title: Correlates of fitness for duty in hazardous materials firefighters.
abstract: METHODS
  From a statewide medical examination program, we identified firefighters who were deemed unfit for duty by attending physicians (ATTENDING FAIL, n=9) and those who would have been disqualified by the application of selected numerical criteria from the 1997 National Fire Protection Association (NFPA) guidelines (NFPA FAIL, n=27) and criteria from a Medical Workshop (WORK FAIL, n=16). The subjects who were unfit for duty or failed numerical criteria were compared with those who were fit for duty and passed all objective criteria (FIT group, n=302). All subjects were given an overall morbidity rating by a board certified internist. Comparisons on two surrogate measures of fitness, VO(2) max predicted and predicted coronary heart disease (CHD) risk, were also performed.
  
  
  RESULTS
  We found a significant tendency towards worse results (e.g. higher blood pressure or lower spirometric function) among the three FAIL groups compared with the FIT group. The FAIL groups shared only a small overlap, however, with the firefighters with the highest morbidity ratings, lowest predicted VO(2) max, and highest CHD risks. Increasing morbidity was associated with higher age, lower spirometric function, lower predicted VO(2) max, increasing cholesterol, greater BMI, and higher predicted 10 year CHD risk.
  
  
  CONCLUSIONS
  Although the presence of a single serious or poorly controlled condition may render an individual unfit for safe performance as a firefighter, examination of our cohort suggests that multiple risk factor models or overall clinical assessments are superior means of identifying firefighters with poor health status and increased CHD risk.
authors.affiliation: Occupational Medicine, Department of Medicine, The Cambridge Hospital, Cambridge, MA 02139, USA. stefokali@aol.com
authors.forename: S N
authors.initials: SN
authors.lastname: Kales
authors.forename: J M
authors.initials: JM
authors.lastname: Aldrich
authors.forename: G N
authors.initials: GN
authors.lastname: Polyhronopoulos
authors.forename: E O
authors.initials: EO
authors.lastname: Leitao
authors.forename: D
authors.initials: D
authors.lastname: Artzerounian
authors.forename: T H
authors.initials: TH
authors.lastname: Gassert
authors.forename: H
authors.initials: H
authors.lastname: Hu
authors.forename: K T
authors.initials: KT
authors.lastname: Kelsey
authors.forename: C
authors.initials: C
authors.lastname: Sweet
authors.forename: D C
authors.initials: DC
authors.lastname: Christiani
mesh_terms: D000328:Adult; D003327:Coronary Disease / Q000453:epidemiology; D005390:Fires; D015386:Hazardous Substances; D006801:Humans; D008875:Middle Aged; D016272:Occupational Health; D010101:Oxygen Consumption; D010809:Physical Fitness; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D015386:Hazardous Substances