American Osteopathic College of Occupational and Preventive Medicine 2012 Mid-Year Educational Conference St. Petersburg, Florida

Transcription

1 Discuss the History of the NFPA 1582 Standard Lance Walker D.O. MPH Identify required elements of a good NFPA program. Look at elements of a good NFPA program Discuss how departments you work with can maximize their return on investment Talk about occupation specific disease in firefighters National Fire Protection Association International nonprofit established in 1896, establishes consensus codes and standards, research, training and education Standards on everything from fire extinguishers to electrical codes NFPA 1582 Standard on Comprehensive Occupational Medical Program for Fire Departments Standard is a best practices recommendation, does not represent force of law Standard on Professional Qualifications for Fire Fighter, NFPA 1001, 1974 Standard on Fire Department Occupational Safety and Health Program, NFPA 1500, 1987 First Edition of NFPA 1582, Standard on Medical Requirements for Fire Fighters, 1992 then 1997 Standard on Medical Requirements for Fire Fighters and Information for Fire Department Physicians, 2000 Standard on Comprehensive Occupational Medical Program for Fire Departments, is the current edition, New edition due 2013 This standard shall not apply to industrial fire brigades that also can be known as emergency brigades, emergency response teams, fire teams, plant emergency organizations, or mine emergency response teams. OSHA applies to Fire Brigades still applies to Fire Fighters for respiratory protection Non Punitive The medical component was specifically designed to provide a cost-effective investment in early detection, disease prevention, and health promotion for fire fighters Two Standards, one for candidates and one for members G-1

2 NFPA 1582 is a useful tool with many purposes when properly implemented Safety Health Improvement Early Detection of Disease Save Money Enhance Departmental Fitness Two Components Medical Evaluation Class A Conditions Class B Conditions The medical component was specifically designed to provide a cost-effective investment in early detection, disease prevention, and health promotion for fire fighters NFPA 1582 Fitness Evaluation Key Elements of Medical Component Vitals Vision Bloodwork Medical History Resting EKG Pulmonary Function Testing Audiometric Testing Periodic CXR Immunization Updates Infectious disease screening Fecal Occult Blood Screening Physician Evaluation One on one Consultation and Review Key Elements of Fitness Component Body Composition Analysis Aerobic Capacity Evaluation Strength and Flexibility Muscular Endurance Type 1 Diabetic on Insulin Knee Replacement Cardiac catheterization with 1 stent History of DVT on Coumadin Stroke Loss of right eye Atrial Fibrillation rate controlled no Coumadin Hypertension controlled with BBlocker G-2

3 Successful NFPA Program Always non-punitive Goal is to improve health of Firefighters Firefighters need to be made aware of these two important points If presented properly Firefighters will appreciate the value of the program and your job becomes easier and fun Be a good Fire Department Physician Understand the job of the firefighter Understand special demands and risks associated with firefighting Be an advocate for individual and departmental health Take care of the firefighter and the department A good program is: Medically Directed Program Doctor understands the standard The same doctor who performs the exams signs off on clearances. The physical program is treated like a real physical examination, privacy, medical history, respect, counseling, review of labs, recommendations Problems with clearance can be dealt with physician to physician Year round access to physician Preparation Most problems can be eliminated with proper preparation and explanation Prepping the ground What is the program Why do we do it (standard was developed for a reason) Where is it going to happen When are we doing this How does the process work What happens if???? What are you looking for in a program? Just a clearance letter Or a Health and Wellness program? Foundation on which to build from Tale of Three Departments Similar in size and location All have been doing an NFPA program for years Only one Department has built on results, the others have not G-3

4 DEPARTMENTS A AND B Overall Body Fat BMI VO2 Max Plus Body Fat BMI VO2 Max Plus Body Fat BMI VO2 Max DEPARTMENT C Overall Body Fat 21 BMI 27 VO2 Max Plus Body Fat 23 BMI 29 VO2 Max Plus Body Fat 23 BMI 28 VO2 Max 53 What is the Difference? Standard Exercise Program, one hour per day mandated Top Down, Chief Participation Education of Members More than just a check box Seeking to improve every year Unintended good consequences, one smoker in department Firefighters are people too Healthier as a group than the general population But they have the same baseline risks as everyone else plus additional risks Key is to address the common medical conditions which are much more likely to cause disease and death Colon Cancer- occult blood, colonoscopy Diabetes- FBS part of 1582 Hypertension- Blood Pressure part of 1582 Obesity- BMI and body fat % part of 1582 Tobacco Use- Screened for in medical history Hep B testing Female Firefighters - PAP, Breast exam, Mammograms Heart Disease in Firefighters MEDICAL HISTORY IS IMPORTANT Heart attacks are the most frequent cause of death among firefighters 39 sudden cardiac deaths in 2010 represented 49% of all firefighter deaths that year NFPA Fire Fighter Fatalities 2010 G-4

5 Heart Disease in Firefighters 11% of heart attacks occur while responding to a fire 29% of heart attacks occur while fighting a fire 33% of heart attacks occur immediately following the incident This means 73% of heart attacks take place while on active duty Is additional cardiac screening helpful? Standard does not specifically address, leaves it to the Physician s judgment What about candidates? Line of duty deaths declining except in the area of training deaths, specifically recruit training. Heart Disease in Firefighters High Risk Individuals Age over 40 Hypertension, Diabetes, Obesity, Smoking/tobacco use, elevated cholesterol, male Family History of heart disease Your NFPA physical program should be able to identify the high risk individuals and appropriately refer them for further evaluation and testing Heart Disease in Firefighters Can you incorporate advanced testing into your NFPA program? Identify high risk individuals Specific testing and appropriate referrals Bladder, Kidney, Prostate,Testicular Cancer Exposure to combustion, pyrolytic byproducts, and the after fire exposures acrylonitrile, asbestos, arsenic, benzene, benzo(a)pyrene and other polycyclic hydrocarbons (PAHs), cadmium, chlorophenols, chromium, diesel fumes, carbon monoxide, dioxins, ethyleneoxide, formaldehyde, orthotoluide, polychlorinated biphenyls and vinyl chloride Bladder, Kidney, Prostate,Testicular Cancer 1582 has some of the routine screening built in Urinalysis for blood in urine, often sign of bladder or kidney cancer PSA testing for prostate cancer AA over 40, everyone else 50 (per 1582) DRE in the standard often ignored Testicular Exam in Standard G-5

6 Lung Disease Lung Cancers- Some studies have shown an doubling of relative risk in firefighters Don t forget TB Firefighters at risk for obstructive and restrictive lung disease COPD, Asthma 1582 Standard and Evaluating Lung Disease Pulmonary Function Testing screens for restrictive and obstructive disease Gerkin Protocol to evaluate V02 max and diminished Aerobic Capacity Proper use of Chest X-Rays, Baseline, q5yrs Yearly PPD testing or Quantiferon Gold Test Referral where appropriate Smoking Cessation Programs a must Proper use of PPE lwalker@sitemed.net (770) G-6