Atlanta, GA -- Fire departments, in the process of selecting or changing physician services for personnel in their command, should keep in mind that all medical providers are not equal when delivering required physicals, wellness programs and diagnostics to special-needs patients such as firefighters. That is the conclusion of an industry evaluation by SiteMed, a physician-owned occupational medicine company, specializing in on-site firefighter care.
The evaluation, compiled by Gonzalo Fernandez, M.D. and Lance Walker, D.O. who are principals in SiteMed with some 20 years experience in occupational medicine, found a number of common mistakes and/or incorrect assumptions in the firefighting industry’s selection process. Most can be easily avoided.
The team found the most common error to be in the type of physician selected. “Ideally, the medical firm selected to provide services should have a single doctor in charge of the entire program and he/she should be dedicated to that position, year after year, in order to provide consistency and personal patient knowledge from exam to exam,” noted Dr. Fernandez.
Dr. Fernandez stressed the need for a simple process ensuring quick medical feedback for a firefighter with a new medical diagnosis or medication change. “If you have a question, say six months after a routine exam or some rehabilitation, the doctor should not have to familiarize himself with the patient and their history first.”
He added that the physician must have intimate knowledge of the NFPA 1582 Standard, experience which a primary care provider may not possess.
The doctors also found that the dual purpose of immediate treatment and a quick clearance to return to duties, both high priorities in emergency personnel such as firefighters, was, in many cases, misunderstood by medical practitioners whose primary concerns were diagnosis and treatment only.
“There is immediacy to keeping firefighters on the job and, many times there are options other than a recommendation to see a specialist or medications which may disqualify return to duties for a period of time,” Dr. Walker pointed out. “It’s a matter of understanding the industry, how it operates, knowing the applicable standards and the personnel you are treating or examining regularly and having your priorities in sync with the client.”
Although no doctor is going to sacrifice the medical safety of a firefighter for expediency, Doctors Fernandez and Walker found having the experience of optional treatment and its outcomes have helped many fire departments with their consistent readiness and full complement of personnel. Other findings included:
• Advance understanding of the total program by all firefighters is needed to provide a comfort level that the process is not a tool for “weeding out” the unfit, punitive in any way and will be protected by privacy standards. It is provided to insure that each firefighter remains as fit as possible as long as possible. Ongoing wellness programs, complete with diet and exercise recommendations, were perfect, and often insurance-lowering, additions to the annual physical requirements.
• Medical staff training in all areas specific to firefighter regulation, such as NIOSH training for pulmonary function testing and CAOHC certification for audio testing, were often not a requirement in the selection process. The presumption, again often, is that every medical professional has that training and that is just not the case.
• Assurance that a chosen doctor not only has the basic NFPA physical knowledge but can interpret the intent of the rules and act accordingly is often not selection criteria. Again, most primary care doctors will not have this type of experience, and probably do not practice it regularly.
• The medical provider needs to have modernized, well-maintained equipment so the firefighters have confidence in the medical personnel and the testing results.
“Consistency, specialized knowledge of the firefighting industry, experience in the diagnosis and treatment of the most commonly found problem areas and a ‘mind-meld’ between the physician and his client are imperative for the best fire industry programs,” Dr. Fernandez summarized. “Even though the occupational doctor works closely with primary care doctors and specialists if serious conditions are detected, we have found occupational physicians are the better match for a firefighting group on a normal day-to-day basis.”