title: Stress testing in the medical evaluation for hazardous materials duty: results and consequences in three groups of candidates.
abstract: OBJECTIVE
  The objective of this study was to determine the yield of exercise stress testing (GXT) and other methods for evaluating candidates for HAZMAT duty.
  
  
  METHODS
  The authors conducted an analysis of prior and current records of GXTs, medical examinations, blood tests, chest radiographs, spirometry, and audiometry in 190 candidates. The authors also conducted scrutiny of GXT results, using Duke Treadmill Score (DTS), Chronotropic Index (CI), and Heart Rate Recovery (HRR).
  
  
  RESULTS
  Seven candidates were disapproved by history and/or physical examination. Twenty-one others were deferred for GXT-induced, marked hypertension, and/or ST depression >/=2 mm. The latter appeared to be false-positive indications of ischemia, low risks confirmed by DTS, CI, and HRR. Heat stress was not induced in 26 subjects so evaluated.
  
  
  CONCLUSIONS
  GXT identified marked hypertension in 12 HAZMAT candidates and ischemic ST changes in 10, the latter appearing to be false-positives. Other testing yielded useful baselines, rarely disqualifying.
authors.affiliation: Department of Family Medicine and Carolinas Poison Center, Carolinas Healthcare System, Charlotte, North Carolina, USA. larryr@med.unc.edu
authors.forename: Lawrence W
authors.initials: LW
authors.lastname: Raymond
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Barringer
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Konen
mesh_terms: D000328:Adult; D001774:Blood Chemical Analysis; D015992:Body Mass Index; D004562:Electrocardiography; D005080:Exercise Test / Q000379:methods*; D005260:Female; D015386:Hazardous Substances; D006403:Hematologic Tests; D006801:Humans; D008297:Male; D009787:Occupational Medicine / Q000379:methods*; D013902:Radiography, Thoracic; D013147:Spirometry; D016482:Urinalysis; D014792:Visual Acuity; D014938:Work Capacity Evaluation
chemical_list: D015386:Hazardous Substances