Medical Fitness for Duty Evaluation

sec_arr Medical Fitness for Duty Evaluation
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Medical Fitness for Duty Evaluation 

Candidates

Applicants may have undergone a physical fitness test (not part of the medical assessment) such as the CPAT (or similar test) before receiving a tentative job offer. The employer may require a medical evaluation before the physical fitness test. This evaluation should be performed by the applicant’s treating medical provider, and not by the fire department medical provider. A description of the physical fitness test should be given to the treating medical provider. The treating medical provider gives clearance to participate in the fitness test without giving specific medical information to the employer. The applicant’s treating medical provider should be informed that the issues of particular concern include – but are not limited to – cardiovascular diseases (such as hypertrophic cardiomyopathy, arrhythmia, and coronary artery disease), asthma, lung disease, musculoskeletal conditions and history of exertional rhabdomyolysis and risk factors for rhabdomyolysis (such as thyroid disease, renal disease, statin use, sickle cell trait, and sickle cell disease).b The applicant’s treating medical provider may order an imaging exercise stress test based on risk factors (cardiovascular risk stratification, disease such as diabetes) or symptoms of coronary artery disease.

The Task Group recommends against performing routine stress tests on new hires unless they have known conditions (e.g., coronary artery disease) or elevated risk based on cardiovascular risk stratification. American College of Cardiology (ACC) hosts ASCVD Riske Estimator Plus to help with the calculations: http://tools.acc.org/ascvd-risk-estimator/.

 

Individualsc with no known coronary artery disease

Individuals ≥40 years of age who are asymptomatic with no known coronary artery disease (CAD) should be assessed annually for their 10-year risk of atherosclerotic cardiovascular disease (ASCVD)1,d defined as coronary death, nonfatal myocardial infarction, or fatal or nonfatal stroke. The 10-year ACC/AHA Risk Estimator Plus uses the individual’s age, sex, race, total cholesterol, HDL cholesterol, systolic blood pressure, blood pressure lowering medication use, diabetes status, and smoking status to generate a 10-year risk of ASCVD (see http://tools.acc.org/ascvd-risk-estimator/).

Individuals between the ages of 35 and 40 years of age who are asymptomatic with no known CAD should be assessed at least once at age 35 (and re-assessed at the discretion of the agency medical provider up to the age of 40) for their 2-year risks of ASCVD.1,e

Individuals under the age of 35 may be further evaluated using symptom-limiting imaging exercise stress test at the discretion of the agency medical provider based on the individuals’ personal risk factors.

Individuals whose 10-year ASCVD risk is ≥10% (or 2-year ASCVD risk is ≥2%) should be further evaluated using a symptom-limiting imaging exercise stress test (EST). These individuals should not be reassessed in the future with an ASCVD risk but should be evaluated with an EST every 2 to 3 years.  

Individuals returning to work after a diagnosis of coronary artery disease or myocardial infarction

Individuals with a diagnosis of coronary artery disease or myocardial infarction may be cleared for full duty when they meet all of the following criteria:

  • Minimum recovery period to be decided by the agency’s medical provider in consultation with the treating cardiologist.f
  • At baseline and annually:
    • no angina;
    • reduction or elimination of modifiable CAD risk factors (total cholesterol, high- and low-density lipoprotein cholesterol, systolic BP, diabetes, and smoking).
  • At baseline and periodically (at least every other year):
    • normal left ventricular function is defined as a normal left ventricular ejection fraction (LVEF) as measured by a gated blood pool scan, echocardiogram, or ventriculogram and as defined in the LEO chapter on coronary artery disease.
    • normal symptom-limiting imaging exercise stress test as defined above in Stress Testing.

 

 

bFor additional resources, refer to the LEO Chapter on Initial Evaluation, Appendix A, for a sample letter to the treating medical providers.

cUnder this term, we include current firefighters and candidates (those individuals who have received a tentative job offer).

dAlternatively, a 2-year risk of ASCVD may be used.

e The 10-year risk calculator does not provide a risk estimate if the age is under 40.

f Consensus standards on timeframes for returning to work after myocardial infarction, PCI, and CABG vary. See the LEO chapter on coronary artery disease, table 2.