nfpa 600/601 first draft meeting...nfpa technical committee on loss prevention procedures and...

NFPA Technical Committee on

Loss Prevention Procedures and Practices

NFPA 600/601 FIRST DRAFT MEETING

Linthicum Heights, MD

April 18-19, 2018

AGENDA

April 18th

1. Call to order at 11:00 am

2. Moment of Silence for Nancy Pearce

3. Introductions

4. Opening remarks – Chairman Joe Cocciardi

5. NFPA Staff Liaison report – Alex Ing

6. Review and approval of minutes from previous meeting

7. Brief History of NFPA 600

- Direction from last committee meeting (Levels of fire brigades and

associated requirements) See Attachment No. 7

8. Questions posed to the chair from last cycle

a. 10 year TOG “throw out” applicability

b. Issues related to timing and intent of the term “annual” in the standard

c. Issues related to Facility Fire Brigades who perform other functions

d. Fire Safety Directors: NFPA 600 Support Members

e. NFPA 601 – Security Service in Fire Loss Prevention

- Recruiting more security service in fire loss prevention personnel

9. TG Presentations

a. TG #1: Interior Structural Fire Brigades who function as Municipal Fire

Departments

b. TG #2: Emergency Responds Functions performed by Fire Brigades

10. NFPA 600/601 Second Draft

a. Resolve Public Input

b. Resolve Editorial Comments. See Attachment 10-b

11. Adjourn at 5:00 pm

April 19th

12. Call to Order at 8:00am

13. Discussion of upgraded medical requirements for Fire Brigade Members

14. Other business

15. Next meeting for 600/601

16. Adjourn

Technical Committee on Loss Prevention Procedures and Practices Second Draft Meeting Minutes -NFPA 600 Adobe Connect/Conference Call

Quincy, MA February 6, 2014

10:00-6:00 PM EST

Attendees:

From: Stan Davis [ ] Sent: Friday, January 26, 2018 7:24 PM To: Smith, Yvonne ; Ing, Alexander ; "

Cc: John Lussi ; Craig Remsburg < >; Craig Remsburg < > Subject: RE: Thoughts from the Committee Chair on Agenda items for the UPCOMING 600 Meeting All, Just a little history on NFPA 600… Around 1990, the LPPP leadership met with the Standards Council to discuss the scope of NFPA 600 and our proposal to move from a Recommended Practice to a Standard. After significant discussion, it was determined that the LPPP TC could proceed with the caveat that we meet with the NFPA 1500 TC leadership to work out an agreeable scope (where the line is between 600 and 1500). Jeff Mattern from Factory Mutual (Chair of 600 at the time), myself, and two other members of 600 TC met with Chief Alan Brunacini and several members of the 1500 TC in Baltimore. After a nearly full day of discussions, the agreement for where 600 would apply and where 1500 would apply was established.

If an Industrial Fire Brigade responded only within its facility boundaries or to a like facility nearby, that would fall under 600. This is based on the fact that the Industrial Fire Brigade would be very familiar with the hazards that exist at their facility.

If an Industrial Fire Brigade responded mutual aid or first due into a municipal setting, the Industrial Fire Brigade would fall under 1500 as they were responding to areas where they were not intimately familiar with the potential hazards.

Irrespective of where an Industrial Fire Brigade responded, the management of that Brigade could choose to follow 1500.

Much of the discussion focused on firefighter safety (the focus of 1500). The differences between 1500 and 600 in this area were centered on the fact that industry is required to live to multiple OSHA standards for facility employee safety which paralleled many of the requirements in 1500 at the time. The basis for this agreed dividing line between 1500 and 600 falls back to the Industrial Fire Brigade being intimately familiar with the hazards that exist at their facility and the OSHA standards providing an equivalent level of employee safety for the Industrial Fire Brigade. “Levels” of Industrial Fire Brigades was not relevant. What it boiled down to was knowing your hazards and your facility. In 1996, we requested the Standards Council to develop a professional qualification standard for Industrial Fire Brigade members mirroring the municipal firefighter pro qual standard. NFPA 1081 was adopted in 2001 to provide this equivalent professional qualification standard for Industrial Fire Brigade members. Times have changed and both TCs likely have few if any members who recall the issues we worked through to bring a clear separation between 1500 and 600 back in the infancy of our standard. The bottom line is we built parallel standards for Industrial Fire Brigades to those that existed for municipal firefighters. Industrial Fire Brigades have always had the option to choose to declare and follow NFPA 1500. I would recommend that the 600 TC carefully consider changing the dividing line between 600 and 1500. This would likely gain attention from the 1500 TC to recreate the scope line. I would also hate to think that all the work that past 600 TC members put into creating an equivalent standard would

mailto:[email protected]:[email protected]

be thrown out and just push everyone back to 1500. I do not believe that Industrial Fire Brigades and private industry can support that change. Respectfully,

Stan Davis

NFPA LPPP former TC Chair

Deputy Fire Chief

Sweet Valley Vol. Fire Co. From: Smith, Yvonne [mailto:[email protected]] Sent: Friday, January 26, 2018 10:35 To: Smith, Yvonne Cc: Ing, Alexander Subject: Thoughts from the Committee Chair on Agenda items for the UPCOMING 600 Meeting The NFPA Committee on Loss Prevention Procedures and Practices maintains the NFPA 600 (Facility Fire Brigades) standard and will meet this SPRING to update the document. The standard had notable revisions in 2015, and additional revisions of substance are anticipated this cycle. Two notable questions are under consideration by the committee, and committee Task Groups have presented reports on these areas:

- Should the scope and organization of the NFPA 600 document ( Facility Fire Brigades ) be expanded to include emergency response activities other than fires, as appears typical to today’s Facility emergency response teams/personnel. [e.g. should the scope of NFPA 600 include Emergency Response Teams].

- What is the defining line between Interior Structural Fire brigades and Municipal fire departments covered by other standards (e.g. should Facility fire brigades operating beyond the incipient level follow other standards, e.g. NFPA 1500 OR at what level do these “other” standards apply to the Structural Stage Facility Fire Brigade ).

The committee anticipates a robust discussion on these topics and their corollaries. Information or opinions on these thoughts can be sent to the committee through the LPPP staff liaison Alexander Ing [email protected] or the committee chair: Joseph A. Cocciardi Phd, [email protected] . Thanks for your participation in this valuable discussion.

Joseph A. Cocciardi, PhD, MS, CIH, CSP, REHS/RS Cocciardi and Associates, Inc.

4 Kacey Court, Mechanicsburg, PA 17055

mailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]

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ACOEM GUIDANCE STATEMENT

Reprinted from the Journal of Environmental Medicine with Permission of the American College of Occupational and Environmental Medicine, March 21, 2018

Fitness-for-Duty Assessments of Industrial Firefighters:Guidance for Occupational Medicine Physicians

Faiyaz A. Bhojani, MD, MPH, DrPH, Luis A. Castillejo-Picco, MD, MS, PhD, David Cathcart, DO, MPH,

Edward A. Emmett, MD, MS, Stephen Frangos, MD, MPH, P. Mark Glencross, MD, MPH,

Chris J. Herman, CFPS, Kevin O’Shea, MD, MPH, Paul Rountree, MD,

and David E. Turner, MD, PhD, MPH, MBA, ACOEM Task Force

on Fitness-for-Duty Assessments for Industrial Firefighters

Industrial firefighters share many characteristics

with municipal firefighters; however, employers

frequently have not addressed or characterized the

unique job duties, hazards, and specific physical/

mental demands associated with industrial fire-

fighting. In addition, gaps exist in the medical

literature with regard to industrial firefighter dem-

ographics, behavioral risk factors, and chronic

diseases. Finally, the proper methodologies for

fitness-for-duty assessment of employees acting

in this capacity are lacking. To address these gaps,

the American College of Occupational and Envi-

ronmental Medicine (ACOEM) convened a Task

Force in 2014, to develop fitness-for-duty guid-

ance for industrial firefighters. This document

highlights these gaps and suggests research oppor-

tunities to enhance the health and safety of this

population. While an extensive literature review

found a lack of studies for this population—thus

excluding the development of an evidence-based

document—sufficient materials were availablefrom which to draw preliminary conclusions, con-

siderations for best practices, and recommenda-

tions for future studies.

I n October 2014, the American Collegeof Occupational and EnvironmentalMedicine (ACOEM) convened a TaskForce of medical practitioners, corporatemedical directors, university professors,and fire chiefs having a working knowledgeof US oil and gas and petrochemical

ht © 2017 American College of Occupation

From the American College of Occupational andEnvironmental Medicine, Elk Grove Village,Illinois.

