TABLE OF CONTENTS · 2017-06-03 · medical technician (EMT), and/or paramedic. The topic of...

TABLE OF CONTENTS Foreward Preface Chapter 1: Triangle of Care for Pregnant Firefighters 1 Introduction 2 Triangle of Care for Pregnant Firefighters 3 Department Support Available to the Pregnant Firefighter 3 Summary 3 Chapter 2: Legal Rights and Responsibilities for Pregnant Firefighters 4 Introduction 4 Pregnancy Discrimination Act 4 Virginia Human Rights Act and Law 2.1-714-725 5 Family and Medical Leave Act (FMLA) 5 Fairfax County Fire and Rescue Department Standards 6 Fairfax County Public Safety Occupational Health Center (PSOHC) Position Statement 8 Infectious Diesease Phyisicians Recommendation Regarding Post-Exposure Prophylaxis 9 Chapter 3: Reproductive Health Hazards 11 Introduction 11 Risk Assessment Overview 12 Specific Exposure Risks 13 Stress During Pregnancy 16 Shift and/or Night Work 16 Male Reproductive Health Concerns 16 Summary 17 Chapter 4: Maintaining Fitness During Pregnancy 19 Introduction 19 Levels of Exercise During Pregnancy 20 Summary 21

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Chapter 5: Return to Work 22 Introduction 22 Fitness for Duty 22 Department Standards 23 Chapter 5: Attachments 25

• Contact Information • Light Duty SOP 02.03.06 • Family and Medical Leave SOP 02.01.12 • Letter from the Fire Chief/

Request for Family/Medical Leave • Fitness for Duty SOP 02.04.03 • Work Status Notification Form • Discrimination SOP 02.00.05 • Physical Fitness SOP 02.03.09

References/Bibliography 58 Appendix 1 60

• Letter from PSOHC Medical Director to • Employee’s Ob-Gyn/Primary Care Physician • Firefighter Abilities Requirements

Appendix 2 66

• Letter from Dr. Alan Morrison, IDP regarding post-exposure prophylaxis

Acknowledgements 68

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FRD Pregnancy and Reproductive Health Plan

Fairfax County Fire and Rescue Department Safety and Personnel Services Division

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FOREWORD The Fairfax County Fire and Rescue Department’s commitment to the health and safety of all members is clearly stated in our Core Values:

Health and Safety

We believe our health and safety are essential to fulfilling the Fire and Rescue Department’s mission. We are committed to providing the best health and safety programs for our members’ well being and operational readiness.

Safeguarding the reproductive health of all personnel in the FRD is a priority for the management of the Fairfax County Fire and Rescue Department, as well as the leadership of Local 2068. The most tangible example of this commitment is the Public Safety Occupational Health Center (PSOHC). This on-site, full-service clinic provides state-of-the-art occupational and preventive medicine services to career and volunteer firefighters and works closely with Department personnel to establish guidelines, medical standards, and health programs to improve and enhance the health of our population. It is important to note that reproductive safety cannot be viewed from the perspective of pregnancy alone – both male and female firefighters face hazards to their reproductive health in the course of their profession. Reproductive hazards and family needs pose manageable challenges to our organization. The implementation of this Plan demonstrates not only the organization’s commitment to its Core Value of Health and Safety, but also its commitment to women’s programs.


PREFACE Those who choose a career in fire and rescue knowingly enter into a challenging job that is among the most dangerous of industrial professions. Workplace hazards may present as thermal, mechanical, chemical, or infectious disease threats to limb and life. While a large number of these risks are obvious threats and are minimized by protective equipment and safe operational policies, others relating to health effects from exposures to chemicals and products of combustion are not well understood. One such area of concern is that of reproductive health hazards resulting from work as a firefighter, emergency medical technician (EMT), and/or paramedic. The topic of reproductive health hazards (which affect both women and men) is complex and is influenced by employment law, women’s rights, fetal rights, and environmental health concerns. The diverse group of employees found in today’s contemporary fire service is characterized by dedicated men and women working as an integrated team to provide the highest caliber of protection to the public we serve. As the manager of a fire and rescue department nationally recognized for its excellence, I must consider all of the above issues in establishing operational policies and guidelines. As always, it is our intent to provide the safest possible working conditions within the context of our challenging profession. This document is intended to provide you with an overview of what is known about the reproductive hazards of employment in fire and rescue operations. The subject matter for any discussion of reproductive health hazards is very complex and, for that reason, I would strongly encourage you to read this document in its entirety and discuss any concerns or questions you might have with your treating physician (obstetrician/gynecologist) and the staff of our PSOHC. For those of you with a desire to study this topic further, a bibliography of relevant articles and a book on exercise during pregnancy will be made available to all employees at first (Departmental) notification of your pregnancy. Past employment practices in the United States often were notable for exclusionary policies that limited women’s employment opportunities. These policies were rationalized based on gender differences and potential hazards to the fetus. The Pregnancy Discrimination Act, an amendment to Title VII of the Civil Rights Act of 1964, prohibits workplace discrimination on the basis of


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pregnancy, childbirth, or related medical conditions. The provisions of Title VII make it illegal to exclude women from work activities they are capable of performing. Also, from a legal perspective, the rights of the fetus are considered subordinate to the rights of the mother. Therefore, a pregnant employee has a legal right to continue working in our profession as long as she is considered fit for full duties. Obviously, continued work in the field may expose both the employee and developing fetus to certain hazardous conditions. The primary purpose of this document is to inform and educate you on the current state of knowledge regarding these medical risks. As you will discover after reading this Reproductive Health Plan, there is considerable uncertainty regarding the medical consequences of the types of exposures and environments encountered in the fire and rescue profession. We cannot provide you with an accurate risk assessment of the potential for an adverse outcome. Based on this circumstance, we support the position of the International Association of Fire Fighters (IAFF) and our PSOHC that it is appropriate that pregnant firefighters discontinue working in the field when they determine that they are pregnant. However, we also recognize and support your right to continue working in the field for as long as you are fit for duty. We do want to make sure that you – to the extent possible – make an informed decision. To those of you expecting a child, let me offer my congratulations. Following the birth of your child, we look forward to your rejoining your fellow employees. Because our chosen profession demands so much of us from a mental and physical perspective, I would like to encourage you to maintain your health and physical fitness during pregnancy and after the birth of your child. This is important to the health and well-being of both mother and child. Our general expectation is that an employee will be capable of returning to full duty approximately three months after the birth of a child. This is the time frame suggested by the Family and Medical Leave Act (FMLA). Please consult your treating physician regarding an appropriate exercise and diet protocol. As Chief of the Fairfax County Fire and Rescue Department, I will continue to work to make the practice of our profession as safe as possible. This document, and the concept of a “Triangle of Care” described within, is intended to assist you in any planning and decisions related to reproductive health.


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Please do not hesitate to bring any concerns you might have regarding this document (or this topic) to the attention of the appropriate staff within the Fire and Rescue Department or the Public Safety Occupational Health Center.

_______________________________ Chief Michael P. Neuhard County Fire and Rescue Department


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CHAPTER 1: Triangle of Care for Pregnant Firefighters

Introduction The make-up of the Department is changing as a reflection of the County – our ranks are more diversified now than in the past, a trend we strongly encourage and support. A notable part of this diversification is the increased number of women becoming professional firefighters. This document is intended to be a valuable tool for firefighters considering starting or expanding their families and female firefighters who may become pregnant while on active duty. Our profession is a rewarding one – but it is also both physically and mentally demanding. The Department and the PSOHC have joined together with the employee to establish a “Triangle of Care” that will provide support and assistance for the pregnant firefighter during and immediately following her pregnancy. Triangle of Care for Pregnant Firefighters As depicted in Figure 1, the Triangle of Care has three key components: (1) the pregnant employee; (2) the employee’s personal physician (ob/gyn); and (3) the Public Safety Occupational Health Center. Obviously, the employee is the central part of this triangle. All efforts are geared toward your health and safety. Toward this end, STEP ONE is for you to inform the Public Safety Occupational Health Center as soon as your pregnancy is confirmed. Upon receipt of this notification from the pregnant firefighter, the PSOHC will schedule an appointment for you to be seen as soon as possible. During this visit, you will be counseled and given information on a number of concerns, including the importance of staying fit during pregnancy and the known and potential risks/hazards your unborn child may be exposed to should you decide to remain on active duty (rather than requesting light duty after your pregnancy has been confirmed). You will also be given written information to be shared with your personal physician. This information will include a letter from the PSOHC Medical Director in which a full description of the major duties involved in performing your job in the field will be provided. Your physician will be asked to read this document, sign it and return it to the PSOHC for inclusion in your confidential medical record (Appendix 1). This is being done to ensure, to


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the extent possible, that your physician is informed regarding the occupational demands and potentially harmful occupational exposures encountered by professional firefighters.

HEALTH & SAFETY OF EMPLOYEE

AND HER UNBORN CHILD

EMPLOYEE’S PHYSICIAN

EMPLOYEE

PSOHC

Figure 1. THE TRIANGLE OF CARE

Physicians and other health care workers not involved in occupational and/or preventive medicine and, more specifically, Public Safety Medicine, are generally unaware of the true nature of our profession. Your personal physician is, in all likelihood, unaware of the various environmental (toxins, temperature extremes, etc.) conditions, physiological stressors, and mental demands encountered by firefighters on a daily basis. The PSOHC staff has a high level of expertise in this very specialized area of medicine. They represent the best source of information for your personal physician, and are available for consultation with your doctor if requested. Conversely, your private physician has a high level of expertise in the field of obstetrics. He or she will provide most of your care during your pregnancy


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(regularly scheduled examinations; medications, if needed and, ultimately, the delivery of your child). Department Support Available to the Pregnant Firefighter Professional firefighters1 in the Fairfax County Fire and Rescue Department who become pregnant while on active duty are protected by Departmental, state and federal policies and laws with respect to their work status options during pregnancy. The Department does, however, strongly support the recommendation of the International Association of Fire Fighters (IAFF) “that pregnant firefighters should not participate in fire suppression, hazardous material and Emergency Medical Services (EMS) operations from the time pregnancy is confirmed and that pregnant firefighter candidates should defer training.” This recommendation is based on the best available scientific and medical research to identify risks associated with pregnancy. The topic of reproductive risks is addressed in Chapter 3 of this Plan. The Light Duty Coordinator, Safety and Personnel Services Division, is the main point of contact within the Department for pregnant firefighters who wish to request a light duty assignment after confirmation of their pregnancy. Personnel within this Division welcome the opportunity to discuss this matter with you and to assist you in identifying professionally rewarding light and/or alternative assignments. The Light Duty Coordinator may be reached at (703) 246-3800 or via email at [email protected]. Summary The Fairfax County Fire and Rescue Department, in conjunction with the PSOHC, feels that the Triangle of Care concept is a logical and supportive program intended to provide important guidance and medical care for pregnant firefighters. You are the key element in this collaborative effort. It is up to you to facilitate communication between the three “sides” of the Triangle and to take full advantage of the services offered. We stand ready to support you.

