Emergency Responders

Emergency Responders such as industrial firefighters and HAZMAT team members are subject to the following working conditions:
* Use of self-contained breathing apparatus (SCBA) – this infers working in (or the potential for) an immediately dangerous to life and health (IDLH) environment, including oxygen deficient atmospheres and the presence of carbon monoxide, hydrogen cyanide, smoke, and other air contaminants
+ Heavy strength requirement - lifting/carrying/pushing/pulling in the 25-50 kg range; dragging of training dummies or victims weighing 90 kg; dragging of fire hoses, wearing of SCBA and/or bunker gear
* Thermal stress - working in high temperature environments and/or wearing of occlusive bunker gear or chemical suits.
When undertaking ER training or duty, metabolic equivalent (MET) levels of 12 or greater are attained, with heart rates reaching 80-100% of age-predicted maximums. Thermal stress will cause higher heart rates than predicted by the level of exertion alone, and there may be no opportunity for self-pacing. Compared to sedentary firehouse and non-emergency duties, the risk of a fatal heart attack during active fire fighting duties is increased about 50 times, and during training for firefighting, the risk is increased about 10 times. 

Key challenges in the development of a fitness to work program for Emergency Responders are:

* Referencing appropriate medical standards and developing questionnaire, examination, and testing protocols
* Assessing workers with known medical conditions that could limit performance or cause sudden incapacitation
* Assessing risk factors for cardiovascular disease
* Assessing risk factors for heat tolerance
* Determining the cardiovascular disease risk that warrants a cardiology assessment and stress test
* Establishing direct referral arrangements with a consulting cardiologist
* Determining whether a practical test of job demands will be implemented on either a training basis or as a mandatory (bona fide) job requirement.