This position paper was developed by the ACOEMTask Force on Fitness-for-Duty Assessments forIndustrial Firefighters, under the auspices of theEnvironmental Health and the UnderservedOccupational Populations sections, reviewedby the Committee on Policy, Procedures, andPublic Positions, and approved by the ACOEMBoard of Directors. ACOEM requires all sub-stantive contributors to its documents to discloseany potential competing interests, which arecarefully considered. ACOEM emphasizes thatthe judgments expressed herein represent thebest available evidence at the time of publicationand shall be considered the position of ACOEMand not the individual opinions of contributingauthors.

The authors declare no conflicts of interest.Address correspondence to: Marianne Dreger, MA,

ACOEM, 25 Northwest Point Blvd, Suite 700,Elk Grove Village, IL 60007 ([email protected]).

Copyright � 2017 American College of Occupa-tional and Environmental Medicine

DOI: 10.1097/JOM.0000000000001256

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industries to develop fitness-for-duty guid-ance for industrial firefighters and addressthe lack of standards and guidance specificto this population. This lack of a standard-ized approach could result in firefightersbeing improperly assessed for their capa-bility to safely perform industrial firefight-ing duties and puts the firefighter, his/hercoworkers, the workplace, and the commu-nity at risk. This increased risk has thepotential for increased liability to businessentities employing industrial firefighters.

In addition to recommending bestpractices for the determination of an indus-trial firefighter’s fitness-for-duty, an impor-tant part of the Task Force’s charge was tocharacterize where possible, the demo-graphic make-up of the industrial fire-fighter. Such knowledge is essential todifferentiate industrial from municipal fire-fighters particularly as it may relate tocardiovascular disease, the most commoncause of work-related mortality amongmunicipal firefighters. As an additionalbenefit, this information has the potentialfor conducting directed studies that willadvance the health and safety of the indus-trial firefighter population.

METHODOLOGYTask Force members identified a list

of questions (identified under the section onTopics Reviewed) for which the systematicliterature review would seek to document thecurrent state of affairs. Literature searchesutilized Medline, PubMed and PubMed Cen-tral, and National Library of Medicine data-bases to identify and characterize therelevant literature for industrial and munici-pal firefighters, identify gaps that exist forthe industrial firefighters, and advance rec-ommendations to address literature gaps.

The Task Force then designed aquestionnaire (Appendix 1) for industrial fire-fighters to identify the following information:

�

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demographics

�

level and frequency of firefighting duties

�

patterns and frequency of training

�
variations in the medical clearance
process

�
access to and involvement in employer-
directed regular fitness activities

�
risk factors for cardiovascular disease
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The questionnaire was reviewed bythe University of Pennsylvania InstitutionalReview Board (IRB), which concluded theproject did not meet the criteria to beconsidered human research and was thusexempt from further IRB oversight. TheTask Force engaged ORCHSE Strategies,LLC, a health, safety, and environmentalcontrol network that sponsors a cross-industry forum for purposes of benchmark-ing and sharing best practices, to host theonline questionnaire. ORCHSE membercompanies reached out to their firefightersto complete the questionnaire. No identi-fiers were included in the questionnaire anddata collected were anonymous and confi-dential. The Task Force members receivedonly aggregate responses to the question-naire for analysis.

The Task Force identified five ques-tions for systematic literature review todocument the current state of affairs in eacharea:

1.

d r

Vo

What are the differences in job duties formunicipal versus industrial firefighters?

2.
How can cardiovascular fitness for dutybe best determined for industrial fire-fighters?
3.
Are tools currently used to determinefitness for duty useful?
4.
What preventive interventions are avail-able and how effective are they?
5.
How do US laws impact fitness-for-work decisions?
DIFFERENCES IN JOBDUTIES—MUNICIPAL VERSUSINDUSTRIAL FIREFIGHTERS

As previously noted, fitness-for-duty standards and guidance specific tothe industrial firefighter population is lack-ing. The National Fire Protection Associa-tion Standard on ComprehensiveOccupational Medical Program for FireDepartments (NFPA 1582), does notinclude industrial fire brigades in its medi-cal assessment standard.1 The NFPA 600Standard on Facility Fire Brigades containsonly minimal reference to the medicalclearance process.2 This lack of guidancehas contributed to the presence of multiple,differing firefighter assessment methodol-ogies across various industries.

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JOEM � Volume 60, Number 2, February 2018 Industrial Firefighters


NFPA 600 classifies facility fire bri-gades as either incipient stage firefighting,advanced exterior firefighting, or interiorstructural firefighting.2 The incipient stageinvolves fighting a fire in normal clothingusing extinguishers or smaller hand lines(125 gpm). It also requires no evasiveactions (eg, crawling to escape heat orsmoke), and does not necessitate the useof bunker gear or self-contained breathingapparatus (SCBA).2 Advanced exterior orinterior firefighting involves full gear,teams in warm and hot zones utilizingSCBA, attack teams of two or more, estab-lished communication systems, experi-enced members overseeing those lessexperienced, and the requirement of annuallive fire drills. NFPA 600 states that facilityfire brigades are exposed to the same degreeof hazard as community firefighters, butthese hazards do not extend beyond theprivate facility where they work.2

NFPA statistics from 1996 to 2000have found that the risk of death in commer-cial fires exceeds residential fires by morethan 60%.3 Calls to industrial fire depart-ments number less than 100 annually com-pared with several thousand calls forcommunity fire fighters.4 For both groups,the vast majority of the calls are not for fires,but rather for emergency medical services.

To understand industrial firefighterjob duties, the Task Force interviewedindustrial fire chiefs, fire school faculty,fire team medical directors, and industrialfirefighters. In general, there are manysimilarities between industrial and commu-nity (volunteer, municipal, woodland) fire-fighters. Industrial firefighters are exposedto many of the same physical hazards—including impaired heat exchange fromgear, sun, wind, rain, snow, extreme tem-perature fluctuations, humidity, wetness,mud, skin contact with oil and grease,bloodborne pathogens, noxious odors, andrespiratory irritants. Mental health stressorsinclude crucial decision-making, aspects ofsustained work, unpleasant situations, andshiftwork and related fatigue.

Many physical demands are also sim-ilar including the need for explosive strength(running, jumping, rapid pulling, advancehose line), manual dexterity (assemblemachinery, operate hand tools, tie knots onhose, use a wrench), climbing, vision (acuity,depth perception, night vision, color-cod-ing), smell (leaking and burning), and speechand hearing. Municipal firefighting equip-ment and hoses tends to be smaller, whereasindustrial fire equipment and hoses tends tobe more heavy duty. This means the indus-trial firefighter is often handling heavierloads. The physical demands on municipalfirefighters emphasize upper body and over-head work (‘‘overhaul’’). Industrial fire bri-gades tend to require less upper body


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strength but the heavier nature of the equip-ment may put industrial firefighters atincreased risk for back injuries.

Industrial firefighting is also signifi-cantly different from community firefightingin that the knowledge required is more spe-cific for the local setting (eg, explosive,chemical, or marine situations). Municipaland industrial firefighters wear standardstructural firefighting clothing whereasindustrial firefighters’ clothing may includehigh temperature protective and chemicalprotective clothing.5 Resulting dehydrationand hyperthermia are often a greater issue forindustrial firefighters particularly in thosewith poor cardiovascular conditioning andchronic disease. In the survey developed bythis Task Force, the majority of industrialfirefighters who have been community fire-fighters feel the physical work is similar, butthe mental demands and danger are greaterper episode of industrial firefighting.

In larger cities, municipal/structuralfirefighters are generally full-time paidpositions, whereas industrial fire brigadesand smaller city municipal fire departmentsare part-time, volunteers called to duty onlywhen needed. Most industrial fire brigademembers are plant operators or have someother full time job in the facility where theywork. Often, full-time paid municipal fire-fighters engage in an exercise regimen aspart of their regular work duties. Municipalfirefighters may also plan and prepare foodat fire stations. Occasionally, there are alsofirefighter wellness and health offerings.Industrial firefighters rarely have dedicatedwork time for exercise, meals, or wellnessactivities specifically related to the fireteam. Consequently, while strength andhealth maintenance activities may beencouraged for industrial fire teams, theseactivities may need to be performed outsideof work hours.

Typically, municipal firefighterswork 24 hours on and 48 hours off (24/48) shifts or 48/96 shifts.6,7 Industrial firebrigades on the other hand usually work 8to 12 hours, often with rotating shiftworkfor 24-hour plant operations. As shift-workers have increased health risks forobesity, diabetes mellitus, and hyperten-sion, firefighters of all types may also haveshift-work-related health risks.

There are also tactical differences inthe way fires are approached.8 Industrialfires tend to be larger petroleum-based orpressurized gas fires where the emphasis ison pipe and tank firefighting and isolatingand removing the source. Structural fires aremore contained, but people can be trappedinside the structure, thus requiring coordi-nated search and rescue techniques. Addi-tionally, the materials used to fight firesdiffer. Municipal firefighters primarily usewater to fight Class A fires (wood/paper),

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whereas the primary tool for industrial fire-fighters is foam which is used to fight class Band C fires (flammables/electrical).

