OBJECTIVES 2013 Edition of NFPA 1582 1. Discuss NFP A 1582 History - PDF document

American Osteopathic College of Occupational and Preventive Medicine 2013 Mid Year Educational Conference, Phoenix, Arizona February 14-17, 2013 OBJECTIVES 2013 Edition of NFPA 1582 1. Discuss NFP A 1582 History Key Changes in Firefighter Heath and 2. Highlight Key Changes in Document in 2013 edition Wellness 3. Discuss Effective Communication 4. Discuss potential opportunities Lance Walker D.O. MPH AOCOPM Phoenix MidYear Conference National Fire Protection Association (NFPA) Standard on Professional Qualifications for Fire Fighter, NFP A 1001, 1974 Standard on Fire Department Occupational Safety and Health Program, NFP A International nonprofit established in 1896, establishes consensus 1500, 1987 codes and standards, research, training and education First Edition of NFP A 1582, Standard on Medical Requirementsfor Fire Fighters, Standards on everything from fire extinguishers to electrical codes 1992 then 1997 Standard on Medical Requirementsfor Fire Fightersand Information for Fire NFPA 1582 Standard on Comprehensive Occupational M edical Department Physicians, 2000 Program for Fire Departments Standard on Comprehensive Occupational Medical Program for Fire Departments, Standard is a best practices recommendation, does not represent 2003 force of law 2007 edition, 2013 edition is the current edition REM EM BER Structure Nine Chapters six Annexes Non Punitive The medical component was specifically designed to Essential Job Tasks and Job Descriptions Chapter 5 provide a cost-effective investment in early detection, disease prevention, and health promotion for fire M edical Evaluation Chapters 6 and 7 fighters Fitness Evaluation Chapter 8 Two Standards, one for candidates and one for members Evaluation of Specific M edical Conditions Chapter 9 C-1

American Osteopathic College of Occupational and Preventive Medicine 2013 Mid Year Educational Conference, Phoenix, Arizona February 14-17, 2013 DISCUSSION POINTS SO WHAT’SNEW? 1. Immunizationsand Infectious Disease Screening Still 9 Chapters, now two new annexes 2. Medical Standard Changes for Candidates and Members • One annex on pregnancy 3. Fitness Testing Changes • One annex with nice reference materials and 4. Communication 5. Opportunities forms IM M UNIZATIONSAND INFECTIOUS WHAT REM AINSTHESAM E? DISEASE SCREENINGS • TB Screening • Hep B Vaccinations and Titers • Hep CScreening Baseline/after exposure • Td every 10 years (no pertussis?) • M M R • Varicella • IPV as indicated • HIV Screening Offered CHANGESTO VACCINESAND OPPORTUNITY INFECTIOUSDISEASE SCREENING • Work with your Departments • Hep A vaccine • Save M oney Develop Effective Program With Records • IGRA option for TB • Flu, Seasonal and Novel C-2

American Osteopathic College of Occupational and Preventive Medicine 2013 Mid Year Educational Conference, Phoenix, Arizona February 14-17, 2013 M EDICAL STANDARD CHANGESFOR • Category A Conditions (shall not be certified) CANDIDATESAND M EM BERS • Category B Conditions (may be certified if… ) • Remember that M embers are held to a different standard… CHANGESTO M EM BER FOCUSON NINEAREAS WORDING • Fitness • Asthma For incumbent fire department members, conditions listed in • Diabetes Chapter 9 shall not indicate a blanket prohibition for such • Seizures Incumbent members from continuing to perform the essential • M etabolic Syndrome Job tasks, nor shall they require automatic retirement or Separation from the fire department. • Hypertension • Sleep Apnea • M edications • Cardiovascular Evaluation FITNESS FITNESS • Submaximal Exercise Testing • 12 M ETSfor Candidates • 8 M ETSor better for M embers C-3

American Osteopathic College of Occupational and Preventive Medicine 2013 Mid Year Educational Conference, Phoenix, Arizona February 14-17, 2013 ASTHM A/ LUNG DISORDERS ASTHM A/ LUNG DISORDERS • Candidates • M ust have FEV1 and FVC>70% absolute cutoff no matter the diagnosis or condition • Asthma is a Category A M edical Condition (defined as needing 2 consecutive months of meds (BD or CS) at any time in the past two years) • “ I used to take medications for Asthma but I don’t have Asthma anymore” ASTHM A ASTHM A • M embers • Pulmonology Evaluation • 9 Criteria that M UST be M et (Changes from 2007 only) Specialist Referral Required (1) Asthma has resolved without symptomsoff medicationsfor 2 years. • M ust have mild asthma “step 1” or “step 2” asthma as defined by (2) Allergen avoidance or desensitization hasbeen successful National Heart Lung and Blood Institute’s Guidelines for the Diagnosis (3) Spirometry demonstratesadequate reserve (FVCand FEV, greater and M anagement of Asthma than or equal to 90 percent) and no bronchodilator response • Step 1, No control medications, Rescue bronchodilators used less than measured off all bronchodilatorson the day of testing. twice per week (4) Normal or negative response to provocative challenge testing [e.g. • Step 2, Daily control medicine (LI or Low dose inhaled corticosteroids). cold air, exercise (12 METs), methacholine, histamine, mannitol, or Use of rescue bronchodilators less than twice per week • hypertonic saline] or negative response to exercise challenge. Added Exercise Challenge Testing to optionsfor the specialist • Still must meet all 9 criteria including FVCand FEV1 >90% of predicted DIABETES DIABETES • Candidates/ M embers Diabetes • Type 1 and Type 2 can both qualify • Type 1 has 7 criteria candidate/ member must meet (some sub criteria) • Type 2 has 7 criteria candidate/ member must meet C-4

