Correlates of fitness for duty in hazardous materials firefighters

Background and Methods From a statewide medical examination program, we identified firefighters who were deemed unfit for duty by attending physicians (ATTENDING FAIL, n = 9) and those who would have been disqualified by the application of selected numerical criteria from title 1997 National Fire Protection Association (NFPA) guidelines (NFPA FAIL, n = 27) and criteria from a Medical Workshop (WORK FAIL, n = 16). The subjects who were unfit for duty or failed numerical criteria were compared with those who were fit for duty and passed all objective criteria (FIT group, n = 302). All subjects were given an overall morbidity rating by a board certified internist. Comparisons on two surrogate measures of fitness, VO2 max predicted and predicted coronary heart disease (CHD) risk, were also performed. Results We found a significant tendency towards worse results (e.g. higher blood pressure or lower spirometric function) among the three FAIL groups compared with the FIT group. The FAIL groups shared only a small overlap, however; with the firefighters with the highest morbidity ratings, lowest predicted VO2 max, and highest CHD risks. Increasing morbidity was associated with higher age, fewer spirometric function, lower predicted VO2 max, increasing cholesterol, greater BMI, and higher predicted 10 year CHD risk. Conclusion Although the presence of a single serious or poorly controlled condition may render an individual unfit for safe performance as a firefighter; examination of our cohort suggests that multiple risk factor models or overall clinical assessments are superior means of identifying firefighters with poor health status and increased CMD risk. (C) 1999 Wiley-Liss, Inc.