Meeting Agenda First Draft Meeting for NFPA1500 and NFPA 1582 Technical Committee on Fire Service Occupational Safety and Health November 17-19, 2015 Austin, TX

Home , NFPA 1901

I. Welcome and call to order by Chairman Krause

II. Introductions- members and guests

III. Review and accept minutes from the February 2015 meeting

IV. NFPA update – Ken Holland, Staff Liaison

a. NFPA process

b. Meeting update

c. TC membership and alternates

V. Committee discussion and work on NFPA 1500

a. address all public inputs (114 submitted)

b. develop first revisions (where applicable)

VI. Committee discussion and work on NFPA 1582

a. address public inputs (111 submitted)

b. develop first revisions (where applicable)

VII. Group discussion on task group work/meetings

VIII. Old and new business- new project request status

IX. Next Meeting- SDM for NFPA 1500 and NFPA 1582 National Fire Protection Association (NFPA) Fire Service Occupational Safety and Health Technical Committee Meeting February 10 – 12, 2015 Orlando, FL

Chairman Randy Krause called the meeting to order at 0805 hours on February 10, 2015 at the Hilton Garden Inn, Orlando, FL.

Chairman Krause welcomed members and guests to the meeting of the NFPA Fire Service Occupational Safety and Health Technical Committee.

Members and guests were introduced.

Members Present: Randy Krause, Chairman Murrey Loflin, Secretary David Bernzweig Dr. Sandy Bogucki Brett Bowman Jim Brinkley Dennis Childress Tom Cuff Scott Kerwood Tamara DiAnda Lopes Paul J. Napoli Bob Neamy Ryan N. Pietzsch Dr. David Prezant Dr. Daniel Samo Andrew G. Schwartz Denise Smith Dr. Donald Stewart Phil Stittleburg Fred Terryn

Alternates and Non-Voting Members Present: Hayley Fudge Dr. Tom Hales Greg Reynar

Guests: Jeff Bailes Selden, NY Fire Department Frank Califano Occupational & Environmental Medicine of Long Island, NY Dr. Fabrice Czarnecki Department of Homeland Security Dr. Ed Galaid Occupational Medicine, Charleston, SC 1

Dr. Stan Haimes College of Medicine, University of Central Florida Dr. Francesca Litow John Hopkins/IAFF Fellowship

Staff Liaison: Ken Holland

The chairman asked for a motion to accept the meeting minutes from the March 10 – 11, 2014 FSOSH Technical Committee in Tempe, AZ. David Bernzweig made a motion to accept the minutes as read, Phil Stittleburg made the second, and the motion passed.

Chairman Krause discussed the 2017 Annual Revision Cycle for NFPA 1500, Standard for a Fire Department Occupational Safety and Health Program and NFPA 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments.

NFPA 1582 Revision Process Dr. Fabrice Czarnecki, Task Group Chair

Dr. Czarnecki presented an overview of issues to address and discussion points for this revision cycle of NFPA 1582.

Discussion Points  Main issues to discuss o Inconsistencies with the document (typically between Chapter 6 and Chapter 9) o Clarification (e.g. vision) o Missing information/new topics to add o Medical content to update (e.g. seizure)

 Principles o NFPA 1582 reflects “minimal requirements” (Paragraph 1, 2, & 3)/best practices belong in the appendix, especially when consensus-based o NFPA 1582 should be evidence based as much as possible, especially for costly procedures o NFPA 1528 should be a user-friendly document

 Issues to Consider o Merge Chapters 6 & 9/Is there a valid reason to have different “medical” criteria for members and candidates o Remove the word “structural” (as in structural fire-fighting) o State 1% annual risk of sudden incapacitation as threshold o Replace “essential job tasks” with essential job functions”;

The technical committee discussed the ease of use of the standard for physicians and how to make the standard and the document is more “user-friendly” for physicians.

A motion was made by Dan Samo to have Chapter 6 & Chapter 9 listed sequentially in the standard. Jim Brinkley made the second and the motion passed. The issue that the standard is for more than just structural fire-fighting was discussed. A motion was made by Jim Brinkley and a second by Dan Samo to remove the word “structural” from NFPA 1582 (6.16.1 (4)(b); 9.10.5.2 (3)(b); and A.4.1.7 “interior structural”). The motion passed.

Jim Brinkley and David Prezant discussed the changes to the IAFF/IAFC Wellness Fitness Initiative (WFI) which have occurred in this revision cycle of the document. The focus of the presentation focused on Chapter 2 – Medical.

Jim Brinkley presented suggested changes to NFPA 1582 based upon the revisions to the Wellness Fitness Initiative (WFI). The technical committee worked on revisions to NFPA 1582 which will appear on the technical committee’s webpage and will be addressed as public proposals during the 1st Draft Meeting.

Dr. Czarnecki discussed specific topics which need to be addressed and completed by the beginning of June 2015.

 Beta blockers Paragraph 9.16.9.1  Asthma o Needs clarification o Differences between Chapter 6 and Chapter 9, which is probably not in compliance with SCBA challenge test for applicant o Scientific basis?  Coronary artery disease Paragraph 9.4.3 o Timeframe before return to work  Coronary artery disease risk factor evaluation o New tests: CRP, calcium scoring o Maximal vs. submaximal stress test/stress test protocols o Indications for stress testing and echo  Hearing Aids o Dr. Samo has submitted a research project through the NFPA Research Foundation to study if hearing aids function during interior structural fire-fighting;  Hernia  Hypertension o Echo for Stage 2 hypertension in Annex  Metabolic Syndrome o Imaging stress test of applicants o Frequency of imaging test for incumbents o Scientific basis  Pacemaker o Pacer-dependent o Risk of failure (review article)  Psychiatric disorders o PTSD o Substance Abuse 3

o Screening  Seizure o Currently 1 year off medications/5 years on medications o FMSCA: 5 years after single seizure/10 years after epilepsy (use FMSCA requirements) o New data: 10 years/14 years (to reach annual risk of 1% year)  Sleep disorders o Narcolepsy o Obstructive sleep apnea o Shift work disorder o Statement on indication of sleep studies (Annex) o Screening as part of wellness program (Annex) o 511EJT on shift work (Add to 5.1.1 (9))  Stroke o Needs clarification o Use FMSCA recommendations  Vision o 9.12.3.1 and 6.4.1 (and Annex Material) o Needs clarification o Visual activity in worse eye/Monocular vision o Color vision o Visual field  Adding/deleting tests included in annual evaluations and candidates o See WFI recommendations o New cardiac testing (calcium scoring) o Maximal vs. submaximal stress test/stress test protocols o Indications for stress testing and echo-cardiogram o Frequency of stress testing o Side effects of cancer testing in Annex o CV risk calculator  TB Screening o Discussion of material in Annex  Check all web links and references  Two fitness protocols o Add FDNY protocol

NFPA 1500 Revision Process David Bernzweig, Task Group Chair

The technical committee discussed air management issues based upon language between NFPA 1500; NFPA 1404, Standard for Fire Service Respiratory Protection Training; and NFPA 1981, Standard on Open-Circuit Self-Contained Breathing Apparatus (SCBA) For Emergency Services. The issue is created by language in these three standards that aim to address the need for a reserve air supply. The Technical Committee for Fire Service Training raised a correlation issue between the 2013 editions of NFPA 1500, NFPA 1981, and NFPA 1404. The issue is created by language in these three standards that 4 aim to address the need for a reserve air supply. Specifically, the requirement in NFPA 1404 states that the user of SCBA exit the IDLH before the consumption of the reserve air supply, as indicted by End-of- Service Time Indicator (EOSTI) activation, language in NFPA 1500 that states an “exit strategy will be practiced when the SCBA cylinder reaches a level of 600L or more”, and language in NFPA 1981 that states that the “EOSTI alarm shall activate at 33%, +5/-0 % of full cylinder pressure”. The technical committee will develop language since this is a “use” issue.

Other issues related to respiratory protection to be addressed during the revision cycle of NFPA 1500, include respiratory protection for salvage and overhaul, plus respiratory protection for fire investigators.

The technical committee had a discussion regarding the issue of exposure control on the fireground including carcinogens, toxicants, and ultrafine particles. There is correlation between job-related exposures and cancer as well as other illnesses. Currently, there is no standard that currently addresses the control of exposure to carcinogens, toxins, and ultrafine particles. The technical committee is submitting a New Project Initiation Form to the Standards Council on this issue. The scope of this new document/project is to define the minimum requirements for fire departments to control workplace exposure to products of combustion, carcinogens, toxicants, and ultra-fine particles have the potential to result in harm immediately or over a long period of time.

The technical committee worked on revisions to NFPA 1500 which will appear on the technical committee’s webpage and will be addressed during the 1st Draft Meeting. The revisions to NFPA 1500 will be submitted as proposals from the technical committee.

The technical committee discussed the dates and location of the 1st Draft Meeting. The technical committee has to meet between July 6, 2015 and December 14, 2015. Suggested locations are Portland, OR; Austin, TX; San Francisco, CA; and San Diego, CA. Meeting dates discussed were October 13 – 16, 2015 and November 16 – 18, 2015. Chairman Krause and Staff Liaison Ken Holland will work on the dates and meeting location.

A motion was made by Dr. Prezant with a second by David Bernzweig to adjourn the meeting at 1500 hours on Thursday, February 12, 2015.

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Public Input No. 31-NFPA 1500-2015 [ Section No. 1.1 ]

1.1 Scope. This standard shall contain minimum requirements for a fire service–related occupational safety, health, and health wellness program.

Statement of Problem and Substantiation for Public Input

TG Public Proposal; Change should include all uses of the term 'safety and health'. The term should be replaced with ' safety, health, and wellness'. the change should include the document title.

Submitter Information Verification

Submitter Full Name: David Bernzweig Organization: Ohio Association of Professional Firefighters Street Address: City: State: Zip: Submittal Date: Wed Feb 11 11:16:02 EST 2015

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Public Input No. 7-NFPA 1500-2014 [ Section No. 1.2.2 ]

1.2.2 This standard shall specify safety requirements for those members involved in rescue, fire suppression, emergency medical services, hazardous materials operations, special operations, and fire investigations, fire inspections and related activities.

Statement of Problem and Substantiation for Public Input

Fire investigations and fire inspections are activities that are frequently performed by fire deparment personnel and have their own unique exposures for occupational safety and health. These should be recognized as a part of a comprehensive health safety and wellness program that addresses all apsects of fire department services with occupational exposures.

Related Public Inputs for This Document

Related Input Relationship Public Input No. 8-NFPA 1500-2014 [Section No. 5.2]

Submitter Information Verification

Submitter Full Name: Anthony Apfelbeck Organization: Altamonte Springs Building/Fire Safety Division Street Address: City: State: Zip: Submittal Date: Thu Jan 02 15:55:59 EST 2014

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Public Input No. 15-NFPA 1500-2014 [ Chapter 2 ]

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2.2 NFPA Publications.

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National Fire Protection Association, 1 Batterymarch Park, Quincy, MA 02169-7471. NFPA 10, Standard for Portable Fire Extinguishers, 2010 edition 2017 .

NFPA 101® , Life Safety Code®, 2012 edition 2015 . NFPA 472, Standard for Competence of Responders to Hazardous Materials/Weapons of Mass Destruction Incidents, 2013 edition . NFPA 473, Standard for Competencies for EMS Personnel Responding to Hazardous Materials/Weapons of Mass Destruction Incidents, 2013 edition . NFPA 1001, Standard for Fire Fighter Professional Qualifications, 2013 edition . NFPA 1002, Standard for Fire Apparatus Driver/Operator Professional Qualifications, 2009 edition 2017 . NFPA 1003, Standard for Airport Fire Fighter Professional Qualifications, 2010 edition 2013 . NFPA 1006, Standard for Technical Rescuer Professional Qualifications, 2008 edition 2017 . NFPA 1021, Standard for Fire Officer Professional Qualifications, 2009 edition 2014 . NFPA 1051, Standard for Wildland Fire Fighter Professional Qualifications, 2012 edition 2016 . NFPA 1071, Standard for Emergency Vehicle Technician Professional Qualifications, 2011 edition 2016 . NFPA 1221, Standard for the Installation, Maintenance, and Use of Emergency Services Communications Systems, 2013 edition 2016 . NFPA 1403, Standard on Live Fire Training Evolutions, 2012 edition 2017 . NFPA 1404, Standard for Fire Service Respiratory Protection Training, 2006 edition 2013 . NFPA 1451, Standard for a Fire Service Vehicle Operations Training Program, 2007 edition 2013 . NFPA 1521, Standard for Fire Department Safety Officer, 2008 edition 2015 . NFPA 1561, Standard on Emergency Services Incident Management System, 2008 edition 2014 . NFPA 1581, Standard on Fire Department Infection Control Program, 2010 edition 2015 . NFPA 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments, 2013 edition . NFPA 1583, Standard on Health-Related Fitness Programs for Fire Department Members, 2008 edition 2015 . NFPA 1670, Standard on Operations and Training for Technical Search and Rescue Incidents, 2009 edition 2017 . NFPA 1851, Standard on Selection, Care, and Maintenance of Protective Ensembles for Structural Fire Fighting and Proximity Fire Fighting, 2008 edition 2014 . NFPA 1852, Standard on Selection, Care, and Maintenance of Open-Circuit Self-Contained Breathing Apparatus (SCBA), 2008 edition 2013 . NFPA 1901, Standard for Automotive Fire Apparatus, 2009 edition 2016 . NFPA 1906, Standard for Wildland Fire Apparatus, 2012 edition 2016 . NFPA 1911, Standard for the Inspection, Maintenance, Testing, and Retirement of In-Service Automotive Fire Apparatus, 2012 edition 2017 . NFPA 1912, Standard for Fire Apparatus Refurbishing, 2011 edition 2016 . NFPA 1925, Standard on Marine Fire-Fighting Vessels, 2008 edition 2013 . NFPA 1931, Standard for Manufacturer's Design of Fire Department Ground Ladders, 2010 edition 2015 . NFPA 1932, Standard on Use, Maintenance, and Service Testing of In-Service Fire Department Ground Ladders, 2010 edition 2015 . NFPA 1936, Standard on Powered Rescue Tools, 2010 edition 2015 . NFPA 1951, Standard on Protective Ensembles for Technical Rescue Incidents, 2013 edition . NFPA 1952, Standard on Surface Water Operations Protective Clothing and Equipment, 2010 edition 2015 .

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NFPA 1961, Standard on Fire Hose, 2013 edition . NFPA 1962, Standard for the Inspection, Care, and Use of Fire Hose, Couplings, and Nozzles and the Service Testing of Fire Hose, 2008 edition 2013 . NFPA 1964, Standard for Spray Nozzles, 2008 edition 2013 . NFPA 1971, Standard on Protective Ensembles for Structural Fire Fighting and Proximity Fire Fighting, 2013 edition . NFPA 1975, Standard on Station/Work Uniforms for Emergency Services, 2009 edition 2014 . NFPA 1977, Standard on Protective Clothing and Equipment for Wildland Fire Fighting, 2011 edition 2016 . NFPA 1981, Standard on Open-Circuit Self-Contained Breathing Apparatus (SCBA) for Emergency Services, 2007 edition 2013 . NFPA 1982, Standard on Personal Alert Safety Systems (PASS), 2007 edition 2013 . NFPA 1983, Standard on Life Safety Rope and Equipment for Emergency Services, 2012 edition 2017 . NFPA 1984, Standard on Respirators for Wildland Fire-Fighting Operations, 2011 edition 2016 . NFPA 1989, Standard on Breathing Air Quality for Emergency Services Respiratory Protection, 2008 edition 2013 . NFPA 1991, Standard on Vapor-Protective Ensembles for Hazardous Materials Emergencies, 2005 edition 2016 . NFPA 1992, Standard on Liquid Splash-Protective Ensembles and Clothing for Hazardous Materials Emergencies, 2012 edition 2017 . NFPA 1994, Standard on Protective Ensembles for First Responders to CBRN Terrorism Incidents, 2012 edition 2017 . NFPA 1999, Standard on Protective Clothing for Emergency Medical Operations, 2008 edition 2013 . 2.3 Other Publications. 2.3.1 ACGIH Publications. American Conference of Governmental Industrial Hygienists, 1330 Kemper Meadow Drive, Cincinnati, OH 45240-1634.

TLVs® and BEIs®, 2005 2014 . 2.3.2 ANSI Publications. American National Standards Institute, Inc., 25 West 43rd Street, 4th Floor, New York, NY 10036. ANSI/ISEA Z87.1, Practice for Occupational and Educational Eye and Face Protection, 2003 2010 . ANSI Z88.2, Practices for Respiratory Protection, 1992, (withdrawn 1992) . 2.3.3 U.S. Government Publications. U.S. Government Printing Government Publishing Office, Washington, DC 20402. NIOSH Pocket Guide to Chemical Hazards, U.S. Department of Health and Human Services, Center for Disease Control and Prevention. NIOSH Publication 97-140, February 2004. NIOSH Standard for Chemical, Biological, Radiological, and Nuclear (CBRN) Full Facepiece Air Purifying Respirator (APR), March 2003. NIOSH Standard for Chemical, Biological, Radiological, and Nuclear (CBRN) Open Circuit Self-Contained Breathing Apparatus (SCBA), December 2001. Title 29, Code of Federal Regulations, Part 1910.134, Respiratory Protection, 1998 2012 . Title 42, Code of Federal Regulations, Part 84, Approval of respiratory protective devices, 2004. 2.3.4 Other Publications. Lewis, Richard J., Sr., Sax's Dangerous Properties of Industrial Materials, 11th ed., John Wiley & Sons, 2004. Merriam-Webster's Collegiate Dictionary, 11th edition, Merriam-Webster, Inc., Springfield, MA, 2003.

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2.4 References for Extracts in Mandatory Sections. NFPA 1, Fire Code , 2012 edition 2015 . NFPA 472, Standard for Competence of Responders to Hazardous Materials/Weapons of Mass Destruction Incidents, 2013 edition . NFPA 600, Standard on Industrial Fire Brigades, 2010 edition 2015 . NFPA 921, Guide for Fire and Explosion Investigations, 2011 edition 2017 . NFPA 1002, Standard for Fire Apparatus Driver/Operator Professional Qualifications, 2009 edition 2017 . NFPA 1006, Standard for Technical Rescuer Professional Qualifications, 2008 edition 2017 . NFPA 1250, Recommended Practice in Fire and Emergency Services Organization Risk Management, 2010 edition 2015 . NFPA 1404, Standard for Fire Service Respiratory Protection Training, 2006 edition 2013 . NFPA 1451, Standard for a Fire Service Vehicle Operations Training Program, 2007 edition 2013 . NFPA 1521, Standard for Fire Department Safety Officer, 2008 edition 2015 . NFPA 1670, Standard on Operations and Training for Technical Search and Rescue Incidents, 2009 edition 2017 . NFPA 1710, Standard for the Organization and Deployment of Fire Suppression Operations, Emergency Medical Operations, and Special Operations to the Public by Career Fire Departments, 2010 edition. NFPA 1901, Standard for Automotive Fire Apparatus, 2009 edition 2016 . NFPA 1971, Standard on Protective Ensembles for Structural Fire Fighting and Proximity Fire Fighting, 2013 edition . NFPA 1977, Standard on Protective Clothing and Equipment for Wildland Fire Fighting, 2011 edition 2013 . NFPA 1981, Standard on Open-Circuit Self-Contained Breathing Apparatus (SCBA) for Emergency Services, 2007 edition 2013 . NFPA 1982, Standard on Personal Alert Safety Systems (PASS), 2007 edition 2013 . NFPA 1984, Standard on Respirators for Wildland Fire-Fighting Operations, 2011 edition 2016 . NFPA 1991, Standard on Vapor-Protective Ensembles for Hazardous Materials Emergencies, 2005 edition 2016 . NFPA 1994, Standard on Protective Ensembles for First Responders to CBRN Terrorism Incidents, 2012 edition 2017 .

NFPA 5000® , Building Construction and Safety Code®, 2012 edition 2015 .

Statement of Problem and Substantiation for Public Input

Referenced current editions.

Related Public Inputs for This Document

Related Input Relationship Public Input No. 16-NFPA 1500-2014 [Chapter G]

Submitter Information Verification

Submitter Full Name: Aaron Adamczyk Organization: [ Not Specified ] Street Address: City: State:

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Zip: Submittal Date: Fri Jun 27 17:03:33 EDT 2014

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Public Input No. 151-NFPA 1500-2015 [ New Section after 3.3.37 ]

(NEW) Fireground Toxic Contaminents Airborne, dermal, occular, or respiratory hazards consisting of products of combustion, carcinogens, toxic chemicals, and ultrafine particles

Statement of Problem and Substantiation for Public Input

NFPA 1500 TG Proposal

Submitter Information Verification

Submitter Full Name: DAVID BERNZWEIG Organization: Ohio Association of Professional Firefighters Street Address: City: State: Zip: Submittal Date: Mon Jul 06 22:40:27 EDT 2015

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Public Input No. 27-NFPA 1500-2015 [ Section No. 3.3.37.2 ]

3.3.37.2 Structural Fire Fighting. The activities of rescue, fire suppression, and property conservation in buildings or other structures structures , vehicles, rail cars, marine vessels, aircraft, or like properties. [1710, 2010]

Statement of Problem and Substantiation for Public Input

Remove repeated word

Submitter Information Verification

Submitter Full Name: David Bernzweig Organization: Columbus (OH) Division of Fire Street Address: City: State: Zip: Submittal Date: Wed Feb 11 10:59:53 EST 2015

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Public Input No. 28-NFPA 1500-2015 [ Section No. 4.2.2 ]

4.2.2 The risk management plan shall at least cover the risks associated with the following:

(1) Administration (2) Facilities (3) Training (4) Vehicle operations, both emergency and non-emergency (5) Protective clothing and equipment (6) Operations at emergency incidents (see Annex C) (7) Operations at non-emergency incidents (8) Products of combustion, carcinogens, chemicals, or ultrafine particles (9) Other related activities

Statement of Problem and Substantiation for Public Input

TG Public Input

Submitter Information Verification

Submitter Full Name: David Bernzweig Organization: Columbus (OH) Division of Fire Street Address: City: State: Zip: Submittal Date: Wed Feb 11 11:04:12 EST 2015

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Public Input No. 60-NFPA 1500-2015 [ Section No. 4.2.2 ]

4.2.2 The risk management plan shall at least cover the risks associated with the following:

(1) Administration (2) Facilities (3) Training (4) Vehicle operations, both emergency and non-emergency (5) Protective clothing and equipment (6) Operations at emergency incidents (see Annex C) (7) Operations at non-emergency incidents (8) Non-Emergency Activities (9) Other related activities

A.4.2.2 In addition to the traditional risk exposures invovled in emergency/non-emergency incidents and training, the risk management plan should include activities that fire department members would traditionally be exposed to in the course of day-to-day actvities. Expamples include: Hose Testing, Pump Testing, Equipment and Apparatus Maintenance and Station Maintenance. In addition, non-traditional activities that some departments perform, such as fireworks displays and solicitation of funds on a roadway, should also be covered under the risk management plan.

Statement of Problem and Substantiation for Public Input

There are numerous activities that fire department members perform that are non-emergency but are not related to an "incident" nor are they "other related activities." Examples would include hose testing, pump testing, fire extinguisher demonstrations, fire investigations, maintenance of equipment and even conducting fireworks displays in some jurisdictions. The risk management plan should not ignore these non-emergency type of activities that can easily cause injuries, illnesses and death.

Submitter Information Verification

Submitter Full Name: ANTHONY APFELBECK Organization: ALTAMONTE SPRINGS BUILDING/FIRE SAFETY DIVISION Street Address: City: State: Zip: Submittal Date: Mon Apr 13 08:01:11 EDT 2015

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Public Input No. 29-NFPA 1500-2015 [ Section No. 4.3.1 ]

4.3.1* The fire department shall adopt an official written departmental occupational safety, health, and health wellness policy that identifies specific goals and objectives for the prevention and elimination of accidents and occupational injuries, exposures to communicable disease, illnesses, and fatalities.

Statement of Problem and Substantiation for Public Input

TG Public Proposal

Submitter Information Verification

Submitter Full Name: David Bernzweig Organization: Columbus (OH) Division of Fire Street Address: City: State: Zip: Submittal Date: Wed Feb 11 11:09:03 EST 2015

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Public Input No. 30-NFPA 1500-2015 [ Section No. 4.3.1 ]

4.3.1* The fire department shall adopt an official written departmental occupational safety and health policy that identifies specific goals and objectives for the prevention and elimination of accidents and occupational injuries, exposures to products of combustion, carcinogens, chemicals, ultrafine particles, or communicable disease, illnesses, and fatalities.

Statement of Problem and Substantiation for Public Input

TG Public Proposal

Submitter Information Verification

Submitter Full Name: David Bernzweig Organization: Columbus (OH) Division of Fire Street Address: City: State: Zip: Submittal Date: Wed Feb 11 11:12:00 EST 2015

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Public Input No. 32-NFPA 1500-2015 [ New Section after 4.5.3.2 ]

4.5.4 The Fire Department shall provide orientation training to the members of the committee on best practices for safety committee processes, duties, and responsibilities of safety committee members, and specific training on relevant NFPA standards governing the committee's areas of responsibility or specific tasks of individuals serving on the committee.

Statement of Problem and Substantiation for Public Input

Fire Departments should make sure that it provides to members serving on committees adequate background knowledge and skills so that the committee functions effectively.

Submitter Information Verification

Submitter Full Name: David Bernzweig Organization: Columbus (OH) Division of Fire Street Address: City: State: Zip: Submittal Date: Wed Feb 11 11:21:35 EST 2015

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Public Input No. 97-NFPA 1500-2015 [ New Section after 4.6.1 ]

4.6.1.1 The data collection system shall include the items identified in the national fire service database system.

Statement of Problem and Substantiation for Public Input

NFPA 1500 TG Proposal

Submitter Information Verification

Submitter Full Name: DAVID BERNZWEIG Organization: Ohio Association of Professional Firefighters Street Address: City: State: Zip: Submittal Date: Mon Jul 06 14:28:27 EDT 2015

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Public Input No. 33-NFPA 1500-2015 [ Section No. 4.6.2 ]

4.6.2 The data collection system shall also maintain individual records of any occupational exposure to known or suspected products of combustion, carcinogens, chemicals, ultrafine particles, toxic products, or infectious or communicable diseases.

Statement of Problem and Substantiation for Public Input

TG Public Proposal

Submitter Information Verification

Submitter Full Name: David Bernzweig Organization: Columbus (OH) Division of Fire Street Address: City: State: Zip: Submittal Date: Wed Feb 11 11:28:24 EST 2015

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Public Input No. 34-NFPA 1500-2015 [ Section No. 4.7.2 ]

4.7.2* The health and safety officer shall meet the qualifications defined in NFPA 1521, Standard for Fire Department Safety Officer. A4.7.2 Refer to NFPA 1521 (2015) Annex E

Statement of Problem and Substantiation for Public Input

TG Public Proposal

Submitter Information Verification

Submitter Full Name: David Bernzweig Organization: Columbus (OH) Division of Fire Street Address: City: State: Zip: Submittal Date: Wed Feb 11 11:41:48 EST 2015

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Public Input No. 36-NFPA 1500-2015 [ Section No. 5.1.8 [Excluding any Sub-Sections] ]

The fire department shall provide all members with a documented training and education program that covers the selection, use, maintenance, retirement, and special incidents procedures operation, limitation, maintenance, and retirement criteria for all assigned personal protective equipment (PPE).

Statement of Problem and Substantiation for Public Input

TG Public Proposal

Submitter Information Verification

Submitter Full Name: David Bernzweig Organization: Columbus (OH) Division of Fire Street Address: City: State: Zip: Submittal Date: Wed Feb 11 12:14:29 EST 2015

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Public Input No. 37-NFPA 1500-2015 [ Section No. 5.1.8.1 ]

5.1.8.1 Training shall comply with applicable governing standards and follow the manufacturer’s instructions and guidelines to include the following topics:

(1) The organization’s overall program for the selection and use of protective ensembles, ensemble elements, and SCBAs (2) Technical data package (TDP) where applicable (3) Proper overlap and fit (4) Proper donning and doffing (including emergency doffing) (5) Construction features and function (6) Performance Safe usage and performance limitations (including physiological effects on user and effects of heat transfer on the protective ensemble) (7) Recognizing and responding to indications of protective ensemble and SCBA failure (8) Routine inspection (9) Routine cleaning (10) , cleaning, maintenance, and retirement (11) Special incident procedures operation (12) Proper storage

Statement of Problem and Substantiation for Public Input

Tg Public Proposal

Submitter Information Verification

Submitter Full Name: David Bernzweig Organization: Columbus (OH) Division of Fire Street Address: City: State: Zip: Submittal Date: Wed Feb 11 12:16:54 EST 2015

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Public Input No. 8-NFPA 1500-2014 [ Section No. 5.2 ]

5.2 Member Qualifications. 5.2.1 All members who engage in structural fire fighting shall meet the requirements of NFPA 1001, Standard for Fire Fighter Professional Qualifications. 5.2.2 * All driver/operators shall meet the requirements of NFPA 1002, Standard for Fire Apparatus Driver/Operator Professional Qualifications. 5.2.3 All aircraft rescue fire fighters (ARFF) shall meet the requirements of NFPA 1003, Standard for Airport Fire Fighter Professional Qualifications. 5.2.4 All fire officers shall meet the requirements of NFPA 1021, Standard for Fire Officer Professional Qualifications. 5.2.5 All wildland fire fighters shall meet the requirements of NFPA 1051, Standard for Wildland Fire Fighter Professional Qualifications. 5.2.6 * All members responding to hazardous materials incidents shall meet the operations level as required in NFPA 472, Standard for Competence of Responders to Hazardous Materials/Weapons of Mass Destruction Incidents. 5.2.7 All members who engage in fire investigations shall meet the requirements of NFPA 1033, Standard for Professional Qualifications for Fire Investigator. 5.2.8 All members who engage in fire inspections shall meet the requirements of NFPA 1031, Standard for Professional Qualifications for Fire Inspector and Plan Examiner.

Statement of Problem and Substantiation for Public Input

This PI is intended to correlate with PI No. 7 and include the functions of Investigations and Inspections within the standard which have their own unique occupational exposures.

Related Public Inputs for This Document

Related Input Relationship Public Input No. 7-NFPA 1500-2014 [Section Provides Pro Qual reference standards to correlate with No. 1.2.2] PI No. 7.

Submitter Information Verification

Submitter Full Name: Anthony Apfelbeck Organization: Altamonte Springs Building/Fire Safety Division Street Address: City:

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State: Zip: Submittal Date: Thu Jan 02 16:05:34 EST 2014

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Public Input No. 99-NFPA 1500-2015 [ Section No. 5.3.7 ]

5.3.7 * All live fire training and exercises shall be conducted in accordance with NFPA 1403, Standard on Live Fire Training Evolutions .

Statement of Problem and Substantiation for Public Input

Move this text (along with annex) to NEW section 5.6

Submitter Information Verification

Submitter Full Name: DAVID BERNZWEIG Organization: Ohio Association of Professional Firefighters Street Address: City: State: Zip: Submittal Date: Mon Jul 06 14:33:51 EDT 2015

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Public Input No. 9-NFPA 1500-2014 [ New Section after 5.3.8 ]

5.3.8.1 All training shall occur under the oversight of a instructor that is qualified to NFPA 1041, Standard for Fire Service Instructor Professional Qualifcations.

Statement of Problem and Substantiation for Public Input

While all training does not need to be provided directly by an NFPA 1041 Instructor, all training should be reviewed by and approved by an NFPA 1041 certified instructor. This will ensure that qualified oversight of the offered training does occur and safety is not compromised.

Submitter Information Verification

Submitter Full Name: Anthony Apfelbeck Organization: Altamonte Springs Building/Fire Safety Division Street Address: City: State: Zip: Submittal Date: Thu Jan 02 16:14:49 EST 2014

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Public Input No. 100-NFPA 1500-2015 [ Section No. 5.3.8 ]

5.3.8 * All training and exercises shall be conducted under the direct supervision of a qualified instructor.

Statement of Problem and Substantiation for Public Input

Move this text (along with annex) to NEW section 5.6

Submitter Information Verification

Submitter Full Name: DAVID BERNZWEIG Organization: Ohio Association of Professional Firefighters Street Address: City: State: Zip: Submittal Date: Mon Jul 06 14:36:02 EDT 2015

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Public Input No. 35-NFPA 1500-2015 [ New Section after 5.3.12 ]

TITLE OF NEW CONTENT 5.3.13 All members shall be trained in the risks associated with workplace exposure to products of combustion, carcinogens, chemicals, and ultrafine particles. 5.3.13.1* Members shall be trained to recognize when a workplace exposure has occured and appropriate control methods for personal decontamination, decontamination of protective clothing and equipment, and the risks of cross-contamination. A5.3.13.1 Add Annex language relating to exposure control methods, best practices, etc

Statement of Problem and Substantiation for Public Input

TG Public Proposal

Submitter Information Verification

Submitter Full Name: David Bernzweig Organization: Columbus (OH) Division of Fire Street Address: City: State: Zip: Submittal Date: Wed Feb 11 11:48:29 EST 2015

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Public Input No. 101-NFPA 1500-2015 [ New Section after 5.5 ]

5.6 Training Activities 5.6.1* All training and exercises shall be conducted under the direct supervision of a qualified instructor. 5.6.2* All live fire training and exercises shall be conducted in accordance with NFPA 1403, Standard on Live Fire Training Evolutions. 5.6.2.1 Live fire training exercises shall provide emergency medical services in accordance with section 4.10 of NFPA 1403, Standard on Live Fire Training Evolutions. 5.6.3* For non-live fire training exercises, fire departments shall conduct a risk assessment to determine the appropriate emergency medical capabilities to be available at the training site. A5.6.3 Hands on training can present significant risks to personnel. A risk assessment should consider the potential for injury to members and actions that can be taken to mitigate those risks. Training scenarios may pose several risks, including, but not limited to musculoskeletal injuries (such as strains and sprains), falls, overexertion that may lead to heat related illnesses, and cardiac events. The Emergency Medical capabilities that should be considered include, but are not limited to the provision of pre-placed equipment and supplies, such as defibrillators, backboards, emergency kits; the availability of EMS staffing; and the availability of transport capabilities.

Statement of Problem and Substantiation for Public Input

NFPA 1500 TG Proposal

Submitter Information Verification

Submitter Full Name: DAVID BERNZWEIG Organization: Ohio Association of Professional Firefighters Street Address: City: State: Zip: Submittal Date: Mon Jul 06 14:44:17 EDT 2015

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Public Input No. 40-NFPA 1500-2015 [ New Section after 6.1.1.1 ]

TITLE OF NEW CONTENT If the fire apparatus is equipped with a vehicle data recorder, the AHJ shall develop operating procedures for uploading, monitoring, and reviewing the data.

Statement of Problem and Substantiation for Public Input

This requirement belongs here instead of in 6.1.2.1 and 6.1.3.1. This is a general requirement for all fire apparatus.

Submitter Information Verification

Submitter Full Name: David Bernzweig Organization: Columbus (OH) Division of Fire Street Address: City: State: Zip: Submittal Date: Wed Feb 11 14:38:15 EST 2015

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Public Input No. 38-NFPA 1500-2015 [ Section No. 6.1.1.1 ]

6.1.1.1 * The fire department shall specify restraint devices for fire apparatus, including those restraint devices for emergency medical service (EMS) members operating in the patient compartment of the ambulance.

Statement of Problem and Substantiation for Public Input

This requirement is addressed in the relevant NFPA Standards. See Public Input regarding NFPA 1917.

Submitter Information Verification

Submitter Full Name: David Bernzweig Organization: Columbus (OH) Division of Fire Street Address: City: State: Zip: Submittal Date: Wed Feb 11 14:30:21 EST 2015

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Public Input No. 39-NFPA 1500-2015 [ New Section after 6.1.3 ]

TITLE OF NEW CONTENT All new automotive ambulances shall be specified and ordered to meet the applicable requirements of NFPA 1917, Standard for automotive ambulances

Statement of Problem and Substantiation for Public Input

New NFPA Standard. TC Public Input

Submitter Information Verification

Submitter Full Name: David Bernzweig Organization: Columbus (OH) Division of Fire Street Address: City: State: Zip: Submittal Date: Wed Feb 11 14:33:03 EST 2015

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Public Input No. 41-NFPA 1500-2015 [ Section No. 6.1.4 ]

6.1.4 All new marine fire-fighting vessels shall be specified and ordered to meet the requirements of NFPA 1925, Standard on Marine Fire-Fighting Vessels.

Statement of Problem and Substantiation for Public Input

consistent with other requirements in this standard.

Submitter Information Verification

Submitter Full Name: David Bernzweig Organization: Columbus (OH) Division of Fire Street Address: City: State: Zip: Submittal Date: Wed Feb 11 14:42:30 EST 2015

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Public Input No. 14-NFPA 1500-2014 [ Section No. 6.2.1.1 ]

6.2.1.1 The AHJ shall be responsible for providing driver training instruction that complies with NFPA 1451, Standard for a Fire Service Vehicle Operations Training Program, to members on the operation of specific fire department owned pumpers and mobile water supply apparatus that hold greater than 999 gal (37 .82 L) of on-board water supply.

Statement of Problem and Substantiation for Public Input

NFPA 1451 covers all Apparatus not just apparatus over 999 gallons. The current text reads in a manner to exclude all water carrying apparatus under 999 gallons.

Submitter Information Verification

Submitter Full Name: Kenneth Richards Organization: Old Mystic Fire Department Affilliation: Chair NFPA Technical Committee on Fire Service Training. Street Address: City: State: Zip: Submittal Date: Thu Jun 12 09:01:35 EDT 2014

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Public Input No. 42-NFPA 1500-2015 [ Section No. 6.2.1.1 ]

Statement of Problem and Substantiation for Public Input

remove period

Submitter Information Verification

Submitter Full Name: David Bernzweig Organization: Columbus (OH) Division of Fire Street Address: City: State: Zip: Submittal Date: Wed Feb 11 14:55:54 EST 2015

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Public Input No. 43-NFPA 1500-2015 [ Section No. 6.2.2.2 ]

6.2.2.2 Pumpers and mobile water supply apparatus that do not have anti-lock brake systems (ABS) and carry over 999 gal (37.82 3782 L) of on-board water supply shall be operated in non-emergency mode at all times.

Statement of Problem and Substantiation for Public Input

remove period

Submitter Information Verification

Submitter Full Name: David Bernzweig Organization: Columbus (OH) Division of Fire Street Address: City: State: Zip: Submittal Date: Wed Feb 11 14:57:07 EST 2015

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Public Input No. 62-NFPA 1500-2015 [ Section No. 6.2.5 ]

6.2.5 Drivers shall not move fire apparatus until all persons on the vehicle are seated and secured with seat belts in approved riding positions, other than as specifically allowed in this chapter. Driver shall not move fire apparatus until all persons on the vehicle are seated and secured with seat belts in approved riding position.

Statement of Problem and Substantiation for Public Input

The International Association of Fire Chiefs (IAFC) stands committed to advancing firefighter safety including while operating fire apparatus. The Safety Health Survival Section (SHH) is writing in response to current proposed changes to NFPA 1906 section 14.4 of the proposed 2016 revisions. I would like to bring to you our review and concern about the proposed NFPA 1906 language. Specifically the IAFC SHS does not support the language of section 14.4 of the 2016 NFPA 1906 standard as it compromises the safety of the firefighters operating on apparatus that allow certain units to operate and not require all firefighters to be belted and seated within the cab of the apparatus while it is moving or operating. The IAFC SHS requests that the NFPA 1500 committee review the proposed section 14.4 of the 2016 NFPA 1906 standard and clarify their position on section 6.3 of 20XX NFPA 1500, such that section 14.4 is removed from the 2016 NFPA 1906 document and take action during the next revision cycle to make sure that clarification is reflected in the new edition of NFPA 1500. I would welcome the opportunity to further discuss this position with you. If you have questions or would like to schedule a conference call or in person meeting, please contact me by phone at [phone] or by email at [email]. I have enclosed my contact information, and I look forward to hearing from you. Sincerely, Scott Kerwood, Chair International Association of Fire Chiefs Safety Health Survival Section

Submitter Information Verification

Submitter Full RICHARD MILLER Name: Safety, Health and Survival Section of the International Association Organization: of Fire Chiefs Safety, Health and Survival Section of the International Association Affilliation: of Fire Chiefs Street Address: City: State: Zip: Submittal Date: Sat May 16 15:37:38 EDT 2015

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Public Input No. 44-NFPA 1500-2015 [ Section No. 6.2.10 ]

6.2.10* During At all unguarded railroad grade crossings, during emergency response or non-emergency travel, drivers of fire apparatus shall come to a complete stop at all unguarded railroad grade crossings and ensure that it is safe to proceed before crossing the railroad track(s).

Statement of Problem and Substantiation for Public Input

Clarity. TG Public Input

Submitter Information Verification

Submitter Full Name: David Bernzweig Organization: Columbus (OH) Division of Fire Street Address: City: State: Zip: Submittal Date: Wed Feb 11 15:04:58 EST 2015

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Public Input No. 132-NFPA 1500-2015 [ Section No. 6.3 ]

6.3 Riding in Fire Apparatus. 6.3.1* All persons riding in fire apparatus shall be seated and belted securely by seat belts in approved riding positions at any time the vehicle is in motion other than as allowed in 6.3.4 and 6.3.5. Standing or riding on tail steps, sidesteps, running boards, or in any other exposed position shall exterior location other than an NFPA 1906 compliant riding position be specifically prohibited. 6.3.2 Seat belts shall not be released or loosened for any purpose while the vehicle is in motion, including the donning of respiratory protection equipment or protective clothing. 6.3.3* Members actively performing necessary emergency medical care while the vehicle is in motion shall be secured to the vehicle by a seat belt, or by a vehicle safety harness designed for occupant restraint, to the extent consistent with the effective provision of such emergency medical care. 6.3.3.1 All other persons in the vehicle shall be seated and belted in approved riding positions while the vehicle is in motion. 6.3.4* Fire departments permitting hose loading operations while the vehicle is in motion shall develop written standard operating procedures addressing all safety aspects. 6.3.5* Fire departments permitting tiller training, where both the instructor and the trainee are at the tiller position, shall develop written standard operating procedures addressing all safety aspects. 6.3.6* Helmets shall be provided for and used by members riding in open cab apparatus or open tiller seats. 6.3.6.1 Helmets shall not be worn by persons riding in an enclosed cab. 6.3.7* Eye protection shall be provided for members riding in open cab apparatus or open tiller seats.

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6.3.8* On existing fire apparatus where there is an insufficient number of seats available for the number of members assigned to or expected to ride on that piece of apparatus, alternate means of transportation that provide seated and belted positions shall be used. 6.3.9 Fire departments using an NFPA 1906 compliant On-Board Pump-and-Roll Fire-Fighting Position shall develop procedures and conduct training to ensure the following: 1) The driver is in communication with personnel in the On-Board Pump-and- Roll Fire-Fighting Position at all times while the vehicle is in motion. 2) All personnel on the apparatus are secured with a minimum of a Type 1 seat belt inside the Exterior Fire Attack Position while the apparatus is in motion. 3) Personnel in the On-Board Pump-and-Roll Fire-Fighting Position have the capability of wearing protective structure turnout gear and protective breathing apparatus. 4) The apparatus speed never exceeds 10 mph while the On-Board Pump and- Roll Fire-Fighting Position is occupied. 5) The On-Board Pump-and-Roll Fire-Fighting Position is never occupied to and from the scene.

Additional Proposed Changes

File Name Description Approved Comments from firefighters 1500_responses.pdf who use the exterior fire attack position behind the cab NFPA investigation into Pump_and_Roll_Narratives_-_final_draft_pdf.pdf fatalities resulting from pump and roll operations Current manufacturers that I Current_Manufacturers_of_an_Exterior_Fire_Attack_Position.docx know of which build an exterior fire attack position Pictures of apparatus with an exterior fire attack position at Exterior_position_pictures_from_TEEX_show.pdf the TEEX show in College Station, TX

Statement of Problem and Substantiation for Public Input

The NFPA (National Firefighters Protection Association) 1906 Apparatus Committee has added an option for an exterior fire attack position on a wildland apparatus. The current NFPA 1500 standard (to an extent the OSHA of the fire world) does not include an apparatus that provides a safe exterior fire attack position. NFPA 1500 now must address this change to NFPA 1906. The exterior fire attack position holds an extreme tactical advantage to flank a fast-moving fire in high winds with limited manpower and water. Utilizing an exterior fire attack position is not a choice, it is a necessity. This is the reason it is so widely practiced in fine fuel regions. It is estimated that over 90% of the volunteer fire departments in rural areas practice this tactic despite NFPA guidelines. As a fire chief, a fire department, a governing body or a manufacturer you will be a liability and at risk if you do not follow NFPA recommendations. When I joined my volunteer fire department over 30 years ago, if a firefighter was injured it would have been his/her own responsibility. In today’s world, this is simply not the case. If a firefighter suffers an injury while walking the fire line, attorneys will be looking for who has the deepest pockets and it quickly becomes the fault and the responsibility of the fire department, governing body, and manufacturers. The significance of the NFPA standards has become even more important to protect the assets of the fire department, governing bodies and manufacturers.

The exterior fire attack position is necessary to fire departments that routinely fight fine fuel fires for the following safety reasons and concerns: The firefighter and driver know each other’s position at all times. It significantly reduces the risks of heat exhaustion, heat stress, smoke inhalation, and physical

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exertion (which can lead to heart attack or stroke) that occur walking alongside the vehicle. It eliminates the possibilities of the firefighter tripping, falling, stepping in a hole, stepping on a live power line, getting bitten by a snake, becoming disoriented due to thick or swirling smoke, getting entangled in hose or dragged by the truck, being struck or run over by a truck because of poor visibility or having the vehicle roll-over onto the firefighter The firefighter and the driver can easily communicate and it allows for immediate evacuation of the scene in the event of an emergency. o If the firefighter is walking alongside the vehicle, the firefighter and equipment must be loaded onto the vehicle prior to evacuation. In the event of a wreck or collision the roll-over structure protects the firefighter in the exterior fire attack position along with the chassis cab and its occupants. The firefighter is able to see 360 degrees and assess the situation, terrain, fire behavior and fuel load. Pump control adjustments and additional fire line and nozzles are within reach of the firefighter. The exterior fire attack position behind the cab has been successfully utilized for more than 25 years and there are no records of serious injuries or deaths. o There have been serious injuries and deaths recorded for other riding positions such as on the front bumper, on the tailboard, on top of the bed and beside the tank. o There have been an overwhelming number of serious injuries and deaths recorded due to firefighters walking the fire line alongside the vehicle.

Additional obvious reasons firefighters are riding their trucks with the exterior fire attack position in fine fuel regions is because of the tactical advantages. An estimated 90% or more fire departments in rural areas continue to successfully operate in this manor. The current recommendation of NFPA 1500 to walk the fire line alongside the vehicle does not provide any of the above safety or tactical advantages. There is nothing safe about a firefighter walking alongside a moving vehicle.

The video link below further explains why the exterior fire attack position behind the cab is so important in fine fuel regions. https://www.youtube.com/watch?v=-xjCp6wGIGc

Ask committee member Roger Lackore for his opinion. He experienced this position during the fall of 2014 while it was being discussed in the 1906 committee. Ask whether he felt safe and secure.

Submitter Information Verification

Submitter Full Name: GREG BLANCHAT Organization: BLANCHAT MFG INC Street Address: City: State: Zip: Submittal Date: Mon Jul 06 16:21:22 EDT 2015

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Public Input No. 25-NFPA 1500-2015 [ Section No. 6.3 ]

6.3 Riding in Fire Apparatus. 6.3.1 * All persons riding in fire apparatus shall be seated and belted securely by seat belts in approved riding positions at any time the vehicle is in motion other than as allowed in 6.3.4 and 6.3.5. Standing or riding on tail steps, sidesteps, running boards, or in any other exposed position shall exterior location other than an NFPA 1906 compliant riding position shall be specifically prohibited. 6.3.2 Seat belts shall not be released or loosened for any purpose while the vehicle is in motion, including the donning of respiratory protection equipment or protective clothing. 6.3.3 * Members actively performing necessary emergency medical care while the vehicle is in motion shall be secured to the vehicle by a seat belt, or by a vehicle safety harness designed for occupant restraint, to the extent consistent with the effective provision of such emergency medical care. 6.3.3.1 All other persons in the vehicle shall be seated and belted in approved riding positions while the vehicle is in motion. 6.3.4 * Fire departments permitting hose loading operations while the vehicle is in motion shall develop written standard operating procedures addressing all safety aspects. 6.3.5 * Fire departments permitting tiller training, where both the instructor and the trainee are at the tiller position, shall develop written standard operating procedures addressing all safety aspects. 6.3.6 * Helmets shall be provided for and used by members riding in open cab apparatus or open tiller seats. 6.3.6.1 Helmets shall not be worn by persons riding in an enclosed cab. 6.3.7 * Eye protection shall be provided for members riding in open cab apparatus or open tiller seats.

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The driver is in communication with personnel in the On-Board Pump-and-Roll Fire-Fighting Position at all times while the vehicle is in motion All personnel on the apparatus are seated and belted before the apparatus is placed in motion Personnel in the On-Board Pump-and-Roll Fire-Fighting Position are provided with protection from unintended exposure to flames and heat via the use of fire curtains, protective ensemble, or other appropriate means. The apparatus speed never exceeds 10 mph while the On-Board Pump-and-Roll Fire-Fighting Position is occupied. The apparatus is never exposed to on-road traffic with the On-Board Pump-and-Roll Fire-Fighting Position occupied.

The apparatus is always operated clear of smoke and flames.

Statement of Problem and Substantiation for Public Input

The NFPA 1906 committee has adopted an On-Board Pump-and-Roll Fire-Fighting Position. This specification is intended to increase the safety around the practice of riding wildland apparatus while conducting fire suppression in the flat fine-fuels area of the United States. This practice is prevalent, entrenched in the region’s firefighting community, and is purported to be an effective and reasonably safe practice if performed by trained personnel with adequate apparatus and on even terrain. The NFPA 1906 On-Board Pump-and-Roll Fire-Fighting Position specifications will increase the safety of this practice by mandating, among other things, that apparatus using this method be provided with a roll over protective structure (ROPS), a gate, and an occupant seat with seat belt.

The NFPA 1906 committee discussed exhaustively the merits and hazards of this approach. Given the fact that the practice is so prevalent in certain regions, the consensus of committee is that the responsible move is to provide an apparatus specification that increases the safety of an already established practice rather than continuing to leave the safety of the apparatus to the judgment of individual departments and manufacturers.

The On-Board Pump-and-Roll Fire-Fighting Position requires a modification to the fire department’s occupational safety and health program. This proposal recognizes the legitimacy of the new NFPA 1906 language and provides operational and training mandates that will promote firefighter safety when using apparatus with the On-Board Pump-and-Roll Fire-Fighting Position feature.

Related Public Inputs for This Document

Related Input Relationship Public Input No. 26-NFPA 1500-2015 [Section No. A.6.3.1]

Submitter Information Verification

Submitter Full Name: J. Lackore Organization: Oshkosh Corporation Affilliation: NFPA Fire Apparatus Committee Street Address: City: State: Zip: Submittal Date: Mon Feb 09 11:08:43 EST 2015

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Public Input No. 76-NFPA 1500-2015 [ Section No. 6.3 ]

6.3 Riding in Fire Apparatus. 6.3.1* All persons riding in fire apparatus shall be seated and belted securely by seat belts in approved riding positions at any time the vehicle is in motion other than as allowed in 6.3.4 and 6.3.5. Standing or riding on tail steps, sidesteps, running boards, or in any other exposed position shall be specifically prohibited. 6.3.2 Seat belts shall not be released or loosened for any purpose while the vehicle is in motion, including the donning of respiratory protection equipment or protective clothing. 6.3.3* Members actively performing necessary emergency medical care while the vehicle is in motion shall be secured to the vehicle by a seat belt, or by a vehicle safety harness designed for occupant restraint, to the extent consistent with the effective provision of such emergency medical care. 6.3.3.1 All other persons in the vehicle shall be seated and belted in approved riding positions while the vehicle is in motion. 6.3.4* Fire departments permitting hose loading operations while the vehicle is in motion shall develop written standard operating procedures addressing all safety aspects. 6.3.5* Fire departments permitting tiller training, where both the instructor and the trainee are at the tiller position, shall develop written standard operating procedures addressing all safety aspects. 6.3.6* Helmets shall be provided for and used by members riding in open cab apparatus or open tiller seats. 6.3.6.1 Helmets shall not be worn by persons riding in an enclosed cab. 6.3.7* Eye protection shall be provided for members riding in open cab apparatus or open tiller seats. 6.3.8* On existing fire apparatus where there is an insufficient number of seats available for the number of members assigned to or expected to ride on that piece of apparatus, alternate means of transportation that provide seated and belted positions shall be used.

Statement of Problem and Substantiation for Public Input

The NFPA apparatus committee has added an option to NFPA 1906 for roll-cage protected seating on a Wildland apparatus that provides a safe and efficient exterior riding position. As a past USDA Forest Service employee of 48 years and also served as an Incident Commander on large fire organizations, I have always been an advocate of improved safety for wildland firefighters. It is my experience that up to 80% of fire departments in the great plains presently use pump and roll tactics in the fine fuel areas. We need the proposed updated 1906 and 1500 NFPA standards to encourage safer apparatus be used in the field. I support these changes in NFPA standards and thank you for the consideration of these changes.

Submitter Information Verification

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Submitter Full Name: Joe Hartman Organization: [ Not Specified ] Street Address: City: State: Zip: Submittal Date: Mon Jun 29 16:05:34 EDT 2015

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Public Input No. 45-NFPA 1500-2015 [ Section No. 6.3.1 ]

6.3.1* All persons riding in fire apparatus shall be seated and belted securely by seat belts in approved riding positions at any time the vehicle is in motion other than as allowed in 6.3.4 and 6.3.5. New 6.3.2 Standing or riding on tail steps, sidesteps, running boards, or in any other exposed position shall be specifically prohibited.

Statement of Problem and Substantiation for Public Input

these should be two separate requirements.

Submitter Information Verification

Submitter Full Name: David Bernzweig Organization: Columbus (OH) Division of Fire Street Address: City: State: Zip: Submittal Date: Wed Feb 11 15:24:16 EST 2015

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Public Input No. 46-NFPA 1500-2015 [ Section No. 6.3.1 ]

6.3.1* All persons riding in fire apparatus shall be seated and belted securely by seat belts in approved riding positions at any time the vehicle is in motion other than as allowed in 6.3. 3, 6.3. 4, and 6.3.5. Standing or riding on tail steps, sidesteps, running boards, or in any other exposed position shall be specifically prohibited.

Statement of Problem and Substantiation for Public Input

resolves conflicting language. TG Public Proposal

Submitter Information Verification

Submitter Full Name: David Bernzweig Organization: Columbus (OH) Division of Fire Street Address: City: State: Zip: Submittal Date: Wed Feb 11 15:37:57 EST 2015

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Public Input No. 74-NFPA 1500-2015 [ Section No. 6.3.1 ]

6.3.1 * All persons riding in fire apparatus shall be seated and belted securely by seat belts in approved riding positions within a fully enclosed personnel area at any time the vehicle is in motion other than as allowed in 6.3.4 and 6.3.5. Standing or riding on tail steps, sidesteps, running boards, or in any other exposed other non-enclosed position shall be specifically prohibited.

Statement of Problem and Substantiation for Public Input

Consistent wording with current edition NFPA 1906 (2012) and NFPA 1901 (2009).

During the NFPA 1906: Standard for Wildland Fire Apparatus (2012) revision cycle public input (PI) was received to revise 14.1.1 which currently reads; “Each crew riding position shall be within a fully enclosed personnel area.” The balloted and approved revision for NFPA 1906 (2016) will read; “Each crew riding position shall be within a fully enclosed personnel area except as provided in Section 14.4.” The exception provided in 14.4 will permit an on-board pump-and-roll fire-fighting position outside of the fully enclosed personnel area. This will now permit a firefighter to ride on the exterior of an apparatus while the apparatus is in motion by providing a seat and seatbelt, rollover protective structures (ROPS) and perforated plate/mesh protection in order to perform pump-and-roll mobile attack.

The revision was determined to not conflict with NFPA 1500: Standard on Fire Department Occupational Safety and Health Program (2013) because 6.3.1 permits “approved riding positions” which are not “exposed.” I think permitting the exception (14.4) in the NFPA 1906 (2016) revision is a unsatisfactory compromise of safety standards and the Technical Committee for Fire Service Occupational Safety and Health should not permit this splitting of hairs and instead strengthen the NFPA 1500 standard to meet the current, safer, non-revised NFPA 1906 requirement of riding “within a fully enclosed personnel area.”

I understand the concerns of all departments engaged in wildland fire suppression and strongly support the discontinuation of the operational use of hood riding, boat seats, hose reel straddling, etc. However, my opinion is the “on-board pump-and-roll fire-fighting position” as provided in the NFPA 1906 (2016) revision is not a sufficiently safe alternative for use in the wildland fire environment. Even with the risk mitigations provided it is acknowledged that the on-board pump-and-roll fire-fighting position does not provide the firefighter the same degree of protection that a similar firefighter is afforded when seated and belted within and enclosed personnel area. Even with ROPS and protective mesh the firefighter will be at greater risk from injury or death because of decreased protection during accidental impact or vehicle roller. Compliance with seatbelt use and even remaining seated will be largely unchecked by the driver. In addition, because of the open air nature of the exposed riding position combined with decreased mobility of the rider the firefighter will at greater exposure to environmental hazards including but not limited to smoke, heat, airborne debris and insects, as well as direct flame impingement. There would be no opportunity to shelter in this exposed place if the apparatus was over-run by fire, nor would the occupant be able to safety exit and deploy a fire shelter on the ground if the vehicle was in motion.

For safe and effective pump and roll wildland fire suppression tactics I recommend NFPA 1500 (2013) 6.3.1 annex which reads; “…the NWCG strongly recommend that two fire fighters, each with a hose line, walk ahead and aside of the vehicle’s path, both fire fighters on the same side of the vehicle (not one on each side), in clear view of the driver, with the vehicle being driven in uninvolved terrain.” For those departments with safety concerns about the risk to unfit or unhealthy personnel performing mobile attack while walking alongside the apparatus, I recommend following NFPA 1500 (2013) 10.3.1 and 10.2.5 which reads; “The fire department shall establish and provide a health and fitness program that meets the requirements of NFPA 1583, Standard on Health-Related Fitness Programs for Fire Department Members, to enable members to develop and maintain a level of fitness that allows them to safely perform their assigned functions.” And furthermore, “Members who are unable to meet the physical performance requirements shall enter a physical performance rehabilitation program to facilitate progress in attaining a level of performance commensurate with the individual’s assigned duties and responsibilities.”

Submitter Information Verification

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Submitter Full Name: WILLIAM YOHN Organization: US DEPARTMENT OF THE INTERIOR Street Address: City: State: Zip: Submittal Date: Mon Jun 22 17:38:42 EDT 2015

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Public Input No. 77-NFPA 1500-2015 [ Section No. 6.3.1 ]

6.3.1* All persons riding in fire apparatus shall be seated and belted securely by seat belts in approved riding positions within a fully enclosed personnel area at any time the vehicle is in motion other than as allowed in 6.3.4 and 6.3.5. Standing or riding on tail steps, sidesteps, running boards, or in any other exposed position not within a fully enclosed personnel area shall be specifically prohibited.

Statement of Problem and Substantiation for Public Input

The recent revision of NFPA 1906 (Standard for Wildland Fire Apparatus) created an on-board pump-and-roll firefighting (riding) position, an exception to the requirement to be seated and belted in a fully-enclosed personnel area. This new riding position was added as Section 14.4 in 1906. New Section 14.4 requires a seat and seat belt, a rollover protection structure and perforated plate/mesh protection (also requires controls, safety signs and door/gate).

The primary justification for allowing personnel to ride on the exterior of the apparatus was the need to ride on the apparatus, outside of the enclosed cab, in order to fight "fine fuel" fires. Additional justification related to potential reduction in cardiac arrest by unfit or unhealthy personnel was cited - that is, riding on outside of the apparatus for mobile attack rather than walking along side the apparatus. Alternative equipment and tactics which do not compromise safety but achieve similar results were not considered by the TC on Fire Department Apparatus, including but not limited to the use of heavy equipment (bulldozers/tractor plows) and remotely operated fast reaction turrets (which can be operated while seated and belted in an enclosed apparatus cab). Allowing personnel to fight fire while seated (or more likely, standing) outside of the fully enclosed personnel area accommodates a tactical preference, not an operational necessity and reduces firefighter safety. The federal land management (wildland fire) agencies and several state agencies do not support the practice of riding on the apparatus for mobile attack (See Annex for 6.3.1). NFPA 1906 has created a safety compromise which should not be supported in NFPA 1500.

Submitter Information Verification

Submitter Full Name: DAVID HASTON Organization: USDA Forest Service Street Address: City: State: Zip: Submittal Date: Wed Jul 01 11:01:36 EDT 2015

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Public Input No. 129-NFPA 1500-2015 [ New Section after 7.1 ]

7.1.6.4 Specific roles, responsibilities, and authorities shall be assigned for inspection care and maintenance of protective clothing and protective equipment.

Statement of Problem and Substantiation for Public Input

This sentence is moved from 7.2.5.2 to cover all protective clothing and equipment instead of only protective clothing for structural firefighting.

Submitter Information Verification

Submitter Full Name: Andrew Schwartz Organization: Lion Group, Inc. Street Address: City: State: Zip: Submittal Date: Mon Jul 06 16:01:39 EDT 2015

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Public Input No. 131-NFPA 1500-2015 [ New Section after 7.1 ]

7.1.7 The fire department's protective clothing and equipment program shall provide for training in its use.

Statement of Problem and Substantiation for Public Input

moved requirement for training in 7.2.5 to the general section to cover all ppe, not only structural firefighting ppe as it now provides.

Submitter Information Verification

Submitter Full Name: Andrew Schwartz Organization: Lion Group, Inc. Street Address: City: State: Zip: Submittal Date: Mon Jul 06 16:16:53 EDT 2015

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Public Input No. 52-NFPA 1500-2015 [ Sections 7.1, 7.2, 7.3, 7.4, 7.5, 7.6, 7.7, 7.8, 7.9 ]

Sections 7.1, 7.2, 7.3, 7.4, 7.5, 7.6, 7.7, 7.8, 7.9 7.1 General. 7.1.1 * The fire department shall provide each member with protective ensembles, ensemble elements, and protective equipment designed to provide protection from hazards to which the member is likely to be exposed and that is suitable for the tasks the member is expected to perform. 7.1.1.1 A risk assessment on the selection of protective ensemble, ensemble element, and protective equipment shall be conducted in accordance with the appropriate applicable NFPA standards. 7.1.1.2 The selection of suitable and appropriate protective ensembles, ensemble elements, and other protective equipment shall be based on a Selection program containing an effective risk assessment as specified in NFPA 1851, Standard on Selection, Care, and Maintenance of Protective Ensembles for Structural Fire Fighting and Proximity Fire Fighting . 7.1.2 * Protective ensembles, ensemble elements, and other protective equipment shall be used whenever the member is exposed or potentially exposed to the hazards for which it is provided. 7.1.3 Structural fire-fighting and proximity fire-fighting protective ensembles and ensemble elements shall be cleaned as specified in NFPA 1851, Standard on Selection, Care, and Maintenance of Structural Fire Fighting Protective Ensembles . 7.1.4 * Where station/work uniforms are worn by members, such station/work uniforms shall meet the requirements of NFPA 1975, Standard on Station/Work Uniforms for Emergency Services . 7.1.5 While on duty, members shall not wear personal clothing, accessories, or personal equipment that might not be suitable and appropriate to protect the member from the hazards to which the member could be exposed. 7.1.6 The fire department shall provide for care and maintenance of protective ensembles, ensemble elements, and station/work uniforms as specified in NFPA 1581, Standard on Fire Department Infection Control Program , and NFPA 1851, Standard on Selection, Care, and Maintenance of Protective Ensembles for Structural Fire Fighting and Proximity Fire Fighting . 7.1.6.1 * Where the organization implements an on-site care and maintenance operation, the organization shall follow applicable governing standards that provide for exposure control and protection of members performing the tasks associated with care and maintenance. 7.1.6.2 Where such cleaning is conducted in fire stations, the fire department shall provide at least one washing machine for this purpose in the designated cleaning area specified in NFPA 1581, Standard on Fire Department Infection Control Program .

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7.1.6.3 * Where the fire department implements an on-site care and maintenance operation, the fire department shall acquire the proper type and amount of equipment, materials, and supplies to properly perform cleaning, drying, inspections, and maintenance of protective ensembles and ensemble elements. 7.2 Protective Clothing for Structural Fire Fighting. 7.2.1 * Members who engage in or are exposed to the hazards of structural fire fighting shall be provided with and shall use a protective ensemble that shall meet the applicable requirements of NFPA 1971, Standard on Protective Ensembles for Structural Fire Fighting and Proximity Fire Fighting . 7.2.2 * The protective coat and the protective trousers shall have at least a 2 in. (50 mm) overlap of all layers so there is no gaping of the total thermal protection when the protective garments are worn. 7.2.2.1 The minimum overlap shall be determined by measuring the garments on the wearer, without SCBA, in both of the following positions:

(1) Position A — standing, hands together reaching overhead as high as possible (2) Position B — standing, hands together reaching overhead, with body bent forward at a 90-degree angle, to the side (either left or right), and to the back

7.2.3 Single-piece protective coveralls shall not be required to have an overlap of all layers, provided there is continuous composite protection. 7.2.4 Gloves. 7.2.4.1 Fire departments that provide protective coats with protective resilient wristlets secured through a thumb opening shall be permitted to provide gloves of the gauntlet type for use with these protective coats. 7.2.4.2 * Fire departments that do not provide such wristlets attached to all protective coats shall provide gloves of the wristlet type or other interface component for use with these protective coats. 7.2.5 The fire department shall adopt and maintain a protective clothing and protective equipment program that addresses the selection, care, maintenance, and use of structural fire-fighting protective ensembles, and training in its use. 7.2.5.1 The selection, care, and maintenance of protective ensembles for structural fire fighting shall be as specified in NFPA 1851, Standard on Selection, Care, and Maintenance of Protective Ensembles for Structural Fire Fighting and Proximity Fire Fighting . 7.2.5.2 Specific roles, responsibilities, and authorities shall be assigned for inspection and maintenance. 7.2.6 The fire department shall require all members to wear all protective ensemble components specific to the operation. 7.3 Protective Clothing for Proximity Fire-Fighting Operations. 7.3.1 * When determining the need for proximity ensembles, the organization shall perform a risk assessment as required by Chapter 5 of NFPA 1851, Standard on Selection, Care, and Maintenance of Protective Ensembles for Structural Fire Fighting and Proximity Fire Fighting .

