Physical Examination
Physical Examination
The Fire Protection career field is a physically demanding job with unique requirements. Once selected, each Cadet must pass a physical examination by a licensed Texas physician prior to the first scheduled day of training in the ACCFTA. Cadets will not be permitted to participate in any hands-on firefighting skills or physical training without this documentation.
The examining physician shall ensure the Cadet does not have any Category A Medical Conditions IAW NFPA 1582. No Cadet shall be admitted to the ACCFTA with a Category A Medical Condition. (Any questions concerning these requirements shall be directed to the ACCFTA Director.) The examining physician needs to certify the Cadet can perform firefighting skills under the following conditions:
- Operating both as a member of a team and independently in situations of high stress conditions.
- Spending extensive time outside exposed to the elements.
- Tolerating extreme fluctuations in temperature while performing duties; fire fighters are required to perform physically demanding work in hot (up to 400 degree temps), humid (up to 100%) atmospheres while wearing equipment that significantly impairs body-cooling mechanisms.
- Experiencing frequent transitions from hot to cold and from humid to dry atmospheres.
- Working in wet, icy, or muddy areas.
- Performing a variety of tasks on slippery surfaces such as rooftops or ladders.
- Working in areas where sustaining traumatic or thermal injuries is possible.
- Facing exposure to carcinogenic dusts such as asbestos, toxic substances such as hydrogen cyanide, acids, carbon monoxide, or organic solvents, either through inhalation or skin contact.
- Wearing personal protective equipment (PPE) that weighs approximately 50 lbs while performing firefighting tasks.
- Performing physically demanding work while wearing positive-pressure breathing equipment with 1.5 inches of water column resistance to exhalation at a flow of 40 Liter/minute.
- Working for long periods of time, requiring sustained physical activity and intense concentration.
- Making rapid transitions from rest to near-maximal exertion without warm-up periods.
- Operating in environments of high noise, poor visibility, limited mobility; at heights; and in enclosed or confined spaces.
- Using manual and power tools in the performance of duties.
- Relying on senses of sight, smell, hearing, and touch to help determine the nature of the emergency, to maintain personal safety and to make critical decisions in a confused, chaotic, and potentially life-threatening environment throughout the duration of the operation.
Category A Medical Conditions
Category A medical conditions are those that would preclude a person from performing as a member in a training or emergency operational environment by presenting a significant risk to the safety and health of the person or others. Link to the IAFF Guide to NFPA 1582.
(This is intended as a “quick-sheet” overview and shall not be used without a complete understanding of NFPA 1582 Standard on Comprehensive Occupational Medical Program for Fire Departments. To obtain a copy of NFPA 1582, visit the NFPA website.)
There shall be NO Category A Medical Conditions for the following:
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Head
- Defect of skull preventing helmet use or leaving underlying brain unprotected from trauma
- Any skull or facial deformity that would not allow for a successful fit test for respirators used by that department
- Any condition that results in the candidate not being able to safely perform one or more of the essential job tasks
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Neck
- Any condition that results in the candidate not being able to safely perform one or more of the essential job tasks
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Eyes and Vision
- Far visual acuity less than 20/40 binocular, corrected with contact lenses or spectacles, or far visual acuity less than 20/100 binocular for wearers of hard contacts or spectacles, uncorrected
- *Color perception—monochromatic vision resulting in inability to use imaging devices such as thermal imaging cameras
- *Monocular vision
- Any condition that results in the candidate not being able to safely perform one or more of the essential job tasks
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Ears and Hearing
- Chronic vertigo or impaired balance as demonstrated by the inability to tandem gait walk
- On audiometric testing, average hearing loss in the unaided better ear greater than 40 decibels (dB) at 500 Hz, 1000 Hz, 2000 Hz, and 3000 Hz when the audiometric device is calibrated to ANSI Z24.5, Audiometric Device Testing
- Any condition (or hearing impairment) that results in the candidate not being able to safely perform one or more of the essential job tasks
- *Hearing aid or cochlear implant
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Dental
- Any condition that results in inability to safely perform one or more of the essential job tasks.
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Nose, Oropharynx, Trachea, Esophagus, and Larynx
- *Tracheostomy
- *Aphonia
- Any nasal, oropharyngeal, tracheal, esophageal, or laryngeal condition that results in inability to safely perform one or more of the essential job tasks including fit testing for respirators such as N-95 for medical response, P-100 for particulates and certain vapors, and SCBA for fire and hazmat operations
- Any condition that results in inability to safely perform one or more of the essential job tasks.
