ACOEM GUIDANCE STATEMENT Fitness-for-Duty Assessments of Industrial Firefighters: Guidance for Occupational Medicine Physicians Faiyaz A. Bhojani, MD, MPH, DrPH, Luis A. Castillejo-Picco, MD, MS, PhD, David Cathcart, DO, MPH, Edward A. Emmett, MD, MS, Stephen Frangos, MD, MPH, P. Mark Glencross, MD, MPH, Chris J. Herman, CFPS, Kevin O’Shea, MD, MPH, Paul Rountree, MD, and David E. Turner, MD, PhD, MPH, MBA, ACOEM Task Force on Fitness-for-Duty Assessments for Industrial Firefighters Industrial firefighters share many characteristics industries to develop fitness-for-duty guid- The questionnaire was reviewed by with municipal firefighters; however, employers ance for industrial firefighters and address the University of Pennsylvania Institutional frequently have not addressed or characterized the the lack of standards and guidance specific Review Board (IRB), which concluded the unique job duties, hazards, and specific physical/ to this population. This lack of a standard- project did not meet the criteria to be mental demands associated with industrial fire- ized approach could result in firefighters considered human research and was thus fighting. In addition, gaps exist in the medical being improperly assessed for their capa- exempt from further IRB oversight. The literature with regard to industrial firefighter dem- bility to safely perform industrial firefight- Task Force engaged ORCHSE Strategies, ographics, behavioral risk factors, and chronic ing duties and puts the firefighter, his/her LLC, a health, safety, and environmental diseases. Finally, the proper methodologies for coworkers, the workplace, and the commu- control network that sponsors a cross- fitness-for-duty assessment of employees acting nity at risk. This increased risk has the industry forum for purposes of benchmark- in this capacity are lacking. To address these gaps, potential for increased liability to business ing and sharing best practices, to host the the American College of Occupational and Envi- entities employing industrial firefighters. online questionnaire. ORCHSE member ronmental Medicine (ACOEM) convened a Task In addition to recommending best companies reached out to their firefighters Force in 2014, to develop fitness-for-duty guid- practices for the determination of an indus- to complete the questionnaire. No identi- ance for industrial firefighters. This document trial firefighter’s fitness-for-duty, an impor- fiers were included in the questionnaire and highlights these gaps and suggests research oppor- tant part of the Task Force’s charge was to data collected were anonymous and confi- tunities to enhance the health and safety of this characterize where possible, the demo- dential. The Task Force members received population. While an extensive literature review graphic make-up of the industrial fire- only aggregate responses to the question- found a lack of studies for this population—thus fighter. Such knowledge is essential to naire for analysis. excluding the development of an evidence-based differentiate industrial from municipal fire- The Task Force identified five ques- document—sufficient materials were available fighters particularly as it may relate to tions for systematic literature review to from which to draw preliminary conclusions, con- cardiovascular disease, the most common document the current state of affairs in each siderations for best practices, and recommenda- cause of work-related mortality among area: tions for future studies. municipal firefighters. As an additional benefit, this information has the potential 1. What are the differences in job duties for n October 2014, the American College for conducting directed studies that will municipal versus industrial firefighters? I of Occupational and Environmental advance the health and safety of the indus- 2. How can cardiovascular fitness for duty Medicine (ACOEM) convened a Task trial firefighter population. be best determined for industrial fire- Force of medical practitioners, corporate fighters? medical directors, university professors, 3. Are tools currently used to determine and fire chiefs having a working knowledge METHODOLOGY fitness for duty useful? of US oil and gas and petrochemical Task Force members identified a list 4. What preventive interventions are avail- of questions (identified under the section on able and how effective are they? Topics Reviewed) for which the systematic 5. How do US laws impact fitness-for- From the American College of Occupational and literature review would seek to document the work decisions? Environmental Medicine, Elk Grove Village, current state of affairs. Literature searches Illinois. utilized Medline, PubMed and PubMed Cen- This position paper was developed by the ACOEM DIFFERENCES IN JOB Task Force