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7.3.2 When it is determined proximity protective ensembles and ensemble elements are required, members shall be provided with and shall use proximity fire-fighting protective ensembles and ensemble elements that are compliant with NFPA 1971, Standard on Protective Ensembles for Structural Fire Fighting and Proximity Fire Fighting . 7.3.2.1 The minimum overlap shall be determined by measuring the garments on the wearer, without SCBA, in both of the following positions:

7.3.3 Single-piece proximity protective coveralls shall not be required to have an overlap of all layers, provided there is continuous full thermal and radiant heat protection. 7.3.4 Where SCBA is worn over or outside the proximity protective garment, the fire department shall inform the member of the potential high levels of radiant heat that can result in the failure of the SCBA. 7.3.4.1 The fire department shall require additional approved radiant reflective criteria, including but not limited to a protective cover, for the expected proximity fire-fighting exposures when the SCBA is worn over or outside the proximity protective garment. 7.4 * Protective Clothing for Emergency Medical Operations. 7.4.1 The fire department shall develop standard operating procedures outlining the minimum required levels of protection based on a risk assessment of the medical care activities involved. 7.4.1.1 Members who perform emergency medical care or are otherwise likely to be exposed to blood or other body fluids shall be provided with emergency medical garments, emergency medical face protection devices, emergency medical examination gloves, emergency medical work gloves, and emergency medical footwear or emergency medical footwear covers that are compliant with NFPA 1999, Standard on Protective Clothing for Emergency Medical Operations . 7.4.2 * Members shall wear emergency medical examination gloves when providing emergency medical care. 7.4.2.1 Patient care shall not be initiated before the gloves are in place. 7.4.2.2 Emergency medical work gloves shall be permitted to be used in place of emergency medical examination gloves in situations involving physical hazards. 7.4.3 Each member shall use emergency medical garments and emergency medical face protection devices, including particulate filtering masks, prior to any patient care during which large splashes of body fluids can occur, such as childbirth or situations involving spurting blood. 7.4.4 Contaminated emergency medical protective clothing shall be cleaned and disinfected or disposed of as specified in NFPA 1581, Standard on Fire Department Infection Control Program .

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7.4.4.1 Emergency medical examination gloves and emergency medical footwear covers shall not be reused and shall be disposed of after use. 7.4.4.2 Any item of emergency medical protective clothing that is not designated for “multiple use” shall not be reused and shall be disposed of after use. 7.5 * Chemical-Protective Clothing for Hazardous Materials Emergency Operations. 7.5.1 * Vapor-Protective Ensembles. 7.5.1.1 Members who engage in operations during hazardous materials emergencies where there is the potential for exposure to known chemicals in gaseous or vapor form that pose skin hazards, to chemicals that have not been identified, or to chemical environments that are classified as immediately dangerous to life or health (IDLH) shall be provided with and shall use vapor-protective ensembles that meet the applicable requirements of NFPA 1991, Standard on Vapor-Protective Ensembles for Hazardous Materials Emergencies . 7.5.1.2 Prior to use of the ensemble, members who engage in hazardous materials operations shall consult the technical data package, manufacturers' instructions, and manufacturers' recommendations as provided and required by NFPA 1991, Standard on Vapor-Protective Ensembles for Hazardous Materials Emergencies , to ensure that the ensemble is designed to provide the member protection for the specific hazardous materials emergency. 7.5.1.3 All members who engage in operations during hazardous materials emergencies where there is potential for exposure to known chemicals in gaseous or vapor form that pose skin hazards, to chemicals that have not been identified, or to chemical environments that are classified as IDLH shall be provided with and shall use SCBA that meet the applicable requirements of Section 7.12 . 7.5.1.3.1 Additional outside air supplies shall be permitted to be utilized in conjunction with SCBA, provided such systems are positive pressure and have been certified by NIOSH under 42 CFR 84, Approval of respiratory protective devices . 7.5.1.4 Vapor-protective ensembles, certified to the 2005 edition of NFPA 1991, Standard on Vapor-Protective Ensembles for Hazardous Materials Emergencies , shall be permitted to be used for protection from chemical agents, biological agents, and radioactive particulate encountered during terrorism incidents. 7.5.1.5 Where the risk assessment shows that members will also be exposed to liquefied gases, members shall be provided with and shall use vapor-protective ensembles that meet the additional optional requirements for liquefied gas protection in NFPA 1991, Standard on Vapor-Protective Ensembles for Hazardous Materials Emergencies . 7.5.1.6 Where the risk assessment shows that members will also be exposed to potential chemical flash fires, members shall be provided with and shall use vapor-protective ensembles that meet the additional optional requirements for chemical flash fire protection in NFPA 1991, Standard on Vapor-Protective Ensembles for Hazardous Materials Emergencies . 7.5.1.7 * Vapor-protective ensembles shall not be used alone for any fire-fighting applications or for protection from ionizing radiation, cryogenic liquid hazards, or explosive atmospheres. 7.5.1.8 Vapor-protective ensembles shall be permitted to be used for protection from liquid splashes or solid chemicals and particulates.

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7.5.2 * Liquid Splash-Protective Ensembles and Clothing. 7.5.2.1 Members who engage in operations during hazardous materials emergencies that will expose them to known chemicals in liquid-splash form shall be provided with and shall use liquid splash-protective ensembles or clothing that meet the applicable requirements of NFPA 1992, Standard on Liquid Splash- Protective Ensembles and Clothing for Hazardous Materials Emergencies . 7.5.2.2 Prior to use of the ensemble or clothing, members who engage in hazardous materials operations shall consult the technical data package, manufacturers' instructions, and manufacturers' recommendations as provided and required by NFPA 1992, to ensure that the ensemble or clothing is designed to provide the member protection for the specific hazardous chemical emergency. 7.5.2.3 All members who engage in operations during hazardous materials emergencies that will expose them to known chemicals in liquid-splash form shall be provided with and shall use either SCBA that meet the applicable requirements of 7.12.1 , or other respiratory protective devices that are certified by NIOSH under 42 CFR 84 as suitable for the specific chemical environment. 7.5.2.3.1 Additional outside air supplies shall be permitted to be utilized in conjunction with SCBA, provided such systems are positive pressure and have been certified by NIOSH under 42 CFR 84. 7.5.2.4 Liquid splash-protective ensembles or clothing shall not be used for protection from chemicals in vapor form or from unknown liquid chemicals or chemical mixtures. 7.5.2.4.1 Only vapor-protective ensembles specified in 7.5.1 and SCBA specified in 7.12.1 shall be considered for use. 7.5.2.5 Liquid splash-protective ensembles or clothing shall not be used for protection from chemicals or specific chemical mixtures that have a vapor pressure greater than 5 mm Hg at 77°F (25°C) and have known or suspected carcinogenicity as indicated by one of the following documents:

(1) Sax's Dangerous Properties of Industrial Materials (2) NIOSH Pocket Guide to Chemical Hazards

7.5.2.6 Liquid splash-protective suits shall not be used for protection from chemicals or specific chemical mixtures with skin toxicity notations as indicated by the American Conference of Governmental Industrial Hygienists, TVLs ® and BEIs ® , and that have a vapor pressure greater than 5 mm Hg at 77°F (25°C). 7.5.2.7 Where the risk assessment shows that members will also be exposed to potential chemical flash fires, members shall be provided with and shall use liquid splash-protective ensembles and clothing that meet the additional optional requirements for chemical flash fire protection in NFPA 1992, Standard on Liquid Splash-Protective Ensembles and Clothing for Hazardous Materials Emergencies . 7.5.2.8 * Liquid splash-protective suits shall not be used alone for any fire-fighting applications or for protection from ionizing radiation, biological, liquefied gas or cryogenic liquid hazards, or from flammable or explosive atmospheres, or from hazardous chemical vapor atmospheres. 7.5.2.9 Liquid splash-protective suits shall be permitted to be used for protection from solid chemicals and particulates. 7.5.3 * Protective Ensembles for CBRN Terrorism Incidents.

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7.5.3.1 Members who engage in assessment, extrication, rescue, triage, treatment decontamination, and support function operations for incidents involving CBRN terrorism agents shall be provided with the protective ensembles and protective equipment specified in 7.5.3.3 through 7.5.3.6 . 7.5.3.2 * The approach to any potentially hazardous atmosphere, including biological hazards, shall be made with a plan that includes an assessment of the hazard and exposure potential, respiratory protection needs, entry conditions, exit routes, and decontamination strategies. 7.5.3.2.1 Before emergency response personnel are assigned to operations involving CBRN terrorism agents, the incident commander shall perform a risk assessment of the incident to determine the type of protective ensembles and other protective equipment that is needed. 7.5.3.3 Where the risk assessment indicates one or more of the following, all members who will be performing the operations shall be provided with and shall use at least ensembles certified as compliant with NFPA 1991, Standard on Vapor-Protective Ensembles for Hazardous Materials Emergencies :

(1) There is an ongoing release of the agent with likely gas/vapor exposure. (2) The identity or concentration of the vapor or liquid agent is unknown. (3) Liquid contact is expected, and no direct skin contact can be permitted. (4) Exposure of members could be at levels that would result in substantial possibility of immediate death, immediate serious incapacitation, or a severely impaired ability to escape. (5) Most victims in the area appear to be unconscious or dead. (6) Members will be close to the point of release.

7.5.3.3.1 All members who engage in operations for incidents involving CBRN terrorism agents and who are required to wear vapor-protective ensembles that meet NFPA 1991, Standard on Vapor-Protective Ensembles for Hazardous Materials Emergencies , shall be provided with and shall use either of the following respiratory protection:

(1) SCBA that meet the applicable requirements of 7.12.1 , provided that the SCBA is fully encapsulated by the protective ensemble (2) Open-circuit SCBA that are certified by NIOSH as compliant with NIOSH Standard for Chemical, Biological, Radiological, and Nuclear (CBRN) Open Circuit Self-Contained Breathing Apparatus (SCBA)

7.5.3.4 Where the risk assessment indicates one or more of the following, all members who will be performing the operations for incidents involving CBRN terrorism agents shall be provided with and shall use at least Class 2 ensembles certified as compliant with NFPA 1994, Standard on Protective Ensembles for First Responders to CBRN Terrorism Incidents :

(1) Exposure is at IDLH conditions. (2) The agent or threat has generally been identified. (3) The actual release has subsided except for where the potential for direct contact with residual vapor or gas is probable. (4) Surfaces at the emergency scene are highly contaminated. (5) Victims in the area are symptomatic, not ambulatory, but showing signs of movement.

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7.5.3.4.1 All members who engage in operations for incidents involving CBRN terrorism agents and who are required to wear NFPA 1994, Standard on Protective Ensembles for First Responders to CBRN Terrorism Incidents , Class 2 ensembles shall use open-circuit SCBA that are certified by NIOSH as compliant with NIOSH Standard for Chemical, Biological, Radiological, and Nuclear (CBRN) Open Circuit Self-Contained Breathing Apparatus (SCBA) . 7.5.3.5 Where the risk assessment indicates one or more of the following, all members who will be performing the operations for incidents involving CBRN terrorism agents shall be provided with and shall use at least Class 3 ensembles certified as compliant with NFPA 1994, Standard on Protective Ensembles for First Responders to CBRN Terrorism Incidents :

(1) Exposure is at levels below IDLH conditions. (2) Exposure to liquids is expected to be incidental through contact with contaminated surfaces or victims well after the release has occurred. (3) Victims are symptomatic but ambulatory.

7.5.3.5.1 All members who engage in operations for incidents involving CBRN terrorism agents and who are required to wear NFPA 1994, Standard on Protective Ensembles for First Responders to CBRN Terrorism Incidents , Class 3 ensembles shall use one of the following types of respirators:

(1) Open-circuit SCBA that are certified by NIOSH as compliant with NIOSH Standard for Chemical, Biological, Radiological, and Nuclear (CBRN) Open Circuit Self-Contained Breathing Apparatus (SCBA) (2) Air-purifying respirators (APRs) with a minimum rated service life of at least 30 minutes that are certified by NIOSH as compliant with NIOSH Standard for Chemical, Biological, Radiological, and Nuclear (CBRN) Full Facepiece Air Purifying Respirator (APR)

7.5.3.6 * Where the risk assessment indicates the potential presence of biological or radiological particulates only, all members who will be performing the operations for incidents involving CBRN terrorism agents shall be provided with and shall use at least Class 4 ensembles certified as compliant with NFPA 1994, Standard on Protective Ensembles for First Responders to CBRN Terrorism Incidents . 7.5.3.6.1 All members who engage in operations during chemical and biological terrorism incidents and who are required to wear NFPA 1994, Standard on Protective Ensembles for First Responders to CBRN Terrorism Incidents , Class 4 ensembles shall use one of the following types of respirators:

(1) Open-circuit SCBA that are certified by NIOSH as compliant with NIOSH Standard for Chemical, Biological, Radiological, and Nuclear (CBRN) Open Circuit Self-Contained Breathing Apparatus (SCBA) (2) APR with a minimum rated service life of at least 30 minutes that are certified by NIOSH as compliant with NIOSH Standard for Chemical, Biological, Radiological, and Nuclear (CBRN) Full Facepiece Air Purifying Respirator (APR)

7.5.3.7 Vapor-protective ensembles, certified as compliant with NFPA 1991, Standard on Vapor-Protective Ensembles for Hazardous Materials Emergencies , that are used in operations involving any exposure to CBRN terrorism agents, shall be decontaminated following that use or shall be disposed of where decontamination will not stop the chemical or biological assault on the ensemble and the protective qualities would be diminished or nullified.

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7.5.3.8 All NFPA 1994, Standard on Protective Ensembles for First Responders to CBRN Terrorism Incidents , Class 2, Class 3, and Class 4 protective ensembles and NFPA 1971, Standard on Protective Ensembles for Structural Fire Fighting and Proximity Fire Fighting , protective ensembles with the CBRN option that are used in operations involving any exposure to chemical or biological terrorism agents shall be disposed of following that use. 7.5.3.9 Disposal shall be in accordance with applicable local, state/provincial, and federal regulations. 7.5.3.10 All protective ensembles that are to be used for incidents involving CBRN terrorism agents shall be inspected and maintained as required by the technical data package and the manufacturer's instructions. 7.6 Inspection, Maintenance, and Disposal of Chemical-Protective Clothing. 7.6.1 All chemical-protective clothing shall be inspected and maintained as required by the technical data package, manufacturers' instructions, and manufacturers' recommendations. 7.6.2 All chemical-protective clothing that receives an exposure to a chemical or a chemical mixture shall be disposed of if decontamination will not stop the chemical assault on the garment and the protective qualities will be diminished or nullified. 7.6.2.1 Disposal shall be in accordance with applicable state or federal regulations. 7.7 Protective Clothing and Equipment for Wildland Fire Fighting. 7.7.1 * The fire department shall establish standard operating procedures for the use of wildland protective clothing and equipment. 7.7.2 Members who engage in or are exposed to the hazards of wildland fire-fighting operations shall be provided with and use protective garments and protective equipment that meet the requirements of NFPA 1977, Standard on Protective Clothing and Equipment for Wildland Fire Fighting . 7.7.3 * Members who engage in or are exposed to the hazards of wildland fire-fighting operations shall be provided with a fire shelter, in a crush-resistive case, and wear it in such a way as to allow for rapid deployment. 7.8 Protective Ensembles for Technical Rescue Operations. 7.8.1 Members of special teams whose primary function is search, rescue, recovery, and site stabilization operations for technical rescue incidents other than wilderness or water rescue incidents shall be provided with and shall use a protective ensemble that is certified as compliant with NFPA 1951, Standard on Protective Ensembles for Technical Rescue Incidents . 7.8.1.1 Before emergency response personnel are assigned to technical rescue incidents, the incident commander shall perform a risk assessment of the expected hazards to determine the type of protective ensembles and other protective equipment that is needed. 7.8.1.2 Where the risk assessment indicates exposure to physical and thermal hazards are expected, utility technical rescue protective ensembles and ensemble elements shall be used.

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7.8.1.3 Where the risk assessment indicates exposure to physical, thermal, liquid, and body fluid-borne pathogen hazards are expected, rescue and recovery technical rescue protective ensembles and ensemble elements shall be used. 7.8.1.4 Where the risk assessment indicates exposure to physical, thermal, liquid, and body fluid-borne pathogen hazards and CBRN agents is vapor, liquid splash, and particulate forms are expected during terrorism incident operations, CBRN technical rescue protective ensemble and ensemble elements requirements shall be used. 7.8.2 The protective coat and protective trousers shall have at least a 2 in. (50 mm) overlap of all layers so there is no gaping of the total thermal and barrier protection when the protective garments are worn. 7.8.2.1 The minimum overlap shall be determined by measuring the garments on the wearer, without respiratory protection, in both of the following conditions:

(1) Position A — standing, hands together reaching overhead as high as possible (2) Position B — standing, hands together reaching overhead, with the body bent forward at a 90-degree angle, to the side (either left or right), and to the back

7.8.2.2 Single-piece protective coveralls shall not be required to have an overlap of all layers, provided there is continuous composite protection. 7.8.3 Members engaged in technical rescue operations that require respiratory protection shall be provided with and shall use respirators that are certified by NIOSH to 42 CFR Part 84. 7.8.3.1 * Where air-purifying respirators (APRs) and powered air-purifying respirators (PAPRs) are selected to provide the respiratory protection, the APRs and PAPRs shall be provided with the chemical or particulate filter elements that provide protection against the specific contaminants based upon the anticipated level of exposure risk associated with different response situations. 7.8.3.2 * Where it cannot be determined that an APR or PAPR will provide effective protection against the contaminant, or if the identity of the contaminant is not known, SCBA shall be worn until it can be determined that other respiratory protection can be used. 7.8.3.3 Where SCBA are selected to provide the respiratory protection, the SCBA shall meet the applicable requirements of 7.12.1 . 7.8.4 Members who engage in or are exposed to the hazards of search, rescue, recovery, and site stabilization for technical rescue shall be provided with and shall use primary eye protection that meets the requirements of NFPA 1951. 7.8.5 Technical rescue protective clothing and protective equipment shall be used and maintained in accordance with the manufacturer's instructions. 7.8.5.1 The fire department shall establish a maintenance and inspection program for technical rescue protective clothing and equipment.

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7.8.5.2 Proper decontamination procedures for all technical rescue protective clothing and equipment shall be followed to prevent contamination of the user or support personnel. 7.9 * Protective Clothing and Equipment for Surface Water Operations. 7.9.1 Members of special teams whose primary function is surface water search and rescue operations or other surface water incident operations, including operations in surface water, swift water, tidal water, surf, and ice, shall be provided with and shall use a protective ensemble that is certified as compliant with NFPA 1952, Standard on Surface Water Operations Protective Clothing and Equipment . 7.9.2 Surface water operations protective clothing and protective equipment shall be used and maintained in accordance with the manufacturer's instructions. 7.9.3 The fire department shall establish a maintenance and inspection program for surface water operations protective clothing and equipment. 7.9.4 Proper decontamination procedures for all surface water protective clothing and equipment shall be followed to prevent contamination of the user or support personnel.

Statement of Problem and Substantiation for Public Input

TG Proposal to reorder these sections.

Submitter Information Verification

Submitter Full Name: David Bernzweig Organization: Columbus (OH) Division of Fire Street Address: City: State: Zip: Submittal Date: Wed Feb 11 16:34:48 EST 2015

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Public Input No. 102-NFPA 1500-2015 [ Section No. 7.1.1.1 ]

7.1.1.1 A risk assessment on assessment for the selection of protective ensemble ensembles , ensemble element elements , and protective equipment shall be conducted in accordance with the appropriate applicable NFPA standards. OSHA 1910.132.

Statement of Problem and Substantiation for Public Input

OSHA 1910.132 requires that the employer conduct a risk assessment for the need for protective clothing and should be referenced under the general requirements. NFPA standards with risk assessment requirments should be referenced under each of the specific types of equipment.

Submitter Information Verification

Submitter Full Name: Andrew Schwartz Organization: Lion Group, Inc. Street Address: City: State: Zip: Submittal Date: Mon Jul 06 14:48:41 EDT 2015

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Public Input No. 105-NFPA 1500-2015 [ Section No. 7.1.1.2 ]

7.1.1.2 The selection of suitable and appropriate protective ensembles, ensemble elements, and other protective equipment shall be based on a Selection selection program containing an effective risk assessment as specified in NFPA 1851, Standard on Selection, Care, and Maintenance of Protective Ensembles for Structural Fire Fighting and Proximity Fire Fighting in compliance with OSHA 1910.132 and applicable NFPA standards .

Statement of Problem and Substantiation for Public Input

NFPA 1851 only covers selection of structural and proximity firefighting ppe, therefore this section should be changed to reference the general OSHA ppe standard.

Submitter Information Verification

Submitter Full Name: Andrew Schwartz Organization: Lion Group, Inc. Street Address: City: State: Zip: Submittal Date: Mon Jul 06 14:53:43 EDT 2015

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Public Input No. 47-NFPA 1500-2015 [ Section No. 7.1.1.2 ]

7.1.1.2 The selection of suitable and appropriate protective ensembles, ensemble elements, and other protective equipment shall be based on a Selection selection program containing an effective risk assessment as specified in NFPA 1851, Standard on Selection, Care, and Maintenance of Protective Ensembles for Structural Fire Fighting and Proximity Fire Fighting. ; NFPA 1855, Standard on Selection, Care, and Maintenance of Protective Ensembles for Technical Rescue Incidents;

Statement of Problem and Substantiation for Public Input

TG Public Proposal

Submitter Information Verification

Submitter Full Name: David Bernzweig Organization: Columbus (OH) Division of Fire Street Address: City: State: Zip: Submittal Date: Wed Feb 11 15:43:23 EST 2015

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Public Input No. 48-NFPA 1500-2015 [ New Section after 7.1.2 ]

7.1.2.1 The Fire Department shall provide body armor for all members who operate in areas where a potential for violence or civil unrest exists.

Statement of Problem and Substantiation for Public Input

Move from Annex 7.1.2 to main body. TG Public Input

Submitter Information Verification

Submitter Full Name: David Bernzweig Organization: Columbus (OH) Division of Fire Street Address: City: State: Zip: Submittal Date: Wed Feb 11 15:49:04 EST 2015

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Public Input No. 98-NFPA 1500-2015 [ New Section after 7.1.2 ]

7.1.3 The fire department shall require all members to wear or use all protective ensemble, ensemble elements, and other protective equipment specfic to the operation in which members are engaged.

Statement of Problem and Substantiation for Public Input

Moved this content from 7.2.6 and revised wording to apply to all protective clothing and equipment, not just gloves.

Submitter Information Verification

Submitter Full Name: Andrew Schwartz Organization: Lion Group, Inc. Street Address: City: State: Zip: Submittal Date: Mon Jul 06 14:29:22 EDT 2015

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Public Input No. 51-NFPA 1500-2015 [ Section No. 7.1.5 ]

7.1.5 4 Station/Work Uniforms 7.1.4.1 While on duty, members shall not wear personal clothing, accessories, or personal equipment that might not be suitable and appropriate to protect the member from the hazards to which the member could be exposed.

Statement of Problem and Substantiation for Public Input

TG Public Input

Submitter Information Verification

Submitter Full Name: David Bernzweig Organization: Columbus (OH) Division of Fire Street Address: City: State: Zip: Submittal Date: Wed Feb 11 16:15:46 EST 2015

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Public Input No. 122-NFPA 1500-2015 [ Section No. 7.1.6 [Excluding any Sub-Sections] ]

The fire department shall provide for care inspection, care and maintenance of protective ensembles, ensemble elements, and station/work uniforms as specified in NFPA 1581, Standard on Fire Department Infection Control Program , and NFPA 1851, Standard on Selection, Care, and Maintenance of Protective Ensembles for Structural Fire Fighting and Proximity Fire Fighting components according to the manufacturer's instructions unless specialized care and maintenance requirements are required by NFPA standards for specific types of protective ensembles, ensemble elements, or components; in which case the specialized care and maintenance requirements in the applicable NFPA standard shall apply .

Statement of Problem and Substantiation for Public Input

the existing section references 1851, which is only applicable to protective clothing for structural firefighting. the language needs to be broadened to cover all ppe unless 1851 and other scam docs override it.

Submitter Information Verification

Submitter Full Name: Andrew Schwartz Organization: Lion Group, inc. Street Address: City: State: Zip: Submittal Date: Mon Jul 06 15:34:46 EDT 2015

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Public Input No. 58-NFPA 1500-2015 [ Section No. 7.1.6 [Excluding any Sub-Sections] ]

The fire department shall provide for care and maintenance of protective ensembles, ensemble elements, and station/work uniforms as specified in NFPA 1581, Standard on Fire Department Infection Control Program, and NFPA 1851, Standard on Selection, Care, and Maintenance of Protective Ensembles for Structural Fire Fighting and Proximity Fire Fighting, and in accordance with the manufacturers instructions .

Statement of Problem and Substantiation for Public Input

Manufacturers provide detailed information regarding the maintenance and care of their materials in the Users Manuals. Departments need to ensure that they are not washing the garments inappropriately and thereby causing more harm than good.

Related Public Inputs for This Document

Related Input Relationship Public Input No. 59-NFPA 1500-2015 [Section No. 7.4.4 [Excluding any Sub-Sections]] Same reasoning

Submitter Information Verification

Submitter Full Name: Christina Baxter Organization: US Department of Defense Street Address: City: State: Zip: Submittal Date: Tue Apr 07 09:51:52 EDT 2015

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Public Input No. 89-NFPA 1500-2015 [ Section No. 7.1.6.2 ]

7.1.6.2 Where such cleaning is conducted in fire stations, the fire department shall provide for this purpose at least one washing machine for this purpose machine compliant with NFPA 1851 Standard on Selection, Care, and Maintenance of Protective Ensembles for Structural Fire Fighting and Proximity Firefighting in the designated cleaning area specified in NFPA 1581, Standard on Fire Department Infection Control Program.

Statement of Problem and Substantiation for Public Input

The section should be amended to clarify that NFPA 1851 compliant washing equipment must be provided.

Submitter Information Verification

Submitter Full Name: Andrew Schwartz Organization: Lion Group, Inc. Street Address: City: State: Zip: Submittal Date: Mon Jul 06 13:31:19 EDT 2015

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Public Input No. 90-NFPA 1500-2015 [ Section No. 7.1.6.3 ]

Statement of Problem and Substantiation for Public Input

The section should clarify that the cleaning should be compliant with NFPA 1851.

Submitter Information Verification

Submitter Full Name: Andrew Schwartz Organization: Lion Apparel, Inc. Street Address: City: State: Zip: Submittal Date: Mon Jul 06 13:36:34 EDT 2015

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Public Input No. 128-NFPA 1500-2015 [ Section No. 7.2.5.2 ]

7.2.5.2 Specific roles, responsibilities, and authorities shall be assigned for inspection and maintenance.

Statement of Problem and Substantiation for Public Input

This should be moved to the general section so that it covers all PPE not just protective clothing for structural firefighting.

Submitter Information Verification

Submitter Full Name: Andrew Schwartz Organization: Lion Group, Inc. Street Address: City: State: Zip: Submittal Date: Mon Jul 06 15:56:57 EDT 2015

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Public Input No. 88-NFPA 1500-2015 [ New Section after 7.2.6 ]

TITLE OF NEW CONTENT 7.2.X* (New) The fire department shall develop specific procedures for rapid extrication for a downed firefighter that involves the use of specific equipment worn by the firefighter. A.7.2.X A Drag Rescue Device (DRD) has been required as part of protective coats and protective coveralls. However, this feature is not present in all garments and the ability to extract firefighters can be undertaken by other means that may be achieved through the use of other equipment and procedures. The specific procedures selected by the fire department should take into consideration the equipment provided to the firefighter including any elements certified to NFPA 1971 and that any hand holds or other means for rapid extrication of the firefighter stay in place on the firefighter when deployed.

Statement of Problem and Substantiation for Public Input

While the drag rescue device (DRD) was incorporated as a life-saving feature for protective coat, limited information is available to suggest that its use provides the intended benefits for rapid extraction of a downed firefighter that cannot be achieved by other means. Therefore, it has been suggested that the DRD become optional in future editions of NFPA 1971 and if absent, the manufacturer provide a warning that the organization establish specific procedures for the rapid extrication of downed firefighters by some other identified means. This specific input attempts to address the need for rapid extrication of firefighter being determined and implemented by the fire department.

Submitter Information Verification

Submitter Full Name: JEFFREY STULL Organization: INTERNATIONAL PERSONNEL PROTECTION, INC. Street Address: City: State: Zip: Submittal Date: Mon Jul 06 05:20:28 EDT 2015

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Public Input No. 93-NFPA 1500-2015 [ Section No. 7.2.6 ]

7.2.6 The fire department shall require all members to wear all protective ensemble components specific to the operation.

Statement of Problem and Substantiation for Public Input

This section should be moved to general because it pertains to all protective ensemble elements.

Submitter Information Verification

Submitter Full Name: Andrew Schwartz Organization: Lion Group, Inc. Street Address: City: State: Zip: Submittal Date: Mon Jul 06 13:59:33 EDT 2015

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Public Input No. 95-NFPA 1500-2015 [ Section No. 7.3.2 [Excluding any Sub-Sections] ]

When it is determined proximity protective ensembles and ensemble elements are required, members shall be provided with and shall use proximity fire-fighting protective ensembles and ensemble elements that are compliant with the proximity requirements of NFPA 1971, Standard on Protective Ensembles for Structural Fire Fighting and Proximity Fire Fighting.

Statement of Problem and Substantiation for Public Input

The section should be clarified to indicate that proximity PPE should meet the proximity requirements of NFPA 1971.

Submitter Information Verification

Submitter Full Name: Andrew Schwartz Organization: Lion Group, Inc. Street Address: City: State: Zip: Submittal Date: Mon Jul 06 14:04:31 EDT 2015

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Public Input No. 112-NFPA 1500-2015 [ Section No. 7.4.1.1 ]

7.4.1.1 Members who perform emergency medical care or are otherwise likely to be exposed to blood or other body fluids shall be provided with emergency medical garments, emergency medical eye and face protection devices, emergency medical examination gloves, emergency medical work gloves, and emergency medical footwear or emergency medical footwear covers that emerengency medical helmets, multiple-use emergency medical [C]BRN protective ensembles, and emergency medical footwear that are compliant with NFPA 1999, Standard on Protective Clothing for Emergency Medical Operations.

Statement of Problem and Substantiation for Public Input

I updated this sentence to make consistent with the general ppe categories listed in the NFPA 1999 Table of Contents.

Submitter Information Verification

Submitter Full Name: Andrew Schwartz Organization: Lion Group, Inc. Street Address: City: State: Zip: Submittal Date: Mon Jul 06 15:07:33 EDT 2015

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Public Input No. 59-NFPA 1500-2015 [ Section No. 7.4.4 [Excluding any Sub-Sections] ]

Contaminated emergency medical protective clothing shall be cleaned and disinfected or disposed of as specified in NFPA 1581, Standard on Fire Department Infection Control Program and in accordance with the manufacturer's directions .

Statement of Problem and Substantiation for Public Input

Need to ensure that the manufacturer's directions are included in the plan if reuse of garments following decontamination/washing is planned.

Related Public Inputs for This Document

Related Input Relationship Public Input No. 58-NFPA 1500-2015 [Section No. 7.1.6 [Excluding any Sub-Sections]]

Submitter Information Verification

Submitter Full Name: Christina Baxter Organization: US Department of Defense Street Address: City: State: Zip: Submittal Date: Tue Apr 07 09:58:22 EDT 2015

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Public Input No. 130-NFPA 1500-2015 [ New Section after 7.8.1 ]

7.8.1 The selection, care, and maintenance of protective ensembles for Technical Rescue Operations shall be as specified in NFPA 1855: Standard for Selection, Care, and Maintenance of Protective Ensembles for Technical Rescue Incidents .

Statement of Problem and Substantiation for Public Input

Document needs to be updated to reflect the new SCAM requirements in 1855 for tech rescue.

Submitter Information Verification

Submitter Full Name: Andrew Schwartz Organization: Lion Group, Inc. Street Address: City: State: Zip: Submittal Date: Mon Jul 06 16:06:59 EDT 2015

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Public Input No. 53-NFPA 1500-2015 [ Section No. 7.10.7 ]

7.10.7* When engaged in any operation where they could encounter atmospheres that are IDLH or potentially IDLH, or where the atmosphere is unknown, is undefined or potentially hazardous (including overhaul and post-fire environments) the fire department shall provide and require all members to use SCBA that has been certified as being compliant with NFPA 1981, Standard on Open-Circuit Self-Contained Breathing Apparatus (SCBA) for Emergency Services .

Statement of Problem and Substantiation for Public Input

TG Public Input

Submitter Information Verification

Submitter Full Name: David Bernzweig Organization: Columbus (OH) Division of Fire Street Address: City: State: Zip: Submittal Date: Wed Feb 11 16:49:40 EST 2015

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Public Input No. 54-NFPA 1500-2015 [ Section No. 7.10.8 ]

7.10.8* Members using SCBA shall not compromise the protective integrity of the SCBA for any reason when operating in IDLH, potentially IDLH, or unknown atmospheres by undefined or potentially hazardous atmospheres (including overhaul and post-fire environments) by removing the facepiece or disconnecting any portion of the SCBA that would allow the ambient atmosphere to be breathed.

Statement of Problem and Substantiation for Public Input

TC Public Input

Submitter Information Verification

Submitter Full Name: David Bernzweig Organization: Columbus (OH) Division of Fire Street Address: City: State: Zip: Submittal Date: Wed Feb 11 17:03:09 EST 2015

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Public Input No. 103-NFPA 1500-2015 [ Section No. 7.12.1.2 ]

7.12.1.2 Open-circuit SCBA that does not meet the 1992 1997 or later editions of NFPA 1982, Standard on Personal Alert Safety Systems (PASS), shall be removed from fire service use.

Statement of Problem and Substantiation for Public Input

Update Document; NFPA 1500 TG Proposal

Submitter Information Verification

Submitter Full Name: DAVID BERNZWEIG Organization: Ohio Association of Professional Firefighters Street Address: City: State: Zip: Submittal Date: Mon Jul 06 14:49:24 EDT 2015

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Public Input No. 154-NFPA 1500-2015 [ Section No. 7.12.3.1 ]

7.12.3.1 Fit-Tested Air-purifying respirators (APRs) shall be used only in non-IDLH atmospheres for those contaminants that NIOSH certifies them against.

Statement of Problem and Substantiation for Public Input

APRs must be fit tested to ensure proper protection

Submitter Information Verification

Submitter Full Name: DAVID BERNZWEIG Organization: Ohio Association of Professional Firefighters Street Address: City: State: Zip: Submittal Date: Mon Jul 06 23:46:26 EDT 2015

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Public Input No. 155-NFPA 1500-2015 [ New Section after 7.13.1 ]

7.13.1.1* The facepiece fit test shall use an aerosol quantitative fit test method. A7.13.1.1 The use of 'controlled negative pressure' quanitative fit testing is not scientifically proven as an effective fit test method.

Statement of Problem and Substantiation for Public Input

The use of 'controlled negative pressure' quanitative fit testing is not scientifically proven as an effective fit test method

Submitter Information Verification

Submitter Full Name: DAVID BERNZWEIG Organization: Ohio Association of Professional Firefighters Street Address: City: State: Zip: Submittal Date: Mon Jul 06 23:51:43 EDT 2015

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Public Input No. 106-NFPA 1500-2015 [ New Section after 7.14.5 ]

7.14.5.1 These restrictions shall apply regardless of the specific fitting test measurement that can be obtained under test conditions.

Statement of Problem and Substantiation for Public Input

NFPA 1500 TG Proposal

Submitter Information Verification

Submitter Full Name: DAVID BERNZWEIG Organization: Ohio Association of Professional Firefighters Street Address: City: State: Zip: Submittal Date: Mon Jul 06 14:57:39 EDT 2015

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Public Input No. 108-NFPA 1500-2015 [ New Section after 7.15.2 ]

(NEW)* SCBA cylinders used for structural firefighting shall have a minimum gas capacity of 1699 liters of air.

Statement of Problem and Substantiation for Public Input

NFPA 1500 TG Proposal

Submitter Information Verification

Submitter Full Name: DAVID BERNZWEIG Organization: Ohio Association of Professional Firefighters Street Address: City: State: Zip: Submittal Date: Mon Jul 06 14:59:52 EDT 2015

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Public Input No. 18-NFPA 1500-2014 [ Section No. 7.15.9.1 ]

7.15.9.1 An EEBSS shall not be initiated if the “donors” cylinder has less than 600 L 50% of air remaining.

Statement of Problem and Substantiation for Public Input

By removing 600 L and replacing it with 50% of the cylinder air it will make it easier and safer for the users to train and remember. When training personnel on SCBA use we train them to stay in tune with how much air is left in the cylinder in PSI and with the heads up display in the face mask using 50% is much easier and simpler for the user.

Submitter Information Verification

Submitter Full Name: Kenneth Richards Organization: Old Mystic Fire Department Affilliation: Chair NFPA Technical Committee Fire Service Training Street Address: City: State: Zip: Submittal Date: Thu Jul 03 15:45:46 EDT 2014

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Public Input No. 19-NFPA 1500-2014 [ Section No. 7.15.11 ]

7.15.11 * Standardized IDLH exiting shall require that an exit strategy will be practiced when the SCBA cylinder reaches a level of 600 L or more 50% .

Statement of Problem and Substantiation for Public Input

Replacing 600L with 50% will make it easier and safer for the user. We train on keeping track of the psi left in your cylinder by starting your exit strategy at 50% this gives you 17% of your cylinder air supply before your EOSTI activates at the new 33%.

Submitter Information Verification

Submitter Full Name: Kenneth Richards Organization: Old Mystic Fire Department Affilliation: Chair NFPA Technical Committee on Fire Service Training Street Address: City: State: Zip: Submittal Date: Thu Jul 03 15:54:40 EDT 2014

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Public Input No. 133-NFPA 1500-2015 [ New Section after 7.20 ]

7.20.4. The fire department shall establish a program for retirement and disposal of all protective clothing and equipment. 7.20.5 Unless otherwise subject to an applicable NFPA standards for retirement, the fire department shall use the retirement criteria provided by the manufacturer.

Statement of Problem and Substantiation for Public Input

NFPA 1851 only covers structural and proximity firefighting ppe. The document should also cover retirement considerations for all ppe.

Submitter Information Verification

Submitter Full Name: Andrew Schwartz Organization: Lion Group, Inc. Street Address: City: State: Zip: Submittal Date: Mon Jul 06 16:34:48 EDT 2015

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Public Input No. 110-NFPA 1500-2015 [ New Section after 7.20.3 ]

7.20.4 (New) Open-Circuit SCBA for emergency services shall be retired in accordance with NFPA 1852, Standard on Selection, Care, and Maintenance of Open-Circuit Self-Contained Breathing Apparatus.

Statement of Problem and Substantiation for Public Input

NFPA 1500 TG Proposal

Submitter Information Verification

Submitter Full Name: DAVID BERNZWEIG Organization: Ohio Association of Professional Firefighters Street Address: City: State: Zip: Submittal Date: Mon Jul 06 15:03:46 EDT 2015

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Public Input No. 111-NFPA 1500-2015 [ New Section after 7.20.3 ]

7.20.5 (NEW) Protective clothing and protective equipment other than identified in 7.20.3 and 7.20.4 shall be retired in accordance with manufacturers instructions.

Statement of Problem and Substantiation for Public Input

NFPA 1500 TG Proposal

Submitter Information Verification

Submitter Full Name: DAVID BERNZWEIG Organization: Ohio Association of Professional Firefighters Street Address: City: State: Zip: Submittal Date: Mon Jul 06 15:05:49 EDT 2015

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Public Input No. 109-NFPA 1500-2015 [ Section No. 7.20.3 ]

7.20.3 Members' protective Protective ensembles for structural fire fighting and protective ensembles for proximity fire fighting shall be retired in accordance with NFPA 1851, Standard on Selection, Care, and Maintenance of Protective Ensembles for Structural Fire Fighting and Proximity Fire Fighting.

Statement of Problem and Substantiation for Public Input

NFPA 1500 TG Proposal

Submitter Information Verification

Submitter Full Name: DAVID BERNZWEIG Organization: Ohio Association of Professional Firefighters Street Address: City: State: Zip: Submittal Date: Mon Jul 06 15:02:52 EDT 2015

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Public Input No. 55-NFPA 1500-2015 [ Chapter 8 ]

Chapter 8 Emergency Operations 8.1 Incident Management. 8.1.1* Emergency operations and other situations that pose similar hazards, including but not limited to training exercises, shall be conducted in a manner that recognizes hazards and prevents accidents and injuries. 8.1.2 An incident management system that meets the requirements of NFPA 1561, Standard on Emergency Services Incident Management System, shall be established with written standard operating procedures applying to all members involved in emergency operations. 8.1.3 The incident management system shall be utilized at all emergency incidents. 8.1.4 The incident management system shall be applied to drills, exercises, and other situations that involve hazards similar to those encountered at actual emergency incidents and to simulated incidents that are conducted for training and familiarization purposes. 8.1.5* At an emergency incident, the incident commander shall be responsible for the overall management of the incident and the safety of all members involved at the scene. 8.1.6 As incidents escalate in size and complexity, the incident commander shall divide the incident into tactical-level management components and assign an incident safety officer to assess the incident scene for hazards or potential hazards. 8.1.7* At an emergency incident, the incident commander shall establish an organization with sufficient supervisory personnel to control the position and function of all members operating at the scene and to ensure that safety requirements are satisfied. 8.1.8*

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At an emergency incident, the incident commander shall have the responsibility for the following:

(1) Arrive on-scene before assuming command (2) Assume and confirm command of an incident and take an effective command position (3) Perform situation evaluation that includes risk assessment (4) Initiate, maintain, and control incident communications (5) Develop an overall strategy and an incident action plan and assign companies and members consistent with the standard operating procedures (6) Initiate an accountability and inventory worksheet (7) Develop an effective incident organization by managing resources, maintaining an effective span of control, and maintaining direct supervision over the entire incident, and designate supervisors in charge of specific areas or functions (8) Review, evaluate, and revise the incident action plan as required (9) Continue, transfer, and terminate command (10) On incidents under the command authority of the fire department, provide for liaison and coordination with all other cooperating agencies (11) On incidents where other agencies have jurisdiction, implement a plan that designates one incident commander or that provides for unified command

8.1.8.1 Interagency coordination shall meet the requirements of NFPA 1561, Standard on Emergency Services Incident Management System. 8.2 Communications. 8.2.1 The fire department shall establish and ensure the maintenance of a fire dispatch and incident communications system that meets the requirements of NFPA 1561 and NFPA 1221, Standard for the Installation, Maintenance, and Use of Emergency Services Communications Systems. 8.2.2* The fire department standard operating procedures shall provide direction in the use of clear text radio messages for emergency incidents. 8.2.2.1 The standard operating procedures shall use “emergency traffic” as a designator to clear the radio traffic for an emergency affecting the incident. 8.2.2.2 This “emergency traffic” shall be permitted to be declared by any member who becomes aware of an emergency affecting the incident. 8.2.3* When a member has declared “emergency traffic,” that person shall use clear text to identify the type of emergency, change in conditions, or tactical operations. 8.2.3.1 The member who has declared the “emergency traffic” shall conclude the “emergency traffic” message by transmitting “all clear, resume radio traffic” to end the emergency situation or to re-open the radio channels to communication after announcing the emergency message. 8.2.3.2 The standard operating procedures shall use “mayday” as a designator to identify when a member is in a life-threatening situation and in need of immediate assistance. 8.2.3.3 This “mayday” shall be permitted to be declared by any member who is in or who becomes aware of a member who is in a life-threatening situation and in need of immediate assistance.

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8.2.3.4 The incident commander shall conclude the “mayday” by transmitting “Mayday cleared, resume normal radio traffic.” 8.2.4* The fire department communications center shall start an incident clock when the first arriving unit is on-scene of a working structure fire or hazardous materials incident, or when other conditions appear to be time sensitive or dangerous. 8.2.4.1* The dispatch center shall notify the incident commander at every 10-minute increment with the time that resources have been on the incident until the fire is knocked down or the incident becomes static. 8.2.4.2 The incident commander shall be permitted to cancel the incident clock notification through the fire department communications center based on the incident conditions. 8. X Crew Resource Management During Emergency Operations. 8.X.1* The incident commander shall integrate crew resource management into the regular functions of incident command.

8. 3 Risk Management During Emergency Operations. 8.3.1* The incident commander shall integrate risk management into the regular functions of incident command. 8.3.2* The concept of risk management shall be utilized on the basis of the following principles:

(1) Activities that present a significant risk to the safety of members shall be limited to situations where there is a potential to save endangered lives. (2) Activities that are routinely employed to protect property shall be recognized as inherent risks to the safety of members, and actions shall be taken to reduce or avoid these risks. (3) No risk to the safety of members shall be acceptable when there is no possibility to save lives or property. (4) In situations where the risk to fire department members is excessive, activities shall be limited to defensive operations.

8.3.3* The incident commander shall evaluate the risk to members with respect to the purpose and potential results of their actions in each situation. 8.3.4 Risk management principles shall be routinely employed by supervisory personnel at all levels of the incident management system to define the limits of acceptable and unacceptable positions and functions for all members at the incident scene. 8.3.5* At significant incidents and special operations incidents, the incident commander shall assign an incident safety officer who has the expertise to evaluate hazards and provide direction with respect to the overall safety of personnel. 8.3.6 At terrorist incidents or other incidents involving potential CBRN exposure, the incident commander shall assess the risk to members and ensure that protective equipment appropriate for the risk is available for and used by members.

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8.3.7* Because of the possibility of members being exposed to nerve agents during terrorist activities, fire departments shall consider providing atropine auto-injectors for members. 8.4 Personnel Accountability During Emergency Operations. 8.4.1* The fire department shall establish written standard operating procedures for a personnel accountability system that is in accordance with NFPA 1561, Standard on Emergency Services Incident Management System. 8.4.2 The fire department shall consider local conditions and characteristics in establishing the requirements of the personnel accountability system. 8.4.3 It shall be the responsibility of all members operating at an emergency incident to actively participate in the personnel accountability system. 8.4.4 The incident commander shall maintain an awareness of the location and function of all companies or crews at the scene of the incident. 8.4.5 Officers assigned the responsibility for a specific tactical level management component at an incident shall directly supervise and account for the companies and/or crews operating in their specific area of responsibility. 8.4.6 Company officers shall maintain an ongoing awareness of the location and condition of all company members. 8.4.7 Where assigned as a company, members shall be responsible to remain under the supervision of their assigned company officer. 8.4.8 Members shall be responsible for following personnel accountability system procedures. 8.4.9 The personnel accountability system shall be used at all incidents. 8.4.10* The fire department shall develop, implement, and utilize the system components required to make the personnel accountability system effective. 8.4.11* The standard operating procedures shall provide the use of additional accountability officers based on the size, complexity, or needs of the incident. 8.4.12 The incident commander and members who are assigned a supervisory responsibility for a tactical level management component that involves multiple companies or crews under their command shall have assigned a member(s) to facilitate the ongoing tracking and accountability of assigned companies and crews. 8.5 Members Operating at Emergency Incidents. 8.5.1 The fire department shall provide an adequate number of personnel to safely conduct emergency scene operations.

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8.5.1.1* Operations shall be limited to those that can be safely performed by the personnel available at the scene. 8.5.2 No member or members shall commence or perform any fire-fighting function or evolution that is not within the established safety criteria of the organizational statement as specified in 4.1.1. 8.5.3 When inexperienced members are working at an incident, direct supervision shall be provided by more experienced officers or members. 8.5.3.1 The requirement of 8.5.3 shall not reduce the training requirements contained in 5.1.3 and 5.1.4. 8.5.4* Members operating in hazardous areas at emergency incidents shall operate in crews of two or more. 8.5.5 Crew members operating in hazardous areas shall be in communication with each other through visual, audible, or physical means or safety guide rope, in order to coordinate their activities. 8.5.6 Crew members shall be in proximity to each other to provide assistance in case of emergency. 8.5.7 In accordance with the requirements of 8.8.2, at least two members shall be present outside the hazardous area available for assistance or rescue at emergency operations where members are operating inside a hazardous area. 8.5.8* At aircraft rescue fire-fighting incidents, the initial IDLH shall be identified as the area within 75 ft (23 m) of the skin of the aircraft. 8.5.8.1 After size-up, the incident commander shall adjust the IDLH designation as the situation dictates, to meet operational needs. 8.5.8.2 Aircraft rescue fire-fighting operations inside the area identified as the IDLH shall be in accordance with 8.5.4. 8.5.9* When members are performing special operations, the highest available level of emergency medical care shall be standing by at the scene with medical equipment and transportation capabilities. Basic life support (BLS) shall be the minimum level of emergency medical care. 8.5.10 Emergency medical care and medical monitoring at hazardous materials incidents shall be provided by or supervised by personnel who meet the minimum requirements of NFPA 473, Standard for Competencies for EMS Personnel Responding to Hazardous Materials/Weapons of Mass Destruction Incidents. 8.5.11 At all other emergency operations, the incident commander shall evaluate the risk to the members operating at the scene and, if necessary, request that at least BLS personnel and patient transportation be available. 8.5.12 When members are operating from aerial devices, they shall be secured to the aerial device with a system in compliance with NFPA 1983, Standard on Life Safety Rope and Equipment for Emergency Services.

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8.5.13 The incident commander shall ensure fire investigators or other members that enter an IDLH atmosphere or hazardous area use the PPE, SCBA, or both, as appropriate for risks that might be encountered. 8.5.14* Members involved in water rescue shall be issued and wear personal flotation devices that meet U.S. Coast Guard requirements. 8.5.15 Fire departments shall develop a standard operating procedure for operating near energized lines or equipment. 8.5.15.1* Procedures shall be developed for isolating personnel from the energized conductor. 8.5.15.2 All fire fighters shall be made aware of the increased danger involving downed power lines when working, especially in limited visibility. 8.5.15.3 Fire department personnel shall not be permitted to move or cut electrical meters. 8.5.15.4 Fire fighters shall locate and isolate downed electrical wires and wait for utility company personnel to disconnect the power to those wires. 8.5.15.4.1 In cases of known immediate life-threatening situations, properly trained and equipped personnel shall be permitted to mitigate the hazard. 8.5.15.5 Fire fighters shall keep a minimum distance from an overhead or downed power line until the line is de-energized and always function under the premise that a line is hot. 8.5.15.6 The incident commander shall convey and continually re-evaluate strategic decisions related to fireground electrical hazards to all personnel on the scene. 8.5.15.7 All fire fighters shall be made aware of the hazards of applying a solid-stream water application around energized electrical conductors. 8.5.15.8 All fire fighters shall be repeatedly trained in safety-related practices for working around electrical energy. 8.6 Hazard Control Zones. 8.6.1 Hazard control zones shall be established at every emergency incident to identify the level of risk to emergency responders and the appropriate level of PPE. 8.6.2 The perimeters of the hazard control zones shall be designated by the incident commander. 8.6.3 If the perimeters change during the course of the incident, these changes shall be communicated to all members on the scene. 8.6.4*

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Hazard control zones shall be as follows:

(1) Designated as hot, warm, and cold (similar to hazardous materials incidents) (2) Marked with the applicable colored hazard tape, signage, or other appropriate means wherever possible (3) Communicated to all personnel attending the incident prior to being assigned to a hazard zone

8.6.4.1* Hot zone (red tape) is the area presenting the greatest risks to members, will often be classified as an IDLH atmosphere, and presents the highest risk of human injury and/or exposure; therefore all members shall wear all of the PPE appropriate for the risks that might be encountered while in the hot zone. 8.6.4.1.1* All members operating within the hot zone shall have an assigned task. 8.6.4.2* Warm zone (yellow tape) shall serve as a limited access area for members directly aiding or in support of operations in the hot zone where significant risk of human injury can still exist. 8.6.4.3 Cold zone (green tape) shall establish the public exclusion or clean zone where there are minimal risks for human injury or exposure, or both, in this zone. 8.6.4.4 Where a no-entry zone is designated, no personnel shall enter the no-entry zone due to imminent hazard(s) or the need to protect evidence. 8.6.5 The incident commander shall ensure that the designation of the appropriate protective clothing and equipment is commensurate with the hazard in the zone the member will be operating in. 8.6.6 All officers and members shall ensure the appropriate use of personnel protective equipment within that zone. 8.6.7 The process of utilizing hazard control zones shall continue until the incident hazards have been mitigated or the incident is over. 8.7* Traffic Incidents. 8.7.1 When members are operating at an emergency incident and their assignment places them in potential conflict with motor vehicle traffic, all efforts shall be made to protect the members. 8.7.2 Each department shall establish, implement, and enforce standard operating procedures regarding emergency operations for traffic incidents. 8.7.3 Apparatus and warning devices shall be placed to take advantage of topography and weather conditions (uphill / upwind) and to protect fire fighters from traffic. 8.7.4* Apparatus shall be placed to the rear of the incident or the emergency in a manner that reduces the chance of a vehicle being struck by oncoming traffic. 8.7.4.1 When acting as a shield, apparatus warning lights shall remain on.

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8.7.4.2 All additional responding vehicles, when arriving on the scene, shall be positioned beyond the traffic barrier unless their function requires placement before the barrier. 8.7.4.3* Apparatus shall be placed at an angle to the incident that maximizes safety. 8.7.4.4 The blocking apparatus shall be placed at least 50 ft (15.24 m) behind the first operating unit to create a safe working area. 8.7.5* One or more of the following warning devices shall be used to warn oncoming traffic of the emergency operations and the hazards to members operating at the incident:

(1) Fluorescent and retro-reflective warning devices such as traffic cones (2) Federal Highway Administration (FHWA)-approved 48 in. by 48 in. retro-reflective signs stating “Emergency Scene Ahead” (with directional arrow overlay) (3) Illuminated warning devices such as highway flares (4) Other warning devices appropriate to warn oncoming traffic of the emergency operations

8.7.6 Warning devices shall be placed and utilized with proper considerations given to visual obstruction such as hills, curves, blind spots, or unusual localized weather conditions such as fog or rain. 8.7.7 The first arriving unit shall ensure that traffic is controlled before addressing the emergency operations. 8.7.8 Members shall position themselves and any victims in a secure area. 8.7.9 Members shall park or stage unneeded fire apparatus and personal vehicles off the roadway whenever possible. 8.7.10* When members are operating at a traffic incident and their assignment places them in potential conflict with motor vehicle traffic, they shall wear a garment that is constructed with high-visibility fluorescent and retro- reflective material visible from all directions. 8.7.11* Members used for traffic control purposes shall receive training that is commensurate with their duties and in accordance with any applicable state and local laws and regulations. 8.8 Rapid Intervention for Rescue of Members. 8.8.1 The fire department shall provide personnel for the rescue of members operating at emergency incidents. 8.8.2* In the initial stages of an incident where only one crew is operating in the hazardous area at a working structural fire, a minimum of four individuals shall be required, consisting of two members working as a crew in the hazardous area and two standby members present outside this hazardous area available for assistance or rescue at emergency operations where entry into the danger area is required. 8.8.2.1 The “initial stages” of an incident shall encompass the tasks undertaken by the first arriving company with only one crew assigned or operating in the hazardous area.

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8.8.2.2 The standby members shall be responsible for maintaining a constant awareness of the number and identity of members operating in the hazardous area, their location and function, and time of entry. 8.8.2.3 The standby members shall remain in radio, visual, voice, or signal line communication with the crew. 8.8.2.4* One standby member shall be permitted to perform other duties outside of the hazardous area, such as apparatus operator, incident commander, or technician or aide, provided constant communication is maintained between the standby member and the members of the crew. 8.8.2.5 The assignment of any personnel, including the incident commander, the safety officer, or operators of fire apparatus, shall not be permitted as standby personnel if by abandoning their critical task(s) to assist or, if necessary, perform rescue, they clearly jeopardize the safety and health of any fire fighter working at the incident. 8.8.2.5.1 No one shall be permitted to serve as a standby member of the fire-fighting crew when the other activities in which the fire fighter is engaged inhibit the fire fighter's ability to assist in or perform rescue, if necessary, or are of such importance that they cannot be abandoned without placing other fire fighters in danger. 8.8.2.6 The standby member shall be provided with full protective clothing, protective equipment, and SCBA appropriate for the risk that might be encountered. 8.8.2.6.1 The full protective clothing, protective equipment, and SCBA shall be immediately accessible for use by the outside crew if the need for rescue activities inside the hazardous area occurs. 8.8.2.7 The standby members shall don full protective clothing, protective equipment, and SCBA prior to entering the hazardous area. 8.8.2.8 When only a single crew is operating in the hazardous area in the initial stages of the incident, this standby member shall be permitted to assist with, or if necessary perform, rescue for members of his or her crew, provided that abandoning his or her task does not jeopardize the safety or health of the crew. 8.8.2.9 Once a second crew is assigned or operating in the hazardous area, the incident shall no longer be considered in the “initial stage,” and at least one rapid intervention crew shall be deployed that complies with the requirements of 8.8.2. 8.8.2.10 Initial attack operations shall be organized to ensure that if, on arrival at the emergency scene, initial attack personnel find an imminent life-threatening situation where immediate action could prevent the loss of life or serious injury, such action shall be permitted with less than four personnel. 8.8.2.10.1 No exception as permitted in 8.5.10 shall be allowed when there is no possibility to save lives. 8.8.2.10.2 Any such actions taken in accordance with 8.5.10 shall be thoroughly investigated by the fire department with a written report submitted to the fire chief. 8.8.3

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As the incident expands in size or complexity, which includes an incident commander's requests for additional resources beyond a fire department's initial attack assignment, the dedicated rapid intervention crew (RIC) shall on arrival of these additional resources be either one of the following:

(1) On-scene members designated and dedicated as an RIC (2) On-scene crew/company or crews/companies located for rapid deployment and dedicated as RICs

8.8.3.1 During fire fighter rescue operations each crew/company shall remain intact. 8.8.4 An RIC shall consist of at least two members and shall be available for immediate rescue of a member or a crew. 8.8.4.1 Each RIC shall be fully equipped with protective clothing, protective equipment, SCBA, and any specialized rescue equipment that could be needed given the specifics of the operation under way. 8.8.5 At incidents where any SCBA being used is equipped with an RIC universal air connection (UAC), the RIC shall have the specialized rescue equipment necessary to complete the RIC UAC connection to a supplied air source . 8.8.5.1 Where applicable, the breathing air source and any hoses and connections shall meet the requirements of NFPA 1981, Standard on Open-Circuit Self-Contained Breathing Apparatus (SCBA) for Emergency Services, and be NIOSH certified to 42 CFR 84. 8.8.5.2 The breathing air source shall have no less than 1200 L of breathing air before entering the hazard area. 8.8.6 The composition and structure of a RIC shall be permitted to be flexible based on the type of incident and the size and complexity of operations. 8.8.7* The incident commander shall evaluate the situation and the risks to operating crews and shall provide one or more RICs commensurate with the needs of the situation. 8.8.8 In the early stages of an incident, which includes the deployment of a fire department's initial attack assignment, the RIC shall be in compliance with 8.2.4.1 and 8.8.2.5 and be either one of the following:

(1) On-scene members designated and dedicated as an RIC (2) On-scene members performing other functions but ready to redeploy to perform RIC functions

8.8.9 The assignment of any personnel shall not be permitted as members of the RIC if abandoning their critical task(s) to perform rescue clearly jeopardizes the safety and health of any member operating at the incident. 8.8.10 During fire fighter rescue operations each crew/company shall remain intact. 8.8.11 At least one dedicated RIC shall be standing by with equipment to provide for the rescue of members that are performing special operations or for members that are in positions that present an immediate danger of injury in the event of equipment failure or collapse. 8.9 Rehabilitation During Emergency Operations.

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8.9.1* The fire department shall develop standard operating procedures that outline a systematic approach for the rehabilitation of members operating at incidents. 8.9.2* The incident commander shall consider the circumstances of each incident and initiate rehabilitation in accordance with the standard operating procedures and with NFPA 1561. 8.9.3* Such on-scene rehabilitation shall include at least rest, hydration, active cooling where required, basic life support care, food where required, and protection from extreme elements. 8.9.4 Each member operating at an incident shall be responsible to communicate rehabilitation needs to their supervisor. 8.9.5* Each member who engages in wildland fire-fighting operations shall be provided with 2 qt (2 L) of water. 8.9.5.1 A process shall be established for the rapid replenishment of water supplies. 8.10 Scenes of Violence, Civil Unrest, or Terrorism. 8.10.1* Fire department members shall not become involved in any activities at the scene of domestic disturbance, civil unrest, or similar situations where there is ongoing violence, without the confirmed presence of law enforcement personnel who have deemed the scene secure. 8.10.2 Under no circumstances shall fire department equipment or personnel be used for crowd control or dispersement purposes. 8.10.3* The fire department shall develop and maintain written standard operating procedures that establish a standardized approach to the safety of members at incidents that involve violence, unrest, or civil disturbance. 8.10.4 The fire department shall be responsible for developing an interagency agreement with its law enforcement agency counterpart to provide protection for fire department members at situations that involve violence. 8.10.5* The fire department shall develop a standard communication method that indicates that an incident crew is faced with a life-and-death situation requiring immediate law enforcement intervention. 8.10.6 Such violent situations shall be considered essentially a law enforcement event, and the fire department shall coordinate with the law enforcement incident commander throughout the incident. 8.10.7 The fire department incident commander shall identify and react to situations that do involve or are likely to involve violence. 8.10.8 In such violent situations, the fire department incident commander shall communicate directly with the law enforcement incident commander to ensure the safety of fire department members. 8.10.9 In such violent situations, the fire department incident commander shall stage all fire department resources in a safe area until the law enforcement agency has secured the scene.

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8.10.10 When violence occurs after emergency operations have been initiated, the fire department incident commander shall either secure immediate law enforcement agency protection or shall withdraw all fire department members to a safe staging area. 8.10.11 At civil disturbances or similar incidents where protective equipment generally considered as law enforcement–related, such as body armor, shall be utilized only by members who are trained and qualified to use such equipment. 8.10.12 Fire department companies or crews that provide support to law enforcement agency special weapons and tactics (SWAT) operations shall receive special training. 8.10.12.1 Special standard operating procedures shall be developed that describe the training and safety of these fire department crews for such operations. 8.10.12.2 These activities shall be considered as special operations for the purpose of this standard. 8.11 Post-Incident Analysis. 8.11.1 The fire department shall establish requirements and standard operating procedures for a standardized post-incident analysis of significant incidents or those that involve serious injury or death to a fire fighter. 8.11.2 The fire department incident safety officer shall be involved in the post-incident analysis as defined in NFPA 1521, Standard for Fire Department Safety Officer. 8.11.3 The analysis shall conduct a basic review of the conditions present, the actions taken, and the effect of the conditions and actions on the safety and health of members. 8.11.4 The analysis shall identify any action necessary to change or update any safety and health program elements to improve the welfare of members. 8.11.5 The analysis process shall include a standardized action plan for such necessary changes. 8.11.5.1 The action plan shall include the change needed and the responsibilities, dates, and details of such actions.

Statement of Problem and Substantiation for Public Input

Crew Resource Management (CRM) has been used successfully in the airline industry and the military to reduce accidents, injuries, and fatalities. Overcoming barriers to changing the safety culture in these industries has been accomplished through improved communications, situational awareness, decision-making, and teamwork. These same factors (communications, situational awareness, decision-making, teamwork) are critical to any safe fire ground operation. By requiring the incident commander to practice CRM on all emergency operations, accidents, injuries, and fatalities can be reduced.

Submitter Information Verification

Submitter Full Scott Kerwood Name: Organization: Hutto Fire Rescue

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International Association of Fire Chiefs - Safety, Health and Survival Affilliation: Section Street Address: City: State: Zip: Submittal Date: Mon Feb 16 21:49:51 EST 2015

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Public Input No. 113-NFPA 1500-2015 [ New Section after 8.2.1 ]

8.2.2 (NEW) While operating in the hot or warm zone, all personnel shall be equipped with a fire department portable radio.

Statement of Problem and Substantiation for Public Input

NFPA 1500 TG Proposal

Submitter Information Verification

Submitter Full Name: DAVID BERNZWEIG Organization: Ohio Association of Professional Firefighters Street Address: City: State: Zip: Submittal Date: Mon Jul 06 15:10:49 EDT 2015

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Public Input No. 114-NFPA 1500-2015 [ Section No. 8.3.7 ]

8.3.7* Because of the possibility of members being exposed to nerve agents during terrorist activities, fire departments shall consider providing atropine auto-injectors for members Fire departments shall conduct a risk assessment to determine the need to provide appropriate chemical antidote kits for members in the event of a CBRN incident .

Statement of Problem and Substantiation for Public Input

NFPA 1500 TG Proposal

Submitter Information Verification

Submitter Full Name: DAVID BERNZWEIG Organization: Ohio Association of Professional Firefighters Street Address: City: State: Zip: Submittal Date: Mon Jul 06 15:15:41 EDT 2015

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Public Input No. 115-NFPA 1500-2015 [ New Section after 8.5.1 ]

(NEW) 8.5.1.1 Career Fire Departments shall meet the requirements of section 5.2.4 of NFPA 1710, Standard for the Organization and Deployment of Fire Suppression Operations, Emergency Medical Operations, and Special Operations to the Public by Career Fire Departments.

Statement of Problem and Substantiation for Public Input

NFPA 1500 TG Proposal

Submitter Information Verification

Submitter Full Name: DAVID BERNZWEIG Organization: Ohio Association of Professional Firefighters Street Address: City: State: Zip: Submittal Date: Mon Jul 06 15:23:37 EDT 2015

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Public Input No. 116-NFPA 1500-2015 [ New Section after 8.5.1 ]

(NEW) 8.5.1.2 Volunteer Fire Departments shall meet the requirements of section 4.3 of NFPA 1720: Standard For The Organization And Deployment Of Fire Suppression Operations, Emergency Medical Operations And Special Operations To The Public By Volunteer Fire Departments.

Statement of Problem and Substantiation for Public Input

NFPA 1500 TG Proposal

Submitter Information Verification

Submitter Full Name: DAVID BERNZWEIG Organization: Ohio Association of Professional Firefighters Street Address: City: State: Zip: Submittal Date: Mon Jul 06 15:25:20 EDT 2015

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Public Input No. 118-NFPA 1500-2015 [ Section No. 8.5.1.1 ]

8.5.1.1 3 * Operations shall be limited to those that can be safely performed by the personnel available at the scene.

Statement of Problem and Substantiation for Public Input

to follow proposed 8.5.1.1 & 8.5.1.2 (NEW)

Submitter Information Verification

Submitter Full Name: DAVID BERNZWEIG Organization: Ohio Association of Professional Firefighters Street Address: City: State: Zip: Submittal Date: Mon Jul 06 15:26:44 EDT 2015

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Public Input No. 119-NFPA 1500-2015 [ Section No. 8.5.8 [Excluding any Sub-Sections] ]

At aircraft rescue fire-fighting incidents, the initial IDLH shall be identified as the area within 75 ft (23 m) of the skin of the from wingtip to wingtip for the specific aircraft.

Statement of Problem and Substantiation for Public Input

NFPA 1500 TG Proposal; consistent with current industry definition.

Submitter Information Verification

Submitter Full Name: DAVID BERNZWEIG Organization: Ohio Association of Professional Firefighters Street Address: City: State: Zip: Submittal Date: Mon Jul 06 15:28:28 EDT 2015

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Public Input No. 121-NFPA 1500-2015 [ New Section after 8.5.9 ]

(NEW) 8.5.9.1 Basic life support (BLS) shall be the minimum level of emergency medical care.