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Lungs and Chest Wall
- Active hemoptysis
- Current empyema
- Pulmonary hypertension
- Active tuberculosis
- *A forced vital capacity (FVC) or forced expiratory volume in 1 second (FEV1) less than 70 percent predicted even independent of disease
- *0bstructive lung diseases (e.g., emphysema, chronic bronchitis, asthma) with an absolute FEVdFVCless
than 0.70 and with either the FEV1below normal or both the FEV1 and the FVC below normal (less than 0.80) (see references inE2) - *Hypoxemia — oxygen saturation less than 90 percent at rest or exercise desaturation by 4 percent or to less than 90 percent (exercise testing indicated when resting oxygen is less than 94 percent but greater than 90 percent)
- *Asthma—reactive airways disease requiring bronchodilator or corticosteroid therapy for 2 or more consecutive months in the previous 2 years, unless the candidate can meet the requirement in 6.8.1.1
- Lung Transplant
- *A candidate who has in the past required bronchodilator, corticosteroid, or anti-inflammatory therapy (e.g., leukotriene receptor antagonists, such as Montelukast) for asthma but who does not believe
he/she has asthma shall be evaluated by a pulmonologist or other expert in asthmatic lung diseases, such as an allergist, to determine if the candidate meets all four requirements in 6.8.1.1 - Challenge testing shall be performed of all anti- inflammatory medications (e.g., inhaled or oral steroids, leukotriene receptor antagonists) for 4 weeks preceding the test, off all antihistamines (e.g., oral allergy medications) for I week, and off all bronchodilators on the day of testing
- Any condition that results in inability to safely perform one or more of the essential job tasks.
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Aerobic Capacity
- Aerobic capacity less than 12 metabolic equivalents (METs) (12 METs= 42 mL 02/kg/min).
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Heart
- Coronary artery disease, including history of myocardial infarction, angina pectoris, coronary artery bypass surgery, coronary angioplasty, and similar procedures
- *Cardiomyopathy or congestive heart failure, including signs or symptoms of compromised left or right ventricular function or rhythm, including dyspnea, S3 gallop, peripheral edema, enlarged ventricle,
abnormal ejection fraction, and/ or inability to increase cardiac output with exercise - *Acute pericarditis, endocarditis, or myocarditis
- *Syncope, recurrent
- *A medical condition requiring an automatic implantable cardiac defibrillator or history of ventricular tachycardia or ventricular fibrillation due to ischemic or valvular heart disease, or cardiomyopathy
- Third-degree atrioventricular block
- *Cardiac pacemaker
- Hypertrophic cardiomyopathy, including idiopathic hypertrophic subaortic stenosis
- Heart Transplant
- Any condition that results in the candidate not being able to safely perform one or more of the essential job tasks
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Vascular System
- Hypertension – (a)*Uncontrolled or poorly controlled hypertension (b) *Hypertension with evidence of end – organ damage
- *Thoracic or abdominal aortic aneurysm
- Carotid artery stenosis or obstruction resulting in greater than or equal to 50 percent reduction in blood flow
- *Peripheral vascular disease resulting in symptomatic claudication
- Any other condition that results in inability to safely perform one or more of the essential job tasks
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Abdominal Organs and Gastrointestinal System
- Presence of uncorrected inguinal/femoral hernia regardless of symptoms
- Any condition that results in the candidate not being able to safely perform one or more of the essential job tasks
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Metabolic Syndrome
- *Medical conditions shall include metabolic syndrome with aerobic capacity less than 12 METs.
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Reproductive System
- Any genital condition that results in inability to safely perform one or more of the essential job tasks.
