Firefighter fitness-for-duty medical screening: A peer review quality improvement pilot

Despite the overwhelming evidence that sudden cardiac death is the most frequent cause of firefighter fatalities, many fire departments do not have a program to measure or maintain basic firefighter fitness and health. This project evaluated and compared medical screening outcomes of four industrial fire brigades within a multinational oil and gas corporation and introduced a quality improvement plan. The goal of this project was to apply the evidence and measure outcomes to determine the most effective way to ensure that firefighters in a corporate setting are healthy. This was accomplished by utilizing established guidelines in developing an educational program followed by monthly indicators looking for improvement in quality and increased rate of recommendations for restricted duty. The results of this project were mixed but did show an initial rate increase of 1.4% of restrictions placed by clinicians providing screening exams, and the overall quality of the exams showed significant improvement by the third month. However, there was insufficient time to see if these improvements were sustainable. Recommendations for future study are to continue the pilot quality improvement peer review process for another six months and incorporate an annual physical fitness evaluation pilot that would include endurance, strength and flexibility assessments as recommended by the 2008 joint taskforce for the International Association of Firefighters (IAFF) and International Association of Fire Chiefs joint Labor Management Wellness-Fitness Initiative and National Fire Protection Association Standards (NFPA 1582).