Tactical Teams

Medical Evaluation

The sections below list the additional considerations, if any, for each LEO guidance chapter.

Diabetes Guidance

The LEO chapter on Diabetes Mellitus should be used with no changes.

Neurological Guidance

For seizure disorders, the LEO chapter on Seizures and Epilepsy should be used with no changes.

Pending the development of the LEO chapter on neurological disorders, the need for restrictions should be considered for other neurological disorders (for example: tremors, ataxia, vertigo with recent symptoms, decreased hand sensation, hand paresthesias, multiple sclerosis, myasthenia gravis, Menière’s disease, Parkinson’s disease and stroke).

Vision Guidance

The LEO chapter on Eyes and Vision should be used with the following changes:

For tactical team members who remotely guide robots or drones:

Intermediate vision visual acuity: 20/20 or better binocularly (OU) — Snellen equivalent — corrected at 24 inches. [This is the distance from eyes to screen when remotely guiding a robot or a drone.]

Hearing Guidance

The LEO chapter on Hearing should be used with no changes.

Cardiovascular Guidance

The LEO chapter on Cardiovascular Disease should be used with no changes.

Respiratory Guidance

The LEO Pulmonary Disorders chapters on Chronic Obstructive Pulmonary Disease (COPD) and Asthma should be used with the following changes:

The recommendations in this section are the consensus of the LEO Task Group.

Tactical team members with any history of asthma or COPD who might need to wear any type of respirator (negative pressure, positive pressure, and SCBA) and are classified as mild COPD or well-controlled asthma should be evaluated with a job task simulation test* while wearing the designated respirator.

Tactical team members with any history of asthma or COPD who might need to wear any type of respirator who are classified as other than mild COPD or well-controlled asthma should be restricted from respirator use and referred to their treating physician for reevaluation and optimization of treatment. If they then meet the criteria of mild COPD or well-controlled asthma, they should be evaluated with a job task simulation test* while wearing the designated respirator.

Any tactical team members with any history of asthma or COPD who might need to wear any type of respirator who fail the exercise challenge test while wearing the designated respirator should be restricted from respirator use and referred to their treating physician for reevaluation and optimization of treatment. If they still meet the criteria of mild COPD or well-controlled asthma, they should be re-evaluated with a job task simulation test* while wearing the designated respirator.

Musculoskeletal Guidance

The LEO chapter on Musculoskeletal Disorders should be used with no changes.

Infectious Diseases Guidance

The LEO chapter on Infectious Diseases should be used with no changes.

Mental Health Guidance

The LEO chapter on Mental Health Disorders should be used with no changes.

Medications Guidance

The LEO chapter on Medications should be used with the following changes:

Due to the use of enhanced personal protective equipment (PPE), use of medications which adversely affect heat tolerance may require restrictions. Antipsychotics, tricyclic antidepressants, antihistamines, diuretics, beta-blockers, amphetamines are some examples of medications that may predispose to heat illness.1 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3550168/)

Pregnancy Guidance

The LEO chapter on Pregnancy should be used with the following changes:

Pregnant tactical team members should be advised of the following additional risk: Increased heat-related risks due to heavy protective equipment (tactical body armor), physical exertion and weight of equipment.

Use the tactical team-specific handout from Appendix D to provide information on pregnancy to female tactical team members.

Amputations and Prosthetics Guidance

The LEO chapter on Amputations and Prosthetics should be used with no changes.

Sleep Disorders Guidance

The LEO chapter on Sleep Disorders should be used with no changes.

Substance Use Guidance

The LEO chapter on Substance Use Disorders should be used with no changes.

Miscellaneous Issues

Pending the development of LEO guidance chapters on these disorders, tactical team members should be evaluated for restrictions based on conditions that would adversely affect heat tolerance and respirator use. Some that might be considered include:

• History of heat related illness (e.g., heat stroke or heat exhaustion)
• History of rhabdomyolysis
• Dermatological conditions (e.g., burn scarring, diffuse psoriasis)
• Skull or facial deformity likely to interfere with use of PPE.

*Job task simulation test: See Appendix C of the Asthma chapter. The test should be specific to the tactical team member’s essential job functions.