The 2013 edition of NFPA 1582 has been released, and several important changes have been made. Here, we detail the key changes and how they may affect your fire department.
NFPA is first and foremost a health and wellness document. One of the cornerstones of health and wellness is disease prevention and early detection of disease. Increasingly our firefighters are being exposed to a sicker population and thus more communicable diseases. It is more important than ever that they are protected through vaccination and screenings.
What hasn’t changed
Your firefighters should still be vaccinated against Hepatitis B, Varicella (chicken pox), Tetanus, Diptheria, Measles, Mumps, Rubella and Polio (as indicated by risk). Most of your younger candidates will have received all of these vaccines as part of their routine school vaccinations. However it is important to document that this is the case. In our evaluation of candidates we have found several who were never vaccinated for one reason or another. The main reason has been due to their parents objecting to vaccines secondary to moral or health concerns.
Routine screenings should still include yearly tuberculosis screening, baseline and post exposure hepatitis C screening and optional HIV screening. Hepatitis C and HIV screening are both done through blood testing. TB screening can be done using the traditional PPD skin test but the 2013 edition also allows for the use of a blood test for TB screening. This type of blood testing is more accurate. It also is logistically easier because it does not require the two to three day incubation period and reading like the skin test does. The disadvantage at this point is still cost, as the TB blood test costs significantly more than traditional skin testing.
Hepatitis A has been added as a required vaccine. The 2007 edition of NFPA 1582 states that Hepatitis A vaccine was to be offered to high-risk members of the department. Generally this was limited to heavy-rescue or SCUBA teams that might have exposure to fecal material in the line of duty. The 2013 edition expands Hepatitis A vaccine to include all fire department members. Most younger candidates and members will have been vaccinated as part of their routine childhood vaccinations.
Flu vaccine has been added as a vaccine that shall be provided. This applies to the seasonal flu vaccine as well as any additional flu vaccine that becomes available. Like the H1N1 vaccine a few years ago (see video below), the flu vaccine has been shown to be effective for the prevention of flu, and will reduce the chance that your firefighters will be sick and either come to work and get other members sick, or miss work. This is a money saver for your department. It also reduces the chance that your firefighters will be spreading the flu to the general public.
Hepatitis B immunity screening
It is important that immunity to Hepatitis B is documented using a titer test after the vaccination series has been given. However it is not necessary to test for Hepatitis B immunity yearly. One of the expensive mistakes departments make is to do a titer test yearly and give Hepatitis B boosters. According to the Centers for Disease Control and Prevention, once immunity has been demonstrated with one positive titer test, immunity is considered to be life-long. Rechecking and boosting is unnecessary and expensive.
One of the most difficult aspects of vaccination and infectious disease screenings is record keeping. It is often the case that tests and vaccinations are repeated unnecessarily because of incomplete or absent records. It is important that documentation be consistent and accessible. For that reason, we recommend that vaccines and screenings be done through a single source as part of your NFPA 1582 health and wellness program.
Dr. Gonzalo Fernandez earned his undergraduate degree from Emory University in Atlanta and is a graduate of the Medical College of Georgia. He completed his residency at Floyd Medical Center in Rome, Ga., and has been practicing in North Carolina since 2001. He is the Corporate Consulting Physician for Progress Energy and has extensive experience in hazmat, fire brigade and firefighter exams. He is also a national lecturer of NFPA 1582 related topics. He can be reached at firstname.lastname@example.org.
Dr. Lance Walker completed undergraduate training in Biology at William Jewell College in Liberty, Mo. He received a Doctorate Degree in Osteopathic Medicine from the Oklahoma State University College of Osteopathic Medicine. His residency was completed in Family Medicine at Floyd Medical Center in Rome, Ga. He is the Associate Medical Director for Georgia Power, and also serves as an Aviation Medical Examiner, Certified Independent Medical Examiner and a Certified Medical Review Officer. He can be reached at email@example.com.
Fernandez and Walker are affiliated with SiteMed, is a physician owned occupational medicine company specializing in on-site firefighter exams.