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Well Being: Priority testing for your physical exam

August 20, 2021 
By Elias Markou

At the Halton Hills Fire Department, where I have been the chief medical officer for the firefighters for 18 years, we have made firefighter physical exams and baseline testing a key component of the monitoring and maintenance of our firefighters. New recruits joining the department go through a comprehensive physical exam that includes extensive blood work. Veteran firefighters will visit me every two years to run new blood work data to compare old values with new blood work values. This is an ongoing process for our firefighters.

We know the fire fighting profession engages in extreme physical performance, daily risk from injury, and severe illness. A regular firefighter physical exam should be a critical health data exercise for all fire departments. Just collecting the health data is not enough, analysis of firefighter health, wellness and performance should be the hallmark of such a process.    

Every firefighter physical exam should incorporate the 2018 National Fire Protection Agency (NFPA) Standard 1582 on Comprehensive Occupational Medicine Program for Fire Departments to help firefighter perform their jobs at their best. These physical exam standards are minimal requirements but considered appropriate for both career and volunteer firefighters.  

The NFPA, although having no enforcement or punitive authority, is the agency that has gone on record to highly recommend fire departments incorporate some or all of these health standards to keep firefighters safe.


Under the NFPA 1582, firefighters should have the following done during a physical exam.

  1. Health history and physical exam
  2. Urinalysis
  3. Blood analysis (metabolic profile and lipid profile)
  4. EKG and cardiac risk calculator
  5. Pulmonary function test (spirometry)
  6. Infectious disease screening (tuberculosis and hepatitis)
  7. Chest x-ray
  8. Cancer screening
  9. Audiometric exam
  10. Vision testing 
  11. Sleep apnea assessment
  12. Vaccination review and update

In our firefighter physical exam at Halton Hills, we make cardiovascular health screening a major priority. Many studies have looked at cardiovascular health in firefighters. A February 2020 NFPA study called the “U.S. Fire Department Profile”, determined the cause of death in 47 per cent of volunteer firefighters was a cardiovascular incident (health attack, heart event). The study went on to say that fire departments need an aggressive reduction plan to address the cardiovascular risk factors to improve physical fitness to reduce cardiovascular related deaths in the line of duty. In these situations, the first step is properly identifying the risk and having fire departments implement programming that helps address cardiovascular health.

A 2018 study in the Journal of Emergency Medical Services examined firefighters with coronary health disease (CHD). This group of firefighters represent the majority of cardiac deaths found in firefighters. The study went on to point to the need of more in-depth cardiovascular screening by the fire service and services. 

Here’s what fire departments can do to address cardiovascular risk in firefighters:

  1. An annual electrocardiogram for all firefighters
  2. Physical exam with health history
  3. Blood analysis looking at all cardiovascular related testing. Examples of the cardio blood tests include apolipoprotein A, apolipoprotein B, homocysteine, CRP, CK, cholesterol panel, glucose, insulin, serum B12, serum folate and ESR
  4. Heavy metal testing (often connected to arteriosclerosis issues).
  5. Public health testing for the viruses CMV and coxsackievirus (connected to cardiovascular disease)
  6. Annual nutritional training 
  7. Annual detoxification programming
  8. Educational training on cardiovascular disease
  9. Access to physical fitness equipment and time for exercise 
  10. Stress management courses and training
  11. Sleep assessment and training

As a result of these findings, we know that firefighter’s risk of cardiovascular disease with in the fire service is high. More lobbying by NFPA to continue to improve is imperative, as is the fire service’s shift to implement comprehensive cardiovascular screening and program implementation is key.

A Fire Department’s Guide to Implementing NFPA 1582

U.S. Fire Department Profile. National Fire Protection Association. February 2020.

Dr. Elias Markou is one very busy naturopathic doctor. He is in private practice in Mississauga, Ont., and is the chief medical officer for the Halton Hills Fire Department. Dr. Markou was a firefighter for six years; he has a special interest in firefighter health,  is a writer and blogger who is regularly featured on television and radio and in print. Contact him at

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