Assessing Firefighters Fitness

Occupational health service professionals in particular have to be familiar with the requirements and nature of the firefighting,

as well as with the working conditions and work community.

The workload in firefighting and rescue work is often high, and accidents and fires can occur at any time, in any place and under a variety of circumstances.

In emergency situations, accurate observations, quick decisions as well as safe and efficient actions are needed in unpredictable and dangerous conditions.

Firefighters need to have good health and their physical performance and mental capacity have to be on a sufficient level, in order to be able to cope with demanding work tasks without overstrain and risk to their health. 

Firefighters are exposed to various kinds of hazards and stress factors, such as mechanical injuries, injuries caused by high or low temperatures, accidents caused by various machines and equipment, physical overexertion, mental stress, and biological exposure, as well as injuries caused by chemical exposure.

Firefighting and rescue tasks necessitate the use of fire-protective equipment, special garments and a self-contained breathing apparatus weighing 6-15 kg.

While wearing protective equipment and carrying tools (weighing together up 50 kg) a firefighter must be able to climb stairs, help a victim or resist the propulsive force of a water spout. Irregular working hours are an additional individual stress factor.

It is most important to assess whether a firefighter can safely participate in smoke-diving, without risking his or her own health safety or that of others.

Furthermore, firefighters face many kinds of rescue tasks, as well other tasks, such as driving rescue vehicles, making inspections, taking part in paramedic actions, etc.

The following guidelines have been issued for smoke-diving firefighters.

Smoke-diving is the heaviest task, and both professional and voluntary firefighters have as the demands of smoke-diving the same for both.

Health status and medical requirements In the assessment of the health status of firefighters, particular attention is paid to the special requirements of the work.

The personnel performing the examinations must therefore be familiar with fire service tasks.

When evaluating the fitness of a firefighter to work, one has to be able to assess anomalies of health status that may impair working capacity.

Sufficiently good health is a part of a firefighter´s occupational safety, which involves not only the worker himself, but also his workmates, the rescue team, and those to be rescued.  The health status of firefighters is evaluated in different health examinations which fall into two categories: recruitment and periodical examinations.

The leading principle is that recruitment examinations are performed prior to the beginning of any training to the profession.

There are certain health anomalies that are considered to be insurmountable obstacles in firefighting work.

Such obstacles are: angina pectoris, asthma, diabetes, severe arthrosis, psychiatric diseases, and misuse of alcohol and drugs.

The situation is often unclear, and each case has to be evaluated separately.

Mental aptitude and social work ability have also emerged as crucial factors.

The applicants have to take psychological tests which play a significant role in the selection of students, and efforts are being taken to improve the tests in order to eliminate certain personality disturbances, as well.

The recruitment examinations include:

1. Physical fitness tests

2. Psychological tests, and

3. Medical examination

Throughout their career, firefighters have to undergo periodical health examinations, which may also have a preventive function. In order to counteract the possible hazardous effects of the factors that firefighters are exposed to in their work, attempts are being made to screen for some common risk factors of coronary diseases, as well as early symptoms of various other diseases, and to prevent these diseases from breaking out, as well as to relieve the existing ailments.

There are also special health examinations for persons in particular assignments, for example surface rescue and underwater rescue divers.

Frequency and contents of health examinations:

The frequency and contents of the health examinations depend partly on the number of examinees and the available resources. It is recommended to conduct the examinations every fifth or every third year for the younger (under forty) age group, too. If the examinations are conducted more rarely, this however entails that the physical condition of those under 40 years of age is evaluated more frequently if their health status so requires.

Such cases include:

- Poor physical condition for unknown reasons

- Recovery from a prolonged disease prior to reassuming duties

- Voluntary assessments

- A superior’s request to evaluate a worker’s fitness for duty

- Nursing visits

Firefighters over 40 years of age are examined every two years, and those over 50 years every year. 

There are some guidelines according to which routine tests could be included (blood tests- (haemoglobin, cholesterol, glucose, urinary test-albumine, glucose, thorax x-rays, stress EKG, spirometry, spiroergometry, vision, hearing). Some disease groups are mentioned here as examples.

Coronary heart disease, disturbances in brain circulation and some cardiac arhythmias (for instance atrial fibrillation) are absolute contraindications as well as any disease causing dizziness. Hypertension under medication and on a stable level should be accepted if it is under regular observation, and if the possible side effects of the necessary medication are not a contraindication to firefighting. 

Obstructive and restrictive lung diseases are contraindications. A person with asthma may work in paramedics, but is not allowed to do smoke-diving.

Common problems are caused by bone and joint diseases, which cause trouble quite differently compared for instance with office work. Bone and joint diseases must be regarded on the basis of the most obvious progress of the disease, and the influence of the disease on the functional capacity. 

Mental diseases are contraindications for firefighting and rescue work, as well as present or past history of alcohol or drugs abuse.

A special problem is suspicion of the use of anabolic steroids or other doping drugs.

Perfect hearing is not necessary, but firefighters must be capable of normal communication. It is important especially to sense the direction from where sounds are coming. Thus severe loss of hearing or deafness of one ear are contraindications.

The same principle applies to sight, if the refractive error can be corrected with spectacles. Total blindness of one eye is an absolute contraindication.