1 Much of the procedural information contained in this Plan is specific to career firefighters. However, volunteers should be aware that the PSOHC stands ready to provide occupational medicine support and counsel.


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CHAPTER 2: Legal Rights and Responsibilities for Pregnant Firefighters

Introduction The Fairfax County Fire and Rescue Department supports and upholds federal, state and local laws and standards designed to protect the legal rights of all employees. The Department recognizes that pregnancy is a normal occurrence in a woman’s life (and career), and wishes to provide useful information regarding the employee’s legal rights and responsibilities, while at the same time stressing our recommendation of “safety first” for the pregnant employee and her unborn child. The following paragraphs provide a brief overview of the relevant laws and standards designed to protect the rights of pregnant women. Pregnancy Discrimination Act The Pregnancy Discrimination Act is an amendment to Title VII of the Civil Rights Act of 1964. The Act states that discrimination on the basis of pregnancy, childbirth, or related medical conditions constitutes unlawful sex discrimination under Title VII. Women who are pregnant or affected by related conditions must be treated in the same manner as other applicants or employees with similar abilities or limitations. Title VII’s pregnancy-related protections include hiring, pregnancy and maternity leave, health insurance, and fringe benefits. An excellent summary of the Act can be found at: http://www.EEOC.gov/types/pregnancy.html. For the purposes of this Plan, it is important to note that pregnant employees have a right to work as long as they are capable of performing their jobs. This puts responsibility for determining when to leave the field (and request a light duty assignment) almost entirely on the pregnant firefighter. The Safety and Personnel Services Division (SPSD), PSOHC, and your primary care physician are all valuable sources of counsel regarding this decision.


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http://www.eeoc.gov/types/pregnancy.html


Virginia Human Rights Act and Law 2.1-714-725. The Virginia Human Rights Act, which went into effect in 1987, covers all employers and prohibits discrimination in employment based upon race, color, religion, national origin, sex, age, marital status, disability, pregnancy, childbirth and related medical conditions. The law (2.1-714-725) makes violation of a federal discrimination statute a violation of Virginia law. Family and Medical Leave Act (FMLA) of 1993 (Public Law 103-3) Under the FMLA, an eligible employee may take up to 12 work weeks of leave during any 12-month period for one or more of the following reasons:

The birth of a child, and to care for the newborn child;

The placement of a child with the employee through adoption or foster care, and to care for the child;

To care for the employee’s spouse, son, daughter, or parent with a serious

health condition; and

Because a serious health condition makes the employee unable to perform one or more of the essential functions of his or her job.

During family and medical leave (FML), an employer must maintain the

employee’s existing level of coverage under a group health plan. At the end of FML, an employer must take an employee back into the same or an equivalent job.

Fairfax County Fire and Rescue Department Standards Family and Medical Leave1 (SOP 02.01.12). Procedures for administering the County’s family and medical leave policies, are provided in this SOP. Language in this SOP is taken almost directly from Public Law 103-3 and procedures

1 All employees requesting FML will be sent a Memorandum from the Fire Chief that provides detailed information regarding start/end date of FML; health insurance retention requirements; return to work procedures; and other important guidance. A copy of this Memorandum can be found in Chapter 5 of this Plan.


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outlined mirror those of the Family and Medical Leave Act of 1993. Summary information specific to pregnancy and pregnancy-related requests includes:

Whenever the need for family and/or medical leave is foreseeable, the employee shall, in writing, send a request through the chain of command to the Fire Chief, with a copy to the Personnel/Payroll Section of the Human Resources Division (Attention: Personnel/Payroll Supervisor). The request should be at least 30 days in advance whenever possible. The employee shall indicate the anticipated duration of absence and reason for the request.

Family leave used in connection with the birth or the placement of a child

for adoption or foster care must be completed within 12 months of the date of the birth or placement of the child.

Family leave may be taken intermittently or on a reduced schedule, but

only with supervisor's approval.

Prenatal care is explicitly included; routine physical exams are explicitly excluded.

During the leave period, the County will continue coverage under the

health insurance plan in which the employee is participating prior to going on leave at the level and under the conditions coverage would have been provided if the employee had not gone on leave. If an employee uses leave without pay during the 12-week family and medical leave entitlement, the County will continue to contribute the County's share of the employee's health insurance premium.

Employees on family or medical leave whose health insurance coverage

level changes (i.e., individual to two party) are responsible for filing the appropriate health insurance forms within the specified time period. Employees whose coverage level increases are responsible for the increased employee contribution.

Discrimination (SOP 02.00.05). The discrimination SOP ensures all Department employees a work environment that is free from any form of discrimination, harassment, intimidation. Light Duty (SOP 02.03.06). The Light Duty Program is designed to keep an individual involved with the Department by utilizing the skills of injured, ill, or


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other related conditions of uniformed personnel during that period that they are not able to perform the full duties of a firefighter. Pregnant firefighters may, if they wish, request a light duty assignment as soon as their pregnancy has been confirmed. Procedures for light duty assignments specific to pregnancy are:

1) Pregnant personnel shall immediately notify the PSOHC of a confirmed pregnancy and receive an informational packet.

2) Request a completed Work Status Notification form (FRD-158) for her

supervisor and the Light Duty Coordinator (LDC).

3) Once a decision has been made to abstain from regular duties, pregnant personnel may report to the LDC for assignment.

4) Submit a request for family and medical leave (FML) to the LDC following

procedures outlined in SOP 02-01.12, Family and Medical Leave.

5) An employee shall return to full and unrestricted duty when she has been given written permission from her physician and has a completed FRD-158 form from the PSOHC.

6) If not fit for duty at the expiration of FML coverage, submit for fitness for

duty evaluation and provide the LDC with a completed FRD-158 from the PSOHC indicating work status and follow guidelines as outlined in SOP 02.04.03, Fitness for Duty.

Fitness for Duty (SOP 02.04.03). The Department may require any firefighter to undergo a "Fitness for Duty" examination at the Public Safety Occupational Health Center PSOHC for cause. As stated in this SOP, "A fitness for duty evaluation shall be considered when an employee's physical condition hinders his or her ability to render full, efficient, and safe performance of his or her duties. If the consensus of the employee's supervisors, including the Deputy Chief, determines a fitness for duty evaluation is appropriate, the employee shall submit to the fitness for duty evaluation." From an historical perspective, essentially all firefighters have elected to initiate light duty assignments as soon as they determine they are pregnant. On rare occasions, firefighters elected to remain in the field during their first trimester.


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Due to the significant medical and physiological changes which typically occur during the late second trimester and third trimester of pregnancy, a firefighter would generally not be considered fit for full duties during this (latter) half of pregnancy. This assessment would be made on an individualized basis and requires close coordination with the PSOHC. If the employee has missed participation in a scheduled Work Performance Evaluation (WPE), this test must be successfully completed before an employee can be cleared for return to full duty status. Fairfax County Public Safety Occupational Health Center (PSOHC) Position Statement The PSOHC is tasked with providing occupational health and preventive medicine services to employees working in Public Safety within Fairfax County. The PSOHC has reviewed the available medical literature relevant to possible work-related exposures during pregnancy and nursing. What follows are the recommendations of the PSOHC for pregnant firefighters, based on our medical expertise and our interpretation of existing medical literature as it relates to the reproductive health of female firefighters. The PSOHC respects the rights of individual firefighters to evaluate the relative risks and benefits of continued work when pregnant. To help you make an informed decision, you will be provided with a current compilation of medical articles relevant to this topic. Additionally, we will be pleased to meet with you at any time to discuss these issues on a face-to-face basis. If you should elect to continue working while pregnant, we encourage you to take all practical steps to limit your exposure to toxic gases/chemicals, including proper use of your SCBA during fire suppression and continuous use of SCBA during overhaul activities. The issue of medical risk to the infants of breast feeding firefighters is as complex as the issue of pregnancy discussed above. It is clear, however, from various animal studies conducted by researchers funded by the National Institutes of Health (www.nih.gov) that there is a tendency for toxic chemicals to be concentrated in the milk of nursing mothers.


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Decisions regarding appropriate precautions and/or countermeasures to be taken by breast feeding firefighters are solely the responsibility of the individual2. Breast feeding firefighters may wish to seek advice from their private physician and/or health care personnel within the PSOHC. Additionally, PSOHC physicians will, of course, be available for consultation at any time following a potential exposure to assist you in evaluating the risk of any particular situation. Please contact the PSOHC with any concerns you have in this regard. The PSOHC will continue to monitor medical literature relevant to these topics. The primary points of contact within the clinic for these activities are Nancy Kane Cross, PA-C and Dr. Donald Stewart, PSOHC Medical Director. You may contact the clinic at: (703) 246-4949. Infectious Disease Physicians, Inc. Recommendation(s) Regarding Post-Exposure Prophylaxis. In the event of an infectious disease exposure, all personnel (regardless of gender) should refer to the Department’s Exposure Control Plan. Following is a summary of counsel provided by the Department’s contract infectious disease physician regarding post-exposure prophylaxis3 with antiretroviral therapy. A full copy of the letter from Dr. Alan Morrison (IDP) may be found in Appendix 2.

Post-exposure prophylaxis with antiretroviral therapy is warranted for high risk events for FRD personnel, independent of gender.