Municipal firefighters have abroader scope of job duties. As job dutiesare more narrow for industrialized fire-fighters, there may be more opportunityfor accommodation of various medical con-ditions.6 There is a different skill set as wellbetween the two.8 Municipal firefightersare trained in rapid intervention and teamconcepts, accountability systems, andsearch procedures. Industrial firefightersdeal more with confined space rescue andmust have knowledge of the properties ofpressurized gas fires and large scale flam-mable liquids. Additionally, industrial fire-fighters are frequently trained in high-anglerescue. Table 1 describes other differencesthat may exist.

The literature review, completed sur-vey, and interviews, found industrial firebrigades to be as diverse as the companiesfor which they work. While the scope ofduty may be limited to handling fire extin-guishers—with anything larger requiring amunicipal fire department response—moretypically, industrial fire brigades are highlystructured with command and control per-sonnel, officers, and front-line firefighters.As the fire chief is usually not activelyengaged in fighting the fire, he/she is notsubject to the same physical demands—notclassifying the chief as a firefighter violatesthe closely-knit nature of the firefightingteam. However, for purpose of classifyingphysical demands, we use the term ‘‘fire-fighters’’ for those actively and offensivelyengaged in the isolation and removal of thefire source.

HOW CAN CARDIOVASCULARFITNESS FOR DUTY BE BEST

DETERMINED FORINDUSTRIAL FIREFIGHTERS?

In 2007, a National Institute for Occu-pational Safety and Health (NIOSH) alert,addressed the risks of firefighters dying frompreventable cardiovascular disease (CVD).9

Later research supported NIOSH’s find-ings.10–16 A 2014 study found 45% of on-duty firefighter deaths were caused byCVD.17 Nearly all firefighter cardiac deathsinvolve coronary risk factors—predictorsinclude previous coronary heart disease(CHD), hypertension, and smoking.10,18,19

Metabolic syndrome, psychological stress,noise, sleep disorders, smoke, carbon mon-oxide, cyanide, and thermoregulatory stressare also associated with cardiovascular risk/fitness in firefighters.20–24 Studies havedemonstrated that more than 40% of fire-fighters exceed low CHD risk.18 Volunteerfirefighters have the highest risk for cardiacfatality and CHD.25,26

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TABLE 1. General Differences between Industrial and Community Firefighters

Industrial (Excluding Incipient Firefighters) Community (Volunteer/Municipal/Woodlands)

TrainingCandidate ability test � þþTrained as medic/paramedic þ þþþTraining with mock fires þþþ þ

KnowledgeProperties of large scale flammable liquids þþþ þPlant operations þþþ �Trenching and shoring þþ þConfined space þ þþþSearch and rescue þ þþþAccountability systems (locate firefighters) þ þþþ

CallsCalls, high volume team/dept. Under 100 per year Over 1000 per yearCalls, low volume team/dept. One per 6 mo One per weekRepeat responses in 24 hrs 0 þþþMedical emergency Vast majority 2 out of 3First due in (first on scene) 6þ, often all in 3–6 escalating rapidly as neededSome distance to get to equipment Yes No

EnvironmentRemote þ �Marine þ �Industrial þ �Woodlands � þHigh rise � þInterior � þ

GearBunker gear, boots, Glove helmet, SCBA þ þChemical suit/decontamination þþ þ (special teams)High temperature suit þþ þ (special teams)

StrengthUpper body work þþ þþþLower body work þþþ þþþPulling more hoses, heavier þþþ þþCarrying hoses up, dragging injured þ þþLadder raising þ þþWork on uneven surface þ þþLift heavy objects off trapped þ þþClimb hillsides/shoveling � þþ (wildland)Chopping with axe � þþCrawling � þþ

EquipmentExtinguishers þþ þHose, number and size þþþ þFoam þþþ þFixed monitors þþþ �Hydrants, ladder, pumper þ þHand tools, Jaws of life þ þþþ

Fire typeChemical þþþ þExplosive þþþ þFuel þþþ þElectrical þ (high voltage) þWood � þþþ

HazardsMetal structures þþ þNoise (pressurized fuels) þþ �Electric þ (high voltage) þCarcinogens þ (ex. asbestos) þ (ex. Benzopyrene)Chemicals (HCN, HCL, solvents) þþ þ

Key: þþþ much more; þþ common; þ occasional or present; � rare or absent; SCBA, self-contained breathing apparatus.Sources: 2015 industrial fire chief interviews, Brayton Fire Training Field, College Station, TX; NFPA 1582 list of essential job tasks; and International Fire Chiefs Association’s

guide to implementing NFPA 1582.

Bhojani et al JOEM � Volume 60, Number 2, February 2018


Industrial firefighting statistics andsmaller industrial fires are frequently notpublic knowledge.27 Firefighting statisticsinclude deaths attributed to fire response


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that may occur days after the events, and itis even more doubtful such information ismade available related to industrial fireresponse. In the absence of complete data,


� 2017 American College of

industrial firefighters may have similardemographic and cardiovascular risks asvolunteer community firefighters. The sur-vey conducted by the Task Force assessed


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health risks of male industrial firefighterswho self-reported their height, weight, andwaist circumference. Based upon aNational Institute of Health risk table,28

90% were found to have increased, high,very high, or extremely high risk for type 2diabetes, hypertension, and CHD.

Recent biomonitoring of industrialfirefighters has demonstrated high peak aero-bic demands in industrial live fire simulations(Glencross PM, Turner D. PhysiologicDemands of Industrial Firefighting Simula-tions; 2016. Unpublished manuscript). Fire-fighting tasks require similar burst andsustained aerobic demands as required inresidential firefighting.29–31 In the clinicalsetting, aerobic capacity can be determinedusing the gold standard of metabolic testing orestimated using treadmill testing using con-version tables. Aerobic capacity and fitnessare also good predictors of cardiac abnormal-ities and risk.32–35 Maximal treadmill tests(to voluntary exhaustion) should be used toestimate peak aerobic fitness. Submaximalstress tests in firefighters, such as the Gerkin(WFI treadmill protocol) have been shown tooverestimate VO2 max and thus underesti-mate potential cardiac risk and aerobic fit-ness.36–39 Maximal heart rate formulas andsteady-state assumptions used to calculateVO2 max tables contribute to inaccurate esti-mates with submaximal testing. For example,if 40 mL/kg/min (11 METS) is used as afitness threshold for firefighters, submaximalstress testing leads to dangerous and errone-ous results by suggesting that 17% to 30% ofunfit firefighters are aerobically fit.37,39

Elevated body mass index (BMI)was thought to be due to many firefighters’higher muscle mass.40 However, this hasbeen disproven.41-43 While in other popu-lations, obesity and body composition donot correlate with exercise tolerance, thereis evidence it does in firefighters.44,45 Fur-thermore, in firefighters, an elevated BMIlimits the benefits of exercise.32

Autopsy studies have linked cardio-megaly and left ventricular hypertrophy(LVH) to sudden cardiac death in fire-fighters. As a result, there have been callsfor increased early detection by echocar-diogram because ECG alone is a specifictest, but lacks sensitivity.46–50 Smoking,CHD, hypertension, and obesity are alllinked to LVH in firefighters.51

Besides clinic-based testing, industrialfire teams can also develop other tests todemonstrate aerobic fitness. Several studieshave demonstrated success in matching timedperformance in the field, (running, runningwith weights) with measured VO2 max in thelaboratory, thereby constructing simple toadminister field tests.31,52–54 Some of thesestudies used absolute VO2 max cut-offs.When the measured task requires the carriageof body weight, use of a relative VO2 max


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goal should be considered. In other words, thesame firefighting task may have higher aero-bic demands in an individual having a higherbody weight and wearing a larger size ofwet clothing. Fitness training programs arestrongly recommended for firefightersalthough few industrial fire teams participatein formal programs.4,32,55,56

IS PSYCHOLOGICAL STRESSDIFFERENT FOR STRUCTURAL

VERSUS INDUSTRIALFIREFIGHTERS?

There is extensive literature addressingthe psychological stressors of firefightingespecially in first responders; however, theliterature is devoid of specific studies inindustrial firefighters. The Task Force’s sur-vey identified a cohort of industrial fire-fighters who had also served as communityfirefighters. The perception of this cohortwas that the stress of industrial firefightingwas greater than what they had experienced ascommunity firefighters (Turner D, CathcartD, Glencross PM. ORCHSE Survey of Indus-trial Firefighters; 2016. Unpublished manu-script). Psychological stress in the industrialfirefighter is a recognized gap in the literature,and as such represents an opportunity forresearch to assess the extent and impact itmay have on the health and safety ofthese individuals.