American Osteopathic College of Occupational and Preventive Medicine 2013 Mid Year Educational Conference, Phoenix, Arizona February 14-17, 2013 DIABETES SEIZUREDISORDERS • Candidates/ M embers Diabetes  Highlights • NO TOD • Stress Test with Imaging • Signed Statement • 12 months of diabetic history • No Hypoglycemic Episodes • New Language about A1C M easurements and Accuracy • If insulin 3 months control must be demonstrated SEIZUREDISORDERS SEIZUREDISORDERS • Candidates/ M embers • Qualification Criteria • Both can qualify 1. No Seizure for one ear off seizure meds 2. Normal Neuro Exam • Expansion of Definition 3. Normal Imaging Studies • Streamlined process same for candidates and 4. Normal EEG (awake, asleep, photic, Hyperventilation) members 5. Signed Statement from Neurologist • Five Criteria, one year off meds or five years on stable regimen, Neurologist consult with specific testing M ETABOLICS YNDROM E M ETABOLICS YNDROM E (1) Abdominal obesity, defined as a waist circumference >40 in. (>102 cm) in men, >35 in. (>88 cm) in women (2) Triglycerides >150 mg/ dl (3) HDL cholesterol < 40 mg/ dl for men, < 50 mg/ dl for women (4) Blood pressure > 135/ 85 mmHg (5) Fasting Blood glucose > 110mg/ dl. C-5

American Osteopathic College of Occupational and Preventive Medicine 2013 Mid Year Educational Conference, Phoenix, Arizona February 14-17, 2013 M ETABOLICS YNDROM E M ETABOLICS YNDROM E • Candidates • M embers • Category A M etabolic Syndrome <12 M ETS(DQ • StressTest with imaging anyway) • Category B M etabolic Syndrome > 12 M ETS • M ust make 12 M ETS HYPERTENSION HYPERTENSION • Candidates • Category A • Uncontrolled or Poorly Controlled Hypertension • Hypertension with End Organ Damage • Uncontrolled = Stage 2 Hypertension >160 systolic or >100 diastolic • M ay refer back to PCP for treatment re-eval in one month HYPERTENSION SLEEP APNEA • M embers • Stage 1 referral for evaluation and treatment • Stage 2 or TOD will trigger restriction or disqualification until addressed C-6

American Osteopathic College of Occupational and Preventive Medicine 2013 Mid Year Educational Conference, Phoenix, Arizona February 14-17, 2013 SLEEP APNEA SLEEP APNEA • Candidates • Recommendationson Screening • Category B Condition if unresponsive to treatment • Berlin Questionnaire • M embers • Epworth • M ust be properly treated M EDICATIONS M EDICATIONS • Category A M edications for Candidates 1. Narcoticsincluding Methadone 2. Sedative-Hypnotics 3. Full-Dose or low-dose anticoagulation therapy 4. Bblockers(at dosesthat prevent cardiac response to exercise), high dose diuretics, central acting anti-hypertensives 5. Respiratory Medications 6. High dose corticosteroidsfor chronic disease 7. Anabolic Steroids 8. Any other drug that might interfere with performance of essential job tasks M EDICATIONS M EDICATIONS • M edications in M embers • Category B M edications for Candidates 1. Methadone 1. Cardiovascular Agents 2. Anticoagulants 2. Stimulants 3. Narcotics 3. Psychiatric Medications 4. Muscle Relaxants 4. Other than high-dose systemic corticosteroids 5. Sedativesand Hypnotics 5. Antihistamines 6. Psychiatric Medications(might) 6. Muscle relaxants 7. Anti-Hypertensive agents 7. Leukotriene receptor antagonists(e.g., Montelukast) used for 8. High Dose Corticosteroids allergies that do not affect the lower respiratory system 9. Anabolic Steroids 10. Any other medicationsthat might interfere with performance of essential job tasks C-7