 2010 and retrieved on February 10th, 2010 which
allowed the firefighters 16 days to complete the questionnaires. Prior to dispersing the
questionnaires this author met with the fire chief of the AFD and the union president to address
any questions they may have had and to gain their support for the project. A total of 33
questionnaires were distributed and 31 completed questionnaires were returned resulting in
in a return rate of 93.9%. The questions were formulated based on information gained from the
literature review and from this author’s personal observations as a member of the AFD for 15
years. Because of this personal knowledge, questions regarding the existence of pre-employment
medical evaluations, annual medical evaluations, and physical fitness programs were eliminated
from the questionnaire. The focus of the questionnaire was directed towards assessing individual
firefighter’s cardiac risk factors and determining their level of participation in health and fitness
programs currently available to them. The questionnaire was also used to determine if the
firefighters were in favor of implementing an annual medical evaluation program.
The following section provides an overview of the questions along with rationale for their
inclusion in the questionnaire. Question number one asked that the respondent indicate their age
and number of years in the fire service. As with the external firefighter questionnaire this
information was important to collect since studies have shown a corresponding increase in
cardiac risk factors due to increasing age and length of time in the fire service. Question number
two had the respondent indicate when their last medical evaluation occurred that met the criteria
listed in NFPA 1582. The purpose of this question was to determine how many respondents
were currently obtaining medical evaluations on their own initiative. Question number three
ANNUAL MEDICAL EVALUATIONS AT THE ABERDEEN FIRE 26
asked if the respondent had a primary physician and attempted to determine how often they saw
their physician and for what purpose. This question was used to determine if there were
firefighters at the AFD who did not have a primary physician they could go to on an annual basis
for medical evaluations. Question number four asked if the respondent participated in the City of
Aberdeen’s Wellness Program or if they were aware that it even existed. The Wellness program
is managed by the City of Aberdeen’s Human Resource Director. Annual health screening
which includes cholesterol testing, diabetes screening and identification of cardiac risk factors is
offered to all city employees free of charge. Question number five addressed the six modifiable
cardiac risk factors identified by the AHA. This question was considered a key component of
this research because it has been shown that an annual medical evaluation that is designed to
identify and treat the six modifiable cardiac risk factors is the most effective way for firefighters
to decrease their risk of cardiovascular disease. A body mass index table was included with each
questionnaire that enabled the respondent to calculate their BMI and body classification type.
The body classification types consisted of the following: a BMI of 19 to 25 was classified as
normal, 26 to 30 was classified as overweight, 31 to 39 was classified as obese, and 40 to 54 was
classified as extreme obesity. Question number six was used to determine if the firefighters at
the AFD were aware that annual medical evaluations were recommended by both The Fire
Service Joint Labor Management Wellness-Fitness Initiative and NFPA 1582. This question was
used to ascertain the current level of awareness of these two documents in order to determine a
starting point for educating the members as to the benefits of medical evaluations. Question
number seven asked the respondent to indicate whether they were in favor of the AFD
implementing a mandatory annual medical evaluation program. This question was used to assess
whether there would be opposition to implementing a medical evaluation program as well as
ANNUAL MEDICAL EVALUATIONS AT THE ABERDEEN FIRE 27
document the concerns of the firefighters. Question number eight was used to determine how
many firefighters currently employed by the AFD participated in a voluntary cardiac stress test
offered by the Grays Harbor County Medical Program Director, Dr. Daniel Canfield, during the
first quarter of 2007. Dr. Canfield, a retired paramedic/firefighter from the AFD, offered this
service to the AFD as a result of a line of duty death of a firefighter in March of 2006. The
firefighter, who was employed by another municipality within our county, was taking part in surf
rescue training when he died from cardiac arrest secondary to hypothermia and exhaustion. In
speaking with Dr. Canfield, he stated that he was motivated to offer this test in order to provide a
proactive tool for members of the AFD to identify and treat cardiovascular disease before it
resulted in a catastrophic event (D. Canfield, personal communication, January 15, 2010). This
question also had those firefighters who had declined to participate in the cardiac stress test
document their reasons for abstaining. This question was considered important to include
because, as with the Health and Wellness program provided by the City of Aberdeen, there is no
financial cost to the firefighter and determining why some members chose to not participate in
the stress test could help to identify personal barriers. Question number nine was directed
towards firefighters at the AFD who were not obtaining annual medical evaluations from their
own physicians. This question was included as an additional attempt to identify personal barriers
that would have to be overcome if the AFD were to implement an annual medical evaluation
program. Questions ten and eleven were identical to questions ten and eleven of the external
firefighter questionnaire. Question ten had the respondent rate their cardiovascular fitness level
ranging from excellent to poor and question number eleven had them indicate how they had
determined their answer to question number ten. Again, the purpose of these two questions was
to highlight that without quantifiable data obtained from a medical evaluation, determining one’s
ANNUAL MEDICAL EVALUATIONS AT THE ABERDEEN FIRE 28
cardiovascular fitness level is not possible. Question number twelve had the respondent indicate
if they regularly exercised to determine the current fitness culture at the AFD and question
number thirteen was used to determine if the respondent was aware that heart attacks were the
leading cause of firefighter deaths for the past five years. Question fourteen addressed the topic
of physical fitness at the AFD and asked the respondent to indicate if they felt there were barriers
preventing them from maintaining a physically fit state. The answers available to the respondent
were identified from the literature review as being the most common reasons firefighters had
given for not maintaining their fitness. Question fourteen also asked the respondent to indicate if
they currently exercised while on-duty. As with question number twelve, this question was used
to determine the current fitness culture at the AFD. Question fifteen asked the respondent to
indicate whether they would be in favor of implementing annual physical fitness assessments as
described in NFPA 1583 and The Joint Labor Management Wellness-Fitness Initiative. The tests
described in this question consist of an aerobic capacity test utilizing a treadmill, body
composition analysis, muscular strength and flexibility measurement and that the program would
be designed to be non-punitive in nature. Although this question was not directly related to the
purpose of this research paper, the information obtained was directed towards determining the
current fitness culture at the AFD.
The following limitations for this questionnaire are noted. As with the external
firefighter questionnaire, the AFD firefighter questionnaire was not administered to a test
population prior to dissemination to the research group to determine if the questions were
optimally phrased to obtain the desired information. It should also be noted that the author, who
is a member of the AFD, included the answers from his own questionnaire in the results. This is
not believed to have impacted the results in a negative manner. A limitation applicable to all of
ANNUAL MEDICAL EVALUATIONS AT THE ABERDEEN FIRE 29
the questionnaires used in this research was that the data received was all self-reported and not
verified by this author. It is believed, however, that the provision of organizational anonymity
for the external fire departments and personal anonymity for all the firefighters involved allowed
for candid and insightful responses.
Telephone interviews were held with the City of Aberdeen’s medical insurance
representative, the City of Aberdeen’s Human Resources Director, the EMS Medical Program
Director and local medical professionals in order to determine what options were available to
local fire departments should they choose to implement medical screening programs. The
conversations were informal and unscripted on the part of this researcher. The one limitation
noted for these interviews was the interview with the medical insurance representative. She
stated that she was not in a position to document in writing the opinions she had expressed but
felt that the insurance carrier would most likely share her conclusions. The information collected
from these interviews is contained within the Results section of this research.
Results
The data collected from the questionnaires was entered into a Microsoft Excel
spreadsheet and is presented here in narrative format. The complete results are displayed in
Appendix H for the AFD questionnaire, Appendix I for the external firefighter questionnaire
(EFQ), and Appendix J for the fire chief questionnaire. The results for the EFQ and the AFD
firefighters are presented separately where appropriate to facilitate comparison between the two
groups. The EFQ cohort consisted of 62 firefighters of which 32 were career firefighters and 30
were volunteer firefighters. The AFD cohort was comprised of 31 career firefighters. Data
collected indicated an average age of 38.5 for the EFQ and 36.1 for the AFD. The average
length of time in the fire service was 12.4 years for the EFQ respondents and 13.9 years for AFD
ANNUAL MEDICAL EVALUATIONS AT THE ABERDEEN FIRE 30
respondents. In order to gain further insight into the demographics of each cohort the
respondents were separated into one of four age groups. The results are displayed in Table 1.
Table 1
Age Group Comparison of the AFD and EFQ Respondents
______________________________________________________________________________
Age group AFD respondents
18 to 30 years old 29% 33%
EFQ respondents
31 to 40 years old 42% 18%
41 to 50 years old 19% 31%
51 to 60 years old 10% 18%
______________________________________________________________________________
Examination of the age group data indicated that 29% of the AFD respondents and 49%
of the EFQ respondents are nearing or have achieved an age that has been identified as having an
increased risk for cardiovascular disease, that being 45 for males and 55 for females.
