强制性消防员医学检查

Could this be you during those times of heavy exertion at a working fire or complex rescue? Could this be you denying your “stomach upset” or jaw discomfort? Are you on a river in Egypt –called “de-Nile?”

Statistics from 2010 for消防队员 line-of-duty deathscaused by cardiac arrest indicate these deaths accounted for 56.4 percent of all deaths, and there is a 44 percent average from cardiac arrest andheart diseaseover the past 10 years. Firefighters are dying from preventable diseases. What about our retired brethren? Although there are no comprehensive studies, I would surmise they die early from all kinds of preventable diseases like heart disease, diabetes, cancer, and high blood pressure. Not much of a retirement.

Did you have a comprehensive medical evaluation that followed National Fire Protection Association (NFPA) 1582,消防部门综合职业医疗计划的标准, Chapter 6, Medical Evaluations of Candidates, when you were hired by your fire department? This initial medical evaluation will establish the baseline for your continued medical evaluations if your physician finds a change in heart, lung, vision, hearing, lab work, or other vital功能。可以实施纠正过程，以防止潜在的致命疾病或疾病进一步发展。随着我们的年龄和击败身体的工作，我们不可避免地会有一些需要尽早发现，干预和治疗的医疗状况。如果未进行入学医学评估，我们如何知道随着时间的流逝，医学上对我们发生了什么？

Here is the hard question, if a problem is found–is it preexisting or newly acquired on the job? Many states have presumptive legislation for heart, lung, and, in some states, cancer and infectious diseases. What about the rest of you? How can you prove that your disease was acquired on the job?

雇主是否负责开始和维护其消防员的全面医疗测试的Occupational Safety and Health Administration (OSHA)?¹尽管这些标准适用于消防队，但作为最佳实践，它们也应适用于您。

我们会故意进入完全参与的不安全结构火灾吗？在没有大量培训和计划的情况下进入复杂的限制空间救援？当然不是！那么，为什么我们要通过自己的职业反弹，对我们身体内部可能存在潜在的灾难性医疗状况的可能性视而不见？知道，理解会更好, and treat these conditions? There is a saying in our world, “Predictable is preventable,²”当然还有心脏病，癌症，糖尿病，高胆固醇和高血压是可以预见的AND可以预防。知道这些因素以及超过50％的消防员死亡是由可预防疾病引起的事实，我认为是时候了MANDATORY FIREFIGHTER MEDICAL EXAMINATIONS对于我们所有的消防员，定期安排。我不忽略这可能存在的劳动/管理和财务问题，我认为消防员的健康和福利是最重要的问题，本文将不会解决这些劳动问题。

Now this may scare you for many reasons, but research and the literature have demonstrated extensive coronary artery disease in firefighters stems from a combination of personal and workplace factors. The personal factors are well known: age, gender, family history, diabetes mellitus, hypertension, smoking, high blood cholesterol, obesity, and lack of exercise. Not as widely known, however, is that firefighters have exposures to workplace factors that are associated with adverse cardiovascular outcomes, such as exposure to fire smoke (notably carbon monoxide, hydrogen cyanide, and particulates), heat stress, noise, and shift work.³

How do we address the subsequent medical evaluations in those departments already having such programs? A greater question: if you do not have a current program, how do you start one?

对于正在进行的计划，由合格的卫生保健从业人员进行的全面身体评估⁴consists of the items found in NFPA 1582 Section 6 as a guideline for ongoing evaluations and should consist, at a minimum, of these items: vital signs (blood pressure, pulse, height and weight); head; ears; eyes; nose and throat; heart; peripheral vessels; lungs; abdomen; back; extremities; joints for flexibility; lymph nodes; skeletal and muscular tone and condition; evaluation of your nervous system; examination of your skin, nails, and hair; and, for men, a prostate examination. These evaluations can detect early cancers, heart disease, hypertension, and high cholesterol.

This evaluation should also encompass additional testing, including an audiogram to benchmark hearing loss; vision, including depth perception and peripheral and color vision); height and weight, to see if you are gaining or losing weight; a chest X-ray to detect any disease like chronic obstructive pulmonary diseases (COPD) or tuberculosis; and a pulmonary function test. For cardiac health, a stress treadmill electrocardiogram must be performed on the initial firefighter entry exam and included as a periodic examination at least every five years. Laboratory studies should include a comprehensive blood test to include blood chemistries for liver enzymes, kidney function, cholesterol, and any heavy metals if the firefighter is a hazmatresponder.

定期医学评估可能会引起一些不合格的医学发现；我建议您指的是NFPA 1582和那些不合格的医疗罚款。已经发现，对于大多数患有疾病的消防员而言，他们的治疗方法包括消防员与医师之间的机密关系。该信息不一定与部门共享。显然，如果患有严重的心脏病，并且您需要四路旁路，则需要告知您的部门即将进行的手术。在这些医疗条件下，如果提供适当的医疗服务，没有理由消防员不应该重返工作岗位。

对于没有现有计划的部门，我建议您与当地的医疗保健专业人员建立关系，并要求他们成为您的“部门医生”。他们可以阅读NFPA指南和标准，并按照您部门的指南实施全面的医疗评估计划，许多州还制定了垂直医疗标准，可以解决初始和正在进行的医疗评估计划。

Many of you may not agree that this is the right way to go, since it may cause an early end to your career; but personally, I get tired of reading of my brother and sister firefighter deaths, and I’ve been to too many firefighter funerals. Together, we can actually do something to prevent unnecessary firefighter deaths. So what are we waiting for?

JOHN K. MURPHY, JD, MS, PA-C, EFO,retired as adeputy fire chief after 32 years of career service; is a practicing attorney and physician assistant, and is a frequent speaker on legal and medical issues at local, state, and national fire service conferences. He is a contributing author to188金宝搏是正规吗and afireengineering.com podcast host.

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