ARE TOOLS CURRENTLY USEDTO DETERMINE FITNESS FOR

DUTY USEFUL?Firefighters are universally subject

to a high level of physical and mentalstresses during their jobs. Industrial fire-fighters, like their municipal counterparts,share similar demanding environmentalfactors, but as has been suggested, fatalityrates are likely much higher in the setting ofindustrial fires.57 Proper tools to assessfitness-for-duty are therefore important toensure firefighters are properly equipped tohandle the dangers of the job while mini-mizing casualties. While studies regardingfirefighter fitness exist, very few focus onindustrial departments.

Prospective firefighters must passphysical assessments prior to service. Sev-eral different methods currently assess fit-ness, but there are no universally acceptedstandards across all organizations. NFPApublishes several codes and standards bywhich many groups abide. (NFPA 1583provides fitness guidelines that incorporatemeasures of aerobic capacity, flexibility,muscular and endurance, and body compo-sition testing as part of a regular fitnessregimen.58) The Candidate Physical AbilityTest (CPAT) is widely used simulation testfor which contains eight firefighting tasksthat mimic real-life scenarios: (1) stair


Environmental Medicine

climb; (2) hose drag; (3) equipment carry;(4) ladder raise and extension; (5) forcibleentry; (6) search; (7) rescue; and (8) ceilingbreach and pull.59

Industrial fire brigades may havetheir own internal guidelines for fitness-for-duty measurements. Royal DutchShell’s global requirements specify mini-mum fitness and health indicators for fire-fighters and rescue teams. These includetesting of visual acuity, blood pressure, thecardiovascular system, and breathing appa-ratus usage.60 Occupational Safety andHealth Administration (OSHA) standardsrequire passing a trade test, determined bylocal jurisdictions, which varies by specificroles, but may include elements found inthe CPAT such as ladder climb, victimrescue, and equipment carry.61

Bhojani developed a cumulative fit-ness score ranging from 0 to 140 based onseven parameters of fitness to determineoverall industrial firefighter fitness-for-duty evaluation.62 These factors included:(1) resting heart rate; (2) diastolic bloodpressure; (3) aerobic capacity; (4) body fatpercentage; (5) muscular strength; (6) mus-cular endurance; and (7) flexibility. Allseven components correlated significantlywith the total fitness score even after con-trolling for age and experience.

Assessments such as CPAT are gearedtoward all firefighters across industries, asthe exercises are applicable in many typesof situations. OSHA 1910.156(c)(2) listsnational training and educational programsspecifically for the oil refinery industry, suchas those at Texas A&M University and LamarUniversity, after which all similar programsshould be modeled.63 NFPA has standardsthat describe general job performancerequirements for industrial firefighters.64 Itis unclear whether additional established toolsare necessary specifically for industrial fire-fighters. A study comparing industrial fire-fighters to municipal firefighters in Californiafound that ‘‘despite programmatic differen-ces, these departments demonstrated similar,relatively high degrees of physical fitness andsimilar blood lipid concentrations, blood pres-sure levels, and cardiac risk factors.’’4 How-ever, the industrial firefighter sample wassmall (n¼ 17). Additional studies examiningphysiological characteristics of industrial fire-fighters based on NFPA standards would helpdetermine if it would be beneficial to imple-ment additional tools specific to industrialfirefighting.

WHAT PREVENTIVEINTERVENTIONS AREAVAILABLE AND HOWEFFECTIVE ARE THEY?Recognizing that cardiovascular dis-

ease and sudden cardiac death represent the


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single most frequent cause of duty-relatedfatalities in firefighters, an important ques-tion to be considered as part of this reviewis, ‘‘What preventive interventions areavailable and how effective are they inreducing cardiovascular risk?’’ As withother research questions there is a gap inthe literature specifically addressing indus-trial firefighters. Therefore, this reviewaddresses the effectiveness of wellness/fit-ness programs to reduce risk factors forcardiovascular disease and to improve car-diovascular capacity in the workforce ingeneral and in municipal firefighters spe-cifically as a potential surrogate forindustrial firefighters.

There is abundant evidence in theliterature to support the beneficial effectsof diet and exercise to prevent cardiovascu-lar disease. The landmark RAND study ofUS employers validated the effectiveness ofworkplace wellness programs to influencebeneficial changes in behavioral risk fac-tors for cardiovascular disease.65 The studyreported statistically significant and clini-cally meaningful improvements among par-ticipants of wellness programs in exercisefrequency, smoking behavior, and weightcontrol.

A 2013 study sampled fire depart-ments that had implemented medical andfitness programs comparable to those rec-ommended in the Fire Service Joint LaborManagement Wellness Fitness Initiative(WFI).66 WFI recommendations included:

1.

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NFPA 1582 compliant annual medicalphysical examinations to all fire servicepersonnel

2.

A designated health/fitness coordinator

3.

Peer fitness trainers

4.
Time for physical training/working out
while on duty for all fire service per-sonnel

The researchers identified 10 firedepartments generally meeting the WFIrecommendations and a closely matchednumber of fire departments that did notmeet the criteria. There were 1002 malefirefighters in the study; 522 in fire depart-ments aligned with WFI recommendations,and 480 not meeting recommended criteria.The study found that firefighters in depart-ments meeting WFI criteria were less likelyto be obese (adjusted odds ratio[AOR]¼ 0.58; 95% confidence interval[CI]¼ 0.41 to 0.82), more likely to meetendurance capacity standards for firefight-ing (AOR¼ 5.19; 95% CI¼ 2.49 to 10.83),and have higher estimated VO2 max(40.7� 0.6 vs 37.5� 1.3 for firefightersin standard departments; P¼ 0.001). How-ever, studies have found that fewer than20% of US municipal fire departmentsroutinely engage in fitness programs andperiodic fitness-testing.32

© 2017 American College of Occupation

Delisle et al36 proposed the potentialof a peer-mentor intervention to modifyfitness outcomes in firefighters designatedas high risk for cardiovascular disease via a3-month, high-intensity, pilot study. Thesmall cohort firefighters (n¼ 29) demon-strated the effectiveness of this social cog-nitive theory approach to increase VO2 maxand decrease body fat percentage versus acontrol group. This difference persisted at1-year follow-up. The significance of thispilot study could be that is shows theimportance of involving firefighters in theplanning, implementation, and evaluationprocess—although, intervention costs werenot considered.

The only long-term, randomized,prospective trial in municipal firefightersthat was identified in the literature reviewwas the PHLAME (Promoting HealthyLifestyles: Alternative Models’ Effects)Firefighter Study.67 This trial focused onnutrition, physical activity, and the mainte-nance of a healthy bodyweight. A team-centric intervention group, an individual-focused motivational interviewing inter-vention, and a control group receiving usualcare were followed for 7 years. The inter-ventions did not result in significant norsustainable improvements in weight, car-diopulmonary fitness levels, or healthyphysical activity behaviors.

Therefore, if industrial firefightersare better represented by US employees,will they be more likely to respond favor-ably to worksite wellness programs as sup-ported by the RAND study; conversely, willthey be more resistant to workplace inter-ventions as suggested by the PHLAMEstudy of municipal firefighters? It is evidentfrom this review that inadequate attentionhas been given to industrial firefighters as agroup; their demographic make-up andoverall health status remains virtuallyunknown. It is, therefore, not possible atthis time to predict the outcome of work-place interventions for this group of pro-fessionals. The implication is that studiesdirected toward industrial firefighters willbe necessary to elucidate the best approachto achieving sustained changes in diet andexercise behaviors to reduce the risk ofcardiovascular disease.

HOW DO US LAWS IMPACTFITNESS-FOR-WORK

DECISIONS?This document does not address

Americans with Disabilities Act (ADA)or Genetic Information NondiscriminationAct (GINA) considerations. The evaluatingphysician needs to review federal and statelaws and regulations related to safety-sen-sitive positions, post-offer evaluation, med-ical accommodations, applicability of paid



versus volunteer firefighting, public safetyexemption for periodic examinations ofemployees, and family health inquiriesrelated to cardiovascular disease risk. Thesafety-sensitive nature of firefighting dutiesand the volunteer status of firefighters inmany industrial settings potentially allowfor comprehensive annual fitness-for-dutyassessments. It is important, however, thatknowledgeable stakeholders, includinglegal and human resources, be consultedin the construct of the physical assessmentprocess to ensure compliance with allrelevant laws.