In order to determine if the fire departments and firefighters were taking steps to reduce
the risk of heart attack the following information was collected. The external fire departments
and the AFD all required candidates for employment to undergo pre-employment physical
evaluations. This was confirmed by data collected from the fire chief questionnaires. The fire
chiefs who supervised volunteer firefighters also reported that their volunteer firefighters were
given pre-employment medical evaluations that met the medical requirements set forth by the
Washington State Bureau of Volunteer Firefighters. The fire chiefs indicated, however, that this
medical evaluation was slightly less inclusive than the criteria contained in NFPA 1582. For
career firefighters, the pre-employment physicals were compliant with NFPA 1582. For the EFQ
ANNUAL MEDICAL EVALUATIONS AT THE ABERDEEN FIRE 31
respondents, 91.9% were aware that their department required pre-employment physicals, 4.8%
did not think physicals were required and 3.2% did not know if they were required.
All of the departments surveyed indicated they do not require firefighters, whether they
are career or volunteer, to undergo annual medical evaluations once they are employed. In
determining whether the firefighters obtained annual medical evaluations on their own initiative,
50% of the EFQ respondents reported they did not, 43.5% indicated that they did and 6.5% did
not answer the question. For the firefighters at the AFD, a range of years was provided for them
to indicate when they had last undergone a medical evaluation that met the criteria outlined in
NFPA 1582. For 22.6% of the AFD respondents five years or longer had elapsed since they had
undergone a physical and 16.1% indicated they had never had a physical evaluation that met the
requirements. The data also indicated that 6.5% of the firefighters had physicals within the past
three years, 16.1% within the past two years, and 38.7% within the past year. The high
percentage of firefighters receiving physicals within the past year is explained by the fact that
50% of those firefighters received them as part of their pre-employment hiring process.
Examination of this data indicated that 50% of the EFQ respondents and 45.2% of the
AFD respondents could be at increased risk for cardiovascular disease due to the length of time
since their last medical evaluation. It was an encouraging finding, however, that all four
departments surveyed provided thorough pre-employment medical evaluations for their
firefighters.
The members of the AFD were asked to indicate whether they had their own primary
care physician and to indicate if they saw their physician annually or just on an as needed basis.
The results showed that 94% of the AFD firefighters did have a primary physician but that
only 32% went to their doctor annually and that 65% went only when they were sick.
ANNUAL MEDICAL EVALUATIONS AT THE ABERDEEN FIRE 32
The members of the AFD were asked to perform a self assessment to determine if they
had any of the six modifiable cardiac risk factors that could place them at increased risk for
cardiovascular disease and those results are displayed in Table 2.
Table 2
Assessment of Modifiable Cardiac Risk Factors for AFD Respondents
______________________________________________________________________________
Cardiac risk factors
Smoking 97% No 3% Yes
AFD respondents
Knowledge of cholesterol level 52% No 45% Yes
Medical history of hypertension 90% No 10% Yes
Aerobic exercise: 120 min/week 55% No 45% Yes
Body mass index category 26% Normal 55% Overweight 19% Obese
History of diabetes 100% No
______________________________________________________________________________
Examination of the data included in Table 2 indicated that some respondents at the AFD
may be at an increased risk of cardiovascular disease. The AFD respondents considered at
increased risk would be those that were not aware of their cholesterol level, were not obtaining
adequate aerobic exercise or were categorized as either overweight or obese.
The AFD respondents were asked to indicate if they participated in the Wellness Program
sponsored by the Association of Washington Cites and the Human Resources Department. Only
26% of the respondents indicated that they participated in the program, 74% indicated that they
did not and of those 74%, 13% were not aware that the program existed. This data indicated
that the health resources currently available to the AFD respondents are being underutilized.
ANNUAL MEDICAL EVALUATIONS AT THE ABERDEEN FIRE 33
The AFD respondents were also queried regarding their familiarity with The Fire Service
Joint Labor Management Wellness-Fitness Initiative. Specifically, they were asked to indicate if
they were aware that both the Wellness-Fitness Initiative and NFPA 1582 required firefighters to
undergo annual medical evaluations. The results indicate that 38% of the respondents were
aware of the requirement, 39% were not aware it and 22% indicated they were only vaguely
aware of the requirement. These results indicated that widespread knowledge is lacking among
this group regarding the elements contained within the initiative or NFPA 1582.
The firefighters from both cohorts were asked to indicate whether they would support the
implementation of mandatory annual medical evaluations at their fire departments or
if they felt that the program should only require voluntary participation. The results for this
question are displayed in Table 3.
Table 3
Implementation of Mandatory vs. Voluntary Medical Evaluations
______________________________________________________________________________
AFD response
Support mandatory evaluations 87% 60%
EFQ response
Support voluntary evaluations 3% 37%
Undecided 10% 3%
______________________________________________________________________________
One EFQ respondent commented that annual medical evaluations should be a mandatory
requirement for career firefighters but should be a voluntary requirement for the volunteer
firefighters. The results indicated that the majority of respondents supported the implementation
of mandatory medical evaluations at their fire departments which was not an expected result
ANNUAL MEDICAL EVALUATIONS AT THE ABERDEEN FIRE 34
considering that mandatory programs of any kind are often viewed with trepidation in the fire
service.
To assess the level of awareness the firefighters had regarding the risk of heart disease in
the fire service the firefighters were asked to indicate if they knew that heart attacks had been the
leading cause of line of duty deaths for the past five years. For the EFQ firefighters, 77%
indicated they were aware of the risk, 16% were not aware and 5% reported that they were
vaguely aware. In response to the same question 97% of the AFD firefighters knew that heart
attacks had been the leading cause of line of duty deaths and 3% percent did not. This data was
encouraging since firefighters who are aware of the increased risk of heart attack in the fire
service may be more likely to participate in programs designed to reduce cardiac risk factors.
In an attempt to identify barriers that would inhibit the implementation of programs
designed to improve the health of firefighters the following data was collected. The four fire
chiefs surveyed were asked to list the three most significant barriers they felt they would face if
they attempted to implement annual medical evaluations at their fire departments. Three of the
fire chiefs indicated that the financial burden of such a program would be a major obstacle given
their current budgetary constraints. Other barriers identified by the fire chiefs included
negotiating with the labor unions, promoting participation among the firefighters, designing the
program so that it promoted health and was not punitive, and addressing the concerns of the
firefighters who may feel that annual medical evaluations would be a threat to their job security.
The fire chiefs were asked if annual medical evaluations would be a procedure covered
by their department’s medical insurance plan. For the career firefighters, two of the departments
did have medical plans that included medical evaluations as a covered service but two
departments reported that their insurance plan would not. It was also reported that annual
ANNUAL MEDICAL EVALUATIONS AT THE ABERDEEN FIRE 35
medical evaluations for the volunteer firefighters included in this research would not be
covered by their fire department’s medical insurance plan.
The fire chiefs were asked to indicate whether their departments had policies in place
that delineated medical and physical fitness standards for their firefighters. The three fire chiefs
of the external fire departments indicated that they did not have policies in place that addressed
either the medical or physical fitness criteria of their employees. The fire chief of the AFD
indicated that a policy for medical fitness did exist but that there was not a policy in place
regarding the physical fitness criteria of firefighters.
The four fire chiefs were asked to indicate if their fire departments had developed an
essential job task analysis as described in NFPA 1582. The three external fire chiefs reported
that their fire departments had not developed a job task analysis but the fire chief of the AFD
reported that a job task analysis had been developed several years ago to assist physicians in
determining what duties firefighters could perform while on light duty.
In summary, the data collected from the fire chiefs indicated that the financial cost of
implementing annual medical evaluations would be the primary obstacle they would have to
address. The financial cost could be a significant barrier for the two fire departments with
medical insurance plans that do not include medical evaluations as a covered service for their
career firefighters. This barrier also exists for the two departments that have volunteer
firefighters since they are not eligible to receive medical evaluations covered by their fire
department’s medical insurance. Only one fire department had developed an essential job task
analysis for firefighters. This document is a requirement under NFPA 1582 and is used by
physicians to determine if a firefighter is capable of performing fire ground operations based on
specific tasks. Finally, none of the fire departments surveyed indicated that they have a policy in
ANNUAL MEDICAL EVALUATIONS AT THE ABERDEEN FIRE 36
place that described a physical fitness standard their firefighters must meet, and only one fire
department had a policy in place that described the medical standard a firefighter must meet
to be considered fit for duty. Results from the fire chief questionnaire also indicated that the
AFD was the only organization included in the research that had a member experience a heart
attack. In fact, the other fire departments reported no documented employee time loss due to
cardiovascular disease over the past five years.
To assess why some firefighters were not obtaining annual medical evaluations on their
own initiative the respondents were asked to indicate what personal barriers they felt existed.
The questionnaire provided four responses from which the respondents were instructed to choose
all that applied and the results are displayed in Table 4.
