(MD or DO only) C-TEC Public Safety Physical · They will complete the CTEC Public Safety Physical. The Fire/EMT physical will be $455.00 which will include a chest x-ray and stress

Rev. 9/27/18

C-TEC Public Safety Students,

We are looking forward to seeing you soon!

As you proceed to fulfill the physical fitness verification requirement for our public safety programs,

please note that you have two options:

1. Have your family physician (MD or DO only) complete the accompanying C-TEC Public Safety

Physical.

OR

2. You may utilize Licking Memorial Occupational Health located at 1865 Tamarack Rd. in Newark.

They will complete the CTEC Public Safety Physical. The Fire/EMT physical will be $455.00 which

will include a chest x-ray and stress test. The EMT physical will be $125.00. If you plan to take

both classes within a 15-month period of time mark both the Fire and EMT boxes on your

physical form.

In order to make an appointment at Licking Memorial Occupational Health, simply call the main

line, 220-564-4972, and tell the clerk you need to schedule a Student Firefighter/EMT physical

for CTEC/COTC.

Additional questionnaires that are included with the Licking Memorial Occupational Health

physical should be completed prior to your appointment to decrease the amount of time spent

at Occupational Health. Because Licking Memorial Occupational Health specializes in pre-

screenings and physicals with public safety agencies in central Ohio, some of the language is

employee oriented and can be completed as applicable.

o Patient Demographic – complete ”Patient Information” and “Reason for Visit Today”

sections (Reason for visit = CTEC/COTC Fire Fighter/EMT Physical)

o NFPA Firefighter / Police Questionnaire – complete all

o OSHA Respirator Medical Evaluation Questionnaire – complete all

o LMHP Occupation Health Audiometric Exam – complete patient section only

o Sleep Apnea Questionnaire – complete patient section only

*If you plan to take both the Fire and EMT classes within a 15-month period of time mark the Fire &

EMT box on your physical form not the EMT Only.

Please call 740-364-2282 in the event you have questions.

Thank you,

Erna Holland

C-TEC Public Safety Coordinator

PHYSICAL FITNESS VERIFICATION

for C-TEC Firefighting & EMT Students STUDENTS FULL NAME:___________________________________________ D.O.B. _____ / _____ / __________ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

TO THE PHYSICIAN (M.D. or D.O. ONLY)

Your Patient will be engaging in very strenuous and physically demanding exercise and activities while enrolled in the Firefighter Training and/or EMT training program @ C-TEC, and as such, is required by law to undergo a National Fire Protection Association (NFPA) 1582 compliant medical evaluation prior to beginning this course of study.

Please utilize the following 18 pages as your guidance for the NFPA 1582 Standard on Medical Requirements for Firefighters.

Physician’s Statement:

After conducting a thorough NFPA 1582 compliant examination and considering the

physical, physiological, intellectual, and psychological demands of Firefighting and/or EMT

training, I find no medical reason that ___________________________________ should be (Student’s Full Name)

excluded from performing the essential job tasks associated with the following occupational

course(s) of study:

FIREFIGHTING & EMT

EMT ONLY __________________________________ ________________________________ _____ / _____ / __________ Physician’s Name (Printed) Physician’s (Signature) DATE __________________________________ ________________________________ Physician’s Office Address Physician’s Medical License # __________________________________ City, State & Zip Code __________________________________ Physician’s Office Ph. #

__________________________________ _____ / _____ / __________ Students’s (Signature) DATE

REFERENCE MATERIAL BASED ON NFPA 1582:

STANDARD ON COMPREHENSIVE OCCUPATIONAL MEDICAL PROGRAM FOR FIRE DEPARTMENTS 2013 EDITION

This document is provided as a reference resource for physicians when determining the fitness of the candidate for

firefighting and/or emergency medical technician duties prior to entry into the Career & Technology Educational Centers

Please evaluate the candidate for any existing Category A or Category B medical conditions (pages 3 - 18) in reference

to the their ability to safely perform the Essential Job Tasks and Descriptions (listed on page 2), as related to their

respective course of study. (i.e., Firefighter [FF] or Emergency Medical Technician [EMT])

(C-TEC) training program(s).

or emergency operational environment by presenting a significant risk to the safety and health of

the person or others.

Candidates with CATEGORY B medical conditions shall be certified as meeting the medical

requirements for acceptance into the C-TEC EMT, FFI or FFII training program ONLY if they can

Category A: A medical condition that would preclude a person from performing as a member in a training

Category B: A medical condition that, based on its severity, could 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.

perform the essential job tasks WITHOUT posing significant safety and health risk to themselves,

members or civilians.

Candidates with CATEGORY A medical conditions SHALL NOT be certified as meeting the requirements

for acceptance into the C-TEC EMT, FFI or FFII training program.

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FF EMT

X (1)

X X (2)

X X (3)

X (4)

X (5)

X X (6)

X (7)

X (8)

X X (9)

X X (10)

X X (11)

X (12)

X X (13)

Essential Job Tasks and Descriptions.

and psychological demands of the occupation should be included when evaluating the candidate's ability to

perform the essential job tasks. The medical evaluation shall include a medical history, physical examination,

Purpose:

systems (sprinklers)

Functioning as an intergral component of a team, where sudden incapacitation of a member can

Exposure to toxic fumes, irritants, particulates, biological (infectious) and nonbiological hazards

and/or heated gases, despite the use of personal protective ensembles and SCBA

result in significant fluid loss that frequently progresses to clinical dehydration and can elevate core

temperature to levels exceeding 102.2 F (39 C)

Searching, finding, and rescue-dragging or carrying victims ranging from newborns to adults weighing

Depending on the local jurisdiction, climbing six or more flights of stairs while wearing a fire

protective ensemble, including SCBA, weighing a least 50 lb (22.6kg) or more and carrying equipment/

tools weighing an additional 20 to 40 lb (9 to 18 kg)

Wearing a fire protective ensemble, including SCBA, that is encapsulating and insulated, which will

other emergency response actions under stressful conditions including working in extremely hot or

cold environments for prolonged periods of time

Wearing SCBA, which includes a demand-valve type positive-pressure facepiece or HEPA filter masks,

which requires the ability to tolerate increased respiratory workloads

While wearing personal protective ensembles (PPE) and self-contained breathing apparatus (SCBA),

result in mission failure or in risk of injury or death to civilians or other team members.

over 200 lb (90 kg) to safety despite hazardous conditions and low visibility.

