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Medical Fitness for Work in UK Fire Services
Dr Tok Hussain Consultant Occupational Physician – Healthwork Ltd ALAMA Fire Services Representative Dr Tok Hussain 21/04/2017
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Standards – pre 2004 Godber report 1968
Joint working party appointments provisions 1988 Blanket bans ALAMA 1989 – lung function measure, VA 6/6, grip 35 and 33, back pull 117, Vo2 max by step test 2004 appointments ans promotions regs altered ‘a medical practitioner selected by the fire authority is satisfied that his general state of health and fitness is satisfactory to carry out the duties of the role’ FRS Act 2004 repealed Appointment and Promotions regulations ALAMA – accept/reject/retire – no longer justifiable under DDA Dr Tok Hussain 21/04/2017
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Influences DDA 1995 (as amended 2005) Oct 2004
Fire Service Act 1947 replaced by Fire and Rescue Services Act 2004 (Oct 2004) 2004 DCLG ‘Medical and Occupational Evidence for Recruitment and Retention in the Fire and Rescue Service’ Evolving consensus based standards – ALAMA Equal ops and employment rights IPDS best principles Dr Tok Hussain 21/04/2017
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Problems with standards
Discriminatory if too prescriptive Non-individualised Blanket bans discriminatory Diversity issues Can lead to over-rejection and excessive IHR Diversity issues – standards prevent people form joining who could be firefighters - diversity Dr Tok Hussain 21/04/2017
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Why have standards? Uniformity of medical advice
Easier to select and manage individuals Operational efficiency Risk reduction? Dr Tok Hussain 21/04/2017
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Current Practice Individualised approach Evidence based Risk based
Multi-disciplinary involvement including management Functional tests More flexible approach – not old rigid approach Dr Tok Hussain 21/04/2017
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Doc is he fit? Chronic conditions Is work likely to make him worse?
Chronic back pain Fit but sickness absence of 4 episodes per year of 2 weeks per time Is work likely to make him worse? Asthma BA use Acceptability of risk Epilepsy seizure risk Dr Tok Hussain 21/04/2017
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Diabetes Type 1 and type 2 Hypoglycaemia Diabetes UK Driving
Survey and guidelines ALAMA, CFOA, DRC, DUK, FBU Guidelines launch Oct 2008 Driving Coping strategies Importance of general fitness Hypoglycaemia only on insulin or sulphonyluresa DUK guidelines for hazardous occupations Coping strategies – knowledge, motivation, comitment, self monitoring frequently, multiple short acting injectionsTDS and medium/long at bedtime, Glargine, carbohydrate on person, running high, injecting after a meal, Dr Tok Hussain 21/04/2017
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Asthma BA use Exposure to smoke and fumes Restricted BA use
Individual assesment based on asthma control Ongoing work – Paul Cullinan (Brompton) Concerns in current asthmatics or severe/moderate childhood asthma Exercise testing for asthma Serving firefighters are asthmatic Dr Tok Hussain 21/04/2017
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Vision 2002 Review (ODPM fire division, CFOA) Contact lenses
Corrected VA 6/9 binocularly minimum 6/12 worst eye Uncorrected standard 6/18 and 6/24 Aids to vision Contact lenses Colour vision Laser eye surgery Soft contact lenses OK……………….hard not OK on fireground Previous 6/6 more stringent than army! Colour vision debate continues……………….confuse blue/green hoses with black or black oxygen cylinder vs maroon acetlyene cylinders or confuse a red warning light ………………..functional tests Protomamoly no – deurotonomoly yes Laser eye surgery – 3 months to 6 months recovery Dr Tok Hussain 21/04/2017
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Hearing Audiometry and questionnaire 3 yearly Functional testing
validation Dr Tok Hussain 21/04/2017
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Epilepsy Risk assessment
DVLA 2% per annum risk of seizure acceptable in group 2 drivers Dr Tok Hussain 21/04/2017
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Mental Illness PTSD CISD Strict diagnostic criteria CBT or EMDR
Usually recover CISD Nice guidelines CISD = Critical Incidence Stress Debreifing Mitchell method ?? Dr Tok Hussain 21/04/2017
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Joint Replacements Knee problematic Hip Birmingham Spinal disc
Wear of joint is a concern Dr Tok Hussain 21/04/2017
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Medical management of ill health
Early OH assessment Early interventions Physio, counselling, etc Funded investigations Funded treatment Case conference approach Dr Tok Hussain 21/04/2017
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Rehabilitation Early rehabilitation Permanent alteration of duties IHR
Other duties Reduced hours, reduce duties Graded return to work Alteration of duties temporary Reasonable adjustments Permanent alteration of duties IHR Dr Tok Hussain 21/04/2017
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ANY QUESTIONS ? Dr Tok Hussain 21/04/2017
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