The topic of health and wellness in the fire service has been growing over the years. This can be attributed to a number of factors: workers compensation, absenteeism,, injury reduction, and or improved fitness to decrease adverse health risks/events to help our firefighters.. All of these things are positives in helping our greatest resource - the firefighter. However it does also open the door to a lot of problems if not properly addressed. For example, the two most asked questions I often get it “What is your policy?” or “ What is your fitness standard that establishes them fit for duty?” Both questions are excellent but often times not that easy to answer.

Now you may be thinking “Yes they are easy to answer....” but over the past 9 years I have come to realize that they are multiple factors to take into account when identifying the minimal fitness needs of firefighters. For example we need to understand the rights of the firefighter, we need to have union approval, and we need to establish what we gain from implementing a health and wellness program. These are just a few of the things that need to be answered, but most important we need to define what a healthy firefighter is or rather “what does it mean to be fit for duty”.

I have come across many different definitions for “fit for duty” or “health and wellness policy” but none of them actually satisfy me because they are too and do not account for differences in physical demands and personnel composition across departments. There are a number of resources available to help develop these items but they too are too vague. The idea of “mandatory, non-punitive” never really made sense to do you make people do something without having an action occur. According the recommendations of the IAFF / IAFC Wellness Fitness Initiative a firefighter should have a VO2max score of 42 ml·kg-1·min-1 for aerobic fitness. But what if they have an aerobic capacity of 30 ml·kg-1·min-1. Are they considered unfit for duty? Do we just leave it to them to correct it? Do we force them to correct it? Do we leave it alone? Is it a valid means of stating they are “Fit for duty”? My point is either way you look at it; a decision needs to be made via Senior Administration, Local union, or District / City Officials. (Good, bad, or indifferent).

How about body mass index (BMI)? We know based off research that BMI is a good predictor of injury and a possible screening tool, but that does not mean they are “fit for duty”. I mean how do I know a firefighter who has a high BMI and is out of shape can’t do the job? I know plenty of firefighters who are overweight and never exercise and do the job very well, and contrary to that I know a lot of firefighters who eat well, exercise all the time but are not very good firefighters. So it is not fair in my honest opinion to look at body mass index, body composition, or even any isolated area/test of fitness.

Ok, so you are thinking “what about specific task aimed at firefighting”? Again, this is not really a good indicator of “Fit for Duty”. Why? Some departments have used the star drill to assess their firefighter’s level of fitness. Yes it is difficult and yes it is firefighter specific, but has it been validated by science. Will it hold up in court if challenged by a member of the department? What if you found someone who struggled with it? Is it due to a lack of training , lack of fitness, or not familiar with the test. For example: you have an overweight firefighter who everyone knows is out of shape and struggles with the star drill. Administration feels that they are deemed unfit for duty, and suspend them without pay. This opens a Pandora box for lawsuits and a number of other issues (that I won’t go into). In addition, will it protect them from having a heart attack?

No matter how you look at it, the word “standard” or the minimal requirement related to firefighting tasks often worries me. The notion of having a policy that is “mandatory, non-punitive” is like jumbo shrimp and makes no sense. So what do we do? First, because there is no definition that states “this is considered fit for duty” it has to be negotiated by all parties involved. It is very important that both the Department and the Union negotiate and come to understanding of what would be deemed “Fit for duty” for their department. Remember, not every department is the same so it needs to be open to discussion. Second, it is the responsibility of the union to protect it members, and it is the job of the department to look after the department as a whole. Both usually want to protect the firefighter but they usually are coming at it in different directions.

I am sure there will be those who read this and think I am crazy. Take the firefighter who has 10% body fat, can run 1.5 miles in 8 minutes and do every crazy workout known to man....they typically say “it is our responsibility to be in shape to do the job” and then there will be those who are morbidly obese and in unhealthy and will say “What does a 1.5 mile run have to do with pulling hose”, and guess what....they are both wrong and right. I have said it numerous time, it is my job to help the firefighter, which means I need to understand both sides. Over the years I have come to understand that there is no finite body type or specific body that makes a healthy firefighter. Again, I have seen the young, strong, and healthy firefighter get hurt much easily on the fire ground in comparison to the older more robust firefighter. But I have also seen the older more experienced, out of shape firefighter have heart problems off the fire ground.

So as you can see, it is not that simple. Yet, I listen and learn from my firefighters as much as they do from me and I have to develop my own definition of what it means to be “fit for duty” and not just physically fit to do physical tasks but also to cope physiologically with the job-related mental and emotional stress. How did I develop this concept? I first ask “What are we really trying to achieve? Do six pack abs define a healthy firefighter or is it longevity (on and after the job”), then i start to apply science and experience. Second, I try and list the questions to answers I do not know and do my best to answer them. Finally, I try and take into account all the firefighters (from the morbidly obese to excellent shape), the union, and senior administration into consideration and develop an idea of balance.