(FF while wearing PPE and SCBA)

While wearing PPE and SCBA, climbing ladders, operating from heights, walking or crawling in the

dark along narrow and uneven surfaces that might be wet or icy, and operating in proximity to

electrical power lines or other hazards

Unpredictable emergency requirements for prolonged periods of extreme physical exertion

without benefit of warm-up, scheduled rest periods, meals, access to medication (s), or hydration

Operating fire apparatus or other vehicles in an emergency mode with emergency lights and sirens

Critical, time-sensitive, complex problem solving during physical exertion in stressful, hazardous

environments, including hot, dark, tightly enclosed spaces, that is further aggravated by fatigue,

flashing lights, sirens, and other distractions

Ability to communicate (give and comprehend verbal orders) while wearing PPE and SCBA under

conditions of high background noise, poor visibility, and drenching hoselines and/or fixed protection

from fire apparatus to an occupancy [approximately 150 ft (50 m)], which can involve negotiating

multiple flights of stairs, ladders, and other obstacles

While wearing PPE and SCBA, advancing water-filled hoselines up to 2 1/2 inch (65mm) in diameter

objects, ventilating roofs or walls using power or hand tools, forcible entry), rescue operations, and

perform firefighting tasks (e.g., hoseline operations, extensive crawling, lifting and carrying heavy

Firefighter I and/or Firefighter II training program. Consideration to the physical, physiological, intellectural

and any laboratory tests required to detect physical or medical condition (s) that could adversely affect his/her

ability to safely perform the essential tasks as specified in NFPA1582, Chapter 5, and listed as follows:

A medical evaluation of this candidate shall be performed prior to his/her admittance into the C-TEC EMT,

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Far visual acuity less than 20 / 40 binocular, corrected with contact lenses or spectacles, or far visual acuity

Deformities of the skull associated with evidence of disease of the brain, spinal cord, or peripheral nerves

to communicate effectively due to oropharyngeal dysfunction

Loss or congenital absence of the bony substance of the skull that could result in the inability to properly wear

perform one or more of the essential job tasks.

Category B medical conditions include the following:

Category A medical conditions include the following:

Head

less than 20 / 100 binocular for wearers of hard contacts or spectacles, uncorrected. (Successful long-term soft

contact lens wearers [i.e., six months without a problem] are not subject to the uncorrected standard.

Color perception - monochromatic vision resulting in inability to use imaging devices such as thermal

imaging cameras. This does not refer to abnormal color perception such as red/green color blindness

Monocular vision. Eligibilty for a DOT / CDL exemption is not applicable.

Any eye condition which results in the candidate being unable to safely perform one or more of the

essential job task.

Diseases of the eye such as retinal detachment, progressive retinopathy, or optic neuritis which can result in

Thoracic outlet syndrome which results in frequent episodes of pain or inability to perform work

Congenital cyst, chronic draining fistulas, or similar lesions which result in the inability to properly wear

protective equipment and the inability to communicate effectively due to oropharyngeal dysfunction

Contraction of neck muscles which result in the inability to properly wear protective equipment and the

inability to safely perform functions as a team member due to limitation of flexibility

Any skull or facial deformity that would not allow for a successful fit test for respirators used by the fire

service

Any head condition that results in the candidate not being able to safely perform one or of the essential

job tasks

Deformities of the skull such as depressions or exostoses which prevent proper wearing of protective

equipment

the failure to read placards and street sighn or to see and respond to hazardous situations

Opthalmological procedures such as radial keratotomy, Lasik procedure, or repair of retinal detachment

without sufficient time to allow stabilization of visual acuity and to ensure that there are no post-surgical

complications (approximately 2 weeks for radial keratotomy and Lasik-type surgeries, and 3 months for

retinal detachment).

Eyes and Vision

Neck

Category A medical conditions include any neck condition tha results in the candidate not being able to safely

Category B medical conditions shall include the following:



protective equipment, or the ability to communicate effectively due to oropharyngeal dysfunction

that could result in sudden incapacitation the inability to properly wear protective equipment, or the ability

Medical conditions Affecting Ability to Safely Perform Essential Job Tasks.

Head and Neck

Defect of skull preventing helmet use or leaving underlying brain unprotected.

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Any ear condition (or hearing impairment) which results in the candidate being unable to safely perform one

more of the essential job tasks.

Understanding spoken commands, both over the radio and while wearing SCBA

Hearing alarm signals, including building evacuation, low air alarm on the SCBA, and PASS alarms

Hearing and locating the source of calls for assistance from victims or other firefighters.

Chronic vertigo or impaired balance as demonstrated by 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

Meniere's syndrom or severe labyrinthitis.