DISCUSSIONThe Task Force has undertaken an

extensive literature review in an attempt toprovide an evidence-based guidance forassessing the fitness-for-duty of an indus-trial brigade firefighter. This was initiateddue to the exclusion of industrial fire bri-gades from the very comprehensive NFPA1582 medical standard and the paucity ofinformation on the medical clearance pro-cess contained in the NFPA 600 standard,which is specifically intended to coverindustrial fire brigades. The lack of specificstudies of industrial firefighters within themedical literature excluded the possibilityof an evidence-based guidance document.There was, however, sufficient informationto draw some preliminary conclusions andto formulate a series of recommendations interms of potential research opportunities aswell as considerations for best practiceapproaches to the assessment of the cardio-vascular fitness of industrial firefighters.

In general, there are many similari-ties between industrial fire brigades andcommunity firefighters; however, thereare distinct differences with industrial fire-fighters. These differences potentially placethe industrial firefighter at an elevated riskby virtue of the greater hazards and morediverse fire types they encounter, their morerigorous training demands, the greater lev-els of mental stress, and a demographic ofchronic disease, deconditioning, and obe-sity. Based upon responses from industrialfirefighters surveyed by the Task Force,90% had increased, high, very high, orextremely high risk for diabetes, hyperten-sion, or coronary heart disease. How best toquantify this risk within the setting of afitness-for-duty evaluation is a main objec-tive of this Task Force. Risk calculatorshave not been validated in industrial fire-fighters, and the commonly used sub-max-imal stress tests overestimate VO2 max andas a result underestimate potential cardiacrisk and aerobic fitness.

A number of fitness-for-duty meth-odologies exist across industry, and manydo adopt the NFPA 1582 standard to assessindustrial firefighters. The presumption that



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any firefighter activities with similar peakdemands will lead to similarly observedadverse cardiac events suggests that indus-trial firefighters should be screened aggres-sively for cardiac disease and aerobiccapacity. One major problem with theNFPA 1582 standard is that the recom-mended approach to cardiovascular screen-ing is sub-maximal stress tests (Gerkin WFItreadmill protocol) which, as noted, over-estimate VO2 max and, if utilized in thissetting, may lead to the erroneous medicalclearance of aerobically unfit individualsfor firefighting duties. Several studies existthat determine best practices for fire-fighters’ fitness-for-duty, but none focuseson industrial firefighting, likely due to alack of assessment tools specifically devel-oped for industry.

Preventive measures to reduce cardio-vascular disease risk factors and improveaerobic fitness are critically important forindustrial firefighters; unfortunately, nostudies exist within this population to assessthe effectiveness of any intervention. Theonly long-term, randomized, prospectivetrial in municipal firefighters identified inthis review did not result in significant norsustainable improvements in weight, cardio-pulmonary fitness levels, or healthy physicalactivity behaviors.

RECOMMENDATIONSUntil additional specific medical

information on industrial firefighters isavailable, the Task Force makes the follow-ing recommendations:

1.

ht

� 2

Reference NFPA 1582 for all aspects ofthe physical assessment with the excep-tion of cardiovascular fitness.

2.
Implement maximal exercise tolerancetests for the cardiovascular assessmentsince aerobic capacity and fitness hasshown to be a good predictor of cardiacabnormalities as well as risk. Commonlyused submaximal stress tests in fire-fighters, such as the Gerkin (WFI tread-mill protocol) overestimate VO2 max.
3.
Eliminate use of submaximal stress test-ing as it has it has been shown todangerously overestimate cardiovascu-lar fitness.
4.
Encourage additional follow-up researchin the following areas:a. Develop a careful analysis of job
tasks with consideration for shift-work, overtime, physical require-ments for the tasks, as well as thepsychological, cognitive, and envi-ronmental stressors for industrialfirefighters.

b. Conduct studies at local sites oracross a particular industrial sector(eg, oil refineries, chemicalmanufacturing, etc) to evaluate the

© 2

017

017 American College of Occupational a

American College of Occupational and En

nature of the jobs and to assesswhether fitness practices specificto those areas are valid and benefi-cial towards completing the job ofan industrial firefighter in a safe andefficient manner.

c. Investigate the demographic makeupof industrial firefighters and includean assessment of their cardiovascularrisk profile, biometric data, andoverall health.

d. Conduct studies to identify barriersto implementing sustainable healthpromotion programs in industrialfirefighters and assess the effective-ness of worksite programs in reduc-ing the incidence of cardiovasculardisease.

e. Additional studies examining phys-iological characteristics of industrialfirefighters based on NFPA stand-ards would help determine if it willbe beneficial to implement addi-tional tools and/or tests specific toindustrial firefighting.

f. Develop and validate fitness-training

nd

vir

programs for industrial firefighters.

In summary, industrial brigade fire-fighters share many characteristics withmunicipal firefighters, but their unique jobresponsibilities and the physical/mentaldemands under which they work have notbeen adequately studied. The Task Forcefound gaps in the medical literature as todemographic makeup, behavioral risk fac-tors, and burden of chronic disease, effec-tiveness of preventive interventions toenhance wellness through risk factor reduc-tion and aerobic fitness, and the propermethodology for a fitness-for-duty assess-ment. Due to these gaps, the Task Force willundertake the development of a guidancedocument for industrial firefighters emu-lating the model provided by the currentACOEM Guidance for the Medical Evalua-tion of Law Enforcement Officers (LEO).68

ACKNOWLEDGMENTSThe Task Force wishes to thank

reviewers Jeffrey Huth, MD, PhD, CDC/NIOSH, and Stefanos N. Kales, MD, MPH,Harvard Medical School & Harvard THChan School of Public Health, for theirassistance, and to acknowledge ORCHSEfor their work in implementing the survey.

REFERENCES1. National Fire Protection Association. Codes

and Standards. NFPA 1582 – Standard onComprehensive Occupational Medical Programfor Fire Departments; 2013; 1.1.4.

2. National Fire Protection Association. Codesand Standards. NFPA 600 – Standard on Facil-ity Fire Brigades; 2013.

3. Klaene B, Sanders R. Expert advisors providestrategic support: cooperation and pre-incidentplanning are essential to fighting at large

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4. Garver JN, Jankovitz KZ, Danks JM, Fittz AA,Smith HS, Davis SC. Physical fitness of an indus-trial fire department vs. a municipal fire depart-ment. J Strength Cond Res. 2005;19:310–317.

5. Faulkner M, Levine E, Mitchell A, et al. NationalResponse Team. Emerging Risks: ResponderAwareness Training – Bakken Crude Oil [Power-Point presentation]; 2015. Available at: https://nrt.org/sites/2/files/NRT%20Training%20Subcommittee%20Bakken%20Crude%20Oil%20presentation%20V28%20scrubbed.pdf.Accessed November 2, 2017.

6. Vitalie T. Differences between federal, munici-pal, and private employees. Firerecruitcom[web site]; 2009.

7. Bureau of Labor Statistics, U.S. Department ofLabor. Occupational Outlook Handbook, 2016–2017 ed. Firefighters [web site]. Available at:http://www.bls.gov/ooh/protective-service/fire-fighters.htm. Accessed November 2, 2017.

8. Shelley C. Industrial and municipal fire depart-ment interface. Fireengineeringcom [web site];2009. Available at: http://www.fireengineering.-com/articles/print/volume-162/issue-4/features/industrial-and-municipal-fire-department-inter-face.html. Accessed November 2, 2017.

9. Centers for Disease Control and Prevention.Preventing Fire Fighter Fatalities Due to HeartAttacks and Other Sudden CardiovascularEvents. NIOSH publication 133; 2007. Avail-able at: https://www.cdc.gov/niosh/docs/2007-133/pdfs/2007-133.pdf. Accessed November 2,2017.

10. Kales SN, Soteriades ES, Christoudias SG,Christiani DC. Firefighters and on-duty deathsfrom coronary heart disease: a case controlstudy. Environ Health. 2003;2:14.

11. Kales SN, Soteriades ES, Christiani CA, Chris-tiani DC. Emergency duties and deaths fromheart disease among firefighters in the UnitedStates. N Engl J Med. 2007;356:1207–1215.

12. Kales SN, Smith DL. Sudden cardiac death inthe fire service. Occup Med (Lond). 2014;64:228–230.

13. Kahn SA, Woods J, Rae L. Line of duty fire-fighter fatalities: an evolving trend over time.J Burn Care Res. 2015;36:218–224.

14. Soteriades ES, Smith DL, Tsismenakis AJ, BaurDM, Kales SN. Cardiovascular disease in USfirefighters: a systematic review. Cardiol Rev.2011;19:202–215.

15. Smith DL, Barr DA, Kales SN. Extreme sacri-fice: sudden cardiac death in the US Fire Ser-vice. Extrem Physiol Med. 2013;2:6.

16. Smith DL, DeBlois JP, Kales SN, Horn GP.Cardiovascular strain of firefighting and the riskof sudden cardiac events. Exerc Sport Sci Rev.2016;44:90–97.

