NFPA 1582
Standard on Comprehensive
Occupational Medical Programs
for Fire Departments
2003-2007 Editions
Sandy Bogucki, MD, PhD
Branford Fire Department
Section of Emergency Medicine
Yale University School of Medicine
• Medical Requirements for
Firefighters
• Consensus standard
process
– Not law or regulation
– Took 4 years to develop
from NFPA 1001
• Prescribed medical
evaluation and tests to be
performed on firefighters to
determine fitness for duty
• Divided medical conditions
into Category A and
Category B
– Few similar standards
• Described roles and
qualifications for FD
Physicians
NFPA 1582
(1992 Edition)
NFPA 1582
(1992 Edition)
• Few analogous documents
– Pilots, CDL’s: Regulations
– Law enforcement, HAZMAT, EMS have no
consensus medical standard
– Results in frequent inappropriate use of 1582.
NFPA 1582
1997, 2000 Editions
• Incorporated medical progress (PTCA
stenting)
• Expanded instructions for physicians to
enhance understanding of FF demands
• Largely eliminated Category A due to
ADA concerns
Problems with 1582, 2000 ed.
• Not affecting non-traumatic L-O-D death rates
• Inadequate science to support requirements
• Not being used to full benefit
– Doc’s only read Chapter 3
• Majority don’t understand demands of fire fighting
• Majority don’t get involved in FD Health & Safety roles
– Incompatible with real world practice
• Especially with respect to incumbent medical conditions
– Ambiguity of Category B
• Equivocal standards due to ADA concerns
• Not consistent with OSHA requirements,
recommendations of 1583 and Labor-Management
fitness/wellness initiative
Line of Duty Death and Injury
• Per fire, increasing
• Cardiovascular causes
still most common
• Operations-related
trauma, asphyxiation
increasing
– Investigations focus on
operational issues
– Contribution from
medical issues unknown
Line of Duty Cardiovascular
Death Investigations
• Cardiac risk factors and/or cardiac
disease frequently known
• No FD medical requirements
• Medical evaluations performed by
physicians not familiar with FF demands
• Increased proportion of volunteers
• No fitness/wellness programs or
requirements
NFPA 1582
(2003 Edition)
– Expanded scope of
medical evaluation to
detect conditions for
which FF’s are at
increased risk.
• Made yearly medical
evaluation mandatory
– Developed model list of
EJT’s of FF’s upon
which medical
requirements are based.
• Require FD’s to supply
FD Physicians with list of
local EJT’s or formal
validation of the model list
in NFPA 1582
– Category A and Category B
medical conditions updated
• Now apply only to candidates
– Incumbents are restricted by
FD Physician from specific job
tasks when medically
indicated
• FD determines to what extent
restrictions can be
accommodated: Light duty,
change in job description,
retirement, etc.
• FD Physicians do not make
hiring/firing decisions
– FD Physicians are required to
monitor for health trends,
participate in safety divisions
and supervise health &
wellness programs
NFPA 1582
(2003 Edition)
Medical requirements must be
based on essential job tasks
•
•
•
•
•
Interior structural firefighting
Wildland, ARFF, Shipboard
Driver-Operator
HazMat, Technical Rescue
Rescue, EMS
Essential job tasks
(1) Performing firefighting tasks
(e.g. hose line 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, while wearing
personal protective ensembles
and SCBA, including working in
extremely hot or cold
environments for prolonged
time periods.
Essential job tasks
• (2) Wearing a selfcontained breathing
apparatus, which
includes a demand
valve-type positive
pressure face piece or
HEPA filter masks which
requires the ability to
tolerate increased
respiratory workloads
Essential job tasks
• (3) Exposure to toxic
fumes, irritants, particulates,
biological (infectious) and
non-biological hazards,
and/or heated gases,
despite the use of personal
protective ensemble
including self-contained
breathing apparatus.
Essential job tasks
• (4) Depending on
the local jurisdiction,
climbing 6 or more
flights of stairs while
wearing fire protective
ensemble weighing at
least 50 pounds and
equipment/tools
weighing an additional
20 to 40 pounds.