Data pertaining to antiretroviral medications in pregnancy support the

notion that they are, indeed, safe. In fact, they are utilized regularly to prevent HIV transmission from mother to child.

Evaluation of pregnant women who have taken antiretroviral treatment

suggests no increased incidence of fetal malformations or congenital

2 Reference International Union, United Automobile, Aerospace & Agricultural Implement Workers of America, UAW, et al. v. Johnson Controls, Inc. No. 89-1215. Argued October 10, 1990 – Decided March 20, 1991. Held: Title VII, as amended by the Pregnancy Discrimination Act (PDA), forbids sex-specific fetal-protection policies. 3 Recommended reading: Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis (Centers for Disease Control and Prevention, 2001).


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anomalies. Thus, the safety and efficacy of these products is fully supported.

No adjustment in work is necessary.

Dr. Morrison is available to provide additional education for women who are currently pregnant or who are anticipating pregnancy regarding this issue. He may be contacted at (703) 560-7900.


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CHAPTER 3: Reproductive Health Hazards Introduction

The term “reproductive hazards” refers to substances or agents that affect the reproductive health of women or men or the ability of couples1 to have healthy children. Radiation, some chemicals, certain drugs (legal and illegal), tobacco products, certain bacteria/viruses, and alcohol are examples of reproductive hazards.

The harmful effects of certain workplace agents have been known for many years. For example, more than 100 years ago, lead was discovered to cause miscarriages, stillbirths, and infertility in female pottery workers. Rubella (German measles) was recognized as a major cause of birth defects in the 1940s. However, the causes of most reproductive health problems are still not known. A reproductive hazard could cause one or more health effects, depending on when one is exposed. For example, exposure to harmful substances during the first three months of pregnancy might cause a birth defect or a miscarriage. During the last six months of pregnancy, exposure to reproductive hazards could slow the growth of the fetus, affect the development of its brain, or cause premature labor. Reproductive hazards may not affect every worker or every pregnancy (NIOSH 1999). As noted earlier in this document, the Department, in compliance with federal, state, and local laws, supports the right of a pregnant firefighter to make her own decision regarding work status during pregnancy. It is, for the most part, up to the firefighter to determine when she elects to leave the field to assume a light duty position. This holds true up to the point where, after medical evaluation (Fitness for Duty, SOP 02.04.03) by the PSOHC, it is determined the firefighter is no longer capable of performing the full duties of a firefighter. The Department does, however, concur with the recommendation from the IAFF that pregnant firefighters leave the field upon confirmation of their pregnancy duty. This recommendation is made in the context of existing scientific and medical information available regarding reproductive risks. Given the nature of the job and the fact that firefighters are exposed to environmental, chemical, 1 Men are also susceptible to reproductive hazards. The primary audience for this document, however, is active duty female firefighters.


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biological and physical hazards in varying amounts and combinations on a routine basis, a pregnant firefighter working in the field may be putting her unborn child at risk. Pregnant firefighters who go on light duty for the duration of their pregnancy retain all employment rights (rank, wages, etc.). Risk Assessment Overview The purpose of this section is to summarize relevant issues regarding your reproductive health that would be associated with continued work in the field as a firefighter/medic. You have to perform a “risk to benefit” analysis in order to make a decision about your work status. Hopefully, you will be able to make a more informed decision after reviewing this section and the following section, which discusses specific types of risks. Finally, you are encouraged to gather as much information (from a variety of sources) as needed to help you make an informed decision. Please consider the following points which will assist you in your personal assessment of the risks involved.

There appear to be (potentially) significant risks involved with continued work as a firefighter during pregnancy – these should be weighted against the potential benefits (primarily to be in a familiar work environment).

A review of the very limited medical literature relevant to this topic does

not provide definitive answers regarding this issue. (No one can quantify your risk for an adverse outcome.) However, studies performed to date suggest there is significant reason for caution.

The normal demographics of reproduction reveal that there is a significant

risk of an adverse outcome during pregnancy. Out of 10,000 pregnancies, 20% will end in spontaneous abortion (natural fetal death), and 3% (150) will result in serious birth defects. Therefore, natural fetal death and birth defects are relatively common occurrences. This would make it difficult to establish causation if a firefighter – choosing to continue work in the field – should have an adverse outcome.


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You should consider that the IAFF, an organization representing the interests of firefighters, advises pregnant firefighters to come out of the field when they determine that they are pregnant.

Continued work in the field potentially exposes a firefighter to a variety of

risks (chemical, infectious, thermal, traumatic) with consequences ranging from insignificant to potential loss of life.

The above points are intended to encourage you to consider a number of issues that may or may not be readily apparent to the employee who is not normally required to deliberate on an issue such as reproductive hazards. While the above points may seem uniformly negative, it is assumed that the employee is well versed on the opposite side of this deliberation (i.e., the various reasons for continuing to work in the field). This is an emotional and complicated issue that cuts across many issues: That of women’s rights, as a fetal rights concern, as an occupational health issue, and, finally, as a concern to employers (legally and medically). The County of Fairfax recognizes an employee’s right to continue working in the field as long as she is fit for duty. All of these factors must be considered by the person with the greatest vested interest the employee and an informed decision made that is right for that individual. Specific Exposure Risks Primary exposure to chemical substances in the career of firefighters comes about as a result of exposure to products of combustion. The primary exception to this would be chemical vapors or liquids encountered in the management of hazardous materials mishaps. Obviously, employees are generally well protected from hazardous materials by the protective ensemble worn for this purpose. In a similar fashion, most structural fire fighting is now undertaken with the protective benefit of supplied air (Self-Contained Breathing Apparatus or SCBA). Properly worn SCBA results in a dramatic decrease in exposure to environmental substances. However, there is still a very low level exposure during working fires. (SCBA is generally considered to be capable of reducing environmental exposures by a factor of 2000.) During a response to a working fire; however, there are often times when crews are exposed to more dilute concentrations of combustion products, i.e., prior to donning SCBA. This may represent a potential exposure to harmful substances. Cutaneous (skin) exposures to soiled gear


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and/or unprotected eye exposures also constitute a potential source of exposure to a number of harmful chemicals. Although the type of chemical(s) present at an incident scene is dependent upon the types of fuels that have burned, some toxic gases are common to most fires. These include carbon monoxide, hydrogen cyanide, acrolein, formaldehyde, benzene, acetaldehyde and formic acid. These gases are suspended in smoke, which is primarily made up of oxygen, nitrogen, carbon dioxide, carbon monoxide and carbon particles. The most prevalent of these gases is carbon monoxide. Also present in smoke from early fires (low energy fires) are “free radical” particles. These molecules are highly reactive in biological systems and may do harm even at low levels of exposure. (In high exposure levels, they are responsible for incapacitation or possibly death.) While the medical literature contains a number of papers identifying health concerns associated with fire fighting (primarily heart and lung disease, as well as certain types of cancers), there is very little research which addresses workplace reproductive hazards. Lack of definitive research addressing this workplace concern is a function of the very large number of potential chemical hazards (tens of thousands of different chemicals are formed during fires), the cost of toxicology studies, and the tendency of toxicology studies to focus on acute rather than chronic effects (such as reproductive disorders). One chemical component that is always present in the structural fire fighting environment is carbon monoxide (CO). Carbon monoxide is thought to be the cause of “most fire-related deaths,” and is “underrated by the fire services.” This same paper, which reviewed the levels of carbon monoxide in working fires, characterizes CO as the most common and significant (acute) hazard to the unprotected firefighter (McDiarmid, et al, 1991). The CO molecule is highly toxic to the respiratory system because it binds with blood (hemoglobin) 200 times more strongly than does oxygen. Therefore, CO kills by binding to hemoglobin and not allowing adequate transport of oxygen across the pulmonary surface. Of particular concern is the fact that the human fetus is unusually susceptible to the physiological effects of carbon monoxide. Therefore, if a pregnant woman is exposed to carbon monoxide, the baby absorbs more carbon monoxide from the mother’s blood than the mother herself. The mother may not have many symptoms, but the baby may be seriously affected. Some data suggest that exposure in the latter part of the pregnancy presents the greatest risk; but the level of exposure(s) tested is not


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representative of the levels firefighters may encounter in the field and at the station.

Although the fire service has traditionally focused on the exposure risk to contaminants at a fire scene, diesel exhaust may be a more prevalent source of carbon monoxide on a day-to-day basis. Diesel exhaust from apparatus can fill the engine bays with carbon monoxide and even infiltrate fire station living and sleeping quarters. Effects from the exposure highly depend on how often and how long a person is exposed.

All firefighters responding to medical emergency calls risk exposure to other potentially hazardous materials such as body fluids, contaminated blood, infectious disease(s), etc. Data regarding the "true" risk of such exposure(s) are limited. It is, however, prudent to observe Department regulations regarding Personal Protective Equipment (PPE) and personal hygiene (frequent and thorough hand washing, etc.) at all times.

Information presented below provides useful reference sites regarding known reproductive risks.

Occupational Safety and Health Administration (OSHA) Standards. OSHA has standards specific to chemicals that are known to cause hazards to reproductive systems such as lead, dibromochloropropane, ethylene oxide, and glycol ethers. These standards may be accessed in their entirety on OSHA’s website (www.osha.gov). Most OSHA standards include sections that provide information on recommended personal protective equipment and/or minimizing one’s risk of exposure.

Center for the Evaluation of Risks to Human Reproduction (CERHP). The CERHP,established by the National Institutes of Health Institute of Environmental Health Sciences in 1998, provides scientifically-based, uniform assessments of the potential for adverse effects on reproduction and development caused by agents to which humans may be exposed. This information may be accessed via their website (http://cerhr.niehs.nih.gov). The Center has endeavored to provide summary information on reproductive risks in language easily understood by those who are not scientifically trained.