Average uncorrected hearing deficit at the test frequencies of 500 Hz, 1000 Hz, 2000Hz, and 3000 Hz greater

Ears and Hearing

There are currently no hearing tests that accurately predict whether the firefighter will adequately be able to safely

perform essential job duties. Physician evaluation of the candidate should be completed based on the candate's

performance in reference to the following hearing specific tasks:

Bear in mind that all of these tasks are performed with varying background noise levels. Inablity to hear sound of

intensity or to distinguish voice from background noise can lead to failure to respond to immintently hazardous

Hearing aid or cochlear implant unless the candidate meets the criteria above criteria without them

Unequal hearing loss which leads to the inability to localize sounds, leading to failure in the ability to safely

perform search and rescue and other localization tasks.

Peripheral vision in the horizontal meridian of less than 110 degrees in the better eye or any condition that

significantly affects peripheral vision in both eyes.

Eyes and Vision/Category B (continued)

situations.



Atresia, stenosis, or tumor of the auditory canal.

Severe recurrent external otitis which results in the inability to hear sounds of low intensity or to distinguish

voice from background noise, leading to failure to respond to imminently hazardous situations.

Agenesis or traumatic deformity of the auricle which results in the ability to properly wear protective

equipment and the inability to hear sounds of low intensity or to distinguish voice from background noise,

leading to failure to respond to imminently hazardous situations.

Severe mastoiditis or surigical deformity of the mastoid which results in the inability properly wear

protective equipment and the inability to hear sounds of low intensity or to distinguish voice from back-

ground noise, leading to failure to respond to imminently hazardous situations.

Testing.

Chronic otitis media which results in frequent episodes of pain and the inability to hear sounds of low

intensity or to distinguish voice from background noise, leading to failure to respond to imminently

than 40 dB in either ear.

hazardous situations.

Surgical procedures to correct or improve hearing or other conditions of the ear.

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Active hemoptysis

Current empyema

Pulmonary hypertension

Active tuberculosis

A forced vital capacity (FVC) or forced expiratory volume in 1 second (FEV) less than 70 percent predicted

independent of disease.

Obstructive lung diseases (e.g., emphysema, chronic bronchitis, asthma) with an absolute FEV₁/FVC less than

0.70 and with either the FEV₁ below normal or both the FEV₁ and the FVC below normal (less than 0.80).Hypoxemia - oxygen saturation less than 90 percent at rest or exercise desaturation by 4 % or to less than 90 %

(exercise testing indicated when resting oxygen is less than 94 % but greater than 90 %).

properly wear protective equipment.

Extensive oral tissue loss which results in the inability to wear protective equipment and the inability to

communicate effectively due to oropharyngeal dysfunction.

Relationship between the mandible and maxilla that interferes with satisfactory post-orthodontic

replacement or ability to use protective equipment or communicate due to oropharyngeal dysfunction.

Nose, Oropharynx, Trachea, Esophagus and Larynx


Dental

Category A medical condititions include any dental condition that results in inability to safely perform one or more of

safely perform one or more of the essential job tasks.


Diseases of the jaws or associated tissues which result in the inability to communicate effectively and / or to

properly wear protective equipment.

Orthodontic appliances which result in the inability to communicate to communicate effectively and / or to

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

Tracheostomy

Aphonia

response, P-100 for particulates and certain vapors, and SCBA for fire and hazmat operations.


Congenital or acquired deformity which results in the inability to properly wear protective equipment.

Allergic rhinitis which results in frequent episodes of pain and the inability to safely perform work, and the

inability to safely perform essential job tasks due to limitations of endurance.

Recurrent Epistaxis

Recurrent Sinusitis which results in frequent episodes of pain and the inability to safely perform essential job

tasks due to limitations of endurance and the inability to safely wear SCBA from facial pain, sinus congestion

and / or coughing.

Severe Dysphonia which results in the inability to communicate effectively due to oropharyngeal dysfunction

Anosmia

Tracheal stenosis

Nasopharyngeal polyposis

Obstructive apneas if unresponsive to treatment.

Lungs and Chest Wall


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on several studies.

Bronchiectasis, if abnormal pulmonary function or recurrent infections

Infectious diseases of the lung or pleural space

Cystic fibrosis

Aerobic Capacity

Category A medical conditions include an aerobic capacity less than 12 metabolic equivalents (METS)

(12 METs = 42 mL O₂/kg/min). The evaluation of aerobic capacity should be performed after appropriate medical

evaluation. Testing should be conducted using an appropriate maximal or sub maximal protocol. Bicycle

ergometry is not appropriate because it underestimates true aerobic capacity. A low aerobic capacity can be an

indicator of, and is a risk factor for, ischemic heart disease. For firefighting, 12 METs or greater is necessary based

Asthma - reactive airways disease requiring bronchodilator or corticosteroid therapy for 2 consecutive months

in the previous 2 years, unless the candidate can meet the following requirements:

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 disease, such as an allergist.

Lungs and Chest Wall / Category A (continued)

Any pulmonary condition that results in the candidate not being able to safely perform one or more of the

essential job tasks

Lung transplant

to determine if the candidate meets all of the following;

a. Asthma has resolved without symptoms off medications for 2 years,

b. Allergen avoidance or desensitization has been successful,

c. Spirometry demonstrates adequate reserve (FVC and FEV₁ greater than or equal to 90 %) and no broncho-

Central or obstructive apnea (e.g., sleep apnea) if unresponsive to treatment

dilator response measured off all bronchodilators on the day of testing.

d. Normal or negative response to provocative challenge testing [e.g., cold air, exercise (12 METS),

methacholine, histamine, mannitol, or hyperetonic saline] or negative response to exercise challenge.

Challenge testing shall be performed off 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 1 week, and off all bronchodilators on the day of testing.


Pulmonary resectional surgery, chest wall surgery, and pneumothorax that results in the inability to safely

perform essential job tasks due to limitations of strength or endurance could result in the potential for

sudden incapacitation.