Table 4
Personal Barriers Preventing Firefighters from Obtaining Annual Medical Evaluations
______________________________________________________________________________
AFD response EFQ response
Organization’s responsibility 13% 21%
Cost is financially prohibitive 16% 10%
Physically fit: Don’t need one 13% 10%
Could result in job loss 3% 6%
______________________________________________________________________________
Additional comments received in response to this question were that some of the
firefighters had not previously considered getting annual medical evaluations and for others
medical evaluations were not a high priority. Table 4 indicates that a large percentage of
the firefighters are not obtaining medical evaluations because they felt it was the fire
ANNUAL MEDICAL EVALUATIONS AT THE ABERDEEN FIRE 37
department’s responsibility to provide them and also that the financial cost was prohibitive. The
data also indicated that some firefighters did not feel they needed medical evaluations because
they considered themselves physically fit. It was interesting to note that the fear that medical
evaluations could result in job loss was not a significant factor.
The respondents from both cohorts were asked to indicate what organizational barriers
they felt existed that were preventing firefighters within their departments from maintaining a
physically fit state. The questionnaire provided eight responses from which the respondents
were instructed to choose all that applied and the results are shown in Table 5.
Table 5
Firefighters Perceived Organizational Barriers to Physical Fitness
_____________________________________________________________________________
Barrier identified AFD response EFQ response
No barriers identified 10% 24%
Call volume vs. staffing 74% 32%
Budget constraints 48% 29%
Not an organizational priority 45% 58%
Lack of awareness of the issue 13% 32%
Poor equipment 26% 32%
Union/Management issue 3% 16%
Individual laziness 52% 66%
_____________________________________________________________________________
Examination of the data in Table 5 indicates that for the AFD respondents the high call
volume run by the department was the primary obstacle to obtaining physical fitness. Both
ANNUAL MEDICAL EVALUATIONS AT THE ABERDEEN FIRE 38
cohorts also cited budget constraints, individual laziness and their organization’s culture as
significant barriers that must be addressed in order to improve firefighter fitness.
In an effort to provide fire departments with viable options that would address the
financial and logistical barriers identified by this research, three alternatives were identified that
have the potential to reduce the incidence of cardiovascular disease. First, during an interview
with the Human Resource Director for the City of Aberdeen it was reported that the City of
Aberdeen Wellness Committee, in conjunction with the Human Resources Department and the
Association of Washington Cities, provides free annual health screening to all city employees
and their spouses. Although the screening elements are not specifically designed for firefighters,
they do assess an individual’s cardiac risk factors. The tests include screening values for height,
weight, blood pressure, total cholesterol, and glucose. The results are reviewed with the
employee by a health professional and the entire process lasts approximately 15 minutes (L.
Hein, personal communication, March 14, 2010). As previously noted in this research only 26%
of the AFD firefighters currently participate in this program. The second option identified was
cardiac screening offered by a consortium of local physicians associated with Grays Harbor
Cardiovascular Imaging. The Managing Director of Operations stated that his clinic could
provide in-depth cardiac screening which included evaluation of stroke risks, 12 lead EKG
analysis, body mass index analysis, assessment of peripheral artery disease and blood analysis
including cholesterol levels, glucose monitoring and liver function tests (K. Sprouffske, personal
communication, January 27, 2010). At the time of this report the cost of this service was $90.00
dollars. He also stated that his organization could provide 12-lead treadmill testing and
pulmonary function tests designed to specifically meet the needs of firefighters. The third option
identified was that each firefighter could obtain annual medical evaluations with their own
ANNUAL MEDICAL EVALUATIONS AT THE ABERDEEN FIRE 39
physicians that met the requirements of NFPA 1582. The members of the AFD have medical
insurance through the Association of Washington Cities Regence BlueShield and are covered
under the PPO Medical Plan-2010. Under this plan preventative care in the form of physical
examinations is considered a covered service, subject to a co-pay of $10.00 dollars. The medical
screening elements contained within NFPA 1582 were sent to the insurance representative at
Regence BlueShield and it was confirmed that medical evaluations would be a covered service
under the current medical plan. A question pertinent to this research was determining if the
insurance plan would cover an annual physical evaluation that was part of a mandatory health
screening program. This question was posed to the service representative at Regence
BlueShield. The representative stated that the service would be covered minus the $10.00 dollar
co-pay as long as the mandatory health screening program was designed to promote health and
wellness and was not a condition of employment (M. Vess, personal communication, February
16, 2010). This information differs from the information contained within the PPO Medical
Program Guide which stated that physical examinations that are used to obtain or continue
employment are excluded from insurance coverage. At the time of this report this researcher was
unable to obtain documentation from the insurance carrier stating that mandatory medical
evaluations would be a covered service. This issue would require communication between the
City of Aberdeen’s Human Resource Director and Regence BlueShield. The three medical
screening options identified have the potential to reduce the financial burden placed on the fire
departments while providing effective cardiac screening for firefighters.
The last problem addressed was determining if physical fitness was an organizational
priority for the fire departments included in this research. This question was asked of the four
fire chiefs and their responses were varied. Two of the chiefs reported they felt that their
ANNUAL MEDICAL EVALUATIONS AT THE ABERDEEN FIRE 40
organizations supported physical fitness as a priority and one chief reported that philosophically
fitness was a priority but that lack of funding did not support the philosophy. The fourth chief
emphatically stated that physical fitness was not a priority for his organization.
In comparison, Table 5 indicates that 45% of the AFD respondents and 58% of the EFQ
respondents felt that physical fitness was not a priority for their organizations.
In order to gauge what priority the firefighters at the AFD placed on fitness they were
asked to indicate if they participated in a voluntary cardiac treadmill stress test that was offered
free of charge to the fire department during March 2007. Only one half of the firefighters
employed during that time period participated in the testing. Some of the reasons given by those
that chose not to participate included that they were too busy, did not think they needed it and,
one respondent felt that it could lead to mandatory testing.
The respondents from both cohorts were asked to indicate if they exercised regularly to
improve their cardiovascular fitness level and those results are contained in Table 6.
Table 6
Self-Reported Exercise Frequency
_____________________________________________________________________________
Exercise frequency AFD respondents
Exercise regularly 52% 58%
EFQ respondents
Do not exercise regularly 0% 15%
Inconsistent exercise regimen 48% 27%
_____________________________________________________________________________
It is noted that a limitation of this question was that the term regular exercise was not
defined and therefore allowed for individual interpretation by the respondents. The data does
ANNUAL MEDICAL EVALUATIONS AT THE ABERDEEN FIRE 41
indicate, however, that a significant number of respondents from both cohorts are not obtaining
regular exercise to improve their cardiovascular fitness. The AFD respondents were asked to
indicate if they exercised while they were on-duty and 65% responded that they did and 35%
responded that they did not. The fact that the majority of firefighters are exercising while on
duty was an encouraging finding.
The respondents from both cohorts were also asked to rate their current cardiovascular
fitness level. The respondents were provided answers ranging from excellent to poor and the
results are displayed in Table 7
Table 7
Self- Reported Cardiovascular Fitness Levels
_____________________________________________________________________________
Fitness level AFD respondent
Excellent 10% 10%
EFQ respondent
Very good 32% 23%
Good 26% 40%
Average 29% 24%
Poor 3% 2%
_____________________________________________________________________________
Again the limitation noted for this question was that each fitness level was not clearly
defined which allowed for individual interpretation by each respondent. It is noted that the
majority of respondents placed themselves in the very good to average range with very few
rating themselves as excellent and an even smaller percentage choosing the poor fitness category.
The respondents were asked to indicate how they determined their fitness level by
ANNUAL MEDICAL EVALUATIONS AT THE ABERDEEN FIRE 42
selecting from the three answers provided and those results are displayed in Table 8.
Table 8
Determination of Self-Reported Fitness Level
_____________________________________________________________________________
Determination criteria AFD respondents
Medical/physical testing 35% 32%
EFQ respondents
As compared to others 71% 53%
Just picked a category 10% 16%
_____________________________________________________________________________
The results indicate that approximately one third of each cohort could rate their
cardiovascular fitness level based on quantifiable data obtained from medical and physical
testing. The majority of the respondents based their fitness level on how they compared to their
peer group. A small percentage of respondents indicated they just picked a category without
having a basis for doing so.
The EFQ respondents were asked if their fire department had a policy in place regarding
firefighter physical fitness. The answers to this question were compared to the answers from the
external fire chiefs who had previously reported that no policies existed. The EFQ respondent
answers indicated that 79% of them were aware that no policy existed, 2% thought there were
policies in place and 16% indicated they did not know if there was a policy or not.