Essential job tasks
• (5) Wearing fire
protective ensemble that
is encapsulating and
insulated. Wearing this
clothing will result in
significant fluid loss that
frequently progresses to
clinical dehydration and
can elevate core
temperature to levels
exceeding 39 degrees C.
Essential job tasks
• (6) Searching, finding, and rescue-dragging or
carrying victims ranging from newborns up to adults
weighing over 200 pounds to safety despite
hazardous conditions and low visibility.
Essential job tasks
• (7) Advancing waterfilled hoselines up to 2.5”
in diameter from fire
apparatus to occupancy
(approximately 150 ft);
may involve negotiating
multiple flights of stairs,
ladders and other
obstacles.
Essential job tasks
• (8) Climbing ladders, operating from heights,
walking or crawling in the dark along narrow
and uneven surfaces, operating in proximity to
electrical power lines and other hazards.
Essential job tasks
• (9) Unpredictable
emergency
requirements for
prolonged periods of
extreme physical
exertion without
benefit of warm-up,
scheduled rest
periods, meals,
access to medication
or hydration.
Essential job tasks
• (10) Operating
fire apparatus or
other vehicles in
an emergency
mode with
emergency lights
and sirens.
Essential job tasks
• (11) Critical, time sensitive, complex problem
solving during physical exertion in stressful,
hazardous environments (including hot, dark,
tightly enclosed spaces) further aggravated
by fatigue, flashing lights, sirens and other
distractions.
Essential job tasks
• (12) Ability to
communicate (give and
comprehend verbal orders)
while wearing protective
ensemble and selfcontained breathing
apparatus under
conditions of high
background noise, poor
visibility, and drenching
from hose lines and/or
fixed protection systems
(sprinklers).
Essential job tasks
• (13) Functioning as an
integral component of a
team, where sudden
incapacitation of a
member may result in
mission failure or in risk
of injury or death to
other team members
(e.g. two in, two out as
described in NFPA
1500).
•
Essential Job Tasks
In addition to general firefighting
duties (as listed above)
members of specialized teams
such as hazardous materials
units, SCUBA teams, technical
rescue teams, EMS teams, or
units supporting tactical law
enforcement operations may be
required to perform additional
tasks not specified above. These
tasks require members to wear
or utilize specialized PPE that
may increase weight,
environmental isolation, sensory
deprivation and/or dehydration
potential above levels
experienced with standard fire
suppression PPE. They also
may include additional medical
and/or physical requirements
that shall not be enumerated in
this standard.
NFPA 1582 Requirements
Changes- 2003
• Occupational Medical
Program Customized to
Local FD’s
– FD’s have to tell MD’s what
their FF’s do
– MD’s have to understand
what FF’s do
– MD’s have to look for and
evaluate morbidity/mortality
trends in their FD’s
– Includes fitness/wellness
component
– MD’s don’t hire/fire
NFPA 1582 Requirements
Changes-2003
• Category A and B applies only to
candidates; assumes all 13 EJT’s
(Interior structural FF, Driver
Operator)
• Category A
–
–
–
–
–
–
–
Heart & cardiovascular disease
Smoking
Asthma
Diabetes
Epilepsy
Vision, hearing
Certain medications
NFPA 1582 Requirements
Changes-2003
• Incumbents undergo full
medical evaluation
yearly
– Preventive cardiology
– Screening for conditions
with known excess
morbidity in FF’s
– Data trending
– Workplace intervention
NFPA 1582 Requirements
Changes-2003
• Incumbents are
restricted from
performing various
duties in the presence
of certain medical
conditions
• FD’s determine
whether/how
restrictions can be
accommodated
NFPA 1582 Requirements
Changes-2007
• Diabetes Mellitus
– Category A but with
exceptions
• Asthma
– New testing parameters
• Seizure Disorders
– Evaluation and requirements
amended in 2003 edition
• Coronary Artery Disease
– Evaluation and requirements
amended in 2003 edition
Sneak Preview - 2010
• Prosthetics?
• Hearing aids?