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Protecting the Protectors: How Medical Surveillance Keeps Police and Firefighters Safe

Especially for jobs with high physical and mental demands, a medical surveillance program is a critical tool in keeping the hardest working employees healthy.
By: | September 9, 2020

The Department of Labor classifies occupations into five buckets depending on the physical demands involved — sedentary, low, medium, heavy and very heavy. The roles of police officers and firefighters fall into the “very heavy” category.

These first responders must be prepared to spring into action at a moment’s notice. Speed, strength and endurance are all must-haves, and new recruits are tested on all three before acceptance into their respective disciplines.

But the ability to churn out 40 pushups per minute or run a 7-minute mile doesn’t necessarily paint a complete picture of a first responder’s health.

Police officers and firefighters face occupational health hazards beyond sprains and strains. They are also exposed to an array of dangerous substances that could lead to disease if left unchecked.

“Their exposures are physical, biologic and chemical,” said Dr. Ronda McCarthy, National Medical Director, Medical Surveillance Services, Concentra. Think smoke inhalation, contact with bloodborne pathogens, and today, the added risk of contracting COVID-19.

On the frontlines, police officers and firefighters never know what they’ll face from day to day.

Assessing job readiness, therefore, demands more than tests of fitness. It calls for a comprehensive medical surveillance program based on the highest standards of care. Here’s what a best-in-class program looks for, and how it reduces risk for police officers, firefighters and their employers.

Identifying Top Occupational Health Hazards

Dr. Ronda McCarthy, National Medical Director, Medical Surveillance Services, Concentra

Medical surveillance programs consist of a baseline evaluation when a new hire comes on board and annual evaluations thereafter. These assessments are designed to measure and monitor the chief exposures associated with the job.

So, building a program tailored for police and fire professionals first demands knowing what risks these professionals face. Here are three of the top occupational health hazards that a surveillance program should consider:

1. Respiratory Irritants

“Carbon monoxide exposure is a significant risk for firefighters,” McCarthy said. “Depending on what’s burning, there could be a host of other harmful chemicals in the air. Presumably, they would be wearing respirators, but sometimes respirators are removed too soon while there are still hazardous fumes lingering. And in the case of responding police officers, they may not have protective gear available at all.”

In addition to harmful gases, smoke also contains particulate matter that, at best, causes irritation and shortness of breath, and at worst can contribute to long term damage and lung disease.

2. Heightened Cardiovascular Risk

Currently, one out of every four Americans dies of cardiovascular disease.

For firefighters, the proportion is even higher. Several factors coalesce to increase this risk, including preexisting heart disease, smoke inhalation, heat illness and the overall physical stress of the job, plus the mental and emotional distress that’s part and parcel of any first responder’s position.

“In many states, there’s a legislative presumption that if a police office or a firefighter has a heart problem within 24-72 hours of responding to an incident, it’s assumed to be work related,” McCarthy said.

“Firefighters with preexisting cardiovascular disease are at the greatest risk for cardiac events associated with training and emergency response. Medical evaluations focus on early detection so preventive measures can be taken that can be lifesaving.”

3. Air- and Bloodborne Pathogen Exposure

Firefighters and police officers are first responders and whether it’s a fire, car accident or a violent incident, they’ll be on the scene to help tend to the wounded. In this role, there’s a very real risk of exposure to bloodborne pathogens, such as hepatitis C and HIV.

Today, of course, there’s the added threat of potentially coming into contact with a COVID-19-positive person. As of early April, at least 1,000 NYPD officers had contracted coronavirus, including five deaths. Unfortunately, it’s a risk that face masks cannot completely eliminate.

Establishing a Schedule of Medical Evaluations

Understanding these exposures and their long-term effects, clinicians can determine what to look for in their initial and follow-up evaluations.

“Our baseline examination includes collecting a thorough occupational and medical history, including any previous illnesses, surgeries, medications, allergies, etc. We also look specifically at any occupational exposures they’ve had in the past — whether they’ve been in contact with certain chemicals or pathogens,” McCarthy said.