Pleural effusion

Fibrothorax, chest wall deformity, and diaphragm abnormalities that result in inability to safely perform

essential job tasks due to limitations of endurance.

Interstitial lung diseases

Pulmonary vascular diseases or history of pulmonary embolism

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(3) Aortic stenosis is acceptable if stenosis is mild -- that is, mean aortic valvular pressure gradient is less than

20 mm Hg.

(4) Aortic regurgitation is acceptable if left ventricular size is normal or slightly increased and systolic

Cardiac hypertrophy of hypertrophic cardiomyopathy

History of congenital abnormality that has been treated by surgery but with residual complications or that has

not been treated by surgery, leaving residuals or complications.

Chronic pericarditis, endocarditis, or myocarditis.

function is normal.

(5) Prosthetic valves are acceptable unless anticoagulaton is in effect.

Recurrent supraventricular or atrial tachycardia, fllutte, or fibrillation

Left bundle branch block unless exercise can be performed with an adequate heart rate response

Second-degree atrioventricular block in the absence of structural heart disease

sinus pause more than 3 seconds

Ventricular arrhythmia (history or presence of multifocal PVC's or nonsustained ventricular tachycardia on

resting EKG with or without symptoms; history or presence of sustained ventricular tachycardia with or

without symptoms).

Medical clearance requires the following:

(1) An echocardiograph that shows normal function and no evidence of structural abnormalities

(2) Stress testing with imaging to a workload of at least 12 METs off cardiac medications that shows no

evidence of ischemia, ventricular tachycardia, or ventricular fibrillation. Premature Ventricular

(PVCs) should resolve with increasing levels of exercise.

Recurrent syncope

A medical condition requiring an automatic implantable cardiac defibrillator or history of ventricular tachy-

cardia or ventricular fibrillation due to ischemic or valvular heart disease, or cardiomyopathy.

Heart transplant


Valvular lesions of the heart, including prosthetic valves -- Specific recommendations include the following:

(1) Mitral stenosis is acceptable if in sinus rhythm and stenosis is mild -- that is, valve area is greater than

1.5 cm² or pulmonary artery systolic pressure is less than 35 mm Hg.

(2) Mitral insufficiency is acceptable if in sinus rhythm with normal left ventricular size and function.

Heart and Vascular System


Coronary artery disease, including history of myocardial infarction, angina pectoris, coronary 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

Third-degree atrioventricular block

Cardiac pacemaker

Hypertrophic cardiomyopathy, including idiopathic hypertrophic subaortic stenosis

Any cardiac condition that results in the candidate not being able to safely perform one or more of the

essential job tasks

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Peptic or duodenal ulcer or Zollinger-Ellison syndrome with symptoms uncontrolled by drugs or surgery

Abdominal Organs and Gastrointestinal System



Presence of uncorrected inguinal / femoral / hernia regardless of symptoms

Any gastrointestinal condition that results in the candidate not being able to perform one or more of the

essential job tasks

causing incresed risk of infection and / or strangulation

Inflammatory bowel disease which causes disabling pain or diarrhea

Cholycystitis that causes frequent pain due to stones or infections resulting in frequent pain


Vasospastic phenomena such as Raynaud's phenomenon

Thromboplebitis, thrombosis, or varicosities

Chronic lymphedema due to lymphadenopathy or venous valvular incompetency

Congenital or acquired lesions of the aorta or major vessels (i.e. syphilitic aortitis, domonstrable athero-

sclerosis that interferes with circulation and congenital acquired dilation of the aorta)

Circulatory instability as indicated by orthostatic hypotension, persistent tachycardia, and peripheral

vasomotor disturbances

History of surgical repair of aneurysm of the heart or major vessel

Hypertension

(a) Uncontrolled or poorly controlled hypertension (defined as: the presence of end organ damage or stage 2

hypertension [BP systolic > 160 mm Hg or BP diastolic BP diastolic > 100 mm Hg.] Following appropriate

1 month's time.)

(b) Hypertension with evidence of end organ failure

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 vascular condition that results in inability to safely perform one or more of the essential job tasks

and successful management of stage 1 or stage 2 hypertension, a candidate can be evaluated after

Vascular System


Gastritis that causes recurrent pain and impairment

GI bleeding that causes fatigue and / or hemodynamic instability

Acute hepatitis (until resolution of acute hepatitis as determined by clinical examination and appropriate

laboratory testing

Hernia including the following:

(1) Uncorrected umbilical, ventral, or incisional hernia if significant risk exists for infection or strangulation

(2) Significant symptomatic hiatal hernia if associated with asthma, recurrent pneumonia, chronic pain, or

chronic ulcers

(3) Surgically corrected hernia more than 3 months after surgical correction with persistent abnormality

Intestinal obstruction (recent obstruction with impairment)

Chronic or recurrent pancreatitis

Diverticulitis

History of gastrointestinal surgery (a bowel resection with subsiquent frequent diarrhea)

Asplenia

Cirrhosis, hepatic or biliary that is symptomatic or in danger of bleeding

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Diseases of the ureter, bladder, or prostate

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

(3) HDL cholesterol < 40 mg/dl for men, < 50 mg/dl for women

(4) Blood pressure > 135 / 85 mm Hg

(5) Fasting blood glucose > 110 mg/dl

Category A medical conditions include metabolic syndrome with aerobic capacity less than 12 METS

Category B medical conditions include metabolic syndrome with aerobic capacity greater than 12 METS

Reproductive System

Category A medical conditions include any genital condition that results in inability to perform one or more of the

essential job tasks.