The final question posed to the AFD respondents was used to determine if there would
be interest in developing an annual fitness assessment as outlined in NFPA 1583 and The Fire
Service Joint Labor Management Wellness-Fitness Initiative. The testing listed in the
questionnaire included a treadmill test, body composition analysis, muscular strength, muscular
ANNUAL MEDICAL EVALUATIONS AT THE ABERDEEN FIRE 43
endurance, and flexibility. The question also indicated that the programs described in the two
publications are to be non-punitive. The results indicated that 97% of the department was in
favor of implementing this program while 3% were against it.
Discussion
For the fire departments included in this research, one could apply the English idiom that
the elephant sitting in the corner of the apparatus bay is named “heart attack” and that no one
wants to acknowledge him. It is an indisputable fact, however, that heart attack is the number
one cause of line of duty firefighter death and has been so for the last twenty years (Basri &
Bergman, 2009a; USFA, 2002). There has been progress made on a national level to address this
issue with standards such as NFPA 1582 and The Fire Service Joint Labor Management
Wellness-Fitness Initiative but information gained from this research indicated that locally the
fire departments and firefighters have not formally addressed the issue. Only one of the fire
departments included in this research had developed a medically fit for duty policy and none of
the fire departments had developed a physical fitness standard. The fact that only one of the four
departments included in this research had past experience with a member having a heart attack
may account for the lack of attention to this issue. It was determined, however, that 97% of the
AFD respondents and 77% of the EFQ respondents were aware that heart attacks were the
number one cause of firefighter line of duty deaths.
The AHA has developed a list of nine cardiac risk factors used by physicians to assess
an individual’s risk of cardiovascular disease (AHA, 2008). It was determined from this research
that 29% of the AFD and 49% of the EFQ respondents were at or nearing an age associated with
increased cardiac risk, that being 45 for males and 55 for females as reported by Loy (2001a).
This research attempted to assess the cardiac risk factors of the AFD respondents and the data
ANNUAL MEDICAL EVALUATIONS AT THE ABERDEEN FIRE 44
indicated that the department’s personnel were not effectively managing their modifiable cardiac
risk factors, with 74% of the respondents either overweight or obese, 52% indicating that they
were not aware of their cholesterol level, and 55% reporting they were not obtaining sufficient
aerobic exercise. According to Loy (2001a) people who had achieved an age identified as being
at increased risk and who also had two or more elevated cardiac risk factors were classified as
being at moderate risk for heart disease.
On a positive note, all the fire departments surveyed did provide pre-employment
medical evaluations that were compliant with NFPA 1582 for the career firefighters and the
Washington State Bureau of Volunteer Firefighter medical evaluation for the volunteer
firefighters. It was determined; however, that none of the fire departments required that their
firefighters undergo annual medical evaluations once they are employed. This practice could be
placing firefighters at risk for heart attack because, as Scanlon and Ablah (2008) reported,
firefighters who have untreated or undiagnosed cardiac risk factors are at the greatest risk of
dying. This is further supported by Kales et al. (2003) who reported that 25% of the 52
firefighter deaths from heart attack he examined had pre-existing arterial disease, high
cholesterol levels, or hypertension and had not had a medical evaluation in the two years
preceding their deaths. The results of this research project indicated that 45.2% of the AFD and
50% of the EFQ respondents were at increased risk because they were not obtaining annual
medical evaluations on their own initiative and therefore may have undiagnosed cardiovascular
disease. Kales et al. (2003) reached the conclusion that since the firefighter deaths reviewed in
his study were predominantly linked to pre-existing cardiac conditions the fire service must
improve its attention to fitness and move towards implementing annual medical screening. He
contends that this would greatly reduce the incidence of premature death from cardiovascular
ANNUAL MEDICAL EVALUATIONS AT THE ABERDEEN FIRE 45
disease in the fire service. Kales et al. (2007) in another study of cardiovascular disease and its
effect on firefighters reported that because of the physical and psychological stressors associated
with the job of fire fighting, undiagnosed cardiovascular disease is particularly deadly to
firefighters.
Firefighters must be made to understand that their occupation places them at increased
risk of death from cardiovascular disease. According to the CDC (2010) cardiovascular disease
is the number one cause of death in the adult U.S. population and firefighters need to be aware
that as a group they are included in these statistics. Data from a series of surveys under the
auspices of the NHANES data base indicated that 29% of the U.S. adult population has
hypertension, 16% have elevated cholesterol levels and 33% are considered obese (NHANES,
n.d.). The findings of Davis et al. (2002) support this since the firefighters included in their
multi-year study all experienced age-related increases in their cardiac risk factors, which
included increased cholesterol levels, weight gain, and hypertension.
According to the USFA only 25% of U.S fire departments have a health and wellness
program in place designed to protect firefighters from illness or injury (USFA, 2009b). This is
consistent with the findings of this research that found that none of the four departments
surveyed had a formal health and wellness program. Both NFPA 1582 and The Fire Service
Joint Labor Management Wellness-Fitness Initiative recommend that fire departments
implement wellness programs that have mandatory medical evaluations as a component of the
program (NIOSH, 2007; IAFF, 2008). A positive finding from this research was that 87%
of the AFD respondents and 60% of the EFQ respondents indicated that they would support the
implementation of mandatory medical evaluations at their fire departments. The support of the
firefighters would be instrumental in the development of any new program designed to identify
ANNUAL MEDICAL EVALUATIONS AT THE ABERDEEN FIRE 46
and reduce the incidence of cardiovascular disease.
Common barriers to improving firefighter health were identified in the literature review
and consisted primarily of funding issues, program design, and motivating firefighters to stay
engaged with the program (USFA, 2009a). This research project identified similar barriers with
funding being the primary concern expressed by the fire chiefs and the firefighters in each
cohort. This obstacle cannot be underestimated given the current financial hardship facing all
the departments included in this study. Other significant barriers identified included the impact
of high call volume on the firefighter’s ability to maintain fitness and the perception that fitness
was not an organizational priority. It was interesting to note that a large percentage of each
cohort cited individual laziness as a personal barrier preventing firefighters from achieving a
physically fit state. A formal program endorsed by each organization could go a long way
towards improving group participation through the use of peer support and peer pressure.
NFPA 1582 recommends that fire departments appoint dedicated department physicians
that are specifically trained in occupational medicine to manage health screening programs for
firefighters (NIOSH, 2007). The standard does recognize the financial burden associated with
this type of program and offers as an alternative that each firefighter could obtain medical
evaluations from their own private physicians using the criteria contained in NFPA 1582.
Besides the full implementation of NFPA 1582, three viable alternatives were identified during
this research. Each has the benefit of identifying the firefighter’s cardiac risks while placing
minimal financial burden on the fire departments. It was identified that the members of the AFD
have access to the City of Aberdeen Wellness Program that offers free annual medical
screening that would be effective in identifying cardiac risk factors as well as provide access to
counseling on general wellness issues. Unfortunately it was determined that only 26% of the
ANNUAL MEDICAL EVALUATIONS AT THE ABERDEEN FIRE 47
AFD respondents are currently taking advantage of this program. It was not determined from
this research if comparable programs existed for the external fire departments. The cardiac
screening capabilities of a local cardiovascular clinic were also identified as being an excellent
resource that local fire departments could utilize. The fee for this service was nominal and they
indicated that they were willing to develop a program that specifically meets the needs of
firefighters. Finally, depending on an individual’s medical insurance plan, firefighters could
obtain annual medical evaluations on their own if their insurance included medical evaluations as
a covered service.
A part of this research included documentation of each respondent’s current exercise
regimen and the data indicated that only one half of all the respondents currently obtain aerobic
exercise on a regular basis. The firefighters who do not routinely perform aerobic conditioning
are placing themselves at risk for a heart attack. According to Basri and Bergman (2010)
firefighters need to obtain at least 30 minutes of aerobic exercise four times per week and Loy
(2001b) indicated that for aerobic training to be beneficial a person must exercise at more than
70% of their age predicted maximum heart rate.
The implications of this research for the fire departments involved and specifically the
AFD are literally a matter of life and death. The AFD has already had a member experience a
heart attack and at the time of this report that incident has not resulted in widespread operational
or cultural changes that would promote the reduction of heart disease among its members.
Reducing the incidence of heart attacks among firefighters will require a multifaceted
approach. There must be education provided so that firefighters understand that the inherent
stressors of the job place them at risk for developing cardiovascular disease. They must be made
aware of the existence of their modifiable risk factors so that they can take steps to mitigate them
ANNUAL MEDICAL EVALUATIONS AT THE ABERDEEN FIRE 48
and fire departments must find ways to promote a culture of health and fitness for the firefighters
which will ultimately lead to a more productive work force that is better equipped to meet the
challenges of today’s fire service.
