One Step at a Time

Statistics show that the leading cause of firefighter deaths is not fire, but stress or overexertion, usually in the form of a heart attack. It is therefore becoming increasingly important that all departments encourage their firefighters to live a healthy lifestyle.

One department in particular is taking important steps to prove that the health safety of its firefighters is just as important as their fireground safety. About two years ago, the Sedona (Ariz.) Fire Department (SFD) implemented a comprehensive wellness program, and on Jan. 1, it unveiled its Medically Fit-for-Duty Policy, which outlines what it means to be fit for duty and provides specific guidelines on how to handle those firefighters deemed unfit.

 

Leading by Example

If you put aside the politics associated with firefighter fitness, the bottom line is that both labor and management want physically fit on-duty firefighters. The last thing any fire chief wants is to speak at a firefighter’s funeral, especially when the death could have, or rather, should have been prevented; the same holds true for the deceased union member’s brethren. With this in mind, SFD labor and management designed its non-punitive Medically Fit-for-Duty Policy, using cooperation, collaboration and compromise as its guiding principles.

The new policy is supported by the district’s comprehensive wellness program, which includes critical incident stress management (CISM) and nutrition and exercise counseling. Seven of the SFD’s 63 uniformed personnel are certified Peer Fitness Trainers (PFT) through the American Council on Exercise. Each SFD fire station is equipped with state-of-the-art fitness equipment-not just free weights, but aerobic machines and job-simulated training equipment. Personnel routinely “exercise” in turnouts with SCBA to mimic the strain of job-specific suppression-oriented activities. Furthermore, on a quarterly basis, an exercise physiologist conducts training sessions for SFD personnel related to exercise techniques, nutrition, flexibility and other wellness-geared modalities.

Is the program expensive? Absolutely. However, I prefer to use the term cost-effective. Look at the bigger picture. If injuries are reduced and deaths prevented, equipment and training expenditures should be viewed as an investment. Medically fit-for-duty firefighters provide more effective and efficient emergency services, and taxpayer dollars are saved through injury reduction.

Let’s also consider the benefits to the individual firefighters-not the just department as a whole. Many firefighters can retire at a relatively young age with healthy minds and bodies. If they understand the benefits of doing so, they will be encouraged to maintain their fitness not just for themselves, but for their spouses, children and grandchildren.

But do wellness programs really work? Since implementing its wellness program, the SFD’s 63 suppression personnel have lost upwards of 400 lbs.; one firefighter alone has lost more than 100 lbs.! On-the-job injuries have been reduced by more than 50 percent. The expenditures for fitness-related training and equipment have truly been an investment in the SFD. Also, the SFD is medically self-insured and has realized additional savings here.

The SFD hopes that implementing the Medically Fit-for-Duty Policy will further improve the benefits realized under the comprehensive wellness program. The one aspect of this policy that will likely receive the most attention: what to do if the SFD physician deems a firefighter “not fit-for-duty.” To summarize, a “not fit-for-duty” firefighter is placed on leave for a 12-week period. During these 12 weeks, the firefighter is converted to a 40-hour work week, with 20 of those hours recorded as district-expensed light duty; the remaining 20 hours are designated as sick leave from the firefighter’s leave bank. The 20 hours of light duty are earmarked for time with a Peer Fitness Trainer. “Positive improvement” with approval from the department physician will place the firefighter back on regular duty with a Peer Fitness Trainer-supervised and -monitored exercise, nutrition and wellness program.

Below I’ve included the district’s policy so you can see how the SFD plans to address health and wellness issues in our district. Perhaps reviewing our policy will give you some ideas about how to structure your own.

 

SFD Medically Fit-for-Duty Policy

I. Purpose: This procedure identifies the policy for the SFD in relation to personnel being medically ready for duty.

 

II. Scope: This policy applies to all District Operations personnel.

 

III. Policy: It is the policy of the SFD to provide service in the safest manner possible to its personnel, customers and bystanders. The SFD expects and requires its personnel to be able to function on emergency scenes as well as during daily duties in a safe manner and with a sufficient level of physical fitness.

 

IV. Definitions:
A. Medically Fit-for-Duty: Physical condition suitable to meet job description without undue stress or harm upon self or crewmembers.

B. Positive Improvement: Any improvement in relation to sub-par element secondary to intervention.

C. Negative Improvement: Any lack of improvement or worsening of physical conditions, either with or without appropriate effort.

D. Reassignment: District-assigned position at the discretion of the Fire Chief.

E. The SFD Physician: The SFD-appointed physician responsible for annual physicals and fit-for-duty exams.

F. Gerkin Protocol: You will be asked to walk the treadmill belt as the speed is increased to 3 mph and subsequently to 4.5 mph. The grading will gradually increase from 0-2 percent. This gradual increase in both the speed and grading is repeated in each stage until the individual either reaches the target exercise heart rate (85 percent of the maximum heart rate), or until they show signs of chest pain, shortness of breath or other physical symptoms that make the individual unable to continue the exercise. The test is then stopped and the individual will rest to allow their heart rate and blood pressure to stabilize. The final stage of exercise the individual is able to do will be documented to establish their aerobic capacity.