Statement of Problem and Substantiation for Public Input

NFPA 1500 TG Proposal

Submitter Information Verification

Submitter Full Name: DAVID BERNZWEIG Organization: Ohio Association of Professional Firefighters Street Address: City: State: Zip: Submittal Date: Mon Jul 06 15:34:06 EDT 2015

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Public Input No. 120-NFPA 1500-2015 [ Section No. 8.5.9 ]

8.5.9* When members are operating at a structure fire or performing special operations, the highest available level of emergency medical care shall be standing by at the scene with medical equipment and transportation capabilities. Basic life support (BLS) shall be the minimum level of emergency medical care.

Statement of Problem and Substantiation for Public Input

NFPA 1500 TG Proposal

Submitter Information Verification

Submitter Full Name: DAVID BERNZWEIG Organization: Ohio Association of Professional Firefighters Street Address: City: State: Zip: Submittal Date: Mon Jul 06 15:32:44 EDT 2015

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Public Input No. 123-NFPA 1500-2015 [ Section No. 8.5.11 ]

8.5.11 At all other emergency operations, except as required in 8.5.9 and 8.5.10, the incident commander shall evaluate the risk to the members operating at the scene and, if necessary, request that at least BLS personnel and patient transportation be available.

Statement of Problem and Substantiation for Public Input

NFPA 1500 TG Proposal

Submitter Information Verification

Submitter Full Name: DAVID BERNZWEIG Organization: Ohio Association of Professional Firefighters Street Address: City: State: Zip: Submittal Date: Mon Jul 06 15:35:31 EDT 2015

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Public Input No. 125-NFPA 1500-2015 [ New Section after 8.5.13 ]

8.5.13.1* (NEW) Members performing overhaul operations shall wear appropriate protective clothing and a supplied-air respirator.*

Statement of Problem and Substantiation for Public Input

NFPA 1500 TG Proposal

Submitter Information Verification

Submitter Full Name: DAVID BERNZWEIG Organization: Ohio Association of Professional Firefighters Street Address: City: State: Zip: Submittal Date: Mon Jul 06 15:46:57 EDT 2015

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Public Input No. 126-NFPA 1500-2015 [ New Section after 8.5.13 ]

8.5.13.1 (NEW) Members engaged in overhaul activities shall wear appropriate protective clothing and a supplied-air respirator.

Statement of Problem and Substantiation for Public Input

NFPA 1500 TG Proposal

Submitter Information Verification

Submitter Full Name: DAVID BERNZWEIG Organization: Ohio Association of Professional Firefighters Street Address: City: State: Zip: Submittal Date: Mon Jul 06 15:54:49 EDT 2015

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Public Input No. 127-NFPA 1500-2015 [ New Section after 8.5.13 ]

8.5.13.2 (NEW) When overhaul is not actively taking place, fire investigators or other members who enter the fire area following extinguishment shall wear protective clothing and a supplied-air respirator OR an appropriate air-purifying respirator for respiratory hazards that may be encountered.

Statement of Problem and Substantiation for Public Input

NFPA 1500 TG Proposal

Submitter Information Verification

Submitter Full Name: DAVID BERNZWEIG Organization: Ohio Association of Professional Firefighters Street Address: City: State: Zip: Submittal Date: Mon Jul 06 15:56:19 EDT 2015

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Public Input No. 124-NFPA 1500-2015 [ Section No. 8.5.13 ]

8.5.13 * The incident commander shall ensure fire investigators or other members that enter that personnel working in an IDLH atmosphere or hazardous area use the PPE, SCBA, or both, as appropriate appropriate protective clothing and SCBA for risks that might be encountered.

Statement of Problem and Substantiation for Public Input

NFPA 1500 TG Proposal

Submitter Information Verification

Submitter Full Name: DAVID BERNZWEIG Organization: Ohio Association of Professional Firefighters Street Address: City: State: Zip: Submittal Date: Mon Jul 06 15:37:23 EDT 2015

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Public Input No. 134-NFPA 1500-2015 [ Section No. 8.5.15 [Excluding any Sub-Sections]

]

Fire departments shall develop a standard operating procedure for operating near energized lines or equipment hazardous energy sources .

Statement of Problem and Substantiation for Public Input

NFPA 1500 TG Proposal

Submitter Information Verification

Submitter Full Name: DAVID BERNZWEIG Organization: Ohio Association of Professional Firefighters Street Address: City: State: Zip: Submittal Date: Mon Jul 06 17:02:41 EDT 2015

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Public Input No. 135-NFPA 1500-2015 [ Section No. 8.5.15.5 ]

8.5.15.5* Fire fighters shall keep a minimum safe distance from an overhead or downed power line until the line is de-energized and always function under the premise that a line is hot.

Statement of Problem and Substantiation for Public Input

NFPA 1500 TG Proposal

Submitter Information Verification

Submitter Full Name: DAVID BERNZWEIG Organization: Ohio Association of Professional Firefighters Street Address: City: State: Zip: Submittal Date: Mon Jul 06 17:04:18 EDT 2015

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Public Input No. 136-NFPA 1500-2015 [ New Section after 8.5.15.8 ]

(NEW) 8.5.15.9 Fire departments shall develop a standard operating procedure for operating near rooftop photovoltaic (PV) generators. 8.5.15.9.1* Procedures shall be developed for isolating personnel from the energized equipment. A8.5.15.9.1 Examples include protective shields, mechanical/human barriers, or alerting techniques that are distinguishable and effective under the conditions. 8.5.15.9.2 All fire fighters shall be made aware of the increased danger involving rooftop photovoltaic equipment when working, especially in limited visibility. 8.5.15.9.3 Fire department personnel shall notify IC of any PV electrical generators on the premises. 8.5.15.9.4 In cases of known immediate life-threatening situations, properly trained and equipped personnel shall be permitted to mitigate the hazard. 8.5.15.9.5* Fire fighters shall keep a minimum distance from PV electrical generators until the system is de-energized and always function under the premise that the array is hot. A8.5.15.9.5* Marking and labeling around the main service panels may assist in locating shutoffs. Attempts to secure the main electrical service and "PV System Disconnect" will lower the hazard, but personnel should consider rooftop array as still energized. Systems equipped with module-level controls provide a higher degree of safety and will shut down each module to a safe level. Contacting qualified PV installers may be required to safely shut down a damaged system. 8.5.15.9.6 The incident commander shall convey and continually re-evaluate strategic decisions related to fireground electrical hazards involving PV systems to all personnel on the scene. 8.5.15.9.7 All fire fighters shall be made aware of the hazards of applying a solid-stream water application around energized PV systems. 8.5.15.9.8 All fire fighters shall be repeatedly trained in safety related practices for working around PV systems.

Statement of Problem and Substantiation for Public Input

NFPA 1500 TG Proposal

Submitter Information Verification

Submitter Full Name: DAVID BERNZWEIG Organization: Ohio Association of Professional Firefighters Street Address: City: State: Zip: Submittal Date: Mon Jul 06 17:05:33 EDT 2015

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Public Input No. 137-NFPA 1500-2015 [ Section No. 8.6.4 [Excluding any Sub-Sections] ]

Hazard control zones shall be as follows:

(1) Designated as no-entry, hot, warm, and cold (similar to hazardous materials incidents) (2) Marked with the applicable colored hazard tape, signage, or other appropriate means wherever possible (3) Communicated to all personnel attending the incident prior to being assigned to a hazard zone

Statement of Problem and Substantiation for Public Input

NFPA 1500 TG Proposal

Submitter Information Verification

Submitter Full Name: DAVID BERNZWEIG Organization: Ohio Association of Professional Firefighters Street Address: City: State: Zip: Submittal Date: Mon Jul 06 21:04:42 EDT 2015

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Public Input No. 138-NFPA 1500-2015 [ New Section after 8.6.4.1 ]

8.6.4.1 (NEW) No-entry zone (red/white chevron tape) is the area at an incident scene that no person(s) are allowed to enter, regardless of what personal protective equipment (PPE) they are wearing due to dangerous conditions 8.6.4.1.1* Where a no-entry zone is designated, no personnel shall enter the no-entry zone due to imminent hazard(s) or the need to protect evidence. (moved from 8.6.4.4) A8.6.4.1.1 Any control zone can include a no-entry zone

Statement of Problem and Substantiation for Public Input

NFPA 1500 TG Proposal

Submitter Information Verification

Submitter Full Name: DAVID BERNZWEIG Organization: Ohio Association of Professional Firefighters Street Address: City: State: Zip: Submittal Date: Mon Jul 06 21:07:35 EDT 2015

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Public Input No. 139-NFPA 1500-2015 [ Section No. 8.6.4.4 ]

8.6.4.4 Where a no-entry zone is designated, no personnel shall enter the no-entry zone due to imminent hazard(s) or the need to protect evidence.

Statement of Problem and Substantiation for Public Input

NFPA 1500 TG Proposal; moved to 8.6.4.1.1

Submitter Information Verification

Submitter Full Name: DAVID BERNZWEIG Organization: Ohio Association of Professional Firefighters Street Address: City: State: Zip: Submittal Date: Mon Jul 06 21:10:32 EDT 2015

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Public Input No. 140-NFPA 1500-2015 [ Section No. 8.7 ]

8.7 * Traffic Incidents. 8.7.1 When members are operating at an emergency incident and their assignment places them in potential conflict with motor vehicle traffic, all efforts shall be made to protect the members. 8.7.2 Each department shall establish, implement, and enforce standard operating procedures regarding emergency operations for traffic incidents. 8.7.3 Apparatus and warning devices shall be placed to take advantage of topography and weather conditions (uphill / upwind) and to protect fire fighters from traffic. 8.7.4 * Apparatus shall be placed to the rear of the incident or the emergency in a manner that reduces the chance of a vehicle being struck by oncoming traffic. 8.7.4.1 When acting as a shield, apparatus warning lights shall remain on. 8.7.4.2 All additional responding vehicles, when arriving on the scene, shall be positioned beyond the traffic barrier unless their function requires placement before the barrier. 8.7.4.3 * Apparatus shall be placed at an angle to the incident that maximizes safety. 8.7.4.4 The blocking apparatus shall be placed at least 50 ft (15.24 m) behind the first operating unit to create a safe working area. 8.7.5 * One or more of the following warning devices shall be used to warn oncoming traffic of the emergency operations and the hazards to members operating at the incident:

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8.7.9 Members shall park or stage unneeded fire apparatus and personal vehicles off the roadway whenever possible. 8.7.10 * When members are operating at a traffic incident and their assignment places them in potential conflict with motor vehicle traffic, they shall wear a garment that is constructed with high-visibility fluorescent and retro-reflective material visible from all directions. 8.7.11 * Members used for traffic control purposes shall receive training that is commensurate with their duties and in accordance with any applicable state and local laws and regulations.

Additional Proposed Changes

File Name Description Approved NEW_CHAPTER_9_Submitted.docx NEW Chapter 9 ( Adapted from Section 8.7)

Statement of Problem and Substantiation for Public Input

NFPA 1500 TG Proposal

Submitter Information Verification

Submitter Full Name: DAVID BERNZWEIG Organization: Ohio Association of Professional Firefighters Street Address: City: State: Zip: Submittal Date: Mon Jul 06 21:12:48 EDT 2015

124 of 208 10/13/2015 11:07 AM Global Change for Chapters 6 and 9: Explanatory notes should be incorporated with and follow text of the presented Standards for Candidates and Members in each section. The current format for NFPA 1582 is not user friendly as the explanatory notes are presented in the Annex separate from the Standards for Candidates and Members. Because the explanatory notes contain very useful information that informs the Standards, the text of the explanatory should be presented together along with the Standard. This change would alleviate the need to constantly flip back and forth from the Standard to the Annex accessing the 1582 document.

9.4.3.2 Coronary Artery Disease - Physician Guidance Addition (4) Add a timeframe for return to work. Is there a minimum time period (e.g. 3 months) after coronary artery stent placement, MI, or other coronary artery incident that a member should wait before returning to work? Please comment on the role of cardiac rehabilitation programs in returning members to work.

9.4.17.2 Supraventricular Arrhythmias, Atrial Fibrillation, or Atrial Flutter. In the comments regarding anticoagulation, please include guidance for newer anticoagulant drugs including: coumarins and indandiones, factor Xa inhibitors, heparins, and thrombin inhibitors.

9.4.20 Hypertension. Members with Stage II Hypertension should be evaluated by echocardiogram to determine if cardiac hypertrophy is present. Additionally, what is the frequency by which members with uncontrolled hypertension should be evaluated by echocardiogram? (For example, check echocardiogram every 5 years for persons with uncontrolled hypertension?)

9.4.21.2 Metabolic Syndrome - Physician Guidance. Add evaluation standards including the need for imaging stress testing, comprehensive diabetes evaluation (if diabetes is present), and frequency of evaluation for incumbent members.

9.10.19 Reflex Sympathetic Dystrophy is also known as Completed Regional Pain Syndrome.

9.12.3.1 Disorders of the Eyes or Vision – Physician Evaluation. The phrasing of the current document is confusing. Please clarify the far visual acuity standards for binocular vision in both corrected and uncorrected states. Please include color vision requirements. Please comment on near visual acuity requirements for reading.

9.12.3.2 Disorders of the Eyes or Vision – Physician Guidance. Please add visual acuity evaluation requirements following evaluation and treatment, the physician shall report any applicable job limitations to the fire department.

9.12.4 Abnormal Hearing. Please discuss further the role of hearing aids in the Fire Service as many members of departments across the country are wearing hearing aids without problems.

9.13.6.1 Single Unprovoked Seizure and Epileptic Conditions. FMCSA requires a 5 year seizure-free period following a single unprovoked seizure and 10 years seizure free following treatment for epilepsy. This FMCSA standard should be adopted.

9.16.4 Anticoagulation. Add statement on newer anticoagulant drugs including: coumarins and indandiones, factor Xa inhibitors, heparins, and thrombin inhibitors.

9.16.7 Sedatives and Hypnotics. I suggest adding another category – MEDICATIONS USED TO TREAT INSOMNIA - to the list of medications that require special guidance. The list of medications range from prescription medications to over the counter medications, and include a wide variety of drug classes including: benzodiazepines, sedative-hypnotics, antihistamines, and over the counter allergy-pain-cold medications. National Fire Protection Association Report http://submittals.nfpa.org/TerraViewWeb/ContentFetcher?commentPara...

Public Input No. 141-NFPA 1500-2015 [ New Section after 8.8.1 ]

8.8.1.1 (NEW) Personnel assigned to perform the function of the Initial Rapid Intervention Crew (IRIC) or the Rapid Intervention Crew (RIC) shall be trained o the requireemts of NFPA 1407, Standard for Training Fire Service Rapid Intervention Crews (2015).

Statement of Problem and Substantiation for Public Input

NFPA 1500 TG Proposal

Submitter Information Verification

Submitter Full Name: DAVID BERNZWEIG Organization: Ohio Association of Professional Firefighters Street Address: City: State: Zip: Submittal Date: Mon Jul 06 21:38:14 EDT 2015

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Public Input No. 143-NFPA 1500-2015 [ New Section after 8.9.1 ]

8.9.1.1 (NEW) Personnel shall not use more than 2 SCBA cylinders before they are sent to rehabilitation operations. This includes work cycles using SCBAs during active firefighting operations and overhaul operations.

Statement of Problem and Substantiation for Public Input

NFPA 1500 TG Proposal

Submitter Information Verification

Submitter Full Name: DAVID BERNZWEIG Organization: Ohio Association of Professional Firefighters Street Address: City: State: Zip: Submittal Date: Mon Jul 06 21:49:16 EDT 2015

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Public Input No. 142-NFPA 1500-2015 [ Section No. 8.9.1 ]

8.9.1* The fire department shall develop standard operating procedures that outline a systematic approach for the rehabilitation of members operating at incidents Personnel shall undergo rehabilitation in accordance with NFPA 1584, Standard on the Rehabilitation Process for Members During Emergency Operations and Training Exercises .

Statement of Problem and Substantiation for Public Input

NFPA 1500 TG Proposal

Submitter Information Verification

Submitter Full Name: DAVID BERNZWEIG Organization: Ohio Association of Professional Firefighters Street Address: City: State: Zip: Submittal Date: Mon Jul 06 21:47:29 EDT 2015

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Public Input No. 144-NFPA 1500-2015 [ Sections 8.9.2, 8.9.3, 8.9.4, 8.9.5 ]

Sections 8.9.2, 8.9.3, 8.9.4, 8.9.5 8.9.2 * The incident commander shall consider the circumstances of each incident and initiate rehabilitation in accordance with the standard operating procedures and with NFPA 1561. 8.9.3 * Such on-scene rehabilitation shall include at least rest, hydration, active cooling where required, basic life support care, food where required, and protection from extreme elements. 8.9.4 Each member operating at an incident shall be responsible to communicate rehabilitation needs to their supervisor. 8.9.5 * Each member who engages in wildland fire-fighting operations shall be provided with 2 qt (2 L) of water. 8.9.5.1 A process shall be established for the rapid replenishment of water supplies.

Statement of Problem and Substantiation for Public Input

NFPA 1500 TG Proposal

Submitter Information Verification

Submitter Full Name: DAVID BERNZWEIG Organization: Ohio Association of Professional Firefighters Street Address: City: State: Zip: Submittal Date: Mon Jul 06 21:50:58 EDT 2015

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Public Input No. 145-NFPA 1500-2015 [ Section No. 8.10.1 ]

8.10.1* Fire department members shall not become involved in any activities at the scene of domestic disturbance, civil unrest, or active shooter, or similar situations where there is ongoing violence, without the confirmed presence of law enforcement personnel who have deemed the scene secure.

Statement of Problem and Substantiation for Public Input

NFPA 1500 TG Proposal

Submitter Information Verification

Submitter Full Name: DAVID BERNZWEIG Organization: Ohio Association of Professional Firefighters Street Address: City: State: Zip: Submittal Date: Mon Jul 06 21:54:51 EDT 2015

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Public Input No. 146-NFPA 1500-2015 [ New Section after 8.10.3 ]

8.10.3.1 (NEW) The fire department shall develop and maintain written standard operating procedures that establish a standardized approach to the safety of members at incidents with an active shooter.

Statement of Problem and Substantiation for Public Input

NFPA 1500 TG Proposal

Submitter Information Verification

Submitter Full Name: DAVID BERNZWEIG Organization: Ohio Association of Professional Firefighters Street Address: City: State: Zip: Submittal Date: Mon Jul 06 21:56:57 EDT 2015

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Public Input No. 147-NFPA 1500-2015 [ Section No. 10.1.3 ]

10.1.3 Candidates and members who will engage in fire suppression emergency response and operations shall meet the medical requirements specified in NFPA 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments.

Statement of Problem and Substantiation for Public Input

NFPA 1500 TG Proposal

Submitter Information Verification

Submitter Full Name: DAVID BERNZWEIG Organization: Ohio Association of Professional Firefighters Street Address: City: State: Zip: Submittal Date: Mon Jul 06 22:09:30 EDT 2015

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Public Input No. 148-NFPA 1500-2015 [ New Section after 10.4.1 ]

10.4.1.1 The individual member health file shall be separate from the members personal/human resources file and maintained in accordance with 29 CFR 1910.1020, the American with Disabilities Act (ADA),a nd the Fair Labor Standards Act (FMLA).

Statement of Problem and Substantiation for Public Input

NFPA 1500 TG Proposal

Submitter Information Verification

Submitter Full Name: DAVID BERNZWEIG Organization: Ohio Association of Professional Firefighters Street Address: City: State: Zip: Submittal Date: Mon Jul 06 22:20:15 EDT 2015

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Public Input No. 149-NFPA 1500-2015 [ Section No. 10.4.2 ]

10.4.2 The individual health file shall record the results of regular medical evaluations and , physical performance tests, any occupational illnesses or injuries, and any events that expose the individual to known or suspected hazardous materials, toxic products, or contagious diseases.

Statement of Problem and Substantiation for Public Input

NFPA 1500 TG Proposal

Submitter Information Verification

Submitter Full Name: DAVID BERNZWEIG Organization: Ohio Association of Professional Firefighters Street Address: City: State: Zip: Submittal Date: Mon Jul 06 22:24:01 EDT 2015

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Public Input No. 150-NFPA 1500-2015 [ Section No. 10.7.4 ]

10.7.4 A member who has been determined to be unable to perform the essential job functions will only be returned to duty when a qualified person the fire department physician has confirmed that the member can perform the essential job functions.

Statement of Problem and Substantiation for Public Input

NFPA 1500 TG Proposal

Submitter Information Verification

Submitter Full Name: DAVID BERNZWEIG Organization: Ohio Association of Professional Firefighters Street Address: City: State: Zip: Submittal Date: Mon Jul 06 22:27:00 EDT 2015

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Public Input No. 84-NFPA 1500-2015 [ Chapter 11 [Title Only] ]

Behavioral Health and Wellness Programs

Change title to "Organizational Health and Wellness Programs"

Statement of Problem and Substantiation for Public Input

Reccomend title change to : "Organizational Health and Wellness Programs"

The title should reflect a more global approach to organizational health and incorporate aspects of behavioral health that apply to the organization as well as individuals. A broader term reflects the understanding of the significant importance of interpersonal dynamics in the fire service for individual crews and the organization as a whole.

Related Public Inputs for This Document

Related Input Relationship Public Input No. 85-NFPA 1500-2015 [Section No. 11.1]

Submitter Information Verification

Submitter Full Name: Donna Brehm Organization: FusionEX LLC Affilliation: First Responders Resiliency Network/Project Rebirth Street Address: City: State: Zip: Submittal Date: Fri Jul 03 13:59:55 EDT 2015

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Public Input No. 85-NFPA 1500-2015 [ Section No. 11.1 ]

11.1 * Behavioral Health Program. 11.1.1* The fire department shall provide access to a behavioral health program for its members and their immediate families. 11.1.1.1 The behavioral health assistance program shall include the capability to provide assessment, basic counseling, stress crisis intervention assistance, and triage and assessment regarding, at a minimum, alcohol and substance abuse, stress and anxiety, depression, and personal problems that adversely affect fire department work performance. 11.1.2* The behavioral health program shall, when clinically indicated, refer members and their immediate families for appropriate clinical and specialty care from providers equipped to deliver evidence-based treatment consistent with current best practices and standards of care. 11.1.3* The fire department shall adopt and follow clear, written policies regarding alcoholism, substance abuse, and other behavioral conditions that can adversely affect performance or fitness for duty, or both. 11.1.3.1 When fitness for duty is in question, such fitness shall be evaluated and determined in accordance with Section 10.7. 11.1.4* The fire department shall adopt and follow clear, written policies consistent with applicable statutes, regulations, and standards respecting records, confidentiality, data gathering and reporting, and protection and release of privileged information related to its behavioral health program. 11.1.4.1 These policies shall identify to whom and under what conditions information can be released and what use, if any, can be made of records for purposes of research, program evaluation, and quality assurance. 11.1.5 Member records maintained by a behavioral health program shall not become part of a member's personnel file. 11.1.6 The program shall be systematically reviewed on a regular basis to provide an objective evaluation of operation and performance.

Additional Proposed Changes

File Name Description Approved Changes_to_NFPA_1500_Chapter_11.docx

Statement of Problem and Substantiation for Public Input

The current text does not accurately reflect the state of the art for behavioral health within the fire service. Since 911, significant changes have taken place. Although CISM is no longer the "term of choice" there are no other options (even NFF has not offered an alternative). Many providers have expanded upon critical stress management to address ongoing/daily challenges faced by first providers, recognizing the cumulative effect these experiences have on the provider and subsequently their families and crew-members. Hence, the expansion to

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organizational health. Our collective experiences affect the organization, and even more so as we rise in rank and have greater influence on the organization. Monitoring personal and organizational health as a collective is vital to the organization and provides a vehicle to address such issues as multi-generational conflict, use of electronic media, challenges of the disparity between hiring criteria now versus 25 years ago, gender and race related issues, the impact of trauma events such as the Boston Marathon and the Connecticut school shooting as well as smaller, more local events demand that the fire service adapt its procedures and approaches regarding behavioral health. The First Responder Resiliency Network is an affiliate of Project Rebirth, a non-profit dedicated to developing resiliency within the military community as well as the public safety first responders.

This submission also includes associated appendix material to replace the current appendix (specific references included) as well as a new definition for Chapter 3 for "Organizational Health."

Related Public Inputs for This Document

Related Input Relationship Public Input No. 84-NFPA 1500-2015 [Chapter 11 [Title Only]] Public Input No. 86-NFPA 1500-2015 [Chapter 12 [Title Only]]

Submitter Information Verification

Submitter Full Name: Donna Brehm Organization: FusionEX LLC Affilliation: First Responder Resiliency Network/Project Rebirth Street Address: City: State: Zip: Submittal Date: Fri Jul 03 14:15:59 EDT 2015

137 of 208 10/13/2015 11:07 AM Changes to NFPA 1500 Chapters 11

Add new definition for Organizational Health: Organizational Health includes, but is not limited to, a group of programs addressing behavioral health, education on prevention and preparedness related to behavioral health, organizational dynamics and leadership development.

(Revise title) Chapter 11: Organizational Health and Wellness Programs

(Revised) 11.1* The fire department shall develop and maintain a comprehensive organizational health program for its members and their immediate families.

(Revised) 11.1.1 A behavioral health program shall be developed to include the ability to provide basic counseling and crisis intervention, including, at a minimum, alcohol and substance abuse, anxiety, depression, traumatic exposure, and other personal problems that adversely affect the department work performance.

(Delete in entirety) 11.1.2 Justification: This document should not specify the type of treatment to support members or their families. Evidence-based treatments are only one type of treatment that can be applied to behavioral health issues and are often based upon a population very different than fire service members, rendering them less than effective. This decision should be left to professional behavioral specialists.

(New numbering) 11.1.1.2 The fire department shall adopt and follow clear written policies regarding alcoholism, substance abuse, and other behavioral conditions that can adversely affect performance or fitness for duty or both.

(New numbering) 11.1.1.2.1 When fitness for duty is in question, such fitness shall be evaluated and determined in accordance with Section 10.7.

(New numbering) 11.1.1.3 The fire department shall adopt and follow clear, written policies consistent with applicable statutes, regulations and standards respecting records, confidentiality, data gathering and reporting, and protection and release of privileged information related to its behavioral health program.

(New numbering) 11.1.1.3.1 These policies shall identify to whom and under what conditions information can be released and what use, if any, can be made of records for purposes of research, program evaluation, and quality assurance.

(New numbering) 11.1.1.3.2 Member records maintained by a behavioral health program shall not become part of a member’s personnel file.

(New) 11.1.1.2* The fire department shall develop and maintain a program to assist members in creating personal resiliency to stress and traumatic exposures.

(New) 11.1.1.3 The fire department shall develop and maintain a program that supports the enhancement of organizational health through leadership development and organizational/group dynamics evaluation and training.

11.2 Wellness Program –remain as written in the current standard.

Chapter 11 Appendix issues:

Replace all associated appendix items related to 11.1 with the following singular appendix item:

Justification: The text is outdated and does not provide overtly useful information to first responders. References are out of date and some agencies/organizations have been gone for many years. The appendix needs to be updated to reflect current behavioral health practices and applications specifically intended for fire department first responders.

Recommended Replacement:

A 11.1 Organizational Health

Historically, fire departments have relied on traditional generic Employee Assistance Programs to address behavioral health issues. In many cases, these programs have not achieved the results expected and desired with fire department members. A unique understanding of the fire service and its inherent dynamics, as well as advanced knowledge about trauma and addictions, is required of behavioral health specialists and counselors to effectively address fire department members’ behavioral issues and maintain overall organizational health. Fire departments that have reached out to, and created a strong relationship with such behavioral health specialists have seen significant improvements in their organization’s overall health and wellbeing. The intrinsic value to the first responders of the availability of such behavioral health specialists trained in the unique cultural aspects of the fire service is essential to the success of the program.

Current research with first responders has shown the importance of developing understanding in how the body and brain respond to stress is essential. Developing coping mechanisms in helping first responders maintain ongoing personal behavioral health is a core component of this program. Providing first responders with techniques to help mitigate the impacts of traumatic exposures is critical to long term personal health, interpersonal dynamics and overall organizational health. The term resiliency is used to address this multi-faceted approach for overall health and well-being.

Best practices begin this education and training in recruit classes and continues into retirement and throughout the member’s years of service.

A true overarching organizational health program can encompass all or some of the following services:

Employee Assistance Program (EAP) Services specifically designed for fire departments

 EAP behavioral health problem identification and assessment  Treatment and/or referrals to outside agencies, as appropriate  Family support  Follow-up services and case management  Leadership development  Executive coaching  Coaching for supervisors dealing with troubled employees  Workplace mediation  Conflict Resolution  Traumatic Exposure Recovery Programs  Health promotion materials/activities  “Back to work” conferences for employees after illness/injury  Management of behavioral health care under insurance plans

First Responder Services

 Acute stress reactions  Traumatic exposures  Post Traumatic Stress Disorder (PTSD)  Officer and department wide training  Department diversity training  Organizational Health support  Depression and grief  Family situations  LODD support services  Stress management  Addictions  Health and wellness concerns  Other issues that can impact work productivity

A 11.2.1—OK to keep-it is all the Wellness Program and is fine as written in the existing standard.

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Public Input No. 86-NFPA 1500-2015 [ Chapter 12 [Title Only] ]

Occupational Exposure to Atypically Stressful Events

Statement of Problem and Substantiation for Public Input

The First Responder Resiliency Network working group would like to recommend a change to the title for Chapter 12:

New Title: "Traumatic Exposure to Events"

We feel the current title is misleading and inaccurate. Defining "atypical" is very personal and can only be defined by the first responder based upon the severity and his/her cumulative experiences. ANYTHING can be traumatic for a first responder. Use of this term brings the standard up to current state of the art for behavioral professionals who are familiar with the fire service.

Please see associated public input for the remainder of Chapter 12.

Related Public Inputs for This Document

Related Input Relationship Public Input No. 85-NFPA 1500-2015 [Section No. 11.1] First responder behavioral health

Submitter Information Verification

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Public Input No. 87-NFPA 1500-2015 [ Section No. 12.1 ]

12.1* General. 12.1.1 The fire department physician shall maintain medical oversight of all clinical aspects of the program. 12.1.2* The fire department shall adopt and utilize a written policy outlining its protocols to address occupational exposure to atypically stressful events. 12.1.3 Protocols shall clearly outline assistance and intervention available to affected members. 12.1.3.1 Participation in clinically related interventions shall be voluntary and at the member’s election. 12.1.3.2 Assessment of potential for sustained clinical impact shall be available through the fire department’s behavioral health program. 12.1.3.3* Where specialty treatment is indicated, referral shall be made to licensed and certified specialists competent to provide evidence-based treatment consistent with current best practices and standards of care as established by authoritative guidelines.

Additional Proposed Changes

File Name Description Approved Changes_to_NFPA_1500_Chapter12.docx

Statement of Problem and Substantiation for Public Input

This submission includes new text for Chapter 12 and associated adjustment for numbering. Also included is associated appendix material with the appropriate link back to the body of the document, as proposed.

The First Responder Resiliency Network core team (affiliated with Project Rebirth, a non-profit dedicated to military and public responders) has proposed these changes to update the current text and put it more in line with current behavioral specialists' thinking. Since 911, a significant change has occurred with traumatic stress reactions and therapy. The use of the term "CISM" although outdated as a defined type of therapy, is still in use but is being modified by different practitioners to be more effective and address cumulative traumatic exposure as well as the additional effects of regular duty shifts, sleep deprivation, shift schedules, family demands, and other work-related issues.

This is a significant issue and deserves national and department level attention. The increase in traumatic events over the past few years is noticeable. Most departments are not addressing the behavioral health issues, but illness and suicides are increasing. It is time to focus on the problem and find ways to guide departments, big and small, career and volunteer, in developing programs to assist their first responders. The current appendix language denounces CISM but does not give alternatives or guidance. Even the National Fallen Firefighters has denounced "CISM" in its current form but does not offer alternatives! We would like to provide text that will provide a starting point for guidance and move this area of first responder health forward.

Submitter Information Verification

Submitter Full Name: Donna Brehm

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Chapter 12: Recommendations

(Revised title) Chapter 12: Traumatic Exposure to Events

(Revise) 12.1* The fire department shall maintain a relationship with an appropriately licensed and or certified behavioral specialist well versed in the fire department culture.

(Revise) 12.1.2* The fire department shall adopt a written policy outlining the program and protocols to address traumatic exposure to events.

(Remains as written) 12.1.3 Protocols shall clearly outline assistance and intervention available to affected members.

12.1.3.1 Delete entirely. Justification: The issue is covered in the requirement to develop protocols and is redundant.

12.1.3.2 Delete entirely. Justification: Addressed in 12.1 and 12.1.2.

12.1.3.3 Delete entirely. Justification: This document should not specify the type of treatment to support members. Evidence-based treatments are only one type of treatment that can be applied to behavioral health/traumatic exposure situations and are often based upon a population very different than fire service members, rendering them less than effective. This decision should be left to professional behavioral specialists.

Recommended replace Appendix material for 12.1.2:

Over the past 10-15 years, fire departments across the country have realized some of the components and their implementation of the early Critical Incident Stress Management (CISM) programs have not met the needs of fire department members or responders from other emergency service departments and organizations.

Current approaches integrate information about the brain and brain trauma, understanding how repeated exposure to traumatic events can erode resilience, mentally and physically, accumulating over time, affecting each person differently and how to empower each individual to manage his/her own symptoms.

Some examples of traumatic events are: • Line of duty deaths • Suicide of a colleague

• Serious work related injury • Multi-casualty / disaster / terrorism incidents • Events with a high degree of threat to the personnel • Significant events involving children • Events in which the victim is known to the personnel • Events with excessive media interest • Events that are prolonged and end with a negative outcome • Any significantly powerful, overwhelming distressing event

Best practices for an effective CISM, or similar, program include the following aspects and should be considered by fire departments desiring to improve their CISM program.

 Selection of highly respected and trusted members to serve on the peer team, along with the department’s behavioral health specialist.  Department-wide education on the program prior to implementation to include training for new members.  Regularly scheduled peer team meetings for ongoing education and incident review  Debriefings should focus specifically on those directly exposed to the traumatic event. Not all members who respond to an event are exposed to the trauma and if included in the debrief may be unnecessarily exposed to the details of the trauma and subsequently negatively impacted.

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Organization: FusionEX LLC Affilliation: First Responder Resiliency Network/Project Rebirth Street Address: City: State: Zip: Submittal Date: Sat Jul 04 10:10:01 EDT 2015

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Public Input No. 152-NFPA 1500-2015 [ New Section after 12.1.3.3 ]

Chapter 13 Exposure to Fireground Toxic Contaminants

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13.1 The AHJ shall provide training on the hazards associated with exposure to fireground toxic contaminants. 13.1.1 Training shall include:

(1) Awarweness (2) Prevention (3) Mitigation (4) Risk factors

13.2 The AHJ shall provide SOPs related to the prevention and mitigation of firefighter exposure to fireground toxic contaminents. 13.3 The AHJ shall provide for the cleaning and maintenance of protective clothing and equipment. The AHJ shall ensure that soiled or contaminated protective clothing and equipment is removed from service until cleaned and disinfected in accordanceFPA 1851. 13.3.1 The AHJ shall ensure that soiled or contaminated protective clothing and equipment is removed from service until cleaned and disinfected in accordance with NFPA 1851. 13.4 Mitigation of fireground toxic contaminant exposure 13.4.1 Appropriate protective clothing and shall be worn during all phases of fireground operations. 13.4.2 Respiratory protection during overhaul shall consist of a supplied-air respirator. 13.4.2.1* Respiratory protection for any entry into the post-fire environment before or after overhaul shall be at least a fitted full face air-purifying respirator (APR) with protection against fireground toxic contaminants. 13.4.2.1.1 When using an APR:

(1) air monitoring shall be conducted to ensure that the appropriate protection is provided (2) a filter change out schedule shall be established for the environmental hazards present at each incident

13.5 Post-incident fireground toxic contaminant exposure 13.5.1 The AHJ shall train its members on the appropriate doffing and containment of contaminated protective clothing and equipment. 13.5.1.1 Training shall include prevention of possible cross-contamination 13.5.2 The AHJ shall provide SOPs related to decontamination of firefighters exposed to fireground toxic contaminents. 13.5.3 The AHJ shall provide appropriate decontamination facilities and equipment for firefighters exposed to fireground toxic contaminents. 13.5.3.1 Firefighter personal hygiene following exposure to fireground toxic contaminents shall include:

(1) Wiping skin areas near the interfaces of protective clothing and equipment (PCE) with a wet wipe immediately after doffing PCE (2) Taking a hot shower within an hour of an incident where an exposure may have occured

13.6 Exposure reporting requirements 13.6.1 The AHJ shall establish an exposure reporting system for its members to record possible exposure to fireground toxic contaminents, airbourne hazards, dusts, or chemicals. 13.6.1.1 The exposure report records shall be maintained by the AHJ for at least 15 years following the members separation from the AHJ or until the death of the member 13.6.1.2 The member shall have access to their personal exposure records. 13.6.2 All personnel potentially exposed to fireground toxic contaminents, airbourne hazards, dusts, or chemicals shall complete an exposure report.

Statement of Problem and Substantiation for Public Input

This chapter is needed to address the lack of firefighter hygiene requirements for the mitigation and prevention of

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exposure to foreground toxic contaminants.

Submitter Information Verification

Submitter Full Name: DAVID BERNZWEIG Organization: Ohio Association of Professional Firefighters Street Address: City: State: Zip: Submittal Date: Mon Jul 06 22:50:34 EDT 2015

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Public Input No. 56-NFPA 1500-2015 [ Chapter A ]

Annex A Explanatory Material Annex A is not a part of the requirements of this NFPA document but is included for informational purposes only. This annex contains explanatory material, numbered to correspond with the applicable text paragraphs.

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A.1.2.3 It is possible that an existing program or policy can satisfy the requirements of this standard; if so, it can be adopted in whole or in part in order to comply with this standard. Examples of such existing programs and policies can be a mandatory SCBA rule, seat belt rule, corporate safety program, or municipal employee assistance program. The achievement of these objectives is intended to help prevent accidents, injuries, and exposures and to reduce the severity of those accidents, injuries, and exposures that do occur. They will also help to prevent exposure to hazardous materials and contagious diseases and to reduce the probability of occupational fatalities, illnesses, and disabilities affecting fire service personnel. A.1.4.1 In no case should the equivalency afford less competency of members or safety to members than that which, in the judgment of the authority having jurisdiction, would be provided by compliance with meeting the requirements of Chapter 5. A.1.5.1 The specific determination of the authority having jurisdiction depends on the mechanism under which this standard is adopted and enforced. Where the standard is adopted voluntarily by a particular fire department for its own use, the authority having jurisdiction should be the fire chief or the political entity that is responsible for the operation of the fire department. Where the standard is legally adopted and enforced by a body having regulatory authority over a fire department, such as the federal, state, or local government or a political subdivision, this body is responsible for making those determinations as the authority having jurisdiction. The plan should take into account the services the fire department is required to provide, the financial resources available to the fire department, the availability of personnel, the availability of trainers, and such other factors as will affect the fire department's ability to achieve compliance. A.1.5.2 For a fire department to evaluate its compliance with this standard, it must develop some type of logical process. The worksheet in Annex B (Figure B.2) illustrates one way that an action plan can be developed to determine code compliance. This standard is intended to be implemented in a logical sequence, based upon a balanced evaluation of economic as well as public safety and personnel safety factors. The compliance schedule request assures that risk is objectively assessed and reasonable priorities set toward reaching compliance. Interim compensatory measures are intended to assure that safety action is being addressed until full compliance is reached and formally adopted into the fire department organization's policies and procedures. This can include, but is not limited to, increased inspections, testing, temporary suspension or restriction of use of specific equipment, specialized training, and administrative controls.

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A.3.2.1 Approved. The National Fire Protection Association does not approve, inspect, or certify any installations, procedures, equipment, or materials; nor does it approve or evaluate testing laboratories. In determining the acceptability of installations, procedures, equipment, or materials, the authority having jurisdiction may base acceptance on compliance with NFPA or other appropriate standards. In the absence of such standards, said authority may require evidence of proper installation, procedure, or use. The authority having jurisdiction may also refer to the listings or labeling practices of an organization that is concerned with product evaluations and is thus in a position to determine compliance with appropriate standards for the current production of listed items. A.3.2.2 Authority Having Jurisdiction (AHJ). The phrase “authority having jurisdiction,” or its acronym AHJ, is used in NFPA documents in a broad manner, since jurisdictions and approval agencies vary, as do their responsibilities. Where public safety is primary, the authority having jurisdiction may be a federal, state, local, or other regional department or individual such as a fire chief; fire marshal; chief of a fire prevention bureau, labor department, or health department; building official; electrical inspector; or others having statutory authority. For insurance purposes, an insurance inspection department, rating bureau, or other insurance company representative may be the authority having jurisdiction. In many circumstances, the property owner or his or her designated agent assumes the role of the authority having jurisdiction; at government installations, the commanding officer or departmental official may be the authority having jurisdiction. A.3.3.3 Air Transfer. Air is allowed to flow from the cylinder with a higher pressure to the cylinder with a lower pressure until the pressure equalizes, at which time the transfer line is disconnected between the two cylinders. A.3.3.4 Aircraft Rescue and Fire Fighting. Such rescue and fire-fighting actions are performed both inside and outside of the aircraft. A.3.3.5.1 Hazardous Atmosphere. A hazardous atmosphere can be immediately dangerous to life and health. A.3.3.8 Candidate. In an employment context, the Americans with Disabilities Act (discussed in further detail in Annex B of NFPA 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments) requires that any medical examination to be conducted take place after an offer of employment is made and prior to the commencement of duties. Therefore, in the employment context, the definition of candidate should be applied so as to be consistent with that requirement. Volunteer fire fighters have been deemed to be “employees” in some states or jurisdictions. Volunteer fire departments should seek legal counsel as to their legal responsibilities in these matters. A.3.3.10 Chemical Flash Fire. A policy of wearing protective clothing is needed that recognizes the significant threat to fire fighters who can be exposed to flash fires in either structural fire-fighting or hazardous materials environments. It is hoped that fire fighters utilize awareness training on burn injuries caused by the ignition of the environment. There is a distinct difference between chemical flash fires and flashovers occurring in structural fire-fighting environments. Flashover is a phenomenon that generates temperatures in the range of 1200°F to 1500°F (650°C to 815°C). A chemical flash fire requires an ignition source and a chemical atmosphere that contains a concentration above the lower explosive limit (LEL) of the chemical. Chemical flash fires generate heat from 1000°F to 1900°F (540°C to 1040°C). As a rule, a structural fire flashover is confined to a designated area with walls as a boundary. The size of a chemical flash fire depends on the size of the gas or vapor cloud and, when ignited, the flame front expands outward in the form of a fireball. The resulting effect of the fireball's energy with respect to radiant heat significantly enlarges the hazard areas around the gas released. [1991, 2005] A.3.3.12 Clear Text. Ten codes or agency-specific codes should not be used when using clear text.

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A.3.3.16 Company. For fire suppression, jurisdictions exist where the response capability of the initial arriving company is configured with the response of two apparatus. In some jurisdictions, apparatus is not configured with seated and belted positions for four personnel and therefore would respond with an additional vehicle in consort with the initial arriving engine to carry additional personnel. This response would be to ensure that a minimum of four personnel are assigned to and deployed as a company. The intent of this definition and the requirements in the standard is to ensure that these two (or more) pieces of apparatus would always be dispatched and respond together as a single company. Some examples of this include the following:

(1) Engine and tanker/tender that would be responding outside a municipal water district (2) Multiple-piece company assignment, specified in a fire department's response standard operating procedures, such as an engine company response with a pumper and a hose wagon (3) Engine with a vehicle personnel carrier (4) Engine with an ambulance or rescue unit

Company, as used in this standard, is synonymous with company unit, response team, crew, and response group, rather than a synonym for a fire department. A.3.3.17 Confined Space. Additionally, a confined space is further defined as having one or more of the following characteristics:

(1) The area contains or has a potential to contain a hazardous atmosphere, including an oxygen- deficient atmosphere. (2) The area contains a material with a potential to engulf a member. (3) The area has an internal configuration such that a member could be trapped by inwardly converging walls or a floor that slopes downward and tapers to a small cross section. (4) The area contains any other recognized serious hazard.

A.3.3.21 Cryogenic Liquid. Cryogenic liquids include, but are not limited to, helium, nitrogen, and oxygen. [1991, 2005] A.3.3.24.1 Communicable Disease. Also known as contagious disease. A.3.3.30 Faceshield. Faceshields should be used only in conjunction with spectacles and/or goggles. A.3.3.34 Fire Department. The term fire department can include any public, governmental, private, industrial, or military organization engaging in this type of activity. A.3.3.35 Fire Department Facility. This does not include locations where a fire department can be summoned to perform emergency operations or other duties, unless such premises are normally under the control of the fire department. A.3.3.37.1 Proximity Fire Fighting. Specialized thermal protection from exposure to high levels of radiant heat, as well as thermal protection from conductive and convective heat, is necessary for persons involved in such operations due to the scope of these operations and the close distance to the fire at which these operations are conducted, although direct entry into flame is not made. These operations usually are exterior operations but could be combined with interior operations. Proximity fire fighting is not structural fire fighting but could be combined with structural fire-fighting operations. A.3.3.39 Fire Suppression. Fire suppression includes all activities performed at the scene of a fire incident or training exercise that expose fire department members to the dangers of heat, flame, smoke, and other products of combustion, explosion, or structural collapse.

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A.3.3.40 Flame Resistance (Protective Apparel). Flame resistance can be an inherent property of the textile material, or it can be imparted by specific treatment. A.3.3.42 Hazard. Hazards include the characteristics of facilities, equipment, systems, property, hardware, or other objects and the actions and inactions of people that create such hazards. A.3.3.48 Health and Safety Officer. This individual can be the incident safety officer, or that can also be a separate function. A.3.3.55 Incident Management System (IMS). The system is also referred to as an incident command system (ICS). A.3.3.56 Incident Safety Officer. The incident safety officer can have assistants. A.3.3.58 Infection Control Program. This program includes, but is not limited to, implementation of written policies and standard operating procedures regarding exposure follow-up measures, immunizations, members' health screening programs, and educational programs. A.3.3.63 Liquefied Gas. Examples of liquefied gases include, but are not limited to, ammonia, 1,2-butadiene, chlorine, ethylene oxide, hydrogen chloride, liquefied petroleum gas, and methyl chloride. Testing in NFPA 1991, Standard on Vapor-Protective Ensembles for Hazardous Materials Emergencies, is only conducted for a limited number of liquefied gases. Users should consult the technical data package to determine which liquefied gases have been tested with the suit's primary materials. [1991, 2005] A.3.3.64 Member. A fire department member can be a full-time or part-time employee or a paid or unpaid volunteer, can occupy any position or rank within the fire department, and can engage in emergency operations. A.3.3.71.1 Defensive Operations. Defensive operations are generally performed from the exterior of structures and are based on a determination that the risk to personnel exceeds the potential benefits of offensive actions. A.3.3.71.5 Special Operations. Special operations include water rescue, extrication, hazardous materials, confined space entry, high-angle rescue, aircraft rescue and fire fighting, and other operations requiring specialized training. A.3.3.73 Particulates. Particulates do not include aerosols or suspended liquid droplets in air. Aerosols are considered liquids. A.3.3.77 Protective Ensemble. The elements of the protective ensemble are coats, trousers, coveralls, helmets, gloves, footwear, and interface components. A.3.3.80 Rapid Intervention Crew/Company (RIC). Emergency services personnel respond to many incidents that present a high risk to personnel safety. Departments in compliance with OSHA 29 CFR 1910.134, Respiratory protection, must have a minimum of two persons on-scene, fully equipped when members are operating in an IDLH or potentially IDLH atmosphere. The primary purpose is the rescue of injured, lost, or trapped fire fighters. Departments utilizing an incident management system in accordance with NFPA 1561, Standard on Emergency Services Incident Management System, or 29 CFR 1910.120, Hazardous waste operations and emergency response, along with a personnel accountability system have incorporated the RIC into their management system. Many departments have redefined their response plans to include the dispatch of an additional company (engine, rescue, or truck) to respond to incidents and stand by as the RIC. Incident commanders can assign additional RICs based on the size and complexity of the incident scene. In some departments they can also be known as a rapid intervention team. At wildland incidents this would be addressed through the planning process and contingency planning.

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A.3.3.84 Respiratory Protection Equipment (RPE). Examples are filter respirators, chemical cartridge or canister respirators, air-line respirators, powered air-purifying respirators, and self-contained breathing apparatus. A.3.3.92 Spectacles. Safety glasses are an example of spectacles.

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A.4.1.1 The organizational statement is a very important basis for many of the provisions of this standard. The statement sets forth the legal basis for operating a fire department, the organizational structure of the fire department, number of members, training requirements, expected functions, and authorities and responsibilities of various members or defined positions. A key point is to clearly set out the specific services the fire department is authorized and expected to perform. Most fire departments are responsible to a governing body. The governing body has the right and should assert its authority to set the specific services and the limits of the services the fire department will provide and has the responsibility to furnish the necessary resources for delivery of the designated services. The fire department should provide its governing body with a specific description of each service with options or alternatives and with an accurate analysis of the costs and resources needed for each service. Such services could include structural fire fighting, wildland fire fighting, airport/aircraft fire fighting, emergency medical services, hazardous materials response, high-angle rescue, heavy rescue, and others. Spelling out the specific parameters of services to be provided allows the fire department to plan, staff, equip, train, and deploy members to perform these duties. It also gives the governing body an accounting of the costs of services and allows it to select those services they can afford to provide. Likewise, the governing body should identify services it cannot afford to provide and cannot authorize the fire department to deliver, or it should assign those services to another agency. The fire department should be no different from any other government agency that has the parameters of its authority and services clearly defined by the governing body. Legal counsel should be used to assure that any statutory services and responsibilities are being met. The majority of public fire departments are established under the charter provisions of their governing body or through the adoption of statutes. These acts define the legal basis for operating a fire department, the mission of the organization, the duties that are authorized and expected to be performed, and the authority and responsibilities that are assigned to certain individuals to direct the operations of the fire department. The documents that officially establish the fire department as an identifiable organization are necessary to determine specific responsibilities and to determine the parties responsible for compliance with the provisions of this standard. In many cases, these documents could be a part of state laws, a municipal charter, or an annual budget. In such cases, it would be appropriate to make these existing documents part of the organizational statement, if applicable. In cases other than governmentally operated public fire departments, there is a need to formally establish the existence of the organization through the adoption of a charter, the approval of a constitution or articles of incorporation, or some equivalent official action of an authorized body. A fire department that operates entirely within the private sector, such as an industrial fire department, could legally establish and operate a fire protection organization by the adoption of a corporate policy as described in the organizational statement. In addition to specifically defining the organization that is expected to comply with this standard, 4.1.1 requires that the organizational structure, membership, expected functions, and training requirements be contained in documents that are accessible for examination. These requirements are intended to reinforce the fact that the fire department is an identifiable organization that operates with known and specific expectations. Where a fire department functions as a unit of a larger entity, such as one of several municipal departments or a particular unit of a private corporation, the larger organization is often able to provide some of the same elements that are required to be provided by the fire department. This would satisfy the requirements for the fire department to provide those elements. A.4.1.2 Additional information on fire department organization and operations can be found in Section 7 of the NFPA Fire Protection Handbook and in Chapter 4 of Managing Fire and Rescue Services, published by the International City/County Management Association.

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A.4.1.4 They should be done in accordance with NFPA 1620, Standard for Pre-Incident Planning, to provide assistance to responding personnel in effectively managing emergencies for the protection of occupants, responding personnel, property, and the environment. A.4.1.4.1 They should be done in accordance with NFPA 241, Standard for Safeguarding Construction, Alteration, and Demolition Operations. A.4.2.1 The risk management plan should consider all fire department operations, the duties and responsibilities of members (uniform and civilian), and policies and procedures. The risk management plan should include goals and objectives to ensure that the risks associated with the daily operations of the fire department are identified and effectively managed. For additional guidance on the development of a risk management plan, see NFPA 1250, Recommended Practice in Fire and Emergency Services Organization Risk Management.

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A.4.2.3 The entire risk management decision-making process can be summarized as follows:

(1) Identify or recognize (2) Evaluate (3) Establish priorities for action (4) Act and control (5) Monitor and re-evaluate

Discussions about frequency and risk arise in the evaluation phase. What are the real or potential risks in terms of frequency and severity to fire department members? How will the organization develop effective control measures to ensure a safe work environment for all members? Since no two fire departments are alike, there is no standard scale to measure and evaluate frequency and risk. Some fire departments will have a greater or lesser degree of tolerance for risk than others. The intent of the risk management process is for a fire department to develop a standard level of safety. This standard level of safety defines the parameters of the acceptable degree of risk for which members perform their job functions. By definition, frequency is how often something does, or might, happen. Risk is a measure of the consequences if an undesirable event occurs. There are many factors that enter into the risk discussion, including cost, time lost from work, loss of use of resources, inability to deliver services, and fewer services available. Each risk will have its own set of factors that will dictate how the fire department will try to determine how severe the consequences might be. This scale is used to establish the degree of priority. Priority of the risk is in direct relation to inherent risks that have had a harmful effect on the department and its members. A primary purpose of the risk management plan is to focus efforts on incidents that might not occur very often (low frequency) but that could have severe consequences associated with them (high risk). The reason for the focus on low frequency/high risk incidents is that since they do not occur on a frequent basis, responders might not be as prepared to deal with them, and the outcomes can be harmful or detrimental to fire fighters. Examples of low frequency/high risk events could include high rise fires, technical rescues, multi-alarm fires, or mass casualty incidents. There are two factors that will ensure that a low frequency/high risk event will be successful. The first factor is an aggressive training program. Every day is a training day. With an aggressive training program, this will ensure the successful outcome of an incident. The second factor is rapid prime decision making. Personnel, through training and continuous retraining, have the necessary knowledge, skills, and abilities (KSA) to ensure the successful outcome of a low frequency/high risk incident. Figure A.4.2.3 illustrates the relationship between frequency and risk, and emphasizes the importance of addressing low frequency/high risk incidents. Figure A.4.2.3 Risk and Frequency Graph.

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A.4.3.1 The following is an example of a safety policy statement: It is the policy of the fire department to provide and to operate with the highest possible levels of safety and health for all members. The prevention and reduction of accidents, injuries, and occupational illnesses are goals of the fire department and shall be primary considerations at all times. This concern for safety and health applies to all members of the fire department and to any other persons who could be involved in fire department activities. A.4.3.3 Experience has shown that there is often a significant difference between a written occupational safety and health program and the actual program that has been implemented. Periodic evaluations are one method the fire chief can use to measure how the program is being conducted. This evaluation should be conducted by a qualified individual from outside of the fire department, because outside evaluators provide a different perspective, which can be constructive. Outside evaluators could include municipal risk managers, safety directors, consultants, insurance carrier representatives, fire chiefs, safety officers, or others having knowledge of fire department operations and occupational safety and health program implementation. A.4.4.3 The responsibility for establishing and enforcing safety rules and regulations rests with the management of the fire department. Enforcement implies that appropriate action, including disciplinary measures if necessary, will be taken to ensure compliance. A standard approach to enforcement should address both sanctions and rewards. All fire department members should recognize and support the need for a standard regulatory approach to safety and health. In addition to the management responsibilities, an effective safety program requires commitment and support from all members and member organizations. A.4.4.5 The importance of investigating accidents to personnel, equipment, or vehicles in relation to the prevention of reoccurring accidents is time-proven. However, the occurrence of an accident is, fortunately, relatively rare considering the amount of action carried out by fire service members. Relying solely on accident data to prescribe safety procedures is analogous with closing the birdcage after the bird has escaped. Compared to the actual number of accidents reported, a host of incidents known as near-misses occur. The philosophy of investigating near-miss incidents deserves merit. There are countless “almost- accidents” that occur every day. In an effort to truly prevent more accidents, and to effectively manage the safety of the personnel, near-miss incidents should be documented and quantified to truly determine the exposures to risk that people, equipment, and vehicles are exposed to each day. These incident investigations begin with a culture that readily accepts near-miss incident reports without penalty or ridicule. A system should also be in place to investigate the near-miss incident to determine the causal factors involved. Examples can include human error, lack of education or training, lack of familiarity with or operation of equipment, or equipment malfunctions or design shortcomings. Managing the infinite possibilities of near-miss incidents and accidents is laborious and seems overwhelming. Attention to the risks measured in the workplace and investigation into the potential incidents and accidents is, arguably, the beginning of an effective safety process. See also A.4.4.3. A.4.4.5.4 The National Fire Fighter Near-Miss Reporting System is a voluntary, confidential, non-punitive, and secure reporting system with the goal of improving fire fighter safety. Submitted reports are available at www.firefighternearmiss.com and should be reviewed by members.

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A.4.5.1 One of the most important provisions for improving the safety and health of the fire service is through an official organizational structure that has the support of the members and the fire department management. Without official recognition and support, safety and health committees could be ineffective showpieces, lack authority, or be dominated by particular interests. To avoid such situations, it is recommended that a safety and health committee be composed of equal numbers of fire department management representatives and member representatives. Specific areas of responsibility of the joint safety and health committee should be outlined in detail through written procedures or contractual negotiation. A.4.5.3 The requirement in 4.5.3.1 for one regularly scheduled meeting every 6 months is intended as a minimum. Committee meetings should be held as often as necessary to deal with the issues confronting the group. The written minutes of each meeting should be distributed and posted in a conspicuous place in each fire station so that all members can be aware of issues under discussion and actions that have been taken. A.4.6.1 The data collection system for accidents, injuries, illnesses, exposures, and deaths should provide both incident-specific information for future reference and information that can be processed in studies of morbidity, mortality, and causation. The use of standard coding as provided by NFPA 901, Standard Classifications for Incident Reporting and Fire Protection Data, will allow compatibility with national and regional reporting systems. A.4.6.4 See NFPA 1401, Recommended Practice for Fire Service Training Reports and Records, for further information and guidance.

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A.5.1.1 The primary goal of all training, education, and professional development programs is the reduction of occupational injuries, illnesses, and fatalities. As members progress through various job duties and responsibilities, the department should ensure the introduction of the necessary knowledge, skills, and abilities to members who are new in their job titles, as well as ongoing development of existing skills. These programs should include information to ensure that members are trained prior to performing individual duties, as well as ongoing professional development to ensure competency. Training programs should include but not be limited to the following:

(1) Community risk reduction (fire prevention, public education, investigation, etc.) (2) Health and safety (3) Fire suppression (4) Emergency medical (5) Human resources (leadership, supervision, interpersonal dynamics, equal employment opportunity, etc.) (6) Incident management system (7) Hazardous materials (8) Technical rescue (9) Information systems and computer technology (10) Position-specific development (fire fighter, company officer, chief officer, telecommunicator, investigator, inspector, driver/operator, etc.)

A.5.1.4 The use of a structured on-the-job training (OJT) program with close supervision can assist fire departments to utilize new members in non-IDLH environments during emergency operations. A.5.1.8 For maintenance of structural and proximity PPE refer to NFPA 1851, Standard on Selection, Care, and Maintenance of Protective Ensembles for Structural Fire Fighting and Proximity Fire Fighting. Departments should develop a training schedule that, at minimum, should include training for new fire fighters and for all members when there is a change in equipment. A.5.2.2 Statistics presented by the National Fire Protection Association (NFPA) and the United States Fire Administration (USFA) indicate an alarming trend in the increased number of fire fighter fatalities and injuries associated with vehicle operations. Fire departments respond with a variety of apparatus, and the members operating this apparatus must have the appropriate knowledge, skills, and abilities to operate this apparatus. The first step in this process is to properly train and educate members on the various types of apparatus they could be required to operate. NFPA 1451, Standard for a Fire Service Vehicle Operations Training Program, provides the curriculum for members to develop the necessary knowledge, skills, and abilities to meet the requirements of 5.2.2. The second step is to ensure that the fire department performs an annual proficiency evaluation of all drivers/operators as required by Section 5.5. Also, the training and education should address the standard operating procedures associated with vehicle operations, especially emergency response. These are necessary components of the department's plan to reduce the risks associated with vehicle operations. This is a systems approach to ensure the safety and health of members and the citizens they serve.

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A.5.2.6 In the United States, federal regulations require a minimum amount of training for fire service personnel who respond to hazardous materials incidents. These requirements can be found in 29 CFR 1910.120, Hazardous waste operations and emergency response (OSHA), and in 40 CFR 311, Worker protection (EPA). These regulations affect all fire departments in the United States whether full-time career, part-time, combination career and volunteer, or fully volunteer. These regulations apply in all states and not just in those states with federally approved state OSHA programs. In the U.S. federal regulations, First Responder Operations Level is defined as follows: “First responders at the operations level are individuals who respond to releases or potential releases of hazardous substances as part of the initial response to the site for the purpose of protecting nearby persons, property, or the environment from the effects of the release. They are trained to respond in a defensive fashion without actually trying to stop the release. Their function is to contain the release from a safe distance, keep it from spreading, and prevent exposure. First responders at the operational level shall have received at least 8 hours of training or have had sufficient experience to objectively demonstrate competency in the following areas in addition to those listed in the awareness level and the employer shall so certify:

(1) Knowledge of the basic hazard and risk assessment techniques (2) Knowing how to properly select and use proper personal protective equipment provided to the First Responder Operations Level (3) An understanding of basic hazardous materials terms (4) Knowing how to perform basic control, containment, and/or confinement operations within the capabilities of the resources and personal protective equipment available with their unit (5) Knowing how to implement basic decontamination procedures (6) An understanding of the relevant standard operating procedures and termination procedures”

The First Responder Operations Level in both the U.S. federal regulations and NFPA 472, Standard for Competence of Responders to Hazardous Materials/Weapons of Mass Destruction Incidents, is similar. Whereas the U.S. federal regulations (29 CFR 1910.120 or 40 CFR 311) govern the fire service in every state in the United States, the minimum level of training for all fire fighters must be the First Responder Operations Level. A.5.3.1 In order to ensure compliance with the minimum requirements of NFPA 1001, Standard for Fire Fighter Professional Qualifications, fire department training programs should be accredited by a training organization such as a state fire training agency. In addition, NFPA 1405, Guide for Land-Based Fire Departments That Respond to Marine Vessel Fires, provides recommended guidelines for those members who respond to marine vessel fires. A.5.3.5 The essence of any successful respiratory protection training program is the establishment of written operational policies and the reinforcement of those policies through comprehensive training. The AHJ should ensure that each member demonstrates knowledge of at least the following:

(1) Why respiratory protection equipment (RPE) is necessary and how improper fit, usage, or maintenance can compromise the protective effect of the respirator (2) What the limitations and capabilities of the RPE are (3) How to use the RPE effectively in emergency situations, including situations in which the RPE malfunctions (4) How to inspect, put on and remove, use, and check the seals of the facepiece (5) What the procedures are for maintenance and storage of the respiratory protection equipment (6) How to recognize medical signs and symptoms that can limit or prevent the effective use of RPE (7) The requirements of Section 7.10

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A.5.3.7 Several accidents have occurred where smoke bombs or other smoke-generating devices that produce a toxic atmosphere have been used for training exercises. Where training exercises are intended to simulate emergency conditions, smoke-generating devices that do not create a hazard are required. A.5.3.8 Fire departments can utilize instructors who are not necessarily trained and/or certified to the requirements of NFPA 1041, Standard for Fire Service Instructor Professional Qualifications. However, in using these instructors they should ensure that they are familiar with the fire department, its organization, and its operations and, in addition, are qualified in that particular area of expertise. A.5.3.9 Members can be trained and/or certified at the local, state, or national level in basic life support (BLS) or advanced life support (ALS). Jurisdictions can require specialty skills within certain levels. A.5.3.10 To reduce the risk of an injury or illness members should wear protective ensemble elements that are suitable and appropriate and maintained in a clean and serviceable condition. Members should exercise caution when wearing personal clothing, accessories, or personal equipment items that these items do not adversely affect the performance of the protective ensemble or ensemble element. It is recommended that clothing meeting the requirements of NFPA 1975, Standard on Station/Work Uniforms for Emergency Services, be worn whenever possible. Clothing that can melt, drip, burn, shrink, transmit heat, or ignite should not be worn. For care and maintenance of structural and proximity PPE, refer to NFPA 1851, Standard on Selection, Care, and Maintenance of Protective Ensembles for Structural Fire Fighting and Proximity Fire Fighting. To avoid the possibility of injury or burns, members should wear clothing made of material that will provide the best protective levels available. It is recommended that Nomex or other fire-resistant clothing be worn whenever possible. Clothing that can melt, drip, burn, shrink, transmit heat, or ignite should not be worn. A.5.5.3 An annual skills check should address the professional qualification specific to a member's assignment and duty expectation. As an example, a fire fighter is checked for skills required by NFPA 1001, Standard for Fire Fighter Professional Qualifications. A driver/operator would be checked for skills required by NFPA 1002, Standard for Fire Apparatus Driver/Operator Professional Qualifications.

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A.6.1.1 It is recommended that only apparatus that were designed and manufactured to meet the 1991 or later editions of the NFPA fire apparatus standards or that have been refurbished in accordance with NFPA 1912, Standard for Fire Apparatus Refurbishing, to meet the 1991 or later editions of the NFPA fire apparatus standards be permitted to operate in first-line service. This will ensure that, while the apparatus might not totally comply with the current edition of the automotive fire apparatus standards, many of the improvements and upgrades required by the standards since 1991 are available for the fire fighters who use the apparatus. It is recommended that an apparatus manufactured prior to 1991 that is less than 25 years old, that has been properly maintained, and that is still in serviceable condition be placed in reserve status and upgraded to incorporate as many features of the post-1991 fire apparatus as possible. Apparatus not manufactured to NFPA fire apparatus standards or that is over 25 years old should be replaced. See Annex D of NFPA 1901, Standard for Automotive Fire Apparatus, for more complete guidelines for first-line and reserve fire apparatus. A.6.1.1.1 Information regarding ambulance specifications can be found in the current U.S. Federal Government General Services Administration's Federal Specification for the “Star-of-Life Ambulance,” KKK-A-1822E. A.6.1.5 The means of holding the item in place or the compartment should be designed to minimize injury to persons in the enclosed area of the fire apparatus or patient compartment of an ambulance. Loose equipment during the event of a crash, a rapid deceleration, or a rapid acceleration can be the cause of serious injury or the crash of the apparatus. A.6.2.1 NFPA 1451, Standard for a Fire Service Vehicle Operations Training Program, can be used to meet the requirements of an “approved driver training program.” A.6.2.2 The determination of driver's license requirements is a function of a particular authority in each location. This agency can be a state or provincial Department of Transportation or an equivalent agency. Other authorities, such as military branches, have the authority to issue permits to operate their vehicles. It is a responsibility of the fire department to determine the requirements that apply in each situation and for each class of vehicle. A.6.2.3 Policies should be enacted to limit unnecessary and inappropriate emergency response, as a means of reducing the risk of accidents involving emergency vehicles. A.6.2.4 The driver of any vehicle has legal responsibility for its safe and prudent operation at all times. While the driver is responsible for the operation of the vehicle, the officer is responsible for the actions of the driver.

