Evidence-based medical examinations for firefighters.
NIOSH 2002 Dec; :1-22
Our study evolved from an investigation of medical surveillance for one of six Massachusetts hazardous materials teams from 1993 - 1995. The principal investigator later received a special emphasis research-career award (1996-1999) from NIOSH to investigate incident and medical surveillance in firefighters and the program included all six hazardous materials teams of Massachusetts. The current award (1998-2002) was designed to focus on medical examinations and had the following specific aims: (1) To evaluate the ability of objective fitness guidelines, and baseline health ratings to predict increased risks of injury, cardiac events or other adverse outcomes. (2) To evaluate whether firefighters with abnormal hearing are at increased risk for injury or other adverse outcome. (3) To examine the clinical utility of various examination components among firefighters. (4) To help develop evidence-based medical evaluations for firefighters. In the past five years, the firefighters have been followed on an annual basis and a computerized state repository has been maintained with data on physical examinations of firefighters and other tests including various blood tests, vision and hearing tests and electrocardiograms. Several research projects were completed using the available information. Nine peer-reviewed articles have been published in scientific journals, and several national and regional invited presentations were given from the current award. A number of evidence-based improvements in firefighter medical evaluations have been identified. We found that significant exposures and injuries identified by medical surveillance during hazardous materials duty are infrequent and the use of biochemical testing is of limited utility, and the frequency of this testing may be reduced. With regards to respiratory exposures, we found that the hazardous materials technicians do not appear to lose pulmonary function at a faster rate than regular firefighter. One other important consideration is the evaluation of fitness for duty in firefighters with blood pressure readings >/=160/100 mm Hg. Our research suggests that firefighters with high blood pressure readings should receive further evaluation and demonstrate improved blood pressure control prior to receiving medical clearance as "fit for duty." With respect to myocardial infarctions, the 10- year estimated CHD risk of fire fighters is similar to the general population and increases with age. Extrapolation from general population paradigms, risk assessment and stratification, previous studies and a case-control analysis of on-duty CHD fatalities, all suggest similar risk profiles for those at elevated risk for cardiovascular disease. Our research supports that medical screening could have an important impact on reducing fire figthers' risk for adverse outcomes.
Medical-examinations; Fire-fighters; Fire-fighting; Risk-analysis; Risk-factors; Injuries; Injury-prevention; Hearing-disorders; Physical-examination; Blood-tests; Hearing-tests; Electrocardiography; Occupational-exposure; Cardiovascular-disease; Medical-screening
Medical Director, Employee and Industrial Health, The Cambridge Hospital, Department of Medicine, Occupational and Environmental Health, 1493 Cambridge Street, Cambridge, MA 02139
Final Grant Report
Research Tools and Approaches; Health Services Research
National Institute for Occupational Safety and Health
Harvard University, Department of Environmental Health, Boston, Massachusetts