Urinary System



Renal failure or insufficiency requiring continuous ambulatory peritoneal dialysis (CAPD) or hemodialysis

Any urinary condition that results in the candidate not being able to safely perform one or more of the

essential job tasks

Pregnancy, for its duration

Dysmenorrhea

Endometriosis, ovarian cysts, or other gynecologic conditions

Testicular or epididymal mass

Diseases of the kidney

Cervical vertebral fractures with multiple vertebral body compression greater than 25 %; evidence of poster-

ior 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

Chronic active hepatis that results in weakness or general malaise

Metabolic Syndrome

Metabolic syndrome includes three or more of the following components:

(1) Abdominal obesity, defined as a waist circumference > 40 inches (>102 cm) in men, > 35 inches (> 88 cm) in women

(2) Triglycerides > 150 mg/dl

Abdominal Organs and Gastrointestinal System / Category B (continued)

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Amputation of either thumb proximal to the mid-proximal phalanx

Amputation or congenital absence of lower-extremity limb (foot or above) unless the candidate meets all of

the following conditions:

(1) Stable, unilateral below-the-knee (BKA) amputation with at least the proximal third of the tibia present

for a strong and stable attachment point with the prothesis

(2) Fitted with a prosthesis that will tolerate the conditions present in structural firefighting when worn in

conjunction with standard fire fighting PPE

(3) At least 6 months of prosthetic use in a variety of activities with no functional difficulties

(4) Amputee limb healed with no significant inflammation, persistent pain, necrosis, or indications of

Extremities


Joint replacement, unless all the following conditions are met:

(1) Normal range of motion without history of dislocations post-replacement

(2) Repetitive and prolonged pulling, bending, rotations, kneeling, crawling, and climbing without pain or

impairment

(3) No Limiting pain

(4) Evaluation by an orthopedic specialist who concurs that the candidate can complete all essential job tasks

Amputation or congenital absence of upper-extremity limb (hand or higher)

neurological deficits, pain, or limit flexibility

Scoliosis with angle less than 40 degrees

Arthritis of the cervical, thoracic, or lumbosacral spine.

Facet atrophism, high lumbosacral angle, hyperlordosis, Schmorl's nodes, Scheuermann's disease, spina

bifida occulta, spondylolisthesis, spondolysis, or transitional vertebrae

History of infections or infarcts in the spinal cord, epidural space, vertebrae, or axial skeletal joints

History of diskectomy or laminectomy or vertebral fractures

History of spine fusion that results in instability; reduced mobility, strength, or range of motion; persistent

pain

Lumbosacral vertebral fractures with vertebral body compression greater than 50 %; evidence of posterior

Spine and Axial Skeleton / Category A (continued)

element involvement, nerve root damage, disc involvement, dislocation (partial, moderate, severe), frag-

mentation, abnormal exam, ligament instability, symptomatic, and / or less than 6 months post injury or less

than 1 year since surgery

Any spinal or skeletal condition that results in the candidate not being able to safely perform one or more of

the essential job tasks


Congenital or developmental malformations of the back, particularly those that can cause instability,

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 %; evidence of posterior

element involvement, nerve root damage, disc involvement, dislocation (severe -- with or without surgery),

(6) Evaluated by a prosthetist or orthopedic specialist with expertise in the fitting and function of prosthetic

limbs who concurs that the candidate can complete all essential job tasks, including wearing PPE and

SCBA while climbing ladders or crawling in the dark along narrow and uneven surfaces that may be wet

or icy.

instability at the amputee limb attachment point

(5) No significant psychosocial issues pertaining to the loss of limb or use of the prosthesis

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training and the performance of the fire-fighter essential job skills.

generalized, and psychomotor seizure disorders other than as follows:

*(1) No seizures for 1 year off all anti-epileptic medication or 5 years seizure free on a stable medication

regimen

specified in *(1) and *(4) [above], and that the candidate is neuroligically cleared for fire-fighting

*(4) Awake and asleep EEG studies with photic stimulation and hyperventilation are normal

(5) A definitive statement from a qualified neurological specialist that the candidate meets the criteria

> Operational environmental impact (e.g., heat, stress, activity, variable night shifts) on the candidates

ability to perform the essential job tasks should be considered and should be specifically addressed by a

neurological specialist

Myasthenia gravis with activity or evidence of progression within previous 3 years, free of disease

exacerbation, off all drugs and other treatment, with normal cognitive function, neurologic exam, and

respiratory status.

Progressive muscular dystrophy or atrophy

Uncorrected cerebral aneurysm

All single unprovoked seizures and epileptic conditions, including simple partial, complex partial,

Neurological Disorders


Ataxias of heredo-degenerative type

Cerebral arteriosclerosis as evidenced by a history of transient ischemic attack, reversible ischemic neuro-

logical deficit, or ischemic stroke

Hemiparalysis or paralysis of a limb

Multiple sclerosis with activity or evidence of progression within previous 3 years:

> The candidate's neurological exam should be normal, and they should not require medications that can

impair their ability to safely perform essential job tasks.

Extremities / Category A - 4 (continued)

(7) Any extremity condition that results in the candidate not being able to perform one or more of the

essential job tasks

(2) Neurologic examination is normal

(3) Imaging (CAT or MRI scan) studies are normal


History of shoulder dislocation with residual instability (subluxation) or significant limitation of motion,

with surgical repair

Significant limitation of function of shoulder, elbow, wrist, hand, or finger due to weakness, reduced range of

motion, atrophy, unequal length, absence, or partial amputation

Significant lack of full function of hip, knee, ankle, foot, or toes due to weakness, reduced range of motion,

atrophy, unequal lenth, absence, or partial amputation

History of meniscectomy or ligamentious repair of knee with residual instability or laxity of ligament or

intra-articular arthritis with resulting instability of limb, inadequate range of motion, or increased pain that

limits crawling, kneeling, jumping, safe ladder use, or safe stretcher carrying.