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A.6.2.7 The development, implementation, and periodic review of standard operating procedures for driving any fire department vehicle is an important element in clearly identifying the fire department's policy on what is expected of drivers. Safe arrival is of prime importance. Standard operating procedures should include a “challenge and response” dialogue between the vehicle driver on an emergency response and the officer or other member in the driver compartment. The “challenge and response” dialogue should be instituted to determine the driver's intentions when approaching any perceived or identified hazard on the response route, to remind the driver of the presence of the hazard and the planned procedures for managing the hazard, and to ensure that the driver is coping with stressors encountered during the response and not focusing only on arriving at the site of the emergency. The specific inclusion of railroad grade crossing is based upon recommendations made by the National Transportation Safety Board (NTSB) to NFPA following the 1989 investigation of a collision between a fire department pumper and a passenger train. The NTSB report states that “planning how to safely traverse grade crossings encountered en route is a necessary part of any fire company's response plan.” NTSB recommends that the following be considered when developing the plans: If it is not practical to plan an emergency response route that avoids grade crossings, selection of crossings that are equipped with automatic warning devices is preferable to selection of those that are not. All planning should include identification of the location at the crossing from which a driver or other observer assigned to the apparatus can see the maximum available distance down the track(s) on both sides. At crossings over a single straight track with no nearby obstructions, briefly stopping or slowing the apparatus to allow a proper scan both left and right can be sufficient. If the tracks are curved, vision is obstructed, or the crossing has more than one set of tracks where the presence of one train could hide the approach of another, sight distance can be optimized by having one or more members cross the tracks on foot and look for approaching trains. Fire fighter fatality studies describe 10 incidents that occurred from 1984 to 2004 in which fire fighters were killed during the backing of fire apparatus. This is a significant issue that the fire service must address in terms of standard operating procedures, training programs, and implementation. When fire apparatus is in the backing mode, standard operating procedures need to dictate that members assigned to back apparatus be in communication with the driver/operator. This can be accomplished by using the radio system, intercom system, or other means. Standard operating procedures should dictate that the apparatus not be moved until verbal and visual contact is made with the driver/operator and the backer. Also, standard operating procedures must dictate that the backer be in the line of sight with the driver/operator via the apparatus mirrors on either side of the apparatus. The intent is to ensure that the backing of fire apparatus is accomplished in a safe and effective manner.

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A.6.2.7.1

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Many incidents require the non-emergency response of fire apparatus. Each fire department must identify incidents that do not require the use of warning lights and sirens. Examples of non-emergency incidents can include lockouts, carbon monoxide detectors sounding, a fire reported out, assist law enforcement, backfills or move-ups, and other incidents as determined by the AHJ. The intent is to reduce the risk to fire department members and the citizens of the community from unnecessary harm. The response can always be upgraded to emergency response if the situation warrants based upon additional information. Fire department water tankers (tenders) provide a mobile water supply to support fire fighting and other fire department operations. They are generally used in rural areas without fire hydrant coverage but can also be found in the fleets of many suburban and urban fire departments. Although their number as a percent of the overall apparatus fleets is small, estimated at just 2 percent, they are involved in a disproportionate number of crashes that are fatal to fire fighters and others. A study of fire fighter fatalities from 1990 through 2000 found that fire tankers were the second most common vehicle type involved in crashes that killed fire fighters. Tankers/tenders were second only to personal vehicles in the number of fatal crashes. The United States Fire Administration (USFA) produced a report entitled Safe Operation of Fire Tankers in 2003. The report (FA-248) is available free from the USFA in print and can be downloaded from the USFA web site at www.usfa.fema.gov. The report provides comprehensive information on the safe construction, use, and operation of fire department tankers/tenders. The report deals with fire apparatus with water tanks sizes of 1000 gal (3800 L) or more. The recommendations contained in the report, therefore, can apply to any piece of fire apparatus with a large water tank. Attention to a small number of operational recommendations can make the operation of fire tankers/tenders safer for fire fighters and those that share the road with this type of apparatus. The following recommendations should become part of standard operating procedures for departments operating tankers (tenders):

(1) Fire fighters should always wear seat belts when driving or as the passenger in any vehicle, including tankers/tenders. The fire fighter's best chance for survival is to remain with the vehicle during a crash and to be protected by the structure of the vehicle. During the period from 1990 to 2001, 82 percent of the fire fighters killed in tanker/tender crashes were not wearing seat belts. (2) If the right-hand wheels of the apparatus leave the paved surface of the roadway for any reason, the apparatus should be slowed before attempting to return all wheels to the roadway. In 66 percent of the fatal tanker/tender crashes from 1990 to 2001, the right wheels of the apparatus left the roadway. If the vehicle is returned to the roadway surface at speed, the apparatus can veer violently to the left. Drivers then often overcompensate by steering to the right, and the apparatus either begins to roll or leaves the roadway and crashes. Slowing the vehicle prior to returning to the roadway will minimize the chances of such an event. (3) Slow down. Speed was cited as a factor in 55 percent of fatal crashes of fire department tankers/tenders from 1990 to 2001. The weight of the water and the weight of the apparatus combine to make fire department tankers/tenders very heavy vehicles. They cannot stop quickly, and their handling characteristics are unlike other fire apparatus. The USFA Safe Operation of Fire Tankers report recommends that tankers/tenders never be operated over the posted speed limit and that they be controlled to speeds at or less than the cautionary speeds listed on yellow signs on curves. (4) Make sure that the apparatus is up to the task. Fuel or milk tankers converted to fire department water tankers usually do not have the brake capacity or tank baffles that are needed to transport water — fuel and milk are lighter than water. The total weight of a tanker/tender should not exceed the rated capacity of the vehicle's braking system. In addition to weight concerns, tankers/tenders must be maintained in a ready state. Their mechanical systems must be checked and maintained on a regular basis. (5) Ensure that drivers/operators have the necessary knowledge, skills, and abilities to specifically drive and operate tankers/tenders. Tankers/tenders do not operate or have the same driving characteristics as other fire apparatus. Drivers should be specifically trained on each vehicle, and untrained drivers should not be allowed to operate tankers/tenders. (6) Drive with the tank completely full or completely empty. Even with proper baffling, a semi-full water tank will allow water to move more freely. This water movement can create control problems for the apparatus operator. If the full tank of water is not used, dump the rest of the load in a safe place and drive the tanker/tender empty until the entire tank can be filled.

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A.6.2.8 Accidents at intersections contribute to both civilian and fire fighter deaths and injuries while fire department vehicles are responding to or returning from an emergency incident. Coming to a complete stop when there are any intersection hazards and proceeding only when the driver can do so safely will reduce accidents and the risk of injury or death. It is recommended that intersection control devices be installed that allow emergency vehicles to control traffic lights at intersections. A.6.2.10 Vehicle accidents at railroad crossings have resulted in a number of deaths and injuries to fire department members. A study by NTSB concluded that a train's warning horn becomes an ineffective device for warning large vehicles or trucks unless the vehicle driver stops, idles the engine, turns off all radios, fans, wipers, and other noise-producing equipment in the cab, lowers the window, and listens for a train's horn before entering a grade crossing. A.6.2.14 When members respond to incidents or to the fire station in their own vehicles, the operation of these vehicles is governed by all applicable traffic laws and codes as enacted by the AHJ. All members should be held strictly accountable for compliance with the applicable traffic laws and regulations as well as fire department rules, regulations, and procedures relating to emergency response. Where traffic laws and regulations allow for private vehicles to be operated as emergency vehicles, the fire department should only allow members who have met the requirements to drive fire department vehicles in an emergency mode to drive privately owned vehicles in an emergency mode. A.6.2.14.2 For more information, see FA-220, Firefighter Fatality Retrospective Study, Federal Emergency Management Agency, United States Fire Administration, April 2002. A.6.3.1 It is intended that the requirements of Section 6.3 apply to all situations when persons or members are riding on fire apparatus other than for the specific variances in 6.3.4 and 6.3.5. Included in the “seated and belted” requirement are any times the fire apparatus is traveling to, participating in, or returning from any funeral, parade, or public relations/education event. Fire fighters cannot be allowed to ride on the outside of apparatus in order to fight wildland fires. The Fire Line Safety Committee (FLSC) of the National Wildfire Coordinating Group (NWCG) represents the U.S. Forest Service, Bureau of Land Management, Bureau of Indian Affairs, Fish and Wildlife Agency, National Park Service, and National Association of State Foresters. Their position is that the practice of fire fighters riding on the outside of vehicles and fighting wildland fires from these positions is very dangerous, and they strongly recommend this not be allowed. One issue is the exposure to personnel in unprotected positions. Persons have been killed while performing this operation. Also, the vehicle driver's vision is impaired. The second issue is that this is not an effective way to extinguish the fire, as it can allow the vehicle to pass over or by areas not completely extinguished. Fire can then flare up underneath or behind the vehicle and could cut off escape routes. The FLSC and the NWCG strongly recommend that two fire fighters, each with a hose line, walk ahead and aside of the vehicle's path, both fire fighters on the same side of the vehicle (not one on each side), in clear view of the driver, with the vehicle being driven in uninvolved terrain. This allows the fire fighters to operate in an unhurried manner, with a clear view of fire conditions and the success of the extinguishment. Areas not extinguished should not be bypassed unless follow-up crews are operating behind the lead unit and there is no danger to escape routes or to personnel. A.6.3.3 There are instances in which members need to provide emergency medical care while the vehicle is in motion. In some situations, the provision of such medical care would not allow the members to remain seated and secured to the vehicle. Such situations, while they occur infrequently, could include performing chest compressions during cardiopulmonary resuscitation (CPR). If a vehicle accident were to occur while an unsecured member was performing necessary emergency medical care, there would be substantial risk of injury to the member.

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A.6.3.4 The following recommendations will assist the user in implementing 6.3.4:

(1) Hose loading procedures should be specified in a written standard operating procedure that includes at least the safety conditions listed in A.6.3.4 (2) through A.6.3.4 (7). All members involved in the hose loading should have been trained in these procedures. (2) There should be a member, other than those members loading hose, assigned as a safety observer. The safety observer should have an unobstructed view of the hose loading operation and be in visual and voice contact with the apparatus operator. (3) Non–fire department vehicular traffic should be excluded from the area or should be under the control of authorized traffic control persons. (4) The fire apparatus can be driven only in a forward direction at a speed of 5 mph (8 kmph) or less. (5) No members should be allowed to stand on the tailstep, sidesteps, running boards, or any other location on the apparatus while the apparatus is in motion. (6) Members should be permitted to be in the hose bed but should not stand while the apparatus is in motion. (7) Prior to the beginning of each hose loading operation, the situation should be evaluated to ensure compliance with all the provisions of the written procedures. If the written procedures cannot be complied with, or if there is any question as to the safety of the operation for the specific situation, then the hose should not be loaded on moving fire apparatus.

A.6.3.5 The following recommendations will assist the user in meeting the requirements of the standard:

(1) Tiller training procedures should be specified in a written standard operating procedure that includes at least the safety conditions listed in A.6.3.5 (2) through A.6.3.5 (6). All members involved in tiller training should have been trained in these procedures. (2) The aerial apparatus should be equipped with seating positions for both the tiller instructor and the tiller trainee. Both seating positions should be equipped with seat belts for each individual. The tiller instructor should be permitted to take a position alongside the tiller trainee. (3) The tiller instructor's seat should be permitted to be detachable. Where the instructor's seat is detachable, the detachable seat assembly should be structurally sufficient to support and secure the instructor. The detachable seat assembly should be attached and positioned in a safe manner immediately adjacent to the regular tiller seat. The detachable seat assembly should be equipped with a seat belt or vehicle safety harness. The detachable seat assembly should be attached and used only for training purposes. (4) Both the tiller instructor and the tiller trainee should be seated and belted. (5) The instructor and trainee should wear and use both helmet and eye protection if not seated in an enclosed area. (6) In the event the aerial apparatus is needed for an emergency response during a tiller training session, the training session should be terminated, and all members should be seated and belted in the approved riding positions. There should be only one person at the tiller position. During the emergency response, the apparatus should be operated by a qualified driver/operator.

A.6.3.6 Helmets should be worn by all members in riding positions in an open cab that does not provide the protection of an enclosed cab. A.6.3.7 Primary eye or face protection, or both, should be issued to members who might ride in either exposed positions in open cab apparatus or open tiller seats. Fire department standard operating procedures should outline the safety issues associated with wearing eye protection while driving. A.6.3.8 Such alternate means of transportation could include, but not be limited to, other fire apparatus, automobiles, and/or other personnel carriers.

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A.6.4.1 The purpose of this paragraph is to ensure that all vehicles are inspected on a regular basis and checked for the proper operation of all safety features. This inspection should include tires, brakes, warning lights and devices, headlights and clearance lights, windshield wipers, and mirrors. The apparatus should be started, and the operation of pumps and other equipment should be verified. Fluid levels should also be checked regularly. Where apparatus is in regular daily use, these checks should be performed on a daily basis. Apparatus stored in unattended stations that might not be used for extended periods should be checked weekly. Any time such a vehicle is used, it should be checked before being placed back in service. The 24-hour reference provides for situations in which a vehicle can be used within the period preceding a scheduled inspection, although any deficiencies noted in use should be corrected without delay. The safety equipment carried on fire department vehicles should be inspected in conjunction with the inspection of the vehicle. A.6.5.6 See A.6.4.1.

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A.7.1.1 The provision and use of protective ensemble, ensemble elements, and protective equipment should include safety shoes, gloves, goggles, safety glasses, and any other items appropriate to the members' activities. This applies to all activities members are expected to perform, including non-emergency activities. The applicable regulations pertaining to industrial worker safety should be consulted to determine the need for protective equipment in non-emergency activities. For proper PPE selection, risk assessment as specified in NFPA 1851, Standard on Selection, Care, and Maintenance of Protective Ensembles for Structural Fire Fighting and Proximity Fire Fighting, should be conducted. A.7.1.2 The fire department should provide body armor for all members who operate in areas where a potential for violence or civil unrest exists. A.7.1.4 Because it is impossible to ensure that every member — whether a volunteer, call, or off-duty career member — will respond to an incident in a station/work uniform or will change into station/work uniform clothing before donning protective garments, it is very important that members understand the hazards of some fabrics that more easily melt, drip, burn, shrink, or transmit heat rapidly and cause burns to the wearer. Clothing made from 100 percent natural fibers or blends that are principally natural fibers should be selected over other fabrics that have poor thermal stability or that ignite easily. The very fact that members are fire fighters indicates that all clothing that they wear should be flame resistant (as children's sleepwear is required to be) to give a degree of safety if unanticipated happenings occur that expose the clothing to flame, flash, sparks, or hot substances. A.7.1.6.1 Fire departments need to be especially diligent in the handling of protective ensembles and ensemble elements that are or are suspected of being exposed to blood and body fluids. Fire departments are encouraged to review the criteria specified in NFPA 1581, Standard on Fire Department Infection Control Program, and 29 CFR 1910.1030, Bloodborne Pathogen Standard. A.7.1.6.3 Examples of the proper type of safety equipment should include MSDSs, eye protection (safety glasses and goggles), nitrile gloves, rubber gloves, fluid-resistant suit or waterproof apron, optional dust mask, uniforms; sharp containers, and eyewash station. A.7.2.1 The fire department should consider providing each member with two complete sets of structural fire-fighting protective clothing that meet the requirements of NFPA 1971, Standard on Protective Ensembles for Structural Fire Fighting and Proximity Fire Fighting, whenever possible. It is not reasonable to expect that a fire department would have enough stock protective clothing available to all members in the event that the protective clothing became soiled, wet, or contaminated during daily activities. Fire fighters provided with two complete sets of structural fire-fighting protective clothing can change easily into proper-fitting garments and will not be unnecessarily exposed or expose the public to contaminants. Structural protective clothing that is cleaned and properly and completely dried before the next use will last longer and provide greater protection than soiled or damp garments. A.7.2.2 Properly fitting protective clothing is important for the safety of the fire fighter. It is important to understand that all protective clothing should be correctly sized to allow for freedom of movement. Protective garments that are too small or too large and protective trouser legs that are too long or too short are safety hazards and should be avoided. Protective coat sleeves should be of sufficient length and design to protect the coat/glove interface area when reaching overhead or to the side. For proper fitting of a fire fighter, the protective clothing manufacturer should be contacted to provide sizing instructions. A.7.2.4.2 Some protective coats, particularly those certified as part of a protective ensemble with the CBRN option, can include different interface components instead of wristlets to provide increased integrity against penetration of CBRN terrorism agents.

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A.7.3.1 The technical committee's intent is that members utilize the appropriate protective clothing designed specifically for the type of emergency incident or fire-fighting activities for which the member is regularly engaged. A.7.4 Fire department personnel involved in emergency medical operations should be protected against potential medical hazards. These hazards include exposure to blood or other body fluids contaminated with infectious agents such as hepatitis and human immunodeficiency viruses. The purpose of emergency medical protective clothing is to shield individuals from these medical hazards and conversely to protect patients from potential hazards from the emergency responder. Emergency medical gloves are to be used for all patient care. Emergency medical garments and face protection devices are to be used for any situation where the potential for contact with blood or other body fluids is high. NFPA 1999, Standard on Protective Clothing for Emergency Medical Operations, covers garments, gloves, and face protection devices that are designed to prevent exposure to blood or other body fluids for those individuals engaged in emergency medical patient care and similar operations. NFPA 1999, Standard on Protective Clothing for Emergency Medical Operations specifies a series of requirements for each type of protective clothing. Garments can be full-body clothing or clothing items such as coveralls, aprons, or sleeve protectors. For the intended areas of body protection, the garment must allow no penetration of virus, offer “liquidtight” integrity, and have limited physical durability and hazard resistance. Gloves must allow no penetration of virus, offer “liquidtight” integrity, and meet other requirements for tear resistance, puncture resistance, heat aging, alcohol resistance, sizing, and dexterity. Face protection devices can be masks, hoods, visors, safety glasses, or goggles. Any combination of items can be used to provide protection to the wearer's face, principally the eyes, nose, and mouth. For the intended areas of face protection, these devices must allow no penetration of virus, offer “liquidtight” integrity, and provide adequate visibility for those portions of the device covering the wearer's eyes. A.7.4.2 In order to avoid all potential exposure to infectious diseases, it is important that all members use medical gloves when providing patient care. All members who could come in contact with the patient should use medical gloves. A.7.5 See Annex E, Hazardous Materials PPE Information.

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A.7.5.1 NFPA 1991, Standard on Vapor-Protective Ensembles for Hazardous Materials Emergencies, covers vapor-protective ensembles that are designed to provide “gastight” integrity and are intended for response situations where no chemical contact is permissible. This type of suit is equivalent to the clothing required in EPA's Level A. The standard specifies a battery of 25 chemicals and 2 chemical warfare agents, which were selected because they are representative of the classes of chemicals that are encountered during hazardous materials emergencies and terrorism incidents involving chemical agents. Vapor-protective ensembles should resist permeation by the chemicals present during a response. Permeation is the movement of chemical through a material at a molecular level. The effects of permeation are often unobservable. Permeation resistance is measured in terms of breakthrough time and permeation rate or the amount of cumulative permeation in the case of chemical warfare agents. An acceptable material is one where the breakthrough time exceeds the expected period of garment use, and the measured permeation rate is below the minimum permeation rate used for determining breakthrough time. Chemical permeation resistance for 1 hour or more against each chemical in the NFPA 1991 battery is required for primary suit materials (garment, visor, gloves, footwear, and seams) for testing of industrial chemicals. Acceptable performance of materials against chemical warfare agents is determined by measuring the amount of permeating chemical that passes through the material within 1 hour. This cumulative permeation is compared against acceptable dose levels that have been established for safe use of protective clothing without effects to individual wearers. To be certified for any additional chemicals or specific chemical mixtures, an ensemble must meet the same permeation performance requirements. Other performance requirements are included in NFPA 1991 in order to reflect simulated emergency hazardous materials response use conditions or conditions that might be encountered during a terrorism incident involving chemical agents, biological agents, or radiological particulates. To determine adequate suit component performance in hazardous chemical environments, the following tests are required by NFPA 1991:

(1) An ensemble pressurization test to check the airtight integrity of each protective suit (2) An inward leakage test to demonstrate that the ensemble prevents the inward leakage of vapors or gases (3) An overall suit water penetration test designed to ensure the suit provides full-body protection against liquid splashes (4) Penetration resistance testing of closures (5) Leak and cracking pressure tests for exhaust valves

To ensure that the materials used for vapor-protective suits will afford adequate protection in the environment where they will be used, material testing for burst strength, tear resistance, abrasion resistance, flammability resistance, cold temperature performance, and flexural fatigue are also required. Additional optional criteria based on additional tests are provided for demonstrating protection against liquefied gases or chemical flash fires. A.7.5.1.7 Materials used in vapor-protective ensembles are tested for limited thermal resistance; however, this testing only prevents the use of inherently flammable materials. There are no performance criteria provided in NFPA 1991, Standard on Vapor-Protective Ensembles for Hazardous Materials Emergencies, to demonstrate protection of NFPA 1991-compliant vapor-protective ensembles during fire-fighting operations. There are no test requirements or performance criteria in NFPA 1991 addressing protection from ionizing radiation, cryogenic liquid hazards, or explosive atmospheres.

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A.7.5.2 NFPA 1992, Standard on Liquid Splash-Protective Ensembles and Clothing for Hazardous Materials Emergencies, covers liquid splash-protective ensembles or clothing, which are designed to protect emergency responders against liquid chemicals in the form of splashes, but not against continuous liquid contact or chemical vapors and gases. Liquid splash-protective ensembles or clothing can be acceptable for some chemicals that do not present vapor hazards. Essentially, this type of clothing meets EPA Level B needs. It is important to note, however, that wearing liquid splash-protective ensembles or clothing does not protect the wearer from exposure to chemical vapors and gases, since this clothing does not offer gastight performance, even if duct tape is used to seal clothing interfaces. Therefore, where the environment is unknown or not quantified through monitoring, where exposures include carcinogens or skin-toxic chemicals involving chemicals with vapor pressures above 5 mm Hg at 25°C (77°F), or where the splash-protective ensemble or clothing has not been certified for the chemical exposure, an ensemble compliant with NFPA 1991 should be utilized. NFPA 1992 specifies a battery of seven chemicals including liquid chemicals with low vapor pressures with no known skin absorption toxicity or no known or suspected human carcinogenicity, that are representative of the classes of chemicals likely to be encountered during hazardous materials emergencies. Chemical-penetration resistance against the NFPA 1992 battery of test chemicals is required. Any additional chemicals or specific chemical mixtures for which the manufacturer is certifying the suit should meet the same penetration performance requirements. Additional optional criteria are provided for demonstrating protection against chemical flash fires. Other NFPA 1992 performance requirements include an overall suit water-penetration test to ensure the suit provides integrity of the ensemble or clothing against the inward leakage of liquids. The standard contains performance criteria to ensure that the materials used for liquid-splash suits afford adequate protection in the environment where they will be used. The test requirements include material testing for burst strength, tear resistance, flammability resistance, abrasion resistance, cold temperature performance, and flexural fatigue testing. A.7.5.2.8 There are no performance criteria provided in NFPA 1992, Standard on Liquid Splash-Protective Ensembles and Clothing for Hazardous Materials Emergencies, to demonstrate protection of NFPA 1992-compliant liquid splash-protective suits during fire-fighting operations. There are no test requirements or performance criteria in NFPA 1992 addressing protection from ionizing radiation, biological, liquefied gas, or cryogenic liquid hazards, from flammable or explosive atmospheres, or from hazardous chemical vapor atmospheres.

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A.7.5.3 CBRN protection is addressed in three standards, including NFPA 1991, Standard on Vapor-Protective Ensembles for Hazardous Materials Emergencies, NFPA 1994, Standard on Protective Ensembles for First Responders to CBRN Terrorism Incidents, and NFPA 1971, Standard on Protective Ensembles for Structural Fire Fighting and Proximity Fire Fighting. NFPA 1991 provides requirements for the highest level of CBRN protection, where hazards involving CBRN terrorism agents are most severe. These include the conditions where the agent has not been identified, the release is still occurring, and victims in the area of the release are apparently dead or unconscious. Testing of ensembles for NFPA 1991 requirements is described in A.7.5.1. NFPA 1994 sets requirements for different classes of protective ensembles for use at incidents involving CBRN terrorism agents as used by first responders. Class 2 ensembles provide the highest level of protection against CBRN terrorism agents, including vapors, liquids, and particulates, and have performance consistent with SCBA use for IDLH conditions. Class 3 ensembles also protect against CBRN terrorism agents that include vapors, liquids, or particulates, but are at conditions of exposure that are less than IDLH, which would permit the use of air-purifying respirators (APRs). There are two primary areas of evaluation: tests for integrity of the ensemble against the hazardous environment, and tests of the material to demonstrate how it acts as a barrier against different CBRN terrorism agents. There are three different integrity tests. An inward leakage test is applied to Class 2 and Class 3 ensembles using the Man-in-Simulant test (MIST). This test measures the inward leakage of a surrogate agent into the clothing while worn by a test subject. The higher the MIST result or protection factor, the better the integrity. Class 2 performance has been set for levels that are consistent based on SCBA use while Class 3 performance is consistent with APR use. MIST does not apply to Class 4 because these ensembles are not intended to provide chemical protection. Class 4 protective ensembles provide only biological or radiological particulate protection. A liquid integrity test is applied to each ensemble. A longer test is used for Class 2 than for Class 3 and Class 4. The liquid integrity test is applied to Class 4 because this clothing could be subjected to wet decontamination. For Class 4, a particle integrity test is used where a test subject wears the ensemble inside a closed environment with fluorescent particles. Particle leakage is detected using ultraviolet light. This particle test is not applied to Class 2 and Class 3 because it is believed that successful MIST evaluations indicate particle holdout. For material tests, permeation testing as described in A.7.5.1 is used for Class 2 and Class 3 ensembles. For Class 2, permeation testing with gases is carried out at levels that are used for CBRN approvals of APRs. The liquid chemical permeation tests for Class 2 are performed using the more rigorous closed-top procedures compared to open-top procedures for Class 3. All ensemble materials are evaluated for viral-penetration resistance using a bloodborne pathogen surrogate. The CBRN option for NFPA 1971 is based on Class 2 performance. The same integrity and material barrier requirements are applied; however, ensemble elements and materials are subjected to extensive conditioning involving laundering, heat exposures, repeated flexing, and abrasion prior to testing integrity and barrier characteristics. The tests are intended to simulate extensive use of the ensemble prior to encountering CBRN terrorism agents. (See also A.7.5.3.6). A.7.5.3.2 Any response plan involving a biological or weapons of mass destruction (WMD) biological hazard should be based on relevant infectious disease or biological safety recommendations by the Centers for Disease Control and Prevention (CDC) and other expert bodies. A.7.5.3.6 The CBRN option for structural and proximity fire-fighting protective ensembles in NFPA 1971, Standard on Protective Ensembles for Structural Fire Fighting and Proximity Fire Fighting, can only be applied to complete ensembles of garments, helmet, gloves, footwear, and hood with a specified SCBA that has been certified by NIOSH as compliant with the NIOSH Standard for Chemical, Biological, Radiological, and Nuclear (CBRN) Full Facepiece Air Purifying Respirator (APR). Non-CBRN elements cannot be used with the CBRN ensemble. CBRN ensembles are only intended to allow members escape and provide rescue during the escape when CBRN agents are encountered. A.7.7.1 Fire departments that provide both wildland and structural fire-fighting services should establish guidelines for members on which ensemble to wear for a given fire-fighting or other emergency incident.

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A.7.7.3 Fire shelters are no longer addressed in NFPA 1977, Standard on Protective Clothing and Equipment for Wildland Fire Fighting. Specifications for fire shelters are provided in USDA Forest Service Specification 5100-606, Shelter Fire. A.7.8.3.1 NIOSH provides nine classes of particulate filters (three classes of filter efficiency — 95 percent, 99 percent, and 99.97 percent), each with three categories of resistance to filter efficiency degradation (N, R, and P). Additionally, performance against toxic industrial gases, vapors, and certain CBRN agents are also specified by NIOSH. A.7.8.3.2 APRs and PAPRs do not supply oxygen. Use should be limited to known contaminants and known exposure levels and used only in adequately ventilated areas. APRs and PAPRs cannot be used when concentrations of contaminants are unknown, or when appropriate exposure limit is not known, or when cartridge or filter service life is unknown. A.7.9 Fire department personnel involved in surface water operations should be protected against potential hazards. These hazards include exposure to physical, environmental, thermal, and certain common chemical and biological hazards. NFPA 1952, Standard on Surface Water Operations Protective Clothing and Equipment, covers full body suits, helmets, gloves, footwear, and personal flotation devices for those individuals engaged in surface water operations and similar operations. NFPA 1952 specifies a series of requirements for each type of protective clothing. Requirements are established for dry suit environments, wet suit environments, and ice suit environments. A.7.10.1.1 Selection of respiratory protection devices is an important function, particularly where resources are limited and respirators have to be used for different applications with different equipment. Urban search and rescue (USAR), CBRN, confined space, hazardous materials, and other operations can require different filter elements, SCBA breathing air cylinders, umbilical connections, and features that are easier to ascertain and coordinate with a selection stage. A.7.10.4 At least one additional reserve SCBA should be available at the incident scene for each 10 SCBA in use, to provide for replacement if a failure occurs. A.7.10.7 Hazardous atmospheres requiring SCBA can be found in, but are not limited to, the following operations: structural fire fighting, aircraft fire fighting, shipboard fire fighting, confined space rescue, and any incident involving hazardous materials. A.7.10.8 The required use of SCBA means that the user should have the facepiece in place, breathing air from the SCBA only. Wearing SCBA without the facepiece in place does not satisfy this requirement and should be permitted only under conditions in which the immediate safety of the atmosphere is assured. All members working in proximity to areas where SCBA use is required should have SCBA on their backs or immediately available for donning. Areas where the atmosphere can rapidly become hazardous could include rooftop areas during ventilation operations and areas where an explosion or container rupture could be anticipated. A hazardous atmosphere would be suspected in overhaul areas and above the fire floor in a building. Members working in these areas are required to use their SCBA unless the safety of the atmosphere is established by testing and maintained by effective ventilation. With effective ventilation in operation, facepieces could be removed under direct supervision, but SCBA should continue to be worn or immediately available.

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A.7.12.1.3 The use of long-duration SCBA should be restricted to operations in tunnels and underground structures, on board ships, and in other situations where the need for this capability is demonstrated. Weight and stress reduction should be an objective in the acquisition of new SCBA and when upgrading currently used SCBA. Weight and other stress factors are major contributions to fire fighter fatigue and injury, and SCBA should be chosen accordingly. A.7.12.3.3 Because of the cumulative hazards associated with the repeated use of filter canisters and cartridges under emergency response conditions, canisters and cartridges that have been placed in service should be removed, replaced, and discarded after training, regardless of exposure time. A.7.13.1 In quantitative fit testing, the testing machine provides a numerical value of each test exercise and then a computed fit factor that can be used as a benchmark for future fit testing the following year. The test subject must obtain at least a fit factor of 500 for the person to pass the fit test with the full facepiece. The strip chart that the test machine provides becomes the written record, and a computer-generated record can be done at the same time. There is little judgment required by the operator of the fit test other than to make sure the test subject and the procedures are followed to the letter. Proper respiratory protection programs include provisions for conducting a respirator fit testing to ensure that the respirator fits the user properly. APRs reduce the user's exposure by varying degrees, depending on the type of respirator used. An effective face-to-facepiece seal is extremely important when using respiratory protection SCBA. Even a minor leakage can allow contaminants to enter the facepiece, even with positive-pressure respiratory protection SCBA. Any outward leakage will increase the rate of air consumption, reducing the time available for use and safe exit. The facepiece should seal tightly against the skin, without penetration or interference by any protective clothing or other equipment. In those instances where members cannot meet the facepiece seal requirement with equipment currently used by the AHJ, individually fitted facepieces should be provided. Fit testing is a procedure used to evaluate how well a given respirator fits a given person by assessing leakage around the face seal. Without fit testing, persons unknowingly can have poor face seals, allowing contaminants to leak around the mask and be inhaled. Poor face seals are due to certain facial characteristics (facial size, beards, large sideburns, scars, or other facial uniqueness) that prevent direct contact between the skin and the sealing surface of the respirator and result in leakage or inadequate respiratory protection. Improper use of a respirator or improper fit testing of any respirator can lead to a false sense of security and possibly result in injury or death to the user. A.7.13.5 A protection factor of at least 10,000 in the positive-pressure mode is recommended for positive- pressure SCBA. The quantitative test can be used to determine which facepieces fit an individual well and thus aids in selecting the facepiece that best conserves the amount of air in the cylinder. A.7.13.6 WARNING: If a facepiece from one manufacturer is used on a unit from another manufacturer, the NIOSH approval will be voided.

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A.7.14.3 The following is an excerpt from 29 CFR 1910.134(g): “(g) Use of respirators. This paragraph requires employers to establish and implement procedures for the proper use of respirators. These requirements include prohibiting conditions that may result in facepiece seal leakage, preventing employees from removing respirators in hazardous environments, taking actions to ensure continued effective respirator operation throughout the work shift, and establishing procedures for the use of respirators in IDLH atmospheres or in interior structural firefighting situations.

(1) Facepiece seal protection. (i) The employer shall not permit respirators with tight-fitting facepieces to be worn by employees who have:

(A) Facial hair that comes between the sealing surface of the facepiece and the face or that interferes with valve function; or (B) Any condition that interferes with the face-to-facepiece seal or valve function.” This prohibition applies to any negative- or positive-pressure personal respiratory protection device of a design relying on the principle of forming a face seal to perform at maximum effectiveness. A beard growing on the face at points where the seal with the respirator is to occur is a condition that has been shown to prevent a good face seal. This is so regardless of what fit test measurement can be obtained. However, if the beard is styled so no hair underlies the points where the SCBA facepiece is designed to seal with the face, then the employer may use the SCBA to protect the employee. A.7.14.6 The user should be able to demonstrate the successful use of an SCBA with contact lenses in a nonhazardous training environment before being allowed to use them in an incident. Successful long-term soft contact lens use should be measured by the ability to wear soft contact lenses for at least 6 months without any problems.

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A.7.15.1 Given the considerable amount of stored energy inside an SCBA cylinder, cylinders should always be filled using manufacturers' recommendations and following any existing NIOSH, CGA, or other regulatory agency guidelines. Because of the failure during refilling of 11 cylinders using aluminum alloy 6351-T6, SCBA cylinders made of this alloy should be diligently inspected, both externally and internally, by properly trained inspectors at least annually. Most of these failed cylinders had not been maintained properly. Some were being used beyond their DOT-defined hydrostatic test period. Some had not been retrofitted with a special neck-ring that the manufacturer had recommended to reduce the possibility of failure. For additional information, refer to the United States Department of Transportation (DOT) Research and Special Programs Administration (RSPA) Safety Advisory Notice of 1994 (Federal Register Vol. 59, July 26, 1994), DOT Safety Advisory Notice of 1999 (Federal Register Vol. 64, October 18, 1999), and the NIOSH Respirator User Notice of December 7, 1999. Several of the ruptured cylinders were made using aluminum alloy 6351-T6. This alloy has been identified as being susceptible to sustained load cracking (SLC) in the neck and shoulder area of the cylinder. The NIOSH Respirator User Notice of December 7, 1999, states: “It is important to note that only a small percentage of cylinders made from aluminum alloy 6351-T6 have actually been found to exhibit sustained load cracking. Moreover, out of several million cylinders manufactured from this alloy by several companies, NIOSH and the U.S. Department of Transportation (DOT) are aware of only 12 ruptures within the United States. Eleven of the 12 ruptures occurred during refilling, six of these 12 ruptures involved SCBA cylinders. Forensic analysis has determined that most of these cylinders failed due to SLC failure. However, in some cases, evidence of other factors such as external mechanical damage was also present.” Changes have now been made in materials specification and design of cylinders. Since 1988, manufacturers have been using aluminum alloy 6061-T6 in the manufacture of all of their cylinders and cylinder liners. Alloy 6061-T6 has become the “standard of the industry” because it is not susceptible to sustained load cracking. The failed cylinders belong to a relatively small population of a particular type of cylinder, and there has been no occurrence of cylinder failure during filling of any other type of SCBA cylinders. Full-wrapped composite cylinders, which are predominantly being purchased by the fire service at this time, have been used since 1988 without failure during refilling. There is, therefore, reason to believe that these other types of SCBA cylinders can continue to be used in the fire service without risk of failure during filling. A.7.15.5 To facilitate this, it is recommended that industry develop an inexpensive, lightweight chamber, or other means, to provide protection at the fire scene during routine cylinder filling. There is no current commonly accepted standard or specifications for protective enclosures in which to fill SCBA cylinders. Until such a standard is defined, such equipment should comply with the standards defined for fragmentation tanks in NFPA 1901, Standard for Automotive Fire Apparatus. A number of SCBA manufacturers have developed systems to quickly fill cylinders. They enable cylinders to be filled while the user is wearing the SCBA. Even though some of these systems have been in use without incident for many years, it is felt that fire fighter and support personnel safety are paramount. This standard therefore recommends that personnel be protected when routinely refilling SCBA cylinders. Until a commonly accepted standard for providing protection during routine refilling of cylinders is defined, the AHJ should determine how best to provide protection for its personnel during routine cylinder filling. Without a commonly accepted standard defining a concise method of protecting personnel during cylinder refilling, the AHJ can choose which method best applies to its personnel. Such protection can consist of refilling cylinders in an enclosure considered acceptable to the AHJ. The protection can consist of using a refill system with a safe record of operation, with no experience of failures or damage to cylinders, supported by sufficient data, or it can consist of an alternate practice considered as safe by the AHJ. A.7.15.6 The possibility exists for catastrophic failure of SCBA cylinders during refilling.

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A.7.15.11 Table Table A.7.15.11 shows the approximate pressures associated with the 600 L minimums when exiting procedures should have already begun to take place. Table A.7.15.11 Pressure Associated with 600 L Minimum Exit Volume

2216 psi 3000 psi 4500 psi 30 minute/1200 L 1100 psi NA 2250 psi 30 minute/1700 L NA 1050 psi NA 45 minute/1800 L 750 psi NA 1500 psi 60 minute/2400 L 550 psi NA 1100 psi

NA: Not applicable. A.7.16.1 Technology has provided the integration of PASS devices with SCBA. When the SCBA unit is activated to an operational mode, the PASS device is activated. Fire departments are encouraged to utilize this technology. The use of PASS devices should be coupled with a solid incident management system, a personnel accountability system, and adequate communications to properly ensure the safety of fire fighters. A.7.16.2 The mandatory use and operation of a PASS by fire fighters involved in rescue, fire suppression, or other hazardous duty is imperative for their safety. The primary intent of this device is to serve as an audible device to warn fellow fire fighters in the event a fire fighter becomes incapacitated or needs assistance. Past fire fighter fatality investigation reports document the critical need to wear and operate PASS devices when fire fighters operate in hazardous areas. Investigation results show that fire fighters most often failed to activate the PASS unit prior to entering a hazardous area. Training and operational procedures are imperative to ensure activation of the PASS whenever PASS devices are used. A.7.17.3 Life safety rope can be significantly weakened by abrasion, misuse, contamination, wear, and stresses approaching its breaking strength, particularly impact loading. Because there is no approved method to service test a rope without compromising its strength, rope rescue and training operations should be carefully observed and monitored for conditions that could cause immediate failure or result in undetectable damage to the rope. If a rope has been used in a situation that could not be supervised or where potential damage could have occurred, it should be removed from service and destroyed. It is important that ropes be inspected for signs of wear by qualified individuals after each use. If indications of wear or damage are noted, or if the rope has been stressed in excess of the manufacturers' recommendations or has been impact loaded, it should be destroyed. The destruction of the rope means that it should be removed from service and altered in such a manner that it could not be mistakenly used as a life safety rope. This alteration could include disposal or removal of identifying labels and attachments and cutting the rope into short lengths that could be used for utility purposes. The assignment of disposable life safety ropes to members or to vehicles has proven to be an effective system to manage ropes that are provided for emergency use and are used infrequently. Special rescue teams, which train frequently and use large quantities of rope, should include members who are qualified to manage and evaluate the condition of their ropes and determine the limitations upon their reuse.

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A.7.18.1.1 Some examples of primary eye protection are goggles and safety glasses, as they provide specific and substantial eye protection against penetration and impact. Helmet faceshields are not primary eye protection, as they do not provide eye protection and should not be relied upon for eye protection. Faceshields should be used to protect the face as secondary protection to primary eye protection. Faceshields currently are often used incorrectly as the only form of eye protection. It is evident that when faceshields are exposed to ultraviolet degradation, abrasion, and products of combustion, they become scratched, cloudy, opaque, and can be rendered unserviceable in a very short period of time. In many instances, the faceshield is lifted so that the wearer can see what he is doing, leaving the eyes unprotected and exposed to the dangers of flying debris. Goggles and other primary eye devices are more easily protected from damage and also provide specific protection for the wearer's eyes. There are numerous products on the market to protect the goggles from damage when stored on the helmet. Users desiring to keep goggles or eye protection stored on top of the helmets should consider one of these devices. The SCBA facepiece can provide both primary eye protection and full-face protection. A.7.19.1 The use of PPE to limit noise exposure should be considered as an interim approach until the noise levels produced by vehicles, warning devices, and radios can be reduced. Protective ear muffs are recommended for fire fighters due to the difficulties of proper fit and insertion of ear plugs. Studies in some jurisdictions have indicated that the most harmful noise exposure can come from radios that are turned up loud enough to be heard over the noise of engines and warning devices. Ear muffs are available that provide effective sound attenuation and rapid donning. They should also be provided with built-in speakers and volume controls for radio and intercom communications. Ear muffs should be worn by operators of noisy equipment (in excess of 90 dBA) at the scene of incidents as well as during response. In some jurisdictions, traffic regulations could limit the use of hearing protection by drivers. The fire apparatus standards require the noise level at any seated position to be a maximum of 90 dBA when measured as specified in the standard, without any warning devices in operation, as the vehicle proceeds at a speed of 45 mph (72 km/h) on a level, hard, smooth surface road. However, it is recommended that the specifications for new fire apparatus provide maximum sound requirements that would allow members to ride in those vehicles without using hearing-protective devices. A maximum limit of 85 dBA without audible warning devices and 90 dBA with warning devices in operation is recommended. Interior noise levels should be measured with the vehicle in motion at the speed that produces the highest noise level, up to 55 mph (80 km/h). All windows should be closed, and the noise level should be measured in each passenger area. A.7.19.2 When operating in situations where other protective clothing and equipment are necessary, such as in structural fire fighting, the interface between hearing protection and other necessary protection might not be adequately addressed by currently used devices. For example, ear muffs might not interface with helmets, and foam plastic ear plugs could be dangerous in a fire environment due to the potential for melting. In addition, a reduction in hearing capability in an emergency operations setting could create additional hazards. Effective hearing protection should also be used during non-emergency activities such as equipment checks and engine warm-ups. Attention should be given to correcting the deficiencies through the advent of improved protective devices and through the use of alternate or improved procedures that create less noise.

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A.7.19.3 An effective hearing conservation program should address the regular audiometric testing of members to identify hearing loss, the development and implementation of steps to prevent further hearing loss by members exhibiting such loss, and the ongoing identification and reduction or elimination of potentially harmful noise sources in the work environment. The standards for hearing conservation included in 29 CFR 1910.95, Occupational noise exposure, should be used as a basic minimum approach to this problem. Any approach to hearing conservation should address personal protective devices, audiometric testing, and the reduction of noise exposure that can be achieved by modifying existing equipment or changing procedures. Examples of modifications would include moving siren speakers and air horns down onto front bumpers, responding with windows closed, and installing sound-attenuating insulation in cabs of fire apparatus. The noise produced by audible warning devices should also be evaluated to determine the most effective balance between warning value and harmful characteristics. Some studies indicate that high-low alternating-tone sirens and lower-pitch air horns could be more effective warning devices and less damaging to hearing. A long-term approach to hearing conservation should deal with the purchase of apparatus and equipment that is less noisy by design, with noise standards included in the specifications. Improved radio equipment that produces higher clarity of sound with less output volume should also be considered. For more information on fire department hearing conservation programs, consult the U.S. Fire Administration publication FA-118, Fire and Emergency Service Hearing Conservation Program Manual.

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A.8.1.1 The National Wildfire Coordinating Group (NWCG) is an operational group that coordinates programs of the participating wildland fire management agencies and is comprised of representatives of the U.S. Forest Service, four Department of Interior agencies (Bureau of Land Management, National Park Service, Bureau of Indian Affairs, and the U.S. Fish and Wildlife Service), the Intertribal Timber Council, 50 state forestry agencies and Puerto Rico (through the National Association of State Foresters), the U.S. Fire Administration, and the Federal Emergency Management Agency (FEMA). The NWCG has several sources of information regarding wildland fire fighting operations, safety, and training, including the NWCG Incident Response Pocket Guide, the Fireline Handbook PMS 410-1, and the Wildland Fire Qualification System Guide PMS 310-1. For a complete list of NWCG publications, see http://www.nwcg.gov/pms/pubs/pubs.htm. A.8.1.5 The incident commander should automatically integrate fire fighter safety and survival into the regular command functions. When this integration occurs, the incident commander promotes fire fighter welfare by performing the standard job of command. Under fire conditions, the incident commander is at an extreme disadvantage to perform any additional tasks. The safety plan for the incident commander has to be the regular command plan. Due to the high number of fire fighter injuries and deaths attributable to lack of or poor implementation of the safety function on the incident scene, the incident commander should recognize the importance of integrating the safety function into the incident command structure as described in NFPA 1561, Standard on Emergency Services Incident Management System. A.8.1.7 Due to the high number of fire fighter injuries and deaths attributable to lack of or poor implementation of incident management, incident managers should be familiar with the use of incident management teams or incident command team as described in NFPA 1561, Standard on Emergency Services Incident Management System.

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A.8.1.8 The following explains the responsibilities of the incident commander:

(1) The incident commander should always integrate fire fighter health and safety considerations into the command process. This integration ensures that safety will always be considered and will not be reserved for unusual or high-risk situations when the incident commander is under a high degree of stress. An incident action plan that addresses fire fighter safety should be a routine function of command. (2) Early evaluation enables the incident commander to consider current conditions in a standard manner and then predict the sequence of events that will follow. The consideration of fire fighter safety should be incorporated into this evaluation and forecasting. (3) Effective communications are essential to ensure that the incident commander is able to receive and transmit information, obtain reports to maintain an awareness of the situation, and communicate with all component parts of the incident organization to provide effective supervision and controls. (4) Strategic decisions establish the basic positioning of resources and the types of functions they will be assigned to perform at the scene of a fire or emergency incident. The level of risk to which members are exposed is driven by the strategy; offensive strategy places members in interior positions where they are likely to have direct contact with the fire, while defensive strategy removes members from interior positions and high-risk activities. The attack plan is based on the overall strategy and drives the tactical assignments that are given to individual or groups of companies/crews and the specific functions they are expected to perform. Risk identification, evaluation, and management concepts should be incorporated into each stage of the command process. (5) Tactical level management component people are command agents and are able to both monitor companies/crews at the actual location where the work is being done (geographic) and to provide the necessary support (functional). The incident commander uses a tactical-level management unit as off-site (from the command post) operational/communications/safety managers-supervisors. The incident commander uses the incident organization along with communications to stay connected. Some incident management systems identify tactical-level management components such as a division or a group for a functional position within the system, whereas other systems use the term sectors for either geographical or functional areas. As incidents escalate, the incident management system should be utilized to maintain an effective span of control ratio of not greater than 1 to 7 with an optimum ratio of 1 to 5. (6) The incident commander should routinely evaluate and re-evaluate conditions and reports of progress or lack of progress in reaching objectives. This process will allow the incident commander to determine if the strategy and attack plans should be continued or revised. The failure to revise an inappropriate or outdated attack plan is likely to result in an elevated risk of death or injury to fire fighters. (7) Effective command and control should be maintained from the beginning to the end of operations, particularly if command is transferred. Any lapse in the continuity of command and the transfer of information increases the risk to fire fighters.

A.8.2.2 The intent of the use of “clear text” for radio communications is to reduce confusion at incidents, particularly where multiple agencies are operating at the same incident.

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A.8.2.3

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Examples of emergency conditions could be “evacuate the building/area,” “wind shift from the north to south,” “change from offensive to defensive operations.” Examples of situations where the term “mayday” should be used include a lost or missing member, an SCBA malfunction or loss of air, a member seriously injured or incapacitated, a member trapped or entangled, or any life-threatening situation that cannot be immediately resolved. When a fire fighter experiences a life-threatening situation, he or she must quickly and efficiently be able to take the steps necessary to survive and alert rescuers. This is the time when an individual fire fighter will be tested on his or her knowledge of self-survival techniques. Paramount to surviving such an experience is being able to communicate the emergency to rescuers. The terms used to communicate these needs must be chosen carefully. The terms used must be easily understood over the radio in times when operational noise is high. The terms used must also be recognizable as an emergency call for assistance by those on the incident. All persons, regardless of language accent, must easily be able to annunciate the terms used. And finally, the terms used must be short with two syllables maximum to allow for a simple single inflexion of the voice to recognize the term. “Mayday” satisfies all of the above demands for a term that can be used to communicate a fire fighter’s need for immediate assistance. “Mayday” is approved for fire service use by the National Search and Rescue Committee and is currently being used by most fire departments in the United States. Most importantly, “mayday” is easily remembered and understood over the radio when operational noise challenges radio communications. The concern over “mayday” causing confusion with aeronautical and nautical emergencies is unfounded. In April 2002, Dr. Burton A. Clark, EFO, CFO, Management Science Program chair at the National Fire Academy, and operations chief for DHS/FEMA during national disasters wrote to Rear Admiral Ken Venuto (USCG), chairman of the National Search and Rescue Committee, requesting clarification on the use of “mayday.” In August 2002, Captain Steve Sawyer (USCG) returned a letter to Dr. Clark stating, “Your recent letter inquired about use by fire departments of the term “mayday” over ground fire radios when the life of a fire fighter is in danger. Use of “mayday” under such circumstances is permissible under U.S. law and regulations. The radio frequencies concerned are different from the aeronautical and maritime frequencies, so use of the term should not cause confusion. Further, any effective means of calling for help is authorized under both national and international radio regulations for true distress situations. Within the letter Captain Sawyer gives further insight on the appropriate use of “mayday.” On page 2 of the letter it states, ‘Mayday’ is recognized nationally and internationally as a signal meaning life is in danger and immediate assistance is required, although federal regulations only mention its use for ship aircraft. The above guidance is based on review of the regulations and consultation with experts of the Coast Guard, FCC, International Civil Aviation Organization, and others. We trust that this explanation will help not only for your local training and operations; you may also find it useful seeking to update relevant guidance in NFPA or other standards, as appropriate.” In addition to “emergency traffic” and “mayday,” the fire department can use additional signals such as an air horn signal for members to evacuate as part of their standard operating procedures. Some fire departments have developed an evacuation signal that consists of repeated short blasts of apparatus air horns. The sequence of air horn blasts should not exceed 10 seconds in length, followed by a 10-second period of silence, and it is done three times (a total air horn evacuation signal including periods of silence lasts 50 seconds). When this evacuation signal is used, the incident commander should designate specific apparatus to sound the evacuation signal using air horns. The apparatus used should not be in close proximity to the command post, if possible, thus reducing the chance of missing any radio messages. During fire fighter rescue operations, the incident commander should consider implementing the following:

(1) Requesting additional resources (2) Including a medical component (3) Utilizing staging for resources (4) Committing the RIC team from standby mode to deployment (5) Changing from strategic plan to a high-priority rescue operation (6) Initiating a PAR (personnel accountability report) (7) Withdrawing companies from the affected area (8) Assigning a rescue officer

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(9) Assigning a safety officer (10) Assigning a backup rapid intervention crew/company (11) Assigning an advanced life support (ALS) or basic life support (BLS) company (12) Requesting additional command level officers (13) Requesting specialized equipment (14) Ensuring that dispatch is monitoring all radio channels (15) Opening appropriate doors to facilitate egress and access (16) Requesting additional vertical/horizontal ventilation (17) Providing lighting at doorways, especially at points of entry

A.8.2.4 Some fire departments can also wish to be provided with reports of elapsed time-from-dispatch. This method can be more appropriate for fire departments with long travel times where significant incident progress could have occurred prior to the first unit arrival. A.8.2.4.1 Common procedure is for the dispatch center to announce “incident clock is 10 minutes,” “incident clock is 20 minutes,” “incident clock is 30 minutes,” and so forth. A.8. X.1 The incident commander has the ultimate responsibility for the safety and survival of all fire department members operating at an incident. Crew Resource Management (CRM) provides a basis for improving the following: (1) Communications (2) Situational Awareness ( 3 ) Decision-Making (4) Teamwork (5) Workload Management (6) Error Management A.8.3. 1 The incident commander has the ultimate responsibility for the safety of all fire department members operating at an incident and for any and all other persons whose safety is affected by fire department operations. Risk management provides a basis for the following:

(1) Standard evaluation of the situation (2) Strategic decision making (3) Tactical planning (4) Plan evaluation and revision (5) Operational command and control

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A.8.3.2 The risk to fire department members is the most important factor considered by the incident commander in determining the strategy that will be employed in each situation. The management of risk levels involves all of the following factors:

(1) Routine evaluation of risk in all situations (2) Well-defined strategic options (3) Standard operating procedures (4) Effective training (5) Full protective clothing ensemble and equipment (6) Effective incident management and communications (7) Safety procedures and safety officers (8) Backup crews for rapid intervention (9) Adequate resources (10) Rest and rehabilitation (11) Regular evaluation of changing conditions (12) Experience based on previous incidents and critiques

When considering risk management, fire departments should consider the following Rules of Engagement after evaluating the survival profile of any victims in the involved compartment:

(1) We will risk our lives a lot, in a calculated manner, to save SAVABLE LIVES. (2) We will risk our lives a LITTLE, in a calculated manner, to save SAVABLE property. (3) We WILL NOT risk our lives at all for a building or lives that are already lost.

A.8.3.3 The acceptable level of risk is directly related to the potential to save lives or property. Where there is no potential to save lives, the risk to fire department members should be evaluated in proportion to the ability to save property of value. When there is no ability to save lives or property, there is no justification to expose fire department members to any avoidable risk, and defensive fire suppression operations are the appropriate strategy. A.8.3.5 An incident safety officer should be established at all major incidents and at any high-risk incidents. The incident safety officer should be assigned to operate under the incident commander. Depending on the specific situation, this assignment could require one or more members. If the fire department's safety officer is not available or does not have the expertise necessary for the incident, the incident commander should assign one or more members that have the expertise to assume this responsibility. All members should be familiar with the basic duties and responsibilities of an incident safety officer. A.8.3.7 Atropine auto-injectors are used in the military and have been purchased by many fire departments. Fire departments that have auto-injectors available for their members need to provide training on the use of the auto-injector. A.8.4.1 A standard system to account for the identity and assignment of each member could be relatively simple when all members arrive as assigned crews on fire apparatus. The identity of each crew member should at least be recorded in a standard manner on the vehicle, and each company officer is responsible for those members. In fire departments where members arrive in their own vehicles or assemble at the scene, a system is required to record the identity of each member arriving and to organize them into companies or groups with appropriate supervision. This requires a standard system of “reporting in” at the incident and becoming part of the organized system of operations.

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A.8.4.10 The personnel accountability system is a method of maintaining constant awareness of the identities and location of all personnel involved in emergency operations. The personnel accountability system philosophy starts with the incident command system principles of company unity and unity of command. These duties can be fulfilled initially maintaining company accountability by documenting the situation status and resource status on the tactical worksheet. Other methods include command boards, apparatus riding lists, company personnel boards, and electronic bar-coding systems. These components can be used in conjunction with one another to facilitate the tracking of personnel by both location and function. The components of the personnel accountability system should be modular and expand with the size and complexity of the incident. At major incidents, this function should be separate from the role of the incident commander. The function of personnel accountability should be assigned to an accountability officer (resource status and situation status) who is responsible for maintaining the status of all assigned resources at an incident. As the incident escalates, this function would be placed under the planning section. A.8.4.11 These accountability supervisors should work with the incident commander and tactical-level management component supervisor to assist in the ongoing tracking and accountability of members. A.8.5.1.1 The limitation of emergency scene operations to those that can be safely conducted by the number of personnel on the scene is intended to reduce the risk of fire fighter death or injury due to understaffing. While members can be assigned and arrive at the scene of an incident in many different ways, it is strongly recommended that interior fire-fighting operations not be conducted without an adequate number of qualified fire fighters operating in companies under the supervision of company officers. It is recommended that a minimum acceptable fire company staffing level should be four members responding on or arriving with each engine and each ladder company responding to any type of fire. The minimum acceptable staffing level for companies responding in high-risk areas should be five members responding or arriving with each engine company and six members responding or arriving with each ladder company. These recommendations are based on experience derived from actual fires and in-depth fire simulations and are the result of critical and objective evaluation of fire company effectiveness. These studies indicate significant reductions in performance and safety where crews have fewer members than the above recommendations. Overall, five member crews were found to provide a more coordinated approach for search and rescue and fire-suppression tasks. During actual emergencies, the effectiveness of companies can become critical to the safety and health of fire fighters. Potentially fatal work environments can be created very rapidly in many fire situations. The training and skills of companies can make a difference in the need for additional personnel and in reducing the exposure to safety and health risks to fire fighters where a situation exceeds their capabilities. A.8.5.4 For additional information, see 29 CFR 1910.134, Respiratory protection. A.8.5.8 Studies have shown that the severity of incidents involving ARFF can rapidly escalate to catastrophic proportions. If fire fighting and rescue operations are to be effective, fully assembled ARFF companies should be on-scene within the time requirements as specified in NFPA 403, Standard for Aircraft Rescue and Fire-Fighting Services at Airports. Experience has shown that it is extremely difficult to assemble personnel who are responding from separate locations for individual ARFF companies within these time constraints. It is strongly recommended that the minimum ARFF company staffing level be three on-duty members responding on or with each ARFF vehicle. It is also recommended that structural fire apparatus responding in support of ARFF operations should be staffed in accordance with A.8.5.1.1. (See alsoNFPA 1710, Standard for the Organization and Deployment of Fire Suppression Operations, Emergency Medical Operations, and Special Operations to the Public by Career Fire Departments .) A.8.5.9 If advanced life support personnel are available, this level of service would be preferred. Basic life support is the minimum acceptable level.

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A.8.5.14 Consideration for rescue of members working over, in, and around water should be addressed by the incident commander and incident safety officer within the incident action plan. A.8.5.15.1 Examples include protective shields, mechanical/human barriers, or alerting techniques that are distinguishable and effective under the conditions. A.8.6.4 Figure A.8.6.4 shows the concept of hazard control zones. The hot zone is the area presenting the greatest risks to members and will often be classified as an IDLH atmosphere. The hot zone can include no-entry zones. Examples of no-entry zones could be holes in floors, explosive devices, crime scenes, and so forth. The warm zone is a limited-access area for members directly aiding or in support of operations in the hot zone. Significant risk of human injury (respiratory, exposures, etc.) can still exist in the warm zone. The cold zone establishes the public exclusion or clean zone. There are minimal risks for human injury and/or exposure in this zone. It might not always be possible or practical to mark the hazard control zones with colored tape, signage, or other appropriate means, depending on the nature or location of the incident, available resources, and so forth. If possible, these hazard control zones should be clearly marked. Other means of marking hazard control zones can include flashing beacons, streets, fences, and so forth. It is essential that the perimeters of these zones are communicated to all members at the incident and that they are aware of these zones and their implications. When colored tape is being used to mark control zones, it is recommended that the following tape colors be used:

(1) No-entry zone: red/white chevron (2) Hot zone: red (3) Warm zone: yellow (4) Cold zone: green

Figure A.8.6.4 Example of Control Zones.

A.8.6.4.1 A hot zone can include a no-entry zone (marked with red and white chevron tape or other means). No personnel should enter the no-entry zone due to imminent hazard(s) or the need to protect evidence. Examples of no-entry zones could be holes in floors, explosive devices, crime scenes, and so forth. Examples of the PPE are SCBA, flash hood, and so forth. A.8.6.4.1.1 The hot zone is an area with greater potential for risk of injury or exposure. Members entering the hot zone without an assigned task are placing themselves at greater risk for no reason. In addition, they can be increasing the risk of others operating within this zone by creating some confusion. A.8.6.4.2 Examples of significant risk of human injury include respiratory and exposures.

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A.8.7 For additional information on establishing safe practices at highway incidents, see the NFSIMSC publication, “Model Procedures Guide for Highway Incidents,” the U.S. Fire Administration publication FA-272, Emergency Vehicle Safety Initiative, and the U.S. DOT publication, Manual on Uniform Traffic Control Devices for Streets and Highways, Chapter 61. A.8.7.4 The apparatus should be positioned to shield the operational area and place the pump panel in the protected area. A.8.7.4.3 As an example, apparatus could be placed between the fire or emergency and oncoming traffic. A.8.7.5 Warning signs should be placed in the following sequence based on the expected on-scene time:

(1) The initial arriving apparatus should deploy the sign as shown in “Phase A” in Figure A.8.7.5. (2) If the incident is expected to take longer than 15 to 30 minutes, a second sign should be deployed as shown in “Phase B” in Figure A.8.7.5, and the original “Emergency Scene Ahead” sign should be changed to the appropriate directional arrow. (3) Flares, or cones, or both should be placed to block one or two lanes or to completely block a roadway. At least 4 to 6 cones or flares, or both should be used to build a lane closure or safety zone.

Using an estimated speed, flares, or cones, or both, should be placed at the distance indicated in Table A.8.7.5. Table A.8.7.5 Warning Device Placement

Fastest Speed Expected (mph) Minimum Distance to Furthest Warning Device 20 100 30 150 40 220 50 310 60 420 70 550

Figure A.8.7.5 Typical Emergency Scene Application.

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A.8.7.10 Members that operate on roadway incidents should be provided with garments that ensure proper conspicuity enhancement consistent with the requirements in the Manual on Uniform Traffic Control Devices, 2009 edition, §6D.03, “Worker Safety Considerations.” A.8.7.11 Proper training on traffic control can be obtained from local or state highway departments, law enforcement, and other agencies involved with controlling the roadway traffic. The AHJ should participate in local or regional traffic incident management committees. The fire department should also be familiar with The National Traffic Incident Management Coalition’s National Unified Goal. A.8.8.2 The assembling of four members for the initial fire attack can be accomplished in many ways. In their response plan, the fire department should determine the manner in which they plan to assemble members. The four members assembled for initial fire-fighting operations can include an officer, chief officer, or any combination of members arriving separately at the incident. Members who arrive on the scene of a working structural fire prior to the assembling of four persons can initiate exterior actions in preparation for an interior attack. These can include, but are not limited to, actions such as the establishment of a water supply, the shutting off of utilities, the placement of ladders, the laying of the attack line to the entrance of the structure, or exposure protection. If members are going to initiate actions that would involve entering a structure because of an imminent life-threatening situation where immediate action can prevent the loss of life or serious injury and four members are not yet on the scene, the members should carefully evaluate the level of risk that they would be exposed to by taking such action. If it is determined that the situation warrants such action, incoming companies should be notified so that they will be prepared to provide necessary support and backup upon arrival. A.8.8.2.4 The following examples show how a department could deploy a team of four members initially at the scene of a structure fire, regardless of how the team members are assembled:

(1) The team leader and one fire fighter could advance a fire-fighting hose line into the IDLH atmosphere, and one fire fighter and the pump operator become the standby members. (2) The team leader could designate the pump operator to be the incident commander. The team leader and one fire fighter enter the IDLH atmosphere, and one fire fighter and the pump operator remain outside as the standby members. (3) Two fire fighters could advance the hose line in the IDLH atmosphere, and the team leader and the pump operator remain outside as standby members.

A.8.8.7 The difficulty in rescuing a downed member or member in trouble cannot be overstated. While one crew/company might suffice at a single-family dwelling, the act of rescuing a member who is lost, trapped, or missing will become increasingly difficult at a large commercial building or high-rise building. The ability to rapidly deploy a rapid intervention crew/company from the command post to an area remote from the location of the command post can adversely affect the successful rescue of a member. Consideration should be given to assigning a RIC to each point of crew entry at a commercial building. For example, if the incident commander has established a tactical level management component (TLMC) at the front and rear of a commercial building, consideration should be given to assigning a RIC to each TLMC. Likewise, at a working fire in a high-rise building, consideration should be given to assigning multiple RICs to vertical positions near the area(s) of operation. At incidents such as the ones described, it could be desirable for the incident commander to establish a RIC TLMC comprised of multiple companies, dependent upon the complexity of the incident. A.8.9.1 Having a preplanned rehabilitation program that is applicable to most incident types is essential for the health and safety of members. The rehabilitation plan should outline an ongoing rehabilitation for simple or short-duration incidents as well as a process to transition into the rehabilitation needs of a large or long-duration incident.

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A.8.9.2 See NFPA 1584, Standard on the Rehabilitation Process for Members During Emergency Operations and Training Exercises, for guidelines for implementing incident scene rehabilitation. A.8.9.3 Rest should be provided away from potentially toxic exposures and loud noises, preferably with the opportunity to dress down and sit down. Adequate water supplies should allow for up to 1 qt (1 L) per person for incidents lasting an hour or more. Water must be potable, such as in sealed individualized plastic bottles. Avoid caffeinated and high-sugar beverages. In hot, humid conditions, and/or where members have been working hard for more than 40 minutes, a means to actively cool core body temperature should be provided to prevent heat stress. Forearm immersion in cool water, misting fans, cooling vests, and so forth are types of active cooling. For more information on active cooling, see “Active Versus Passive Cooling During Work in Warm Environments While Wearing Firefighting Protective Clothing,” by G. A. Selkirk, T. M. McLellan, and J. Wong. Medical evaluation and treatment in the on-scene rehabilitation area should be conducted according to EMS protocols developed by the fire department in consultation with the fire department physician and the EMS medical director. If ALS personnel are available, this level of EMS care is preferred. The assignment of an ambulance or other support crew to the rehabilitation function is essential during long-duration or heavy-exertion incident operations. This crew can assist with rehabilitation functions as well as be available to provide immediate life support needs for members. Food should be made available for longer-duration incidents (more than three hours). If possible, supplied food should be nutritious. Members should be provided with a means to wash contaminants from their hands and faces before refueling. Weather factors during emergency incidents can impact severely on the safety and health of members, particularly during extremes of heat or cold. Where these factors combine with long-duration incidents or situations that require heavy exertion, the risks to members increase rapidly. The fire department should develop procedures, in consultation with the fire department physician, to provide relief from adverse climatic conditions. Typical rehabilitation considerations for operations during hot-weather extremes are as follows:

(1) Moving fatigued or unassigned personnel away from the hazardous area of the incident (2) Removal of PPE (3) Ensuring that personnel are out of direct sunlight (4) Ensuring that there is adequate air movement over personnel, either naturally or mechanically (5) Providing for active cooling by using forearm immersion, misting fans, or other devices proven to quickly and effectively lower a member's core body temperature to avoid heat stress (6) Providing personnel with fluid replenishment, especially water (7) Providing medical evaluation for personnel showing signs or symptoms of heat exhaustion or heat stroke (8) Providing a change of clothing and possibly a change of protective garments

Typical rehabilitation considerations for operations during cold-weather extremes are as follows:

(1) Moving fatigued or unassigned personnel away from the hazardous area of the incident (2) Providing shelter from wind and temperature extremes (3) Providing personnel with fluid replenishment, especially water (4) Providing medical evaluation for personnel showing signs or symptoms of frostbite, hypothermia, or other cold-related injury (5) Providing a change of clothing and possibly a change of protective garments

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A.8.9.5 The importance of hydration during wildland fire-fighting operations cannot be overemphasized. This concept should be clearly understood and utilized by all members. A method of replenishment of this water supply should be in place to provide 8 qt to 12 qt (8 L to 12 L) of water per day, per member. A.8.10.1 Fire department members should not enter an environment where there is ongoing violence, or the threat of violence such as persons with weapons, without coordination with law enforcement personnel. This does not necessarily limit the ability of cross-trained fire/law enforcement personnel or specialty trained EMS personnel from entering a violent scene to assist the law enforcement or fire department responders. A.8.10.3 Such situations include but are not limited to civil disturbances, fights, violent crimes, drug-related situations, family disturbances, deranged individuals, and people interfering with fire department operations. A.8.10.5 Incidents that appear routine in nature can, after the arrival of responding crews, turn into a violent or hostile environment. A standard communication phrase, known only by communications personnel and other responders, can warn others to the dangers of the situation without triggering violence or hostilities.