Recommendations
The finding that the majority of firefighters who took part in this research were aware
that heart attack was the leading cause of firefighter deaths was encouraging since awareness of
the issue should provide incentive for firefighters and their organizations to address heart disease
in a proactive and positive manner. What was not encouraging was that based on the data
obtained from this research a number of respondents could be considered at moderate risk for
heart disease. This combined with the fact that none of the fire departments surveyed provided
or mandated annual medical evaluations could result in a firefighter having a heart attack from
undiagnosed and untreated cardiovascular disease. With only half of the respondents indicating
they obtained medical evaluations on their own initiative, a significant number of respondents
may not even be aware they have elevated cardiac risk factors.
Another encouraging finding was a majority of the respondents indicated that they would
support the implementation of mandatory medical evaluation programs. It is this author’s
recommendation that each fire department included in this research should utilize this support to
implement a mandatory medical evaluation program designed to identify and manage their
firefighter’s cardiac risk factors. This research identified four options available that would meet
this need. The adoption of NFPA 1582 while being the most inclusive program would also be
the most expensive program for a fire department to implement due to its stringent requirements.
The second option applies to the firefighters at the AFD and that is to promote greater
participation in the Wellness Program managed by the City of Aberdeen Wellness Committee.
ANNUAL MEDICAL EVALUATIONS AT THE ABERDEEN FIRE 49
This program would provide the most expedient solution as well as result in no cost to the fire
department or its employees. This was not identified as an option for the external fire
departments included in this research and it is recommended that those fire departments
determine if similar programs exist in their jurisdictions. The third option available to all the
firefighters included in this research was the service offered by Grays Harbor Cardiovascular
Imaging. The quoted fee was nominal considering the in-depth cardiovascular screening and this
option had the added benefit that the program could be specifically designed to meet the needs of
firefighters. The fourth option applies to those firefighters who have medical insurance plans
that include medical evaluations as a covered service. Those firefighters could obtain annual
medical evaluations using the criteria contained in NFPA 1582. What was clear from the
literature was the recommendation that any program implemented should require mandatory
participation by firefighters to ensure that all firefighters are reducing their cardiac risk factors.
It is recommended that each fire department form a joint labor/management wellness
committee that should utilize the information contained in The Fire Service Joint Labor
Management Wellness-Fitness Initiative, the Health and Wellness Guide for the Volunteer Fire
and Emergency Services, and NFPA 1582 to develop mandatory medical evaluation programs
within their departments that promote cardiovascular health. For the AFD, official
communication between the City of Aberdeen Human Resource Department and its medical
insurance carrier Regence BlueShield must take place to determine if mandatory medical
evaluations would be a covered service under the current medical plan.
Each fire department should also task its labor/management wellness committee with
identifying solutions to the personal and organizational barriers unique to their department that
are preventing firefighters from improving their overall fitness. A challenge that these
ANNUAL MEDICAL EVALUATIONS AT THE ABERDEEN FIRE 50
committees must face is the current organizational culture of their fire departments. The goal of
the wellness committee should be to promote a culture that actively supports the health and
wellness of its firefighters in a non-punitive manner.
It is further recommended that an inter-agency wellness committee be formed by all the
departments included in this survey. Formation of this committee would facilitate the sharing of
ideas and solutions and foster improved cooperation among the involved agencies which would
lead to an overall improvement in the health of local fire service personnel. Participation by
multiple agencies in one cardiac screening program could also result in a discounted price being
offered to the entire group.
The cost of doing nothing is too high. It is a fact that firefighter lives will be saved by
implementing cardiac screening programs and this should motivate both firefighters and their fire
departments to act expeditiously to address this issue.
ANNUAL MEDICAL EVALUATIONS AT THE ABERDEEN FIRE 51
References
Aberdeen Fire Department. (2004, March). Aberdeen Fire Department Safety and Accident
Prevention Program. Aberdeen, WA.
Aberdeen Fire Department. (2010, January 29). Aberdeen Fire Department Policy and
Procedures. Aberdeen, WA.
American Heart Association. (2008). Risk factors and coronary heart disease. Retrieved January
23, 2010, from http://www.americanheart.org/presenter.jhtml?identifier=500
Basri, R. (2005, August). The key to reducing firefighter deaths. Firehouse, 30(8), 82.
Basri, R., & Bergman, E. (2009a, April). Cardiovascular disease in firefighters: Defining the
problem firefighters are at higher risk of cardiac death than the public. Firehouse, 34(4),
48-51.
Basri, R., & Bergman, E. (2009b, May). Cardiovascular disease in firefighters: who is at risk-
physical activity can provoke heart attacks and sudden death. Firehouse, 34(5), 40-41.
Basri, R., & Bergman, E. (2009c, September). Cardiovascular disease in firefighters: annual
physical exams-the importance of identifying and managing cardiac risk factors.
Firehouse, 34(9), 48-51.
Basri, R., & Bergman, E. (2010, March). Preventing cardiovascular disease- a comprehensive
medical program includes lifestyle modification. Firehouse, 35(3), 116-118.
Centers for Disease Control and Prevention. (2010, January 29). Heart disease is the number one
cause of death (Fact Sheet). Retrieved from Centers for Disease Control and Prevention
Website: http://www.cdc.gov/dhdsp/announcements/american_heart_month.htm
City of Aberdeen. (2003, December 17). City of Aberdeen - Personnel Policies. Aberdeen, WA.
ANNUAL MEDICAL EVALUATIONS AT THE ABERDEEN FIRE 52
Davis, S. C., Jankovitz, K. Z., & Rein, S. (2002, September). Physical fitness and cardiac risk
factors of professional firefighters across the career span. Research Quarterly for
Exercise and Sport, 73(3), 363-370.
Federal Emergency Management Agency. (2006). Executive Development-Student Manual (3rd
ed., 2nd Printing).
Heiden, E., Testa, M., & Musolf, D. (2008). Faster better stronger. New York, NY:
HarperCollins.
Heifetz, M., & Linsky, R. (2002). Leadership on the Line. Cambridge, MA: Harvard University
Press.
International Association of Firefighters, International Association of Fire Chiefs. (2008). The
fire service joint labor management wellness-fitness initiative (3 ed.).
Kales, S. N., Soteriades, E. S., Christophi, C. A., & Christiani, D. C. (2007, March 22).
Emergency duties and death from heart disease among firefighters in the United States.
The New England Journal of Medicine, 356(12), 1207-1215.
Kales, S. N., Soteriades, E. S., Christoudias, S. G., & Christiani, D. C. (2003, November 6).
Firefighters and on-duty deaths from coronary heart disease: A case control study.
Environmental Health: A Global Assess Science Source. Retrieved from
http://www.ehjournal.net/content/2/1/14
Lloyd-Jones, D., Adams, R. J., Brown, T. M., Carnethon, M., Dai, S., De Simone, G., Ferguson,
T. B., ... Wylie-Rosett, J. (2009, December 17). Heart Disease and Stroke Statistics 2010
Update. A Report from the American Heart Association. Circulation: Journal of the
American Heart Association, e1 - e170. doi: 10.1161/CIRCULATIONAHA.109.192667
Loy, S. (2001a, March). I am firefighter, I am immortal no, you’re not. Fire Chief, 45(3), 29-30.
ANNUAL MEDICAL EVALUATIONS AT THE ABERDEEN FIRE 53
Loy, S. (2001b, April). Play by the numbers to measure department fitness. Fire Chief, 45(4), 14-
15.
National Fire Protection Association. (2007). Standard on comprehensive occupational medical
program for fire departments (2007 ed.)
National Health and Examination Survey. Retrieved from http://www.cdc.gov/nchs/nhanes.htm
National Institute for Occupational Health and Safety. (2007). Preventing fire fighter fatalities
due to heart attacks and other sudden cardiovascular events. (pp. 1-24) Retrieved from
http://cdc.gov/niosh/docs/2007-133/pdfs/2007-133pdf
Ogden, C., Carroll, M., McDowell, M., & Flegal, K. (2007). Obesity among adults in the United
States-no change since 2003-2004 (NCHS No. 1). Retrieved from Centers for Disease
Control and Prevention: http://www.cdc.gov/nchs/data/databriefs/db01.pdf
Ostchega, Y., Yoon, S., Hughes, J., & Louis, T. (2008). Hypertension awareness, treatment and
control-continued disparities in adults: United States 2005-2006 (NCHS No. 3).
Retrieved from Centers for Disease Control and Prevention:
http://www.cdc.gov/nchs/data/databriefs/db03.pdf
Scanlon, P., & Ablah, E. (2008). Self-reported cardiac risks and interest in risk modification
among volunteer firefighters: A survey based study. Journal of the American Osteopathic
Association, 108(12), 694-698.
Schober, S., Carroll, M., Lacher, D., & Hirsch, R. (2007). High serum total cholesterol-an
indicator for monitoring cholesterol lowering efforts: United States adults, 2005-2006
(NHCS No. 2). Retrieved from Centers for Disease Control and Prevention:
http://www.cdc.gov/nchs/data/databriefs/db02.pdf
ANNUAL MEDICAL EVALUATIONS AT THE ABERDEEN FIRE 54
USFA Strategic Plan-Fiscal Years 2009-2013. Improve the Fire and Emergency Services’
Capability for Response to and Recovery from All Hazards. Retrieved from
http://www.usfa.gov/downloads/pdf/strategic_plan.pdf
United States Fire Administration. (2002). Firefighter Fatality Retrospective Study (FA-220).