17. Ratchford EV, Carson KA, Jones SR, Ashen MD.Usefulness of coronary and carotid imagingrather than traditional atherosclerotic risk factorsto identify firefighters at increased risk for car-diovascular disease. Am J Cardiol. 2014;113:1499–1504.

18. Byczek L, Walton SM, Conrad KM, ReicheltPA, Samo DG. Cardiovascular risks in fire-fighters: implications for occupational healthnurse practice. AAOHN J. 2004;52:66–76.

19. Geibe JR, Holder J, Peeples L, Kinney AM,Burress JW, Kales SN. Predictors of on-dutycoronary events in male firefighters in theUnited States. Am J Cardiol. 2008;101:585–589.


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http://www.nfpa.org/news-and-research/publications/nfpa-journal/2002/november-december-2002http://www.nfpa.org/news-and-research/publications/nfpa-journal/2002/november-december-2002http://www.nfpa.org/news-and-research/publications/nfpa-journal/2002/november-december-2002https://nrt.org/sites/2/files/NRT%2520Training%2520Subcommittee%2520Bakken%2520Crude%2520Oil%2520presentation%2520V28%2520scrubbed.pdfhttps://nrt.org/sites/2/files/NRT%2520Training%2520Subcommittee%2520Bakken%2520Crude%2520Oil%2520presentation%2520V28%2520scrubbed.pdfhttps://nrt.org/sites/2/files/NRT%2520Training%2520Subcommittee%2520Bakken%2520Crude%2520Oil%2520presentation%2520V28%2520scrubbed.pdfhttps://nrt.org/sites/2/files/NRT%2520Training%2520Subcommittee%2520Bakken%2520Crude%2520Oil%2520presentation%2520V28%2520scrubbed.pdfhttps://nrt.org/sites/2/files/NRT%2520Training%2520Subcommittee%2520Bakken%2520Crude%2520Oil%2520presentation%2520V28%2520scrubbed.pdfhttp://www.bls.gov/ooh/protective-service/firefighters.htmhttp://www.bls.gov/ooh/protective-service/firefighters.htmhttp://www.fireengineering.com/articles/print/volume-162/issue-4/features/industrial-and-municipal-fire-department-interface.htmlhttp://www.fireengineering.com/articles/print/volume-162/issue-4/features/industrial-and-municipal-fire-department-interface.htmlhttp://www.fireengineering.com/articles/print/volume-162/issue-4/features/industrial-and-municipal-fire-department-interface.htmlhttp://www.fireengineering.com/articles/print/volume-162/issue-4/features/industrial-and-municipal-fire-department-interface.htmlhttps://www.cdc.gov/niosh/docs/2007-133/pdfs/2007-133.pdfhttps://www.cdc.gov/niosh/docs/2007-133/pdfs/2007-133.pdfhttps://www.cdc.gov/niosh/docs/2007-133/pdfs/2007-133.pdf

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20. Angerer P, Kadlez-Gebhardt S, Delius M,Raluca P, Nowak D. Comparison of cardiocir-culatory and thermal strain of male firefightersduring fire suppression to exercise stress testand aerobic exercise testing. Am J Cardiol.2008;102:1551–1556.

21. Baur DM, Christophi CA, Kales SN. Metabolicsyndrome is inversely related to cardiorespira-tory fitness in male career firefighters. JStrength Cond Res. 2012;26:2331–2337.

22. Donovan R, Nelson T, Peel J, Lipsey T, VoylesW, Israel RG. Cardiorespiratory fitness and themetabolic syndrome in firefighters. Occup Med(Lond). 2009;59:487–492.

23. Barger LK, Rajaratnam SM, Wang W, et al.,Harvard Work Hours Health and Safety Group.Common sleep disorders increase risk of motorvehicle crashes and adverse health outcomes infirefighters. J Clin Sleep Med. 2015;11:233–240.

24. Smith DL, Petruzzello SJ, Kramer JM, MisnerJE. Physiological, psychophysical, and psycho-logical responses of firefighters to firefightingtraining drills. Aviat Space Environ Med.1996;67:1063–1068.

25. Sen S, Palmieri T, Greenhalgh D. Cardiac fatal-ities in firefighters: an analysis of the U.S. FireAdministration Database. J Burn Care Res.2016;37:191–195.

26. Wolkow A, Netto K, Langridge P, et al. Coro-nary heart disease risk in volunteer firefightersin Victoria, Australia. Arch Environ OccupHealth. 2014;69:112–120.

27. Zapatka RE. Industrial firefighters are fire-fighters too. Excerpt. Fireengineeringcom[Web site]; 2005.

28. National Heart, Lung and Blood Institute. ThePractical Guide: Identification, Evaluation, andTreatment of Overweight and Obesity inAdults; 2000. Available at: http://www.nhlbi.nih.gov/files/docs/guidelines/prctgd_c.pdf.Accessed November 2, 2017.

29. Adams J, Roberts J, Simms K, Cheng D, Hart-man J, Bartlett C. Measurement of functionalcapacity requirements to aid in development ofan occupation-specific rehabilitation trainingprogram to help firefighters with cardiac dis-ease safely return to work. Am J Cardiol.2009;103:762–765.

30. Perroni F, Tessitore A, Cortis C, et al. Energycost and energy sources during a simulatedfirefighting activity. J Strength Cond Res.2010;24:3457–3463.

31. Williams-Bell FM, Villar R, Sharratt MT,Hughson RL. Physiological demands of thefirefighter Candidate Physical Ability Test.Med Sci Sports Exerc. 2009;41:653–662.

32. Durand G, Tsismenakis AJ, Jahnke SA, BaurDM, Christophi CA, Kales SN. Firefighters’physical activity: relation to fitness and cardio-vascular disease risk. Med Sci Sports Exerc.2011;43:1752–1759.

33. Baur DM, Leiba A, Christophi CA, Kales SN.Low fitness is associated with exercise abnor-malities among asymptomatic firefighters.Occup Med (Lond). 2012;62:566–569.

34. Gulati M, Pandey DK, Arnsdorf MF, et al.Exercise capacity and the risk of death inwomen: the St James Women Take Heart Proj-ect. Circulation. 2003;108:1554–1559.


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36. Delisle AT, Piazza-Gardner AK, Cowen TL,et al. Validation of a cardiorespiratory fitnessassessment for firefighters. J Strength CondRes. 2014;28:2717–2723.

37. Dolezal BA, Barr D, Boland DM, Smith DL,Cooper CB. Validation of the firefighter WFItreadmill protocol for predicting VO2 max.Occup Med (Lond). 2015;65:143–146.

38. Klaren RE, Horn GP, Fernhall B, Motl RW.Accuracy of the VO2peak prediction equation infirefighters. J Occup Med Toxicol. 2014;9:17.

39. Mier CM, Gibson AL. Evaluation of a treadmilltest for predicting the aerobic capacity of fire-fighters. Occup Med (Lond). 2004;54:373–378.

40. Ode J, Knous J, Schlaff R, Hemenway J, Peter-son J, Lowry J. Accuracy of body mass index involunteer firefighters. Occup Med (Lond).2014;64:193–197.

41. Baur DM, Christophi CA, Tsismenakis AJ,Jahnke SA, Kales SN. Weight-perception inmale career firefighters and its association withcardiovascular risk factors. BMC Public Health.2012;12:480.

42. Baur DM, Christophi CA, Cook EF, Kales SN.Age-related decline in cardio-respiratory fitnessamong career firefighters: modification byphysical activity and adiposity. J Obes.2012;2012:6.

43. Poston WS, Haddock CK, Jahnke SA, JitnarinN, Tuley BC, Kales SN. The prevalence ofoverweight, obesity, and substandard fitnessin a population-based firefighter cohort. JOccup Environ Med. 2011;53:266–273.

44. Tsismenakis AJ, Christophi CA, Burress JW,Kinney AM, Kim M, Kales SN. The obesityepidemic and future emergency responders.Obesity (Silver Spring). 2009;17:1648–1650.

45. Nogueira EC, Porto LG, Nogueira RM, et al.Body composition is strongly associated withcardiorespiratory fitness in a large Brazilianmilitary firefighter cohort: the Brazilian Fire-fighters Study. J Strength Cond Res. 2016;30:33–38.

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51. Soteriades ES, Targino MC, Talias MA, et al.Obesity and risk of LVH and ECG abnormali-ties in US firefighters. J Occup Environ Med.2011;53:867–871.

52. Lindberg AS, Oksa J, Gavhed D, Malm C. Fieldtests for evaluating the aerobic work capacity offirefighters. PLoS One. 2013;8:e68047.

53. von Heimburg E, Medbø JI, Sandsund M,Reinertsen RE. Performance on a work-simu-lating firefighter test versus approved labora-tory tests for firefighters and applicants. Int JOccup Saf Ergon. 2013;19:227–243.