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A.9.1.1 Where health, safety, building, and fire codes are not legally applicable to fire department facilities, steps should be taken to ensure that equivalent standards are applied and enforced. In the absence of local requirements, the provisions of NFPA 1, Fire Code; NFPA 70, National Electrical Code; NFPA 101, Life Safety Code; NFPA 5000, Building Construction and Safety Code; the Uniform Plumbing Code; and the Uniform Mechanical Code should be applied. In addition, the workplace safety standards specified in 29 CFR 1910, Occupational Safety and Health Standards, or an equivalent standard should be applied. Applicable requirements of the Americans with Disabilities Act should be met. A.9.1.3 As new stations are constructed or existing stations are renovated, a separation between the apparatus floor and living quarters should be provided. A.9.1.5 The operation of a fire department requires the storage and indoor operation of fire apparatus that are generally housed in an enclosed building. The need to keep the apparatus and other vehicles ready for immediate service and in good operating condition, which requires the indoor running of vehicles for response and routine service/pump checks, makes storage in an enclosed area, such as an apparatus bay, necessary. The exhaust from all internal combustion engines, including diesel and gasoline- powered engines, contains over 100 individual hazardous chemical components that, when combined, can result in as many as 10,000 chemical compounds. A large majority of these compounds are today listed by state and federal regulatory agencies as being cancer causing or suspected carcinogens. The target components listed by NIOSH/OSHA consist of both hydrocarbon carbon components and compounds, which are produced as both gas-phase and particulate-phase compounds. The gases and particulates, which are viewed by NIOSH and OSHA as life threatening, consist of a cancer-causing substance know as polynuclear aromatic hydrocarbons (PAHs). Gases in diesel exhaust, such as nitrous oxide, nitrogen dioxide, formaldehyde, benzene, sulfur dioxide, hydrogen sulfide, carbon dioxide, and carbon monoxide, can also create health problems. According to NIOSH, human and animal studies show that diesel exhaust should be treated as a human carcinogen (cancer-causing substance). In accordance with the NIOSH Pocket Guide to Chemical Hazards, as it pertains to diesel exhaust, NIOSH recommends that occupational exposure to carcinogens be limited to the lowest feasible concentration. NIOSH uses OSHA's classification, outlined in 29 CFR 1990.103, Definitions, which states in part, “Potential occupational carcinogen means any substance, or combination or mixture of substances, which causes an increased incidence of benign and/or malignant neoplasm, or a substantial decrease in the latency period between exposure and onset of neoplasm in humans or in one or more experimental mammalian species as the result of any oral, respiratory or dermal exposure, or any other exposure which results in the induction of tumors at a site other than the site of administration.” This definition also includes any substance that is metabolized into one or more potential occupational carcinogen by mammals. A.9.1.8 As part of the fire station inspection program, the areas around the pole hole and the padding at the bottom of the pole should be regularly checked to ensure the safety of members using the pole. A.9.3 In some jurisdictions, fire department facilities are maintained by other agencies. In these situations, fire departments should develop a process to expedite requests for repairs or modifications to the facility to address safety or health concerns.

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A.10.1.5 If any member, either career or volunteer, reports for duty under the influence of alcohol or drugs, or any other substance that impairs the member's mental or physical capacity, this situation cannot be tolerated. Evidence of substance abuse could include a combination of various factors such as slurred speech, red eyes, dilated pupils, incoherence, unsteadiness on feet, smell of alcohol or marijuana emanating from the member's body, inability to carry on a rational conversation, increased carelessness, erratic behavior, inability to perform a job, or other unexplained behavioral changes. The possibility of liability exists if a member who is under the influence of alcohol or drugs is allowed to remain on duty, to operate or drive vehicles or equipment on duty, or to drive a private vehicle from the duty site. A member who is believed to be under the influence of alcohol or drugs cannot be allowed to operate equipment or drive a vehicle, including a private vehicle, until the condition of the member has been determined and verified. A.10.2.1 Fire departments should consider use of the recruiting, mentoring, and training process found in the physical performance requirements referenced in the IAFF/IAFC Candidate Physical Ability Test (CPAT) Manual. A.10.4.1 The health data base for a fire department should include the reports of regular physical evaluations, injury and illness reports, health exposures, and any supporting information that could be useful in tracking, analyzing, or predicting the health effects of various events on individuals or the group. This process should comply with the medical record-keeping requirements of 29 CFR 1910.120, Hazardous waste operations and emergency response. A.10.4.3 This information should be managed in a manner that respects the confidentiality of doctor-patient relationships. Electronic data processing is often employed to facilitate management of such a data base. A.10.4.4 The fire department should try to obtain autopsy or other medical information for all deceased employees or former employees. This information could be useful in establishing relationships between occupational factors and resulting fatalities at some time in the future. Autopsies for fire fatalities should be conducted and recorded according to a standard protocol. A.10.5.1 Where fire department members routinely respond to emergency medical incidents, the fire department should consult with medical professionals and agencies on measures to limit the exposure of members to infectious and contagious diseases. This should include the provision and maintenance of equipment to avoid or limit direct physical contact with patients, when feasible. A.10.6.3 A fire department physician should have specific expertise and experience relating to the needs of fire department members and a thorough knowledge of the physical demands involved in emergency operations. If possible, the fire department physician should be a specialist in the field of occupational medicine. A.10.6.4 Depending on the size and the needs of a fire department, the fire department physician might or might not be required on a full-time basis. A fire department should have a primary relationship with at least one officially designated physician. This physician can serve as the primary medical contact and, in turn, deal with a number of other physicians and specialists. A large fire department can designate more than one fire department physician or might determine that a relationship with a group practice or multiple-provider system is more appropriate to its needs. In any case, the option to consult with a physician who is particularly aware of the medical needs of fire department members and who is available on an immediate basis should exist.

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A.11.1 The term behavioral health program is recommended in place of the prior designation (member assistance program) to minimize conflation of the services to be delivered with the model of service delivery. The emphasis here is specifically directed toward behavioral health services to be provided, leaving the model for their provision to the discretion of the sponsoring department and its vendors. A.11.1.1 Basic levels of assistance as enumerated in the standard should be available at the first step of access. The objective should be to provide these services in a manner that facilitates ease of access and usage, minimizes delays and obstacles, and encourages proactive utilization. Members and their families should be informed about the program, its services, and how to access its resources, both at the time that they enter the organization and regularly throughout their tenure. The behavioral health assistance program should also serve as a resource for identification of and access to other important community resources such as self-help groups (e.g., Alcoholics Anonymous, Alanon, Alateen), community health resources, parenting resources, and the like. The behavioral health assistance program should articulate with the fire department’s program to address occupational exposure to atypically stressful events (see Chapter 12 ). The fire department behavioral health assistance program does not need to be operated or financed by the fire department. Many community/county/state mental health agencies provide such services and these can be available without charge or at reduced fees. Labor and employee organizations can also sponsor and/or operate such programs. The fire department need have only the ability to identify when pertinent problems exist and be able to provide confidential referral for professional services when indicated. Program standards developed by the Association of Labor-Management Administrators and Consultants on Alcoholism (ALMACA) recommend the following:

(1) The physical location at which services are provided should facilitate easy access while ensuring confidentiality. (2) Medical and disability plans should be reviewed to ensure that plans provide adequate coverage for alcohol, substance, and mental health needs (including, where feasible, outpatient care and day treatment options). (3) Staff should be sufficiently familiar with medical and disability benefit plans to facilitate adequate advising regarding the extent, nature, and cost of the recommended treatment and the reimbursement available.

Primary staff for the program should hold the following:

(1) Appropriate managerial and administrative experience (2) Skill in problem identification, interviewing, client motivation, and appropriate referral (3) Appropriate training, licensure, and certification with respect to any direct clinical or counseling services that can be provided by primary staff

Active and appropriately prepared peer personnel are often critical to the success of a fire service behavioral health program. These personnel serve most effectively as a bridge and a link between the professional services and service providers of the program and their coworkers, friends, and associates. They can service valuable roles in outreach, referral, connection, awareness, and support for those who could benefit from support but might be unaware of its availability, are resistant to seeking help, or are uncertain about its benefits or its confidentiality. With proper training, they can help coworkers evaluate situations, consider alternatives, and access resources. Preparation should include training regarding resources, protocols, and procedures related to program, listening skills, referral skills, and appropriate elements of program content for outreach and education. Preparation should emphasize boundaries between peer roles and staff responsibilities, especially with respect to counseling and intervention. It is important that members and their families are informed about the program and the services it offers and are continually updated on its existence, availability, and confidentiality. Information about the program should be made available to all new members and their families.

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A.11.1.2 Referrals for specialty care should be made whenever a member or family requires treatment beyond primary counseling. Specialists receiving referrals should be fully licensed and certified to provide care consistent with appropriate standards (e.g., American Society of Addiction Medicine for alcohol and substance abuse treatment; the American Association for Marriage and Family Therapy for family and relationship issues) and current guidelines for evidence-based practice in the treatment of clinical diagnoses (e.g., published reviews of the Cochrane Collaboration). A.11.1.3 Policies should recognize the impacts of addictions on job performance, safety, and quality of life and emphasize the need for proactive efforts in treatment and rehabilitation. Responsibilities of management, member organizations, and members as they relate to the policy should be clearly delineated. Prerogatives of management and responsibilities of member organizations should not be altered or abridged by the policies enacted. Participation in assistance programs should not affect future service or career advancement, nor should participation protect the member from disciplinary action for sustained substandard job performance or infractions of department regulations. Joint sponsorship by management and member organizations is highly desirable, and cooperative action in administration of the policy is encouraged. A.11.1.4 Adherence to federal regulations regarding confidentiality of alcohol and other drug abuse records is required of programs receiving federal funds, directly or indirectly. Compliance with all aspect of the Health Information Portability and Accountability Act (HIPAA) is also required. A.11.2.1 Components of a prevention and health promotion program include cardiac risk reduction, smoking/tobacco cessation, blood pressure regulation, strength and aerobic physical fitness training, nutrition, stress management, diabetes prevention, metabolic syndrome prevention, weight management or control, and so forth, and should provide education and counseling for the purpose of preventing health problems and enhancing overall well-being. A.11.2.2 The fire department should develop a policy on the use of tobacco products for all members. The fire department should also develop a policy on the acceptance of new members into the fire department with regard to the use of tobacco products. A.12.1 Substantial research has been conducted and reported since the last revision of this standard respecting occupational exposure to atypically stressful events and interventions directed toward mitigating their impact. Certain well-engrained approaches, most specifically critical incident stress debriefing (CISD), have not been shown to be effective in controlled studies and have been reported to have resulted in paradoxical, adverse outcomes for at least some participants. A number of authoritative guidelines now recommend against routine debriefing. Accordingly, this revision specifically deletes reference to CISD/CISM (critical incident stress management) as a required or desirable intervention and shifts its emphasis toward the use of professional services. A.12.1.2 The fire department’s written policy should indicate the responsibilities of the organization, its officers, and its members in ensuring that the impact of occupational events is systematically anticipated and considered. The policy should enhance support from officers, supervisors, and peers and full integration where indicated with the department’s behavioral health assistance program (Chapter 11 ). Examples of atypically stressful events include mass casualty incidents, fire fighter line of duty fatality, or any other circumstance that falls outside the ordinary experience of its members. A.12.1.3.3 Examples of licensed and certified specialists include psychiatrists, psychologists, and clinical social workers.

Statement of Problem and Substantiation for Public Input

This is the explanatory information for the proposed section 8.X.1.

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Submitter Information Verification

Submitter Full Scott Kerwood Name: Organization: Hutto Fire Rescue International Association of Fire Chiefs - Safety, Health and Survival Affilliation: Section Street Address: City: State: Zip: Submittal Date: Mon Feb 16 22:10:51 EST 2015

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Public Input No. 26-NFPA 1500-2015 [ Section No. A.6.3.1 ]

A.6.3.1 It is intended that the requirements of Section 6.3 apply to all situations when persons or members are riding on fire apparatus other than for the specific variances in 6.3.4 and 6.3.5. Included in the “seated and belted” requirement are any times the fire apparatus is traveling to, participating in, or returning from any funeral, parade, or public relations/education event. Fire fighters cannot be allowed to ride on the outside of apparatus in order to fight wildland fires unless it is in an NFPA 1906 compliant riding position . The Fire Line Safety Committee (FLSC) of the National Wildfire Coordinating Group (NWCG) represents the U.S. Forest Service, Bureau of Land Management, Bureau of Indian Affairs, Fish and Wildlife Agency, National Park Service, and National Association of State Foresters. Their position is that the practice of fire fighters riding on the outside of vehicles and fighting wildland fires from these positions is very dangerous, and they strongly recommend this not be allowed. One issue is the exposure to personnel in unprotected positions. Persons have been killed while performing this operation. Also, the vehicle driver's vision is impaired. The second issue is that this is not an effective way to extinguish the fire, as it can allow the vehicle to pass over or by areas not completely extinguished. Fire can then flare up underneath or behind the vehicle and could cut off escape routes. The FLSC and the NWCG strongly recommend The use of a moving apparatus to fight wildland fires must be undertaken only after careful deliberation, preparation, and training. Whether riding on the apparatus in an NFPA 1906 compliant On-Board Pump-and-Roll Fire-Fighting Position, or walking alongside the apparatus while it is moving, it is essential that the driver and the firefighters remain in constant contact and coordination. The decision to allow fire suppression using a moving apparatus, and the method employed, should consider the terrain, fuel load, weather, wind direction, and other factors. Fire suppression using a moving apparatus with personnel outside the cab should only be attempted when the terrain is even and the fire advance is predictable. Always plan for a route of escape in the event of an unanticipated shift in wind. If the walking alongside method is selected, the Fire Line Safety Committee (FLSC) of the National Wildfire Coordinating Group (NWCG) recommends that two fire fighters, each with a hose line, walk ahead and aside of the vehicle's vehicle’s path, both fire fighters on the same side of the vehicle (not one on each side), in clear view of the driver, with the vehicle being driven in uninvolved terrain. This allows the fire fighters to operate in an unhurried manner, with a clear view of fire conditions and the success of the extinguishment. Areas not extinguished should not be bypassed unless follow-up crews are operating behind the lead unit and there is no danger to escape routes or to personnel. If the On-Board Pump-and-Roll Fire-Fighting Position method is selected, the department should follow the guidance found in the body of this standard. Develop and train on safe and effective methods of operation that may include only operating the apparatus on the burned portion of the terrain and using multiple following apparatus to suppress missed areas and perform mop-up. Just like when using the walking alongside method, areas not extinguished should not be bypassed unless follow-up crews are operating behind the lead unit and there is no danger to escape routes or to personnel. Fire departments faced with the need to perform wildand fire suppression from a moving apparatus should also consider the use of a bumper or roof mounted remote control turret. This device can be operated from inside the cab during pump and roll operations. Advances in turret control technology produce a very quick and responsive control that may provide an alternative to having firefighters operating outside of the cab.

Statement of Problem and Substantiation for Public Input

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This annex text revision is required to support the change to paragraph 6.3.1 in the body.

Related Public Inputs for This Document

Related Input Relationship Public Input No. 25-NFPA 1500-2015 [Section No. 6.3]

Submitter Information Verification

Submitter Full Name: J. Lackore Organization: Oshkosh Corporation Street Address: City: State: Zip: Submittal Date: Mon Feb 09 11:18:38 EST 2015

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Public Input No. 75-NFPA 1500-2015 [ Section No. A.6.3.1 ]

Statement of Problem and Substantiation for Public Input

Organizational update

Submitter Information Verification

Submitter Full Name: WILLIAM YOHN Organization: US DEPARTMENT OF THE INTERIOR Street Address: City: State: Zip: Submittal Date: Mon Jun 22 17:49:56 EDT 2015

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Public Input No. 49-NFPA 1500-2015 [ Section No. A.7.1.4 ]

A.7.1.4 Because it is impossible to ensure that every member — whether a volunteer, call, or off-duty career member — will respond to an incident in a station/work uniform or will change into station/work uniform clothing before donning protective garments, it is very important that members understand the hazards of some fabrics that more easily melt, drip, burn, shrink, or transmit heat rapidly and cause burns to the wearer. Clothing made from 100 percent natural fibers or blends that are principally natural fibers should be selected over other fabrics that have poor thermal stability or that ignite easily. The very fact that members are fire fighters indicates that all clothing that they wear should be inherently flame resistant (as children's sleepwear is required to be) to give a degree of safety if unanticipated happenings occur that expose the clothing to flame, flash, sparks, or hot substances.

Statement of Problem and Substantiation for Public Input

TG Public Input

Submitter Information Verification

Submitter Full Name: David Bernzweig Organization: Columbus (OH) Division of Fire Street Address: City: State: Zip: Submittal Date: Wed Feb 11 16:05:32 EST 2015

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Public Input No. 153-NFPA 1500-2015 [ Section No. A.7.10.7 ]

A.7.10.7 Hazardous atmospheres requiring SCBA can be found in, but are not limited to, the following operations: structural fire fighting, overhaul in the post-fire environment, aircraft fire fighting, shipboard fire fighting, confined space rescue, and any incident involving hazardous materials.

Statement of Problem and Substantiation for Public Input

Supplied air is the most appropriate level of respiratory protection in the post-fire environment.

Submitter Information Verification

Submitter Full Name: DAVID BERNZWEIG Organization: Ohio Association of Professional Firefighters Street Address: City: State: Zip: Submittal Date: Mon Jul 06 23:41:58 EDT 2015

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Public Input No. 104-NFPA 1500-2015 [ New Section after A.7.12.3.3 ]

7.12.3.4 When a NFPA 1984 compliant respirator is not available, the AHJ shall conduct a risk analysis to determine an appropriate NIOSH-approved respirator to be used during wildland firefighting operations for the environment where it will be used.

Statement of Problem and Substantiation for Public Input

NFPA 1500 TG Proposal. Needed to address that current lack of NFPA 1984 approved respirators.

Submitter Information Verification

Submitter Full Name: DAVID BERNZWEIG Organization: Ohio Association of Professional Firefighters Street Address: City: State: Zip: Submittal Date: Mon Jul 06 14:52:42 EDT 2015

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Public Input No. 21-NFPA 1500-2014 [ Section No. A.7.15.11 ]

A.7.15.11 Table Table A.7.15.11 shows the approximate the pressures associated with the 600 L 50% minimums when exiting procedures should have already begun to take place. Table A.7.15.11 Pressure Associated with 600 L 50% Minimum Exit Volume

2216 psi 3000 psi 4500 psi 30 minute /1200 L

1100 1108 psi NA 1500 psi 2250 psi 30 minute /1700 L

NA 1108 psi 1050 1500 psi NA 2250 psi 45 minute /1800 L

750 1108 psi NA 1500 psi 2250 psi 60 minute /2400 L

550 1108 psi NA 1500 psi 1100 2250 psi

NA: Not applicable.

Statement of Problem and Substantiation for Public Input

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Keeps annex in line with main body of document.

Submitter Information Verification

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Public Input No. 16-NFPA 1500-2014 [ Chapter G ]

Annex G Informational References G.1 Referenced Publications. The documents or portions thereof listed in this annex are referenced within the informational sections of this standard and are not part of the requirements of this document unless also listed in Chapter 2 for other reasons.

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G.1.1 NFPA Publications.

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National Fire Protection Association, 1 Batterymarch Park, Quincy, MA 02169-7471. NFPA 1, Fire Code, 2012 edition 2015 . NFPA 10, Standard for Portable Fire Extinguishers, 2010 edition 2017 . NFPA 25, Standard for the Inspection, Testing, and Maintenance of Water-Based Fire Protection Systems, 2011 edition 2017 . NFPA 30, Flammable and Combustible Liquids Code, 2012 edition 2015 .

NFPA 70 ®, National Electrical Code ®, 2011 edition 2017 .

NFPA 72 ®, National Fire Alarm and Signaling Code, 2013 edition 2016 .

NFPA 101 ®, Life Safety Code ®, 2012 edition 2015 . NFPA 241, Standard for Safeguarding Construction, Alteration, and Demolition Operations, 2009 edition 2013 . NFPA 403, Standard for Aircraft Rescue and Fire-Fighting Services at Airports, 2009 edition 2014 . NFPA 472, Standard for Competence of Responders to Hazardous Materials/Weapons of Mass Destruction Incidents, 2013 edition . NFPA 473, Standard for Competencies for EMS Personnel Responding to Hazardous Materials/Weapons of Mass Destruction Incidents, 2013 edition . NFPA 704, Standard System for the Identification of the Hazards of Materials for Emergency Response, 2012 edition 2017 . NFPA 901, Standard Classifications for Incident Reporting and Fire Protection Data, 2011 edition 2016 . NFPA 1001, Standard for Fire Fighter Professional Qualifications, 2013 edition . NFPA 1002, Standard for Fire Apparatus Driver/Operator Professional Qualifications, 2009 edition 2017 . NFPA 1003, Standard for Airport Fire Fighter Professional Qualifications, 2010 edition 2015 . NFPA 1006, Standard for Technical Rescuer Professional Qualifications, 2008 edition 2017 . NFPA 1021, Standard for Fire Officer Professional Qualifications, 2009 edition 2014 . NFPA 1041, Standard for Fire Service Instructor Professional Qualifications, 2012 edition . NFPA 1051, Standard for Wildland Fire Fighter Professional Qualifications, 2012 edition 2016 . NFPA 1071, Standard for Emergency Vehicle Technician Professional Qualifications, 2011 edition 2016 . NFPA 1250, Recommended Practice in Fire and Emergency Services Organization Risk Management, 2010 edition 2015 . NFPA 1221, Standard for the Installation, Maintenance, and Use of Emergency Services Communications Systems, 2013 edition 2016 . NFPA 1401, Recommended Practice for Fire Service Training Reports and Records, 2012 edition 2017 . NFPA 1403, Standard on Live Fire Training Evolutions, 2012 edition 2017 . NFPA 1404, Standard for Fire Service Respiratory Protection Training, 2006 edition 2013 . NFPA 1405, Guide for Land-Based Fire Departments That Respond to Marine Vessel Fires, 2011 edition 2016 . NFPA 1451, Standard for a Fire Service Vehicle Operations Training Program, 2007 edition 2013 . NFPA 1521, Standard for Fire Department Safety Officer, 2008 edition 2015 . NFPA 1561, Standard on Emergency Services Incident Management System, 2008 edition 2014 . NFPA 1581, Standard on Fire Department Infection Control Program, 2010 edition 2015 . NFPA 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments, 2013 edition . NFPA 1583, Standard on Health-Related Fitness Programs for Fire Department Members, 2008 edition 2015 .

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NFPA 1584, Standard on the Rehabilitation Process for Members During Emergency Operations and Training Exercises, 2008 edition 2015 . NFPA 1620, Standard for Pre-Incident Planning, 2010 edition 2017 . NFPA 1710, Standard for the Organization and Deployment of Fire Suppression Operations, Emergency Medical Operations, and Special Operations to the Public by Career Fire Departments, 2010 edition 2016 . NFPA 1851, Standard on Selection, Care, and Maintenance of Protective Ensembles for Structural Fire Fighting and Proximity Fire Fighting, 2008 edition 2014 . NFPA 1901, Standard for Automotive Fire Apparatus, 2009 edition 2016 . NFPA 1906, Standard for Wildland Fire Apparatus, 2012 edition 2016 . NFPA 1911, Standard for the Inspection, Maintenance, Testing, and Retirement of In-Service Automotive Fire Apparatus, 2012 edition 2017 . NFPA 1912, Standard for Fire Apparatus Refurbishing, 2011 edition 2016 . NFPA 1925, Standard on Marine Fire-Fighting Vessels, 2008 edition 2013 . NFPA 1931, Standard for Manufacturer's Design of Fire Department Ground Ladders, 2010 edition 2015 . NFPA 1932, Standard on Use, Maintenance, and Service Testing of In-Service Fire Department Ground Ladders, 2010 edition 2015 . NFPA 1936, Standard on Powered Rescue Tools, 2010 edition 2015 . NFPA 1951, Standard on Protective Ensembles for Technical Rescue Incidents, 2013 edition . NFPA 1961, Standard on Fire Hose, 2013 edition . NFPA 1962, Standard for the Inspection, Care, and Use of Fire Hose, Couplings, and Nozzles and the Service Testing of Fire Hose, 2008 edition 2013 . NFPA 1964, Standard for Spray Nozzles, 2008 edition 2013 . NFPA 1971, Standard on Protective Ensembles for Structural Fire Fighting and Proximity Fire Fighting, 2013 edition . NFPA 1975, Standard on Station/Work Uniforms for Emergency Services, 2009 edition 2014 . NFPA 1977, Standard on Protective Clothing and Equipment for Wildland Fire Fighting, 2011 edition 2016 . NFPA 1981, Standard on Open-Circuit Self-Contained Breathing Apparatus (SCBA) for Emergency Services, 2007 edition 2013 . NFPA 1982, Standard on Personal Alert Safety Systems (PASS), 2007 edition 2013 . NFPA 1983, Standard on Life Safety Rope and Equipment for Emergency Services, 2012 edition 2017 . NFPA 1989, Standard on Breathing Air Quality for Emergency Services Respiratory Protection, 2008 edition 2013 . NFPA 1991, Standard on Vapor-Protective Ensembles for Hazardous Materials Emergencies, 2005 edition 2016 . NFPA 1992, Standard on Liquid Splash-Protective Ensembles and Clothing for Hazardous Materials Emergencies, 2012 edition 2017 . NFPA 1994, Standard on Protective Ensembles for First Responders to CBRN Terrorism Incidents, 2012 edition 2017 . NFPA 1999, Standard on Protective Clothing for Emergency Medical Operations, 2008 edition 2013 .

NFPA 5000 ®, Building Construction and Safety Code ®, 2012 edition 2015 . NFPA Fire Protection Handbook, 20th edition, 2008. G.1.2 Other Publications.

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G.1.2.1 ASTM Publications. ASTM International, 100 Barr Harbor Drive, P.O. Box C700, West Conshohocken, PA 19428-2959. ASTM F 739, Standard Test Method for Resistance of Protective Clothing Materials to Permeation by Liquids or Gases Under Conditions of Continuous Contact, 1999 2012 . ASTM F 903, Standard Test Method for Resistance of Materials Used in Protective Clothing to Penetration by Liquids, 2004 2010 . ASTM F 1052, Standard Test Method for Pressure Testing Vapor Protective Ensembles, 2002 2014 . ASTM F 1359/F 1359M , Standard Test Method for Liquid Penetration Resistance of Protective Clothing or Protective Ensembles Under a Shower Spray While on a Mannequin, 2004 2013 . G.1.2.2 Federal Emergency Management Agency, United States Fire Administration Publications. U.S. Fire Administration, 16825 S. Seaton Avenue, Emmitsburg, MD 21727. Also at http://www.usfa.fema.gov/ FA-118, Fire and Emergency Service Hearing Conservation Program Manual, 1991. FA-220, Firefighter Fatality Retrospective Study, 2002. FA-248, Safe Operation of Fire Tankers, 2003. FA-272, Emergency Vehicle Safety Initiative, 2004. G.1.2.3 IAFF/IAFC Publications. (IAFF) 1750 New York Avenue, NW, Washington, DC 20006; (IAFC) 4025 Fair Ridge Drive, Fairfax, VA 22033-2868. The IAFF/IAFC Fire Service Joint Labor Management Candidate Physical Ability Test (CPAT) Manual. G.1.2.4 IAPMO Publications. International Association of Plumbing and Mechanical Officials, 5001 4755 E. Philadelphia Street, Ontario, CA 91761. Uniform Mechanical Code, 2003. Uniform Plumbing Code, 2003 IAPMO UMC , 2012 . IAPMO UPC CD , 2012 . G.1.2.5 ICMA Publications. International City/County Management Association, 777 North Capitol Street N.E., Suite 500, Washington, DC 20002-4201 . Managing Fire and Rescue Services, 2002 2012 . G.1.2.6 NFSIMSC Publications. Fire Protection Publications, Oklahoma State University, Stillwater, OK 74078. National Fire Service Incident Management System Consortium (NFSIMSC), “Model Procedures Guide for Highway Incidents,” 1st edition, 2004. G.1.2.7 NTIMC Publications. National Traffic Incident Management Coalition, 444 N Capitol St. NW — N . W ., Suite 249 — , Washington, DC 20001, National Unified Goal, 2007 2008 . G.1.2.8 NWCG (National Wildfire Coordinating Group) Publications. National Interagency Fire Center Publications, Great Basin Cache Supply Office, 3833 S. Development Avenue, Boise, ID 83705-5354 . NWCG-NFES No. 1077, Incident Response Pocket Guide, January 2004, (Superseded by PMS-461) . NWCG-PMS 210, Wildland Fire Incident Management Field Guide, 2014 (Supersedes PMS-410-1). NWCG-PMS 310-1, Wildland Fire Qualification System Guide, 2011 2014 . NWCG-PMS 410-1, Fireline Handbook, 2004. NWCG-PMS 461, Incident Response Pocket Guide, 2014 (Supersedes PMS-410-1).

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G.1.2.9 USDA Forest Service Publications. Missoula Technology and Development Center (MTDC), 5785 Highway 10 West, Missoula, MT 59808-9361. USDA Forest Service Specification 5100-606 608c , Shelter Fire, M-2002 2009 . G.1.2.10 U.S. DOT Publications. American Association of State Highway and Transportation Officials, 444 North Capitol Street, NW, Suite 249, Washington, DC 20001. Also at http://mutcd.fhwa.dot.gov/index.htm Manual on Uniform Traffic Control Devices for Streets and Highways, 2003 2012 . G.1.2.11 U.S. Government Publications. U.S. Government Printing Government Publishing Office, Washington, DC 20402. Americans with Disabilities Act, 1992. Federal Register, Vol. 59, 38028, July 26, 1994. Federal Register, Vol. 64, 56243, October 18, 1999. General Services Administration, Federal Specification for the “Star-of-Life Ambulance,” KKK-A-1822E, June 1, 2002. NIOSH Pocket Guide to Chemical Hazards, U.S. Department of Health and Human Services, Public Health Services, Publication DHHS No. 85 2005 - 114 149 , September 1985 2005 . NIOSH Respirator User Notice of December 7, 1999. NIOSH Standard for Chemical, Biological, Radiological, and Nuclear (CBRN) Full Facepiece Air Purifying Respirator (APR), March 2003. Title 29, Code of Federal Regulations, Part 1910, Occupational Safety and Health Standards. Title 29, Code of Federal Regulations, Part 1910.95, Occupational noise exposure, 1996 2008 . Title 29, Code of Federal Regulations, Part 1910.120, Hazardous waste operations and emergency response, 2002 2013 . Title 29, Code of Federal Regulations, Part 1910.1030, Bloodborne Pathogen Standard, 2012 . Title 29, Code of Federal Regulations, Part 1910.134, Respiratory protection, 1998 2012 . Title 29, Code of Federal Regulations, Part 1990.103, Definitions, 2004. Title 40, Code of Federal Regulations, Part 311, Worker protection, June 1989. G.1.2.12 Other Publications. Selkirk, G. A., T. M. McLellan, and J. Wong, “Active Versus Passive Cooling During Work in Warm Environments While Wearing Firefighting Protective Clothing,” Journal of Occupational and Environmental Hygiene, 1:521–531. G.2 Informational References. The following documents or portions thereof are listed here as informational resources only. They are not a part of the requirements of this document. LeCuyer, John. Designing the Fitness Program: A Guide for Public Safety Organizations, PennWell Corporation, Saddle Brook, NJ, 2001. G.3 References for Extracts in Informational Sections. NFPA 1991, Standard on Vapor-Protective Ensembles for Hazardous Materials Emergencies, 2005 edition 2016 .

Statement of Problem and Substantiation for Public Input

Referenced current addresses, and editions.

Related Public Inputs for This Document

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Related Input Relationship Public Input No. 15-NFPA 1500-2014 [Chapter 2] Referenced current editions.

Submitter Information Verification

Submitter Full Name: Aaron Adamczyk Organization: [ Not Specified ] Street Address: City: State: Zip: Submittal Date: Fri Jun 27 18:12:57 EDT 2014

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Public Input No. 139-NFPA 1582-2015 [ Global Input ]

Use the latest AHA ASCVD calculator, available at http://tools.cardiosource.org/ASCVD- Risk-Estimator/, for all the cardiovascular risk assessment, instead of the Framingham risk scores.

Statement of Problem and Substantiation for Public Input

The AHA calculator is recent and recommended by AHA.

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 21:03:56 EDT 2015

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Public Input No. 42-NFPA 1582-2015 [ Global Input ]

Should we make a global change to the term "Fire Department" to "Fire and Emergency Services Organization" as used in other NFPA standards to make these documents more useful to a wider audience

Statement of Problem and Substantiation for Public Input

I believe the NFPA standards are useful to all public safety and emergency service organizations. This broader description provides opportunities to other emergency service groups to utilize the great work of the standards council and the committee members.

Submitter Information Verification

Submitter Full Name: KENNETH PRAVETZ Organization: CITY OF VIRGINIA BEACH FIRE DEPARTMENT Street Address: City: State: Zip: Submittal Date: Mon Apr 06 14:30:21 EDT 2015

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Public Input No. 70-NFPA 1582-2015 [ Global Input ]

Standards for incumbents and members should not be different.

Statement of Problem and Substantiation for Public Input

The current double standards for members and applicants is in violation of ADA. It is also not supported by good medicine or science. Medical standards should be defined by job functions, not by status (applicant vs. member). I recommend consultation with NFPA attorneys.

Accommodation may be different for members and applicants. Accommodation is an administrative decision (from the AHJ), and not a medical decision.

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 14:25:33 EDT 2015

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Public Input No. 71-NFPA 1582-2015 [ Global Input ]

Chapters 6 and 9 should be moved to be next to each other.

The topics (cardiovascular, pulmonary...) should be in the same order and have similar numbering in chapter 6 and 9.

Statement of Problem and Substantiation for Public Input

These changes would make the document easier to use.

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 14:35:03 EDT 2015

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Public Input No. 72-NFPA 1582-2015 [ Global Input ]

Remove annex C from NFPA 1582 (and keep the reference to NFPA 1583)

Statement of Problem and Substantiation for Public Input

That change would make the document easier to use by removing 14 pages.

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 14:37:50 EDT 2015

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Public Input No. 50-NFPA 1582-2015 [ Section No. 1.1.2 ]

1.1.2 This standard provides information and guidance for physicians and other health care providers responsible for fire department occupational medical programs.

Statement of Problem and Substantiation for Public Input

NFPA 1582 goes beyond providing information.

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jun 21 16:27:24 EDT 2015

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Public Input No. 53-NFPA 1582-2015 [ Section No. 1.1.3 ]

1.1.3 These requirements are applicable to public, governmental, military, private, and industrial fire department organizations providing rescue, fire suppression, emergency medical services, hazardous materials mitigation, special operations, and other emergency services.

Statement of Problem and Substantiation for Public Input

Fire suppression is the occupational criteria behind NFPA 1582. Employees who are only providing emergency medical services should not be covered by NFPA 1582 -- to be consistent with Chapter 5.

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND St Joseph Medical Center Street Address: City: State: Zip: Submittal Date: Sun Jun 21 16:36:11 EDT 2015

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Public Input No. 29-NFPA 1582-2014 [ Chapter 2 ]

Chapter 2 Referenced Publications 2.1 General. The documents or portions thereof listed in this chapter are referenced within this standard and shall be considered part of the requirements of this document. 2.2 NFPA Publications. National Fire Protection Association, 1 Batterymarch Park, Quincy, MA 02169-7471. NFPA 1001, Standard for Fire Fighter Professional Qualifications, 2013 edition . NFPA 1002, Standard for Fire Apparatus Driver/Operator Professional Qualifications,2009 edition 2017 . NFPA 1003, Standard for Airport Fire Fighter Professional Qualifications,2010 edition 2015 . NFPA 1006, Standard for Technical Rescuer Professional Qualifications,2008 edition 2017 . NFPA 1021, Standard for Fire Officer Professional Qualifications,2009 edition 2014 . NFPA 1051, Standard for Wildland Fire Fighter Professional Qualifications,2012 edition 2016 . NFPA 1500, Standard on Fire Department Occupational Safety and Health Program, 2013 edition . NFPA 1561, Standard on Emergency Services Incident Management System,2008 edition 2016 . NFPA 1581, Standard on Fire Department Infection Control Program,2010 edition 2015 . NFPA 1583, Standard on Health-Related Fitness Programs for Fire Department Members,2008 edition 2015 . NFPA 1584, Standard on the Rehabilitation Process for Members During Emergency Operations and Training Exercises,2008 edition 2015 . 2.3 Other Publications. 2.3.1 ANSI Publications. American National Standards Institute, Inc., 25 West 43rd Street, 4th Floor, New York, NY 10036. ANSI Z24.5, Audiometric Device Testing, 1951. 2.3.2 CDC Publications. Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333. “Measles, Mumps, and Rubella — Vaccine Use and Strategies for Elimination of Measles, Rubella, and Congenital Rubella Syndrome and Control of Mumps: Recommendations of the Advisory Committee on Immunization Practices (ACIP),” Morbidity and Mortality Weekly Report, May 19, 1998, 47 (No. RR-8): 1-57. “Poliomyelitis Prevention in the United States: Updated Recommendations of the Advisory Committee on Immunization Practices (ACIP),” Morbidity and Mortality Weekly Report, 49(No. RR-5):1-22, May 19, 2000.

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2.3.3 U.S. Government Publications. U.S. Government Printing Office, Washington, DC 20402. Title 29, Code of Federal Regulations, Part 1910.95, “Occupational noise exposure,” 1996 2008 . Title 29, Code of Federal Regulations, Part 1910.120, “Hazardous waste operations and emergency response,” 2002 2013 . Title 29, Code of Federal Regulations, Part 1910.134, “Respiratory protection,” 1998 2012 . Title 29, Code of Federal Regulations, Part 1910.1020, “Access to employee exposure and medical records.” 1996 2011 . Title 29, Code of Federal Regulations, Part 1910.1030, “Bloodborne pathogens,” 2001 2012 . U.S. Dept. of Health & Human Services, National Heart, Lung and Blood Institute, Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7), 2004 U.S. Dept. of Health & Human Services, National Heart Lung and Blood Institute, Guidelines for the Diagnosis and Management of Asthma (EPR-3), June 2007. 2.3.4 Other Publications. International Council of Ophthalmology, “International Clinical Diabetic Retinopathy Disease Severity Scale,” San Francisco, CA, October 2002, http://www.icoph.org/standards/pdrdetail.html. Merriam-Webster's Collegiate Dictionary, 11th edition, Merriam-Webster, Inc., Springfield, MA, 2003. 2.4 References for Extracts in Mandatory Sections. NFPA 1500, Standard on Fire Department Occupational Safety and Health Program, 2013 edition .

Statement of Problem and Substantiation for Public Input

Referenced current editions.

Related Public Inputs for This Document

Related Input Relationship Public Input No. 30-NFPA 1582-2014 [Chapter F]

Submitter Information Verification

Submitter Full Name: Aaron Adamczyk Organization: [ Not Specified ] Street Address: City: State: Zip: Submittal Date: Fri Jun 27 21:36:29 EDT 2014

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Public Input No. 52-NFPA 1582-2015 [ Section No. 2.3.4 ]

2.3.4 Other Publications. International Council of Ophthalmology, “International Clinical Diabetic Retinopathy Disease Severity Scale,” San Francisco, CA, October 2002, http://www.icoph.org/standards/pdrdetail.html. Merriam-Webster's Collegiate Dictionary, 11th edition, Merriam-Webster, Inc., Springfield, MA, 2003.

Statement of Problem and Substantiation for Public Input

"Other Publications" and the rest of the paragraph should not be on the same line, to be consistent with the rest of the chapter.

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND St Joseph Medical Center Street Address: City: State: Zip: Submittal Date: Sun Jun 21 16:32:54 EDT 2015

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Public Input No. 4-NFPA 1582-2013 [ Section No. 3.3.12 ]

3.3.12 Infection Control Program. The fire department's formal policy and implementation of procedures relating to the control of infectious and communicable disease hazards where employees, patients, or the general public could be exposed to blood, body fluids, or other potentially infectious materials in the fire department work environment. [1500, 2013] Need to add - airborne and droplet transmitted diseases as taken from the new Ryan White Disease List published 11/2/11 in the Federal Register

Statement of Problem and Substantiation for Public Input

The Ryan White Law , Part G added several new diseases under airborne and droplet transmission that need to be included for full post exposure coverage for Fire/EMS personnel. This was published in the Federal Register on 11/2/11

Submitter Information Verification

Submitter Full Name: KATHERINE WEST Organization: Infection Control/Emerging Concepts Street Address: City: State: Zip: Submittal Date: Wed Aug 14 08:22:22 EDT 2013

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Public Input No. 54-NFPA 1582-2015 [ Section No. 4.2.1 ]

4.2.1 The fire department physician shall fulfill the following responsibilities:

(1) Understand the physiological, psychological, and environmental demands placed on fire fighters (2) Evaluate fire department candidates and members to identify medical conditions that could affect their ability to safely respond to and participate in emergency operations (3) Utilize the essential job task descriptions supplied by the fire department to determine a candidate's or a member's medical certification (4) Identify and report the presence of Category A or disqualifying Category B medical conditions if present in candidates (5) Inform the fire chief or his/her designee whether or not the candidate or current member is medically certified to safely perform the essential job tasks (6) Report the results of the medical evaluation to the candidate or current member, including any medical condition(s) identified during the medical evaluation, and the recommendation as to whether the candidate or current member is medically certified to safely perform the essential job tasks (7) Forward copies of any abnormal results along with patient instructions regarding primary care follow-up to candidates or current members who were instructed to seek (as appropriate) medical follow-up to address any medical conditions, or lab abnormalities, identified during the medical evaluation (8) Review results of the annual occupational fitness evaluation as described in Chapter 8 (9) Provide or arrange for a prescriptive rehabilitation and/or fitness program when indicated to aid a member's recovery from illness or injury and enhance his/her ability to safely perform essential job tasks (10) Participate in injury prevention and health promotion programs for fire fighters

Statement of Problem and Substantiation for Public Input

These are important activities that should be outlined in NFPA 1582.

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND St Joseph Medical Center Street Address: City: State: Zip: Submittal Date: Sun Jun 21 16:41:14 EDT 2015

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Public Input No. 5-NFPA 1582-2013 [ Section No. 4.3 ]

4.3 Candidate and Member Responsibilities. Each candidate or member shall adhere to the following requirements:

(1) Cooperate, participate, and comply with the medical evaluation process (2) Provide complete and accurate information to the fire department physician and other authorized medical care provider(s) (3) Report any occupational exposure such as exposure to hazardous materials or toxic substances and exposure to infectious or contagious diseases (4) Report to the fire department physician any medical condition that could interfere with the ability of the individual to safely perform essential job tasks, such as illness or injury, use of prescription or nonprescription drugs, and pregnancy

Provide records of all childhood diseases and vaccinations/immunizations as part of the hiring process

Statement of Problem and Substantiation for Public Input

OSHA is enforcing the CDC guidelines for vaccination/immunizations for healthcare personnel. Fire/EMS are listed in the definition of health care worker in CDC, and OSHA standards. The vaccine and immunization guidelines were published by the CDC in MMWR publication - November, 2011.

Definition on page 2, requirement for secure computerized records on page 3 - this is to have the Designated Officer able to "jump" start proper post exposure medical follow up.

Submitter Information Verification

Submitter Full Name: KATHERINE WEST Organization: Infection Control/Emerging Concepts Street Address: City: State: Zip: Submittal Date: Wed Aug 14 08:28:11 EDT 2013

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Public Input No. 55-NFPA 1582-2015 [ Section No. 4.4.1 ]

4.4.1 * Specific information concerning medical diagnosis shall be released by the fire department physician only with written permission from the candidate or member and/or as required by law .

Statement of Problem and Substantiation for Public Input

Consistency with existing laws (eg, "law enforcement" exception to HIPAA, or court order)

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND St Joseph Medical Center Street Address: City: State: Zip: Submittal Date: Sun Jun 21 16:44:56 EDT 2015

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Public Input No. 56-NFPA 1582-2015 [ Section No. 5.1.1 ]

5.1.1 The fire department shall evaluate the following 13 essential job tasks against the types and levels of emergency services provided to the local community by the fire department, the types of structures and occupancies in the community, and the configuration of the fire department to determine the essential job tasks of fire department members and candidates:

(1) * While wearing personal protective ensembles and self-contained breathing apparatus (SCBA), performing fire-fighting tasks (e.g., hoseline operations, extensive crawling, lifting and carrying heavy objects, ventilating roofs or walls using power or hand tools, forcible entry), rescue operations, and other emergency response actions under stressful conditions including working in extremely hot or cold environments for prolonged time periods (2) Wearing an SCBA, which includes a demand valve–type positive-pressure facepiece or HEPA filter masks, which requires the ability to tolerate increased respiratory workloads (3) Exposure to toxic fumes, irritants, particulates, biological (infectious) and nonbiological hazards, and /or heated gases, despite the use of personal protective ensembles and SCBA (4) Depending on the local jurisdiction, climbing six or more flights of stairs while wearing a fire protective ensemble, including SCBA, weighing at least 50 lb (22.6 kg) or more and carrying equipment/tools weighing an additional 20 to 40 lb (9 to 18 kg) (5) Wearing a fire protective ensemble, including SCBA, that is encapsulating and insulated, which will result in significant fluid loss that frequently progresses to clinical dehydration and can elevate core temperature to levels exceeding 102.2°F (39°C) (6) While wearing personal protective ensembles and SCBA, searching, finding, and rescue-dragging or carrying victims ranging from newborns to adults weighing over 200 lb (90 kg) to safety despite hazardous conditions and low visibility

1 (7) While wearing personal protective ensembles and SCBA, advancing water-filled hoselines up to 2 ⁄2 in. (65 mm) in diameter from fire apparatus to occupancy [approximately 150 ft (50 m)], which can involve negotiating multiple flights of stairs, ladders, and other obstacles (8) While wearing personal protective ensembles and SCBA, climbing ladders, operating from heights, walking or crawling in the dark along narrow and uneven surfaces that might be wet or icy, and operating in proximity to electrical power lines or other hazards (9) Unpredictable emergency requirements for prolonged periods of extreme physical exertion without benefit of warm-up, scheduled rest periods, meals, access to medication(s), or hydration (10) Operating fire apparatus or other vehicles in an emergency mode with emergency lights and sirens (11) Critical, time-sensitive, complex problem solving during physical exertion in stressful, hazardous environments, including hot, dark, tightly enclosed spaces, that is further aggravated by fatigue, flashing lights, sirens, and other distractions (12) Ability to communicate (give and comprehend verbal orders) while wearing personal protective ensembles and SCBA under conditions of high background noise, poor visibility, and drenching from hoselines and/or fixed protection systems (sprinklers) (13) Functioning as an integral component of a team, where sudden incapacitation of a member can result in mission failure or in risk of injury or death to civilians or other team members (14) Work in shifts that can extend beyond 12 hours, including during nighttime

Statement of Problem and Substantiation for Public Input

Change for (3) is a clarification.

Suggested job task (14): Shift work and night work are essential job tasks for fire fighters.

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Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND St Joseph Medical Center Street Address: City: State: Zip: Submittal Date: Sun Jun 21 16:48:33 EDT 2015

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Public Input No. 77-NFPA 1582-2015 [ Section No. 5.1.4 ]

5.1.4 The fire department shall provide the fire department physician with the a current and validated list of essential job tasks to be used in the medical evaluation of members and candidates.

Statement of Problem and Substantiation for Public Input

Consistency with 9.1.2

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 15:37:32 EDT 2015

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Public Input No. 6-NFPA 1582-2013 [ Section No. 6.1.1 ]

6.1.1 * The medical evaluation of a candidate shall include a medical history, examination, and any laboratory tests required to detect physical or medical condition(s) that could adversely affect his/her ability to safely perform the essential job tasks outlined in 5.1.1. Should include vaccine/immunization records

Statement of Problem and Substantiation for Public Input

All new hires need to be screened for protection from airborne/droplet transmitted diseases - Chickenpox, MMR, Tdap booster, as well as HBV vaccine and TB testing history. If not protected, the department needs to offer vaccine.

Submitter Information Verification

Submitter Full Name: KATHERINE WEST Organization: Infection Controol/Emerging Concepts Street Address: City: State: Zip: Submittal Date: Wed Aug 14 08:35:54 EDT 2013

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Public Input No. 110-NFPA 1582-2015 [ Section No. 6.2.2 ]

6.2.2 Candidates with Category A medical conditions shall not be certified as meeting the medical requirements of this standard. The classification as Category A assumes that all the essential job tasks listed in 5.1.1 are required by the fire department. If not all these essential job tasks are required, some Category A medical conditions might be allowed in applicants.

Statement of Problem and Substantiation for Public Input

Different medical determinations are allowed with different essential job functions.

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 19:32:22 EDT 2015

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Public Input No. 58-NFPA 1582-2015 [ Section No. 6.2.3 ]

6.2.3 Candidates with Category B medical conditions shall be certified as meeting the medical requirements of this standard only if they can perform the essential job tasks without posing a significant safety and health risk to themselves, members, or civilians members of the public .

Statement of Problem and Substantiation for Public Input

"Civilians" is demeaning and is not the correct terminology. Fire fighters are also civilians, when non-military.

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jun 21 16:52:46 EDT 2015

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Public Input No. 45-NFPA 1582-2015 [ Sections 6.4, 6.5 ]

Sections 6.4, 6.5 6.4 Eyes and Vision. 6.4.1 Category A medical conditions shall include the following:

(1) * Far visual acuity less than 20/40 binocular, corrected with contact lenses or spectacles, or far visual acuity less than 20/100 binocular for wearers of hard contacts or spectacles, uncorrected (2) * Color perception — monochromatic vision resulting in inability to use imaging devices such as thermal imaging cameras (3) * Monocular vision (4) Any eye condition that results in the candidate not being able to safely perform one or more of the essential job tasks

6.4.2 Category B medical conditions shall include the following:

(1) * Diseases of the eye such as retinal detachment, progressive retinopathy, or optic neuritis (2) * Ophthalmological procedures such as radial keratotomy, Lasik procedure, or repair of retinal detachment (3) Peripheral vision in the horizontal meridian of less than 110 degrees in the better eye or any condition that significantly affects peripheral vision in both eyes

6.5* Ears and Hearing. 6.5.1 Category A medical conditions shall include the following:

(1) Chronic vertigo or impaired balance as demonstrated by the inability to tandem gait walk (2) On audiometric testing, average hearing loss in the unaided better ear greater , corrected with h earing aid or cochlear implant greater than 40 decibels (dB) at 500 Hz, 1000 Hz, 2000 Hz, and 3000 Hz when the audiometric device is calibrated to ANSI Z24.5, Audiometric Device Testing (3) Any ear condition (or hearing impairment) that results in the candidate not being able to safely perform one or more of the essential job tasks (4) * Hearing aid or cochlear implant

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6.5.2 Category B medical conditions shall include the following:

(1) * Unequal hearing loss (2) Average uncorrected hearing deficit at the test frequencies 500 Hz, 1000 Hz, 2000 Hz, and 3000 Hz greater than 40 dB in either ear (3) Atresia, stenosis, or tumor of the auditory canal (4) * External otitis, recurrent (5) * Agenesis or traumatic deformity of the auricle (6) * Mastoiditis or surgical deformity of the mastoid (7) * Ménière's syndrome, labyrinthitis, or tinnitus (8) * Otitis media, recurrent (9) Surgical procedures to correct or improve hearing or other conditions of the ear

Statement of Problem and Substantiation for Public Input

Removes the restriction preventing able-bodied individuals from becoming firefighting professionals due to correctable hearing loss.

Submitter Information Verification

Submitter Full Name: Robert McPherson Organization: United States Army Street Address: City: State: Zip: Submittal Date: Mon Apr 06 21:25:09 EDT 2015

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Public Input No. 59-NFPA 1582-2015 [ Section No. 6.4.1 ]

6.4.1 Category A medical conditions shall include the following:

(1) * Far visual acuity less than 20/40 20 binocular, corrected uncorrected or corrected with contact lenses or spectacles (2) Far visual acuity less than 20/100 in the worse eye , or far uncorrected or corrected with contact lenses or spectacles (3) Far visual acuity less than 20/100 binocular for wearers of hard contacts or spectacles, uncorrected (4) * Color perception — monochromatic vision resulting in inability to use imaging devices such as thermal imaging cameras (5) * Monocular vision (6) , uncorrected, unless the applicant has been wearing soft contact lenses for more than 6 months with good tolerance (7) Near visual acuity less than 20/40 binocular, uncorrected or corrected (8) * Color deficiency resulting in inability to recognize and distinguish among the colors of traffic signals showing the standard red, amber, and green (9) * Monocular vision (10) Horizontal field of vision less than 120 degrees in each eye (11) Night blindness (12) Any eye condition that results in the candidate not being able to safely perform one or more of the essential job tasks

Statement of Problem and Substantiation for Public Input

1. Far visual acuity: ACOEM consensus to require 20/20 visual acuity to drive under emergency conditions 2. Near visual acuity: needed in order to read policies, placards... 3. Far visual acuity in worse eye: needed to provide effective peripheral vision under low-light conditions when driving under emergency conditions 4. Color vision: Same criteria as FMCSA (Terra View created an extra paragraph, number 4)

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jun 21 16:56:04 EDT 2015

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Public Input No. 61-NFPA 1582-2015 [ Section No. 6.4.2 ]

6.4.2 Category B medical conditions shall include the following:

Statement of Problem and Substantiation for Public Input

Consistency with my proposed changes for 6.4.1

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jun 21 17:43:33 EDT 2015

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Public Input No. 73-NFPA 1582-2015 [ Section No. 6.4.2 ]

6.4.2 Category B medical conditions shall include the following:

Statement of Problem and Substantiation for Public Input

The prevalence of amblyopia is about 3% of the population. Amblyopia deserves a separate entry in NFPA 1582, as it could be confused with monocular vision.

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 15:14:07 EDT 2015

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Public Input No. 44-NFPA 1582-2015 [ Section No. 6.5 ]

6.5* Ears and Hearing. 6.5.1 Category A medical conditions shall include the following:

(1) Chronic vertigo or impaired balance as demonstrated by the inability to tandem gait walk (2) On audiometric testing, average hearing loss in the unaided better ear greater the better ear corrected with Hearing Aid or cochlear implant greater than 40 decibels (dB) at 500 Hz, 1000 Hz, 2000 Hz, and 3000 Hz when the audiometric device is calibrated to ANSI Z24.5, Audiometric Device Testing (3) Any ear condition (or hearing impairment) that results in the candidate not being able to safely perform one or more of the essential job tasks (4) * Hearing aid or cochlear implant

6.5.2 Category B medical conditions shall include the following:

Statement of Problem and Substantiation for Public Input

To resolve the unequal requirements between vision and hearing. Currently the vision tests allows for glasses or other corrective devises to be used where as the hearing test does not allow for corrective devises. This prevents otherwise fully qualified candidates from being considered for positions as fire fighters.

Submitter Information Verification

Submitter Full Name: R M Organization: [ Not Specified ] Street Address: City: State: Zip: Submittal Date: Mon Apr 06 21:23:54 EDT 2015

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Public Input No. 60-NFPA 1582-2015 [ Section No. 6.5.1 ]

6.5.1 Category A medical conditions shall include the following:

(1) Chronic vertigo or impaired balance as demonstrated by the inability to tandem gait walk (2) On audiometric testing, average hearing loss in the unaided better ear greater than 40 decibels (dB) at 500 Hz, 1000 Hz, 2000 Hz, and 3000 Hz when the audiometric device is calibrated to ANSI Z24.5, Audiometric Device Testing (3) Any ear condition (or hearing impairment) that results in the candidate not being able to safely perform one or more of the essential job tasks (4)*

Hearing aid or cochlear implant

(1) cochlear implant (2) Hearing aids, unless the meet the following criteria: a) Audiometric testing with the heading aids in place using sound field testing, one aided ear at a time while masking the unaided ear, showing an average hearing loss in the aided better ear lower than 40 decibels (dB) at 500 Hz, 1000 Hz, 2000 Hz, and 3000 Hz (2), b) the hearing aids allow sound localization, c) the hearing aids are proven to function when exposed to heat and water from fire-fighting tasks

Statement of Problem and Substantiation for Public Input

A fire department I work for has several dozens fire fighters with hearing aids. No device failure and no adverse outcome has ever been reported.

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jun 21 17:19:35 EDT 2015

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Public Input No. 62-NFPA 1582-2015 [ Section No. 6.7.1 ]

6.7.1 Category A medical conditions shall include the following:

(1) * Tracheostomy (2) * Aphonia (3) Any nasal, oropharyngeal, tracheal, esophageal, or laryngeal condition that results in inability to safely perform one or more of the essential job tasks including fit testing for respirators such as N-95 for medical response, P-100 for particulates and certain vapors, and used by the fire department, and SCBA for fire and hazmat operations

Statement of Problem and Substantiation for Public Input

Clarification -- no need to refer to specific respirators that may not be used by a specific agency

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jun 21 17:58:35 EDT 2015

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Public Input No. 65-NFPA 1582-2015 [ Section No. 6.8.1 [Excluding any Sub-Sections] ]

Category A medical conditions shall include the following:

(1) Active hemoptysis (2) Current empyema (3) Pulmonary hypertension (4) Active tuberculosis

(5) * A forced vital capacity (FVC) or forced expiratory volume in 1 second (FEV1) less than 70 percent predicted even independent of disease (6) * Obstructive lung diseases (e.g., emphysema, chronic bronchitis, asthma) with an absolute FEV1/FVC less than 0.70 and with either the FEV1 below normal or both the FEV1 and the FVC below normal (less than 0.80) (see references in F.2 ) (7) * Hypoxemia — oxygen saturation less than 90 percent at rest or exercise desaturation by 4 percent or to less than 90 percent (exercise testing indicated when resting oxygen is less than 94 percent but greater than 90 percent) (8) * Asthma — (including reactive airways disease requiring bronchodilator or corticosteroid therapy for 2 or more consecutive months at least once in the previous 2 years) , unless the candidate can meet the requirement in 6.8.1.1 (9) Any pulmonary condition that results in the candidate not being able to safely perform one or more of the essential job tasks (10) Lung transplant (11) Obstructive sleep apnea with excessive daytime sleepiness, unless all the following criteria are met: successfull treatment, documentation of compliance with CPAP or documentation of sleep study with an oral applicance or documentation of sleep study after surgery, and no excessive daytime sleepiness with treatment

Statement of Problem and Substantiation for Public Input

Clarification from existing language

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jun 21 18:17:43 EDT 2015

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Public Input No. 64-NFPA 1582-2015 [ Section No. 6.8.1.1 ]

6.8.1.1* A candidate who has been diagnosed with asthma or has in the past required bronchodilator, corticosteroid, or anti-inflammatory therapy (e.g., leukotriene receptor antagonists, such as Montelukast) for asthma but who does not believe he/she has asthma shall be evaluated by a pulmonologist or other expert in asthmatic lung diseases, such as an allergist, to determine if the candidate meets all the following:

(1) The applicant denies bronchospasm during exertion, temperatur/humidity extremes, or irritant exposures. (2) The applicant denies the use of bronchodilator rescue medications during exertion, temperatur/humidity extremes, or irritant exposures. (3) As defined by the National Heart Lung and Blood Institute's Guidelines for the Diagnosis and Management of Asthma has resolved without symptoms off medications for ,” the member has mild asthma classified as either “Step One” (no control medications and requires inhaled bronchodilator rescue medications for attacks no more than two times per week) or “Step Two” (daily control medications consisting of low-dose inhaled corticosteroids or cromolyn or oral leukotriene receptor antagonists (e.g., Montelukast) and requires inhaled bronchodilator rescue medications for attacks no more than two times per week). (4) The applicant's asthma has not required systemic corticosteroids, emergency room treatment, or hospital admission in the last 2 years. (5) Allergen avoidance or desensitization has been successful.

(6) Spirometry demonstrates adequate reserve (FVC and FEV1 greater than or equal to 90 percent) and no bronchodilator response measured off all bronchodilators on the day of testing. (7) Normal or negative response to provocative challenge testing [e.g., cold air, exercise (12 METs), methacholine, histamine, mannitol, or hypertonic saline] or negative response to exercise challenge.

6.8.1.1.1 Challenge testing shall be performed off all anti-inflammatory medications (e.g., inhaled or oral steroids, leukotriene receptor antagonists) for 4 weeks preceding the test, off all antihistamines (e.g., oral allergy medications) for 1 week, and off all bronchodilators on the day of testing.

Statement of Problem and Substantiation for Public Input

Consistency with 9.7.6.1 From a legal perspective, ADA does not allow different medical criteria for candidates and members, since the essential job functions are the same. From a medical/scientific perspective, the criteria should again be the same to define job restrictions.

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jun 21 18:07:00 EDT 2015

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Public Input No. 155-NFPA 1582-2015 [ Section No. 6.8.2 ]

6.8.2 Category B medical conditions shall include the following:

(1) * Pulmonary resectional surgery, chest wall surgery, and pneumothorax (2) Pleural effusion (3) * Fibrothorax, chest wall deformity, and diaphragm abnormalities (4) * Interstitial lung diseases (5) * Pulmonary vascular diseases or history of pulmonary embolism (6) * Bronchiectasis, if abnormal pulmonary function or recurrent infections (7) Infectious diseases of the lung or pleural space (8) Cystic fibrosis (9) Central or obstructive apnea (e.g., sleep apnea) if unresponsive to treatment

Statement of Problem and Substantiation for Public Input

Sleep apnea requires additional investigation (especially compliance with treatment).

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Mon Jul 06 13:25:53 EDT 2015

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Public Input No. 111-NFPA 1582-2015 [ Section No. 6.9.1 ]

6.9.1* Category A medical conditions shall include an aerobic capacity less than 12 metabolic equivalents (METs) (1 MET = 42 3.5 mL O2/kg/min).

Statement of Problem and Substantiation for Public Input

Correction

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 19:37:17 EDT 2015

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Public Input No. 66-NFPA 1582-2015 [ Section No. 6.10.1.1 ]

6.10.1.1 Category A medical conditions shall include the following:

(1)* Coronary artery disease, including history of myocardial infarction, angina pectoris, coronary artery bypass surgery, coronary angioplasty, and similar procedures (2) * Cardiomyopathy or congestive heart failure, including signs or symptoms of compromised left or right ventricular function or rhythm, including dyspnea, S3 gallop, peripheral edema, enlarged ventricle, abnormal ejection fraction, and/or inability to increase cardiac output with exercise (3) * Acute pericarditis, endocarditis, or myocarditis (4) * Syncope, recurrent (5) * A medical condition requiring an automatic implantable cardiac defibrillator (unless the condition has completely resolved) or history of ventricular tachycardia or ventricular fibrillation due to ischemic or valvular heart disease, or cardiomyopathy (6) Third-degree atrioventricular block (7) * Cardiac pacemaker, if the applicant is pacemaker-dependent (8) Hypertrophic cardiomyopathy, including idiopathic hypertrophic subaortic stenosis (9) Any cardiac condition that results in the candidate not being able to safely perform one or more of the essential job tasks (10) Heart transplant

Statement of Problem and Substantiation for Public Input

Current language would disqualify some applicants with remote history of Kawasaki.

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jun 21 18:20:44 EDT 2015

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Public Input No. 67-NFPA 1582-2015 [ Section No. 6.10.1.2 ]

6.10.1.2 Category B medical conditions shall include the following:

(1) * Valvular lesions of the heart, including prosthetic valves (2) * Recurrent supraventricular or atrial tachycardia, flutter, or fibrillation (3) * Left bundle branch block (4) Second-degree atrioventricular block in the absence of structural heart disease (5) Sinus pause more than 3 seconds (6) * Ventricular arrhythmia (history or presence of multifocal PVCs or nonsustained ventricular tachycardia on resting EKG with or without symptoms; history or presence of sustained ventricular tachycardia with or without symptoms) (7) * Cardiac

hypertrophy or hypertrophic cardiomyopathy

(1) hypertrophy (2) * History of a congenital abnormality (3) * Chronic pericarditis, endocarditis, or myocarditis (4) Brugada syndrome (5) Long QT syndrome (6) Arrhythmogenic right ventricular cardiomyopathy (7) Cardiac pacemaker, if the applicant is not pacemaker-dependent (8) Coronary artery disease, if not covered by 6.10.1.1

Statement of Problem and Substantiation for Public Input

Consistency with 6.10.1.1

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jun 21 18:25:42 EDT 2015

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Public Input No. 68-NFPA 1582-2015 [ Section No. 6.11.1 ]

6.11.1 Category A medical conditions shall include the following:

(1) Presence of uncorrected inguinal/femoral hernia regardless of symptoms if symptomatic (2) Any gastrointestinal condition that results in the candidate not being able to safely perform one or more of the essential job tasks

Statement of Problem and Substantiation for Public Input

An asymptomatic, fat-containing hernia should not lead to restrictions.