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http://www.osha.gov/

http://cerhr.niehs.nih.gov/


Stress During Pregnancy Studies have shown that stress during pregnancy can increase the risk of low-birth weight and premature births. A new study concludes that stress-related changes in a pregnant woman’s heart rate and blood pressure, along with chronic anxiety, can affect the heart rate of her developing fetus (Youakim, 1999). The American Medical Association (AMA) recommends that expectant women who spend more than four hours a day on their feet should quit or switch to a desk job by week 24. Some experts recommend that a woman stop working (or switch to a desk job) at week 20 if the job requires heavy lifting, climbing stairs (or ladders), pulling or pushing, or bending below the waist. The caveat to the information above is that these recommendations were made for women whose professions, while certainly demanding, are not comparable to firefighter duties. Shift and/or Night Work Research results on the effect of shift work or night shifts on pregnancy have been mixed. Some associated shift work with premature births, low birth weight and impaired fetal growth, but other studies have found no such link. A recent study (Reuters Health, 2004) from Denmark showed that women in the population who regularly worked the night shift had a higher risk of low birth weight delivery. There are no research results on the effects of shift work on pregnancy specific to our profession. Male Reproductive Health Concerns While the primary emphasis of this document is female reproductive hazards, pregnancy, and return to work issues, it is important to note that male firefighters also can be subject to reproductive health hazards. Specifically, adverse outcomes of concern include male fertility (altered sperm counts, motility disorders) and genetic abnormalities of sperm. Certain chronic chemical exposures can also result in impotence, although these medical effects would be more likely seen in chemical workers. While some chemicals (such as dibromo-chloro-propane) are known to cause male infertility with mild exposures, the effect of most chemicals on male fertility is not well known.


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Another medical concern related to fire fighting is the effect of high core (body) temperatures, which can occur while fire fighting in bunker gear. Tests done to document body temperatures during actual or simulated fire fighting demonstrate that firefighters at times reach high core body temperatures (up to 39 degrees C, or 102 degrees F). In controlled testing, tests were terminated in certain individuals because they reached the 39 degree C limit (established as a research safety criteria). Most firefighters know anecdotally that structural fire fighting in appropriate protective clothing (especially in summer months) can result in heat exhaustion. There is a clear, established link between hyperthermia and reduced sperm production. The most credible concern regarding male firefighter reproductive health was identified in a study by Olshan, et al (1990). This study examined birth registry data from British Columbia between 1952 – 1973. The authors suggest there was an excess of certain congenital heart defects (septal defects and a condition called patent ductus arteriosus) in the offspring of male firefighters. The specific reproductive toxicity of most chemical substances encountered in fire fighting is not well known, and it is appropriate to exercise caution regarding exposure to products of combustion or chemicals encountered in haz-mat operations. In fact, there is evidence that most of the chemicals tested to date affect both sexes. A paper by Mattison (1983) suggests that more substances are toxic to males’ reproductive process than to women. In summary, male firefighters are also subject to a number of workplace environmental hazards and conditions which may result in increased risk of reproductive disorders. An ancillary concern is the potential of contracting an infectious disease that then could be transmitted to a spouse and subsequently to the firefighter’s offspring. Hepatitis B, Hepatitis C, HIV, and herpetic viruses are examples of these infectious diseases. Summary Chapter 3 of this document has attempted to provide a summary overview of the hazards to reproductive health which may affect both men and women. These medical risks may be chemical exposures during fires or hazardous materials events, physical effects due to hyperthermia or trauma, or exposure to infectious diseases. Some of these risks are known and well defined; however, the vast majority of them are not well understood. Additionally, there is not adequate evidence in the medical literature to make informed decisions or provide accurate


17


estimates of the risks of adverse outcomes. Therefore, each individual must evaluate the available information, conduct a personal risk assessment, and make a decision regarding a proper course of action. For those inclined to delve further into this complicated medical and operational issue, a short bibliography of the relevant medical articles is provided in the References/Bibliography section of this document.


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CHAPTER 4: Maintaining Fitness During Pregnancy

Introduction Recommendations regarding exercise during pregnancy have changed dramatically over the past 20 years. Guidelines published in 1985 by the American College of Obstetrics and Gynecology (ACOG) took the conservative approach, recommending that active women limit the type, duration, and intensity of their exercise during pregnancy to minimize maternal and fetal risk (Clapp, 2002). Current research involving healthy, monitored women has addressed earlier concerns about exercise during pregnancy. Modern studies on aerobic and strength-conditioning exercise in pregnancy have shown no increase in early fetal loss, late pregnancy complications, abnormal fetal growth, or adverse neonatal outcomes. This suggests that previous recommendations have been overly conservative. As a result, most physicians now recommend that their patients (with uncomplicated pregnancies) participate in aerobic and strength-conditioning programs as part of a healthy prenatal and postnatal lifestyle (Clapp, 2002). The ACOG, in 2002, published new guidelines stating that healthy women may safely continue an already established exercise routine. These newer, less restrictive recommendations reflect conclusions researchers have come to in the past decade. Moderate activity during pregnancy, in conjunction with other healthy lifestyle practices, may have a positive health outcome for you and your baby. Table 4-1 provides a summary of the ACOG “Do’s and Don’ts” for exercise during pregnancy for healthy women. Levels of Exercise During Pregnancy The information on strenuous exercise is less conclusive. Additional research is needed to provide guidelines for fit women in physically active professions such as fire fighting.


19


Some promising research is being done on the safety of strenuous exercise during pregnancy in the United States and in Europe, but results are not yet published.

Table 4.1

American College of Obstetrics and Gynecology Recommendations for Exercise During Pregnancy

for Healthy Women DO

• exercise moderately and regularly unless otherwise advised by your health care provider.

• emphasize non-weight bearing activities and those that don't require a keen sense of balance.

• wear loose-fitting, lightweight clothing that allows heat to escape and moisture to evaporate.

• drink plenty of fluids during exercise; eat appropriately. • consume a healthy diet and gain weight as recommended.

DO NOT

• exercise or perform physical work to exhaustion. Quit when you feel tired.

• exercise while laying on your back in the second and third trimester.

• exercise in hot, humid conditions. • perform activities that may traumatize the abdomen or uterus

or cause you to lose your balance. • fast or exercise while you are hungry

Currently there are guidelines only for mild to moderate exercisers. ACOG recommends those women who engage in strenuous activities, previously


20


inactive women, or those with medical or obstetrical complications do so only with close medical supervision. Summary As discussed in Chapter 1 (Triangle of Care) of this document, step one in implementing the Triangle of Care program is to notify the PSOHC as soon as you confirm your pregnancy. Once this notification is received, the PSOHC will schedule an appointment for you to be seen as soon as possible. During this visit, you will be counseled and given information on a number of things, including the importance of staying fit during pregnancy. None of the information provided, however, is intended to serve as a substitute for a physician, nor does the author intend to give medical advice contrary to that of an attending physician’s. It is important to discuss your specific medical history, pregnancy history, exercise routine, and essential job functions with your personal physician. This evaluation process provides your physician the necessary information to make appropriate recommendations for your physical activity level. Information provided by the PSOHC will include a letter from the Medical Director giving a full description of the major duties involved in performing your job (Appendix 1). This information should give your personal physician greater insight into your profession and allow him/her to better guide you in designing a fitness program that is right for you.


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CHAPTER 5: Return to Work Introduction One’s physical condition after pregnancy/childbirth will vary greatly from person to person. The Fairfax County Fire and Rescue Department stands ready to work with all women returning to work after childbirth to identify a fitness program to meet their fitness/reconditioning needs. These programs are implemented through the Public Safety Occupational Health Center (PSOHC) and the Department’s Fitness Coordinator, following approved departmental guidelines and procedures. Fitness for Duty The first step to be completed by all employees in the return to work process is for the employee to schedule an appointment with the PSOHC and, at the time of the appointment, provide PSOHC medical personnel with medical clearance certification from their personal physician or obstetrician/gynecologist (ob/gyn). PSOHC personnel will then, in accordance with SOP 02.04.03, Fitness for Duty and Item 6 on the Memorandum from the Fire Chief, Request for Family/Medical Leave, conduct a Fitness for Duty medical examination to determine the level of physical reconditioning required. The need for a reconditioning program will be determined on an individualized basis. The Fitness for Duty examination includes a counseling session, including discussion regarding the potential need for reconditioning and/or work hardening and the possible need for scheduling a Work Performance Evaluation (WPE); a complete medical examination; and, if deemed necessary, a stress test. Upon completion of this examination, the employee will be released to either full duty or light duty. If an individual is released to light duty, they will be referred to the Fitness Coordinator for counsel regarding a fitness program. Implementation of recommended fitness/reconditioning programs may or not utilize a Peer Fitness trainer. As stated earlier, determination of need will be assessed on a case-by-case basis.


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Department Standards Department standards provide information and established procedural information intended to guide employees through all phases of any event requiring temporary job status change or extended leave. Full text versions of the references summarized below are included in this chapter. Most of these referenced materials may also be found on the Fairfax County intranet.

SOP 02.03.06: Light Duty. Section III.C specifically addresses “Pregnancy” and outlines the requirements for requesting light duty.

SOP 02.01.12: Family and Medical Leave Act. The Department’s SOP is modeled after, and in full compliance with, the Family and Medical Leave Act of 1993 (Public Law 103-3) enacted February 5, 1993, by the Senate and House of Representatives of the United States of America. Memorandum from the Fire Chief: Request for Family/Medical Leave. This standard letter is sent to all employees within the Department who request FML. Language contained in this letter is patterned after guidelines in Public Law 103-3. This letter provides full details regarding estimated start and end date of FML, information an employee may be required to submit for approval of FML, health insurance retention requirements, and return to work procedures. SOP 02.04.03: Fitness for Duty. The purpose of this SOP is to provide definitive guidance for supervisors to follow when an employee shows signs of being unfit for duty. The term “employee” as used in this document applies both to employees of the Fire and Rescue Department and to certified operational members of volunteer departments. This SOP addresses five areas where concern regarding an employee’s ability to perform his/her assigned duties in an acceptable manner may arise. These five areas are: (1) Substance abuse impairment policy; (2) Prescription medication policy; (3) Physical injury or illness policy; (4) Psychological impairment policy; and (5) Physical performance deficiency policy.


