Respiratory Standards

[SOUDER]

According to CFR 1910.134 there must be a Respiratory Standard adopted in the fire servic. A medical evaluation must be overseen by a physician or a PLHCP.
My questions are:
1.)If an employee must have a follow-up evaluation, what time frame is given for this employee to pass the medical exam?

2.) What do you do with this employee during this time frame?

3.) What policies and procedures have you adopted to enforce the passing of the medical evaluation?



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DPS

[Captain John]

Do you have a policy in effect now? Medical evaluations are REQUIRED once a year for the respiratory standard. Presently you have your choice of either quantative or qualatitive testing. We are volunteer., however that does not mean you can bypass the testing. We will make every effort to work within your schedule. However make no mistake, if you go past the time allowed, (WE qualify each FF each year) you are off the fireground. You are unable to pack up. As far as policies & procedures we make sure to keep RECORDS. It is our policy that each FF will have a Fit Test each year. No questions about it.

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[FFTrainer]

John -- can you confirm that medical exam being required every year. If I read 1910.134 right, the medical exam must be administered for initial qualification to wear the SCBA however it does not need to be administered again unless there is:
1. A change in medical history(i.e. you had Pneumonia in March after your exam)
2. A change in work requirements(not sure that applies to the Fire Service, but it's in there.)
3. A change in working conditions(i.e. Temperature extremes -- again not really for the fire service unless you move to Alaska?)

The Qualitative/Quantitative Fit Test is the only thing I see as being mandatory on an "at least annually" basis.

By the way, is that Watchung, NJ??

I will definitely agree with you on the implications of failing/not taking the the tests! You fail!! You sit!! That's what is has to come down to now a days based on the OSHA regs. If you let guy go wearing his SCBA knowing he failed or did not participate in the med. exam and he collapses, you as IC, Chief, Training Officer, Program Administrator .... you're screwed BIG TIME!?!?! I'd rather deal with a ****ed off guy when I tell him to sit until he passes, then deal with a funeral and OSHA if god forbid something goes bad.

Just my two cents!! Let me know some more thoughts on this since it is a hot topic wherever I seem to go.

[Ten8_Ten19]

Medical evals are age-dependent. Required annually for those of us over 40.

[rogerk]

There is some misinterpretation here.

First, the standard 1910.134 is an OSHA regulation mandated in all of the 23 "osha" states.(approved state plans)Tennessee is one of those 23 states.

Second, the standard requires annual screening. This can be done in writing, answering the questions on the OSHA suggested form for that purpose. Answering yes to any of questions 1 through 9, kicks in a requirement for further medical exam by a Dr. or a few other medical professionals decribed in the document. This requirement is for all ages by the way.

Third, fit testing of SCBA's is a part of the standard, but not part of the medical compliance.

As far as what to do with a firefighter that has not passed the screening, awaiting a physical, or did not pass the physical...those are issues of labor contracts, labor laws, or in the case of a vollunteer dept., possibly using him/her as auxiliary function. IE: not an interior qualified member. Some paid depts might have provisions to place an "unfit" firefighter to light duty work temporarily. Other depts. might place the employee on sick or injury leave. Some might, but I would not endorse, placing the person in a job which similar to what some vollunteer depts do, exterior, such as driver/operator/etc.

[Ten8_Ten19]

Thanks for setting me straight rogerk. I was thinking of Maine's standard which does require annual medical eval over age 40. We are not an OSHA state so we got a standard more restrictive than OSHA. I intended to enlighten but managed to confuse.

[FFTrainer]

Rogerk --

Am I mis-reading hear or have you gotten further explanation on this. Based on the attached copy of the standard, it appears to me that only the Fit Test is an annual requirement. Maybe I'm wrong, but then again, that's why I read and post to these forums so I can get more info!?!?