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jun 21 18:27:31 EDT 2015

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Public Input No. 69-NFPA 1582-2015 [ Section No. 6.14.1 ]

6.14.1 Category A medical conditions shall include the following:

(1) Renal failure or insufficiency requiring continuous ambulatory peritoneal dialysis (CAPD) or hemodialysis (2) Any urinary condition that results in the candidate not being able to safely perform one or more of the essential job tasks (3) Chronic kidney disease of stage 4 or 5 (GFR < 30 ml/min)

Statement of Problem and Substantiation for Public Input

Risk of CAD increases with chronic kidney disease

See FMCSA MEP recommendations on chronic kidney failure (page 8)

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jun 21 18:31:13 EDT 2015

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Public Input No. 114-NFPA 1582-2015 [ Section No. 6.15.1 ]

6.15.1 Category A medical conditions shall include the following:

(1) Scoliosis of thoracic or lumbar spine with angle greater than or equal to 40 degrees (2) History of spinal surgery with rods that are still in place (3) Any spinal or skeletal condition producing sensory or motor deficit(s) or pain due to radiculopathy or nerve root compression (4) Any spinal or skeletal condition causing pain that frequently or recurrently requires narcotic analgesic medication (5) Cervical vertebral fractures with multiple vertebral body compression greater than 25 percent; evidence of posterior element involvement, nerve root damage, disc involvement, dislocation (partial, moderate, severe), abnormal exam, ligament instability, symptomatic, and/or less than 6 months post injury or less than 1 year since surgery (6) Thoracic vertebral fractures with vertebral body compression greater than 50 percent; evidence of posterior element involvement, nerve root damage, disc involvement, dislocation (severe — with or without surgery), abnormal exam, ligament instability, symptomatic, and/or less than 6 months post injury or less than 1 year since surgery (7) Lumbosacral vertebral fractures with vertebral body compression greater than 50 percent; evidence of posterior element involvement, nerve root damage, disc involvement, dislocation (partial, moderate, severe), fragmentation, abnormal exam, ligament instability, symptomatic, and/or less than 6 months post injury or less than 1 year since surgery (8) History of spine fusion that results in instability; reduced mobility, strength, or range of motion; or persistent pain. (9) Any spinal or skeletal condition that results in the candidate not being able to safely perform one or more of the essential job tasks

Statement of Problem and Substantiation for Public Input

Consistency with chapt 9

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 19:58:02 EDT 2015

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Public Input No. 118-NFPA 1582-2015 [ Section No. 6.15.1 ]

6.15.1 Category A medical conditions shall include the following:

(1) Scoliosis of thoracic or lumbar spine with angle greater than or equal to 40 degrees (2) History of spinal surgery with rods that are still in place (3) Any spinal or skeletal condition producing sensory or motor deficit(s) or pain due to radiculopathy or nerve root compression (4) Any spinal or skeletal condition causing pain that frequently or recurrently requires narcotic analgesic medication (5) Cervical vertebral fractures with multiple vertebral body compression greater than 25 percent; evidence of posterior element involvement, nerve root damage, disc involvement, dislocation (partial, moderate, severe), abnormal exam, ligament instability, symptomatic, and/or less than 6 months post injury or less than 1 year since surgery (6) Thoracic vertebral fractures with vertebral body compression greater than 50 percent; evidence of posterior element involvement, nerve root damage, disc involvement, dislocation (severe — with or without surgery), abnormal exam, ligament instability, symptomatic, and/or less than 6 months post injury or less than 1 year since surgery (7) Lumbosacral vertebral fractures with vertebral body compression greater than 50 percent; evidence of posterior element involvement, nerve root damage, disc involvement, dislocation (partial, moderate, severe), fragmentation, abnormal exam, ligament instability, symptomatic, and/or less than 6 months post injury or less than 1 year since surgery (8) Any spinal or skeletal condition that results in the candidate not being able to safely perform one or more of the essential job tasks

Statement of Problem and Substantiation for Public Input

Lack of scientific basis for these recommendations of duration

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 20:06:08 EDT 2015

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Public Input No. 35-NFPA 1582-2014 [ Section No. 6.15.1 ]

6.15.1 Category A medical conditions shall include the following:

(1) Scoliosis of thoracic or lumbar spine with angle greater than or equal to 40 degrees (2) History of spinal surgery involving fusion of two or more vertebrae or spinal surgery with rods that are still in place (3) Any spinal or skeletal condition producing sensory or motor deficit(s) or pain due to radiculopathy or nerve root compression (4) Any spinal or skeletal condition causing pain that frequently or recurrently requires narcotic analgesic medication (5) Cervical vertebral fractures with multiple vertebral body compression greater than 25 percent; evidence of posterior element involvement, nerve root damage, disc involvement, dislocation (partial, moderate, severe), abnormal exam, ligament instability, symptomatic, and/or less than 6 months post injury or less than 1 year since surgery (6) Thoracic vertebral fractures with vertebral body compression greater than 50 percent; evidence of posterior element involvement, nerve root damage, disc involvement, dislocation (severe — with or without surgery), abnormal exam, ligament instability, symptomatic, and/or less than 6 months post injury or less than 1 year since surgery (7) Lumbosacral vertebral fractures with vertebral body compression greater than 50 percent; evidence of posterior element involvement, nerve root damage, disc involvement, dislocation (partial, moderate, severe), fragmentation, abnormal exam, ligament instability, symptomatic, and/or less than 6 months post injury or less than 1 year since surgery (8) Any spinal or skeletal condition that results in the candidate not being able to safely perform one or more of the essential job tasks

Statement of Problem and Substantiation for Public Input

the proposed change will resolve inconsistency when compared to the 2007 edition and will better define category A pathology.

Submitter Information Verification

Submitter Full Name: paul malak Organization: Physician Affilliation: Mercy Corporate Health Street Address: City: State: Zip: Submittal Date: Fri Oct 10 13:04:11 EDT 2014

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Public Input No. 115-NFPA 1582-2015 [ Section No. 6.15.2 ]

6.15.2 Category B medical conditions shall include the following:

(1) Congenital or developmental malformations of the back, particularly those that can cause instability, neurological deficits, pain, or limit flexibility (2) Scoliosis with angle less than 40 degrees (3) Arthritis of the cervical, thoracic, or lumbosacral spine (4) Facet atrophism, high lumbosacral angle, hyperlordosis, Schmorl's nodes, Scheuermann's disease, spina bifida occulta, spondylolisthesis, spondylolysis, or transitional vertebrae (5) History of infections or infarcts in the spinal cord, epidural space, vertebrae, or axial skeletal joints (6) History of diskectomy or laminectomy or vertebral fractures (7) History of spine fusion that results in instability; reduced mobility, strength, or range of motion; or persistent pain. (8)

Statement of Problem and Substantiation for Public Input

Should be moved to Category A (consistency with chapter 9)

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 19:58:35 EDT 2015

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Public Input No. 104-NFPA 1582-2015 [ Section No. 6.16.1 ]

6.16.1 Category A medical conditions shall include the following:

(1) Joint replacement, unless all the following conditions are met:

(2) Normal range of motion without history of dislocations post-replacement (3) Repetitive and prolonged pulling, bending, rotations, kneeling, crawling, and climbing without pain or impairment (4) No limiting pain (5) Evaluation by an orthopedic specialist who concurs that the candidate can complete all essential job tasks listed in Chapter 5

(6) Amputation or congenital absence of upper-extremity limb (hand or higher) (7) Amputation of either thumb proximal to the mid-proximal phalanx (8) Amputation or congenital absence of lower-extremity limb (foot or above) unless the candidate meets all of the following conditions:

(9) Stable, unilateral below-the-knee (BKA) amputation with at least the proximal third of the tibia present for a strong and stable attachment point with the prosthesis (10) Fitted with a prosthesis that will tolerate the conditions present in

structural

(a) firefighting when worn in conjunction with standard fire fighting PPE (b) At least 6 months of prosthetic use in a variety of activities with no functional difficulties (c) Amputee limb healed with no significant inflammation, persistent pain, necrosis, or indications of instability at the amputee limb attachment point (d) No significant psychosocial issues pertaining to the loss of limb or use of prosthesis (e) Evaluated by a prosthetist or orthopedic specialist with expertise in the fitting and function of prosthetic limbs who concurs that the candidate can complete all essential job tasks listed in Chapter 5, including wearing personal protective ensembles and SCBA while climbing ladders, operating from heights, and walking or crawling in the dark along narrow and uneven surfaces that may be wet or icy (f) Has passed the department’s applicant physical ability test as a condition of appointment without accommodations or modification of the protocol

(11) Chronic nonhealing or recent bone grafts (12) History of more than one dislocation of shoulder without surgical repair or with history of recurrent shoulder disorders within the last 5 years with pain or loss of motion, and with or without radiographic deviations from normal (13) Any extremity condition that results in the candidate not being able to safely perform one or more of the essential job tasks

Statement of Problem and Substantiation for Public Input

NFPA 1582 is not limited to structural firefighting.

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Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 18:50:57 EDT 2015

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Public Input No. 113-NFPA 1582-2015 [ Section No. 6.17.1 [Excluding any Sub-Sections]

]

Category A medical conditions shall include the following:

(1) Ataxias of heredo-degenerative type (2) Cerebral arteriosclerosis as evidenced by a history of transient ischemic attack, reversible ischemic neurological deficit, or ischemic stroke (3) Hemiparalysis or paralysis of a limb (4) * Multiple sclerosis with activity or evidence of progression within previous 3 years (5) * Myasthenia gravis with activity or evidence of progression within previous 3 years (6) Progressive muscular dystrophy or atrophy (7) Uncorrected cerebral aneurysm (8) All single unprovoked seizures and epileptic conditions, including simple partial, complex partial, generalized, and psychomotor seizure disorders other than as allowed in 6.17.1.1 (9) Dementia (Alzheimer's and other neurodegenerative diseases) with symptomatic loss of function or cognitive impairment (e.g., less than or equal to 28 on Mini-Mental Status Exam) (10) Parkinson's disease and other movement disorders resulting in uncontrolled movements, bradykinesia, or cognitive impairment (e.g., less than or equal to 28 on Mini-Mental Status Exam) (11) Narcolepsy with cataplexy (12) Narcolepsy with persistent excessive daytime sleepiness despite medical treatment (13) Any neurological condition that results in the candidate not being able to safely perform one or more of the essential job tasks

Statement of Problem and Substantiation for Public Input

Risk of sudden incapacitation

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 19:56:21 EDT 2015

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Public Input No. 97-NFPA 1582-2015 [ Section No. 6.17.1.1 ]

6.17.1.1 To be medically qualified a candidate shall meet all of the following:

(1) No seizures for 1 year off all anti-epileptic medication or 5 years seizure free on a stable medical regimen the most recent consecutive 5 years after a single unprovoked seizure (2) No seizures for the most recent consecutive 10 years if the applicant was diagnosed with epilepsy (3) Currently on anti-seizure medications or not on anti-seizure medications for the most recent 5 consecutive years (4) Neurologic examination is normal (5) Imaging (CAT or MRI scan) studies are Brain MRI is normal (6) Awake and asleep EEG studies with photic stimulation and hyperventilation are normal (7) A definitive statement from a qualified neurological specialist that the candidate meets the criteria specified in 6.17.1.1 (1) through 6.17.1.1 (4) and that the candidate is neurologically cleared for fire-fighting training and the performance of a fire fighter's essential job tasks

Statement of Problem and Substantiation for Public Input

Suggested changes are consistent with FMCSA MRB and ACOEM recommendations to reach an annual risk of recurrence of 1%.

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 18:14:10 EDT 2015

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Public Input No. 96-NFPA 1582-2015 [ Section No. 6.17.2 ]

6.17.2 Category B medical conditions shall include the following:

(1) Congenital malformations (2) * Migraine (3) Clinical disorders with paresis, dyscoordination, deformity, abnormal motor activity, abnormality of sensation, or complaint of pain (4) History of subarachnoid or intraparenchymal hemorrhage (5) Abnormalities from recent head injury such as severe cerebral contusion or concussion (6) Provoked seizure (7) Shift work disorder (8) Amyotrophic lateral sclerosis (9) Transient ischemic attack

Statement of Problem and Substantiation for Public Input

A history of provoked seizure requires an evaluation to predict a risk of recurrence, depending on the cause.

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 18:12:03 EDT 2015

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Public Input No. 116-NFPA 1582-2015 [ Section No. 6.21.2 ]

6.21.2 Category B medical conditions shall include the following:

(1) Connective tissue disease, such as dermatomyositis, systemic lupus erythematosus, scleroderma, and rheumatoid arthritis (2) * History of thermal, chemical, or electrical burn injury with residual functional deficit (3) Documented evidence of a predisposition to recurrent heat stress or history of heat illness, rhabdomyolysis, metabolic acidosis, or exertion-related incapacitation

Statement of Problem and Substantiation for Public Input

Clarification

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 20:00:53 EDT 2015

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Public Input No. 117-NFPA 1582-2015 [ Section No. 6.22.1 ]

6.22.1 Category A medical conditions shall include the following:

(1) Malignant disease that is newly diagnosed, untreated, or currently being treated, or under active surveillance due to the increased risk for reoccurrence, unless not interfering with safe performance of the essential job tasks (2) Any tumor or similar condition that results in the candidate not being able to safely perform one or more of the essential job tasks

Statement of Problem and Substantiation for Public Input

Current language is too vague (example of basal cell carcinoma)

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 20:02:42 EDT 2015

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Public Input No. 21-NFPA 1582-2014 [ Section No. 7.1.2 ]

7.1.2 Occupational medical evaluations shall be conducted as a baseline for surveillance and annually thereafter. Exception : 1) Departments that run less than 25 calls for service a year may go to a bi-annual surveillance or after a major responce. 2) Departments that no longer respond, due to finicial, staffing or other issue can post pone medical until the issues are resolved and back to a responce mode.

Statement of Problem and Substantiation for Public Input

There are department that do not respond to a large number of calls in a year and the members would have little oppertunity to come in contact with a responce related issue. The expection allows these small departments to save money and choose to provide a medical either on an every other year or after a major responce. A department may go years without a call and althjough it is important to maintian responders health younger members may not need to recieve a medical every year. If a department (team) is placed out of service for any reason and is out of service for a long period medical can be post poned until the issues are resolved. An example is loss of thier only responce vehicle. If it takes a year to get funding and replacement tan medicals can be stoped to assist in saving money.

Submitter Information Verification

Submitter Full Name: Donald Turno Organization: Savannah River Nuclear Solutions Street Address: City: State: Zip: Submittal Date: Mon Feb 03 13:22:35 EST 2014

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Public Input No. 22-NFPA 1582-2014 [ Section No. 7.3 ]

7.3 Timing of the Annual Occupational the Occupational Medical Evaluation of Members. 7.3.1 All members shall receive a baseline medical evaluation after hiring and prior to performing fire fighter emergency functions and at least annually thereafter. 7.3.2 The baseline medical evaluation shall include the components of the annual occupational medical evaluation not performed as part of the candidate medical evaluation, provided the candidate medical evaluation was performed within the past 12 months. 7.3.3 The annual evaluation shall be completed every 12 months (±3 months). 7.3.4 Annual medical evaluations shall be compared to baseline and subsequent evaluations to identify clinically relevant changes. 7.3.5 The interval requirements for performance of the annual occupational medical evaluation shall not preclude more frequent medical evaluations of members for new or recurring conditions when requested by the member, fire department physician, or AHJ.

Statement of Problem and Substantiation for Public Input

If my change from above is accepted than every where in then document remove annual

Submitter Information Verification

Submitter Full Name: Donald Turno Organization: Savannah River Nuclear Solutions Street Address: City: State: Zip: Submittal Date: Mon Feb 03 13:42:35 EST 2014

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Public Input No. 7-NFPA 1582-2013 [ Section No. 7.5 ]

7.5 Medical History. 7.5.1 A medical history questionnaire shall be completed by each member to provide baseline information with which to compare future medical concerns. 7.5.2 An annual medical history questionnaire, which includes changes in health status and known occupational exposures since the previous annual evaluation, shall be completed by each member to provide follow-up information. 7.5.3 Information on the questionnaire and interval concerns shall be reviewed with each member by the fire department physician or designated medical evaluator. Need to add - vaccination/immunization history

Statement of Problem and Substantiation for Public Input

Again, need to add and be specific that vaccine/immunization, childhood disease history is needed. If personnel are not protected, then they are to be offered protective vaccines Reference: CDC Guidelines 11/23/11 and NFPA 1581

Submitter Information Verification

Submitter Full Name: KATHERINE WEST Organization: Infection Control/Emergining Concepts Street Address: City: State: Zip: Submittal Date: Wed Aug 14 08:45:00 EDT 2013

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Public Input No. 134-NFPA 1582-2015 [ Section No. 7.6 ]

7.6 Physical Examination. The annual physical examination shall include each of the following components:

(1) Vital signs [temperature, pulse, and respiratory rate, and blood pressure (BP)]

(2) BP shall be measured according to the recommendations of the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7)

(3) Head, eyes, ears, nose, and throat (HEENT) (4) Neck (5) Cardiovascular (6) Pulmonary (7) Breast (8) Gastrointestinal with digital rectal exam as clinically indicated (9) Genitourinary (includes pap smear, testicular exam, rectal exam for prostate mass) (10) (11) Hernia (12) Lymph nodes (13) Neurological (14) Musculoskeletal (15) Skin (includes screening for cancers) (16) Vision

Statement of Problem and Substantiation for Public Input

Rationale: following ACS authoritative recommendations. See 7.7.17

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 20:49:55 EDT 2015

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Public Input No. 121-NFPA 1582-2015 [ Section No. 7.7.1 ]

7.7.1* Blood Tests. Blood tests shall be performed annually and at baseline, at minimum every three years for fire fighters under the age of 40, and annually after age 40 shall include the following:

(1) CBC with differential, RBC indices and morphology, and platelet count

(2) Electrolytes (Na, K, Cl, HCO3, or CO2) (3) Renal function (BUN, creatinine) (4) Glucose (5) Liver function tests (ALT, AST, direct and indirect bilirubin, alkaline phosphatase) (6) Total cholesterol, HDL, LDL, clinically useful lipid ratios (e.g., percent LDL), and triglycerides

Statement of Problem and Substantiation for Public Input

Prior to age 40, annual blood testing is of limited value. However, this testing should be performed more frequently as a function of age, disease, risk factors and specific occupational exposures.

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 20:18:45 EDT 2015

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Public Input No. 123-NFPA 1582-2015 [ Section No. 7.7.5.1 ]

7.7.5.1 Chest x-rays shall include an initial baseline and shall be repeated every 5 years or as medically indicated.

Statement of Problem and Substantiation for Public Input

The baseline is useful for individuals with a history of respiratory problems or symptoms and for subsequent comparison in healthy individuals in whom symptoms, changes in spirometry, or pulmonary disease later develops. Since the routine use of chest x-rays in surveillance activities in the absence of significant exposures, symptoms, or medical findings has not been found to reduce respiratory or other health problems, chest X-rays as part of regular medical surveillance examinations are not indicated. Repeat chest X-rays should be obtained as clinically indicated i.e. when evaluating a symptomatic fire fighter or when there are changes in pulmonary function testing (PFT), as a recent chest x-ray for comparison is useful. Among uniformed personnel, chest X- ray abnormality may indicate pneumonia, tuberculosis, lung cancer, or other occupational lung disease.

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 20:21:21 EDT 2015

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Public Input No. 124-NFPA 1582-2015 [ Section No. 7.7.6.1 ]

7.7.6.1 A resting 12-lead ECG shall be performed as part of the baseline medical evaluation and shall be performed annually thereafter after age 40 or as clinically indicated .

Statement of Problem and Substantiation for Public Input

Before the age of 40, annual resting ECG testing for coronary artery disease and other cardiovascular diseases is of limited value (AHA & USPSTF guidelines); however, when testing a symptomatic fire fighter, a recent ECG for comparison is useful.

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 20:22:01 EDT 2015

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Public Input No. 125-NFPA 1582-2015 [ Section No. 7.7.6.3 ]

7.7.6.3 * Stress tests with ECGs and and with or without without imaging (echocardiography or radionuclide scanning) shall be performed when clinically indicated by history or symptoms the 10-year Framingham Risk Score is 10 percent or greater . If risk score is greater than 20%, then refer to cardiology . Such a risk score shall be calculated on an annual basis.

Statement of Problem and Substantiation for Public Input

Clarification

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 20:22:52 EDT 2015

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Public Input No. 126-NFPA 1582-2015 [ Section No. 7.7.6.4 ]

7.7.6.4 These tests shall be based on coronary artery disease risk factor stratification or symptoms or for screening of cardiovascular disease and the risk of sudden cardiovascular death performed to the 12 MET level of effort using a validated testing protocol .

Statement of Problem and Substantiation for Public Input

Rationale - Uniformed personnel whose 10-year Framingham cardiovascular disease risk score indicates a risk greater thanof 10% or more, should be evaluated with cardiac exercise stress testing. Those with Framingham risks > 20% should be referred to cardiology. Cardiac exercise stress testing should be done to achieve 12 METS and a validated 12 MET exercise testing protocol must be used. Cardiopulmonary testing should be performed in a medical facility with proper monitoring by a physician and available resuscitation equipment. Testing may be done with or without imaging as determined by the physician. When selecting imaging options, physicians should be aware of the large prevalence of left ventricular hypertrophy in fire fighters who experience on-duty cardiovascular deaths (Yang, Teehan Farioli et al. Sudden Cardiac death among firefighters ≤ 45 years of age in the United States Am J Cardiol 2013).

Uniformed personnel with positive stress test results should be referred to cardiology. Uniformed personnel whose stress test results are negative but who are unable to meet the 12 MET criteria should be referred to a fitness program, counseled on risk factor modification, and retested in 6 months. Uniformed personnel with negative stress tests reaching the 12 MET criteria should be retested after two to five years depending on clinical assessment and risk factors.

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 20:24:36 EDT 2015

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Public Input No. 127-NFPA 1582-2015 [ Section No. 7.7.7.1 ]

7.7.7.1 Mammography shall be performed bi- annually on each female member over the age of 40 and annually after age 50 or as clinically indicated .

Statement of Problem and Substantiation for Public Input

Breast cancer is the most common type of cancer in women (excluding skin cancers) and the second leading cause of cancer death in women, after lung cancer. Breast cancer incidence and mortality rates increase with age. An annual clinical breast examination is required. Self-examination should be encouraged, and educational information should be made available to interested patients. Mammography screening shall be performed on all women uniformed personnel beginning at age 40 and continue every other year until age 50 at which point annual mammography is indicated. Annual mammography should be obtained before age 50 if clinically indicated. Women uniformed personnel with a family history of breast cancer or other personal risks shall be referred for appropriate individualized recommendations for breast cancer screening, such as genetic screening or breast MRI. Women uniformed personnel may wish to have an ongoing clinical association with a women’s health provider.

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 20:26:20 EDT 2015

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Public Input No. 8-NFPA 1582-2013 [ Section No. 7.7.8 ]

7.7.8 Immunizations and Infectious Disease Screening. The following infectious disease immunizations or infectious disease screenings shall be provided, as indicated:

(1) * Tuberculosis (TB) screening by either tuberculin skin testing using the tuberculin purified protein derivative (PPD) or the tuberculin blood test (interferon gamma release assay) shall be performed at baseline. Subsequent tuberculosis screening shall be performed annually or at a frequency according to CDC guidelines unless the member has a history of positive tuberculin screening test, in which case CDC guidelines for management and subsequent chest radiographic surveillance shall be followed (2) Hepatitis C virus screen — baseline and following occupational exposure (3) Hepatitis B virus vaccinations and titers — as specified in CDC guidelines (4) Tetanus/diphtheria vaccine — booster every 10 years (5) Measles, mumps, rubella vaccine (MMR) — one dose of MMR vaccine to members born after 1957 without prior immunization and/or evidence of immunity as outlined in the Morbidity and Mortality Weekly Report article “Measles, Mumps, and Rubella — Vaccine Use and Strategies for Elimination of Measles, Rubella, and Congenital Rubella Syndrome and Control of Mumps: Recommendations of the Advisory Committee on Immunization Practices (ACIP).” (6) Polio vaccine — A single booster of IPV for members traveling to endemic areas in the line of duty, or as outlined in the Morbidity and Mortality Weekly Report article “Poliomyelitis Prevention in the United States: Updated Recommendations of the Advisory Committee on Immunization Practices (ACIP).” (7) Hepatitis A vaccine (8) Varicella vaccine — offered to all non-immune personnel (9) Influenza vaccine (seasonal and novel) — offered to all personnel annually (10) HIV screening — available to all personnel

7.7.8.1 Pre-screening and immunization against biological threat agents shall be made available to members following CDC guidelines or recommendations. 7.7.8.2 * All members shall be immunized against infectious diseases as required by the AHJ and by 29 CFR 1910.1030, “Bloodborne pathogens.” 7.7.8.3 The fire department physician shall ensure that all members are offered currently recommended immunizations. TB testing is NOT required annually. Changed in 2005 to on hire and then based on TB risk assessment. There is no requirement for chest x-ray for persons with a previous history of a positive skin test- only need to complete a questionnaire. This is later mentioned in this document Baseline testing for HCV and HIV is NOT recommended by the CDC. Should only be done for baseline following an exposure to an infected person. Tdap booster x1 should be given instead of Td if the employee is due for a Td and has not had a Tdap booster MMR - if born before 1957 must establish immunity it is no longer assumed. If vaccinated between 1963-1967 need re-vaccination with 2 doses of live virus vaccine (CDC 2011) HAV is not recommended for fire/EMS personnel- see CDC statment on recommendations for Disaster Responders published 9/3/08 and HAV guidelines published October 19, 2007

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Statement of Problem and Substantiation for Public Input

References - Immunization of Healthcare personnel - CDC 11/23/11, TB Guidelines published December 30, 2005, and HAV documents as listed in comments

Submitter Information Verification

Submitter Full Name: KATHERINE WEST Organization: Infection Control/Emerging Concepts Street Address: City: State: Zip: Submittal Date: Wed Aug 14 08:50:00 EDT 2013

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Public Input No. 128-NFPA 1582-2015 [ Section No. 7.7.8 [Excluding any Sub-Sections] ]

The following infectious disease immunizations or infectious disease screenings shall be provided, as indicated:

(1) * Tuberculosis (TB) screening by either tuberculin skin testing using the tuberculin purified protein derivative (PPD) or the tuberculin blood test (interferon gamma release assay) shall be performed at baseline. Subsequent tuberculosis screening shall be performed annually or at a frequency according to CDC guidelines unless the member has a history of positive tuberculin screening test, in which case CDC guidelines for management and subsequent chest radiographic surveillance shall be followed (2) Hepatitis C virus screen — baseline and following occupational exposure (3) Hepatitis B virus vaccinations and titers — as specified in CDC guidelines. Laboratory confirmation of immunity shall be tested 1-2 months after completion of the vaccination 3 dose series. (4) Tetanus/diphtheria vaccine — /pertussion (Tdap) vaccine, which can be given once to replace the Td booster every 10 years or the 5 year wound management Td dose . (5) Measles, mumps, rubella vaccine (MMR) — one dose of MMR vaccine to members born after 1957 without prior immunization and/or evidence of immunity as outlined in the Morbidity and Mortality Weekly Report article “Measles, Mumps, and Rubella — Vaccine Use and Strategies for Elimination of Measles, Rubella, and Congenital Rubella Syndrome and Control of Mumps: Recommendations of the Advisory Committee on Immunization Practices (ACIP).” In absence of documented immunity, two doses of the Measles, mumps, rubella vaccine (MMR) shall be administered according to current immunization guidelines. (6) Polio vaccine — A single booster of IPV for members traveling to endemic areas in the line of duty, or as outlined in the Morbidity and Mortality Weekly Report article “Poliomyelitis Prevention in the United States: Updated Recommendations of the Advisory Committee on Immunization Practices (ACIP).” (7) Hepatitis A vaccine (8) Varicella vaccine — offered to all non-immune personnel (9) Influenza vaccine (seasonal and novel) — offered to all personnel annually (10) HIV screening — available to all personnel

Statement of Problem and Substantiation for Public Input

Remain consistent with current immunization practices.

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 20:27:29 EDT 2015

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Public Input No. 74-NFPA 1582-2015 [ Section No. 7.7.8.2 ]

7.7.8.2* All members shall be immunized offered immunizations against infectious diseases as required by the AHJ and by 29 CFR 1910.1030, “Bloodborne pathogens.”

Statement of Problem and Substantiation for Public Input

29 CFR 1910.1030 does not mandate immunizations.

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 15:27:44 EDT 2015

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Public Input No. 10-NFPA 1582-2013 [ Section No. 7.7.9.2 ]

7.7.9.2 * There shall be a written protocol for members who present with BBP exposures. 7.7.9.2 - baseline testing on the employee post exposure is not needed of the source patient tests negative. New testing methods have eliminated the "window phase" (b) HBsAg - looking for current infection not passed disease (d) HCV-RNA ( test for actual virus) (5) Source patient is tested by rapid HIV method (1998, rapid HCV method (2010), HbsAg, syphilis if source is postive for HIV or HCV- ofter co-infected. Medical facility is responsible for source patient testing according to the state testing law) (8) - PEP Hotline is to be consulted before PEP drugs are prescribed (CDC post exposure guidelines 2001, 2005) OShA enforced (9) - there is no 2 hours time frame, state "hours but not days". this gives time to test the source for rapid HIV and rapid HCV to make drug determination

Statement of Problem and Substantiation for Public Input

References as stated - CDC post exposure guidelines - 2001, 2005 and 2010

Submitter Information Verification

Submitter Full Name: KATHERINE WEST Organization: Infection Control/Emerging Concepts Street Address: City: State: Zip: Submittal Date: Wed Aug 14 09:08:54 EDT 2013

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Public Input No. 9-NFPA 1582-2013 [ Section No. 7.7.10 ]

7.7.10 HIV Testing. HIV testing shall be offered on a confidential basis as part of post-exposure protocols and as requested by the fire department physician or member. 7.7.10.1 All results from HIV tests shall be provided directly to the member and shall be maintained by the physician as confidential documents. 7.7.10.2 Results from HIV tests shall not be forwarded to any local, state, provincial, national, or international authorities or databases unless mandated by public health statutes. 7.7.10 - Rapid HIV and HCV are to be performed on the source patient post exposure with results in less than 1 hour. OSHA enforcement of CDC guidelines 7.7.10.1 - Post exposure test result on the source patient go directly to the Designated Officer as stated in the Ryan White Notification Law. OSHA states that the post exposure test results on the employee stay witht he treating physician and do not go back to the department or department physician. 7.7.10.2 - Disease listed on the national diseases reporting list must be reported by law 7.7.8 (1)- if TB test within 1 year - get report results and 1 TB tes for baseline is performed 7.7.8 (2) - re-test in 8-10 weeks

Statement of Problem and Substantiation for Public Input

References to additions/corrections are - CDC TB guidelines 2005, Ryan White Notification Law, Part G, 2009, U.S. Public Health Department Notifiable Disease Listing

Submitter Information Verification

Submitter Full Name: KATHERINE WEST Organization: Infection Control/Emerging Concepts Street Address: City: State: Zip: Submittal Date: Wed Aug 14 09:00:38 EDT 2013

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Public Input No. 11-NFPA 1582-2013 [ Section No. 7.7.11.2 ]

7.7.11.2 Evaluations shall be performed following known exposures, for recurrent exposures, or where required under federal, state, or provincial regulations. (13) C.i - post exposure HIV testing is only if the source tests positive. then testing is laseline, 6 weeks and 3 months (CDC 2001, 2005) C. ii - HCV-RNA at 2 wqeeks - if negative no further testing. If positive offer 3 drug treatment for 12-24 weeks

Statement of Problem and Substantiation for Public Input

References: CDC Guidelines as stated 2011, 2005 and for HCV treatment 2009

Submitter Information Verification

Submitter Full Name: KATHERINE WEST Organization: Infection Control/Emerging Concepts Street Address: City: State: Zip: Submittal Date: Wed Aug 14 09:32:38 EDT 2013

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Public Input No. 130-NFPA 1582-2015 [ Section No. 7.7.12 ]

7.7.12 Colon Cancer Screening. 7.7.12.1 Fecal occult blood testing harms and benefits shall be provided annually to discussed with all members above the age of 40 or earlier if clinically indicated. 7.7.12.2 Colonoscopy services shall be recommended to all members above the age of 40 50 or earlier if clinically indicated and repeated at regular intervals.

Statement of Problem and Substantiation for Public Input

Uniformed personnel are exposed to a variety of particulate materials, chemicals and asbestos which can increase the risk for colon cancer.

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 20:34:29 EDT 2015

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Public Input No. 133-NFPA 1582-2015 [ New Section after 7.7.13 ]

7.7.14 Lung Cancer Screening. 7.7.14.1 Low-dose computed tomography (LDCT) shall be performed annually in fire fighters over age 55 who have a 30 pack-year cigarette smoking history and currently smoke or have quit within the past 15 years. 7.7.14.2 Screening shall be discontinued once a fire fighter has not smoked cigarettes for 15 years or is too ill to benefit.

7.7.15 Cervical Cancer Screening. 7.7.15.1 Female fire fighters shall be screened for cervical cancer with cytology (Pap smear) every 3 years or screening with a combination of cytology and human papillomavirus (HPV) testing every 5 years. 7.7.16 Testicular Cancer Screening. 7.7.16.1* A baseline examination shall be performed by a healthcare provider. 7.7.17 Bladder Cancer Screening. 7.7.17.1 Urine shall be evaluated for blood (hematuria). 7.7.17.2 Positive dipstick for hematuria shall require a follow-up and referral which may involve upper tract imaging, cystoscopy and/or urine cytology. 7.7.18 Oral Cancer Screening. 7.7.18.1 The entire mouth shall be examined for signs of oral and oropharyngeal cancers. 7.7.19 Thyroid Cancer Screening. 7.7.19.1 Physical exam for palpable nodules shall be part of the annual physical examination. 7.7.20 Sleep Disturbance Screening. 7.7.20.1 Screening for sleep disorders using a validated questionnaire such as the Berlin sleep questionnaire or Epworth Sleepiness Scale shall be provided annually. 7.7.20.2* For fire fighters with a high index of suspicion for a sleep disorder based on questionnaires or biometric data, the physician shall discuss the risks and benefits of testing and treatment.

Statement of Problem and Substantiation for Public Input

Lung cancer: added screening for our highest risk members Cervical cancer: consistent with current screening guidelines Testicular, bladder, oral and thyroid cancers: added screening highlighting risk Sleep disturbance screening: Fire fighters at increased risk of sleep disorders. Highlights the importance to sleep health and hygiene.

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 20:41:49 EDT 2015

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Public Input No. 132-NFPA 1582-2015 [ Section No. 7.7.13 ]

7.7.13* Prostate Cancer. Due to increased prostate cancer risk, the fire department shall provide all male fire fighters with prostate physician shall discuss the harms and benefits of prostate cancer screening, including prostate - specific antigen (PSA) testing, with all male fire fighters beginning at age 50 and annually thereafter. Those with a family history or 7.7.13.1 For male firefighters of African-American heritage , who are at a higher risk for prostate cancer, shall be provided with testing the physician shall discuss the harms and benefits of prostate cancer screening, including PSA testing, beginning at age 40 and annually thereafter.

Statement of Problem and Substantiation for Public Input

Prostate cancer is the second most common type of cancer in men, after skin cancer. In addition, some studies have observed an elevated risk of prostate cancer in fire fighters. The prostate-specific antigen (PSA) test is a blood test that has been used for prostate cancer screening. However, recommendations for its use have been recently changed to a recommendation that medical providers discuss the benefits and risks of PSA testing in order to allow patients to decide whether they want PSA testing.

Male uniformed personnel shall be offered a discussion regarding PSA testing at age 50. Male uniformed personnel who are considered to be at an increased risk for prostate cancer, such as those who have a family history of prostate cancer or are of African-American heritage shall be offered a discussion regarding PSA testing starting at age 40. After this discussion, those men who want to be screened should be tested with the PSA blood test. The digital rectal exam (DRE) may also be done as a part of the screening. Several non-cancerous conditions might result in elevated PSA levels including benign prostatic hypertrophy (BPH) and inflammation, or recent prostate gland stimulation resulting from a DRE or ejaculation. Current consensus also highlights the importance of measuring and comparing PSA results over time, known as PSA velocity. Where an increase over time would indicate higher risk for prostate cancer, the magnitude of this increased risk should be in accordance with current national urological association guidelines.

Family history removed to be compliant with GINA.

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 20:37:09 EDT 2015

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Public Input No. 75-NFPA 1582-2015 [ Section No. 8.2.1 [Excluding any Sub-Sections] ]

A mandatory fitness evaluation that is not punitive (with the exception of the aerobic capacity, as described in 8.8.2.1.3) or competitive shall be conducted annually as part of an individualized program.

Statement of Problem and Substantiation for Public Input

Consistency with 8.8.2.1.3

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 15:30:16 EDT 2015

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Public Input No. 76-NFPA 1582-2015 [ Sections 8.2.2.2, 8.2.2.3, 8.2.2.4 ]

Sections 8.2.2.2, 8.2.2.3, 8.2.2.4 8.2.2.2 An evaluation of muscular strength shall be conducted using each of the following protocols:

(1) Grip strength evaluation (See C.2.1.5 for the NFPA 1583 for a sample protocol.) (2) Leg strength power evaluation (See C.2.1.6 for the NFPA 1583 for a sample protocol.) (3) Arm strength Back/shoulder evaluation (See C.2.1.7 for the NFPA 1583 for a sample protocol.)

8.2.2.3 An evaluation of muscular endurance shall be conducted using each of the following protocols:

(1) Push-up evaluation (See C.2.1.9 for the NFPA 1583 for a sample protocol.) (2) Curl-up Side plank evaluation (See C.2.1.11 for the NFPA 1583 for a sample protocol.)

8.2.2.4 An evaluation of flexibility shall be conducted using the sit-and-reach following protocols .

( See C.2.1.12 for the 1) Straight leg raise evaluation (See NFPA 1583 for a sample protocol.) (2) Shoulder flexion/extension protocol (See NFPA 1583 for a sample protocol.)

Statement of Problem and Substantiation for Public Input

1. The protocols proposed in NFPA1583 and in Annex C of NFPA 1582 are not required (as currently stated in NFPA 1582). Stating that these are "sample protocols" would clarify current language. 2. New protocols provide more information concerning overall fire fighter health. Curl-up of limited value for evaluating trunk stability. Side plank evaluation provides more useful information. Sit and reach of limited value for evaluating flexibility. Straight leg raise and shoulder flexion/extension evaluations provide more useful information and evaluate more joints.

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 15:33:26 EDT 2015

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Public Input No. 43-NFPA 1582-2015 [ Section No. 8.2.2.3 ]

8.2.2.3 An evaluation of muscular endurance shall be conducted using each of the following protocols:

(1) Push-up evaluation (See C.2.1.9 for the protocol.) (2) Curl-up evaluation Static Plank (See C.2.1.11 for the protocol.)

Statement of Problem and Substantiation for Public Input

WFI replaced the curl up with Static Plank due to potential back injuries.

Submitter Information Verification

Submitter Full Name: KENNETH PRAVETZ Organization: CITY OF VIRGINIA BEACH FIRE DEPARTMENT Street Address: City: State: Zip: Submittal Date: Mon Apr 06 15:00:04 EDT 2015

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Public Input No. 140-NFPA 1582-2015 [ Chapter 9 ]

Global Change for Chapter 9 : The Category A and B system used for candidates should be extended for use in Chapter 9 in the evaluation of Medical Conditions in Members. The Category A & B system presents a very clear delineation between medical conditions that preclude personnel from performing training or emergency operational activities, from those conditions that might warrant additional evaluation and consideration . Chapter 9 Essential Job Tasks — Specific Evaluation of Medical Conditions in Members 9.1 Essential Job Tasks. 9.1.1 The essential job tasks listed by number in this chapter are the same as those listed in Chapter 5 and shall be validated by the fire department as required by Chapter 5. 9.1.2 The fire department physician shall use the validated list of essential job tasks in evaluating the ability of a member with specific medical conditions to perform specific job tasks.

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9.1.3 Essential job tasks referenced throughout this chapter by number only shall correspond to the following model list:

(1) * Wearing personal protective ensemble and SCBA, performing fire-fighting tasks (hoseline operations, extensive crawling, lifting and carrying heavy objects, ventilating roofs or walls using power or hand tools, forcible entry, etc.), rescue operations, and other emergency response actions under stressful conditions, including working in extremely hot or cold environments for prolonged time periods (2) Wearing an SCBA, which includes a demand valve–type positive-pressure facepiece or HEPA filter masks, which requires the ability to tolerate increased respiratory workloads (3) Exposure to toxic fumes, irritants, particulates, biological (infectious) and nonbiological hazards, and/or heated gases, despite the use of personal protective ensembles and SCBA (4) Depending on the local jurisdiction, climbing six or more flights of stairs while wearing fire protective ensemble weighing at least 50 lb (22.6 kg) or more and carrying equipment/tools weighing an additional 20 to 40 lb (9 to 18 kg) (5) Wearing fire protective ensemble that is encapsulating and insulated, which will result in significant fluid loss that frequently progresses to clinical dehydration and can elevate core temperature to levels exceeding 102.2°F (39°C) (6) Wearing personal protective ensemble and SCBA, searching, finding, and rescue-dragging or carrying victims ranging from newborns to adults weighing over 200 lb (90 kg) to safety despite hazardous conditions and low visibility

1 (7) Wearing personal protective ensemble and SCBA, advancing water-filled hoselines up to 2 ⁄2 in. (65 mm) in diameter from fire apparatus to occupancy [approximately 150 ft (50 m)], which can involve negotiating multiple flights of stairs, ladders, and other obstacles (8) Wearing personal protective ensemble and SCBA, climbing ladders, operating from heights, walking or crawling in the dark along narrow and uneven surfaces, and operating in proximity to electrical power lines and/or other hazards (9) Unpredictable emergency requirements for prolonged periods of extreme physical exertion without benefit of warm-up, scheduled rest periods, meals, access to medication(s), or hydration (10) Operating fire apparatus or other vehicles in an emergency mode with emergency lights and sirens (11) Critical, time-sensitive, complex problem solving during physical exertion in stressful, hazardous environments, including hot, dark, tightly enclosed spaces, that is further aggravated by fatigue, flashing lights, sirens, and other distractions (12) Ability to communicate (give and comprehend verbal orders) while wearing personal protective ensembles and SCBA under conditions of high background noise, poor visibility, and drenching from hoselines and/or fixed protection systems (sprinklers) (13) Functioning as an integral component of a team, where sudden incapacitation of a member can result in mission failure or in risk of injury or death to civilians or other team members

9.2 Special Teams. 9.2.1 In addition to essential job tasks specified in 9.1.3 (1) through 9.1.3 (13), members of specialized teams such as hazardous materials units, SCUBA teams, technical rescue teams, EMS teams, or units supporting tactical law enforcement operations shall be evaluated for their ability to perform essential job tasks and wear specialized PPE related to the duties of those specialized teams. 9.2.2 The fire department shall define those essential job tasks and shall provide the fire department physician with a description of the risks associated with those tasks and specialized PPE as well as any additional medical and/or physical requirements that are not enumerated in this standard.

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9.2.3 In defining those tasks, the fire department shall consider the impact on the members required to wear or utilize specialized PPE that can increase weight, environmental isolation, sensory deprivation, and/or dehydration potential above levels experienced with standard fire suppression PPE. 9.3 Fire Department Physician Roles. After individually evaluating the member and the member's medical records (including job-related medical rehabilitation records), the fire department physician shall recommend restricting members from performing only those specific job tasks that cannot be safely performed by the member given his/her medical condition. 9.3.1 If an illness, injury, or other debilitating condition has altered a member's ability to safely perform an essential job task, the fire department physician shall notify the fire department that the member is restricted from performing that task while on duty. 9.3.2* The fire department shall determine possible accommodations for members restricted from certain job tasks. 9.3.3* For incumbent fire department members, conditions listed in Chapter 9 shall not indicate a blanket prohibition for such incumbent members from continuing to perform the essential job tasks, nor shall they require automatic retirement or separation from the fire department. 9.3.4 After an individual medical assessment, the physician shall state whether the member, due to a specific condition, can or cannot safely perform his or her essential job tasks. 9.3.5 The AHJ shall determine if the individual can remain in his/her current position or be moved to another position that the individual can perform. 9.4* Cardiovascular Disorders. 9.4.1 Cardiovascular disorders shall include any disorder of the cardiovascular system including but not limited to supraventricular or ventricular arrhythmias (abnormal heart beats), coronary artery disease, and cardiac muscle disease or valve disease. 9.4.2 If the member has any cardiovascular disorders, the member shall be individually evaluated in accordance with 9.4.3 through 9.4.23 to determine if the disorders compromise the member's ability to safely perform the essential job tasks. 9.4.3 Coronary Artery Disease.

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9.4.3.1 Physician Evaluation. The following clinical conditions referable to coronary artery disease including history of myocardial infarction, coronary artery bypass surgery, coronary angioplasty with stent placement, or similar procedures compromise the member's ability to safely perform essential job tasks 1, 2, 4, 5, 6, 7, 9, and 13, and the physician shall report the applicable job limitations to the fire department if any one of the following are present:

9.4.3.2 Physician Guidance. The physician shall consider the following when evaluating a member:

(1) Evaluation of coronary artery disease requires a stress test with imaging and/or coronary angiogram and some assessment of left ventricular function. Following a myocardial infarction or a coronary revascularization procedure, a radionuclide stress test shall be performed to evaluate exercise tolerance and the presence of exercise-induced myocardial ischemia or ventricular arrhythmias. (2) Reports of left ventricular ejection fraction for evaluation of 9.4.3.1 (3) should include “normal” values for the lab performing the test and formal interpretation by a cardiologist. (3) Workload demands of fire fighting have been shown to exceed the levels shown in 9.4.3.1 (4).

9.4.4 Congestive Heart Failure. 9.4.4.1 Physician Evaluation. Congestive heart failure due to any etiology including any disease leading to a lower than normal left or right ventricular ejection fraction, even if corrected by medication, compromises the member's ability to safely perform essential job tasks 1, 2, 4, 7, 9, and 13, and the physician shall report the applicable job limitations to the fire department. 9.4.4.2 Physician Guidance. The physician shall consider that if the heart failure is due to a reversible process that ultimately results in no abnormality in cardiac performance off all cardiac medications (e.g., hyperthyroidism, anemia), then a history of congestive heart failure does not permanently prevent a member from safely performing the essential job tasks. 9.4.5 Restrictive Cardiomyopathy and Constrictive Pericarditis. 9.4.5.1 Physician Evaluation. Restrictive cardiomyopathy and constrictive pericarditis when resulting in heart failure compromise the member's ability to safely perform essential job tasks 1, 2, 4, 7, and 9, and the physician shall report the applicable job limitations to the fire department. 9.4.6 Acute Pericarditis, Acute Endocarditis, and Acute Myocarditis. 9.4.6.1 Physician Evaluation. Acute pericarditis, acute endocarditis, and acute myocarditis compromise the member's ability to safely perform essential job tasks 1, 4, 5, 6, 7, 9, and 13, and the physician shall report the applicable job limitations to the fire department.

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9.4.7 Pericarditis, Endocarditis, or Myocarditis. 9.4.7.1 Physician Evaluation. Chronic pericarditis, endocarditis, or myocarditis when resulting in heart failure or significant valvular incompetence or arrhythmias compromises the member's ability to safely perform essential job tasks 1, 4, 5, 6, 7, and 13, and the physician shall report the applicable job limitations to the fire department. 9.4.7.2 Physician Guidance. Members with pericarditis, endocarditis, or myocarditis shall be carefully assessed for cardiac function, rhythm, and valvular competence at least annually by cardiac echo or other noninvasive or invasive monitoring in consultation with a cardiologist. 9.4.8 Hypertrophic Obstructive Cardiomyopathy. 9.4.8.1 Physician Evaluation. Hypertrophic obstructive cardiomyopathy (HCM) (idiopathic hypertrophic subaortic stenosis) compromises the member's ability to safely perform essential job tasks 1 and 13, and after further evaluation and a final medical determination of the member's condition, the physician shall report any applicable job limitations to the fire department. 9.4.8.2 Physician Guidance. HCM is associated with life-threatening arrhythmias and sudden cardiac death without previous symptoms of heart failure. In specific populations of patients with cardiomyopathies under normal environmental conditions, the following risk factors for sudden cardiac death shall be considered by the physician:

(1) Family history of a premature HCM-related sudden death (in a first-degree relative) (2) Unexplained syncope (3) History of cardiac arrest (4) Sustained ventricular tachycardia (VT) (5) Nonsustained VT (3 beats or more of at least 120 beats/minute documented on a Holter monitor) (6) Left ventricle thickness of 30 mm on echocardiogram (7) * Abnormal blood pressures during the exercise stress test (EST) (peak systolic BP less than 110 mm Hg or a rise less than 30 mm Hg from baseline)

9.4.9 Recurrent Syncope. 9.4.9.1* Physician Evaluation. Recurrent syncope compromises the member's ability to safely perform essential job task 13, and the physician shall report the applicable job limitations to the fire department. 9.4.10 Pacemaker or Automatic Implantable Defibrillator. 9.4.10.1* Physician Evaluation. A medical condition requiring a pacemaker or automatic implantable defibrillator compromises the member's ability to safely perform essential job task 13, and the physician shall report the applicable job limitations to the fire department. 9.4.11 Mitral Valve Stenosis. 9.4.11.1 Physician Evaluation.

Moderate to severe mitral valve stenosis defined as valve area less than or equal to 1.5 cm2 or pulmonary artery systolic pressure greater than 35 mm Hg compromises the member's ability to safely perform essential job tasks 1, 4, 5, 7, and 9, and the physician shall report the applicable job limitations to the fire department. 9.4.12 Mitral Valve Insufficiency. 9.4.12.1 Physician Evaluation. Moderate to severe mitral valve insufficiency, defined as the presence of left ventricular dysfunction, compromises the member's ability to safely perform essential job tasks 1, 4, 5, 7, and 9, and the physician shall report the applicable job limitations to the fire department.

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9.4.12.2 Physician Guidance. Mitral valve prolapse only interferes with safe performance of critical job tasks if associated with arrhythmias or if moderate to severe mitral regurgitation is present. 9.4.13 Aortic Valve Stenosis. 9.4.13.1 Physician Evaluation. Moderate to severe aortic valve stenosis defined as mean aortic valvular gradient greater than or equal to 20 mm Hg and/or valve area less than or equal to 1.0 cm2 compromises the member's ability to safely perform essential job tasks 1, 4, 5, 6, 7, 9, and 13, and the physician shall report the applicable job limitations to the fire department. 9.4.14 Aortic Valve Insufficiency. 9.4.14.1 Physician Evaluation. Moderate to severe aortic valve insufficiency when the cause of left ventricular dysfunction compromises the member's ability to safely perform essential job tasks 1, 4, 7, and 9, and the physician shall report the applicable job limitations to the fire department. 9.4.15 Prosthetic Cardiac Valves. 9.4.15.1 Physician Evaluation. Prosthetic cardiac valves compromise the member's ability to safely perform essential job task 8 if anticoagulation is required and essential job tasks 1, 4, 6, 7, and 9 if left ventricular dysfunction is present, and the physician shall report the applicable job limitations to the fire department. 9.4.16 Wolff-Parkinson-White (WPW) Syndrome. 9.4.16.1* Physician Evaluation. Wolff-Parkinson-White (WPW) syndrome with a history of supraventricular tachycardia (SVT) compromises the member's ability to safely perform essential job task 13, and the physician shall report the applicable job limitations to the fire department. 9.4.17 Other Supraventricular Arrhythmias, Atrial Fibrillation, or Atrial Flutter. 9.4.17.1* Physician Evaluation. Other supraventricular arrhythmias, atrial fibrillation, or atrial flutter when persistent (even if rate controlled) or if anticoagulation is required compromise the member's ability to safely perform essential job task 13 and essential job task 8 if anticoagulation is required, and the physician shall report the applicable job limitations to the fire department. 9.4.17.2 Physician Guidance. The physician shall consider that if the atrial fibrillation is recurrent but self-limited off cardiac medications, there is no evidence of ischemia, and the echocardiogram reveals both a normal mitral valve and a normal-sized left atrium, then the member might be able to safely perform full duties. Paroxysmal atrial tachycardia can sometimes be resolved with modification of diet or treatment of other underlying noncardiac conditions. 9.4.18 Ventricular Arrhythmias and Ectopy. 9.4.18.1 Physician Evaluation. 9.4.18.1.1 The physician shall evaluate the member to determine if a history of ventricular arrhythmias (e.g., ventricular tachycardia and ventricular fibrillation) compromises the member's ability to safely perform essential job task 13, and the physician shall report the applicable job limitations to the fire department. 9.4.18.1.2 A history of ventricular ectopy might compromise the member's ability to safely perform essential job task 13, and after evaluation and a final medical determination of the member's condition, the physician shall report any applicable job limitations to the fire department.

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9.4.18.2 Physician Guidance. The physician shall consider the following:

(1) A history of ventricular arrhythmias, including ventricular tachycardia or ventricular fibrillation, poses significant risk for life-threatening sudden incapacitation in the presence of structural abnormalities, functional abnormalities, or ectopy that occurs during exercise. (2) A history of ventricular ectopy might pose a significant risk for life-threatening sudden incapacitation if structural or ischemic heart disease is present or if ventricular ectopy increases during exercise. (3) Holter monitoring (24-hour ECG recording) might show ventricular ectopy but should show no evidence of ventricular arrhythmias. (4) Echocardiograph must show normal function and no evidence of structural abnormalities. (5) Stress testing off cardiac medications must show no evidence for ischemia, ventricular tachycardia, or ventricular fibrillation. (6) Premature ventricular contractions (PVCs) should resolve with increasing levels of exercise up to 12 METs.

9.4.19 Atrioventricular Block. 9.4.19.1 Physician Evaluation. 9.4.19.1.1 Third-degree or complete atrioventricular block compromises the member's ability to safely perform essential job task 13, and the physician shall report the applicable job limitations to the fire department. 9.4.19.1.2 Other types of atrioventricular block with sinus pause greater than 3 seconds, left bundle branch block, right bundle branch block, or second-degree Type I atrioventricular block might compromise the member's ability to safely perform job task 13 if cardiac structural (i.e., coronary arteries, valves, myocardium) abnormalities are present, if left ventricular function is abnormal, or if heart rate does not increase with exercise in the absence of a mechanical pacemaker, and after further evaluation and a final medical determination of the member's condition, the physician shall report any applicable job limitations to the fire department. 9.4.20 Hypertension. 9.4.20.1* Physician Evaluation. Members with stage I hypertension shall be referred to their primary care physician to ensure that their blood pressure is controlled and to consider periodic screening for asymptomatic end organ damage based on the severity and duration of their hypertension. 9.4.20.2 Members with Stage 2 hypertension (systolic greater than or equal to 160 mm Hg or diastolic greater than or equal to 100 mm Hg) or any member with end organ damage (retinopathy, nephropathy, or vascular or cardiac complications) compromises the member's ability to safely perform essential job tasks 1, 5, 7, 9, and 13, and the physician shall report the applicable job limitations to the fire department. 9.4.21 Metabolic Syndrome. 9.4.21.1* Members with metabolic syndrome are at increased risk for cardiovascular ischemic disease, diabetes, and accelerated hypertension and shall undergo a stress test with imaging; if the results are abnormal or the member is unable to achieve an aerobic capacity of 12 METs, the member’s ability to safely perform essential job tasks 1, 2, 4, 5, 6, 7, 8, 9, 10, and 13 will be compromised. 9.4.22 Cardiac Congenital Abnormality. 9.4.22.1 Physician Evaluation. A history of a cardiac congenital abnormality that has been treated by surgery but with residual complications or that has not been treated by surgery, leaving residuals or complications, might compromise the member's ability to safely perform essential job tasks 1, 4, 5, 6, 7, 9, and 13, and after further evaluation and a final medical determination of the member's condition, the physician shall report any applicable job limitations to the fire department.

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9.4.23 Cardiac Hypertrophy. 9.4.23.1 Physician Evaluation. Cardiac hypertrophy when not a normal response to exercise of the heart might compromise the member's ability to safely perform essential job task 13 and other job functions due to limitations of endurance, and after further evaluation and a final medical determination of the member's condition, the physician shall report any applicable job limitations to the fire department. 9.4.23.2 Physician Guidance. The physician shall consider that this condition can result in the potential for sudden incapacitation. 9.4.24 Heart Transplant. 9.4.24.1 Physician Evaluation. Cardiac transplantation prevents a normal rise in heart rate and increases risk of syncope and sudden cardiac death and therefore shall be considered as compromising the member’s ability to safely perform essential job tasks 1, 2, 4, 5, 6, 7, 8, 9, 10, and 13. 9.4.24.2 Physician Guidance. The physician shall consider that this condition can result in the potential for sudden incapacitation and that the many immunosuppressive drugs required to prevent rejection increase the likelihood for infection. 9.5 Vascular Disorders. 9.5.1 Vascular disorders shall refer to any disorder of the vascular (arterial or venous) system including but not limited to aneurysm, peripheral vascular insufficiency, and thromboembolic disease. 9.5.2 If the member has any vascular disorders, the member shall be individually evaluated in accordance with 9.5.3 through 9.5.11 to determine if the disorders compromise the member's ability to safely perform the essential job tasks, recognizing that heart rate, blood pressure, and shear forces on vessel walls are increased when performing many of the essential job tasks, increasing the risk of acute dissection, rupture, and/or embolic phenomena that even in a normal environment can result in life-threatening sudden incapacitation. 9.5.3 Aortic Aneurysm. 9.5.3.1 Physician Evaluation. Aortic aneurysm (thoracic aortic aneurysm of any size or abdominal aortic aneurysm greater than or equal to 4 cm) compromises the member's ability to safely perform essential job tasks 1, 4, 6, 7, and 13, and the physician shall report the applicable job limitations to the fire department. 9.5.3.2 Physician Guidance. When evaluating a member with an abdominal aortic aneurysm less than 4 cm, the physician shall recognize that treatment requires careful control of blood pressure and regular follow-up with cardiac imaging. 9.5.3.2.1 A minimum of 6 months post-surgical repair of any aortic aneurysm shall be required before the member can be evaluated for return-to-duty status. 9.5.4 Carotid Artery Disease. 9.5.4.1 Physician Evaluation. Carotid artery disease when symptomatic and/or reduction in blood flow of greater than 70 percent is present compromises the member's ability to safely perform job task 13, and the physician shall report the applicable job limitations to the fire department. 9.5.5 Thoracic Outlet Syndrome. 9.5.5.1 Physician Evaluation. Thoracic outlet syndrome (symptomatic) compromises the member's ability to safely perform essential job tasks 1 and 13, and the physician shall report the applicable job limitations to the fire department.

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9.5.6 Peripheral Vascular Disease. 9.5.6.1 Physician Evaluation. Peripheral vascular disease (arterial or venous) when symptomatic (claudication) or severe peripheral edema is present compromises the member's ability to safely perform essential job tasks 1, 4, 5, 7, and 9, and the physician shall report the applicable job limitations to the fire department. 9.5.7 Thrombophlebitis. 9.5.7.1 Physician Evaluation. 9.5.7.1.1 Thrombophlebitis or deep venous thrombosis that is recurrent or persistent or requires anticoagulation compromises the member's ability to safely perform essential job tasks 1, 4, 5, 7, and 9, and the physician shall report the applicable job limitations to the fire department. 9.5.7.1.2 Full-dose or low-dose anticoagulation compromises the member's ability to safely perform essential job task 8, and the physician shall report the applicable job limitations to the fire department. 9.5.8 Circulatory Instability. 9.5.8.1 Physician Evaluation. Circulatory instability as indicated by orthostatic hypotension or persistent tachycardia compromises the member's ability to safely perform essential job tasks 1, 5, 9, and 13, and the physician shall report the applicable job limitations to the fire department. 9.5.9 Peripheral Vascular Disease. 9.5.9.1 Physician Evaluation. Peripheral vascular disease, such as severe Raynaud's phenomenon, might compromise the member's ability to safely perform essential job tasks (e.g., under certain conditions, including cold weather), and after further evaluation and a final medical determination of the member's condition, the physician shall report any applicable job limitations to the fire department. 9.5.10 Lymphedema. 9.5.10.1 Physician Evaluation. Chronic, severe lymphedema or massive edema of any type (e.g., due to lymphadenopathy, severe venous valvular incompetency, endocrine abnormalities, or low flow states) compromises the member's ability to safely perform essential job tasks 1, 4, 5, and 8, and the physician shall report the applicable job limitations to the fire department. 9.5.11 Lesions of Aorta or Major Vessels. 9.5.11.1 Physician Evaluation. 9.5.11.1.1 Congenital or acquired lesions of the aorta or major blood vessels might interfere with circulation and prevent the safe performance of essential job tasks 1, 4, and 7 due to limitations of endurance, and after further evaluation and a final medical determination of the member's condition, the physician shall report any applicable job limitations to the fire department. 9.5.11.1.2 Congenital or acquired lesions of the aorta or major blood vessels could increase the potential for life-threatening sudden incapacitation, which might compromise the member's ability to safely perform essential job task 13, and after further evaluation and a final medical determination of the member's condition, the physician shall report any applicable job limitations to the fire department. 9.6* Endocrine and Metabolic Disorders. 9.6.1 Endocrine and metabolic disorders shall include disorders of the hypothalamic-pituitary-thyroid-adrenal axis.

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9.6.2 If the member has any endocrine and metabolic disorders, the member shall be individually evaluated in accordance with 9.6.3 through 9.6.7 to determine if the disorders compromise the member's ability to safely perform the essential job tasks. 9.6.3 Type 1 Diabetes Mellitus That Requires Treatment with Insulin. 9.6.3.1* Physician Evaluation. Type 1 diabetes mellitus that requires treatment with insulin compromises the member's ability to safely perform essential job tasks 5, 9, and 13, and the physician shall report the applicable job limitations to the fire department, unless the member meets all of the following criteria:

(1) Is maintained by a physician knowledgeable in current management of diabetes mellitus on a basal/bolus (can include subcutaneous insulin infusion pump) regimen using insulin analogs. (2) Has demonstrated over a period of at least 6 months the motivation and understanding required to closely monitor and control capillary blood glucose levels through nutritional therapy and insulin administration. Assessment of this shall take into consideration the member's experience and history dealing with erratic meal schedules, sleep disruption, and high aerobic and anaerobic workloads intrinsic to fire fighting. (3) Has a dilated retinal exam by a qualified ophthalmologist or optometrist that shows no higher grade of diabetic retinopathy than microaneurysms, as indicated on the International Clinical Diabetic Retinopathy Disease Severity Scale. (4) Has normal renal function based on a calculated creatinine clearance greater than 60 mL/min and absence of proteinuria. (Creatinine clearance can be calculated by use of the Cockroft-Gault or similar formula. Proteinuria is defined as 24-hour urine excretion of greater than or equal to 300 mg protein or greater than or equal to 300 mg of albumin per gram of creatinine in a random sample.) (5) Has no autonomic or peripheral neuropathy. (Peripheral neuropathy is determined by diminished ability to feel the vibration of a 128 cps tuning fork or the light touch of a 10-gram monofilament on the dorsum of the great toe proximal to the nail. Autonomic neuropathy can be determined by evidence of gastroparesis, postural hypotension, or abnormal tests of heart rate variability.) (6) Has normal cardiac function without evidence of myocardial ischemia on cardiac stress testing (to at least 12 METs) by ECG and cardiac imaging. (7) Has a signed statement and medical records from an endocrinologist or a physician with demonstrated knowledge in the current management of diabetes mellitus as well as knowledge of the essential job tasks and hazards of fire fighting as described in 9.1, allowing the fire department physician to determine whether the member meets the following criteria:

(8) Is maintained on a stable basal/bolus regimen using insulin analogs and has demonstrated over a period of at least 6 months the motivation and understanding required to closely monitor and control capillary blood glucose levels through nutritional therapy and insulin administration despite varied activity schedules. (9) Has had hemoglobin A1C measured at least four times a year (intervals of two to three months) over the last 12 months prior to evaluation if the diagnosis of diabetes has been present over 1 year. Hemoglobin A1C reading of 8 percent or greater shall trigger a medical evaluation to determine if a condition exists in addition to diabetes that is responsible for the hemoglobin A1C not accurately reflecting average glucose levels, including evidence of a set schedule for blood glucose monitoring and a thorough review of data from such monitoring. (10) Does not have an increased risk of hypoglycemia due to alcohol use or other predisposing factors. (11) Has had no episodes of severe hypoglycemia (defined as requiring assistance of another) in the preceding 1 year, with no more than two episodes of severe hypoglycemia in the preceding 3 years. (12) Is certified not to have a medical contraindication to fire-fighting training and operations.

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9.6.3.2 Physician Guidance. When evaluating a member with Type 1 diabetes mellitus, the physician shall recognize that episodes of severe hypoglycemia are associated with an increased risk of subsequent episodes and that hypoglycemia can interfere with cognitive function and judgment. Presence of microvascular and neurological complications of diabetes might increase the risk of hypoglycemic events. 9.6.4 Type 2 Diabetes Mellitus That Requires Treatment with Insulin. 9.6.4.1* Physician Evaluation. Type 2 diabetes mellitus that requires treatment with insulin compromises the member's ability to safely perform essential job tasks 5, 9, and 13, and the physician shall report the applicable job limitations to the fire department, unless the member meets all of the following criteria:

(1) Is maintained by a physician knowledgeable in current management of diabetes mellitus. (2) Has demonstrated over a period of at least 3 months the motivation and understanding required to closely monitor and control capillary blood glucose levels through nutritional therapy and insulin administration. Assessment of this shall take into consideration the member's experience and prior history dealing with the erratic meal schedules, sleep disruption, and high aerobic and anaerobic workloads intrinsic to fire fighting. (3) Has a dilated retinal exam by a qualified ophthalmologist or optometrist that shows no higher grade of diabetic retinopathy than microaneurysms, as indicated on the International Clinical Diabetic Retinopathy Disease Severity Scale. (4) Has normal renal function based on a calculated creatinine clearance greater than 60 mL/min and absence of proteinuria. (Creatinine clearance can be calculated by use of the Cockroft-Gault or similar formula. Proteinuria is defined as 24-hour urine excretion of greater than or equal to 300 mg protein or greater than or equal to 300 mg of albumin per gram of creatinine in a random sample.) (5) Has no autonomic or peripheral neuropathy. (Peripheral neuropathy is determined by diminished ability to feel the vibration of a 128 cps tuning fork or the light touch of a 10-gram monofilament on the dorsum of the great toe proximal to the nail. Autonomic neuropathy can be determined by evidence of gastroparesis, postural hypotension, or abnormal tests of heart rate variability.) (6) Has normal cardiac function without evidence of myocardial ischemia on cardiac stress testing (to at least 12 METs) by ECG and cardiac imaging. (7) Has a signed statement and medical records from an endocrinologist or a physician with demonstrated knowledge in the current management of diabetes mellitus as well as knowledge of the essential job tasks and hazards of fire fighting as described in Section 9.1, allowing the fire department physician to determine whether the member meets the following criteria:

(8) Is maintained on a stable insulin regimen and has demonstrated over a period of at least 3 months the motivation and understanding required to closely monitor and control capillary blood glucose levels despite varied activity schedules through nutritional therapy and insulin administration. (9) Has had hemoglobin A1C measured at least four times a year (intervals of 2 to 3 months) over the last 12 months prior to evaluation if the diagnosis of diabetes has been present over 1 year. Hemoglobin A1C reading of 8 percent or greater shall trigger a medical evaluation to determine if a condition exists in addition to diabetes that is responsible for the hemoglobin A1C not accurately reflecting average glucose levels, including evidence of a set schedule for blood glucose monitoring and a thorough review of data from such monitoring. (10) Does not have an increased risk of hypoglycemia due to alcohol use or other predisposing factors. (11) Has had no episodes of severe hypoglycemia (defined as requiring assistance of another) in the preceding 1 year, with no more than one episode of severe hypoglycemia in the preceding 5 years. (12) Is certified not to have a medical contraindication to fire-fighting training and operations.

