Occupational health is a field of medicine that provides medical care for workers and advisement for the employer on the fitness for workers' duty. Many standards are established to protect workers. OSHA has a respiratory protection program standard that applies to firefighters because they need to wear respirators to do their job (as do many other occupations). Per the OSHA Respiratory Protection Program: Paid/career firefighters working in an OSHA State Plan State must follow all OSHA Standards, including the OSHA Respiratory Protection Standards (29. 1910.134).1 Additionally, many fire departments require the periodic firefighter occupational evaluation to follow the National Fire Protection Association (NFPA) 1582 - Standard on Comprehensive Occupational Medical Program for Fire Departments.

The NFPA standards have a process for making standards that involve public participation. NFPA standards are updated regularly. The process for developing and updating standards related to fire protection by the NFPA involves four main steps: public input, public comment, technical session, and standards meeting.² Firefighters face unique occupational health risks due to harsh work environments with excessive heat, extreme physical exertion, intense emotional situations, dense smoke, and toxic chemicals. They perform strenuous activities, wear heavy equipment and a respirator. Sudden cardiac death is the leading cause of on-duty firefighter deaths.³ Firefighters have decreased mortality from all cancers and from several site-specific cancers.⁴ Additionally, firefighters have an increased risk of PTSD and Suicide.⁵

Summary of NFPA 1582 - Standard on Comprehensive Occupational Medical Program for Fire Departments – 2022 Edition.⁶ Firefighter health questionnaire with exposure history. Review of immunization record. HCV and HIV screening (at baseline, following occupational exposure, and if requested by fire department physician or firefighter). TB screening (at baseline and annually or per CDC guidelines). Physical exam with a visual exam, hernia exam, and digital rectal exam as clinically indicated. Laboratory analysis (CBC, electrolytes, LFTs, lipids, glucose, and urinalysis). Heavy metal and special exposure screening (evaluations performed following known or recurrent exposures or as required by federal, state, or provincial regulations). Audiology (annual hearing threshold assessment). Pulmonary function testing (annually). Chest XRAY (as medically indicated). Resting ECG (annually after 40 or as clinically indicated). Cardiac risk stratification (firefighters 40 and older and those under 40 known to be at high risk for ASCVD) should be assessed for their 2-year or 10-year risks of ASCVD created by the American College of Cardiology / American Heart Association. For firefighters with a low risk of ASCVD (no further cardiac evaluation needed). Firefighters with intermediate risk of ASCVD (exercise stress test with or without imaging to at least 12 METS or coronary calcium score followed by Astro-CHARM 10-year score). Firefighters with a high risk of ASCVD (refer to cardiology). Cancer screening. Mammography (bi-annually for female firefighters over 40 and annually for those over 50).

Colon Cancer Screening for firefighters 40 and older with fecal occult blood testing. Ages 45 to 75 to undergo visual screening or stool-based immunochemical or DNA testing. Prostate cancer screening (annual PSA testing for male firefighters age 50 and older and 40 and older for those with increased risk of prostate cancer; e.g., African-Americans or a first-degree relative with a history of prostate cancer at an early age). Lung cancer screening (low annual dose CT for firefighters age 50-74 with at least a 20-pack- year smoking history and currently smoking or quitting within the past 15 years). Cervical cancer screening (PAP smear every 3 years for female firefighters age 21-65, or for those who want to lengthen interval, HPV testing with or without cytology every 5 years). Testicular cancer screening (baseline testicular examination by a healthcare provider). Bladder cancer screening (evaluation for hematuria). Oral cancer screening (mouth examination for signs of oral and oropharyngeal cancers by a healthcare provider). Thyroid cancer screening (examination of thyroid bed for nodules by a healthcare provider) Skin cancer screening (annual skin exam). Sleep disturbance screening. And behavioral Health Screening (including PTSD screening).

References:

1. O. S. H. A. (2011). Department of Labor Logo United States Department of Labor. 1910.134 - Respiratory Protection. | Occupational Safety and Health Administration. Retrieved November 2, 2021, from https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.134.
2. N. F. P. A. (2021). How the NFPA standards development process works. NFPA. Retrieved November 2, 2021, from https://www.nfpa.org/Codes-and-Standards/Standards-Development/How-the-process-works.
3. NIOSH fire FIGHTER fatality investigation and PREVENTION program. LEADING recommendations for preventing fire FIGHTER fatalities, 1998-2005. (2008). NIOSH Fire Fighter Fatality Investigation and Prevention Program; Leading Recommendations for Preventing Fire Fighter Fatalities, 1998-2005.
4. Pinkerton, L., Bertke, S. J., Yiin, J., Dahm, M., Kubale, T., Hales, T., Purdue, M., Beaumont, J. J., & Daniels, R. (2020). Mortality in a cohort of US firefighters from San Francisco, Chicago and Philadelphia: an update. Occupational and environmental medicine, 77(2), 84–93.
5. Stanley, I. H., Hom, M. A., Hagan, C. R., & Joiner, T. E. (2015). Career prevalence and correlates of suicidal thoughts and behaviors among firefighters. Journal of affective disorders, 187, 163–171.
6. N. F. P. A. (2021). NFPA 1582. NFPA 1582: Standard on Comprehensive Occupational Medical Program for Fire Departments. Retrieved November 2, 2021, from https://www.nfpa.org/codes-and-standards/all-codes-and-standards/list-of-codes-and-standards/detail?code=1582.