History of intra-articular, malunited, or nonunion of upper or lower extremity fracture with signs of

symptoms (e.g., pain, swelling, atrophy, range of motion, gait)

History of osteomyelitis, septic, or rheumatoid arthritis with resulting functional impairment, disease

activity, and chronicity.

Bone hardware such as metal plates or rods supporting bone during healing

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9.

10.

11.

1.

2.

3.

4.

5.

1.

2.

3.

1.

2.

3.

4.

Neurological Disorders / Category A (continued)

Dementia (Alzeheimer's and other neurodegenerative diseases) with symptomatic loss of function or cog-

nitive 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


sensation, or complaint of pain

History of subarachnoid or intraparenchymal hemorrhage

Abnormalities from recent head injury such as severe cerebral contusion or concussion

Skin


Metastatic or locally extensive basal or squamous cell carcinoma or melanoma

Congenital malformations

Migraine other than as follows:

Exam and imaging studies should be normal, and medications needed to control chronic pain should not

affect neurologic or cardiac function (energy, cognitive ability, equilibrium, etc.) Examples include the

following;

(1) Neuropathy (cranial, perpheral, plexus, etc.). Motor and sensory neurologic exams and diagnostic /

imaging studies (as needed) should be normal, and medications needed to control pain should not

affect nervous system function (energy, cognitive ability, equilibrium, etc.).

(2) Myopathy and / or myositis. Motor strength is normal, pain is controlled without narcotics, renal function

is normal, and neither heart nor diaphragm is involved.

(3) History of infectious myoneuropathies (e.g., Guillain-Barre , post-botulism, post-polio syndrome).

Cognitive function, neurologic exam, and diagnostic imaging studies (as needed) should be normal.

Clinical disorders with paresis, dyscoordination, deformity, abnormal motor activity, abnormality of

Any dermatologic condition that would not allow for a successful fit test for any required respirators or SCBA

Any dermatologic condition that results in the candidate not being able to safely perform one or more of the


Skin conditions of a chronic or recurrent nature (eczema, cystic acne, psoriasis) that cause skin openings or

inflammation or irritation of the skin surface.

The candidate should be evaluated for severity, chronicity, pain, likelihood of serious occupational infectious

essential job tasks

Surgery or skin grafting

Mycosis fungoides

The candidate should be evaluated for systemic involvement, skin involvement that interferes with essential job

tasks, or presence of localized complications such as fissures, weeping, or ulcerations, due to risk of burn

The candidate should be evaluated for thinned, stretched skin that is at risk for easy breakdown, burn damage,

abnormal sensations, or infection.

exposure, requirement for continuous medication, and impairment of ability to safely perform essential job

tasks.

Cutaneous lupus erythematosis

injury and / or infection.

The candidate should be evaluated for associated systemic lupus, skin integrity, and Raynaud's phenomenon.

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6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

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2.

3.

4.

Skin / Category B (continued)

Raynaud's phenomenon.

The candidate should be evaluated for functional limitation of hand and / or foot when exposed to cold or

systemic involvement of skin, muscles, heart, lungs, or neurologic system that would compromise the safe

performance of essential job tasks.

Scleroderma (skin)


Stasis dermatitis

The candidate should be evaluated for sclerodactyly with significant loss of function or systemic involvement.

Vasculitic skin lesions

The candidate should be evaluated for associated leg swelling, loss of function, or systemic involvement.

Atopic dermatitis / eczema

The candidate should be evaluate for percent body involvement with redness and scaling, requirement for reg-

ular application of lubrication / medication, and / or potential effect on safe performance of essential job tasks.

Contact or seborrheic dermatitis

The candidated should be evaluated for extent, severity, chronicity, and known precipitants with attention to

potential risk of serious, occupational infectious exposures or other interference with safe performance of

The candidate should be evaluated for swelling, redness, scaling, itching, weeping, and / or cracking, pain,

loss of function (e.g., cannot stand for long periods of time), or ulceration.

Albinism, Darier's disease, ichthyosis, Marfan syndrome, neurofibromatosis, and other genetic conditions

The candidate should be evaluated for functional limititations, ability to wear helmet, SCBA or other required

occupational infectious exposure.

Mechano-bullous disorders (epidermolysis bullosa, Hailey pemphigus, porphyria, pemphigoid)

The candidate should be evaluated for extent and acuity of blistering, loss of function, aggravating agent(s)

if known, ability to wear protective ensemble, ability to tolerate moderate, incidental, job-related trauma to

skin, risk of occupational infectious exposure, or inability to safely perform essential job tasks.

Urticaria or angioedema

The candidated should be evaluated for extent, severity, chronicity, association with underlying medical

condition, and requirement for medications (antihistamines) that interfere with the ability to safely perform


respirators with proper fit testing, and protective clothing, and requirements for continuous treatment.

Folliculitis, pseudo-folliculitis, miliaria, keloid folliculitis

The candidate should be evaluated for extent, chronicity, and interference with safe performance of essential

job tasks.

Hidradenitis suppurativa, furuncles, carbuncles, or Grade IV acne (cyctic)

The candidate should be evaluated for extent, chronicity, pain, ability to wear protective ensemble, and risk of

Blood and Blood-Forming Organs


Hemorrhagic states requiring replacement therapy

Sickle cell disease (homozygous)

Clotting disorders

Any other hematological condition that results in inability to safely perform one or more of the essential job

tasks.

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1.

2.

3.

4.

5.

6.

1.

2.

(1) Is maintained by a physician knowledgeable in current management of diabetes mellitus.

