March 7, 2024

Why fit for duty isn’t fit for the modern firefighter

Why fit for duty isn’t fit for the modern firefighter

Firefighters are true heroes, prepared to put their lives on the line for us at a moment’s notice. Their job is both physically and emotionally demanding, yet they do it without complaint. Once, the greatest danger they faced was smoke and fire. Now, it’s occupational cancer and a life cut short by preventable disease. But the current “fit for duty” regime is woefully outdated when it comes to the risks they face in the modern world. As one firefighter put it, who cares for those that care for you? Here, we look at why fit for duty is no longer fit for the modern firefighter.

5 Shortcomings of Traditional Fit for Duty Programs

1. Inconsistency in Standards and Implementation: 

There is a notable lack of uniformity in fitness standards across different fire departments. Standards may even vary between neighboring departments. This inconsistency leads to disparities in the preparedness, safety, and long-term health of firefighters. In turn, this undermines the effectiveness of fit-for-duty assessments.

2. Limited Focus on Mental Health: 

Traditional programs often emphasize physical readiness, overlooking the critical importance of mental health. Yet firefighters are more likely to die by suicide than in active firefighting. Given the high-stress nature of firefighting, mental health assessments should be a central part of any fit for duty program.

3. Accessibility and Resource Constraints: 

Most States provide a budget for fit for duty testing, but fire departments are free to choose their fit for duty supplier. Smaller and volunteer fire departments face significant challenges in accessing the necessary resources for comprehensive fit-for-duty programs. Instead, they are constrained to offering the bare minimum to meet any State regulations. This gap compromises the effectiveness of health and fitness evaluations.

4. Long-term Health Monitoring: 

Traditional fit-for-duty evaluations may neglect the importance of monitoring long-term health impacts, particularly those arising from occupational exposures.

5. Comprehensive Wellness Programs: 

Beyond physical fitness, there's a need for programs that address overall wellness, including nutrition, stress management, and lifestyle factors, to support firefighters' long-term health and performance.

PFAS: the silent hazard

One of the most pressing concerns in modern firefighting is exposure to PFAS, or "forever chemicals". These substances all rely on something called a carbon-fluoride bond. This allows them to exhibit some beneficial properties like:

  • Non-stick coatings on cooking pans
  • Non-grease wrappers for fast food
  • Water repellent coatings on clothing
PFAS chemicals are everywhere

These properties have seen PFAS being used extensively in firefighter turnout gear. A recent NIST study identified dozens of these compounds across multiple items of turnout gear. Additionally, they are the basis for all firefighting foams (AFFF), which are essential for fighting certain classes of fire. 

However, these substances are increasingly being linked to significant long-term health risks, including cancer. Evidence is also growing that firefighters are exposed to extremely high levels of PFAS, well above the acceptable safe limit. The insidious nature of PFAS exposure, coupled with its long-term health implications, means firefighters should be assessed regularly. This is an example of where we need to go beyond traditional assessments to address the complexities of modern firefighting.

Updating fit for duty for the modern world

Identifying problems is always easy but creating good solutions can be harder. A modern fit for duty program should directly address the real health and fitness challenges facing firefighters. This means solving the problems identified above:

  • Consistent Standards: Fit for duty standards should be rationalized and updated across the country. NFPA is in the process of creating a new unified standard for emergency responder fitness. However, this doesn’t go far enough. What is needed is primary legislation to ensure firefighters can access the same level of care as military veterans.
  • Mental Health and Wellness: Mental health assessments and wellness checks should become a standard part of the fit-for-duty evaluation. Firefighter health should be about more than just being physically fit for their job. 
  • Accessible and Equitable: Every firefighter should receive equal access to fit for duty testing. But more than this–fit for duty should become fit for life. It should change from being an annual chore that you have to get through to keep your job. Instead, it should become a gateway to comprehensive healthcare akin to what is offered by the VA.
  • Long-Term Health Monitoring: Fit for duty takes snapshots in time and uses these to assess health and wellbeing. But firefighters should be able to monitor their health over time. They need to understand how it evolves from a baseline recorded at the start of their training. This way, they can be vigilant against the long-term health effects of their job.
  • Comprehensive Testing: FIt for duty testing should include as wide a range of tests as possible. These don’t have to be highly invasive, or require multiple visits to different medical facilities. Instead, it should focus on things like minimally invasive PFAS testing, whole body ultrasound, and even novel techniques, like breath tests.

Delivering a 360º fit for duty 

As firefighting evolves, fit for duty must remain fit for purpose. Diagnose Early is working with firefighters and the IAFF union to develop a new holistic 360º approach to fit for duty. This will be supported by our cutting edge technology. This includes a comprehensive AI-powered health data platform, novel testing techniques, and custom fitness tracking via a wearable and app. This will allow Diagnose Early to enhances the safety and well-being of firefighters while setting a new standard for occupational health across high-risk professions


Helping firefighters

to understand the health risks related to toxin exposure