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PSOHC Work Status Notification form. This is the form utilized by PSOHC personnel when an employee’s FML expires and they undergo their required Return to Duty physical. The employee must provide written notification of medical clearance from their physician at the time of the Return to Duty physical. SOP 02.03.09: Physical Fitness. This SOP clearly delineates the Department’s requirements for all firefighters to maintain high levels of aerobic capacity, muscular strength, and endurance to perform safely and effectively in the fire service. It also provides information on programs and resources available to all personnel to assist them in achieving and maintaining (or regaining) optimum physical fitness (Peer Fitness Trainers, physical fitness resource materials, equipment).

Points of Contact In addition to the reference materials included in this chapter, Attachment 5-1 provides a list of important points of contact within the Department. Personnel identified in this “Contact List” represent a valuable resource for all employees.


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CHAPTER 5 ATTACHMENTS • Contact Information • Light Duty SOP 02.03.06 • Family and Medical Leave SOP 02.01.12 • Letter from the Fire Chief/

Request for Family/Medical Leave • Fitness for Duty SOP 02.04.03 • Work Status Notification Form • Discrimination SOP 02.00.05 • Physical Fitness SOP 02.03.09 Fairfax County Fire and Rescue Department Safety and Personnel Services Division

25



CONTACT INFORMATION

Public Safety Occupational Health Center (703) 246-4949

Donald Stewart, M.D., M.S. [email protected]

Light Duty Office (703) 246-3800 Sandra Witt [email protected] Peer Fitness Office (703) 246-4967 Lieutenant Rodney Vaughan [email protected] Behavioral Health Coordinator (703) 246-3970 Chip Theodore [email protected] Safety Office (703) 250-4537 Battalion Chief John Gleske [email protected] Payroll Section (703)246-3927 Laurie Varnau [email protected] Women’s Program Officer (703) 246-2546 Captain Sandra Caple [email protected] Equal Employment Opportunity Office (703) 246-3960 Captain Richard Sweatt [email protected]

mailto:[email protected]








FAIRFAX COUNTY FIRE AND RESCUE DEPARTMENT STANDARD OPERATING PROCEDURE S.O.P. 02.03.06

SUBJECT: LIGHT DUTY PAGE 1 OF 6

CATEGORY: Personnel

SUBCATEGORY: Occupational Health and Safety

APPROVED BY: EFFECTIVE DATE: August 26, 1993 REVISION DATE: May 3, 2004 Michael P. Neuhard CHIEF, FIRE AND RESCUE DEPARTMENT

FORMS REQUIRED: FRD-158, Work Status Notification Form FRD-159, Request for Light Duty Personnel FRD-177, Request for Light Duty – Non-Job-Related FRD-074, Medical Status Report FRD-091, Therapy Report FRD-331, Certification of Health Care Provider NOTE: Current forms are located on the Department's Intranet or the Risk Management Division’s Infoweb page

PURPOSE: To establish policies and provisions for light duty. I. PREFACE

The Light Duty Program is designed to keep an individual involved within the Department by utilizing the skills of injured, ill, or other related conditions of uniformed personnel during rehabilitation. Light duty assignments are available to employees with medical disabilities due to either job-related or non-job-related injuries or illnesses. The Light Duty Program also can be utilized for performance-related issues and other temporary assignments. Any employee on light duty shall report to the Light Duty Coordinator (LDC) in the Health Programs Section of the Safety and Personnel Services Division (SPSD). Physicians and therapists familiar with the job requirements of firefighters shall decide the functional capacities of uniformed personnel after significant injuries, illnesses, or other absences. The LDC also will work with the Public Safety Occupational Health Center (PSOHC) physicians to ensure that uniformed personnel are properly rehabilitated before returning to full duty.

II. POLICY

Permanent light duty assignments or accommodation agreements shall not be made. Any light duty assignment that is required due to an employee’s inability to perform the duties required of his or her position shall be limited to the equivalent of one calendar year from date of incapacity. Uniformed personnel assigned to Operations shall be limited to a maximum of 12 months or 2,912 hours of light duty. Personnel assigned to Administrative Services shall be limited to a maximum of 12 months or 2,080 hours of light duty. Personnel who exceed the maximum shall refer to Section VI of this SOP.

SUBJECT: LIGHT DUTY

EFFECTIVE DATE: August 26, 1993 REVISION DATE: May 3, 2004

S.O.P. 2.03.06

CATEGORY: Personnel


PAGE 2 OF 6

III. PROCEDURES FOR LIGHT DUTY ASSIGNMENTS A. Occupational Injuries/Illness

1. Any employee being treated for a job-related injury shall notify his or her supervisor

immediately when he or she is released to light duty. If the supervisor is unavailable, the employee shall notify the duty safety officer.

2. Any employee released to light duty shall report to the LDC on the following 40-hour

week (Monday-Friday) workday. 3. Assignments shall follow the treating physician's guidelines in conjunction with

Fairfax County Personnel Rules and the Virginia Workers' Compensation Laws. 4. Any employee reporting to light duty for the first time due to a job-related injury or

illness shall have a completed Medical Status Report. 5. It shall be the individual's responsibility to provide weekly medical status updates

from the workers’ compensation treating physician to the LDC if the next appointment is not clearly indicated on a current Medical Status Report.

B. Non-job-related injury/illness

Individuals unable to work due to a non-job-related injury/illness shall use 144 hours of leave or leave without pay and have requested FML before submitting a request for light duty. When submitting a request for light duty assignment, the following procedures shall apply:

1. The individual shall submit a written request on a Request for Light Duty Non-Job-

Related (FRD-177) Form to his or her immediate supervisor that includes an FRD-331 completed by their treating physician stating the projected length of disability, work restrictions, and physical limitations. Due to medical confidentiality, the cause of the disability for non-occupational injuries does not need to be identified for light duty approval.

2. The individual's immediate supervisor shall forward the signed FRD-177 form through

the chain-of-command to the battalion chief for recommendation and to the deputy chief or division supervisor for approval. The approved FRD-177 will then be provided to the LDC. The LDC shall notify the employee once the request has been approved.

3. A determination for a light duty assignment is based on: a. The type(s) of job(s) available. b. The benefit to the Department and the citizens of Fairfax County.

SUBJECT: LIGHT DUTY


S.O.P. 2.03.06

CATEGORY: Personnel


PAGE 3 OF 6

4. The Fire and Rescue Department is not under any obligation to provide light duty assignments for individuals who have non-job-related medical disabilities. Decisions shall be appealed to the respective assistant chief.

5. It shall be the individual's responsibility to provide weekly medical status updates from his or her physician to the LDC if the next appointment is not clearly indicated on a current Medical Status Report form. The LDC shall provide periodic updates to the individual's battalion chief.

C. Pregnancy

1. Pregnant personnel shall immediately notify the PSOHC of a confirmed pregnancy and receive an informational packet.

2. Request a completed Work Status Notification form (FRD-158) for her supervisor and

the LDC.

3. Once a decision has been made to abstain from regular duties, pregnant personnel may report to the LDC for assignment.

4. Submit a request for FML to the LDC following procedures outlined in SOP 02.01.12.

5. An employee shall return to full and unrestricted duty when she has been given written

permission from her physician and has a completed FRD-158 form from the PSOHC. 6. If not fit for duty at the expiration of FML coverage, submit for fitness for duty

evaluation and provide the LDC with a completed FRD-158 from the PSOHC indicating work status and follow guidelines as outlined in SOP 02.04.03, Fitness for Duty.

D. Performance-Based Issues

1. Individuals will be assigned to light duty for failure to complete the work performance evaluation (WPE). The LDC, the Physical Fitness Coordinator, and the PSOHC physicians shall coordinate an individual’s return to full duties.

2. Personnel requiring follow-up medical care (e.g., cardiology, pulmonology, audiology

consultations, etc.) from a PSOHC physical or consultation shall report to the LDC until released to full duty by a PSOHC physician.

3. Light duty personnel may be assigned for other fitness-for-duty issues as outlined in

Standard Operating Procedure 2.04.03, Fitness for Duty.

SUBJECT: LIGHT DUTY


S.O.P. 2.03.06

CATEGORY: Personnel


PAGE 4 OF 6

IV. PROCEDURES FOR PERSONNEL ASSIGNED TO LIGHT DUTY A. Personnel assigned to light duty shall report to the LDC at 0800 hours each day for briefing

and assignment. Those not present at 0800 hours will be considered tardy and will be subject to disciplinary action as described in Standard Operating Procedure 2.00.03, Work Hours. The only exceptions will be those individuals assigned to other work locations or employees at medical therapy appointments.

B. Personnel assigned to light duty shall wear a Class D uniform or clothing appropriate for their

work assignment. C. Personnel working in a light/restricted duty capacity shall be allowed to perform physical

fitness training. Individuals must provide the LDC with written approval from their treating physician showing the type, frequency, and duration of fitness conditioning that they may perform.

D. Individuals shall be required to provide Medical Status Report updates following each

physician’s visit. E. Training shall be maintained (e.g., OARS classroom session, EMT certification, EMSCEP,

and ALS in-station drills). F. Personnel assigned to light duty shall be relieved from duty at 1630 hours each day. Any

overtime must have prior approval of the LDC. G. Annual and compensatory leave shall be granted as it is in the field; requests will be

submitted at least one day before the leave day(s) requested. Any leave already approved during the time that the employee is expected to be on light duty shall be reported to the LDC when the employee first reports for light duty.

H. Personnel assigned to light duty due to a job-related injury/illness shall not be granted injury

leave without a physician's statement confirming that the absence is due to the job-related injury/illness. A Medical Status Report that is signed by a physician shall be presented to the LDC before personnel can be reassigned to light duty. If the individual is unable to physically report to the LDC while on injury leave, the individual shall immediately forward (by fax) the Medical Status Report to the LDC.

I. Personnel assigned to light duty shall be responsible for completing their Time and

Attendance (T&A) Reports and submitting them on time to the LDC. The following job numbers shall be used:

1. Job No. 92A020 - Job-related light duty 2 Job No. 92A014 - Non-job-related injury/illness 3. Job No. 92P010 - Pregnancy 4. Job No. 92P011 - Performance related 5. Job No. 92FMLV - Designated Family Medical Leave

SUBJECT: LIGHT DUTY


S.O.P. 2.03.06

CATEGORY: Personnel


PAGE 5 OF 6

6. Job No. 92INLV – Injury Leave

The subobject code 102 or 402 (as appropriate) shall be used for all job- or non-job-related injuries/illness.