G. Tier 1: Minimal health parameters that fire personnel should maintain for field conditioning.

H. Tier 2: (Minor Deficiencies) Health issues noted where intervention support or change is recommended.

I. Tier 3: (Major Deficiencies) Health issues sufficient for mandatory referral for wellness/fitness intervention, but removal from the field is not required.

J. Tier 4: (Major Deficiencies) Health issues sufficient to mandate removal from the field and mandatory referral for wellness/fitness intervention.

K. Health Standards
See table “Health Standards”

V. Classifications
A. Medically Fit-for-Duty: No Deficiencies (Tier 1).

  1. No required action by the individual.

B. Medically Fit-For-Duty: Minor Deficiencies (Tier 2).

  1. Recommended Peer Fitness counsel.
  2. Review at next annual physical.

C. Medically Fit-for-Duty: Major Deficiencies (Tier 3 or 4).

  1. Required Peer Fitness intervention (physician determined).
  2. Review completed at six months.

    a. Positive improvement: Continue to annual physical.

    b. Negative improvement: Assign new PFT.

  3. Review at next annual physical.

a. Positive improvement: Continue with PFT.

b. Negative improvement: 12-week Light Duty/ Sick Leave (50/50) time off.

(1) Mandatory time with PFT.

(2) Re-evaluate at 12 weeks by SFD physician.

(a) Positive improvement: Possible return to duty.

(b) Negative improvement: Recommended retirement, permanent reassignment or termination of service.

D. Not Medically Fit for Duty: Physician Determination (Tier 4).

  1. Removed from line of duty immediately.
  2. Required 12-week Peer Fitness intervention (Light Duty/SL at 50/50).
  3. Re-evaluated at 12-week point by the SFD physician.

a. Positive improvement: Continue with PFT and possible return to duty.

b. Negative improvement: Assign new PFT (SL 100 percent).

(1) Re-evaluate at 12 weeks by the SFD physician.

(a) Positive improvement: Possible return to duty.

(b) Negative improvement: Recommended retirement, permanent reassignment or termination of service.

 

VI. Guidelines:
A. All operations personnel will have both the annual peer fitness and medical evaluations as per the current SAP#151, Physical Examinations.

B. The tiers (per Classifications, Section V) are for reference only, as the SFD-appointed physician has ultimate responsibility in determining medical fitness for duty.

C. All resources available to get an individual back to full-duty status shall be utilized.

D. Any injury/medical condition attributed to the workplace shall be the responsibility of workers’ compensation.

E. Medical conditions deemed unfit for duty, but not job related, shall be susceptible to the full extent of this policy. Should the individual be unfit to return to duty after all attempts are exhausted according to this policy, the individual shall be permanently reassigned, terminated from service or recommended for retirement, which is ultimately at the discretion of the local Public Safety Personnel Retirement System (PSPRS) Pension Board.

F. Recommendation to PSPRS for medical retirement shall be considered a final option.

G. Confidentiality shall be priority. Only the individual, the PFT and the SFD physician shall be apprised of confidential medical information. The SFD administration (human resources) shall only be notified of the following:

  1. Medically Fit-for-Duty: Recommended Peer Fitness intervention
  2. Medically Fit-For-Duty: Required Peer Fitness intervention
  3. Not Medically Fit-for-Duty: Required Peer Fitness intervention

H. At the individual’s request, a second opinion may be granted at the financial expense of the individual. The final authority lies with the SFD physician.

 

VII. Reassignments: Not Medically Fit for Duty
A. The Fire Chief has final authority over all reassignments.

B. Light Duty/SL daily time shall be utilized according to assigned PFT and Fire Chief or their designee in accordance with the current Light Duty SAP.

C. 50 percent light duty and 50 percent sick leave shall be utilized for the initial 12-week “Not Medically Fit-for-Duty” period. If zero “positive improvement” is achieved during the initial 12-week period, a second 12-week, sick-leave-only period will be assigned.

D. Uncooperative personnel shall be subject to disciplinary measures.

 

Step It Up

Implementing a fitness/wellness program and/or a medically fit-for-duty policy is a great way to encourage your firefighters to maintain or improve their health. I hope the SFD’s medically fit-for-duty policy will at least get you thinking about whether a similar policy would work at your department. After all, six of the 16 Firefighter Life Safety Initiatives are oriented toward firefighter fitness and wellness. Clearly, this is an issue to which we should devote as much attention as possible.

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