on Fitness-for-Duty Assessments for tral, and National Library of Medicine data- Industrial Firefighters, under the auspices of the bases to identify and characterize the DUTIES—MUNICIPAL VERSUS Environmental Health and the Underserved relevant literature for industrial and munici- INDUSTRIAL FIREFIGHTERS Occupational Populations sections, reviewed pal firefighters, identify gaps that exist for As previously noted, fitness-for- by the Committee on Policy, Procedures, and Public Positions, and approved by the ACOEM the industrial firefighters, and advance rec- duty standards and guidance specific to Board of Directors. ACOEM requires all sub- ommendations to address literature gaps. the industrial firefighter population is lack- stantive contributors to its documents to disclose The Task Force then designed a ing. The National Fire Protection Associa- any potential competing interests, which are questionnaire (Appendix 1) for industrial fire- tion Standard on Comprehensive carefully considered. ACOEM emphasizes that the judgments expressed herein represent the fighters to identify the following information: Occupational Medical Program for Fire best available evidence at the time of publication Departments (NFPA 1582), does not and shall be considered the position of ACOEM demographics include industrial fire brigades in its medi- and not the individual opinions of contributing level and frequency of firefighting duties cal assessment standard.1 The NFPA 600 authors. The authors declare no conflicts of interest. patterns and frequency of training Standard on Facility Fire Brigades contains Address correspondence to: Marianne Dreger, MA, variations in the medical clearance only minimal reference to the medical ACOEM, 25 Northwest Point Blvd, Suite 700, process clearance process.2 This lack of guidance Elk Grove Village, IL 60007 ([email protected]). access to and involvement in employer- has contributed to the presence of multiple, Copyright ß 2017 American College of Occupa- tional and Environmental Medicine directed regular fitness activities differing firefighter assessment methodol- DOI: 10.1097/JOM.0000000000001256 risk factors for cardiovascular disease ogies across various industries. e82 JOEM Volume 60, Number 2, February 2018 Copyright © 2017 American College of Occupational and Environmental Medicine. Unauthorized reproduction of this article is prohibited JOEM Volume 60, Number 2, February 2018 Industrial Firefighters NFPA 600 classifies facility fire bri- strength but the heavier nature of the equip- whereas the primary tool for industrial fire- gades as either incipient stage firefighting, ment may put industrial firefighters at fighters is foam which is used to fight class B advanced exterior firefighting, or interior increased risk for back injuries. and C fires (flammables/electrical). structural firefighting.2 The incipient stage Industrial firefighting is also signifi- Municipal firefighters have a involves fighting a fire in normal clothing cantly different from community firefighting broader scope of job duties. As job duties using extinguishers or smaller hand lines in that the knowledge required is more spe- are more narrow for industrialized fire- (125 gpm). It also requires no evasive cific for the local setting (eg, explosive, fighters, there may be more opportunity actions (eg, crawling to escape heat or chemical, or marine situations). Municipal for accommodation of various medical con- smoke), and does not necessitate the use and industrial firefighters wear standard ditions.6 There is a different skill set as well of bunker gear or self-contained breathing structural firefighting clothing whereas between the two.8 Municipal firefighters apparatus (SCBA).2 Advanced exterior or industrial firefighters’ clothing may include are trained in rapid intervention and team interior firefighting involves full gear, high temperature protective and chemical concepts, accountability systems, and teams in warm and hot zones utilizing protective clothing.5 Resulting dehydration search procedures. Industrial firefighters SCBA, attack teams of two or more, estab- and hyperthermia are often a greater issue for deal more with confined space rescue and lished communication systems, experi- industrial firefighters particularly in those must have knowledge of the properties of enced members overseeing those less with poor cardiovascular conditioning and pressurized gas fires and large scale flam- experienced, and the requirement of annual chronic disease. In the survey developed by mable liquids. Additionally, industrial fire- live fire drills. NFPA 600 states that facility this Task Force, the majority of industrial fighters are frequently trained in high-angle fire brigades are exposed to the same degree