J. Personnel released from light duty to full and unrestricted duty shall immediately notify the

LDC and the respective battalion chief. K. Scheduled annual physical appointments shall be maintained when an individual is assigned

to light duty. V. PROCEDURES FOR REQUESTING LIGHT DUTY PERSONNEL A. Light duty assignments shall be based on the limitations/qualifications of the individual. B. Supervisors requesting light duty personnel shall submit a Request for Light Duty Personnel

Form (FRD-159) or send a request via e-mail to the LDC with the following information: 1. Supervisor and work location 2. Description of task to be performed 3. Length of request: hour(s), day(s), week(s), and month(s). C. Supervisors requesting light duty must understand all procedures for personnel assigned to

light duty (Sec. III of this SOP). D. Granting of such requests shall be based on the availability of personnel assigned to light

duty, priority of the project, and time of receipt of the request. Field assignments shall require a written request from the individual’s deputy chief. The LDC shall review the continuation of extended light duty assignments monthly.

E. Each section requesting light duty personnel shall designate one supervisor to whom all light

duty personnel shall report. The supervisor shall ensure that light duty personnel maintain assigned work hours and that their T&As are correctly submitted. The supervisor also shall be responsible for completing employee performance evaluations for light duty personnel whose assignments are in excess of six months.

VI. LIMITATIONS ON LIGHT DUTY ASSIGNMENTS

A. Any light duty assignment that is required due to an employee’s inability to perform the full

field duties required of uniformed personnel assigned to Operations or the duties of an Administrative Services' assignment shall be limited to a maximum of 12 months from date of incapacity. These limitations are for any one compensable injury/illness event, non-job-related injury, or other performance-based issue. Employees who have exhausted the maximum time permitted (or have been assigned to light duty in excess of 9 months with a prognosis indicating probability of work restrictions continuing beyond 12 months) will be offered the following options:

SUBJECT: LIGHT DUTY


S.O.P. 2.03.06

CATEGORY: Personnel


PAGE 6 OF 6

1. Participation in the Alternative Placement Program, as described in S.O.P 2.0.11, Procedures for Uniformed Retirement System Alternative Placement Program, is limited to employees with a job-related injury that precludes the employee from performing full field duties.

2. Referral to County Human Resources for assistance with appointment to a general

County position in which the employee can meet all of the essential job functions and qualifications.

3. Referral to the Uniformed Retirement Board for service connected disability

retirement. 4. Referral to the Uniformed Retirement Board for non-service connected disability

retirement. 5. Resignation. 6. Involuntary separation.

B. Documentation required

All reports and personnel actions (to include transfers, temporary assignments, employee reclassifications, accommodation agreements, etc.) required to effectively administer the provisions of this SOP shall be documented in writing on the approved forms. Copies will be maintained in the employee’s personnel file. Other documentation to include work performance evaluation results and medical status forms will be held in separate files with limited access within the SPSD. Medical information, such as fitness for duty evaluations, shall be filed separately in the employee’s medical record file that is maintained by the PSOHC and/or the authorized physician’s file utilized for workers’ compensation claims.

C. Evaluation Criteria

To ensure that this policy is administered in an objective, consistent, and nondiscriminatory manner, the determination of an employee’s fitness and/or ability to perform essential firefighter job functions must be based on objective job-related criteria. The primary criteria to be used for a fitness for duty determination shall include one or more of the following:

1. Results of a medical and/or psychological examination performed by a County

physician or a physician approved by the Risk Management Division (RMD) with determination of fitness for duty based upon the established Medical Guidelines for Firefighters, the firefighter’s job description, and a list of essential job tasks as outlined in the work performance evaluation.

2. An official report, training record, administrative investigation, performance

evaluation, or request for accommodation.

FAIRFAX COUNTY FIRE AND RESCUE DEPARTMENT STANDARD OPERATING PROCEDURE S.O.P 02.01.12

SUBJECT: FAMILY AND MEDICAL LEAVE PAGE 1 OF 7

CATEGORY: Personnel

SUBCATEGORY: Leave and Overtime

APPROVED BY: EFFECTIVE DATE: August 10, 1998 REVISION DATE: March 23, 2005 Michael P. Neuhard CHIEF, FIRE AND RESCUE DEPARTMENT

FORMS REQUIRED: FRD-331, Certification of Physician or Practioner NOTE: Current forms are located on the Department's Intranet

PURPOSE: To provide procedures for administering the County's family leave and medical leave policies as defined in Chapter 10 of the Personnel Regulations. I. POLICY

Family and medical leave provide employees with leave in connection with the birth or placement of a child for adoption or foster care, to care for a sick or disabled family member, or for an employee’s serious health condition. An employee who follows the procedures outlined herein is entitled to 12 weeks of family or medical leave within a 12-month period.

II. DEFINITIONS

A. Family leave will mean leave used in connection with the birth or placement of a child for adoption or foster care.

B. Medical leave will mean leave used for the care of ill or disabled children, spouse,

parents or parents-in-law, or for recuperation from a serious health condition that renders the employee unable to perform the functions of his or her position.

C. Child will mean a biological, adopted or foster child, a stepchild, a legal ward, or a child

of a person standing in loco parentis, who is less than 18 years of age, or 18 years of age or older and incapable of self-care because of a mental or physical disability.

D. Spouse will mean a husband or wife of an employee as defined or recognized under

Virginia law for purposes of marriage.

E. Parent will mean a biological parent of an employee or an individual who stands or stood in loco parentis to an employee when the employee was a child.

F. Parents-in-law will mean a biological parent of an employee’s spouse.

SUBJECT: FAMILY AND MEDICAL LEAVE

EFFECTIVE DATE: August 10, 1998 REVISION DATE: March 23, 2005

S.O.P 02.01.12

CATEGORY: Personnel


PAGE 2 OF 7

G. In loco parentis will mean those persons with day-to-day responsibilities to care for and financially support a child or, in the case of an employee, who had such responsibility for the employee when the employee was a child. A biological or legal relationship is not necessary.

H. Serious health condition will mean one that requires either inpatient care, or a continuing

regimen of treatment by a health care provider.

I. Continuing regimens of treatment will mean treatment, which usually includes:

• Two or more visits to a health care provider. • Two or more treatments by a health care practitioner on referral form, or under the

direction of a health care provider. • A single visit to a health care provider that results in a regimen of continuing

treatment under the supervision of a health care provider (for example, a course of medication or therapy to resolve the health condition or pregnancy or prenatal care).

J. Incapable of self-care will mean that the individual requires active assistance or

supervision to provide daily self-care in several of the activities of daily living (ADL). ADL includes adaptive activities such as caring appropriately for one’s grooming and hygiene, bathing, dressing, eating, cooking, cleaning, shopping, taking public transportation, paying bills, maintaining a residence, using telephones and directories, and using a post office, etc.

K. Physical or mental disability will mean a physical or mental impairment that substantially

limits one or more of the major life activities of an individual (as defined in 29 C.F.R., Part 1630).

L. A health care provider will mean a doctor of medicine or osteopathy, podiatrist, clinical

psychologist, optometrist, chiropractor, nurse practitioner, nurse-midwife, clinical social worker, or Christian Science practitioner.

M. Workweek is defined as the hours an employee is regularly scheduled to work in a 7

consecutive day period; 12 weeks is equivalent to: 24-hour shift = 672 hours; 12-hour shift = 504 hours; 8-hour shift = 480 hours annually.

III. PROCEDURE

Employee Requests for Leave/Notification of Non-Return

Whenever the need for family and/or medical leave is foreseeable, the employee shall, in writing, send a request through the chain-of-command to the Fire Chief and a copy to the attention of the Personnel/Payroll Supervisor of the Human Resources Section in the Safety and Personnel Services Division. The request should be at least 30 days in advance whenever possible. The employee shall indicate the anticipated duration of absence and reason for the request. A written medical statement (FRD-331) from a health care provider may be required



S.O.P 02.01.12

CATEGORY: Personnel


PAGE 3 OF 7

in connection with a request for medical leave. Additionally, the Fire Chief or his designee may require medical documentation from an employee concerning the continuing necessity for medical leave in connection with any issue concerning the employee’s ability to return to work at the expiration of the medical leave.

B. In the event that the employee does not provide advance notification of the need for Family

Medical Leave, once the Department learns that an absence meets the criteria for the Family Medical Leave Act (FMLA), the immediate supervisor shall request that the Fire Chief designate the absence as FMLA leave even if the employee does not want to designate the absence. The Fire Chief shall use FRD-353A for such notification.

C. The Fire Chief or his designee is responsible for approving family and medical leave and for

notifying the employee in writing. Approval is based on the leave request meeting the criteria established in this procedure.

D. Employees who do not plan to return to work at the expiration of family and/or medical leave shall notify their supervisor no less than (2) two days prior to the expiration of the leave. Failure to return to work without giving adequate notice at the expiration of the leave may result in the conversion of the resignation to an unsatisfactory service separation under Section 9.5 of the Personnel Regulations.

E. Either the Department or the employee may choose to have FMLA-leave entitlement run

concurrent with a workers’ compensation absence.

F. An employee cannot be forced to perform a “light duty” job under workers’ compensation if either the employee or the Department elects to use part of the absence as FMLA leave entitlement, even if the employee is able to perform the light duty.

IV. LEAVE ENTITLEMENT/USAGE

A. If requested, family and medical leave shall be granted to any merit employee for a period of up to 12 work weeks over a 12-month period. The 12-month period for family and medical leave will commence with the first use of family or medical leave.

B. Nothing in this standard operating procedure (SOP) will prohibit the employee from

requesting and the supervisor approving leave in excess of 12 weeks. Such leave usage may be granted in accordance with existing leave regulations contained in Chapter 10 of the Personnel Regulations. Additional leave beyond the 12 weeks will not count as Family and Medical Leave for continuation of benefits purposes.

C. Family and medical leave may include any combination of sick, annual, or leave without pay

at the discretion of the Fire Chief subject to the parameters noted in D and E below. Use of compensatory leave is addressed in Section E below.