(pp. 1-76) Retrieved from http://www.usfa.dhs.gov/downloads/pdf/publications/fa-
220.pdf
United States Fire Administration. (2009a). Firefighter fatalities in the United States in 2008.
Retrieved from http://www.usfa.dhs.gov/downloads/pdf/publications/ff_fat08.pdf
United States Fire Administration. (2009b). Health and wellness guide for the volunteer fire and
emergency services (FEMA FA-321). Emmitsburg, MD.
Ward, B. (2009, December). A matter of heart: living a more healthful life. Fire Engineering,
162(12), 81-84.
Washington State Safety Standards for Firefighters, WA Stat. §§ 296-305-01001-296-305-08000
(1997).
ANNUAL MEDICAL EVALUATIONS AT THE ABERDEEN FIRE 55
Appendix A
ABERDEEN FIRE DEPARTMENT
PRE-EMPLOYMENT PHYSICAL
EXAMINATION
EXAMINATION REQUIREMENTS UNDER NFPA 1582
1. Physical Exam & Summary Review
2. Respiratory Questionnaire and Review
3. Pulmonary Function Test (Spirometry)
4. Blood Work: CMP
CBC
Lipid Panel
Liver Panel
5. Audiometry
6. Visual Acuity – Snellen
7. Chest X-Ray with Interpretation
8. 12 Lead EKG with Interpretation
Ancillary Test:
Urinalysis with Toxicology Screen
Revised: 6/11/2009
ANNUAL MEDICAL EVALUATIONS AT THE ABERDEEN FIRE 56
Appendix B
EXTERNAL FIREFIGHTER QUESTIONNAIRE COVER LETTER
January 19, 2010 TO: Questionnaire Participant FROM: Battalion Chief Tom Hubbard The purpose of this questionnaire is to obtain information to assist me in preparing an applied research project for the Executive Fire Officer Program at the National Fire Academy. My goal is to identify barriers, whether personal or organizational, preventing firefighters from obtaining annual medical physicals designed to identify cardiovascular disease. It is well documented that the leading cause of firefighter fatalities is heart attacks. The secondary focus of this questionnaire is to determine what priority the individual firefighters and their organizations place on physical fitness in order to maintain a “firefighting fit” state of readiness.
Completion of this questionnaire is voluntary and all information obtained will remain confidential as to organization and individual respondent.
For the purpose of this questionnaire the term medical evaluation shall encompass at the very minimum the following tests/procedures as detailed in NFPA 1582.
a. Thorough physical examination b. Analysis to determine BMI. (Fat vs. Lean body mass) c. Blood analysis including cholesterol screening d. 12 Lead EKG e. Age/gender specific cancer screening f. Aerobic/cardiovascular evaluation (Treadmill/Stairmaster)
ANNUAL MEDICAL EVALUATIONS AT THE ABERDEEN FIRE 57
Appendix C
EXTERNAL FIREFIGHTER QUESTIONNAIRE
1. What is your age? ____ Status: Career □ Volunteer □ Number of Years in the Fire Service _______ 2. Does your organization require candidate firefighters to undergo medical evaluations as part of the pre-employment screening process. (Applies to volunteer firefighter applicants as well) Yes □ No □ Don’t Know □ 3. Does your organization provide annual medical evaluations for incumbent firefighters? Yes □ No □ If you answered yes above proceed to question #6 If you answered no above proceed to question #4 4. On your own initiative do you obtain an annual medical evaluation? Yes □ No □ If you answered yes above proceed to question #6 If you answered No proceed to question #5. 5. Select the answer(s) that most accurately reflect why you do not obtain an annual medical Evaluation (choose all that apply)
a. I feel it is my organization’s responsibility to provide them □ b. The cost of obtaining an evaluation is financially prohibitive □
c. I don’t think I need one because I am physically fit □ d. I am concerned that a physical could reveal a problem which might result in my separation from my organization □ e. Other: Please explain below □
ANNUAL MEDICAL EVALUATIONS AT THE ABERDEEN FIRE 58
6. Should annual medical evaluations be mandatory or voluntary? Mandatory □ Voluntary □ Other □ (Explain below) 7. Are you aware that the United States Fire Administration has listed heart attacks as the number one cause of firefighter Line of Duty Deaths for the years 2005 to 2009? Yes □ No □ Somewhat Aware □ 8. Does your organization currently have a policy regarding firefighter physical fitness? Yes □ No □ Don’t Know □ 9. Do you regularly exercise to improve your cardiovascular fitness level? Yes □ No □ I Am Inconsistent □ 10. How would you rate your current cardiovascular physical fitness level?
Excellent □ Very Good □ Good □ Average □ Poor □ 11. How did you determine your answer to question #10? (Choose all that apply) Medical/Physical Testing □ Compared Myself to Others □ I Just Picked One □ 12. Do you feel that maintaining physically fit firefighters is a high priority for your organization? Yes □ No □ 13. In your opinion, what barriers exist in your organization that are preventing firefighters from maintaining a physically fit state? (Choose all that apply) There are no barriers □ Call Volume vs. Staffing □ Budget Constraints □ Not an Organizational Priority □ Lack of Awareness on the Issue □ Poor equipment □ Union/Management issue □ Individual Laziness □ Other □ (Please list below)
ANNUAL MEDICAL EVALUATIONS AT THE ABERDEEN FIRE 59
Appendix D
FIRE CHIEF COVER LETTER
January 19, 2010
TO: Fire Chief XXXXX FROM: Battalion Chief Tom Hubbard The purpose of this questionnaire is to obtain information to assist me in preparing an applied research project for the Executive Fire Officer Program at the National Fire Academy. My goal is to identify barriers, whether personal or organizational, preventing firefighters from obtaining annual medical physicals designed to identify cardiovascular disease. It is well documented that the leading cause of firefighter fatalities is heart attacks. The secondary focus of this questionnaire is to determine what priority the individual firefighters and their organization place on physical fitness in order to maintain a “firefighting fit” state of readiness.
Completion of this questionnaire is voluntary and all information obtained will remain confidential as to organization and individual respondent.
I have included material from NFPA 1582 to assist you in answering the questions contained in the questionnaire. If you have questions or concerns regarding this questionnaire please contact me. Thank you for taking the time to respond to my questions and for allowing me to utilize the personnel within your organization to formulate my research. Upon the conclusion of my paper I would be more than happy to discuss my findings with you. Battalion Chief Tom Hubbard Aberdeen Fire Department
ANNUAL MEDICAL EVALUATIONS AT THE ABERDEEN FIRE 60
Appendix E
FIRE CHIEF QUESTIONNAIRE 1. Does your organization currently require candidates to undergo a medical evaluation prior to employment that fulfills the requirements set forth in NFPA 1582 Standard on Comprehensive Occupational Medical Programs for Fire Departments (2007)?
Yes □ No □ Additional comments: 2. Does your organization currently require incumbent members to undergo an annual medical evaluation that fulfills the requirements set forth in NFPA 1582 Standard on Comprehensive Occupational Medical Programs for Fire Departments (2007)? Yes □ No □ Additional comments: 3. Does your organization have in place an Essential Job Task Analysis described in NFPA 1582 (2007)? Yes □ No □ Additional comments: 4. Does your organization’s current health plan cover the cost of annual medical evaluations for its career members? Yes □ No □ For it volunteer members? Additional comments: Yes □ No □
ANNUAL MEDICAL EVALUATIONS AT THE ABERDEEN FIRE 61
5. Has a member of your organization lost time from work due to a cardiovascular condition in the past 5 years? For the purpose of this questionnaire, cardiovascular condition shall be defined as: Cardiac arrest, Myocardial Infarction, Coronary Artery Disease, Angina Pectoris, Cardiac arrhythmia or Hypertension. Yes □ No □ Additional comments: 6. Does your organization currently have policies in place regarding fitness for duty qualifications that include medical and physical fitness standards? Medical: Yes □ No □ Physical Fitness: Yes □ No □ Additional comments: 6a. If you answered yes to Physical Fitness in question #6, are your members compliant with the policy regarding physical fitness? Yes □ No □ Additional comments: 7. In your opinion, does the organizational culture of your organization support physical fitness as a priority among its members? If not, why do you think that is? Please comment: 8. What do you feel would be the three most significant barriers to implementing annual medical evaluations for your organization? Please comment:
ANNUAL MEDICAL EVALUATIONS AT THE ABERDEEN FIRE 62
Appendix F
FIREFIGHTER FITNESS COVER LETTER ABERDEEN FIRE DEPARTMENT
January 26, 2010 TO: Questionnaire Participant FROM: Battalion Chief Tom Hubbard The purpose of this questionnaire is to obtain information to assist me in preparing an applied research project for the Executive Fire Officer Program at the National Fire Academy. My goal is to identify barriers, whether personal or organizational, preventing firefighters from obtaining annual medical physicals designed to identify cardiovascular disease. It is well documented that the leading cause of firefighter fatalities is heart attacks. The secondary focus of this questionnaire is to determine what priority the individual firefighters and their organizations place on physical fitness in order to maintain a “firefighting fit” state of readiness.