Let’s start with “What are we trying to achieve?” In my honest opinion I believe a health and wellness program should be develop in a proactive manner where all parties achieve success, and that means the ultimate goal is to retire healthy. Understand the fine print needs to be negotiated.

Next we have to list the questions we do not have the answer to:
1. Is exercise on duty allowed? Will equipment be provided?
2. Will just on duty exercise be enough for enough for them to maintain their level of aerobic fitness?
3. If they need to maintain their level of fitness will they be covered for exercise off duty? What type of exercises will be covered?
4. Will they be provided light duty status if injured?
5. Will they be provided a resource to help them succeed if they do not achieve the standard?
6. What would be the time frame for corrective actions?
7. What if they do achieve it?
8. Will blood work be required? If so, who pays for it? On duty?

I can go on and on , but hopefully you get the point.

Finally, taking into account all sides can be challenging but this is where I started to form my definition of what it means to be “Fit for Duty.” No matter how you look at these items they cannot be argued because it is the job and it is what makes a healthy firefighter.

There are 6 categories and each category is specific to needs of the job and longevity of the firefighter.

1. Do you exercise? I do not care what type of you do something for 20 minutes a day 3-4 times a week? Let’s be honest ....all exercise programs work so I do not get into specifics until you actually start making it a priority. Will you be able to meet the agreed upon standard?
2. Do you eat well? Nutrition is similar to exercise, there are only 3 categories: plant based, high protein / low carb, and low calorie....pick any famous diet and they will fall under one of those 3 categories. I do not care if you if you want to eat ice cream at the end of the night (besides you are exercising so its ok) but do you eat whole grains, vegetables, fruits, etc......I do not get caught up specific diets but rather look at what you need. If you have high blood sugar we will educate you on a high protein diet, if you have high cholesterol we will educate you on a more plant based diet. if your overweight we educate you on low calorie diet. That leads us to #3.
3. Do you get your blood work on an annual basis? At the very least simple tests such as blood sugar, cholesterol, spirometry, and inflammation should be monitored. We know that if your numbers are off the chart you will doesn’t matter if your a firefighter or not. If your cholesterol is high it needs to be addressed. If your blood sugar is high (type 2 diabetes) there are a number of health issues, and finally there are number of studies that show the relationship between high inflammation and chronic disease (cancer, heart disease, stroke, etc...)
4. Are you mentally sound? Do you suffer from depression, substance abuse, etc....mental health issues are very common in the fire service and they need to be addressed as they will impact your overall health and wellness. Depression is associated with pre-type 2 diabetes, high levels of inflammation (IL-6) and heart disease. Note: This specific criterion would probably be the hardest to monitor but is just as important as the rest.
5. Are you tactically sound? Do you train? How are your firefighting skills? Health and wellness will save your life over a career, training will save your life on the fire ground. Just because your in shape and can run 1.5 miles in 8 minutes does not mean you are tactically sound. Fitness compliments the does not replace it. As I tell my recruits, the better shape you are in the better you can train...Both will save your life.
6. Do you have physical pain? Let’s be honest, its not a matter of if you get hurt but rather when will you get hurt. Firefighting is a physically demanding job and injuries ill occur somewhere during your career - no matter how in shape you are in. There is one thing I know for sure, firefighter will get old but the job does not change and that means there is an increase possibility they will get injured. This is important to understand because it may prevent you from performing the other 5. Throughout my experience I have helped many or our members rehab their injuries. If a firefighter is suffering from low back pain they may not be able to perform the annual fitness assessments or worse not train properly. On the other end, I have experienced with some of our firefighters the negative side effects of pain management and prescription pills. I have seen the toll it has taken on them mentally and physically. So we must remove the pain (the best we can) so they can function properly and have safe and healthy life.

Defining “fit for duty” has been discussed over the years and there have been numerous explanations but in the end many have created an enormous amount of roadblocks that actually prevent departments from establishing a health and wellness policy that will protect our greatest asset - the firefighter. Again, my job as a strength and conditioning coach for Sacramento Fire is simple...I am there to help them, and this is how i start with each individual. If you are missing one, two, or all of them we start to help you address them slowly. I guess you could say it is our “health and wellness policy” yet there is nothing on paper and every buy’s in.

My recommendation would be to start with these 6 categories and then start to develop a policy that will address each area.

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