A general guideline for vision is that it has to be sufficient according to the requirements for a driving license.

An example of an absolute contraindication against firefighting and rescue work is diabetes. Even if under normal circumstances the diabetes were to be stable with medication, the nature of firefighting work with unpredictable field operations prevents the maintenance of a regular and steady medication and diet. Mild adult type diabetes developing during the career needs close observation. Some other examples of absolute contraindication are rheumatoid arthritis, multiple sclerosi, leukemia and other blood diseases.

During pregnancy the person is not recommended to take part in tasks including smoke-diving, heat exposure or operations with dangerous chemicals.

Guidelines for following up firefighters' physical work capacity

Despite improvements in professional competence, work methods and equipment, firefighters’ work ability and safety in smoke-diving as well as in surface rescue and underwater rescue diving tasks (rescue-diving tasks) depend largely on his/her physical capacity, which should be sufficient for withstanding physical stress factors in the various operative tasks, regardless of age. Finnish multidisciplinary studies have led to the standardization of the health examinations and assessments of the physical capacity of firefighters. The minimum levels of the aerobic and muscular capacity of a firefighter who needs to carry out smoke-diving tasks have also been defined (Lusa 1994). 

Tests of aerobic capacity The most valid and reliable method to test aerobic capacity is direct measurement in a specialized testing laboratory.

The assessment of aerobic capacity can also be based on the indirect estimations of VO2max (maximal oxygen consumption) l/min and ml/min/kg. 

The VO2max of an operative firefighter should be at least 3 l/min and 36 ml/min/kg. At these levels, there is a certain margin in the maximal oxygen consumption for tackling unpredictable situations without obvious risk for overstrain disorders or illnesses.

The following two alternative tests can be used for assessing the aerobic fitness of firefighters: Work site test drill (Louhevaara et al. 1994, Louhevaara and Lusa 1993, Lusa 1994) The work site test drill was developed together with professional firefighters, especially for smoke-diving tasks. The submaximal test drill consists of five common tasks associated with smoke-diving. The test is done wearing full fire-protective equipment (self-contained breathing apparatus with steel air bottles, weighting about 15 kg). The tasks are: Walking without and with two rolls of hose First a firefighter walks on the level for 100 m without any extra load, and then for another 100 m carrying two rolls of hose. One roll weighs 16.6 kg. The length of the hose is 25 m and diameter is 76 mm.

Stair climbing and ascending: A firefighter climbs and ascends 20 m without any extra load. The optimal height of a step is 18-22 cm.  Hammering a truck tire A firefighter uses a sledgehammer to move a truck tire a distance of 3 m on a cement floor. The head of the hammer weighs 6 kg and the handle is 90 cm long with a diameter of 32 cm. The tire (total diameter 103 cm, diameter of tire 25 cm) weighs 47 kg, and it lies flat on the floor during the hammering. Going over and under bars Three light bars at a distance of 2 m from each other are placed on an 8-m long track. The bars are 60 cm above floor level, and their breadth is 2 m. A firefighter goes under the first bar, over the second, and under the third one, turns and goes back in a similar way. This is repeated three times.

Hose rolling: A firefighter walks and rolls up the hose in his hands; the other end of the extended hose is stationary on the floor. The weight, length and diameter of the hose are 5.9 kg, 25 m, and 39 mm, respectively. The fixed maximal working time allowed for the drill is 14,5 min. The fixed times for the separate tasks are 4, 3.5, 2, 3 and 2 minutes, respectively.  For monitoring and classifying physical strain, it is recommended that the heart rate (HR) be measured continuously during the drill. The classification of cardiac strain (% of maximal HR = % HRmax) of the drill is calculated by relating HR during the drill to the subject’s HRmax. The subject’s real HRmax obtained in the maximal direct aerobic test in the laboratory is recommended to be used. It is also possible to use the HRmax obtained by the age-related formula HRmax = 208  0.7 x age. The results are interpreted according to % HRmax values (Table 1).

Table 1. The classification of cardiac strain in the test drill according to the % HRmax results and estimation of the longest working time at each level of strain.

 Submaximal bicycle ergometer test: In the submaximal test, the workload of the subject is below 88% of his/her maximal heart rate. It means about 50-80% of the subjects maximal oxygen consumption. The perceived excertion (RPE) is usually at the level of 11-16. The test is done wearing sportswear. The test is recommended to perform according to the recommendations of WHO or another generally accepted submaximal bicycle ergometer test or Fire Fit testing system. Heart rate is monitored during the test.

The VO2max is extrapolated based on heart rate and the used workload and HRmax. The subject’s real HRmax obtained in the maximal direct aerobic test in the laboratory is recommended to be used. It is also possible to use the HRmax obtained by the age-related formula HRmax = 208  0.7 x age.

Muscular capacity: The following four tests can be used for assessing of the firefighters’ muscular performance

: Sit-up test (number of sit-ups in 60 s)

Pull-up test (maximal number of pull-ups)

Bench press test using a 45-kg barbell (number of repetitions in 60 s)

Squatting test using a 45-kg barbell on the shoulders (number of repetitions in 60 s)

Cardiorespiratory fitness is recommended to be tested every year, and the tests of muscular capacity are recommended to be performed on alternate years.