Baseline testing also includes an EKG, blood work and chest X-rays to evaluate existing cardiovascular risks, such as high cholesterol or atherosclerosis. Spirometry — a breathing test that measures pulmonary function—– is also used and can indicate early lung damage not detected by chest X-rays. Hearing and vision tests are also part of the battery of tests.

“For a new candidate, these tests confirm whether they are fit for duty, but they also establish their normal or baseline, so we have something to compare against during subsequent evaluations,” McCarthy said.

This thorough assessment ideally should be conducted every year for every active police officer or firefighter — with the exception of chest X-rays, which are recommended every five years, and EKGs, which are conducted annually after age 40.

Cancer screenings are also incorporated per U.S. Preventative Task Force recommendations that factor in pre-existing risk factors and age.

The Benefits of Medical Surveillance

Annual evaluations give clinicians the opportunity to intervene at the first sign of disease, whether that involves certain treatments or medications, or simple behavioral modifications.

“The spirometry testing in particular has been helpful because it indicates a problem before any visible lung damage shows up on an X-ray, at which point the damage is already significant and potentially irreversible,” McCarthy said.

“For instance, I’ll see a firefighter who still smokes, and I can show them through their spirometry results that they are experiencing a gradual decline in their respiratory health. When they have a tangible way to see the negative impact on their health and potentially their career, it’s motivation to quit smoking.”

The same can be said of annual blood tests in regard to cardiovascular disease risk. An abnormal lipid profile could warrant lifestyle changes or prescription of a statin. And when it comes to regular cancer screenings, results can be lifesaving.

“If a screening comes back with abnormal results, we can refer the police officer or firefighter to a specialist immediately and potentially find lesions while they are still pre-cancerous, which significantly improves the odds that treatment will be successful,” McCarthy said.

The Value of an Expert Occupational Health Provider

Partnering with a reputable occupational health provider with demonstrated expertise in medical surveillance is critical to ensure police and fire professionals are kept healthy. Occupational health clinicians adhere to clinical guidelines as well as occupational health and safety regulations, meaning they deliver both quality care and compliance.

“Occupational health really requires a different perspective because while you are looking at a police officer or firefighter from a medical point of view, it’s through the lens of their employment. You have to understand clinical best practices, employment law, and the health and fitness standards held by the fire or police department,” McCarthy said.

Concentra’s clinicians receive training specific to the occupational hazards they are most likely to see. When it comes to police and fire, they are trained on the National Fire Protection Association’s (NFPA) standards — currently the most up-to-date, comprehensive set of guidelines laying out recommended fitness level, health status and evaluation schedules for firefighters across the country.

In many cases, Concentra has helped police and fire departments update their own standard to be consistent with the current nationally accepted guidelines, such as the American College of Occupational and Environmental Medicine’s Guidance for the Medical Evaluation of the Law Enforcement Officer.

“Sometimes the employer is still depending on the same medical guidelines they used in the 1980s,” McCarthy said. “We will explain how updating those guidelines not only decreases health and safety risks to their employees, but also decreases their own employment practices liability risk. And we’ll work together on revising the recommendations that are out of date.”

Today, Concentra is taking extra steps to ensure safety amid the COVID-19 pandemic. Every person that comes in for evaluation has their temperature taken, fills out an extensive symptom screener, and must wear a facial covering. Spirometry tests, which were suspended temporarily because it is an aerosol-generating procedure, have been reimplemented with bacterial and viral filters and sanitization procedures.

“When people who are healthy and well come into one of our Concentra medical centers for evaluations, our top priority is keeping them that way,” McCarthy said.

To learn more, visit https://www.concentra.com/tests-and-screenings/surveillance-screenings-and-monitoring/.

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This article was produced by the R&I Brand Studio, a unit of the advertising department of Risk & Insurance, in collaboration with Concentra. The editorial staff of Risk & Insurance had no role in its preparation.




Concentra® is America’s leading provider of occupational medicine, delivering work-related injury care, physical therapy, and workforce health services from more than 520 Concentra medical centers, more than 130 onsite clinics, and more than 30 community-based outpatient centers in 44 states.

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