Completion of this questionnaire is voluntary and all information obtained will remain confidential as to individual respondent.
For the purpose of this questionnaire the term medical evaluation shall encompass at the very minimum the following tests/procedures as detailed in NFPA 1582.
a. Thorough physical examination b. Blood analysis including cholesterol screening c. 12 Lead EKG d. Age/gender specific cancer screening e. Spirometry (Forced Vital Capacity, Forced Expiratory Capacity) f. Chest x-ray
The Body Mass Index Table on the reverse side of this letter is to be used to answer question number 5e. The categories range from normal to extremely obese with the corresponding BMI number directly below. It is well documented that BMI tables can be misleading for individuals who have large muscle mass; however, for the purpose of this questionnaire the information obtained will be representative of the group as a whole and not specific to individual members. Battalion Chief Tom Hubbard
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Appendix G
FIREFIGHTER QUESTIONNAIRE ABERDEEN FIRE DEPRTMENT
1. What is your age? _____ Numbers of Years in the Fire Service: ______ Status: Career ■ Volunteer □ 2. When was the last time you had a medical evaluation that met all or part of the criteria outlined in the attached cover letter? 1 Year □ 2 Years □ 3 Years □ 4 Years □ 5 Years or Greater □ Never □ Was this your pre-employment physical? Yes □ No □ Please list the test(s) that were not part of your physical examination: 3. Do you have a primary physician? Yes □ No □ Do you see them on an annual basis? Yes □ No □ N/A □ Do you primarily see them just when you are sick? Yes □ No □ N/A □ 4. Do you participate in the City of Aberdeen’s Health and Wellness Program offered through the Association of Washington Cities and Aberdeen’s Human Resources Department? Yes □ No □ Did not know it existed □ 5. The American Heart Association has identified several risk factors associated with the increased risk of coronary heart disease and heart attack. The risk factors that can’t be changed by the individual are: Increasing age, gender (males have a greater risk), and heredity (including race). The risk factors that can be changed by the individual are: Tobacco smoke, high cholesterol levels, high blood pressure, physical inactivity, obesity, and diabetes mellitus. a. Do you smoke: Yes □ No □ b. Do you know what your current blood cholesterol levels are? Yes □ No □ c. Do you have high blood pressure? HBP is considered > 140/90 untreated, or currently taking antihypertensive medication. Yes □ No □ d. The American College of Sports Medicine recommends that adults perform 30 minutes of moderate intensity physical exercise five days each week: Do you currently meet this standard? Yes □ No □ e. Using the BMI table provided, indicate your Category:__________ & Number: _____ f. Do you have Type I or Type II diabetes? Yes □ No □
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6. Are you aware that the IAFF and the IAFC have produced The Fire Service Joint Labor Management Wellness-Fitness Initiative which parallels NFPA 1582 in requiring firefighters to undergo annual medical evaluations? Yes □ No □ Vaguely Aware it Exists □ 7. Would you support the implementation of mandatory annual medical evaluations for members of the Aberdeen Fire Department? Yes □ No □ Undecided □ If you answered no or undecided please write down your reason(s) below. 8. A voluntary Cardiac Stress test was offered by Dr. Canfield in January – March 2007. Were you employed by the AFD during this period? Yes □ No □ If you answered yes above, did you participate in the testing? Yes □ No □ If you chose not to take the stress test, please explain briefly why you chose not to participate. 9. If you currently receive annual medical evaluations go to question 10. If you do not obtain annual medical evaluations please select the answer(s) that most accurately reflect why you do not. (choose all that apply)
a. I feel it is my organization’s responsibility to provide them □ b. The cost of obtaining an evaluation is financially prohibitive □
c. I don’t think I need one because I am physically fit □ d. I am concerned that a physical could reveal a problem which might result in my separation from the fire service □ e. Other: Please explain below □ 10. How would you rate your current cardiovascular physical fitness level? Excellent □ Very Good □ Good □ Average □ Poor □ 11. How did you determine your answer to question #10? (Choose all that apply) Medical/Physical Testing □ Compared Myself to Others □ I Just Picked One □
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12. Do you exercise regularly to improve your cardiovascular fitness level? Yes □ No □ I am inconsistent □ 13. Did you know that the United States Fire Administration has listed heart attacks as the number one cause of firefighter deaths for the years 2005 to 2009? Yes □ No □ Vaguely Aware □ 14. In your opinion, what barriers exist at the Aberdeen Fire Department that are preventing firefighters from maintaining a physically fit state? (Choose all that apply) There are no barriers □ Call Volume vs. Staffing □ Budget Constraints □ Not an Organizational Priority □ Lack of Awareness on the Issue □ Poor equipment □ Union/Management issue □ Individual Laziness □ Other □ (Please list below) 15. Do you currently exercise while on-duty? Yes □ No □ 16. NFPA 1583 and the IAFF/IAFC Wellness-Fitness Initiative require annual fitness assessments that measure the following: aerobic capacity (treadmill test), body composition, muscular strength, muscular endurance and flexibility. The program is designed to be non-punitive and is administered by a department Health Fitness Coordinator and Peer Fitness Trainers. Would you be in favor of implementing this program at the Aberdeen Fire Department? Yes □ No □
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Appendix H
ABERDEEN FIRE DEPRTMENT FIREFIGHTER QUESTIONNAIRE DATA (n = 31)
1. What is your age? (Avg. 36.2) Numbers of Years in the Fire Service: (Avg. 13.9) Status: Career ■ (31) Volunteer □ (0) 2. When was the last time you had a medical evaluation that met all or part of the criteria outlined in the attached cover letter?
