One of the life-safety initiatives identified by the National Fallen Firefighters Foundation is the development and implementation of national medical and physical fitness standards that are equally applicable to all firefighters, based on the duties they're expected to perform.

Now I am by no means an expert. I'm only a chief trying, like many of you, to search for ways to reduce firefighter injuries and deaths. I've read the articles, attended the seminars, gone to the conferences and participated in the discussions. The Salina (Kan.) Fire Department has been proactive with health and safety. City management is committed to health and fitness as a priority. We have incumbent medical evaluation and testing, candidate screening, fireground rehab, medical monitoring, and so on. I'm very proud of our efforts, but I'm not convinced we are where we should be. More troubling is that I'm not sure what's missing or what's next.

Can we fix the problems of today? Culture or attitude — doesn't really matter what you call it — is a matter of changing human behavior. Man, that's a tough one. Regardless of how it's approached, change takes time. Most of us have learned through experience that achieving voluntary compliance through education and understanding can be long lasting. I'm not convinced mandated enforcement lasts. I suppose it does, as long as the enforcer's perseverance holds out. We all need a coach, but you can't be there to look over shoulders all the time. We need buy-in at all levels to make a difference.

Candidate assessment

What do we have control of? I suggest we focus on the future through our candidate selection process. Want change? Select those candidates who pose the least amount of health and safety risk.

Setting high entrance standards doesn't come without complication. For example, the candidate pool is greatly reduced. Our local police chief told me that the law enforcement candidate screening process weeds out as many as 96% of the applicants. Only four out of 100 are eligible to be hired. The police department wants only the best. Experience has shown them that the less-qualified don't work out in the long term. But lowering standards may come back to haunt you.

However, I don't know where to draw that line. Is it better to cut yourself short if you can't find the applicants rather than running the risk, liabilities and complications associated with selecting less-qualified candidates?

I would guess we've all been there at least once: “You know, Chief, Joey is a good guy. He's a paramedic. We want him; everyone gets along with him. He was a great football player in high school and his parents are hometown people.” Then the city physician finds a previous knee injury, and the pre-employment physical evaluation places him as being high risk: Joey's body weight ratio is high, he barely passes the respiratory evaluation and he has an extensive family history of heart disease. But you really need paramedics. His personality will mesh well with the department. Do you take him? Whether paid or volunteer, the decision can have serious long-term ramifications. How's your luck?

Can the fire service survive if we become more restrictive with our entrance requirements? I grew up in central Nebraska. I remember early in my career as a volunteer that if the department became too selective, it would be pretty small. Making the change to be more responsible regarding whom we select is not an easy task, but I believe that selecting only those who are fit for duty is our first step to reducing medical-related injuries, illness and death in the fire service.

Incumbent evaluation

One of the quickest ways to effect change relative to firefighter health and safety is to make changes in how and whom you select to be a firefighter, paid or volunteer. Why not use a potential health risk assessment prior to selection?

I suggest we get serious about employee health assessment. We have been working with our city physician to develop a Health Risk Assessment Profile. Each year our department goes through an annual physical assessment, which includes a pulmonary function test and lab work. Through this assessment the physician can identify health changes and risk potential of each employee. If the physician identifies someone with an increased health risk, the employee can be referred to his or her personal physician. The idea is to catch it and address it before it becomes an emergency.

Each employee must go through this assessment prior to undergoing the annual physical ability test. I know we're not alone in taking this approach, because I've read about many similar successful programs. There are many ways to be proactive in evaluating fitness-for-duty of existing employees, and this is just one. It's not about finding employees who aren't fit so you can fire them. It's about not losing a firefighter to a health or fitness condition that could have been caught and treated.

We need to set our standards high. NFPA 1500, 1582 and 1583 are certainly good models. It's not cheap to do pre-employment assessment or incumbent testing, but both can prevent problems and save lives down the road.

Information is out there

There are many experts available in the field of health and fitness, and it takes little effort to seek these professionals out. Many fire departments have implemented successful health and fitness programs, but I feel our industry as a whole still needs work.

I have more questions than answers. What about fire science programs or Firefighter I having a prerequisite of a physical assessment and successful completion of CPAT prior to enrollment? Do we institute mandatory fitness programs, or do we implement mandatory standards and leave it up to the individual? Do we implement voluntary standards with a disclaimer? Whose responsibility is it to be fit? Is it a condition of employment to be able to do your job, or do we adjust the job to a level that can be done safely based on someone's current physical abilities and condition?

It's the responsibility of managers and supervisors to ensure employees don't pose risk to others. We know the court has accepted fitness standards, most notably the respiratory standard, when public safety is involved. We are now being held accountable both civilly and criminally for fitness for duty.

Part of the answer has to be including a physical education curriculum to our annual fire company training. Look at how Lackland Air Force Base raised fitness standards. It now has Physical Readiness Training that consists of daily 40-minute group sessions. This isn't by any means a new concept, but it is a renewed commitment to challenge the fitness of our Air Force.

Many fire departments have established good programs that can be modeled after. For example, Indianapolis has implemented a pre-employment fitness evaluation. The difference here from others is that they require candidates to sign a pre-employment agreement to meet the fitness standards for the duration of their employment. My department currently has everyone sign a no smoking agreement, but nothing pertaining to a fitness agreement.

We already have some great resource material available, such as the U.S. Department of the Interior's well-defined physical fitness standard, Work Capacity Fitness Testing. We have some very good guides and standards in place, including many well-designed department-level programs. Our task is to pull together the existing resources and package the best into something that can be shared service-wide. Someone may even have addressed this as an Executive Fire Officer project. If not, someone should.

As the IAFC's Health, Safety and Survival Section begins to address its mission, I am confident it will discover ways to accomplish each of the 16 life-safety initiatives. It is my hope that sub-committees of this section will take hold to address the individual initiatives. Join the Health, Safety and Survival Section and get involved.

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A 25-year fire service veteran, Chief Darrell Eastin is a member of the IAFC Health and Safety Committee and heads the Salina (Kan.) Fire Department.