(Endocrine and Metabolic Disorders / Category A / items 1 (1)** and 1 (2)**

b. Has had hemoglobin A1C measured at least four times a year (intervals of 2 to 3 months) over the last

12 months prior to evaluation if the diagnosis of diabetes has been present over 1 year. A

hemoglobin A1C reading of 8 percent or greater shall trigger a medical evaluation to determine

if a condition exists in addition to diabetes that is responsible for the hemoglobin A1C not

accurately reflecting average glucose levels. This shall include evidence of a set schedule for

blood glucose monitoring and a thorough review of data from such monitoring.

c. Does not have an increased risk of hypoglycemia due to alcohol use or other predisposing factors.

d. Has had no episodes of severe hypoglycemia (defined as requiring assistance of another) in the

of proteinuria. (Creatinine clearance can be calculated by use of the Cockroft-Gault or similar formula.

Proteinuria is defined as 24-hour urine excretion of greater than or equal to 300mg protein or greater

than or equal to 300 mg of albumin per gram of creatinine in a random sample.

(5) Has normal cardiac function without evidence of myocardial ischemia on cardiac stress testing (to at least

12 METs) by ECG and cardiac imaging.

(6) Has a signed statement and medical records from an endocrinologist or a physician with demonstrated

knowledge in the current management of diabetes mellitus as well as knowledge of the essential job

tasks and hazards of firefighting and that the candidate meets the following criteria:

a. Is being successfully maintained on a regiment consistent with items:


Blood and Blood-Forming Organs (continued)

Anemia

Leukopenia

Polycythemia vera

(2)** Has demonstrated over a period of at least 6 months the motivation and understanding required to

closely monitor and control capillary blood glucose levels through nutritional therapy and insulin

administration. Assessment of this shall take into consideration the erratic meal schedules, sleep

interruptions and high aerobic and anaerobic workloads intrinsic to firefighting.

(3) Has a dilated retinal exam by a qualified ophthamologist or optometrist that shows no higher grade of

Splenomegaly

History of thromboembolic disease

Any other hematological condition that results in inability to safely perform one or more of the essential

job tasks.

Endocrine and Metabolic Disorders


Type 1 diabetes mellitus, unless a candidate meets all of the following criteria:

(1)** Is maintained by a physician knowledgeable in current management of diabetes mellitus on a basal /

bolus (can include subcutaneous insulin infusion pump) regimen using insulin analogs.

diabetic retinopathy than microaneurysms, as indicated on the International Clinical Diabetic

Retinopathy Disease Severity Scale.

(4) Has normal renal function based on a calculated creatinine clearance greater than 60 mL/min and absence

preceding 1 year, with no more than two episodes of severe hypoglycemia in the preceding 3

years.

e. Is certified not to have a medical contraindication to firefighting training and operations.

Insulin-requiring Type 2 diabetes mellitus, unless a candidate meets all of the following criteria:

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3.

1.

2.

Endocrine and Metabolic Disorders / Category A -2 (continued)

(2) Has demonstrated over a period of at least 3 months the motivation and understanding required to

closely monitor and control capillary blood glucose levels through nutritional therapy and insulin

administration. Assessment of this shall take into consideration the erratic meal schedules, sleep

disruption, and high aerobic and anaerobic workloads intrinsic to firefighting.




knowledge in the current management of diabetes mellitus as well as knowledge of the essential job

tasks and hazards of firefighting and that the candidate meets the following criteria:

a. Is maintained on a stable insulin regimen and has demonstrated over a period of 3 months the

motivation and understanding required to closely monitor and control capillary blood glucose

levels despite varied activity schedules through nutritional therapy and insuling administration.

b. Has had hemoglobin A1C measured at least four times a year (intervals of 2 to 3 months) over the last

preceding 1 year, with no more than two episodes of severe hypoglycemia in the preceding

3 years.

e. Is certified not to have a medical contraindication to firefighting training and operations

Any endocrine or metabolic condition that results in the candidate not being able to safely perform one or

more of the essential job tasks


Diseases of the adrenal gland, pituitary gland, parathyroid gland, or thyroid gland of clinical significance --

The candidate should be evaluated for absence of orthostatic hypotension, electrolyte disorders, ability to

maintain hydration during exercise under extreme environmental conditions, and normal thyroxine levels

with supplementation.

Nutritional deficiency diseases or other metabolic disorder


(5) Has no autonomic or peripheral neuropathy. (Peripheral neuropathy is determined by diminished ability

to feel the vibration of a 128 cps tuning fork or the light touch of a 10-gram monofilament on the

dorsum of the great toe proximal to the nail. Autonomic neuropathy can be determined by evidence of

gastroparesis, postural hypotension, or abnormal test of heart rate variability.






12 months prior to evaluation if the diagnosis of diabetes has been present over 1 year. A

hemoglobin A1C reading of 8 percent or greater shall trigger a medical evaluation to determine

if a condition exists in addition to diabetes that is responsible for the hemoglobin A1C not

accurately reflecting average glucose levels. This shall include evidence of a set schedule for

blood glucose monitoring and a thorough review of data from such monitoring.

c. Does not have an increased risk of hypoglycemia due to alcohol use or other predisposing factors.

d. Has had no episodes of severe hypoglycemia (defined as requiring assistance of another) in the

(7) Has a signed statement and medical records from an endocrinologist or a physician with demonstrated

Page 15



3.

1.

2.

3.

1.

2.

months prior to evaluation if the diagnosis of diabetes has been present over 1 year. A hemoglobin A1C

reading of 8 percent or greater shall trigger a medical evaluation to determine if a condition exists in

addition to diabetes that is responsible for the hemoglobin A1C not accurately reflecting average






(5) Has no autonomic or peripheral neuropathy. (Peripheral neuropathy is determined by diminished ability

Connective tissue disease, such as dermatomyositis, systemic lupus erythematosus, scleroderma, and

rheumatoid arthritis.