1 Year (38.7%) 2 Years (16.1%) 3 Years (6.5%) 4 Years (0%) 5 Years or Greater (22.6) Never (16.1%)
Was this your pre-employment physical? Yes (45%) No (42%) Please list the test(s) that were not part of your physical examination: The data indicated that 35% did not receive cancer screening, 23% did not receive spirometry testing, 23% did not receive a chest X-Ray, and 10% did not receive a 12 lead EKG. 3. Do you have a primary physician? Yes (94%) No (6%) Do you see them on an annual basis? Yes (32%) No (68%) N/A □ Do you primarily see them just when you are sick? Yes (65%) No (35%) N/A □ 4. Do you participate in the City of Aberdeen’s Health and Wellness Program offered through the Association of Washington Cities and Aberdeen’s Human Resources Department? Yes (26%) No (61%) Did not know it existed (13%) 5. The American Heart Association has identified several risk factors associated with the increased risk of coronary heart disease and heart attack. The risk factors that can’t be changed by the individual are: Increasing age, gender (males have a greater risk), and heredity (including race). The risk factors that can be changed by the individual are: Tobacco smoke, high cholesterol levels, high blood pressure, physical inactivity, obesity, and diabetes mellitus. a. Do you smoke: Yes (3%) No (97%) b. Do you know what your current blood cholesterol levels are? Yes (45%) No (52%) c. Do you have high blood pressure? HBP is considered > 140/90 untreated, or currently taking antihypertensive medication. Yes (10%) No (90%) d. The American College of Sports Medicine recommends that adults perform 30 minutes of moderate intensity physical exercise five days each week: Do you currently meet this standard? Yes (45%) No (55%) Normal Wt. (26%) e. Using the BMI table provided, indicate your Category: Overweight (55%) Obese (19%) f. Do you have Type I or Type II diabetes? Yes (0%) No (100%)
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6. Are you aware that the IAFF and the IAFC have produced The Fire Service Joint Labor Management Wellness-Fitness Initiative which parallels NFPA 1582 in requiring firefighters to undergo annual medical evaluations? Yes (38%) No (39%) Vaguely Aware it Exists (23%) 7. Would you support the implementation of mandatory annual medical evaluations for members of the Aberdeen Fire Department? Yes (87%) No (3%) Undecided (10%) If you answered no or undecided please write down your reason(s) below. Answers included: “Only if done on duty” “If fitness and nutrition added to daily Training” “As long as it was not punitive” “Poor medical evaluation = loss of job?” “Don’t like the sound of anything mandatory” 8. A voluntary Cardiac Stress test was offered by Dr. Canfield in January – March 2007. Were you employed by the AFD during this period? Yes (71%) No (29%) If you answered yes above, did you participate in the testing? Yes (35%) No (35%) If you chose not to take the stress test, please explain briefly why you chose not to participate. Answers included: “Too busy” “Lazy” “On vacation” “On disability leave” “Already get one from my doctor” “I felt it could lead to a mandatory thing” “Did not think I needed one because of my age” 9. If you currently receive annual medical evaluations go to question 10. If you do not obtain annual medical evaluations please select the answer(s) that most accurately reflect why you do not. (choose all that apply)
a. I feel it is my organization’s responsibility to provide them (13%) b. The cost of obtaining an evaluation is financially prohibitive (16%)
c. I don’t think I need one because I am physically fit (13%) d. I am concerned that a physical could reveal a problem which might result in my separation from the fire service (3%) e. Other: Please explain below (35%) 10. How would you rate your current cardiovascular physical fitness level? Excellent (10%) Very Good (32%) Good (26%) Average (29%) Poor (3%) 11. How did you determine your answer to question #10? (Choose all that apply) Medical/Physical Testing (35%) Compared Myself to Others (71%) I Just Picked One (10%)
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12. Do you exercise regularly to improve your cardiovascular fitness level? Yes (52%) No ()%) I am inconsistent (48%) 13. Did you know that the United States Fire Administration has listed heart attacks as the number one cause of firefighter deaths for the years 2005 to 2009? Yes (97%) No (3%) Vaguely Aware (0%) 14. In your opinion, what barriers exist at the Aberdeen Fire Department that are preventing firefighters from maintaining a physically fit state? (Choose all that apply) There are no barriers (10%) Call Volume vs. Staffing (47%) Budget Constraints (48%) Not an Organizational Priority (45%) Lack of Awareness on the Issue (13%) Poor equipment (26%) Union/Management issue (3%) Individual Laziness (52%) Other (19%) Answers included: “Complacency” “People think they are immune to to this, but because of their job they are a ticking time bomb” “Insufficient workout facility” “Other training and duties take priority over physical fitness” “When you are assigned to the ambulance, working out is almost impossible” “Not enough equipment, go look at the police department” 15. Do you currently exercise while on-duty? Yes (65%) No (35%) 16. NFPA 1583 and the IAFF/IAFC Wellness-Fitness Initiative require annual fitness assessments that measure the following: aerobic capacity (treadmill test), body composition, muscular strength, muscular endurance and flexibility. The program is designed to be non-punitive and is administered by a department Health Fitness Coordinator and Peer Fitness Trainers. Would you be in favor of implementing this program at the Aberdeen Fire Department? Yes (97%) No (3%)
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Appendix I
EXTERNAL FIREFIGHTER QUESTIONNAIRE DATA (n = 62)
1. What is your age? (Avg. 38.5) Status: Career (52%) Volunteer (48%) Number of Years in the Fire Service (Avg. 12.3) 2. Does your organization require candidate firefighters to undergo medical evaluations as part of the pre-employment screening process. (Applies to volunteer firefighter applicants as well) Yes (91.9%) No (4.8%) Don’t Know (3.2%) 3. Does your organization provide annual medical evaluations for incumbent firefighters? Yes (3%) No (97%) If you answered yes above proceed to question #6 If you answered no above proceed to question #4 4. On your own initiative do you obtain an annual medical evaluation? Yes (44%) No (50%) If you answered yes above proceed to question #6 If you answered No proceed to question #5. 5. Select the answer(s) that most accurately reflect why you do not obtain an annual medical Evaluation (choose all that apply)
a. I feel it is my organization’s responsibility to provide them (21%) b. The cost of obtaining an evaluation is financially prohibitive (10%)
c. I don’t think I need one because I am physically fit (10%) d. I am concerned that a physical could reveal a problem which might result in my separation from my organization (6%) e. Other: Please explain below (23%) Answers included: “Should but don’t” “Don’t think about it” “As a volunteer, I have a very physical and demanding job” “I get a ‘physical’ every other year for commercial drivers license, but not very thorough” “Laziness” “Is it really necessary?” “I know my issues, don’t need a MD to tell me to lose weight, eat better, lower my BP, and get more exercise”
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6. Should annual medical evaluations be mandatory or voluntary? Mandatory (60%) Voluntary (37%) Other (3%) (Explain below) Answers included: “Mandatory for career, voluntary for volunteers” “Only if the employer is financially responsible” “The evaluations should be done bi-annually” 7. Are you aware that the United States Fire Administration has listed heart attacks as the number one cause of firefighter Line of Duty Deaths for the years 2005 to 2009? Yes (77%) No (16%) Somewhat Aware (6%) 8. Does your organization currently have a policy regarding firefighter physical fitness? Yes (2%) No (79%) Don’t Know (16%) 9. Do you regularly exercise to improve your cardiovascular fitness level? Yes (58%) No (15%) I Am Inconsistent (27%) 10. How would you rate your current cardiovascular physical fitness level? Excellent (10%) Very Good (23%) Good (40%) Average (40%) Poor (2%) 11. How did you determine your answer to question #10? (Choose all that apply) Medical/Physical Testing (32%) Compared Myself to Others (53%) I Just Picked One (16%) 12. Do you feel that maintaining physically fit firefighters is a high priority for your organization? Yes (32%) No (68%) 13. In your opinion, what barriers exist in your organization that are preventing firefighters from maintaining a physically fit state? (Choose all that apply) There are no barriers (24%) Call Volume vs. Staffing (32%) Budget Constraints (29%) Not an Organizational Priority (58%) Lack of Awareness on the Issue (32%) Poor equipment (32%) Union/Management issue (16%) Individual Laziness (66%) Other (11%) (Please list below) Answers included: “Department not willing to invest in equipment” “Not allowed to work out during day time hours” “Fear of the unknown” “Should city pay for gym membership?” “There is no equipment at station” “There is no expectation of fitness” “No equipment at station and not allowed to access local gym while on duty”
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Appendix J
FIRE CHIEF QUESTIONNAIRE DATA (n = 4)
1. Does your organization currently require candidates to undergo a medical evaluation prior to employment that fulfills the requirements set forth in NFPA 1582 Standard on Comprehensive Occupational Medical Programs for Fire Departments (2007)?
Yes (The four fire chiefs all responded yes) No (0%) Additional comments: “Volunteer firefighters must meet the Washington State Bureau of Volunteer Firefighters which are not as inclusive as NFPA.” 2. Does your organization currently require incumbent members to undergo an annual medical evaluation that fulfills the requirements set forth in NFPA 1582 Standard on Comprehensive Occupational Medical Programs for Fire Departments (2007)? Yes (0%) No (The four fire chiefs all responded no) Additional comments: “Budgetary constraints do not allow the city to enforce this standard.” 3. Does your organization have in place an Essential Job Task Analysis described in NFPA 1582 (2007)? Yes (1 fire chief responded yes) No (3 fire chiefs responded no) Additional comments: “Developed to establish standards for what firefighters can do while on light duty.” 4. Does your organization’s current health plan cover the cost of annual medical evaluations for its career members? Yes (2 fire chiefs responded yes) No (2 fire chiefs responded no) For it volunteer members? Additional comments: Yes (0%) No (For the 2 fire departments with volunteer fire fighters the fire chiefs responded no and the 2 fire chiefs without volunteers indicated N/A).
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5. Has a member of your organization lost time from work due to a cardiovascular condition in the past 5 years? For the purpose of this questionnaire, cardiovascular condition shall be defined as: Cardiac arrest, Myocardial Infarction, Coronary Artery Disease, Angina Pectoris, Cardiac arrhythmia or Hypertension. Yes (1 fire chief responded yes) No (3 fire chiefs responded no) Additional comments: 6. Does your organization currently have policies in place regarding fitness for duty qualifications that include medical and physical fitness standards? Medical: Yes (1 fire chief responded yes) No (3 fire chiefs responded no)
Physical Fitness: Yes (0%) No (4 fire chiefs responded no)
Additional comments: 6a. If you answered yes to Physical Fitness in question #6, are your members compliant with the policy regarding physical fitness? Yes (N/A) No (N/A) Additional comments: 7. In your opinion, does the organizational culture of your organization support physical fitness as a priority among its members? If not, why do you think that is? Please comment: The four answers were: 1. “Yes!” 2. “Philosophically wellness and physical fitness are supported, however, the funding is not available to support the philosophy.” 3. “No, not at all” 4. “I feel the current organization values fitness as a whole. May not be 100%, but definitely is the majority” 8. What do you feel would be the three most significant barriers to implementing annual medical evaluations for your organization? Please comment: Answers included: “Job security, Privacy, Some members not wanting to take the time involved, The perception that they would be punished if they received a poor evaluation, Cost, Getting members to participate and follow through, Funding, Labor contract, Monitoring and accountability, Fire District Commissioner support, and What ifs”
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