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Urinary System
- Renal failure or insufficiency requiring continuous ambulatory peritoneal dialysis (CAPD) or hemodialysis
- Any condition that results in the candidate not being able to safely perform one or more of the essential job tasks
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Spine and Axial Skeleton
- Scoliosis of thoracic or lumbar spine with angle greater than or equal to 40 degrees
- History of spinal surgery with rods that are still in place
- Any spinal or skeletal condition producing sensory or motor deficit(s) or pain due to radiculopathy or nerve root compression
- Any spinal or skeletal condition causing pain that frequently or recurrently requires narcotic analgesic medication
- Cervical vertebral fractures with multiple vertebral body compression greater than 25 percent; evidence of posterior element involvement, nerve root damage, disc involvement, dislocation (partial, moderate, severe), abnormal exam, ligament instability, symptomatic, and/or less than 6 months post injury or less than 1 year since surgery
- Thoracic vertebral fractures with vertebral body compression greater than 50 percent; evidence of posterior element involvement, nerve root damage, disc involvement, dislocation (severe—with or without surgery), abnormal exam, ligament instability, symptomatic, and/or less than 6 months post injury or less than 1 year since surgery
- Lumbosacral vertebral fractures with vertebral body compression greater than 50 percent; evidence of posterior element involvement, nerve root damage, disc involvement, dislocation (partial, moderate,
severe), fragmentation, abnormal exam, ligament instability, symptomatic, and/or less than 6 months post injury or less than 1 year since surgery - Any condition that results in the candidate not being able to safely perform one or more of the essential job
tasks
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Extremities
- Joint replacement – unless all four requirements in 6.16.1 (1) are met
- Amputation or congenital absence of upper-extremity limb (hand or higher)
- Amputation of either thumb proximal to the midproximal phalanx
- Amputation or congenital absence of lower-extremity limb (foot or above) unless the candidate meets all seven requirements listed in 6.16.1 (4)
- Chronic non-healing or recent bone grafts
- History of more than one dislocation of shoulder without surgical repair or with history of recurrent shoulder disorders within the last 5 years with pain or loss of motion, and with or without radiographic deviations from normal
- Any condition that results in the candidate not being able to safely perform one or more of the essential job tasks
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Neurological Disorders
- Ataxias of heredo-degenerative type
- Cerebral arteriosclerosis as evidenced by a history of transient ischemic attack, reversible ischemic neurological deficit, or ischemic stroke
- Hemiparalysis or paralysis of a limb
- *Multiple sclerosis with activity or evidence of progression within previous 3 years
- *Myasthenia gravis with activity or evidence of progression within previous 3 years
- Progressive muscular dystrophy or atrophy
- Uncorrected cerebral aneurysm
- All single unprovoked seizures and epileptic conditions, including simple partial, complex partial, generalized, and psychomotor seizure disorders other than as allowed in 6.17.1.1
- Dementia (Alzheimer’s and other neurodegenerative diseases) with symptomatic loss of function or cognitive impairment (e.g., less than or equal to 28 on Mini-Mental Status Exam)
- Parkinson’s disease and other movement disorders resulting in uncontrolled movements, bradykinesia, or cognitive impairment (e.g., less than or equal to 28 on Mini-Mental Status Exam)
- Any neurological condition that results in the candidate not being able to safely perform one or more of the essential job tasks
- A candidate with epileptic conditions shall have had complete control during the previous 5 years. To be medically qualified a candidate shall meet all of the following:
- No seizures for 1 year off all anti-epileptic medication or 5 years seizure free on a stable medical regimen
- Neurologic examination is normal
- Imaging (CAT or MRI scan) studies are normal
- Awake and asleep EEG studies with photic stimulation and hyperventilation are normal
- A definitive statement from a qualified neurological specialist that the candidate meets the criteria specified in 6.17.1.1(1) through 6.17.1.1(4) and that the candidate is neurologically cleared for firefighting training and the performance of a fire fighter’s essential job tasks
- Any condition that results in the candidate not being able to safely perform one or more of the essential job tasks
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Skin
- Metastatic or locally extensive basal or squamous cell carcinoma or melanoma
- Any dermatologic condition that would not allow for a successful fit test for any respirator required by the fire department
- Any condition that results in the candidate not being able to safely perform one or more of the essential job task
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Blood and Blood-Forming Organs
- Hemorrhagic states requiring replacement therapy
- Sickle cell disease (homozygous)
- Clotting disorders
- Any condition that results in inability to safely perform one or more of the essential job tasks
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Endocrine and Metabolic Disorders
- *Type 1 diabetes mellitus, unless a candidate meets all seven criteria in 6.20.1- (1) a-g
- Insulin-requiring Type 2 diabetes mellitus, unless a candidate meets all seven criteria in 6.20.1- (2) a-g
- Any condition that results in the candidate not being able to safely perform one or more of the essential job tasks
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Systemic Diseases and Miscellaneous Conditions
- Any condition that results in the candidate not being able to safely perform one or more of the essential job tasks.
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Tumors and Malignant Diseases
- Malignant disease that is newly diagnosed, untreated, or currently being treated, or under active surveillance due to the increased risk for reoccurrence
- Any condition that results in the candidate not being able to safely perform one or more of the essential job tasks
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Psychiatric Conditions
- Any condition that results in the candidate not being able to safely perform one or more of the essential job tasks
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Chemicals, Drugs, and Medications
- Those that require chronic / frequent treatment with any of the medications or classes of medications listed in 6.24.1(1-8)
- Tobacco use (where state law allows)
- Evidence of illegal drug use detected through testing conducted in accordance with Substance Abuse and Mental Health Service Administration (SAMHSA)
- Evidence of clinical intoxication or a measured blood alcohol level that exceeds the legal definition of intoxication according to the AHJ at the time of medical evaluation
- Any condition that results in the candidate not being able to safely perform one or more of the essential job tasks
*Cadets seeking employment as a firefighter will also need to pass a National Fire Protection Association (NFPA) 1582 Standard on Medical Requirements for Firefighters and Fire Department Physicians physical examination. This is typically administered by the hiring agency.