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9.6.4.2 Physician Guidance. When evaluating a member with Type 2 diabetes mellitus, the physician shall recognize that episodes of severe hypoglycemia are considered the best predictors of an increased risk of subsequent episodes and hypoglycemia interferes with cognitive function and judgment. 9.6.5 Diabetes Mellitus That Does Not Require Insulin Therapy. 9.6.5.1 Physician Evaluation. Diabetes mellitus that does not require insulin therapy and that is controlled by diet, exercise, and/or oral hypoglycemic agents compromises the member's ability to safely perform essential job tasks 5, 9, and 13, and the physician shall report the applicable job limitations to the fire department, unless the member meets all of the following criteria:

(1) Has had hemoglobin A1C measured at least four times a year (intervals of 2 to 3 months) over the last 12 months prior to evaluation if the diagnosis of diabetes has been present over 1 year. Hemoglobin A1C reading of 8 percent or greater shall trigger a medical evaluation to determine if a condition exists in addition to diabetes that is responsible for the hemoglobin A1C not accurately reflecting average glucose levels, shall including evidence of a set schedule for blood glucose monitoring and a thorough review of data from such monitoring. (2) If on oral hypoglycemic agents, has had no episodes of severe hypoglycemia (defined as requiring assistance of another in the preceding year). (3) Has a dilated retinal exam by a qualified ophthalmologist or optometrist that shows no higher grade of diabetic retinopathy than microaneurysms, as indicated on the International Clinical Diabetic Retinopathy Disease Severity Scale. (4) Has normal renal function based on a calculated creatinine clearance greater than 60 mL/min and absence of proteinuria. (Creatinine clearance can be calculated by use of the Cockroft-Gault or similar formula. Proteinuria is defined as 24-hour urine excretion of greater than or equal to 300 mg protein or greater than or equal to 300 mg of albumin per gram of creatinine in a random sample.) (5) Has no autonomic or peripheral neuropathy. (Peripheral neuropathy is determined by diminished ability to feel the vibration of a 128 cps tuning fork or the light touch of a 10-gram monofilament on the dorsum of the great toe proximal to the nail. Autonomic neuropathy can be determined by evidence of gastroparesis, postural hypotension, or abnormal tests of heart rate variability.) (6) Has normal cardiac function without evidence of myocardial ischemia on cardiac stress testing (to at least 12 METs) by ECG and cardiac imaging.

9.6.6 Nutritional Deficiencies. 9.6.6.1 Physician Evaluation. Nutritional deficiencies, including those caused by congenital or acquired disorders of metabolism, might compromise the member's ability to safely perform essential job tasks 1, 5, and 9, and after further evaluation and a final medical determination of the member's condition, the physician shall report any applicable job limitations to the fire department. 9.6.6.2 Physician Guidance. When evaluating a member with nutritional deficiencies, the physician shall perform an assessment of severity and functional impact and should include percent of ideal body weight, body mass index (BMI), muscle strength, endurance, energy levels, and abilities to feed, hydrate, and absorb essential nutrients pre- and post-fire activities. 9.6.7 Diseases of the Adrenal Gland, Pituitary Gland, Parathyroid Gland, or Thyroid Gland. 9.6.7.1 Physician Evaluation. Untreated or inadequately controlled diseases of the adrenal gland, pituitary gland, parathyroid gland, or thyroid gland of clinical significance compromise the member's ability to safely perform essential job tasks 1, 5, and 9, and the physician shall report the applicable job limitations to the fire department. 9.6.7.2 Physician Guidance. When evaluating a member, the physician shall recognize that clinically controlled diseases of the adrenal gland, pituitary gland, parathyroid gland, or thyroid gland with normal exam and serum levels do not compromise the member's ability to safely perform essential job tasks.

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9.7* Lung, Chest Wall, and Respiratory Disorders. 9.7.1 Lung, chest wall, and respiratory disorders shall include disorders of breathing and the exchange of respiratory gases (oxygen and carbon dioxide), central neurologic control of respiratory drive, nose, sinuses, throat, pharynx, larynx, trachea, airways, lungs, pleura, and chest wall. 9.7.2 When evaluating a member for lung, chest wall, and respiratory disorders, the physician shall consider the following:

(1) Efficient breathing and respiratory gas exchange is required for essential job tasks 1, 2, 3, 4, 5, 7, 9, and 13. (2) Wearing protective clothing increases the oxygen consumption required to safely perform these tasks and, therefore, increases the respiratory workload. (3) SCBA is a positive-pressure demand valve respirator that provides a barrier against the inhalation of noxious/toxic gases and particulate matter but at increased metabolic cost due to its weight and increased respiratory workload (resistance and dead space). (4) If respiratory function or gas exchange is already compromised (increased work of breathing from structural or functional abnormalities, hypoxia, and/or hypercapnia) prior to the performance of essential job tasks, then the increased oxygen demand of strenuous physical exertion, while wearing a personal protective ensemble and/or SCBA, leads to early onset of fatigue or respiratory insufficiency. (5) Lung, chest wall, and respiratory disorders can compromise the member's ability to safely perform essential job tasks 1, 2, 3, 4, 5, 7, 9, and 13.

9.7.3 If the member has any lung, chest wall, or respiratory disorders, the member shall be individually evaluated in accordance with 9.7.4 through 9.7.24 to determine if the disorders compromise the member's ability to safely perform the essential job tasks. 9.7.4 Tracheostomy. 9.7.4.1 Physician Evaluation. Tracheostomy compromises the member's ability to safely wear SCBA (essential job task 2), communicate effectively due to oropharyngeal dysfunction (essential job task 12), and effectively clear secretions or inhaled particulate matter (essential job task 3), and the physician shall report the applicable job limitations to the fire department. 9.7.4.2 Physician Guidance. The physician shall consider that a member with a history of tracheostomy that is now sealed and without persistent respiratory disease or dysfunction does not prevent safe performance of essential job tasks. 9.7.5 Chronic Cough. 9.7.5.1 Physician Evaluation. Chronic cough with or without hemoptysis might compromise the member's ability to safely wear SCBA (essential job task 2) and to safely perform in an irritant environment (essential job task 3), and after further evaluation and a final medical determination of the member's condition, the physician shall report any applicable job limitations to the fire department. 9.7.5.2 Physician Guidance. The physician shall consider the severity of the cough, the impact of irritants and SCBA use on cough severity, and the impact of cough severity on the ability to safely wear SCBA and perform strenuous exertion. The cause of chronic cough and/or hemoptysis needs to be evaluated, as the underlying conditions can also produce increased work of breathing, gas exchange abnormalities, or airway hyperreactivity. 9.7.6* Asthma.

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9.7.6.1 Physician Evaluation. Asthma compromises the member's ability to safely perform essential job tasks 1, 2, 3, 4, 5, 7, 9, and 13, and the physician shall report the applicable job limitations to the fire department, unless the following provisions are met:

(1) The member denies bronchospasm during exertion, temperature/humidity extremes, irritant exposures, fire activities, or hazmat activities. (2) The member denies the use of bronchodilator rescue medications during exertion, temperature/humidity extremes, irritant exposures, fire activities, or hazmat activities. (3) A review of the member's fire department records (training, operations, rehabilitation, and medical) verifies that no asthmatic episodes have occurred during fire suppression or hazardous materials operations or training. (4) As defined by the National Heart Lung and Blood Institute's Guidelines for the Diagnosis and Management of Asthma,” the member has mild asthma classified as either “Step One” (no control medications and requires inhaled bronchodilator rescue medications for attacks no more than two times per week) or “Step Two” (daily control medications consisting of low-dose inhaled corticosteroids or cromolyn or oral leukotriene receptor antagonists (e.g., Montelukast) and requires inhaled bronchodilator rescue medications for attacks no more than two times per week). (5) The member's asthma has not required systemic corticosteroids, emergency room treatment, or hospital admission in the last 2 years.

(6) The member shows adequate reserve in pulmonary function (FVC and FEV1 greater than or equal to 90 percent) and no bronchodilator response measured off all bronchodilators on the day of testing.

(7) * The member has a normal or negative response (less than 20 percent decline in FEV1) from baseline to provocative challenge testing using cold air, methacholine (PC20 greater than 8 is considered normal, as response at dose greater than 8 mg might not be clinically significant), histamine, mannitol, or exercise. For exercise challenge testing, a normal response is a decline in FEV1 less than 13 percent from baseline. (8) The fire department provides and the member agrees to wear SCBA during all phases of fire suppression (i.e., ingress, suppression, overhaul, and egress). (9) The member has a signed statement from a pulmonary or asthma specialist, knowledgeable in the essential job tasks and hazards of fire fighting, that he/she meets the criteria specified in 9.7.6.1 (1) through 9.7.6.1 (6) and that the member can safely perform essential job tasks 1, 2, 3, 4, 5, 7, 9, and 13 without the use of bronchodilator “rescue” medications.

9.7.6.2 Physician Guidance. The physician shall consider the following when evaluating the member's asthmatic condition:

(1) Exposures to exertion, temperature extremes, combustion by-products, irritants, and particulate matter are all potent provokers of asthma attacks. (2) Bronchodilator medications are not adequate maintenance therapy to control symptoms in the irritant environment of the fire ground or hazardous materials incident scene because their use has not been approved by the FDA for use on the fire ground or hazardous materials incident scene and because several studies have implicated the frequent use of beta-agonists (short- and long-acting bronchodilators) as an independent predictor or risk for sudden death and myocardial infarction in the United States, Canada, Britain, New Zealand, and Australia. (3) There is a high probability that acute hyperreactivity in this environment can induce immediate or progressive clinical asthma (bronchospasm and wheeze) that can lead to sudden incapacitation from status asthmaticus and/or cardiac ischemia. There are no studies that support or deny that asthma in this environment can be prevented or adequately controlled by anti-inflammatory medications (inhaled corticosteroids, cromolyn, leukotriene modifiers). It is not acceptable to use or rely on bronchodilator medications for this purpose because in a hazardous environment, SCBA cannot be removed to use a rescue inhaler, and there are no studies that support or deny that their use is preventive or effective in a fire/smoke environment. (4) The member's work history, as well as clinical findings on annual evaluation, should be used as an assessment of the member's practical ability to safely perform the essential job tasks.

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9.7.7* Allergic Lower Respiratory Disorders. 9.7.7.1 Physician Evaluation. Allergic lower respiratory disorders might compromise the member's ability to safely perform essential job tasks 1, 2, 3, 4, 5, 7, 9, and 13, and after further evaluation and a final medical determination of the member's condition, the physician shall report any applicable job limitations to the fire department. 9.7.7.2 Physician Guidance. The physician shall consider that allergic lower respiratory disorder, a term used to define asthma (clinical reversible bronchospasm), is triggered by a known allergic insult and once triggered these patients have demonstrable airway hyperreactivity for weeks to months; it can be recurrent and/or become permanent. 9.7.8* Chronic Obstructive Airways Diseases. 9.7.8.1 Physician Evaluation. Chronic obstructive airways diseases (chronic bronchitis, emphysema), if moderate to severe (absolute FEV1/FVC ratio less than or equal to 0.70 and an FEV1 less than 70 percent predicted), compromises the member's ability to safely perform essential job tasks 1, 2, 3, 4, 5, 7, 9, and 13, and the physician shall report the applicable job limitations to the fire department. 9.7.9 Hypoxemic Disorders. 9.7.9.1 Physician Evaluation. Hypoxemic disorders when moderate to severe (oxygen saturation less than or equal to 90 percent or a Po2 less than or equal to 65 mm Hg, measured at rest and corrected to sea level) or the presence of significant exercise desaturation (a fall in oxygen saturation by 4 percent from baseline or to 90 percent or less) compromises the member's ability to safely perform essential job tasks 1, 2, 3, 4, 7, and 13, and the physician shall report the applicable job limitations to the fire department. 9.7.9.2 Physician Guidance. The physician shall recognize the following situations when evaluating the member:

(1) A resting oxygen saturation of 91 to 93 percent corrected to sea level requires measurement at exercise to determine if desaturation (decrease in oxygen saturation by greater than or equal to 4 percent from baseline or to less than or equal to 90 percent) occurs. (2) Hypoxia can be the result of central regulatory disturbances, obstructive sleep apnea, asthma, chronic obstructive airways diseases, interstitial lung disease, pulmonary hypertension, chronic pulmonary embolism, and so forth. (3) In this environment, gas exchange abnormalities and respiratory insufficiency no matter the cause have the potential for life-threatening sudden incapacitation from cardiopulmonary insufficiency.

9.7.10 Hypercapnic Disorders. 9.7.10.1 Physician Evaluation.

Hypercapnic disorders (elevated carbon dioxide with serum PCO2 greater than or equal to 45 mm Hg) found during evaluation of respiratory complaints or disease compromise the member's ability to safely perform essential job tasks 1, 2, 3, 4, 5, 7, and 13, and the physician shall report the applicable job limitations to the fire department. 9.7.10.2 Physician Guidance. The physician shall consider that hypercapnia can be the result of central regulatory disturbance, medications, obstructive sleep apnea, severe asthma, end-stage chronic obstructive airways diseases, or end-stage interstitial lung disease. In this environment, gas exchange abnormalities and respiratory insufficiency no matter the cause have the potential for life-threatening sudden incapacitation from cardiopulmonary insufficiency. 9.7.11 Pulmonary Hypertension. 9.7.11.1 Physician Evaluation. Pulmonary hypertension compromises the member's ability to safely perform essential job tasks 1, 3, 4, 7, and 13, and the physician shall report the applicable job limitations to the fire department. [For further details see sections on hypoxia (9.7.9), pulmonary embolism (9.7.20), and cardiac valve dysfunction (9.4.11).]

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9.7.12 Tracheal Stenosis. 9.7.12.1 Physician Evaluation. Tracheal stenosis might compromise the member's ability to safely perform essential job tasks 1, 2, 3, 4, 5, 7, and 12 if pulmonary dysfunction is reduced (FVC less than 60 percent of predicted or abnormal inspiratory flow volume loop) or if the underlying cause of the stenosis prevents the successful and safe performance of the essential job tasks, and after further evaluation and a final medical determination of the member's condition, the physician shall report any applicable job limitations to the fire department. 9.7.13 Pulmonary Resection Surgery, Chest Wall Surgery, or Traumatic Pneumothorax. 9.7.13.1 Physician Evaluation. 9.7.13.1.1 If the member has had pulmonary resection surgery, chest wall surgery, and/or traumatic pneumothorax, the physician shall evaluate the member for full recovery from the surgery with full pulmonary function testing (PFT), including spirometry, lung volumes, diffusion, and hemoglobin oxygen saturation. 9.7.13.1.2 Abnormal PFTs or decreased gas exchange might compromise the member's ability to safely perform essential job tasks 1, 2, 3, 4, 7, and 13, and after further evaluation and a final medical determination of the member's condition, the physician shall report any applicable job limitations to the fire department. 9.7.13.2 Physician Guidance. The physician shall consider the following when evaluating the member:

(1) Pulmonary function tests should be performed after adequate healing and pain resolution; generally, this is 4 weeks after thorascopic surgery and 6 to 8 weeks after open-chest surgery. (2) Pulmonary function tests should be either normal or show only a minimal restrictive disorder without evidence for interstitial disease or gas exchange abnormalities.

(3) Moderate to severe restriction (FVC less than 60 percent of predicted with an absolute FEV1/FVC ratio greater than or equal to 0.90) or hypoxia compromises the member's ability to safely perform essential job tasks unless a more complete evaluation of gas exchange and exercise capacity shows the ability to exercise at a workload of 12 METs without evidence of exercise hemoglobin oxygen desaturation.

9.7.14* Spontaneous Pneumothorax. 9.7.14.1 Physician Evaluation. Spontaneous pneumothorax, when present, might compromise the member's ability to safely perform essential job tasks 1, 2, 3, 4, 7, and 13 due to pain and dyspnea, and after further evaluation and a final medical determination of the member's condition, the physician shall report any applicable job limitations to the fire department. 9.7.14.2 Physician Guidance. The physician shall consider that members with a history of spontaneous pneumothorax and cystic/bullous disease (e.g., as demonstrated on chest CAT scan) whose essential job task 4 includes SCUBA diving cannot safely perform this task since pressure changes during diving can induce recurrence. 9.7.15 Fibrothorax, Chest Wall Deformity, and/or Diaphragm Abnormalities. 9.7.15.1 Physician Evaluation. Fibrothorax, chest wall deformity, and/or diaphragm abnormalities might compromise the member's ability to safely perform essential job tasks 2, 4, and 7, and after further evaluation and a final medical determination of the member's condition, the physician shall report any applicable job limitations to the fire department. 9.7.15.2 Physician Guidance. The physician shall consider that moderate to severe restriction (FVC less than 60 percent of predicted with an absolute FEV1/FVC ratio greater than or equal to 0.90) compromises the member's ability to safely perform essential job tasks unless a more complete evaluation of gas exchange and exercise capacity shows the ability to exercise at a workload of 12 METs without evidence of hypoxia or exercise hemoglobin oxygen desaturation.

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9.7.16* Pleural Effusions. 9.7.16.1 Physician Evaluation. Pleural effusions might compromise the member's ability to safely perform essential job tasks 2, 4, and 7, and after further evaluation and a final medical determination of the member's condition, the physician shall report any applicable job limitations to the fire department. 9.7.17 Bronchiectasis and/or Bronchiolitis Obliterans. 9.7.17.1 Physician Evaluation. Bronchiectasis and/or bronchiolitis obliterans might compromise the member's ability to safely perform essential job tasks 1, 2, 3, 4, 5, and 7, and after further evaluation and a final medical determination of the member's condition, the physician shall report any applicable job limitations to the fire department. 9.7.17.2 Physician Guidance. The physician shall consider that the ability to safely perform essential job tasks is based on symptom (frequent productive cough, wheezing, and/or dyspnea) and disease severity (chest CAT scan demonstrating multi-lobar disease and pulmonary function tests demonstrating moderate to severe obstructive or restrictive dysfunction or gas exchange abnormalities). 9.7.18 Interstitial Lung Diseases. 9.7.18.1 Physician Evaluation. Interstitial lung diseases including pneumoconiosis (anthracosis, silicosis, asbestosis), hypersensitivity pneumonitis, eosinophilic pneumonitis, idiopathic pulmonary fibrosis, inhalation pneumonitis, and extensive pulmonary infections might compromise the member's ability to safely perform essential job tasks 1, 2, 3, 4, and 7, and after further evaluation and a final medical determination of the member's condition, the physician shall report any applicable job limitations to the fire department. 9.7.18.2 Physician Guidance. The physician shall consider that moderate to severe restriction (FVC less than 60 percent of predicted with an absolute FEV1/FVC ratio greater than or equal to 0.90) compromises the member's ability to safely perform essential job tasks unless a more complete evaluation of gas exchange and exercise capacity shows the ability to exercise at a workload of 12 METs without evidence of hypoxia or exercise hemoglobin oxygen desaturation. 9.7.19 Sarcoidosis. 9.7.19.1 Physician Evaluation. Sarcoidosis resulting in moderate or severe pulmonary dysfunction, significant visual impairment, cardiac dysfunction (cardiomyopathy or arrhythmia) at rest or exercise, other moderate to severe end-organ dysfunction, or the need for current treatment with systemic corticosteroids compromises the member's ability to safely perform essential job tasks 1, 2, 3, 4, 7, 8, and 13, and the physician shall report the applicable job limitations to the fire department. 9.7.19.2 Physician Guidance. The physician shall consider the following when evaluating a member with sarcoidosis:

(1) Most patients with sarcoidosis are asymptomatic with abnormal chest imaging studies but normal function. (2) If functional assessment by individual examination, pulmonary function tests, ECG, and echocardiogram are normal, the member is capable of safely performing essential job tasks.

(3) Moderate to severe restriction (FVC less than 60 percent of predicted with an absolute FEV1/FVC ratio greater than or equal to 0.90) compromises the member's ability to safely perform essential job tasks unless a more complete evaluation of gas exchange and exercise capacity shows the ability to exercise at a workload of 12 METs without evidence of exercise hemoglobin oxygen desaturation. (4) Cardiac function should be formally assessed with echocardiography and ECG.

9.7.20 Pulmonary Embolism. 9.7.20.1 Physician Evaluation.

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9.7.20.1.1 Acute, recent, recurrent, or chronic pulmonary embolism requiring anticoagulation compromises the member's ability to safely perform essential job task 8, and the physician shall report the applicable job limitations to the fire department. 9.7.20.1.2 Moderate to severe pulmonary dysfunction (restriction or gas exchange abnormalities) or pulmonary hypertension is rare but if present compromises the member's ability to safely perform essential job tasks 1, 2, 4, and 7, and the physician shall report the applicable job limitations to the fire department. 9.7.21 Disorders of Respiratory Regulation. 9.7.21.1 Physician Evaluation. Disorders of respiratory regulation can result in gas exchange abnormalities that might compromise the member's ability to safely perform essential job tasks 1, 2, 4, 7, and 9, and after further evaluation and a final medical determination of the member's condition, the physician shall report any applicable job limitations to the fire department. 9.7.21.2 Physician Guidance. The physician shall consider that conditions including but not limited to obstructive sleep apnea, central apnea, and disordered central breathing regulation require evaluation of medical history, physical exam, pulmonary function tests, gas exchange, exercise tests, sleep tests, and other tests as deemed necessary. 9.7.22 Cystic Lung Diseases. 9.7.22.1 Physician Evaluation. 9.7.22.1.1 Cystic lung diseases (e.g., congenital bullous disease, pneumatocele, blebs, cystic fibrosis) with significant abnormalities on chest film or moderate to severe pulmonary dysfunction (FVC less than 60 percent predicted or gas exchange abnormalities) compromise the member's ability to safely perform essential job tasks 1, 2, and 4, and the physician shall report the applicable job limitations to the fire department. 9.7.22.1.2 Members shall be restricted from SCUBA diving if disease is moderate to severe on chest CAT imaging, even if pulmonary function tests are normal. 9.7.23 Tuberculosis. See Section 9.8. 9.7.24 Lung Cancer. See Section 9.17. 9.7.25 Lung Transplant. 9.7.25.1 Physician Evaluation. Lung function post–lung transplantation shall be considered as compromising a member’s ability to safely perform essential job tasks (1, 2, 4, 5, 6, 7, 8, 9, 10, 13). 9.8 Infectious Diseases. 9.8.1 Infectious diseases shall include systemic, local, acute, and chronic infections as well as post-infectious processes.

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9.8.2 When evaluating a member for infectious diseases, the physician shall consider the following:

(1) Many infections interfere with control of body temperature, hydration, and nutritional status. (2) Many infections also produce severe pain, muscle weakness, compromise mobility, and/or ability to safely perform heavy physical exertion. (3) Members must be able to safely interact with other fire fighters and civilians without posing a significant public health risk due to contagious disease. (4) Acute and/or self-limited infectious processes can require temporary work restriction. Examples include influenza or upper respiratory tract infection, which can interfere with safe performance of essential job tasks 2 and 3, or acute dermatitis, which would interfere with safe performance of essential job task 3. (5) Following resolution of these acute processes, members can return to full duty.

9.8.3 If the member has any infectious diseases, the member shall be individually evaluated in accordance with 9.8.4 through 9.8.12 to determine if the diseases compromise the member's ability to safely perform the essential job tasks. 9.8.4 Skin Infections and Draining Ulcers or Cysts. 9.8.4.1 Physician Evaluation. Skin infections and draining ulcers or cysts might compromise the member's ability to wear PPE (essential job tasks 2 and 5) or present too high a risk for exposure to infectious agents and toxins (essential job task 3), and after further evaluation and a final medical determination of the member's condition, the physician shall report any applicable job limitations to the fire department. 9.8.5 Upper or Lower Respiratory Infections. 9.8.5.1 Physician Evaluation. Upper or lower respiratory infections that result in excessive cough, inability to use SCBA, or pulmonary dysfunction might compromise the member's ability to safely perform essential job tasks 1, 2, 3, 4, 5, and 7, and after further evaluation and a final medical determination of the member's condition, the physician shall report any applicable job limitations to the fire department. 9.8.6 Ear Infections. 9.8.6.1 Physician Evaluation. Ear infections that interfere with balance and/or hearing might compromise the member's ability to safely perform essential job tasks 8 and 12, and after further evaluation and a final medical determination of the member's condition, the physician shall report any applicable job limitations to the fire department. 9.8.7 Gastrointestinal Infections. 9.8.7.1 Physician Evaluation. Gastrointestinal infections including parasites that result in dehydration or frequent use of toilet facilities at least temporarily might compromise the member's ability to safely perform essential job tasks 1, 5, 8, and 9, and after further evaluation and a final medical determination of the member's condition, the physician shall report any applicable job limitations to the fire department. 9.8.8 Kidney or Urinary Infections. 9.8.8.1 Physician Evaluation. Kidney or urinary infections that result in dehydration or the frequent use of toilet facilities might compromise the member's ability to safely perform essential job tasks 1, 5, and 9, and after further evaluation and a final medical determination of the member's condition, the physician shall report any applicable job limitations to the fire department. 9.8.9* Infection That Results in Dizziness, Weakness, Significant Weight Loss, or Pain.

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9.8.9.1 Physician Evaluation. Any infection that results in dizziness, significant weakness, significant weight loss, or significant pain limiting functional capacity compromises the member's ability to safely perform essential job tasks 1, 5, 8, and 9, and the physician shall report the applicable job limitations to the fire department. 9.8.10* Active Pulmonary Tuberculosis. 9.8.10.1 Physician Evaluation. Active pulmonary tuberculosis, by posing a public health risk to the community and other members, compromises the member's ability to safely perform essential job tasks 2, 4, 5, and 12, and the physician shall report the applicable job limitations to the fire department. 9.8.11* Hepatitis. 9.8.11.1 Physician Evaluation. Hepatitis, specifically infectious diseases of the liver caused by viruses including but not limited to A, B, C, D, and E, and the treatment of hepatitis might compromise the member's ability to safely perform essential job tasks 1, 2, 4, 5, 7, 9, and 13, and after further evaluation and a final medical determination of the member's condition, the physician shall report any applicable job limitations to the fire department. 9.8.11.2 Physician Guidance. Medical management of members following occupational exposure or development of any viral hepatitis shall conform to the current CDC guidelines, which includes recommendations for restriction from various types of duty. [See 7.7.8 (2).] 9.8.12* Human Immunodeficiency Virus (HIV) Infection. 9.8.12.1 Physician Evaluation. If the member has been diagnosed with human immunodeficiency virus (HIV) infection, the physician shall evaluate the member to determine if the member can perform the essential job tasks. 9.8.12.1.1 AIDS and significant organ damage or dysfunction resulting from HIV infection compromise the member's ability to safely perform essential job tasks 1, 2, 4, 5, 7, 8, and 9 due to debilitation, and the physician shall report the applicable job limitations to the fire department. 9.8.12.1.2 Anemia, cardiopulmonary dysfunction, or neurologic dysfunction compromises the member's ability to safely perform essential job tasks 1, 2, 3, 4, 5, 7, 9, and 13, and the physician shall report the applicable job limitations to the fire department. 9.8.12.1.3 Peripheral neuropathy compromises the member's ability to safely perform essential job tasks 1, 3, and 5, and the physician shall report the applicable job limitations to the fire department. 9.8.12.1.4 Dementia compromises the member's ability to safely perform essential job tasks 1, 11, and 12, and the physician shall report the applicable job limitations to the fire department. 9.9* Spine Disorders. 9.9.1 Spine disorders shall include conditions of the cervical, thoracic, and lumbosacral spine such as strains, fractures, and discogenic disease as well as cord, cauda equina, and paraspinous syndromes. 9.9.2 When evaluating a member for spine disorders, the physician shall consider the following:

(1) Fire fighters with active, ongoing, or recurrent spinal disorders can have difficulty due to reduced motor strength, sensation, and flexibility as well as problems with fatigue, coordination, gait, and equilibrium. (2) The personal protective ensemble and SCBA can place the fire fighter's spine at a biomechanical disadvantage due to added weight and altered center of gravity.

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9.9.3 If the member has any spine disorders, the member shall be individually evaluated in accordance with 9.9.4 through 9.9.9 to determine if the disorders compromise the member's ability to safely perform the essential job tasks. 9.9.4 Spinal Fusion. 9.9.4.1 Physician Evaluation. Spinal fusion that results in instability or reduced mobility, strength, range of motion, or persistent pain compromises the member's ability to safely perform essential job tasks 1, 2, 4, 5, 6, 7, 8, and 13, and the physician shall report the applicable job limitations to the fire department. 9.9.5 Ankylosing Spondylitis. 9.9.5.1 Physician Evaluation. Ankylosing spondylitis might compromise the member's ability to safely perform essential job tasks 1, 2, 4, 5, 6, 7, and 8, and after further evaluation and a final medical determination of the member's condition, the physician shall report any applicable job limitations to the fire department. 9.9.6 Spinal Condition with Significant Radiculopathy. 9.9.6.1 Physician Evaluation. Spinal condition with significant radiculopathy resulting in peripheral motor weakness, loss of strength, loss of sensation, and loss of reflexes affecting endurance, strength, flexibility, pain, and/or gait disturbances compromises the member's ability to safely perform essential job tasks 1, 2, 4, 5, 6, 7, 8, and 13, and the physician shall report the applicable job limitations to the fire department. 9.9.7 Use of Narcotics or Muscle Relaxants. 9.9.7.1 Physician Evaluation. The use of narcotics or muscle relaxants to treat any spinal condition compromises the member's ability to safely perform essential job tasks 1, 2, 4, 5, 6, 7, 8, and 13, and the physician shall report the applicable job limitations to the fire department. 9.9.7.2 Physician Guidance. The physician shall consider that medication-induced somnolence, discoordination, and/or disequilibrium compromise a member's ability to safely operate in hazardous environments. 9.9.8 Spine Structural Abnormality, Fracture, or Dislocation. 9.9.8.1 Physician Evaluation. Spine structural abnormality, fracture, or dislocation that causes progressive or recurrent impairment might compromise the member's ability to safely perform essential job tasks 1, 2, 4, 5, 6, 7, 8, and 13 due to limitations of endurance, strength, flexibility, or pain, and after further evaluation and a final medical determination of the member's condition, the physician shall report any applicable job limitations to the fire department. 9.9.8.2 Physician Guidance. The physician shall consider that spinal structural abnormality, a fracture, or a dislocation can also result in ligament instability, increasing the risk for future dislocation and neurologic compromise. 9.9.9 Herniation of Nucleus Pulposus. 9.9.9.1 Physician Evaluation. Herniation of nucleus pulposus or a history of laminectomy, discectomy, or single-level fusion might compromise the member's ability to safely perform essential job tasks 1, 2, 4, 5, 6, 7, 8, and 13 due to pain or limitations of endurance, strength, or flexibility, and after further evaluation and a final medical determination of the member's condition, the physician shall report any applicable job limitations to the fire department. 9.10* Orthopedic Disorders. 9.10.1 Orthopedic disorders shall include injuries and illnesses involving upper extremities, pelvis, and lower extremities including nerves, muscles, tendons, joints, and bones.

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9.10.2 When evaluating a member for orthopedic disorders, the physician shall consider the following:

(1) Fire fighters with active, ongoing, or recurrent orthopedic disorders can have difficulty due to reduced motor strength, sensation, and flexibility as well as problems with fatigue, coordination, gait, and equilibrium. (2) The personal protective ensemble and SCBA can place the fire fighter's involved extremity (upper or lower) at a biomechanical disadvantage due to added weight and altered center of gravity. (3) Certain medications (narcotics and muscle relaxants) used to treat orthopedic conditions can produce or worsen somnolence, discoordination, and disequilibrium.

9.10.3 If the member has any orthopedic disorders, the member shall be individually evaluated in accordance with 9.10.4 through 9.10.20 to determine if the disorders compromise the member's ability to safely perform the essential job tasks. 9.10.4 Amputation of Arm, Hand, or Thumb. 9.10.4.1 Physician Evaluation. Amputation of an arm, hand, or thumb compromises the member's ability to safely perform essential job tasks 1, 2, 6, 7, and 8, and the physician shall report the applicable job limitations to the fire department. 9.10.4.2 Physician Guidance. When evaluating a member with an amputation of the arm, hand, or thumb, the physician shall consider the following:

(1) The amputation of these limbs or joints impairs grip and other physical abilities required to safely perform essential job tasks. (2) Prosthetic limbs do not provide adequate function to safely perform these essential job tasks rapidly in a life-threatening, unforgiving environment.

9.10.5 Amputation of Leg. 9.10.5.1 Physician Evaluation. Amputation of a leg above the knee compromises the member's ability to safely perform essential job tasks 1, 4, 6, 7, and 8, and the physician shall report the applicable job limitations to the fire department.

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9.10.5.2 Physician Guidance. When evaluating a member with an amputation of a leg (above or below the knee) or entire foot, the physician shall consider the following:

(1) The amputation of these limbs or joints significantly impacts ambulation and other weight-bearing activities required to safely perform essential job tasks. (2) Prosthetic limbs might not provide adequate function to safely perform these essential job tasks in an immediately dangerous to life and health (IDLH) environment. (3) To safely perform the essential job tasks in Chapter 5, an incumbent with a below-the-knee (BKA) amputation and a state-of-the-art prosthesis shall meet all of the following requirements:

(4) A stable, unilateral BKA with at least the proximal third of the tibia present for a strong and stable attachment point with the prosthesis (5) Fitted with a prosthesis that will tolerate the conditions present in structural firefighting, when worn in conjunction with standard fire fighting PPE (6) At least 6 months of prosthetic use in a variety of physically demanding activities with no functional difficulties (7) The amputee limb is healed with no significant inflammation, persistent pain, necrosis, or indications of instability at the amputee limb attachment point (8) Demonstrates no disabling psychosocial issues pertaining to the loss of limb and/or use of prosthesis (9) Evaluated by a prosthetist or orthopedic specialist with expertise in the fitting and function of prosthetic limbs who concurs that the candidate can complete all essential job tasks listed in Chapter 9, including wearing personal protective ensembles and SCBA while climbing ladders, operating from heights, and walking or crawling in the dark along narrow and uneven surfaces that might be wet or icy

9.10.6 Amputation of Finger(s) Other than Thumb. 9.10.6.1 Physician Evaluation. Amputation of finger(s) other than a thumb might compromise the member's ability to safely perform essential job tasks 1, 2, 6, 7, and 8, and after further evaluation and a final medical determination of the member's condition, the physician shall report any applicable job limitations to the fire department. 9.10.6.2 Physician Guidance. The physician shall consider that the amputation of these limbs or joints might interfere with grip and other physical abilities required to safely perform essential job tasks. 9.10.7 Amputation of Partial Foot or Toe(s). 9.10.7.1 Physician Evaluation. Amputation of a partial foot or toe(s) might compromise the member's ability to safely perform essential job tasks 1, 4, 6, 7, and 8, and after further evaluation and a final medical determination of the member's condition, the physician shall report any applicable job limitations to the fire department. 9.10.7.2 Physician Guidance. The physician shall consider that the amputation of these limbs or joints might prevent ambulation and other physical abilities required to safely perform essential job tasks. 9.10.8 Dislocation of a Joint. 9.10.8.1 Physician Evaluation. Single episode of joint dislocation or dislocation with residual limitation of motion (depending upon degree) might compromise the member's ability to safely perform essential job tasks 1, 2, 4, 6, 7, and 8, and after further evaluation and a final medical determination of the member's condition, the physician shall report any applicable job limitations to the fire department.

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9.10.8.2 Physician Guidance. The physician shall consider that successful surgery for shoulder dislocation, if range of motion and strength were intact, would not interfere with the safe performance of essential job tasks. 9.10.9 Recurrent Joint Dislocation of a Major Joint. 9.10.9.1 Physician Evaluation. Recurrent joint dislocation of a major joint (e.g., shoulder) compromises the member's ability to safely perform essential job tasks 1, 2, 4, 6, 7, and 8, and the physician shall report the applicable job limitations to the fire department. 9.10.9.2 Physician Guidance. When evaluating a member for recurrent joint dislocation, the physician shall consider the following:

(1) Unrepaired, repeated joint dislocations indicate an unstable shoulder or hip, which can easily dislocate leading to sudden incapacitation, placing the member or the person depending on the member at life-threatening risk. (2) Post-surgical repair, the member can safely perform essential job tasks if joint exam shows full functional motion, strength, and stability.

9.10.10 Ligament and/or Meniscus Knee Disease. 9.10.10.1 Physician Evaluation. Ligament and/or meniscus knee disease with symptoms of locking, buckling, or giving-way compromises the member's ability to safely perform essential job tasks 1, 4, 6, 7, and 8, and the physician shall report the applicable job limitations to the fire department. 9.10.10.2 Physician Guidance. When evaluating a member for ligament and/or meniscus knee disease, the physician shall consider the following:

(1) Ligament and/or meniscus knee disease can lead to sudden incapacitation, placing the member or the person depending on the member at life-threatening risk. (2) Post-surgical repair, the member can safely perform essential job tasks if joint exam shows full functional motion, strength, and stability.

9.10.11 Joint Replacements or Artificial Joints. 9.10.11.1 Physician Evaluation. Joint replacements or artificial joints compromise the member's ability to safely perform essential job tasks 1, 4, 6, 7, and 8, and the physician shall report the applicable job limitations to the fire department. 9.10.11.2 Physician Guidance. When evaluating a member with joint replacements or artificial joints, the physician shall verify that all of the following conditions are met:

(1) Normal range of motion without history of dislocations post-replacement (2) Repetitive and prolonged pulling, bending, rotations, kneeling, crawling and climbing without pain or impairment (3) No limiting pain (4) An evaluation by an orthopedic specialist concurring that the incumbent can complete all essential job tasks listed in Chapter 9

9.10.12 Limitation of Joint Motion. 9.10.12.1 Physician Evaluation. Limitation of joint motion (depending upon degree) might compromise the member's ability to safely perform essential job tasks 1, 2, 4, 6, 7, and 8 due to reduced flexibility, and after further evaluation and a final medical determination of the member's condition, the physician shall report any applicable job limitations to the fire department. 9.10.13 Joint Reconstruction.

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9.10.13.1 Physician Evaluation. Joint reconstruction in cases where there is significant residual limitation of motion or strength compromises the member's ability to safely perform essential job tasks 1, 4, 6, 7, and 8, and the physician shall report the applicable job limitations to the fire department. 9.10.13.2 Physician Guidance. The physician shall consider that surgery for a torn anterior cruciate ligament or meniscus can interfere with safe performance of essential job tasks 1, 4, 6, 7, and 8 if quadriceps strength is reduced or if the knee is unstable or develops pain or swelling when stressed. 9.10.14 Fractures. 9.10.14.1 Physician Evaluation. Fracture(s) might compromise the member's ability to safely perform essential job tasks 1, 4, 6, 7, and 8, and after further evaluation and a final medical determination of the member's condition, the physician shall report any applicable job limitations to the fire department. 9.10.14.2 Physician Guidance. When evaluating a member with a fracture, the physician shall consider the following:

(1) Fractures, including hip fractures requiring internal fixation, should not interfere with safe performance of essential job tasks as long as the radiograph demonstrates healing and exam is normal. (2) Non-union fractures are not healed, and members cannot safely perform essential job tasks 1, 4, 6, 7, and 8 until union is achieved.

9.10.15 Appliances. 9.10.15.1 Physician Evaluation. Appliances (screws, pins, and/or metal plates) might compromise the member's ability to safely perform essential job tasks 1, 4, 6, 7, and 8, and after further evaluation and a final medical determination of the member's condition, the physician shall report any applicable job limitations to the fire department. 9.10.15.2 Physician Guidance. When evaluating a member with appliances, the physician shall consider the following:

(1) If the appliances are superficial, they could lead to perforation of the skin under the normal abrasive conditions of fire fighting. (2) If the underlying condition responsible for the surgical implantation has healed, surgical consultation is advised to determine the risk–benefit analysis for removing the appliance. (3) After removing the appliance, radiographic evidence of bone healing at approximately 6 months post-removal should be obtained before the member is allowed to safely perform the essential tasks.

9.10.16 Bone Grafts. 9.10.16.1 Physician Evaluation. Bone grafts might compromise the member's ability to safely perform essential job tasks 1, 4, 6, 7, and 8, and after further evaluation and a final medical determination of the member's condition, the physician shall report any applicable job limitations to the fire department. 9.10.16.2 Physician Guidance. The physician shall consider that bone grafts, if well healed, do not interfere with the safe performance of job tasks as long as the radiograph demonstrates healing and the exam is normal. 9.10.17 Chronic Osteoarthritis or Traumatic Arthritis. 9.10.17.1 Physician Evaluation. Chronic osteoarthritis or traumatic arthritis resulting in frequent episodes of pain and/or reduced range of motion, strength, or endurance compromises the member's ability to safely perform essential job tasks 1, 4, 6, 7, and 8, and the physician shall report the applicable job limitations to the fire department. 9.10.18 Inflammatory Arthritis.

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9.10.18.1 Physician Evaluation. Inflammatory arthritis (in cases where it is severe, recurrent, or a progressive illness or associated with deformity or limitation of range of motion), which can result in frequent episodes of pain, reduced strength, and reduced flexibility, compromises the member's ability to safely perform essential job tasks 1, 4, 6, 7, and 8, and the physician shall report the applicable job limitations to the fire department. 9.10.19 Reflex Sympathetic Dystrophy. 9.10.19.1 Physician Evaluation. Reflex sympathetic dystrophy where pain is severe, narcotics or muscle relaxants are required, or strength/flexibility is limited compromises the member's ability to safely perform essential job tasks 1, 4, 6, 7, and 8, and the physician shall report the applicable job limitations to the fire department. 9.10.20 Osteomyelitis or Septic Arthritis. 9.10.20.1 Physician Evaluation. Osteomyelitis or septic arthritis, if active and causing pain, local drainage, systemic infection, and/or increased risk for pathologic or traumatic fractures, compromises the member's ability to safely perform essential tasks 1, 4, 6, 7, and 8, and the physician shall report the applicable job limitations to the fire department. 9.11 Disorders Involving the Gastrointestinal Tract and Abdominal Viscera. 9.11.1 Disorders involving the gastrointestinal (GI) tract and abdominal viscera shall include conditions of the abdominal wall and peritoneum, as well as esophagus, stomach, small bowel, colon, mesenteric structures, and intra-abdominal organs. 9.11.2 If the member has any disorders involving the gastrointestinal tract and abdominal viscera, the member shall be individually evaluated for the likelihood of inadequate nutrition, a propensity for symptomatic dehydration, anemia, or incapacitating pain syndromes.

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9.11.3 Where the following GI disorders result in the complications defined in 9.11.2, the physician shall evaluate the member's ability to safely perform essential job tasks 1, 4, 6, 7, 9, and 13, and after the evaluation and a final medical determination of the member's condition, the physician shall report any applicable job limitations to the fire department:

(1) Cholecystitis (2) Gastritis (3) GI bleeding (4) Inflammatory bowel disease or irritable bowel syndrome (5) Intestinal obstruction (6) Pancreatitis (7) Diverticulitis (8) History of gastrointestinal surgery (9) Gastric or other GI ulcers, including Zollinger-Ellison syndrome (10) Cirrhosis (11) Splenectomy, if healed, does not compromise the member's ability to safely perform essential job tasks. To prevent infections, Pneumovax is recommended at regular intervals. (12) Hernias, such as the following:

(13) Hernias of the abdominal wall, especially inguinal and femoral hernias, might compromise the member's ability to safely perform essential job tasks 1, 4, 6, 7, and 13 due to the risk of incarceration and bowel strangulation during heavy exertion and lifting. (14) Large ventral hernias have a low risk of incarceration but can weaken the abdominal wall musculature and might compromise the member's ability to safely perform essential job tasks 1, 4, 6, and 7. (15) Umbilical hernias that are small and asymptomatic will not generally interfere with fire-fighting duties. (16) Abdominal wall hernias at any site that have been surgically corrected do not prevent otherwise qualified members from safely performing essential fire-fighting tasks, provided the incision site is well healed and the surgeon has cleared the member for full lifting.

9.12 Medical Conditions Involving Head, Eyes, Ears, Nose, Neck, or Throat. 9.12.1* Physician Evaluation. 9.12.1.1 If the member has any medical conditions involving the head, eyes, ears, nose, neck, or throat, the member shall be individually evaluated for conditions that interfere with the member's ability to comfortably wear and be protected by the fire fighter's protective ensemble and that might compromise the member's ability to safely perform essential job tasks 2, 4, 5, and 13. 9.12.1.2 After the evaluation and a final medical determination of the member's condition, the physician shall report any applicable job limitations to the fire department. 9.12.2 Physician Guidance. When evaluating a member with medical conditions involving the head, eyes, ears, nose, neck, or throat, the physician shall consider the following:

(1) Deformities of the skull associated with evidence of disease of the brain, spinal cord, or peripheral nerves can result in the potential for sudden incapacitation and the inability to properly wear protective equipment. (2) Contraction of head and neck muscles can interfere with wearing of protective equipment, impair speech, or otherwise compromise a member's ability to safely perform essential job tasks.

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9.12.3 Disorders of the Eyes or Vision. 9.12.3.1* Physician Evaluation. Disorders of the eyes or vision including the following might compromise the member's ability to safely perform essential job tasks 6, 8, 10, and 11, and after further evaluation and a final medical determination of the member's condition, the physician shall report any applicable job limitations to the fire department:

9.12.3.2 Physician Guidance. The physician shall consider that new monocular vision requires a minimum of 6 months for depth perception accommodation in order to safely perform other essential job tasks. 9.12.4 Abnormal Hearing. 9.12.4.1* Physician Evaluation. Abnormal hearing requiring a hearing aid, cochlear implant, or impairing a member's ability to hear and understand the spoken voice under conditions of high background noise, or hear, recognize, and directionally locate cries or audible alarms, compromises the member's ability to safely perform essential job tasks 2, 6, 8, 10, 12, and 13, and the physician shall report the applicable job limitations to the fire department. 9.12.5 Vertigo, Ataxia, or Disturbance of Gait and Balance. 9.12.5.1* Physician Evaluation. Any condition causing chronic or recurring vertigo, ataxia, or other disturbance of gait and balance compromises the member's ability to safely perform essential job tasks 1, 8, 10, and 13, and the physician shall report the applicable job limitations to the fire department. 9.12.6 Nose, Nasopharynx, Oropharynx, or Dental Structures. 9.12.6.1* Physician Evaluation. Any deformity or disease of the nose, nasopharynx, oropharynx, or dental structures, including anosmia and sinusitis, might compromise the member's ability to safely perform essential job tasks 2, 3, 5, 8, 12, and 13, and after further evaluation and a final medical determination of the member's condition, the physician shall report any applicable job limitations to the fire department. 9.12.6.2* Physician Guidance. Obstructive sleep apnea, if not properly treated, might compromise the member's ability to safely perform essential job tasks 2, 3, 5, 8, 12, and 13, and after further evaluation and a final medical determination of the member's condition, the physician shall report any applicable job limitations to the fire department. 9.13* Neurologic Disorders. 9.13.1 Neurologic disorders shall refer to ongoing, chronic, or recurrent disorders that impair an individual's neurological functions, including central regulation, cognitive abilities, strength, perception, reflexes, coordination, gait, and equilibrium. 9.13.2 If the member has any neurologic disorder that significantly impairs the member's neurologic functions, including central regulation, cognitive abilities, strength, perception, reflexes, coordination, gait, and equilibrium, the member shall be individually evaluated in accordance with 9.13.3 through 9.13.11 to determine if the disorders compromise the member's ability to safely perform the essential job tasks. 9.13.3 Ataxias.

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9.13.3.1 Physician Evaluation. Ataxias of the hereditary or degenerative type compromise a member's ability to safely perform essential job tasks 1, 4, 6, 7, and 8, and the physician shall report the applicable job limitations to the fire department. 9.13.4 Cerebral Arteriosclerosis. 9.13.4.1* Physician Evaluation. Cerebral arteriosclerosis as evidenced by documented episodes of focal, reversible, or neurological impairment might interfere with the member's ability to safely perform essential job tasks 1 through 13, and after further evaluation and a final medical determination of the member's condition, the physician shall report any applicable job limitations to the fire department. 9.13.4.1.1 Cerebral arteriosclerosis as evidenced by documented episodes of focal, reversible, or neurological impairment, if irreversible, compromises the member's ability to safely perform essential job tasks 1 through 13, and the physician shall report the applicable job limitations to the fire department. 9.13.4.1.2 Cerebral arteriosclerosis as evidenced by documented episodes of focal, reversible, or neurological impairment, if requiring anticoagulation treatment, compromises the member's ability to safely perform essential job task 8, and the physician shall report the applicable job limitations to the fire department. 9.13.5 Neuromuscular, Demyelinating, and Other Progressive Neurologic Diseases. 9.13.5.1* Physician Evaluation. Neuromuscular, demyelinating, and other progressive neurologic diseases compromise the member's ability to safely perform essential job tasks 1, 4, 6, 7, 8, 12, and 13, and the physician shall report the applicable job limitations to the fire department, unless the member is free of clinical disease for 3 years and annual evaluation by a specialist concludes that cognitive function and neurologic exam are normal and the member is on no drugs that can impair job function. 9.13.5.2 Physician Guidance. The physician shall consider that this category refers to but is not limited to multiple sclerosis, myasthenia gravis, muscular dystrophies, Huntington's chorea, amyotrophic lateral sclerosis, and bulbar palsy. 9.13.6 Single Unprovoked Seizure and Epileptic Conditions. 9.13.6.1* Physician Evaluation. Single unprovoked seizure and epileptic conditions, including simple, partial complex, generalized, and psychomotor seizure disorders, compromise the member's ability to safely perform essential job tasks 8, 9, 10, 11, and 13, and the physician shall report the applicable job limitations to the fire department unless the member meets all of the following provisions:

(1) The member has had no seizures for 1 year off all anti-epileptic medication or has been 5 years seizure free on a stable medical regimen. (2) Neurologic examination is normal. (3) Imaging (CAT or MRI scan) studies are normal. (4) Awake and asleep EEG studies with photic stimulation and hyperventilation are normal. (5) A definitive statement from a qualified neurological specialist verifies that the member meets the criteria specified in 9.13.6.1 (1) through 9.13.6.1 (4) and that the member can safely perform the essential job tasks of fire fighting.

9.13.7 Cerebral Vascular Bleeding. 9.13.7.1* Physician Evaluation. Cerebral vascular bleeding compromises the member's ability to safely perform essential job tasks 1, 4, 6, 7, 8, 9, 10, 11, 12, and 13, and the physician shall report the applicable job limitations to the fire department unless the cause of bleeding is surgically corrected, exam (including blood pressure) is normal, and studies (imaging and EEG) are normal off anticonvulsants. 9.13.8 Head Trauma.

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9.13.8.1* Physician Evaluation. Head trauma including concussion, brain contusion, subarachnoid hemorrhage, subdural, and/or epidural hematoma might compromise the member's ability to safely perform essential job tasks 1 through 13, and after further evaluation and a final medical determination of the member's condition, the physician shall report any applicable job limitations to the fire department. 9.13.8.2 Physician Guidance. The physician shall consider having the member evaluated and cleared to return to duty by a qualified neurosurgeon or neurologist following significant head trauma. 9.13.9 CNS Tumors. 9.13.9.1 Physician Evaluation. CNS tumors, depending on their location and the size of the mass, might compromise the member's ability to safely perform essential job tasks 1 through 13, and after further evaluation and a final medical determination of the member's condition, the physician shall report any applicable job limitations to the fire department. 9.13.9.2 Physician Guidance. The physician shall consider that after successful resection of a CNS tumor a member can safely return to duty with a neurosurgeon's certification if exam and imaging studies are normal (except for surgical site) and EEG shows no epileptic activity off all anti-convulsant medications. 9.13.9.2.1 Where applicable, metastatic workup shall be negative. 9.13.10 Parkinson's and Other Diseases with Tremor. 9.13.10.1 Physician Evaluation. Parkinson's and other diseases with functionally significant tremor or abnormal gait or balance compromise the member's ability to safely perform essential job tasks 1, 2, 4, 5, 6, 7, 8, and 9, and the physician shall report the applicable job limitations to the fire department. 9.13.10.2 Physician Guidance. 9.13.10.2.1 The physician shall evaluate gait, balance, movement, and medications required to maintain function. 9.13.10.2.2 The impact of the operational environment including heat, hazards, stress, and exertion shall be considered and specifically addressed. 9.13.11 Progressive Dementia. 9.13.11.1 Physician Evaluation. Progressive dementia (e.g., Alzheimer's) compromises the member's ability to safely perform essential job tasks 1 through 13, and the physician shall report the applicable job limitations to the fire department. 9.14* Psychiatric and Psychologic Disorders. 9.14.1 Psychiatric and psychologic disorders shall include acute, ongoing, chronic, or recurrent disorders that impair psychological or emotional function. 9.14.2 Psychiatric and psychologic disorders might compromise the member's ability to safely perform essential job tasks 1, 3, 4, 5, 7, 8, 11, 12, and 13, and after further evaluation and a final medical determination of the member's condition, the physician shall report any applicable job limitations to the fire department. 9.15* Substance Abuse.

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9.15.1 Substance abuse shall refer to the frequent and/or persistent use of alcohol or other substances causing the following:

(1) Failure to fulfill major obligations either at work or at home (2) Verifiable physical or emotional harm to the member (3) Recurrent legal problems (4) Exacerbation of social and/or other interpersonal problems

9.15.2 If the member has any substance abuse problem, the member shall be referred for counseling/treatment and individually evaluated in accordance with 9.15.3 through 9.15.4 to determine if the problem compromises the member's ability to safely perform the essential job tasks. 9.15.3 DSM IV Criteria. 9.15.3.1 Physician Evaluation. DSM IV criteria for substance abuse of alcohol and controlled substances compromise the member's ability to safely perform essential job tasks 1, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, and 13, and the physician shall report the applicable job limitations to the fire department. 9.15.3.2 Physician Guidance. 9.15.3.2.1 The physician shall use medical evaluations, supervisory evaluations, and/or performance evaluations coupled with urine screen and blood toxicology to form a basis for determining and documenting substance abuse. 9.15.3.2.2 Although there is a high recidivism rate with treatment, members shall be offered counseling/treatment, because in most cases substance abuse is a medical illness. 9.15.4 Methadone Maintenance. 9.15.4.1 Physician Evaluation. Methadone maintenance interferes with cognitive functions, energy, coordination, and equilibrium of the member, and therefore compromises the member's ability to safely perform essential job tasks 1, 4, 5, 7, 8, 10, and 11, and the physician shall report the applicable job limitations to the fire department. 9.16 Medications. 9.16.1 Medications shall include prescribed and over-the-counter medications. 9.16.2 When evaluating a member, the physician shall recognize that the medications in Section 9.16 are listed because of noteworthy side effects that might interfere with the performance of essential job tasks. 9.16.3 If the member is taking medications, the member shall be individually evaluated in accordance with 9.16.4 through 9.16.12 to determine if the medications compromise the member's ability to safely perform the essential job tasks. 9.16.4 Anticoagulation. 9.16.4.1 Physician Evaluation. Full-dose or low-dose anticoagulation or any drugs that prolong prothrombin time, partial thromboplastin time, or international normalized ratio (INR) compromise the member's ability to perform essential job task 8 due to the risk of internal bleeding from trauma with potential for rapid incapacitation from shock or central nervous system hemorrhage, and the physician shall report the applicable job limitations to the fire department. 9.16.5 Narcotics.

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9.16.5.1 Physician Evaluation. Narcotics compromise the member's ability to safely perform essential job tasks 1, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, and 13 due to alterations in mental status including vigilance, judgment, and other neurologic functions, and the physician shall report the applicable job limitations to the fire department. 9.16.6 Muscle Relaxants. 9.16.6.1 Physician Evaluation. Muscle relaxants compromise the member's ability to safely perform essential job tasks 1, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, and 13 due to alterations in mental status and other neurologic functions, and the physician shall report the applicable job limitations to the fire department. 9.16.7 Sedatives and Hypnotics. 9.16.7.1 Physician Evaluation. Sedatives and hypnotics compromise the member's ability to safely perform essential job tasks 1, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, and 13 due to alterations in mental status, vigilance, judgment, and other neurologic functions, and the physician shall report the applicable job limitations to the fire department. 9.16.8 Psychiatric Medications. 9.16.8.1 Physician Evaluation. Psychiatric medications might compromise the member's ability to safely perform essential job tasks 5, 8, 11, and 13 due to increased risk of heat stress, movement disorders, and somnolence, and after further evaluation and a final medical determination of the member's condition, the physician shall report any applicable job limitations to the fire department. 9.16.9 Anti-Hypertensive Agents. 9.16.9.1 Physician Evaluation. Certain classes of anti-hypertensive agents (e.g., beta-blockers, high-dose diuretics, and central agents such as clonidine) compromise the member's ability to safely perform essential job tasks 5 and 8 due to risk for dehydration, electrolyte disorders, lethargy, and disequilibrium, and the physician shall report the applicable job limitations to the fire department. 9.16.9.2 Physician Guidance. If the member is on beta-blockers, high-dose diuretics, or central agents such as clonidine, the physician shall refer the member back to his/her physician for consideration of a change in anti-hypertensive medications. 9.16.9.2.1 Once stable off these medications, the member shall be medically re-evaluated for duty. 9.16.9.2.2 Calcium channel blockers shall be acceptable as anti-hypertensive medications, but if used for other cardiac reasons, refer to Section 9.4. 9.16.10 High-Dose Corticosteroids. 9.16.10.1 Physician Evaluation. High-dose corticosteroids for chronic disease compromise the member's ability to safely perform essential job tasks 5 and 8 due to the underlying disease or the risk for dehydration, electrolyte disorders, myopathy, altered sensorium, and/or lethargy, and the physician shall report the applicable job limitations to the fire department. 9.16.10.2 Physician Guidance. If the member is on systemic corticosteroids, other than high-dose corticosteroids, the physician shall refer the member back to his/her physician for consideration of the underlying disease that might compromise the member's ability to safely perform the essential job tasks. 9.16.11 Anabolic Steroids.

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9.16.11.1 Physician Evaluation. Anabolic steroids compromise the member's ability to safely perform essential job tasks 1, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, and 13 due to alterations in mental status including vigilance, judgment, and other neurologic functions, and the physician shall report the applicable job limitations to the fire department. 9.16.12 Other Medications. 9.16.12.1 Physician Evaluation. The physician shall evaluate the member to determine if other medications might compromise the member's ability to safely perform essential job tasks 5, 8, 11, and 13, and after further evaluation and a final medical determination of the member's condition, the physician shall report any applicable job limitations to the fire department. 9.16.12.2 Physician Guidance. The physician shall consider that the member might require careful evaluation for increased risk of heat stress and other side effects of certain medications (e.g., MAOIs, phenothiazines, anti-cholinergics, tricyclic antidepressants), and shall ensure specialized annual follow-up of members taking these medications. 9.17 Tumors — Malignant or Benign. 9.17.1 Malignant conditions of any organ system can produce specific organ dysfunction or generalized debilitation. 9.17.2 When evaluating a member, the physician shall recognize that malignancy or its treatment can result in anemia, malnutrition, pain, and generalized weakness, temporarily or permanently compromising the member's ability to safely perform essential job tasks 1 through 13. 9.17.3 If the member has tumor, whether malignant or benign, the member shall be individually evaluated in accordance with 9.17.4 through 9.17.12 to determine if the tumors compromise the member's ability to safely perform the essential job tasks. 9.17.4 Benign Tumors. 9.17.4.1 Physician Evaluation. A benign tumor, depending on its location, might compromise the member's ability to safely perform essential job tasks 1 through 13, and after further evaluation and a final medical determination of the member's condition, the physician shall report any applicable job limitations to the fire department. 9.17.4.2 Physician Guidance. The physician shall consider that benign tumors will compromise the member's ability to safely perform essential job tasks 1 through 13 only if the space-occupying lesion and/or its treatment affects energy levels or the involved organ system's function. 9.17.5 Acute Illness Related to Malignancy or Its Treatment. 9.17.5.1 Physician Evaluation. Acute illness related to malignancy or its treatment might compromise the member's ability to safely perform essential job tasks 1, 2, 3, 4, 5, 6, 7, 8, 9, and 13, and after further evaluation and a final medical determination of the member's condition, the physician shall report any applicable job limitations to the fire department. 9.17.5.2 Physician Guidance. The physician shall consider that acute illness related to malignancy or its treatment compromises the member's ability to safely perform essential job tasks 1, 2, 3, 4, 5, 6, 7, 8, 9, and 13 if low energy levels, anemia, weight loss, or specific aspects of that organ's dysfunction lead to debilitation. 9.17.6 Central Nervous System Tumors.

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9.17.6.1 Physician Evaluation. Central nervous system tumors might compromise the member's ability to safely perform essential job tasks 1, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, and 13, and after further evaluation and a final medical determination of the member's condition, the physician shall report any applicable job limitations to the fire department. 9.17.6.2 Physician Guidance. 9.17.6.2.1 When evaluating the member for central nervous system tumors, the physician shall consider that central nervous system tumors compromise the member's ability to safely perform essential job tasks 1, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, and 13 if low energy levels, anemia, undernutrition, weight loss, and specific organ dysfunction (seizures, loss of balance, inability to communicate, inability to process complicated commands in an emergency situation, weakness) are present or lead to a debilitated state affecting anaerobic and aerobic job tasks and the ability to wear personal protective ensembles and SCBA. 9.17.6.2.2 If treated successfully, the member shall undergo evaluation by a specialist who must certify that the exam is normal, imaging studies are normal (except for surgical site), and seizures have not occurred in the absence of anticonvulsant medications, and there is no further evidence of malignancy. 9.17.7 Head and Neck Malignancies. 9.17.7.1 Physician Evaluation. Head and neck malignancies might compromise the member's ability to safely perform essential job tasks 1 through 13, and after further evaluation and a final medical determination of the member's condition, the physician shall report any applicable job limitations to the fire department. 9.17.7.2 Physician Guidance. 9.17.7.2.1 When evaluating the member for head and neck malignancies, the physician shall consider that head and neck malignancies compromise the member's ability to safely perform essential job tasks 1 through 13 if low energy levels, anemia, undernutrition, weight loss, inability to clear oral secretions, or other specific organ dysfunction interfere with respiration, communication, hydration, and/or eating. 9.17.7.2.2 If treated successfully, a member shall undergo evaluation by a specialist, who must certify that exam shows normal function, imaging studies show no tumor, and overall medical evaluation reveals no condition that might compromise safe performance of essential job tasks. 9.17.8 Lung Cancer. 9.17.8.1 Physician Evaluation. Lung cancer might compromise the member's ability to safely perform essential job tasks 1, 2, 3, 4, 5, 7, 8, 9, and 13, and after further evaluation and a final medical determination of the member's condition, the physician shall report any applicable job limitations to the fire department. 9.17.8.2 Physician Guidance. 9.17.8.2.1 When evaluating the member for lung cancer, the physician shall consider that lung cancer compromises the member's ability to safely perform job tasks if low energy levels, anemia, undernutrition, weight loss, weakness, paraneoplastic syndromes, or specific organ dysfunction (abnormal secretions, dyspnea, or pulmonary dysfunction interfering with or prohibiting use of SCBA or strenuous physical activities) are present. 9.17.8.2.2 If treated successfully, the member shall undergo evaluation by a specialist who must certify that the member has normal function, imaging studies show no tumor, and overall medical evaluation reveals no condition that might compromise safe performance of essential job tasks. 9.17.9 Gastrointestinal Malignancies.

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9.17.9.1 Gastrointestinal malignancies might compromise the member's ability to safely perform essential job tasks 1, 3, 4, 5, 7, 8, and 9, and after further evaluation and a final medical determination of the member's condition, the physician shall report any applicable job limitations to the fire department. 9.17.9.2 Physician Guidance. 9.17.9.2.1 When evaluating the member for gastrointestinal malignancies, the physician shall consider that gastrointestinal malignancies compromise the member's ability to safely perform job tasks if low energy levels, anemia, undernutrition, weight loss, weakness, paraneoplastic syndromes, or specific organ dysfunction (abnormal secretions or bowel function interfering with or prohibiting prolonged use of personal protective clothing or prohibiting strenuous physical activities) are present. 9.17.9.2.2 If treated successfully, the member shall undergo evaluation by a specialist who must certify that exam and gastrointestinal functioning appear to be normal (including nutrition intake and excretion), imaging studies show no tumor, and overall medical evaluation reveals no condition that could compromise safe performance of essential job tasks. 9.17.10 Genitourinary Malignancies. 9.17.10.1 Physician Evaluation. Genitourinary malignancies might compromise the member's ability to safely perform essential job tasks 1, 3, 4, 5, 7, 8, and 9, and after further evaluation and a final medical determination of the member's condition, the physician shall report any applicable job limitations to the fire department. 9.17.10.2 Physician Guidance. 9.17.10.2.1 When evaluating the member with a history of genitourinary malignancy, the physician shall consider that genitourinary malignancies compromise the member's ability to safely perform job tasks if altered urinary function prevents prolonged activity without use of toilet facilities or if the underlying tumor has produced low energy levels, anemia, undernutrition, weight loss, or specific organ dysfunction. 9.17.10.2.2 If treated successfully, the member shall undergo evaluation by a specialist who must certify that exam is normal (including nutrition intake and excretion), imaging studies show no tumor, and overall medical evaluation reveals no condition that might compromise safe performance of essential job tasks. 9.17.11 Hematologic or Lymphatic Malignancies. 9.17.11.1 Physician Evaluation. Hematologic or lymphatic malignancies might compromise the member's ability to safely perform essential job tasks 1, 2, 3, 4, 5, 7, 8, and 9, and after further evaluation and a final medical determination of the member's condition, the physician shall report any applicable job limitations to the fire department. 9.17.11.2 Physician Guidance. 9.17.11.2.1 When evaluating the member for hematologic or lymphatic malignancies, the physician shall consider that hematologic or lymphatic malignancies (e.g., leukemias, lymphomas) compromise the member's ability to safely perform essential job tasks 1, 2, 3, 4, 5, 7, 8, and 9 if anemia, lymphopenia, or thrombocytopenia is present or if adverse effects of treatment are present. 9.17.11.2.2 If treated successfully, the member shall undergo evaluation by a specialist who must certify that exam is normal, imaging and laboratory studies show no cancer, and overall medical evaluation reveals no condition that could compromise safe performance of essential job tasks. 9.17.12 Skin Cancer.