S.O.P 02.01.12

CATEGORY: Personnel


PAGE 4 OF 7

D. Sick leave usage is governed by the existing regulations contained in Chapter 10 of the Personnel Regulations. Specifically, women who take family leave following the birth of a child may use sick leave only for the period of time that they are disabled.

E. Employees requesting family and/or medical leave may be required to use accrued annual or

sick leave, as appropriate, prior to the use of leave without pay.

1. Employees who are not exempt from the Fair Labor Standards Act (FLSA) may not be required to use accrued compensatory leave, but may do so at their option.

2. Employees who are not exempt from the Fair Labor Standards Act may not have use of accrued compensatory leave counted against the 12-week FMLA entitlement. 3. Employees who are exempt from the Fair Labor Standards Act may not be required to

use accrued compensatory leave prior to the use of leave without pay; however, if the exempt employee requests the use of accrued compensatory leave in lieu of other paid leave or leave without pay for FMLA purposes, the compensatory leave will count toward the 12-week FMLA entitlement.

F. Nothing in this SOP prohibits an employee from requesting additional leave for which he or

she may be entitled, including advanced sick leave, extraordinary sick leave, transferred leave, or sick leave bank.

V. FAMILY LEAVE

A. Family leave used in connection with the birth or the placement of a child for adoption or foster care must be completed within 12 months of the date of the birth or placement of the child.

B. Family leave may be taken intermittently or on a reduced schedule, but only with supervisor’s

approval.

C. Employees may request family leave as needed under this procedure, but are guaranteed family leave only so long as the cumulative total of family and medical leave absences do not exceed 12 weeks during a 12-month period.

VI. MEDICAL LEAVE

A. As a general rule, where inpatient care is not involved, absences of more than three calendar days (and requiring the continuing treatment of a health care provider) for the employee’s serious health condition or for the care of a sick family member will be considered eligible for medical leave.

B. Prenatal care is explicitly included; routine physical exams are explicitly excluded.



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C. Employees may request medical leave as needed under this procedure, but are guaranteed medical leave only so long as the cumulative total of family and medical leave absences does not exceed 12 weeks during a 12-month period.

D. Nothing in this SOP limits the rights of employees to request sick leave in order to provide

necessary care and attendance to a sick family member under existing sick leave policies. E. An employee may be required to provide medical certification from a health care provider

indicating the need for medical leave, the continuation of medical leave, and/or the ability of the employee to return to work. Family Leave can be denied if form is required and not returned by the specified date.

1. Medical certifications must state, in the case of the employee’s serious health condition,

that he or she is unable to perform the functions of the position. FRD-331 shall be used to obtain the initial certification. The FRD-331 will be returned to the Personnel/Payroll Supervisor, who will then forward the Original to the Employee Relations Division of the Department of Human Resources (per County Regulation) and a copy to the Health Section of the Safety and Personnel Services Division and will be placed in the medical files.

2. Once the certification has been completed, contact with the employee’s health care

provider is limited to clarification and verification of information contained in the medical certification. No additional information can be requested.

3. In the case of Family Medical Leave taken for an employee’s serious health condition,

prior to returning to duty, the employee must first contact the Captain of the Health Section to set-up an appointment with the Public Safety Occupational Health Center.

4. Where the employee is requesting medical leave to care for a seriously ill family

member, the health care provider must either certify that the third-party care is required or that the employee’s presence would be beneficial to the patient. Such certification, in conjunction with an employee’s statement of the care he or she will provide, will be sufficient to satisfy this requirement.

5. If intermittent leave or leave on a reduced schedule is required, the medical certification

must describe the treatment regimen provided, i.e., doctors’ visits, therapy, etc. FRD-331 may be reproduced and used for medical certification.

6. Documents related to medical certification under FMLA must be kept in separate files

and treated as confidential. All FMLA medical certification forms and documents shall be forwarded to the Employee Relations Division of the Department of Human Resources where a separate FMLA file will be maintained.



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F. Medical leave will be granted on an intermittent basis or on a reduced work schedule if certified as necessary by the health care provider.

VII. CONTINUATION OF BENEFITS

A. During the leave period, the County will continue coverage under the health insurance plan in which the employee is participating prior to going on leave at the level and under the conditions coverage would have been provided if the employee had not gone on leave. If an employee uses leave without pay during the 12-week family and medical leave entitlement, the County will continue to contribute the County’s share of the employee’s health insurance premium.

B. Employees on family or medical leave whose health insurance coverage level changes, i.e.,

individual to two-party, are responsible for filing the appropriate health insurance forms within the specified time period. Employees whose coverage level increases are responsible for the increased employee contribution.

C. Employees on family or medical leave are responsible for the payment of the employee’s

contribution for health insurance.

1. If the employee is in a paid leave status, the employee’s share will continue to be paid through a payroll deduction.

2. Employees on family or medical leave who are in a leave without pay status will be

billed each month for their health, life, dental, hospital confinement, and long-term disability premiums under existing rules for payment by employees on leave without pay.

3. Payment must be made by personal check or money order. Special arrangements for

premium payments can be made by contacting the Department of Human Resources Benefits Division.

D. Health insurance coverage will be canceled after a required payment is more than 30 days

late.

E. If health insurance coverage lapses due to nonpayment of the required premium or employee’s cancellation of coverage, the employee may request restoration of health insurance upon return from leave. Health insurance coverage will be restored effective the date the employee returns from family or medical leave. A written request to restore health insurance must be received by the Department of Human Resources Benefits Division within 60 days of the employee returning to work.

F. Any contributions to health insurance made by the County during family and medical leave,

while the employee was in leave without pay status, may be recovered from the employee should he or she not return to work at the expiration of the family or medical leave. Such repayment is not required if the employee’s failure to return is due to his or her serious health



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condition or the care of an ill family member or other circumstances beyond the control of the employee.

G. Employees who terminate employment while on family or medical leave will be eligible for COBRA (continuation of health insurance coverage) if they meet COBRA eligibility requirements. The effective date for COBRA coverage will be based on the date of termination.

VIII. RETURN TO FORMER POSITION

A. An employee on family or medical leave must be returned to his or her former position.

B. Any exception to this provision requires the approval of the Director of the Department of Human Resources prior to the employee’s return to work. The request to return an employee to a different but equivalent position must provide the Director of the Department of Human Resources with a detailed justification of the reason(s) why the employee cannot be returned to his or her former position.

IX. RECORD KEEPING/TIME AND ATTENDANCE

A. The Fire and Rescue Department’s Personnel/Payroll Section is responsible for maintaining records of family and medical leave and for tracking the amount of family and medical leave used within the 12-month period.

B. In addition to the type of leave requested (annual, sick, compensatory, or leave without pay),

the leave request form shall include a notation that the absence is for family and or medical leave (for record keeping purposes only) utilizing job number 92FMLV.

C. Time sheets shall be coded with the routine codes for sick leave, annual leave, or

compensatory leave, as applicable. In addition, they shall include the job numbers in the T & A Manual for family or medical leave.

To ensure that health insurance benefits are not interrupted, family or medical leave without

pay (LWOP) shall be coded with the subobject codes designated in the T & A Manual for leave without pay for family and medical LWOP. They shall also include the appropriate job number.

D. When leave is taken intermittently or is on a reduced schedule, only the time actually taken as

family and medical leave may be charged against the employee’s entitlement. X. MISCELLANEOUS

An employee will not accrue any additional seniority credit during unpaid family or medical leave and will be treated the same as employees who are on leave without pay for any other purpose.

FAIRFAX COUNTY, VIRGINIA

MEMORANDUM

February 17, 2005

TO: FROM: Chief Michael P. Neuhard Fire and Rescue Department SUBJECT: Request for Family/Medical Leave On , you notified us of your need to take family/medical leave due to:

The birth of your child, or the placement of a child with you for adoption or foster care; or A serious health condition that makes you unable to perform the essential functions of your

job; or A serious health condition affecting your spouse, child, parent, parent-in-law,

for which you are needed to provide care. Also, in your request for family/medical leave dated , you notified that the use of this leave would begin , and that you expect this leave to continue through approximately , returning to work . When you begin taking Family Medical Leave you are to immediately inform your supervisor and the supervisor of the Personnel/Payroll Section. Also, upon your return to full unrestricted duty you shall immediately notify your supervisor and the supervisor of the Personnel/Payroll Section. Family Medical Leave is granted for specific incidents. Any further need for Family Medical Leave coverage over the next year must be requested separately and have the appropriate medical documentation required. Except as explained below, you have a right under the Family Medical Leave Act for up to 12 weeks of unpaid leave in a 12-month period for the reasons listed above. Your health benefits must be maintained during any period of unpaid leave under the same conditions as if you continued to work and you must be reinstated to the same or equivalent job with the same pay, benefits, and terms and conditions of employment on your return from leave. This is to inform you that: 1. You are eligible

You are not eligible for leave under the FMLA 2. The requested leave will be counted against your annual FMLA leave

The requested leave will not be counted against your annual FMLA leave entitlement

February 17, 2005 Page 2 3. You will be required to furnish medical certification of a serious health condition. If

required, you must furnish certification by , or we may delay the commencement of your leave until the certification is submitted. This form is to be provided to the Personnel/Payroll Supervisor prior to required date.

You will not be required to furnish medical certification of a serious health condition.

4. You may elect to substitute accrued paid leave for unpaid FMLA leave.

We will not require that you substitute accrued paid leave for unpaid FMLA leave. We will require that you substitute accrued paid leave for unpaid FMLA leave. If paid

leave will be used, the following conditions will apply: N/A 5. (a) If you have County health insurance, the County’s portion of your health insurance

premium will continue to be paid during this 12-week period, regardless of your pay status. However, should you be in leave without pay status, you will be responsible for paying the employee portion of your health insurance premium directly to the County at the following address:

Fairfax County Government Department of Human Resources Benefits Division 12000 Government Center Parkway, Suite 258 Fairfax, Virginia 22035-0039

If you do not return to work following your leave and are not granted additional leave

for a reason other than (1) the continuation, recurrence, or onset of a serious health condition or (2) other circumstances beyond your control, you may be required to reimburse the County for the employer share of any health insurance premiums paid on your behalf while on a leave without pay status.