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55. Roberts MA, O’Dea J, Boyce A, Mannix ET.Fitness levels of firefighter recruits before andafter a supervised exercise training program.J Strength Cond Res. 2002;16:271–277.

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59. Sheaff AK, Bennett A, Hanson ED, et al. Phys-iological determinants of the candidate physicalability test in firefighters. J Strength Cond Res.2010;24:3112–3122.

60. Shell Health. Fitness to Work Functional Specifi-cations: Report HEMS.GL.2000.04. 2015; 1–53.

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65. Mattke S, Liu H, Caloyeras JP, et al. WorkplaceWellness Programs Study. Santa Monica, CA:Rand Corporation; 2013 , Available at: http://www.rand.org/content/dam/rand/pubs/research_reports/RR200/RR254/RAND_RR254.pdf.Accessed November 2, 2017.

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http://www.nhlbi.nih.gov/files/docs/guidelines/prctgd_c.pdfhttp://www.nhlbi.nih.gov/files/docs/guidelines/prctgd_c.pdfhttp://www.nhlbi.nih.gov/files/docs/guidelines/prctgd_c.pdfhttps://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS%26p_id=9810https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS%26p_id=9810https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS%26p_id=9810http://www.rand.org/content/dam/rand/pubs/research_reports/RR200/RR254/RAND_RR254.pdfhttp://www.rand.org/content/dam/rand/pubs/research_reports/RR200/RR254/RAND_RR254.pdfhttp://www.rand.org/content/dam/rand/pubs/research_reports/RR200/RR254/RAND_RR254.pdfhttps://www.leoguidance.org/https://www.leoguidance.org/

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Appendix 1: ORCHSE Surveyof Industrial Firefighters.

Turner D, Cathcart D,Glencross PM (2016).

Unpublished Manuscript

1)

ht ©

� 20

How old are you (years)? 21 to 25; 26to 30; 31 to 35; 36 to 40; 41 to 45; 46 to50; 51 to 55; 56 to 60; 61 to 65; 66 to70; 71 to 75.

2)

Are you: male; female.

3)

What is your height? Feet; inches.

4)

What is your weight (pounds)?

5)
What is your waistband circumference
(belt size in inches)?

6)
How many days per week do you exer-
cise on average? Aerobic (defined as atleast run 15 min/walk 10,000 steps/bike30 min/swim 30 min/other 15 min);non-aerobic (defined as walking or sim-ilar activities that do not meet aerobicthresholds); resistance (defined asweight lifting /strengthening).

7)
Where have you exercised in the last 3months? In company gym; not in com-pany gym but on company grounds;outside of company; part of a fire teamexercise program.
8)
How many years total have you beena firefighter?
9)
What type of fire fighter are you now?(Check all that apply) industrial fire
2017 American College of Occupational an

17 American College of Occupational and Env

team; volunteer community firefighter;paid community firefighter; medic incommunity; military/other firefighter.

10)
How would you characterize your roleon the industrial fire team (select all thatapply) fight fire in full bunker gear/SCBA; command and control only;support role only (ex. engineer/logis-tics/operations); medic; other.
11)
What level of industrial responder bestdescribes what you do? Incipientresponder; exterior firefighter; struc-tural firefighter; exterior/structuralfirefighter; Hazmat operations level(defensive); Hazmat technician(offensive).
12)
What were the medical requirementsto be cleared for the industrial fireteam? (Select all that apply) Note frompersonal physician only; companyphysical examination required; func-tional capacity evaluation; treadmill orstep testing; none.
13)
How often are you required to bemedically cleared for the industrialfire team? Annually; periodically,based upon my age; periodically,based upon my personal health riskfactors; other
14)
Which industrial fire team activitieshave you participated in over the last3 months and how many hours would
d Environmental Medicine. Unauthorized re

ironmental Medicine

you estimate total? Response to actualfires; response to non-fire emergency;hands on training/drills; offsite fire-fighter school; classroom training;competitions.

15)
If you have not had to respond toactual fires in the last 3 months—haveyou responded in the last year? Yes;no. If yes, how many times?
16)
Do you have experience as a commu-nity firefighter? Yes; no. If yes, iden-tify type of community: urban;suburban; rural; agricultural; combi-nation.
17)
If you have experience as a commu-nity firefighter, do you consider indus-trial firefighting to have easierphysical demands; the same physicaldemands, just less frequent; harderphysical demands.
18)
If you have experience as a commu-nity firefighter, do you consider indus-trial firefighting to be more, the sameor less physically stressful; mentallystressful; dangerous; training
19)
Why do you participate in the indus-trial fire team? (Rank all the followingand add other as appropriate.) Pay;teamwork; pride; part of job; chal-lenge; other
20)
Provide any additional commentsregarding industrial firefighting.
production of this article is prohibited

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3/21/2018 National Fire Protection Association Report

https://submittals.nfpa.org/TerraViewWeb/ViewerPage.jsp 1/1

Public Input No. 11-NFPA 600-2018 [ New Section after 4.1.3 ]

TITLE OF NEW CONTENT - Structural Guide

This is not a formal submittal; we would like to put this on the committee meeting agenda.

We have developed an incipient fire brigade team and trained them to the interior structural level toguide and assist public fire fighters who may be responding to onsite emergencies.Type your content here ...

Statement of Problem and Substantiation for Public Input

Structural Guide teams are currently not addressed in NFPA 600. Seeking input on whether it needs to be addressed by the committee.

Submitter Information Verification

Submitter Full Name: Jennifer MorrisOrganization: McKee Foods CorporationStreet Address:City:State:Zip:Submittal Date: Wed Jan 03 10:06:23 EST 2018

NO PUBLIC INPUTS RECEIVED ON NFPA 601

ysmithTypewritten Text

Doc: 600

Editorial Review Comments for TC Meeting Date: 3/5/18

Cycle: F18 SD SL: Alex Ing Meeting Date: 4/18-4/19

EXISTING TEXT:

3.3.8 Enclosed Structure. A structure with a roof or ceiling and at least two walls that can present fire hazards to employees, such as accumulations of smoke, toxic gases, and heat, similar to those found in buildings. EDITORIAL COMMENT

Examples shouldn’t be given in definitions. Recommend reworking this as follows:

3.3.8 Enclosed Structure.

A structure with a roof or ceiling and at least two walls that can present fire hazards like those found in buildings to employees.

A.3.3.8 Enclosed Structure.

Examples of fire hazards that occur in enclosed structures include, but are not limited to, accumulations of smoke, toxic gases, and heat.

SL COMMENT TC Accept

EXISTING TEXT:

3.3.27 Thermal Protective Clothing. Protective clothing such as helmets, footwear, gloves, hoods, trousers, and coats that are designed and manufactured to protect the facility fire brigade member from the adverse effects of fire. EDITORIAL COMMENT

Examples shouldn’t be given in definitions. Recommend reworking this as follows: 3.3.27 Thermal Protective Clothing.

Protective clothing that is designed and manufactured to protect a facility fire brigade member from the adverse effects of fire.

A.3.3.27 Thermal Protective Clothing.

Examples include helmets, footwear, gloves, hoods, trousers, and coats. SL COMMENT TC Accept, also might have them align with 2112, or 2113

EXISTING TEXT:

4.2 Organization and Administration.

4.2.1 Corporate or local management…

(4)*Establishing a written policy for the medical and jobrelated physical performance requirements for facility fire brigade members EDITORIAL COMMENT

Should job-related physical performance requirements have an en dash in it when paired with medical as is true here? If so, we should make a global change that fixes any other such instance. SL COMMENT TC

EXISTING TEXT:

4.2.2.3 The organizational statement shall be available for inspection by the authority having jurisdiction, the facility fire brigade members, and their designated representatives.

EDITORIAL COMMENT

Whose designated representatives? The members'? If so, we should specify. "...and the members' designated representatives."

SL COMMENT TC

EXISTING TEXT:

4.5.1.1 The risk management policy shall include the following recognized principles: EDITORIAL COMMENT

Missing mandatory language! I've offered a fix below: "The risk management policy shall include the following recognized principles:" SL COMMENT

EXISTING TEXT:

4.7.3 Drills shall be evaluated for all of the following: (1) Training and education program EDITORIAL COMMENT

What about the training and education program is being evaluated in the drill? Adherence to it? We should specify. SL COMMENT TC

EXISTING TEXT:

4.9.2 Facility Fire Brigade Leader.

(5) For site-specific hazards,hazardous materials, and processes to which the facility fire brigade can be exposed: (a) Develop pre-incident plans (b) Inform facility fire brigade members

EDITORIAL COMMENT

Recommend removing sublist as below to resolve lack of proper lead-in sentence to the sublist and maintenance of list item making sense with main lead-in: "(5) Developing pre-incident plans for and informing facility fire brigade members of site-specific hazards, hazardous materials, and processes to which the facility can be exposed" SL COMMENT TC

EXISTING TEXT:

4.11.4 There shall be an inventory of facility fire brigade equipment meeting all of the following: (1) Written list maintained on-site (2) Equipment location (3) Reviewed annually (4) Updated as needed for accuracy and new acquisitions EDITORIAL COMMENT

Rewrite to improve linear structure/grammar?

