Fact: The leading cause of death for firefighters in America is sudden cardiovascular failure including myocardial infarction (heart attacks) and cerebrovascular accident (strokes). Fact: The single most effective way to prevent such deaths is to mandate an NFPA 1582 physical for every firefighter in America–period. Myth: You cannot mandate a physical for every firefighter in America.
Although the fire service has long opposed any federal intervention concerning national regulations on firefighters, the power to mandate such physicals exists today. The Commercial Motor Vehicle Act of 1986 mandated the creation of licenses (CDLs) in every state for operators of certain types of motor vehicles (including fire apparatus). The functional result is that no individual can drive a trash truck in America without medical certification.
The result: The perception is that the safety of garbage is more important than the safety of firefighters. Some reading this column will decry this statement as rhetoric intended only to fan the flames of controversy, but actions speak louder than words. I’m not advocating that the requirements for CDLs be applied to firefighters (that standard is too low) but it is an example of how the federal government has the capacity to act in the best interest of its citizens, despite themselves.
Getting More Specific
Let’s break down the myth a bit.
First, many argue that annual physicals cannot, or should not, be mandated for volunteer firefighters. In 1966, a nationally published white paper, “Accidental Death and Disability, the Neglected Disease of Modern Society,” served as the catalyst for the establishment of nationally mandated, state-administrated training standards for all individuals providing EMS. At the time, an emotional argument was posited that such onerous requirements would spell the end of EMS and jeopardize lives by eliminating volunteerism. Instead, the action saved lives as it raised the bar of professionalism across the country, allowing patients to receive care en route to the hospital rather than simply die in the back of hearses. Today, there are nearly one million EMTs, the majority of whom are volunteers.
In 1985, NFPA 1500, an occupational safety standard, came into existence. It was similarly decried as spelling the end of the fire service as it was known. It did. Today, the fire service is infinitely safer than it was in 1985, with fewer fatalities and injuries than at any other time in our nation’s history.
Second, some advocates believe that establishing a mandatory retirement age (e.g., age 65) for all firefighters could more effectively reduce firefighter fatalities. Consider this: In 2011, 48 firefighters died from sudden cardiovascular failure at an average age of 50 years; in 2012, 40 firefighters died at an average age of 53 years; thus far in 2013, 18 firefighters have died at an average age of 48 years of age. Placing an artificial limit based on age alone will not effectively reduce firefighter fatalities.
Legitimate Concerns
There are legitimate arguments put forth by the fire service concerning annual physicals. For example, who is going to pay for them? Without question, firefighters and fire departments should not bear this cost. It should fall to jurisdictions benefitting from the services provided by firefighters. Such costs could be borne by worker’s compensation carriers, local healthcare agencies (hospitals), county and state health departments, and yes, the federal government through grants and assistance to state and local entities. By sharing costs, we can minimize the impact on any one agency.
Other legitimate questions: How will annual physicals impact firefighters’ abilities to continue to provide service? And who is going to bear the costs of treating what may be considered “presumptive medical conditions” found during such physicals?
To the first question: Numerous firefighters have been diagnosed with cardiac conditions, received effective treatment, and returned to full duty. These include such advanced interventions as cardiac catheterizations, including the implantation of stents in coronary vessels. To the second question: Statistics reflect that the cost of treating cancer found early is dramatically less than when found in an advanced stage. There is a higher survivability rate as well as a higher return-to-service rate.
Finally, there are arguments that an NFPA physical is not needed for individuals who do not participate in structural firefighting but are members of companies and provide “fireground support” operations. A simple benchmark might be this: If a member were to die while engaged in fire department operations, would we attempt to get benefits for the fallen firefighter’s family and would we want them to be honored at memorial services? If the answer to these questions is “yes,” the individual should have an annual NFPA physical.
Time for Action
Intelligent people can disagree on how best to implement mandatory physicals for every firefighter in America, and there should be a spirited debate among stakeholders. But the time has come for action–now. Emotional arguments will do little to advance firefighter safety. Simply put, you cannot say you are committed to firefighter safety and not support mandatory NFPA physicals for all firefighters.
