Emergency Medical Services (EMS)

Routine Ongoing Evaluations and Surveillance

This document covers the routine medical evaluation and surveillance of all EMS providers.

Periodic Evaluations

It is the consensus of the Public Safety Medicine Task Group that a medical questionnaire and blood pressure measurement should be completed every three years under the age of 40 and annually thereafter. The medical questionnaire used for the initial evaluation can be used for this purpose. It is also the consensus of the Task Group that routine in-person physical examinations may not be indicated. In-person physical examinations may be indicated for particular medical concerns identified on the questionnaire or as indicated for ongoing evaluation of EMS providers with specific medical conditions (see individual chapters – e.g., heart disease, diabetes, etc.). Routine preventive care should follow the recommendations of the U.S. Preventive Services Task Force.

Immunizations

EMS providers are health care providers and should follow the appropriate CDC immunization recommendations.

Eye Exams

The Task Group’s agrees that periodic eye examinations are recommended at least every 5 years (increasing frequency with increasing agea) with near and distant visual acuity and peripheral vision in each eye. Medical conditions (e.g., diabetes, glaucoma, hypertension, ocular trauma) and medications that affect vision require more frequent and/or more comprehensive evaluations.

Respiratory Protection

EMS providers who use respirators should be in a respiratory protection program consistent with 29 CFR 1910.134 or other governmental standards. They should be fit tested with issued respirators annually as required by 29 CFR 1910. 134. Task Group’s consensus is that routine periodic spirometry is not indicated unless clinically indicated, or the EMS provider is using a negative pressure air purifying elastomeric respirator or SCBA.

Surveillance Programs

1. Hazardous waste operations and emergency response

If the agency has determined that EMS providers (typically hazmat team members) are regulated by 29 CFR 1910.120 hazardous waste operations and emergency response; this standard (or other governmental standards) must be followed. Additional guidance regarding specific medical evaluation components can be found in the Occupational Safety and Health Guidance Manual for Hazardous Waste Site Activities. For tactical teams, see relevant documents of the Public Safety Medicine Guidance.

      2. Hearing testing

If the agency has determined that the EMS provider must be in a hearing conservation program (e.g., exposure to sirens and aircraft noise), the components of that program should follow 29 CFR 1910.95 or other governmental standards.

     3. TB surveillance

EMS providers are health care providers and should follow the appropriate CDC recommendations for TB surveillance (https://www.cdc.gov/tb-healthcare-settings/hcp/screening-testing/frequency.html and https://www.cdc.gov/tb-healthcare-settings/hcp/screening-testing/).

     4. Blood-borne pathogens

EMS providers are health care providers and should follow the appropriate CDC recommendations for blood-borne pathogens (https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6210a1.htm and https://www.cdc.gov/nora/councils/hcsa/stopsticks/whattodo.html).

aFor example: Ages 20 to 39: Every 5 years, Ages 40 to 54: Every 2 to 4 years, Ages 55 to 64: Every 1 to 3 years, Ages 65 and up: Every 1 to 2 years.