ATTACHMENT B
AMERICAN DIABETES ASSOCIATION
STATEMENT OF PROBLEM AND SUBSTANTIAION FOR PROPOSAL
The American Diabetes Association (“Association”) submits this statement on the
diabetes provisions of NFPA 1582 Standard on Comprehensive Occupational Medical
Program for Fire Departments, 2003 Edition and the proposal to modify this
standard.1
The American Diabetes Association
The Association is a nationwide, nonprofit, voluntary health organization founded in
1940. It consists of people with diabetes, health professionals who treat people with
diabetes, research scientists, and other concerned individuals. With over 400,000
general members, over 18,000 health professional members, and over 3 million
contributors, the Association is the largest non-governmental organization that deals
with the treatment and impact of diabetes. The Association establishes, reviews, and
maintains the most authoritative and widely followed clinical practice
recommendations, guidelines, and standards for the treatment of diabetes.2 The
Association also publishes the most authoritative professional journals concerning
diabetes research and treatment.3
The mission of the Association is to prevent and cure diabetes and to improve the
lives of all people affected by diabetes. Related to the NFPA 1582 Standard, this
mission requires supporting a system that provides rigorous safety standards to
protect fire fighters with diabetes and the public, while not unduly denying people
with diabetes the same rights granted to other Americans.
These provisions are found in section 6.18 (evaluation of applicants) and
section 9.6.2 (evaluation of incumbents).
1
2 American
Diabetes Association: Clinical Practice Recommendations 2004,
Diabetes Care 27: Supp. I, 2004.
3 The
Association publishes four professional journals with widespread
circulation: (1) Diabetes (original scientific research about diabetes); (2) Diabetes
Care (original human studies about diabetes treatment); (3) Clinical Diabetes
(information about state-of-the-art care for people with diabetes); and (5) Diabetes
Spectrum (review and original articles on clinical diabetes management).
Assessment of Fire Fighters with Diabetes
The Association strongly opposes blanket bans that automatically disqualify all
individuals with diabetes, or with insulin-treated diabetes, from a given occupation.
Such bans are incompatible with the current science and treatment of diabetes, as
well as contrary to both federal and state civil rights law. Indeed, case law
throughout the United States, including multiple decisions by the United States
Supreme Court, requires individual assessment rather than blanket prohibitions
based on the presence of medical conditions such as diabetes.
The Association firmly believes that each person with diabetes can and should be
individually considered for employment based on the requirements of the specific
job, the particular qualifications of the individual, and the capacity of that individual
to fully and safely perform that job. The Association has adopted the following policy:
Any person with diabetes, whether insulin-dependent or
non-insulin dependent, should be eligible for any
employment for which he or she would be otherwise
qualified.4
Because the effects of diabetes are unique to each individual, it is inappropriate to
consider all people with diabetes the same. Factors to be weighed in an individual
assessment include the individual’s medical condition, treatment regimen (medical
nutritional therapy, oral glucose-lowering agent, and/or insulin), and medical history,
particularly in regard to the occurrence of incapacitating hypoglycemic episodes. Id.
While the Association does not believe that every person with diabetes is qualified to
perform the duties of a fire fighter, it likewise believes that a blanket ban of all
people who use insulin is unsupportable. Based on its knowledge of diabetes and
diabetes managements, as well as information about the duties involved in fire
suppression, the Association is convinced that a protocol can be developed to
identify those people with diabetes who can successfully perform fire fighting duties.
Such a protocol should be stringent – to ensure safety – but its requirements should
be firmly rooted in sound medical and scientific knowledge and the experience of
current fire fighters with diabetes.
Movement Toward a Process for Reasonable Individual Assessment
The current version of NFPA’s Standards with respect to individuals with diabetes is
inconsistent with the above-stated approach. Most importantly, the Standard sets up
a blanket ban by prohibiting any individual with insulin-treated diabetes from
obtaining a position as a fire fighter. The current document fails to establish a
protocol for reasonable assessment of an individual with diabetes whether such an
individual is a candidate or incumbent and whether insulin-treated or not. In
4 American
Diabetes Association, Hypoglycemia and Employment/Licensure
(Position Statement). Diabetes Care 27:S134 (Supp. 1), 2004.
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addition, the explanation of diabetes and diabetes management found in Annex A
does not reflect the most recent advancements in the management of diabetes.
The Association is pleased to have had the opportunity to meet with the NFPA 1582
Task Group on several occasions to provide medical expertise that it believes will
enable NFPA to revise its diabetes standards to provide for an individual assessment
that is consistent with both anti-discrimination law and the safety of fire fighters with
diabetes, their colleagues, and the public. The material submitted by the Association
in this proposal derives, in most aspects, from a document developed prior to and
during a meeting of the NFPA Task Group in May, 2004. As such, it cannot
accurately be viewed as simply the position of the Association based upon our
knowledge of diabetes and diabetes management, but rather reflects a process of
collaboration and compromise between the 1582 Task Group and the Association.
In addition, following the May meeting, the Association made several proposed
changes to the standards language itself (reflected in Attachment A) and has
supplied suggested text for the accompanying physician’s guidance and annex.
The Association applauds NFPA for its ongoing review of these provisions and is
convinced that collaboration between NFPA and the Association will provide the
necessary expertise to develop a reasonable individual assessment protocol for
individuals with diabetes who wish to become or continue to serve as fire fighters. A
workable protocol based on current medical science will benefit people with diabetes
through increased employment opportunities and benefit both fire departments and
the public through an increased labor supply of qualified fire fighters.
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