We’ve all heard the excuses: I am in great health. I have no symptoms. Physicals don’t matter. My friend got a clean bill of health and then dropped dead as he walked out of the doctor’s office. We also have many reports of physicals saving a person’s life by finding something that can be treated successfully. I have personal experience with this. During an annual fire department physical, the doctor found a problem with my thyroid. I received treatment involving medication and thyroid removal. Thankfully, my fire department physical caught this disease early enough so it never affected my career and enabled early treatment of a potentially life-threatening problem. My annual physical saved my life; it worked for me.
In 2006, SHSS conducted a fire department survey on firefighter physicals; in 2016, we repeated the survey to see if improvements were made related to firefighter physicals. One aside to note, in 2006, we received 1,824 responses to the survey; in 2016 we received more than 9,000 responses. This increased response rate can be explained in two ways. First, we did a better job of getting the survey in front of and engaging firefighters to respond to the survey. Second, and more importantly, the fire service is more focused on firefighter health. The remainder of this article analyzes the latest response data and compares it to the 2006 data.
Who Gets a Firefighter Physical?
Table 1 shows data regarding who receives a physical within a fire department. The results provide both good and not so good news. Compared to the 2006 data, the 2016 survey responses show a substantial increase in the number of departments that require physicals for fully career departments and primarily career with volunteer departments; with a smaller increase in volunteer departments with career firefighters. This is good news. In contrast, there was a decrease in the number of fully volunteer departments requiring physicals. This is not so good news.
Table 1 also identified a number of departments that don’t require, recommend or provide annual physicals. The results parallel the data noted above. The number of fully career departments and primarily career with volunteer departments both showed a decrease in the number of departments not requiring physicals. Primarily volunteer with career departments and fully volunteer departments saw numbers that indicate fewer of these departments are working to ensure their firefighters get annual physicals.
Why is this occurring with so many organizations talking about health and safety issues? Are we having a problem getting the information to the latter two groups? Is it a financial consideration? Is it a fire service cultural issue? The more positive results for career and career with volunteer departments may be attributable to strong union initiatives driving these departments to execute firefighter health monitoring programs such as annual physicals.
What standards are used to conduct a firefighter physical?
The data from Table 2 shows that firefighter physicals differ from jurisdiction to jurisdiction. A key takeaway from this data, found across all categories of departments, is a migration away from locally established criteria for physicals. Additionally, the survey provided information that should raise concerns about the efficacy of the NFPA 1582 physicals. In all the categories, more departments use the IAFC/IAFF Wellness Fitness Initiative as the bases for annual physicals rather than the NFPA 1582.
Lastly, in 2016, we asked if the firefighter knew what standard was being used for the annual physical; no such question was asked in 2006. The results indicated that a substantial number of survey participants didn’t know.
Have we made progress in providing behavioral health care?
In 2006, we saw that 91% of the departments performing annual physicals didn’t have a mental-health component. Since then, we’ve become more aware of the effects of post-traumatic stress, bullying and substance abuse. In 2006, we challenged fire departments to incorporate a simple and effective mental-health screening process into the annual physical. Unfortunately, the 2016 survey data has shown only a slight improvement (Table 3). The number of respondents answering “No” to whether their physical includes a mental health component, means that the fire service over the last 10 years has done very little to address mental-health evaluation during an annual physical. Anecdotally, departments created many programs, such as peer support, hotlines and counseling units, but these programs require the firefighter to take the first step. We still need a screening tool the physician conducting the annual physical can use to identify potential underlying mental-health issues. This is no different than running a blood test to identify medical issues. Determining physical and mental-health issues during a physical can save a firefighter’s life and can provide the necessary interventions to improve the firefighter’s job performance.
Who provides a firefighter physical?
We see a movement away from the use of local physicians or medical professionals (Table 4). More departments are using occupational health-service groups or physicians with knowledge and experience on firefighter health and safety issues as compared with the 2006 data.
While a local physician may be more cost-effective or the only act in town, if that physician doesn’t understand the job-performance criteria of a firefighter and the firefighting work environment, the physician is at a disadvantage in making decisions about a firefighter’s ability to do the job. Does every fire department, career and volunteer, have written job descriptions for firefighters that define the scope of what’s expected from firefighters? If so, does your department furnish this job description to the physician or occupational health services?
The Role of the Primary Care Physician
The data in Tables 5 and 6 are new to the 2016 survey. Across the board, approximately 80% of firefighters have their own personal primary-care physician (PPCP). When surveyed about whether the PPCP would be able to identify post-traumatic stress or significant mental-health issues, over 85% in all categories said no.
Our challenge now, is to ensure that all firefighters—interior, exterior, drivers—receive an annual medical physical. We must work to guarantee that the physical meets the generally accepted standard of the fire service. Physicals need to be performed by qualified physicians knowledgeable about the firefighter’s job.
We all agree that LODDs are unacceptable, especially when we have the means to prevent many of these deaths by providing an annual physical. Since 2014, the Safety, Health and Survival Section (SHSS) has focused on firefighter health, including hosting annual Firefighter Physicals Summits. Annual physicals are the best way to detect potentially life-threatening medical conditions. We can’t guarantee that every medical issue will be identified; we also can’t guarantee that a firefighter will be cured forever. We do know that early detection can save lives, making it more likely a firefighter will be able to return to work. More importantly, with annual physicals, more firefighters will be able to live longer, more fruitful lives with their family and friends.
What are you going to do to get all your firefighters an annual physical? Remember, we must guarantee that “Everyone Goes Home.”
David Fischler, J.D., CFO, was Commissioner of the Suffolk County (N.Y.) Department of Fire Rescue and Emergency Services and is a former chief-of-department for the St. James Fire Department. He has been an active member of the Safety, Health & Survival Section since its inception. He has been an active member of the IAFC since 1976.