(e)(7)
Additional medical evaluations. At a minimum, the employer shall provide additional medical evaluations that comply with the requirements of this section if:

(e)(7)(i)
An employee reports medical signs or symptoms that are related to ability to use a respirator;

(e)(7)(ii)
A PLHCP, supervisor, or the respirator program administrator informs the employer that an employee needs to be reevaluated;

(e)(7)(iii)
Information from the respiratory protection program, including observations made during fit testing and program evaluation, indicates a need for employee reevaluation; or

(e)(7)(iv)
A change occurs in workplace conditions (e.g., physical work effort, protective clothing, temperature) that may result in a substantial increase in the physiological burden placed on an employee.

(f)
Fit testing. This paragraph requires that, before an employee may be required to use any respirator with a negative or positive pressure tight-fitting facepiece, the employee must be fit tested with the same make, model, style, and size of respirator that will be used. This paragraph specifies the kinds of fit tests allowed, the procedures for conducting them, and how the results of the fit tests must be used.

(f)(1)
The employer shall ensure that employees using a tight-fitting facepiece respirator pass an appropriate qualitative fit test (QLFT) or quantitative fit test (QNFT) as stated in this paragraph.

(f)(2)
The employer shall ensure that an employee using a tight-fitting facepiece respirator is fit tested prior to initial use of the respirator, whenever a different respirator facepiece (size, style, model or make) is used, and at least annually thereafter.

[rogerk]

FFTrainer

I reread the standard, and I think you're correct in the wording that before the first wearing and fit testing of a respirator a medical questionaire must be filled out. Should questions be answered yes in the first part, then further evaluation kicks in. Then the wording only requires further questionaires and evaluations if the workplace conditions, equipment change, etc.

However, having said that, the wording in the employer respiratory program evaluation is problematic. The broad statements and requirements in 1910.134(k)(1)(i) include (k)(1)(vi) how to recognize medical signs and symptoms, (k)(5)(iii)Any other situation arises in which retraining appears necessary to ensure safe respirator use, as well as a few other general statements.

You are correct about the specific medical questionaire requirements that is required, but an employer would have to cover themselves using the more broad annual program evaluation.

It would be pretty hard, I think, for an employer to say they had a questionaire filled out for an employee upon first fit testing, and no questionaire or medical exam was given to that employee for the next 20 years or so.

I think there's some cross referencing also, which even the OSHA, and NIOSH people do. Using the General Duty Clause of the OSHA statutes, and the general legal principal of "standard of care", reading NFPA 1500, and NFPA 1582. These were standards that were relied upon in the formation of 1910.134, and I believe would be easily used against an employer not requiring more frequent screening of employees.

Sorry, I think I've now probably cluttered this issue with additional points, that I do agree right off are my opinion.

[Capez]

29 CFR 1910.134

What do you mean by follow up eval? in order to be medically cleared, which is what I assume you are talking bout, for hazardous atmospheres you must pass a qualitative fit test, spiromitry and a physical exam. Which part are you looking at re-testing for?? Spiromitry and Fit testing are simple you keep taking it untill you either pass or say that's it. OSHA doesn't have a time criteria except for a yearly test. Inorder to work in hazardous atmospheres you must pass.

If you have contracted out to a medical group let them worry about pass fail requierments. If not, contract out to a medical group and save yourself the headach.

If an employee failed the physical that employee needs to consult with the physician of record as to how to correct the problem. In the mean time the employee should be placed on restricted duty.

Our policy is very simple if you fail the exam you are placed on restricted duty untill you pass the exam the next time it's offered. Repeated failures put you close to flying a desk for a while. Remember Employees who fail the test fall under ADA regulations and you must make reasonable accomadation for the employee, i.e. you can't just fire them for it.

From J.J. Keller and Associates OSHA Compliance manual Appendix A Office of Superfund Region V Respirator protection program. Designed in accordance with OSHA 29 CFR 1910.134 and NIOSH Industrial Respiratory Protection. Under Program Elements Section 10 "Persons will not be assigned to tasks requiering use of respirators unless it has been determined that they are physically able to perform the work and use the equipment. EPA's medical monitoring examination protocol will determine what health and physical conditions are pertinent. the respirator user's MEDICAL STATUS WILL BE REVIEWED ANNUALLY." I think that answers that question.
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Alex Capezza BS, FO1, EMT-I

[This message has been edited by Capez (edited June 01, 2000).]