4.11.4 There shall be an inventory of facility fire brigade equipment meeting all of the following requirements: (1) A written list shall be maintained on-site. (2) Equipment locations shall be specified. (3) The inventory shall be reviewed annually. (4) The inventory shall be updated as needed for accuracy and new acquisitions.

SL COMMENT TC EXISTING TEXT:

4.12.2.1 Qualified apparatus operators shall have completed formal training using performance-based standards. EDITORIAL COMMENT

This is worded strange. Rewrite? 4.12.2.1 Facility fire brigade apparatus operators shall be considered qualified once they complete formal training using performance-based standards. SL COMMENT TC

EXISTING TEXT:

6.3 Operational Requirements…

…the following: (1) Personnel who are not trained in accordance with this standard are not permitted to enter the warm or hot zones established for a fire emergency. (2)*SCBA and thermal protective clothing are worn by facility fire brigade members entering the hot zone. (3) Thermal protective clothing is worn by facility fire brigade members entering the warm zone. (4) Facility fire brigade members operate in teams of two or more in response to fires that have advanced beyond the incipient stage. (5) Facility fire brigade members operating in the hot and warm zones have an established communications system. (6) When facility fire brigade members are operating in the hot zone, at least one facility fire brigade member with the capability to call for assistance remains outside the hot zone and maintains an awareness of the safety of facility fire brigade members located inside the hot zone. (7) When facility fire brigade members are operating in the hot zone, additional brigade members are standing by in the warm zone with approved equipment to provide assistance or rescue. (8) Facility fire brigade members positioned in the warm zone are visible to command positions at all times. (9) Personnel and facility fire brigade members positioned in any fire zone have opportunity to relocate to an alternate position should fire conditions change. (10) Experienced facility fire brigade members oversee activities of less experienced brigade members during firefighting operations.

EDITORIAL COMMENT

Change these list items to requirements? (Shall not be permitted/shall be worn/shall be/shall operate/shall have/shall remain/shall maintain/shall be/shall be/ shall have the opportunity/shall oversee)

SL COMMENT TC EXISTING TEXT:

Annex A

A.1.1

In OSHA, 29 CFR 1910.156, two types of facility fire brigades are defined… EDITORIAL COMMENT

1910.156 is actually in Subpart L, not the other way around. Not necessary to specify the subpart.

SL COMMENT TC

EXISTING TEXT:

Annex A

A.1.1

This distinct advantage of familiarity achieves a higher level of facility fire brigade safety and allows for the fundamental difference between a municipal fire department and an facility fire brigade. EDITORIAL COMMENT

This sentence doesn't really make sense. Please rewrite for clarity.

SL COMMENT TC

EXISTING TEXT:

A.1.3.1 This standard is intended to meet or exceed the facility fire brigade–related requirements of OSHA, 29 CFR 1910, Subpart L, “Fire Protection.” EDITORIAL COMMENT

1910 is in Chapter XVII, not the other way around. No need to specify chapter.

SL COMMENT TC

EXISTING TEXT:

A.3.3.9

(2) College or University Campus. A science laboratory might need a fire brigade dedicated to the special hazards of the laboratory. Other occupancies uses on campus, including EDITORIAL COMMENT

Should be "occupancies," right? Since the examples are occupancies? SL COMMENT TC

EXISTING TEXT:

A.3.3.14.4 Interior Structural Fire Fighting. This definition is modified from OSHA, 29 CFR 1910. EDITORIAL COMMENT

It is not a word-for-word extract, so I suggest changing the wording here. Perhaps “modified”?

SL COMMENT TC

EXISTING TEXT:

A.3.3.17 Incident Management System (IMS). The system is

also referred to as an incident command system (ICS).

The implementation of HSPD-5 led to the development of

EDITORIAL COMMENT

Is this well-known to the readers or should this be explained?

SL COMMENT TC

EXISTING TEXT:

A.4.1.3 A facility fire brigade operating in multiple types should clearly identify each brigade member to show the type of fire incident activities for which they are trained. EDITORIAL COMMENT

This is confusing. Rewrite as follows, or similar? "A facility fire brigade classified in multiple types of response should clearly identify each brigade member and the type of fire incident activities for which each member is trained."

SL COMMENT TC

EXISTING TEXT:

A.4.2.2

ABC Facility Fire Brigade Organizational Statement

Organization: The brigade is headed by a brigade chief. A shift facility fire brigade leader is also assigned to each shift. In the absence of the chief, the shift chief is in charge of the brigade. During a fire incident, the shift chief or brigade chief is in charge of the incident until the local municipal fire department arrives. At this time, the officer in charge of the fire department forces on scene and the shift chief will establish a joint incident command. EDITORIAL COMMENT

Shouldn't it be "shift leader" as explained directly above?

SL COMMENT TC

EXISTING TEXT:

A.4.2.1(3) The establishment of a written policy for the occupational safety and health of facility fire brigade members is intended to help prevent, and reduce the severity of, accidents, injuries, and exposures that occur. An existing corporate safety program or policy could satisfy the requirements of this standard. EDITORIAL COMMENT

The word "help" is extraneous here since "intended" implies it is not absolute. Rewrite as follows: "...is intended to prevent and reduce the severity of accidents, injuries, and exposures that occur."

SL COMMENT TC

EXISTING TEXT:

A.4.2.1(4) The establishment of a written policy for medical and job-related physical performance requirements should help ensure facility fire brigade members are medically and physically capable of performing their required duties and reduce the risk of injuries and illnesses. EDITORIAL COMMENT

Rewrite as follows: "...requirements is intended to ensure facility fire brigade members..." "...performing their required duties and to reduce the risk..."

SL COMMENT TC

EXISTING TEXT:

A.4.2.2

ABC Facility Fire Brigade Organizational Statement

November 2004

EDITORIAL COMMENT

Can we replace with a more current year? 2018 perhaps? SL COMMENT TC

EXISTING TEXT:

A.4.6.2

For information on performance standards for facility fire brigade instructors, see NFPA1041 or equivalent performance standards. EDITORIAL COMMENT

Should this paragraph be moved to the end? SL COMMENT TC

EXISTING TEXT:

A.4.6.2

Where facility fire brigade training is contracted and provided by individuals or agencies outside of the company organization, the designated fire training coordinator should verify and ensure that instructors providing the training are knowledgeable in the subjects being presented. Such training should be accomplished using prepared lesson plans and performance-based standards that have been approved by the facility fire brigade training coordinator. Workers and members of the facility fire brigade who have been trained in the methods of teaching and are recognized by the fire training coordinator as knowledgeable in the subject being presented can provide instruction to the facility fire brigade with the use of prepared lesson plans and performance-based standards that have been approved by the fire training coordinator. EDITORIAL COMMENT

These two paragraphs are incredibly similar. Propose a rewrite combining the two subjects? "Whether facility fire brigade training is contracted and provided by individuals or agencies outside of the company organization or is provided by in-house members of the facility fire brigade who have been trained in teaching methods, the designated facility fire brigade training coordinator should verify and ensure that instructors providing the training are knowledgeable in the subjects being presented. Such training should be accomplished using prepared lesson plans and performance-based standards that have been approved by the facility fire brigade training coordinator." SL COMMENT TC combine?

EXISTING TEXT:

A.4.11.2

(2) Hose and hose accessories in accordance with NFPA 1961 and maintained in accordance with NFPA 1962 EDITORIAL COMMENT

Should this be "selected in accordance with NFPA 1961"? (And maintained in accordance with NFPA 1962?)

SL COMMENT TC

EXISTING TEXT:

A.6.3(2) Industrial fire brigade members using SCBA should be fit-tested to meet the requirements of NFPA and 29 CFR 1910.134, “Respiratory Protection.” EDITORIAL COMMENT

Should this be "Facility" (per global change from industrial to facility in previous edition)? The requirements of NFPA? Should there be a document number here? SL COMMENT TC

Agenda for April 2018 First Draft MeetingMinutes of February 2014 Second Draft MeetingAttachment No. 7 - A Brief History of NFPA 600Firefighter paper Fitness_for_Duty_Assessments_of_Industrial.14.pdfOutline placeholderREFERENCES

Public Input Report on 600Public Input Report on NFPA 600 (NO PI's Received) Attachment 10-b: Editorial Comments for TC Review on NFPA 600

nfpa 600/601 first draft meeting...nfpa technical committee on loss prevention procedures and...

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