Cardiovascular Evaluation

Introduction

This chapter defines cardiovascular fitness as a duty criterion for firefighters. This chapter does not address the physical ability to do the job (job performance) or health and wellness programs.a 

It is important to recognize the difference between

1) medical fitness for duty (i.e., medical qualification) determination,

2) physical ability to perform essential job tasks, and

3) health and wellness promotion.

A medical fitness for duty evaluation aims to assess the risk of sudden incapacitation and/or medical ability to perform essential job functions. This is a function that should be performed by the agency’s medical provider. Physical ability to do the job is an assessment that is done by the department (training or management).  This can be done with a Candidate Physical Abilities Test (CPAT), a similar test, routine training exercises, and/or assessment by management of on-the-job performance.  This is not a task for the agency’s medical provider. Health and wellness programs encourage diet, exercise, and medical surveillance.  While the agency’s medical provider may be asked to participate in developing these programs, this role is separate from the medical fitness for duty.

From a cardiac evaluation standpoint, the risk of sudden incapacitation is predicated on cardiac risk stratification and, when indicated, additional cardiac testing. This evaluation is not associated with any pre-defined aerobic capacity threshold (as this is a wellness measure). The aerobic capacity threshold generally does not predict an individual’s ability to adequately perform essential firefighter job functions. 

Instead of any pre-defined aerobic capacity thresholds, the Task Group proposes that individuals who need cardiac stress testing for any reason (see Fitness for Duty Evaluation section below) should have a “maximal effort” (symptom-limited) exercise stress test.

Stress Testing 

• Normal symptom-limiting imaging exercise stress test (EST) reaching 85% of maximum predicted heart rate, where maximum predicted heart rate is estimated as 220 minus ages in years.2 Some fire departments may list a specific number of METs who want to become firefighters. This number is a management decision and not a medical decision.
• If the stress test is not diagnostic (not reaching 85% of maximum predicted heart rate): further evaluation is needed (e.g., chemical stress test)
• Abnormal stress test (such as arrhythmias, reversible ischemia, or abnormal blood pressure response): The individual should be provided with restrictions and referred for further evaluation

a Some fire departments may list a specific number of METs who want to become firefighters. This number is a management decision and not a medical decision.