History of thermal, chemical, or electircal burn injury with residual functional deficit;

Previous burn injury per se does not interfere with the essential job tasks of firefighting. Extensive burn injury

with or without the need for skin grafting can result in skin surfaces that are easily damaged, sensitive to

chemical or solvent exposure, or lacking in sweat or sebaceous glands. The candidate should be evaluated for

heat or cold intolerance, range of motion and motor strength, and ability to wear personal protective clothing

and equipment.

Documented evidence of a predisposition to recurrent heat stress rhabdomyoloysis, metabolic acidosis, or

exertion-related incapacitation

Tumors and Malignant Diseases


Malignant disease that is newly diagnosed, untreated, or currently being treated, or

due to the increased risk for reoccurance under active surveillance

Any tumor or similar condition that results in the candidate not being able to safely perform one or more of

the essential job tasks

Systemic Diseases and Miscellaneous Conditions

Category A medical conditions include any systemic condition that results in the candidate not being able to safely

perform one or more of the essential job tasks.


glucose levels. This shall include evidence of a set schedule for blood glucose monitoring and a

thorough review of data from such monitoring.

(2) If on oral hypoglycemic agents, has had no episodes of severe hypoglycemia (defined as requiring

assistance of another) in the preceding year.



to feel the vibration of a 128 cps tuning fork or the light touch of a 10-gram monofilament on the

dorsum of the great toe proximal to the nail. Autonomic neuropathy can be determined by evidence of

gastroparesis, postural hypotension, or abnormal test of heart rate variability.



Diabetes mellitus, not on insuling therapy, but controlled by diet, exercise, and / oral hypoglycemic agents

unless all of the following are met:

Endocrine and Metabolic Disorders / Category B (continued)

(1) Has had hemoglobin A1C measured at least four times a year (intervals of 2 to 3 months) over the last 12

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2.

3.

4.

5.

6.

7.

8.

Anebolic steroids

Any chemical, drug, or medication that results in the candidate not being able to safely perform one or more

of the essential job tasks

Full-dose or low-dose anticoagulation medications or any drugs that prolong prothrombin time (PT), partial

thromboplastin time (PTT), or international normalized ratio (INR)

Beta-adrenergic blocking agents at doses that prevent a normal cardiac rate response to exercise, high-dose

diuretics, or central acting antihypertensive agents (e.g., clonidine)

Respiratory medications: inhaled bronchodilators, inhaled corticosteroids, systemic corticosteroids,

theophylline, and leukotriene receptor antagonists (e.g., Montelukast)

Leukotriene receptor antagonists are not Category A condition if used to treat conditions not affecting the

lower respiratory system.

High dose corticosteroids for chronic disease


A history of psychiatric condition or substance abuse problem

Requirement for medications that increase an individual's risk of heat stress, or other interference with the

ability to safely perform essential job tasks

Chemicals, Drugs, and Medications

Category A medical conditions include those that require chronic or frequent treatment with any of the following

medications or classes of medications:

Narcotics, including methadone

Sedative-hypnotics

nutrition and hydration, and medication requirements.

(6) History of bone or soft tissue tumors or malignancies -- the candidate should be evaluated for muscle

strength, deformity interfering with function, or the ability to wear protective ensemble.

(7) History of hematological malignancies -- the candidated should be evaluated for anemia, leukopenia, or

thrombocytopenia, or residual cardiac, pulmonary, GI, dermatological, or neurological effects of surgery,

radiation, or chemotherapy.

Psychiatric Conditions

Category A medical conditions include any psychological condition that results in the candidate not being able to

safely perform one or more of the essential job tasks.

Category B medical conditions shall be evaluated on the basis of an individual's current physical condition and on the

staging and prognosis of the malignancy (i.e., likelihood that the disease will recur or progress), and include

effects on balance, coordination, strength, speech, judgment; and medication requirements.

(3) History of head and neck malignancy --the candidate should be evaluated for the ability to wear SCBA and

maintain nutrition or oral hydration.

(4) History of lung cancer -- the candidate should be evaluated for residual pulmonary function and medication

requirements.

(5) History of GI or GU malignancy -- the candidate should be evaluated for abnormal bowel or urinary function

that would interfere with emergency operations where toilet facilities are unavailable, the ability to maintain

the following:

(1) Benign tumors -- the candidate should be evaluated for space-occupying lesion, treatment, or sequelae

affecting their ability to perform essential job tasks.

(2) History of CNS tumor or malignancy -- the candidate should be evaluated for history or risk of seizure; residual

Tumors and Malignant Diseases (continued)

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1.

2.

3.

4.

5.

6.

7.

The candidate should be evaluated for an underlying condition requiring the medication and effects of medication

that could affect ability to safely perform essential job tasks.

Chemicals, Drugs, and Medications (continued)

A1 - Evidence of illegal drug use detected through testing, conducted in accordance with Substance Abuse and Mental

Health Service Administration (SAMHSA), shall be a Category A medical condition

A2 - Evidence of clinical intoxication or a measured blood alcohol level that exceeds the legal definition of intoxication

according to Ohio Revised Code, at the time of medical evaluation shall be a Category A medical condition.


Muscle relaxants

Leukotriene receptor antagonists (e.g., Montelukast) used for allergies that do not affect the lower

respiratory system

Cardiovascular agents

Stimulants

Psychiatric medications

Other than high-dose systemic corticosteroids

Antihistamines

Page 18

(MD or DO only) C-TEC Public Safety Physical · They will complete the CTEC Public Safety Physical. The Fire/EMT physical will be $455.00 which will include a chest x-ray and stress

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