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9.17.12.1 Physician Evaluation. Skin cancer might compromise the member's ability to safely perform essential job tasks 1, 3, 4, 5, 7, 8, and 9, and after further evaluation and a final medical determination of the member's condition, the physician shall report any applicable job limitations to the fire department. 9.17.12.2 Physician Guidance. 9.17.12.2.1 When evaluating the member for skin cancer, the physician shall consider that skin cancer that requires significant resection, chemotherapy or other systemic anti-neoplastic therapy, or that results in the loss of skin integrity, compromises the member's ability to safely perform job tasks because of low energy levels, anemia, undernutrition, and weight loss, as well as increased risk of burns, infection, dehydration, and heat rash while fire fighting and wearing PPE. 9.17.12.2.2 If treated successfully, the member shall undergo evaluation by a specialist who must certify that exam is normal, imaging and laboratory studies show no cancer, and overall medical evaluation reveals no condition that could compromise safe performance of essential job tasks. 9.18 Pregnancy and Reproductive Health. 9.18.1 Fire Departments shall make available to all male and female fire fighters educational materials outlining the risks from fire fighting on reproductive health. 9.18.2* It is recommended that members who become pregnant report the pregnancy immediately to the fire department physician. Once informed of the pregnancy the fire department physician shall inform the pregnant member of the numerous hazards to the pregnancy and the fetus encountered during routine fire fighting tasks. 9.18.2.1 If the member requests an alternative duty assignment in an environment deemed safe for the pregnancy and the fetus, the physician shall provide appropriate restrictions for essential job tasks 1, 3, 5, 6, 7, and 8 that are unsafe for her or her fetus. 9.18.3 During later stages of pregnancy the member will eventually be unable to safely perform essential job tasks 1, 2, 3, 4, 5, 6, 7, 8, and 9 due to issues with diminished aerobic capacity, balance, speed, and agility. As with any other member, when performance due to medical issues is of concern, the AHJ shall inform the fire department physician and a medical evaluation will be performed to determine the need for restricting the member from those activities that they are not able to safely perform.

Additional Proposed Changes

File Name Description Approved NFPA_1582_Edits_-_WWong_-_7-5-2015.docx

Statement of Problem and Substantiation for Public Input

Edits to the document have been made to improve the usability, function, and content of the NFPA 1582 document. I have suggested changes to the format, content, and I have identified areas where the document can be strengthened.

Submitter Information Verification

Submitter Full Name: WILLIAM WONG Organization: CHICAGO FIRE DEPARTMENT Street Address:

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City: State: Zip: Submittal Date: Mon Jul 06 01:09:56 EDT 2015

107 of 168 10/13/2015 10:13 AM Global Change for Chapters 6 and 9: Explanatory notes should be incorporated with and follow text of the presented Standards for Candidates and Members in each section. The current format for NFPA 1582 is not user friendly as the explanatory notes are presented in the Annex separate from the Standards for Candidates and Members. Because the explanatory notes contain very useful information that informs the Standards, the text of the explanatory should be presented together along with the Standard. This change would alleviate the need to constantly flip back and forth from the Standard to the Annex accessing the 1582 document.

9.10.19 Reflex Sympathetic Dystrophy is also known as Completed Regional Pain Syndrome.

9.12.4 Abnormal Hearing. Please discuss further the role of hearing aids in the Fire Service as many members of departments across the country are wearing hearing aids without problems.

9.16.4 Anticoagulation. Add statement on newer anticoagulant drugs including: coumarins and indandiones, factor Xa inhibitors, heparins, and thrombin inhibitors.

Public Input No. 79-NFPA 1582-2015 [ Section No. 9.1.1 ]

9.1.1 The essential job tasks listed by number considered in this chapter are the same as those listed in Chapter 5 and shall be validated by the fire department as required by Chapter 5.

Statement of Problem and Substantiation for Public Input

Clarity and ease of use of the document. No need to repeat the list from 5.1.1

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 15:50:42 EDT 2015

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Public Input No. 78-NFPA 1582-2015 [ Section No. 9.1.2 ]

9.1.2 The fire department physician shall use the a current and validated list of essential job tasks in evaluating the ability of a member with specific medical conditions to perform specific job tasks.

Statement of Problem and Substantiation for Public Input

The physician needs to the make sure that the list of essential job tasks is current.

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 15:42:41 EDT 2015

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Public Input No. 80-NFPA 1582-2015 [ Section No. 9.1.3 ]

9.1.3 Essential job tasks referenced throughout this chapter by number only shall correspond to the following model list:

(7) Wearing personal protective ensemble and SCBA, advancing water-filled hoselines up to 2 1 ⁄ 2 in. (65 mm) in diameter from fire apparatus to occupancy [approximately 150 ft (50 m)], which can involve negotiating multiple flights of stairs, ladders, and other obstacles (8) Wearing personal protective ensemble and SCBA, climbing ladders, operating from heights, walking or crawling in the dark along narrow and uneven surfaces, and operating in proximity to electrical power lines and/or other hazards (9) Unpredictable emergency requirements for prolonged periods of extreme physical exertion without benefit of warm-up, scheduled rest periods, meals, access to medication(s), or hydration (10) Operating fire apparatus or other vehicles in an emergency mode with emergency lights and sirens (11) Critical, time-sensitive, complex problem solving during physical exertion in stressful, hazardous environments, including hot, dark, tightly enclosed spaces, that is further aggravated by fatigue, flashing lights, sirens, and other distractions (12) Ability to communicate (give and comprehend verbal orders) while wearing personal protective ensembles and SCBA under conditions of high background noise, poor visibility, and drenching from hoselines and/or fixed protection systems (sprinklers) (13) Functioning as an integral component of a team, where sudden incapacitation of a member can result in mission failure or in risk of injury or death to civilians or other team members

Statement of Problem and Substantiation for Public Input

Delete this section. It is a repetition of 5.1.1

Submitter Information Verification

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Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 15:52:35 EDT 2015

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Public Input No. 81-NFPA 1582-2015 [ Section No. 9.2 ]

Statement of Problem and Substantiation for Public Input

Delete this section. The material is already covered in 5.2

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 15:53:57 EDT 2015

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Public Input No. 82-NFPA 1582-2015 [ Section No. 9.3.3 ]

9.3.3* For incumbent fire department members, conditions listed in Chapter 9 shall not indicate a blanket prohibition for such incumbent members from continuing to perform the essential job tasks, nor shall they require automatic retirement or separation from the fire department. A case-by-case assessment by the fire department physicians is necessary.

Statement of Problem and Substantiation for Public Input

Clarification

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 16:05:34 EDT 2015

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Public Input No. 83-NFPA 1582-2015 [ Section No. 9.3.4 ]

9.3.4 After an individual individualized medical assessment, the physician shall state whether the member, due to a specific condition, can or cannot safely perform his or her essential job tasks.

Statement of Problem and Substantiation for Public Input

EEOC language

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 16:09:10 EDT 2015

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Public Input No. 84-NFPA 1582-2015 [ Section No. 9.4.1 ]

9.4.1 Cardiovascular disorders shall include any disorder of the cardiovascular system including but not limited to supraventricular or ventricular arrhythmias (abnormal heart beats), coronary artery disease, and cardiac muscle disease or valve disease.

Statement of Problem and Substantiation for Public Input

Clarification

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 16:10:08 EDT 2015

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Public Input No. 85-NFPA 1582-2015 [ Section No. 9.4.3.1 ]

9.4.3.1 Physician Evaluation. The following clinical conditions referable to coronary artery disease including history of myocardial infarction, coronary artery bypass surgery, coronary angioplasty with or without stent placement, or similar procedures compromise the member's ability to safely perform essential job tasks 1, 2, 4, 5, 6, 7, 9, and 13, and the physician shall report the applicable job limitations to the fire department if any one of the following are present:

(1) Current angina pectoris even if relieved by medication (2) Persistent significant stenosis in any coronary artery (greater than 70 percent lumen diameter narrowing) following treatment (3) Lower than normal left ventricular ejection fraction as measured by radionuclide scan, contrast ventriculography, or echocardiography (4) Maximal exercise tolerance of less than 12 METs (5) Exercise-induced ischemia or , ventricular arrhythmias or conduction abnormalities observed by radionuclide stress test during an evaluation reaching a workload of at least 12 METs (6) History of myocardial infarction, angina, or coronary artery disease with persistence of modifiable risk factor(s) for acute coronary plaque rupture (e.g., tobacco use, hypertension despite treatment or hypercholesterolemia with cholesterol greater than or equal to 180 or low density lipoproteins greater than or equal to 100 despite treatment, or glycosylated hemoglobin greater than 7 8% despite exercise and/or weight reduction) (7) Recovery period of less than 3 months after myocardial infarction (8) Recovery period of less than 3 months after coronary artery bypass surgery (9) Recovery period of less than 1 month after coronary angioplasty with or without stent placement (10) The criteria (1) to (6), including annual radionuclide stress test , should be re-evaluated on an annual basis by the fire department physician.

Statement of Problem and Substantiation for Public Input

The recovery time is missing from NFPA 1582. Suggested times are consistent with recommendations from ACOEM.

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 16:11:07 EDT 2015

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Public Input No. 86-NFPA 1582-2015 [ Sections 9.4.8.1, 9.4.8.2 ]

Sections 9.4.8.1, 9.4.8.2 9.4.8.1 Physician Evaluation. Hypertrophic obstructive cardiomyopathy (HCM) (including idiopathic hypertrophic subaortic stenosis) compromises may compromise the member's ability to safely perform essential job tasks 1 and 13, and after further evaluation and a final medical determination of the member's condition, the physician shall report any applicable job limitations to the fire department. 9.4.8.2 Physician Guidance. HCM is associated with life-threatening arrhythmias and sudden cardiac death without previous symptoms of heart failure. In specific populations of patients with cardiomyopathies under normal environmental conditions, the following risk factors for sudden cardiac death shall be considered by the physician:

(1) Family history of a premature HCM-related sudden death (in a first-degree relative) (2) (3) Unexplained syncope (4) History of cardiac arrest (5) Sustained ventricular tachycardia (VT) (6) Nonsustained VT (3 beats or more of at least 120 beats/minute documented on a Holter monitor) (7) Left ventricle thickness of 30 mm (or more) on echocardiogram (8) * Abnormal systolic blood pressures during the exercise stress test (EST) ( peak systolic BP less than 110 defined as either a failure to increase by at least 20 mm Hg or a rise less than 30 drop of at least 20 mm Hg from baseline during effort )

Statement of Problem and Substantiation for Public Input

1. Consistency between 9.4.8.1 and 9.4.8.2: some types of HCM may be allowed. 2. Family history is not allowed under GINA. 3. The numbers given in (7) have been adjusted according to the 2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 16:24:08 EDT 2015

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Public Input No. 87-NFPA 1582-2015 [ Section No. 9.4.10.1 ]

9.4.10.1* Physician Evaluation. A medical condition requiring a pacemaker or automatic implantable defibrillator compromises the member's ability to safely perform essential job task 13 (unless the member is not pacemaker-dependent) , and the physician shall report the applicable job limitations to the fire department.

Statement of Problem and Substantiation for Public Input

Not being pacemaker-dependent should not lead to restrictions.

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 16:54:11 EDT 2015

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Public Input No. 88-NFPA 1582-2015 [ Section No. 9.4.16.1 ]

9.4.16.1* Physician Evaluation. Wolff-Parkinson-White (WPW) syndrome with structural heart disease compromises the member's ability to safely perform essential job task 13, and the physician shall report the applicable job limitations to the fire department. Wolff-Parkinson-White (WPW) syndrome with a history of supraventricular tachycardia (SVT) compromises the member's ability to safely perform essential job task 13, and the physician shall report the applicable job limitations to the fire department, unless the member has been treated with ablation and has no inducible arrhythmias after ablation .

Statement of Problem and Substantiation for Public Input

Suggested criteria are consistent with ACOEM recommendations.

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 17:00:15 EDT 2015

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Public Input No. 89-NFPA 1582-2015 [ Sections 9.4.20.1, 9.4.20.2 ]

Sections 9.4.20.1, 9.4.20.2 9.4.20.1* Physician Evaluation. Members with stage I hypertension shall be referred to their primary care physician to ensure that their blood pressure is controlled and to consider periodic screening screen for asymptomatic end organ damage based on the severity and duration of their hypertension . End organ damage or a 10% or greater risk of ASCVD over the next 10 years (using the AHA calculator http://tools.cardiosource.org/ASCVD- Risk-Estimator) compromises the member's ability to safely perform essential job tasks 1, 5, 7, 9, and 13, and the physician shall report the applicable job limitations to the fire department, unless a symptom- limiting cardiac exercise test to 12 METs is performed with normal results every 1 to 3 years . 9.4.20.2 Members with Stage 2 hypertension (systolic greater than or equal to 160 mm Hg or diastolic greater than or equal to 100 mm Hg) or any member with end organ damage (retinopathy, nephropathy, or vascular or cardiac complications compromises the member's ability to safely perform essential job tasks 1, 5, 7, 9, and 13, and the physician shall report the applicable job limitations to the fire department. If the blood pressure is subsequently controlled, end organ damage and risk of ASCVD over the next 10 years (using the AHA calculator http://tools.cardiosource.org/ASCVD-Risk-Estimator) shall be assessed. End organ damage or a 10% or greater risk of ASCVD over the next 10 years (using the AHA calculator http://tools.cardiosource.org/ASCVD-Risk-Estimator ) compromises the member's ability to safely perform essential job tasks 1, 5, 7, 9, and 13, and the physician shall report the applicable job limitations to the fire department, unless a symptom-limiting cardiac exercise test to 12 METs is performed with normal results every 1 to 3 years .

Statement of Problem and Substantiation for Public Input

The goal is to decrease the risk of sudden cardiac deaths among members. Suggested changes are consistent with ACOEM recommendations.

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 17:16:51 EDT 2015

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Public Input No. 90-NFPA 1582-2015 [ Section No. 9.4.21.1 ]

9.4.21.1* Members with metabolic syndrome are at increased risk for cardiovascular ischemic disease, diabetes, and accelerated hypertension and shall undergo a stress test with imaging every 1 to 3 years ; if the results are abnormal or the member is unable to achieve an aerobic capacity of 12 METs, the member’s ability to safely perform essential job tasks 1, 2, 4, 5, 6, 7, 8, 9, 10, and 13 will be compromised.

Statement of Problem and Substantiation for Public Input

The frequency of testing is missing from the current edition.

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 17:28:21 EDT 2015

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Public Input No. 91-NFPA 1582-2015 [ Section No. 9.4.23.1 ]

9.4.23.1 Physician Evaluation. Cardiac hypertrophy when not without a normal response to exercise of the heart might compromise the member's ability to safely perform essential job task 13 and other job functions due to limitations of endurance, and after further evaluation and a final medical determination of the member's condition, the physician shall report any applicable job limitations to the fire department.

Statement of Problem and Substantiation for Public Input

Clarification

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 17:31:07 EDT 2015

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Public Input No. 94-NFPA 1582-2015 [ Section No. 9.5.4.1 ]

9.5.4.1 Physician Evaluation. Carotid artery disease when symptomatic and/or reduction in blood flow of greater than 70 60 percent is present compromises the member's ability to safely perform job task 13, and the physician shall report the applicable job limitations to the fire department.

Statement of Problem and Substantiation for Public Input

There is a significant risk of stroke with carotid stenosis of 60% or greater.

See Natural History of ≥60% Asymptomatic Carotid Stenosis in Patients With Contralateral Carotid Occlusion (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1360113/)

Treatment is generally recommended at 60% in asymptomatic patients (http://www.ncbi.nlm.nih.gov/pmc/articles /PMC2665982/)

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 17:57:27 EDT 2015

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Public Input No. 105-NFPA 1582-2015 [ Section No. 9.10.5.2 ]

9.10.5.2 Physician Guidance. When evaluating a member with an amputation of a leg (above or below the knee) or entire foot, the physician shall consider the following:

structural

(a) firefighting, when worn in conjunction with standard fire fighting PPE (b) At least 6 months of prosthetic use in a variety of physically demanding activities with no functional difficulties (c) The amputee limb is healed with no significant inflammation, persistent pain, necrosis, or indications of instability at the amputee limb attachment point (d) Demonstrates no disabling psychosocial issues pertaining to the loss of limb and/or use of prosthesis (e) Evaluated by a prosthetist or orthopedic specialist with expertise in the fitting and function of prosthetic limbs who concurs that the candidate can complete all essential job tasks listed in Chapter 9, including wearing personal protective ensembles and SCBA while climbing ladders, operating from heights, and walking or crawling in the dark along narrow and uneven surfaces that might be wet or icy

Statement of Problem and Substantiation for Public Input

NFPA 1582 is not limited to structural firefighting.

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 18:52:03 EDT 2015

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Public Input No. 154-NFPA 1582-2015 [ Section No. 9.10.19 ]

9.10.19 Reflex Sympathetic Dystrophy Complex regional pain syndrome . 9.10.19.1 Physician Evaluation. Reflex sympathetic dystrophy where pain Complex regional pain syndrome where pain is severe, narcotics or muscle relaxants are required, or strength/flexibility is limited compromises the member's ability to safely perform essential job tasks 1, 4, 6, 7, and 8, and the physician shall report the applicable job limitations to the fire department.

Statement of Problem and Substantiation for Public Input

Updated terminology

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Mon Jul 06 13:08:36 EDT 2015

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Public Input No. 95-NFPA 1582-2015 [ New Section after 9.11 ]

Renal Disease

(1) Chronic kidney disease of stage 4 or 5 (GFR < 30 ml/min), hemodialysis or continuous ambulatory peritoneal dialysis compromises the member's ability to safely perform essential job task 13, and the physician shall report the applicable job limitations to the fire department.

Statement of Problem and Substantiation for Public Input

Risk of CAD increases with chronic kidney disease See FMCSA MEP recommendations on chronic kidney failure (page 8)

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 18:07:40 EDT 2015

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Public Input No. 92-NFPA 1582-2015 [ Section No. 9.12.3.1 ]

9.12.3.1* Physician Evaluation. Disorders of the eyes or vision including the following might compromise the member's ability to safely perform essential job tasks 6, 8, 10, and 11, and after further evaluation and a final medical determination of the member's condition, the physician shall report any applicable job limitations to the fire department:

(1) * Far visual acuity worse than 20/40 binocular corrected with contact lens or spectacles, and far visual acuity uncorrected worse than 20/100 binocular for wearers of hard contacts or spectacles, compromises a member's ability to safely perform essential job tasks 6, 8, 10, and 11. Successful soft contact lens wearers shall not be subject to the uncorrected standard, if the member has been wearing soft contact lenses for more than 6 months with good tolerance . (2) * Monocular vision, stereopsis without fusional capacity, inadequate depth perception night blindness , or loss of peripheral vision (greater than 110 degrees on confrontation horizontal field of vision less than 120 degrees in each eye ) compromises the member's ability to safely perform essential job task 10. (3) Far visual acuity worse than 20/20 binocular, corrected or uncorrected , compromises the member's ability to safely perform essential job task 10. (4) Far visual acuity worse than 20/100 in the worse eye , , corrected or uncorrected, compromises the member's ability to safely perform essential job task 10. (5) Peripheral vision in the horizontal meridian of less than 110 degrees in the better eye or any condition that significantly affects peripheral vision in both eyes. (6) Color deficiency resulting in inability to recognize and distinguish among the colors of traffic signals showing the standard red, amber, and green compromises the member's ability to safely perform essential job task 10. (7) Near visual acuity less than 20/40 binocular, uncorrected or corrected , compromises the member's ability to safely perform essential job tasks 1, 11, 12 and 13.

Statement of Problem and Substantiation for Public Input

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 17:37:51 EDT 2015

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Public Input No. 93-NFPA 1582-2015 [ Section No. 9.12.4.1 ]

9.12.4.1* Physician Evaluation. Abnormal hearing requiring a hearing aid, cochlear implant, or impairing a member's ability to hear and understand the spoken voice under conditions of high background noise, or hear, recognize, and directionally locate cries or audible alarms, compromises the member's ability to safely perform essential job tasks 2, 6, 8, 10, 12, and 13, and the physician shall report the applicable job limitations to the fire department, unless the member is using hearing aids which meet the following criteria: a) Audiometric testing with the heading aids in place using sound field testing, one aided ear at a time while masking the unaided ear, showing an average hearing loss in the aided better ear lower than 40 decibels (dB) at 500 Hz, 1000 Hz, 2000 Hz, and 3000 Hz (2), b) the hearing aids allow sound localization, c) the hearing aids are proven to function when exposed to heat and water from fire-fighting tasks .

Statement of Problem and Substantiation for Public Input

A fire department I work for has several dozens fire fighters with hearing aids. No device failure and no adverse outcome has ever been reported.

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 17:50:42 EDT 2015

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Public Input No. 157-NFPA 1582-2015 [ Section No. 9.13.4 ]

9.13.4 Cerebral Arteriosclerosis. Cerebrovascular disease 9.13.4.1 * Physician Evaluation. Cerebral arteriosclerosis Cerebrovascular disease as evidenced by documented episodes of focal, reversible, or neurological impairment might interfere with the member's ability to safely perform essential job tasks 1 through 13, and after further evaluation and a final medical determination of the member's condition, the physician shall report any applicable job limitations to the fire department. 9.13.4.1.1 Cerebral arteriosclerosis Cerebrovascular disease as evidenced by documented episodes of focal, reversible, or neurological impairment, if irreversible, compromises the member's ability to safely perform essential job tasks 1 through 13, and the physician shall report the applicable job limitations to the fire department . , unless all the following criteria are met: - Waiting period of 12 months after a transient ischemic attack if risk factors are controlled and with treatment with an antiplatelet agent - Waiting period of 12 months after an ischemic stroke (or longer depending on estimated risk of seizure) - No decreased sensation or weakness that interferes with essential job tasks - No physical or cognitive limitations that interferes with essential job tasks 9.13.4.1.2 Cerebral arteriosclerosis as Cerebrovascular disease as evidenced by documented episodes of focal, reversible, or neurological impairment, if requiring anticoagulation treatment, compromises the member's ability to safely perform essential job task 8, and the physician shall report the applicable job limitations to the fire department.

Statement of Problem and Substantiation for Public Input

Suggested changes are consistent with recommendations from FMCSA MEP

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Mon Jul 06 13:42:31 EDT 2015

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Public Input No. 98-NFPA 1582-2015 [ Section No. 9.13.6 ]

9.13.6 Single Unprovoked Seizure and Epileptic Conditions. Seizure disorders 9.13.6.1* Physician Evaluation. Single unprovoked seizure and epileptic conditions, including simple, partial complex, generalized, and psychomotor seizure disorders, compromise the member's ability to safely perform essential job tasks 8, 9, 10, 11, and 13, and the physician shall report the applicable job limitations to the fire department unless the member meets all of the following provisions:

(1) The member has had no seizures for 1 year off all anti-epileptic medication or has been 5 years seizure free on a stable medical regimen most recent consecutive 5 years after a single unprovoked seizure (2) The member has had no seizures for most recent consecutive 10 years if the member was diagnosed with epilepsy (3) Currently on anti-seizure medications or not on anti-seizure medications for the most recent 5 consecutive years . (4) Neurologic examination is normal. (5) Imaging (CAT or MRI scan) studies are Brain MRI is normal. (6) Awake and asleep EEG studies with photic stimulation and hyperventilation are normal. (7) A definitive statement from a qualified neurological specialist verifies that the member meets the criteria specified in 9.13.6.1 (1) through 9.13.6.1 (4 6 ) and that the member can safely perform the essential job tasks of fire fighting.

Statement of Problem and Substantiation for Public Input

Suggested changes are consistent with FMCSA MRB and ACOEM recommendations to reach an annual risk of recurrence of 1%.

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 18:18:04 EDT 2015

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Public Input No. 99-NFPA 1582-2015 [ New Section after 9.13.6.1 ]

Provoked seizures Provoked seizures may compromise the member's ability to safely perform essential job tasks 8, 9, 10, 11, and 13, depending on the underlying cause, and the physician shall report the applicable job limitations to the fire department unless the member meets all of the following provisions:

The cause of the seizure has been successfully treated The risk of recurrence is low (ie, not higher than the risk of seizure in the general population) Evaluation by a neurologist

Statement of Problem and Substantiation for Public Input

A history of provoked seizure requires an evaluation to predict a risk of recurrence, depending on the cause.

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 18:23:04 EDT 2015

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Public Input No. 158-NFPA 1582-2015 [ Section No. 9.13.7 ]

9.13.7 Cerebral Vascular Bleeding. 9.13.7.1 * Physician Evaluation. Cerebral vascular bleeding compromises the member's ability to safely perform essential job tasks 1, 4, 6, 7, 8, 9, 10, 11, 12, and 13, and the physician shall report the applicable job limitations to the fire department unless all the following criteria are met:- the cause of bleeding is surgically corrected , (when indicated) - the exam (including blood pressure) is normal , and

- studies (imaging and EEG) are normal off anticonvulsants .

- Waiting period of 12 months after hemorrhagic stroke or subarachnoid hemorrhage (or longer depending on the estimated risk of seizure) - No decreased sensation or weakness that interferes with essential job tasks - No physical or cognitive limitations that interferes with essential job tasks

Statement of Problem and Substantiation for Public Input

Suggested changes are consistent with FMCSA MEP recommendations

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Mon Jul 06 13:51:52 EDT 2015

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Public Input No. 156-NFPA 1582-2015 [ New Section after 9.13.11 ]

9.13.12 Narcolepsy Narcolepsy with cataplexy or narcolepsy with persistent excessive daytime sleepiness despite medical treatment compromises the member’s ability to safely perform essential job task 13 and the physician shall report the applicable job limitations to the fire department. 9.13.13 Shift work disoder Shift work disoder (confirmed by a physician formally credentialed in sleep medicine) not adequately responding to medical management ) compromises the member’s ability to safely perform essential job task 13 and the physician shall report the applicable job limitations to the fire department.

Statement of Problem and Substantiation for Public Input

These sleep disorders deserve to be mentioned in NFPA 1582. Suggested language is consistent with recommendation from ACOEM.

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Mon Jul 06 13:28:15 EDT 2015

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Public Input No. 100-NFPA 1582-2015 [ New Section after 9.14.2 ]

Specific psychiatric disorders Anxiety disorders compromise the member’s ability to safely perform essential job tasks 1, 3, 4, 5, 7, 8, 11, 12, and 13, and after further evaluation, the physician shall report any applicable job limitations to the fire department unless all following conditions are met:

Compliance with treatment No disqualifying side effects from treatment Appropriate judgment and attention Treatment of comorbidities (including substance abuse and sleep disorders) No irritability No difficulty concentrating No phobia, unless successfully treated No social anxiety disorder, unless successfully treated No panic disorder, unless successfully treated

Bipolar disorders compromise the member’s ability to safely perform essential job tasks 1, 3, 4, 5, 7, 8, 11, 12, and 13, and after further evaluation, the physician shall report any applicable job limitations to the fire department unless all following conditions are met:

DSM-5 criteria for full remission are met Compliance with treatment No disqualifying side effects from treatment Evaluation by a psychiatrist or by a licensed doctoral-level psychologist is required before return to work Ongoing evaluation by a healthcare provider (after return to work) Appropriate judgment and attention Treatment of comorbidities (including substance abuse and sleep disorders) No personality disorder No psychotic features No suicide attempt in the past 24 months No electroconvulsive therapy in the past 6 months No more than one major depressive episode in the lifetime No more than one manic episode in the lifetime No manic episode in the past 12 months

Depressive disorders compromise the member’s ability to safely perform essential job tasks 1, 3, 4, 5, 7, 8, 11, 12, and 13, and after further evaluation, the physician shall report any applicable job limitations to the fire department unless all following conditions are met:

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Ongoing evaluation by a healthcare provider (after return to work) Appropriate judgment and attention Treatment of comorbidities (including substance abuse and sleep disorders) No personality disorder No psychotic features No suicide attempt in the past 24 months No electroconvulsive therapy in the past 6 months No more than one major depressive episode in the lifetime

Antisocial personality disorder, borderline personality disorder and borderline personality disorder compromise the member’s ability to safely perform essential job tasks 1, 3, 4, 5, 7, 8, 11, 12, and 13, and after further evaluation, the physician shall report any applicable job limitations to the fire department. Post-traumatic stress disorder compromise the member’s ability to safely perform essential job tasks 1, 3, 4, 5, 7, 8, 11, 12, and 13, and after further evaluation, the physician shall report any applicable job limitations to the fire department unless all following conditions are met:

Compliance with treatment No disqualifying side effects from treatment Evaluation by a psychiatrist or by a licensed doctoral-level psychologist is required before return to work Appropriate judgment and attention Treatment of comorbidities (including substance abuse and sleep disorders) No irritability No difficulty concentrating No reckless or self-destructive behavior

Delusional disorder compromises the member’s ability to safely perform essential job tasks 1, 3, 4, 5, 7, 8, 11, 12, and 13, and after further evaluation, the physician shall report any applicable job limitations to the fire department unless all following conditions are met:

DSM-5 criteria for full remission are met No psychotic symptoms in the past 6 months Compliance with treatment No disqualifying side effects from treatment Evaluation by a psychiatrist or by a licensed doctoral-level psychologist is required before return to work Ongoing evaluation by a healthcare provider (after return to work) Appropriate judgment and attention Treatment of comorbidities (including substance abuse and sleep disorders) No personality disorder No suicide attempt in the past 24 months No more than one episode of delusional disorder in the lifetime

A brief psychotic episode compromises the member’s ability to safely perform essential job tasks 1, 3, 4, 5, 7, 8, 11, 12, and 13, and after further evaluation, the physician shall report any applicable job limitations to the fire department unless all following conditions are met:

No psychotic symptoms in the past 6 months Compliance with treatment No disqualifying side effects from treatment

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Evaluation by a psychiatrist or by a licensed doctoral-level psychologist is required before return to work Ongoing evaluation by a healthcare provider (after return to work) Appropriate judgment and attention Treatment of comorbidities (including substance abuse and sleep disorders) No personality disorder No suicide attempt in the past 24 months

No more than one psychotic episode in the lifetime

Schizophreniform disorder compromises the member’s ability to safely perform essential job tasks 1, 3, 4, 5, 7, 8, 11, 12, and 13, and after further evaluation, the physician shall report any applicable job limitations to the fire department unless all following conditions are met:

No psychotic symptoms in the past 6 months Compliance with treatment No disqualifying side effects from treatment Evaluation by a psychiatrist or by a licensed doctoral-level psychologist is required before return to work Ongoing evaluation by a healthcare provider (after return to work) Appropriate judgment and attention Treatment of comorbidities (including substance abuse and sleep disorders) No personality disorder No suicide attempt in the past 24 months No more than one psychotic episode in the lifetime

Schizophrenia compromises the member’s ability to safely perform essential job tasks 1, 3, 4, 5, 7, 8, 11, 12, and 13, and after further evaluation, the physician shall report any applicable job limitations to the fire department. Schizoaffective disorder compromise the member’s ability to safely perform essential job tasks 1, 3, 4, 5, 7, 8, 11, 12, and 13, and after further evaluation, the physician shall report any applicable job limitations to the fire department unless all following conditions are met:

DSM-5 criteria for full remission are met Compliance with treatment No disqualifying side effects from treatment Evaluation by a psychiatrist or by a licensed doctoral-level psychologist is required before return to work Ongoing evaluation by a healthcare provider (after return to work) Appropriate judgment and attention Treatment of comorbidities (including substance abuse and sleep disorders) No personality disorder No suicide attempt in the past 24 months No electroconvulsive therapy in the past 6 months No more than one major depressive episode in the lifetime No more than one manic episode in the lifetime No manic episode in the past 12 months No psychotic symptoms in the past 12 months No more than one psychotic episode in the lifetime

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Statement of Problem and Substantiation for Public Input

Suggested changes are consistent with recommendations from FMCSA MEP, DSM 5 and ACOEM work in progress.

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 18:30:32 EDT 2015

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Public Input No. 101-NFPA 1582-2015 [ Section No. 9.15.3 ]

9.15.3 DSM IV 5 Criteria. 9.15.3.1 Physician Evaluation. DSM IV 5 criteria for substance abuse of alcohol and controlled substances disorder compromise the member's ability to safely perform essential job tasks 1, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, and 13, and the physician shall report the applicable job limitations to the fire department. 9.15.3.2 Physician Guidance. 9.15.3.2.1 The physician shall use medical evaluations, supervisory evaluations, and/or performance evaluations coupled with urine screen and blood toxicology to form a basis for determining and documenting substance abuse. 9.15.3.2.2 Although there is a high recidivism rate with treatment, members shall be offered counseling/treatment, because in most cases substance abuse disorder is a medical treatable illness.

Statement of Problem and Substantiation for Public Input

Consistency with new (DSM 5) terminology.

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 18:42:22 EDT 2015

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Public Input No. 103-NFPA 1582-2015 [ Section No. 9.16.7 ]

9.16.7 Sedatives and Hypnotics. 9.16.7.1 Physician Evaluation. Sedatives and hypnotics (including benzodiazepines, dronabinol and "medical marijuana") compromise the member's ability to safely perform essential job tasks 1, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, and 13 due to alterations in mental status, vigilance, judgment, and other neurologic functions, and the physician shall report the applicable job limitations to the fire department.

Statement of Problem and Substantiation for Public Input

These specific examples will help fire department physicians to evaluate members.

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 18:47:22 EDT 2015

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Public Input No. 102-NFPA 1582-2015 [ Section No. 9.16.9.1 ]

9.16.9.1 Physician Evaluation. Certain classes of anti-hypertensive agents (e.g., beta-blockers, high-dose diuretics, and central agents such as clonidine) might compromise the member's ability to safely perform essential job tasks 5 and 8 due to risk for dehydration, electrolyte disorders, lethargy, and disequilibrium, and the physician shall report the applicable job limitations to the fire department.

Statement of Problem and Substantiation for Public Input

Beta-blockers should be banned. They are a class I recommendation after myocardial infarction. Banning beta-blockers would not allow firefighters to return to work after a myocardial infarction. A fire department I work for has over a hundred firefighters on beta-blockers, with no bad outcomes.

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 18:44:17 EDT 2015

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Public Input No. 138-NFPA 1582-2015 [ Section No. A.3.3.1 ]

A.3.3.1 Candidate. Volunteer members are considered employees in some states or jurisdictions. Volunteer fire departments should seek legal counsel as to their legal responsibilities in these matters.

Statement of Problem and Substantiation for Public Input

This annex language does not refer to 3.3.1

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 21:02:51 EDT 2015

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Public Input No. 119-NFPA 1582-2015 [ New Section after A.4.1.2.1 ]

A.4.1.3 The physician plays a central role in all medical aspects of the WFI. The following parameters should be considered in selecting a physician for this program:

(1) The provider has experience in occupational medicine including wellness and fitness health components related to firefighting (2) The provider is board eligible or certified in a relevant specialty such as emergency, family, internal, or occupational medicine (3) The provider has experience coordinating referrals to a variety of medical specialties for care of occupational injuries, cardiac and pulmonary issues, cancer, behavioral and other health issues affecting firefighters. (4) The provider should also be familiar with data collection, risk management and environmental conditions relevant to Labor / Management Wellness Fitness Initiatives.

A number of options that fire departments can implement to increase physician knowledge regarding fire fighter occupational hazards and their management are contained in NFPA 1582. These include:

(1) Providing the physician with an overview of all fire fighter essential job tasks and current job descriptions as well as an outline of the types and levels of service provided by the department. (2) Assisting the physician to understand the physiological and psychological demands of fire fighters, their work conditions/environment and their PPE requirements. Options to increase knowledge in this regard include participating in a ride along and presence at fire scenes. This may be more difficult if the position is contracted out to a health care company.

Ensuring that the physician has a thorough working knowledge of the NFPA 1582 and is actively engaged in the health and safety, behavioral health, rehabilitation, and wellness and fitness programs in their fire department. In addition, ensuring that the physician remains current in the medical literature pertaining to the fire service and consensus clinical practice with relevant Continuing Medical Education (CME).

Statement of Problem and Substantiation for Public Input

Fire departments do not understand how to select an appropriate physician for their needs.

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 20:11:19 EDT 2015

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Public Input No. 106-NFPA 1582-2015 [ Section No. A.4.1.7 ]

A.4.1.7 The fire department should provide the fire department physician with a representative list of essential job tasks for members of fire departments who wear personal protective ensembles and SCBA to conduct interior structural fire-fighting operations. The tasks on this list should be verified by the fire department to be essential to the job under consideration for each individual candidate or member. A sample list based on NFPA 1001, NFPA 1002, NFPA 1003, NFPA 1006, NFPA 1021, and NFPA 1051 is provided in 5.1.1 and Section 9.1. An effective way to transmit this information to the physician is to use the list with checkboxes in front of each essential job task. This list is taken by a candidate or member to the medical provider at the time of medical evaluation. A check in the box indicates that there is no medical reason why an individual cannot safely perform that particular essential job task.

Statement of Problem and Substantiation for Public Input

NFPA 1582 is not limited to structural firefighting

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 18:53:24 EDT 2015

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Public Input No. 108-NFPA 1582-2015 [ Section No. A.4.1.13.1 ]

A.4.1.13.1 Suggested fields (data points) include but are not necessarily limited to the following:

(1) Medical history including the following:

(2) Date of exam (3) Medical history (4) Smoking history (5) Tobacco (smokeless) use (6) Smoking in the past year (7) Tobacco cessation program participation (8) Alcohol use

Family history of heart disease or cancer

(a) (b) Personal history of past disease, disorders, or cancer (c) Exercise history

(9) Current medical and fitness results including the following:

(10) Blood pressure and heart rate

ICD9

(a) ICD10 codes for physician assessment (b) Height and weight (c) Body composition (local recording only) (d) Blood analysis results (e) Urinalysis results (f) Vision (g) Hearing (h) Spirometry (i) Chest x-ray (j) Resting electrocardiogram (k) Cancer screening results (l) Immunizations (m) Aerobic capacity results (n) Muscle strength results (o) Muscle endurance results (p) Flexibility results

Statement of Problem and Substantiation for Public Input

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1. GINA compliance 2. ICD update

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 19:15:49 EDT 2015

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Public Input No. 109-NFPA 1582-2015 [ Section No. A.6.1.1 ]

A.6.1.1 The medical history should include the candidate's known health problems, such as major illnesses, surgeries, medication use, and allergies. Symptom review is also important for detecting early signs of illness. A medical history should also include a personal health history, a family health history, a health habit history, an immunization history, and a reproductive history. An occupational history should also be obtained to collect information about the person's past occupational and environmental exposures.

Statement of Problem and Substantiation for Public Input

GINA compliance

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 19:16:32 EDT 2015

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Public Input No. 137-NFPA 1582-2015 [ Section No. A.6.1.2 ]

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A.6.1.2

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Physical examination should include the following:

(1) Vital signs (temperature, pulse, respiratory rate, and blood pressure (BP)

(2) BP should be measured according to the seven recommendations of the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7). BP should be measured with a properly calibrated and validated instrument. Patients should be seated quietly for at least 5 minutes in a chair with their feet on the floor and the arm supported at heart level. An appropriate-sized cuff (cuff bladder encircling at least 80 percent of the arm) should be used to ensure accuracy. At least two measurements should be made. Systolic BP is the point at which the first of two or more sounds is heard (phase 1), and diastolic BP is the point before the disappearance of sounds (phase 5). [Chobanian et al. 2003]

(3) Head, eyes, ears, nose, and throat (4) Neck (5) Cardiovascular (6) Pulmonary (7) Breast (8) Gastrointestinal (includes rectal exam for mass , and occult blood when clinically indicated ) (9) Genitourinary (includes pap smear, testicular exam, rectal exam for prostate mass ) (10) Hernia (11) Lymph nodes (12) Neurological (13) Musculoskeletal (14) Skin (includes screening for cancers) (15) Vision testing

Laboratory tests on candidates should include the following:

(1) Blood tests, including the following:

(2) CBC with differential, RBC indices and morphology, and platelet count

(3) Electrolytes (Na, K, Cl, HCO 3 , or CO 2 ) (4) Renal function (BUN, creatinine) (5) Glucose (6) Liver function tests (ALT, AST, direct and indirect bilirubin, alkaline phosphatase) (7) Total cholesterol, HDL, LDL, clinically useful lipid ratios (e.g., percent LDL), and triglycerides

(8) Urinalysis. Dipstick test for glucose, ketones, leukocyte esterase, protein, blood, and bilirubin. (9) Audiology. Hearing assessed in each ear at each of the following frequencies: 500 Hz, 1000 Hz, 2000 Hz, 3000 Hz, 4000 Hz, 6000 Hz, and 8000 Hz. Results should be corrected for age as permitted by OSHA. Baseline audiometry is performed in accordance with 29 CFR 1910.95, “Occupational noise exposure.” The basics of this standard include the following:

(10) The first audiogram (for members, this will probably be done during their pre-placement exam) is the baseline audiogram. (11) If subsequent audiograms are better than the baseline, then the best one becomes the baseline. All audiograms should be done with no exposure to industrial noise for the preceding 14 hours.

(12) Spirometry. Pulmonary function testing (spirometry) is conducted to measure the member's forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and the absolute FEV1/FVC ratio.

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FEV1 and FVC results shall be expressed as the absolute value (liters or milliters) and as percent predicted adjusted for gender, age, height, and ethnicity using NHANES III normative equations, with the acceptable threshold being 80 percent predicted. FEV1/FVC ratio results are expressed as the absolute FEV1 value divided by the absolute FVC value, with the acceptable threshold value being 0.71. However, because these norms are population based, it is possible for individuals to be normal just below these thresholds or to have minimal but potentially significant abnormalities just above these thresholds. When percent predicted FEV1 or FVC values are minimally below threshold (typically 74 percent to 79 percent of predicted), the lower limits of normal (LLN) for the appropriate population can, at the discretion of the physician, be used instead of the 80 percent predicted threshold value. For example, the LLN might be more appropriate for taller and older individuals. (See F.2.5 .) (13) Chest radiography. Chest x-ray posterior-anterior and lateral views. (14) Electrocardiograms (ECG). A resting 12-lead ECG. (15) Immunizations and infectious disease screening. The following infectious disease immunizations or infectious disease screenings are to be provided, as indicated:

(16) Tuberculosis screen, purified protein derivative (PPD) tuberculin skin test, or blood test. (17) Hepatitis C virus screen (baseline) (18) Hepatitis B virus vaccinations (19) Tetanus, diphtheria, pertussis (TDAP) vaccine (booster every 10 years) (20) Measles, mumps, rubella (MMR) vaccine (21) Polio vaccine given to uniformed personnel if vaccination or disease is not documented (22) Hepatitis A vaccine due to contaminated water exposures during normal firefighting activities, not just hazmat/rescue activities (23) Varicella vaccine, offered to all nonimmune personnel (24) Influenza vaccine, seasonal and novel, offered to all personnel

Statement of Problem and Substantiation for Public Input

Cancer screening at baseline is not helpful in determining the fitness for duty of an candidate.

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 20:55:57 EDT 2015

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Public Input No. 112-NFPA 1582-2015 [ New Section after A.6.24.1(5) ]

A6.24.1(3) Examples of anticoagulation medications include antithrombin (ATryn), apixaban (Eliquis), argatroban, bivalirudin (Angiomax), dabigatran (Pradaxa), deltaparin (Fragmin), enoxaparin (Lovenox), fondaparinux (Arixtra), rivaroxaban (Xarelto), warfarin (Coumadin ). Antiplatelet agents are not anticoagulation medications and do not lead to restrictions (unless the underlying medical condition does). Examples of antiplatelet agents include aspirin, Aggrenox, clopidogrel (Plavix), prasugrel (Effient), ticagrelor (Brilinta), ticlopidine (Ticlid).

Statement of Problem and Substantiation for Public Input

Clarification for frequently asked question.

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 19:41:54 EDT 2015

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Public Input No. 120-NFPA 1582-2015 [ New Section after A.7.1.3 ]

A.7.2.1 The document relied extensively on the U.S. Preventive Services Task Force (USPSTF), American Heart Association (AHA) and American Cancer Society (ACS) general population recommendations on health screening, it is important to note that these organizations do not routinely consider occupational risk in their recommendations. Therefore, to specifically address known occupational disease risks in fire fighters, such as cardiac events during fire suppression and certain cancers, the document made some recommendations beyond the general population guidelines of these authoritative organizations.

Statement of Problem and Substantiation for Public Input

AHJ’s and members should understand why these recommendations differ from what is recommended for the general population

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 20:12:25 EDT 2015

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Public Input No. 122-NFPA 1582-2015 [ New Section after A.7.2.2(5) ]

A.7.5.1 The Genetic Information Nondiscrimination Act (GINA) prohibits discrimination on the basis of genetic information (including family medical history). The Equal Opportunity Employment Commission (EEOC) has stated that collection of genetic information is only permitted in very limited circumstances, including voluntary wellness programs and then, only with specific informed consent. Voluntary means that participation is not required and that employees may not be penalized for non-participation. For instance, where an employer requires an employee to submit family medical history to a medical provider, even where that provider will not in turn give that information to the employer, the disclosure is not voluntary. Although a fire fighter is not required to provide family medical history under this law, it may prove to be very useful to medical providers screening for potential medical conditions. Nevertheless, family medical history, when collected, must only be utilized as part of a voluntary wellness and fitness program. In other words, it cannot be used in employment decisions. In cases where such history is collected, the employee must sign a statement confirming that the information is being voluntarily disclosed. Additionally, the health care provider must maintain the individual’s confidentiality and only report such information in aggregate terms so that it cannot be tracked back to individual employees.

Statement of Problem and Substantiation for Public Input

Information on GINA should be given.

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 20:20:02 EDT 2015

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Public Input No. 135-NFPA 1582-2015 [ New Section after A.7.7.1 ]

A.7.6.13 Studies have found increased risk for both melanoma and non-melanoma skin cancers in fire fighters. Comprehensive inspection of the skin, especially in sun exposed areas, is recommended. Any suspicious lesions should be referred for dermatological assessment.

Statement of Problem and Substantiation for Public Input

Added screening highlighting risk

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 20:51:31 EDT 2015

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Public Input No. 129-NFPA 1582-2015 [ New Section after A.7.7.8.2 ]

A7.7.8 (4) The Tdap vaccine should not be administered less than 2 years following a Td dose. A7.7.8 (5) Women who receive the MMR vaccine should not become pregnant for three months after the vaccination is administered.

Statement of Problem and Substantiation for Public Input

Remain consistent with current immunization practices.

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 20:29:47 EDT 2015

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Public Input No. 12-NFPA 1582-2013 [ Section No. A.7.7.9.2 ]

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A.7.7.9.2

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The BBP protocol should include the following elements:

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(1) Fact sheet that explains in lay language the risks of infection, the various prophylactic and therapeutic options, the testing and follow-up that will be needed, and recommendations for personal behavior (safe sex, blood donation, etc.) following an exposure (2) Classification table to determine the exposure type and recommendation for prophylaxis (3) Current recommendations of the U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, and Public Health Services (4) List of tests to be done on exposed member, including the following:

(5) HIV (6) Hepatitis B surface antibody (HBsAb), if not previously known to be positive (7) Hepatitis B surface antigen (HBsAg), if not previously known to be positive HBsAb (8) Hepatitis C antibody (HCAb) (9) If HIV prophylaxis is to be given, the following tests:

(10) CBC (11) Glucose, renal, and hepatic chemical function (12) Pregnancy test for females

(13) List of tests to be done on source patient, including the following:

(14) HIV (15) HBsAg (16) HCAb

(17) If source is available, interview for HIV, hepatitis B, and hepatitis C risk/status (18) Determination of risk and need for post-exposure prophylaxis (PEP) (19) Member counseling regarding PEP medication(s) and side effects of treatment; a printed fact sheet for the member to review (20) PEP, if appropriate, given as soon as possible after the incident, preferably within 2 hours (21) Follow-up of members on prophylaxis for the duration of their treatment (22) Assessment of tetanus status and administration of dT booster, if appropriate (23) Assessment of hepatitis B status as follows:

(24) If previously immunized with a positive post-immunization titer, no further treatment is needed. (25) If previously immunized, titer was negative, and source is HBsAg positive or high risk, give hepatitis B immune globulin (HBIG) as soon as possible, preferably within 24 hours, and give a dose of hepatitis B vaccine. (26) If previously immunized and titer is unknown, draw titer and proceed as follows:

(27) If titer is positive, no further treatment is needed. (28) If titer is negative and source is HBsAg positive or high risk, then give HBIG as soon as possible, preferably within 24 hours, and give a dose of hepatitis B vaccine. (29) If previously immunized with negative titer and revaccinated with a negative titer, give HBIG immediately and a second dose 1 month later. (30) If never immunized, give HBIG and begin hepatitis B vaccine series.

(31) Follow-up instructions should include the following information:

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(32) Adverse events and side effects of PEP (33) Signs and symptoms of retroviral illness (fever, adenopathy, rash) (34) Appointments for follow-up blood work, including the following:

(35) HIV at 6 weeks, 3 months, 6 months, and 9 months (36) HBsAb and/or HCAb at 6 weeks, 3 months, and 6 months, if source is hepatitis B and/or hepatitis C positive (37) Every other week CBC, renal, and liver function, if receiving PEP

(4,5). Baseline on exposed person ONLY if source is postive HBsAb - looking for past/pervious infection or vaccination Rapin HIV (1998), followed by viral load. Rapid HCV - if positive follow with HCV-RNA for confirmation of true positive (6) - syphillis if source is positive for HIV or HCV often co-infection (9) - given with in hours but not days after calling PEP hotline for confirmation of indication (11) administer Tdap booster if not received (13) C i - baseline, 6 weeks and 12 weeks ii - HCV 2 weeks post exposure

Statement of Problem and Substantiation for Public Input

Reference - CDC Post exposure Guidelines 2001, 2005, HCV - 2009

Submitter Information Verification

Submitter Full Name: KATHERINE WEST Organization: Infection Control/Emerging Concepts Street Address: City: State: Zip: Submittal Date: Wed Aug 14 09:39:57 EDT 2013

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Public Input No. 131-NFPA 1582-2015 [ New Section after A.7.7.13 ]

A7.7.12.2 Uniformed personnel are exposed to a variety of particulate materials, chemicals and asbestos which can increase the risk for colon cancer. Current research suggests that fire fighters are at increased risk of colorectal cancer. Health care providers should discuss the possible increased risk of colorectal cancer resulting from occupational exposures along with the risks and benefits of initiating screening at age 40 in fire fighters. If the fire fighter decides to start screening at age 40, fecal occult blood testing (FOBT) is the method recommended for use as it has the lowest risk for adverse patient events and is the most cost effective. The USPSTF recommended screening methods for colorectal cancer include fecal occult blood testing, sigmoidoscopy, or colonoscopy beginning at age 50 and continuing until age 75. The risks and benefits of these screening methods vary. The USPSTF concludes there is insufficient evidence to assess the benefits and harms of computed tomographic colonography and fecal DNA testing as screening modalities for colorectal cancer. The USPSTF concluded that screening programs incorporating fecal occult blood testing, sigmoidoscopy, or colonoscopy will all be effective in reducing mortality using any of the following 3 regimens, assuming 100% adherence to the same regimen for that period: • Annual screening with high-sensitivity fecal occult blood testing • Sigmoidoscopy every 5 years, with high-sensitivity fecal occult blood testing every 3 years • Screening colonoscopy every 10 years Fecal occult blood testing uses stool specimens applied to guaiac cards by the patient at home that are sent to a laboratory for later analysis. Multiple different stool samples, usually three, from different days can increase the sensitivity of this colorectal cancer screening test. Diet restrictions apply to this test. Colonoscopy is used to examine the full lining of the colon and rectum. During the colonoscopy, polyp removal or excising a small piece of tissue for biopsy may be performed if indicated. Colonoscopy should start at an earlier age (40 years) and/or be conducted more frequently if clinically indicated. A colonoscopy shall also be performed, regardless of age or schedule, when FOBT results are positive or when there is a consistent change in bowel habits.

Statement of Problem and Substantiation for Public Input

Uniformed personnel are exposed to a variety of particulate materials, chemicals and asbestos which can increase the risk for colon cancer.

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 20:35:55 EDT 2015

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Public Input No. 136-NFPA 1582-2015 [ New Section after A.7.7.13 ]

A7.7.21.2 Fire fighters with a high index of suspicion for sleep disorders should be referred to a specialist for diagnostic sleep studies. See section 9.12.6.2 for guidance regarding obstructive sleep apnea.

Statement of Problem and Substantiation for Public Input

Fire fighters at increased risk of sleep disorders. Highlights the importance to sleep health and hygiene.

Submitter Information Verification

Submitter Full Name: FABRICE CZARNECKI Organization: UNIVERSITY OF MARYLAND Street Address: City: State: Zip: Submittal Date: Sun Jul 05 20:53:00 EDT 2015

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Public Input No. 13-NFPA 1582-2013 [ Section No. A.9.8.11 ]

A.9.8.11 Hepatitis, when not acute or when chronic but without symptoms and without significant liver dysfunction or other organ system dysfunction, does not prevent the successful and safe performance of essential job tasks during fire fighting or EMS work. Hepatitis A, when not acute, is no longer a public health risk. Hepatitis B, C, and so forth, are bloodborne pathogens and are not a public health risk, as universal precautions to prevent the spread of bloodborne infections are a mandatory part of all emergency operations. Treatment to prevent Hepatitis C from progressing to liver insufficiency or failure (cirrhosis) is now available and FDA approved. Members receiving this treatment need to be regularly evaluated to determine their ability to safely perform their essential job tasks. This combination drug therapy protocol can produce dehydration, fatigue, depression, anemia, thrombocytopenia (bleeding disorder), and so forth. Correct term is - Standard Precautons - change was made in 2005

Statement of Problem and Substantiation for Public Input

Standard Precautions is the correct term since 2005. Replace universal precautions and BSI

Submitter Information Verification

Submitter Full Name: KATHERINE WEST Organization: Infection Control/Emerging Concepts Street Address: City: State: Zip: Submittal Date: Wed Aug 14 09:52:51 EDT 2013

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Public Input No. 30-NFPA 1582-2014 [ Chapter F ]

Annex F Informational References F.1 Referenced Publications. The documents or portions thereof listed in this annex are referenced within the informational sections of this standard and are not part of the requirements of this document unless also listed in Chapter 2 for other reasons. F.1.1 NFPA Publications. National Fire Protection Association, 1 Batterymarch Park, Quincy, MA 02169-7471. NFPA 1001, Standard for Fire Fighter Professional Qualifications, 2013 edition . NFPA 1002, Standard for Fire Apparatus Driver/Operator Professional Qualifications, 2009 edition 2017 . NFPA 1003, Standard for Airport Fire Fighter Professional Qualifications, 2010 edition 2015 . NFPA 1006, Standard for Technical Rescuer Professional Qualifications, 2008 edition 2017 . NFPA 1021, Standard for Fire Officer Professional Qualifications, 2009 edition 2014 . NFPA 1051, Standard for Wildland Fire Fighter Professional Qualifications, 2012 edition 2016 . NFPA 1500, Standard on Fire Department Occupational Safety and Health Program, 2013 edition . NFPA 1561, Standard on Emergency Services Incident Management System, 2008 edition 2015 . NFPA 1583, Standard on Health-Related Fitness Programs for Fire Department Members, 2008 edition 2015 . NFPA 1584, Standard on the Rehabilitation Process for Members During Emergency Operations and Training Exercises, 2008 edition 2015 . F.1.2 Other Publications. F.1.2.1 ANSI Publication. American National Standards Institute, Inc., 25 West 43rd Street, 4th Floor, New York, NY 10036. ANSI S3.6, Specification for Audiometers, 1996 2010 . F.1.2.2 IAFF Publications. International Association of Fire Fighters, 4025 Fare Ridge Drive, Fairfax, VA 22033. The Fire Service Joint Labor Management Wellness–Fitness Initiative, 3rd edition. Available at http://www.iafc.org/Operations/content.cfm?ItemNumber-1173. F.1.2.3 U.S. Government Publications. U.S. Government Printing Office, Washington, DC 20402. National Diabetes Information Clearinghouse, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Health (NIH), Sickle Cell Trait and Other Hemoglobinopathies and Diabetes. Important Information for Physicians, http//diabetes.niddk.nih.gov/dm/pubs/hemovari-A1C/. Title 21, Code of Federal Regulations, Part 801.420, “Hearing aid devices; professional and patient labeling,” 1999 2008 . Title 29, Code of Federal Regulations, Part 1630.2(n)(3), “Regulations to Implement the equal employment provisions of the Americans with Disabilities Act,” 2003 2011 . Title 29, Code of Federal Regulations, Part 1910.95, “Occupational noise exposure,” 1996 2008 .

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F.1.2.4 Additional Publications. American Thoracic Society Guidelines Journal of Occupational and Environmental Medicine, 2000. Fire Service Joint Labor-Management Wellness-Fitness Initiative, International Association of Fire Fighters, 1750 New York Avenue, NW, Washington, DC 20006/International Association of Fire Chiefs, 4025 Fair Ridge Drive, Suite 300, Fairfax, VA 22033, 1999. Journal of the American College of Cardiology, October 1994. F.2 Informational References. The following documents or portions thereof are listed here as informational resources only. They are not a part of the requirements of this document. F.2.1 Testing Protocols. American College of Sports Medicine. 1995. Guidelines for Exercise Testing and Prescription. Baltimore, MD: Williams & Wilkins. American Industrial Hygeine Association. 1971. Ergonomic guide to assessment of metabolic and cardiac costs of physical work. Am J Ind Hyg Assoc 32:560-564. Bilzon, J. F. J., E. G. Scarpello, D. V. Smith, N. A. Ravenhill, et al. 2001. “Characterization of the metabolic demands of simulated shipboard Royal Navy fire-fighting tasks.” Ergonomics 44:766–780. Gibbons, R. J., G. J. Balady, J. W. Beasley, et al. 1997. “ACC/AHA guidelines for exercise testing: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing).” J Am Coll Cardiol 30:260–311. Glenhill N, Janitz V 1992. Characteristics of the physical demands of firefighting. Can J. Spt Scr 17 (3): 2017-213. Lemon, P. W., and R. T. Hermiston. 1977. “The human energy cost of fire fighting.” J Occup Med 19:558–562. Malley, K. S., A. M. Goldstein, T. K. Aldrich, K. J. Kelly, M. Weiden, N. Coplan, M. L. Karwa, and D. J. Prezant. 1999. “Effects of fire fighting uniform (modern, modified modern and traditional) design changes on exercise duration in New York City firefighters.” J Occup Med 41:1104–1115. Manning J. E., and T. R. Griggs. 1983. “Heart rate in fire fighters using light and heavy breathing equipment: simulated near maximal exertion in response to multiple work load conditions.” J Occup Med 25:215–218. O'Connell, E. R., P. C. Thomas, D. Lee, L. D. Cady, et al. 1986. “Energy costs of simulated stair climbing as a job-related task in fire fighting.” J Occup Med 28:282–285. Sothmann, M. S., K. Saupe, D. Jasenof, and J. Blaney. 1992. “Heart rate responses of firefighters to actual emergencies.” J Occup Med 34:797–800. U.S. Preventive Services Task Force. 1996. Guide to Clinical Prevention Services, 2nd edition. Baltimore, MD: Williams & Wilkins, 3–14. F.2.2 Spinal Fusion and Its Impact on Adjacent Vertebral Level. Eck, J. C., S. C. Humphreys, and S. D. Hodges. 1999. “Adjacent-segment degeneration after lumbar fusion: a review of clinical biomechanical and radiologic studies.” Am J Orthopedics 1999; 28(6):336–340. Lee, C. K. 1988. “Accelerated degeneration of the segment adjacent to a lumbar fusion.” Spine 13(3):375–377.

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F.2.3 Cardiology. Alfred, E. N., E. R. Bleecker, B. R. Chaitman, T. E. Dahms, S. O. Gottlieb, J. D. Hackney, M. Pagano, R. H. Selvester, W. M. Walden, and J. Warren. 1989. “Short-term effects of carbon monoxide exposure on the exercise performance of subjects with coronary artery disease.” N Engl J Med 321(21):1426–1432. American Diabetes Association. Standards of Medical Care in Diabetes – 2010. Diabetes Care 33: supplement 1, S11-S61, 2010. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, Jones DW, Materson BJ, Oparil S, Wright JT Jr, Roccella EJ; the National High Blood Pressure Education Program Coordinating Committee [2003]. The seventh report of the Joint National Committee [JNC-7] on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. JAMA 289:2560–2571. Gibbons RJ, Balady GJ, Bricker JT, Chaitman BR, Fletcher GF, Froelicher VF, Mark DB, McCallister BD, Mooss AN, O’Reilly MG, Winters WL Jr. [2002]. ACC/AHA 2002 guideline update for exercise testing: summary article: a report of the ACC/AHA Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing guidelines). J Am Coll Cardiol 40:1531– 1540. Greenland, et al. [2007]. ACCF/AHA 2007 Clinical Expert Consensus Document on Coronary Artery Calcium Scoring By Computed Tomography in Global Cardiovascular Risk Assessment and in Evaluation of Patients With Chest Pain A Report of the American College of Cardiology Foundation Clinical Expert Consensus Task Force (ACCF/AHA Writing Committee to Update the 2000 Expert Consensus Document on Electron Beam Computed Tomography). J Am Coll Cardiol 49:378-402. Jouven, X., M. Zureik, M. Desmos, D. Courbon, and P. Ducimetiere. 2000. “Longterm outcome in asymptomatic men with exercise-induced premature ventricular depolarizations.” N Engl J Med 343(12):826–833. Kales SN, Tsismenakis AJ, Zhang C, Soteriades ES [2009]. Blood pressure in fire fighters, police officers, and other emergency responders. Am J Hypertens 22:11-20. “Premature ventricular depolarizations and exercise” (editorial comment on E.N. Alfred reference). 2000 N Engl J Med 343(12):879–880. Schlant RC, Adolph RJ, DiMarco JP, Dreifus LS, Dunn MI, Fisch C, Garson A Jr, Haywood LJ, Levine HJ, Murray JA, Noble RJ, Ronan JA Jr [1992]. Guidelines for electrocardiography. A report of the American College of Cardiology/American Heart Association Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures (Committee on Electrocardiography). Circulation 85(3):1221-1228. Soteriades ES, Kales SN, Liarokapis D, Christiani DC [2003]. Prospective surveillance of hypertension in firefighters. J Clin Hypertens 5:315–320. F.2.4 Asthma and Chronic Obstructive Pulmonary Diseases. Bousquet, J., P. K. Jeffery, W. W. Busse, and M. Johnson, A. M. Vignola. 2000. “Asthma from bronchoconstriction to airways inflammation and remodeling.” Am J Respir Crit Care Med 161(5):1720–1745. Nadel, J. A., and W. W. Busse. 1998. “Asthma.” Am J Respir Crit Care Med 157(4 Pt. 2):S130–138. Postma, D. S., and H. A. Kerstjens. 1998. “Characteristics of airway hyperresponsiveness in asthma and chronic obstructive pulmonary diseases.” Am J Respir Crit Care Med 158 (5 Pt. 2):S187–192. Prezant, D. J., M. Weiden, G. I. Banauch, G. McGuinness, W. N. Rom, T. K. Aldrich, and K. J. Kelly. 2002. “Cough and bronchial responsiveness in firefighters at the World Trade Center site.” N Engl J Med 347:806–815. Senior R. M., and N. R. Anthonisen. 1998. “Chronic obstructive pulmonary diseases (COPD).” Am J Respir Crit Care Med 157(4 Pt. 2):S139–147. Sherman, C. B., S. Barnhart, M. F. Miller, M. R. Segal, M. Aitken, R. Schoene, W. Daniell, and L. Rosentsock. 1989. “Firefighting acutely increases airway hyperreactivity.” Am Rev Resp Dis 40(1):185–190.

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F.2.5 Pulmonary Function Testing: Challenge Testing and Exercise Testing. American College of Sports Medicine. 1995. Guidelines for Exercise Testing and Prescription. Baltimore, MD: Williams & Wilkins. American Thoracic Society, Medical Society of the American Lung Association. 1993. “Guidelines for the evaluation of impairment/disability in patients with asthma.” Am Rev Resp Dis 147(4):1056–1061. Crapo R. O., R. Casaburi, A. L. Coates, Enright P. L., J. L. Hankinson, C. G. Irvin, N. R. MacIntyre, R. T. McKay, J. S. Wanger, S. D. Anderson, D. W. Cockcroft, J. E. Fish, and P. J. Sterk. 2000. “Guidelines for methacholine and exercise challenge testing — 1999.” This official statement of the American Thoracic Society (ATS) was adopted by the ATS Board of Directors July 1999. Am J Respir Crit Care Med 161(1):309–329. Hankinson, J. L., J. R. Odencrantz, and K. B. Fredan. 1999.“Spirometric reference values from a sample of the U.S. general population.” Am J Respir Crit Care Med 1999; 159:179–187. Miller, M. R., Hankinson J, Brusasco V, et al. ATS/ERS Task Force. “Standardization of spirometry.” Eur Respir J 2005. 26:319-338. Tierney MT, Lenar D, Stanforth PR, Craig JN, Fannar RP. 2010. Prediction of aerobic capacity in firefighters using submaximal treadmill and stairmill protocols. J Strength Condition Res 24 (3): 757-764. Townsend, M. C., and the Occupational and Environmental Lung Disorder Committee. 2000. “American College of Occupational and Environmental Medicine Position Statement on Occupational Spirometry in the Occupational Setting.” J Occup Environ Med 42:228–245. F.2.6 Tuberculosis. American Thoracic Society, Centers for Disease Control and Prevention (CDC), and Infectious Diseases Society of America. Treatment of tuberculosis, Mortal Morbid Weekly Rev 2003;52(No. RR-11):1--74. Centers for Disease Control and Prevention (CDC). Guidelines for using the QuantiFERON-TB Gold test for detecting Mycobacterium tuberculosis infection, United States. Mortal Morbid Weekly Rep. 54:48-55, 2005. ATS and CDC. “Diagnostic standards and classification of tuberculosis in adults and children.” 2000. Am J Respir Crit Care Med 161(4):1376–1395. This official statement of the American Thoracic Society (ATS) and the Centers for Disease Control and Prevention (CDC) was adopted by the ATS Board of Directors July 1999. This statement was endorsed by the Council of the Infectious Diseases Society of America (IDSA), Sept. 1999. ATS and CDC. “Targeted tuberculin testing and treatment of latent tuberculosis infection.” 2000. Am J Respir Crit Care Med 161(4):S221–247. This official statement of the American Thoracic Society (ATS) was adopted by the ATS Board of Directors July 1999. This is a joint statement of the ATS and the Centers for Disease Control and Prevention (CDC). This statement was endorsed by the Council of the Infectious Diseases Society of America (IDSA), Sept. 1999. F.2.7 Cancer Screening. Smith R. A., C. J. Mettlin, K. J. Davis, and H. Eyre. 2000. “American Cancer Society guidelines for the early detection of cancer.” CA J Clin 50(1):34–49. F.2.8 Other Publications. U.S. Department of Defense, Department of the Army Regulation 40-501 Medical Services Standards of Medical Fitness. Headquarters Department of the Army, Washington, DC, 27 February 1998. F.3 References for Extracts in Informational Sections. NFPA 1500, Standard on Fire Department Occupational Safety and Health Program, 2013 edition . NFPA 1583, Standard on Health-Related Fitness Programs for Fire Department Members, 2008 edition 2015 .

Statement of Problem and Substantiation for Public Input

Referenced current editions.

Related Public Inputs for This Document

Related Input Relationship

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Public Input No. 29-NFPA 1582-2014 [Chapter 2] Referenced current editions.

Submitter Information Verification

Submitter Full Name: Aaron Adamczyk Organization: [ Not Specified ] Street Address: City: State: Zip: Submittal Date: Fri Jun 27 21:54:32 EDT 2014

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