(b) You have a minimum 30-day grace period in which to make premium payments. If payment is not made on time, your group health insurance may be canceled provided we notify you in writing at least 15 days before the date that your health coverage will lapse, or, at our option, we may pay your share of the premiums during FMLA leave, and recover these payments from your upon you return to work.

February 17, 2005 Page 3 6. You will be required to present a fitness-for-duty certification (FRD-158 Work

Status notification form) prior to being restored to employment. If such certification is required but not received, your return to work may be delayed until the certification is provided. You must contact the Public Safety Occupational Health Center at

703-246-4949 prior to returning to work.

You will not be required to present a fitness-for-duty certification prior to being restored to employment. If such certification is required but not received, your return to work may be delayed until the certification is provided

7. While on leave, you will be required to furnish us with periodic reports every 2 weeks of

your status and intent to return to work. You should provide reports to your shift supervisor and the assigned payroll clerk for your battalion.

While on leave, you will not be required to furnish us with periodic reports of your status and intent to return to work

If the circumstances of your leave change and you are able to return to work earlier than the date indicated on the reverse side of this form:

1. You will be required to notify us at least two workdays prior to the date you intend to report for work

2. You will not, be required to notify us at least two workdays prior to the date you intend to report for work

5. You will be required to furnish recertification relating to any recurrences of serious health condition if you should request Family Medical Leave in the future after the initial use for period stated above, not to exceed 12 weeks

You will not be required to furnish recertification relating to any recurrences of serious health conditions if you should request Family Medical Leave in the future after the initial use for the period stated above, not to exceed 12 weeks

Please contact Laurie E. Varnau, Personnel/Payroll Supervisor at 703-246-3927, if you have any questions.

FAIRFAX COUNTY FIRE AND RESCUE DEPARTMENT STANDARD OPERATING PROCEDURE S.O.P 02.04.03

SUBJECT: FITNESS FOR DUTY PAGE 1 OF 4

CATEGORY: Personnel

SUBCATEGORY: Medical and Fitness Standards

APPROVED BY: EFFECTIVE DATE: December 7, 1987 REVISION DATE: May 3, 2004 Michael P. Neuhard CHIEF, FIRE AND RESCUE DEPARTMENT

FORMS REQUIRED: Review Firefighter’s Bill of Rights FRD-025, Fitness for Duty Evaluation FRD-158, Work Status Notification NOTE: Current forms are located on the Department's Intranet

PURPOSE: To provide definitive guidance for supervisors to follow when an employee shows signs of being unfit for duty. The term employee as used in this document applies both to employees of the Fire and Rescue Department and to certified operational members of volunteer departments. I. PREFACE Contributing factors that impair an employee's ability to perform his or her assigned duties may stem

from the following causes.

1. Alcohol and/or drugs (illegal, prescribed, and/or over-the-counter medications) 2. Injury or illness 3. Psychological impairment (emotional or stress related)

4. Inability to physically perform job II. POLICIES A. It is the Fire and Rescue Department's policy that employees shall report to work in such a

condition as to perform their assigned duties in an acceptable manner. 1. Substance Abuse Impairment Policy: The Fire and Rescue Department’s Rules and

Regulations and Fairfax County’s Standards of Conduct, Chapter 16, state that possessing, using, or being under the influence of alcohol or illegal drugs while an employee is at work or on county premises is strictly prohibited.

2. Prescription Medication Policy: Personnel are to notify their immediate supervisor if they

are prescribed certain mood altering medications. The supervisor shall contact an OHC physician for clarification as to the employee’s ability to work while taking this medication. These medications are sedative hypnotics and opiates. Sedative hypnotics are medications usually prescribed for anxiety and the treatment of stress, such as Valium, Librium, and Xanax. Opiates are usually prescribed for pain management. These are drugs such as Percodan, Percocet, Darvocet and Tylenol #3 and #4. The use of medication for sleep disturbances, such as Ambien also must be approved by the OHC.

SUBJECT: Fitness For Duty

EFFECTIVE DATE: December 7, 1987 REVISION DATE: May 3, 2004

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3. Physical Injury or Illness Policy: A fitness for duty evaluation shall be considered when an illness or injury affects an employee's performance to such an extent as to hinder the employee's ability to render full, efficient, and safe performance of his or her duties. If the consensus of the employee's supervisors, including the deputy chief, determines that a fitness for duty evaluation is appropriate, the employee shall submit to the fitness for duty evaluation, which may include a Work Performance Evaluation (WPE). Employees who have been on extended medical leave for more than two weeks shall be required to be released by the PSOHC with a completed Work Status Notification Form (FRD-158) to their supervisor.

4. Psychological Impairment Policy: A fitness for duty evaluation shall be considered when a

mental, emotional, or stress-related condition affects an employee's performance to such an extent as to hinder the employee's ability to render full, efficient, and safe performance of his or her duties. If the consensus of the employee's supervisors, including the deputy chief, determines a fitness for duty evaluation is appropriate, the employee shall submit to the fitness for duty evaluation. Employees who have been on extended medical leave may be required to submit to a fitness for duty evaluation before they are returned to duty.

5. Physical Performance Deficiency Policy: All Department employees shall meet the

acceptable physical standards required to accomplish their work assignment. A fitness for duty evaluation shall be considered when an employee's physical condition hinders his or her ability to render full, efficient, and safe performance of his or her duties. If the consensus of the employee's supervisors, including the deputy chief, determines a fitness for duty evaluation is appropriate, the employee shall submit to the fitness for duty evaluation, which may include a WPE.

III. PROCEDURES FOR SUBSTANCE ABUSE (ILLEGAL SUBSTANCES, ALCOHOL, AND

PRESCRIBED AND/OR OVER-THE-COUNTER MEDICATIONS)

A. In addition to alcohol and/or illegal drugs, certain prescription and/or over-the-counter medications may impair an employee's work abilities and may not be appropriate for an employee in the work setting. If an employee's explanation that his or her observed behavior is due to the use of over-the-counter or prescribed medication, it shall not deter from proceeding with the drug screen.

B. The following steps shall be accomplished within two hours when it is suspected that an employee

may be under the influence of alcohol or drugs (illegal, prescribed, or over-the-counter drugs). NOTE: If the cause of an employee's impairment is thought to be over-the-counter and/or

prescribed medication, the chief officer shall consult via telephone with the Public Safety Occupational Health Center (PSOHC) physician to determine if a fitness for duty evaluation is needed for the employee. If the PSOHC physician determines that a fitness for duty evaluation is needed, the employee shall be placed on administrative leave until the employee can be examined by the PSOHC physician. The on-duty PSOHC physician may be contacted through the Public Safety Communications Center (PSCC) for a consultation.

1. Immediately relieve the employee from any assigned duties and responsibilities.



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2. Keep the employee at the work location. Do not allow the employee to consume any food or drink.

3. Notify the chief officer (battalion chief, deputy chief or volunteer chief) of the situation and of

the actions taken. If the consensus of the employee's supervisors, including the deputy chief, determine that a fitness for duty evaluation is appropriate, proceed with the fitness for duty evaluation.

4. Begin steps to have the employee immediately tested for drugs and/or alcohol. Drug testing

procedures, forms, and the locations of the testing facilities are available from the chief officer (battalion chief or deputy chief). The Professional Standards Investigator also may be contacted at his or her office or by pager for testing protocols and the locations of the testing facilities.

a. The employee shall be given the forms that explain the testing requirements and

authorization. The forms require the signature of the employee. b. The employee shall be transported to the selected location for the testing as soon as

possible. 5. The following actions shall be taken when any employee is ordered to submit to testing for

drugs and/or for alcohol.

a. The employee shall be placed on administrative leave following testing. b. The chief officer shall make arrangements for the employee to return home. c. The Fire Chief or his or her designee shall be notified of the testing results. d. The employee shall remain on administrative leave until the results of the test are returned. NOTE: An employee with a positive blood alcohol content shall be considered impaired.

An employee who tests positive for drugs shall be considered impaired. 6. If the testing indicates negative for drugs or for alcohol, the Fire Chief or his or her designee

shall consider if further action is necessary based on the circumstances and/or the employee's behavior and may make arrangements to return the employee to his or her duty station.

7. Prior to the employee returning to duty, the PSOHC physician shall prepare a work status

notification and send it to the Fire Chief for his or her signature. IV. PROCEDURES FOR PHYSICAL INJURY OR ILLNESS, SUSPECTED PSYCHOLOGICAL

IMPAIRMENT, AND PHYSICAL PERFORMANCE FITNESS FOR DUTY EVALUATIONS

A. The following procedures shall be used when an employee appears to be unfit for duty based on illness, including extended absences for medical reasons; physical injury; suspected psychological impairment; or physical performance deficiencies.



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1. Notify the chief officer (battalion chief, deputy chief or volunteer chief) of the situation and of the actions taken. If the consensus of the employee's supervisors, including the deputy chief, determine that a fitness for duty evaluation is appropriate, proceed with the fitness for duty evaluation.

2. Relieve the employee from any assigned duties and responsibilities as appropriate. 3. Fill out the Fitness for Duty Form (FRD-025) stating the reason(s) for relieving the employee

of his or her assigned duties. 4. The Deputy Chief of the Safety and Personnel Services Division shall be notified immediately

so that a fitness for duty evaluation or consultation can be arranged for the employee with the PSOHC physician. The deputy Chief can be contacted at his or her office or by pager. If the deputy chief is not available, the on-duty PSOHC physician may be contacted through PSCC for a consultation. The employee shall be placed on administrative leave until a PSOHC physician can examine the employee.

NOTE: The Mobile Crisis Unit from the Woodburn Mental Health Center and/or the Critical

Incident Stress Management Team may be contacted through PSCC for assistance. 5. The physician will notify the deputy chief of the findings of the evaluation and the employee's

work status. The PSOHC will refer the employee to the proper treatment plan. The PSOHC physician will determine when the employee will be allowed to return to full duty.

6. Prior to the employee returning to duty, the PSOHC physician shall prepare a Work Status

notification and send it to the Fire Chief for his or her signature. NOTE: An EAP referral may be required for a fitness for duty evaluation. V. CONFIDENTIALITY STATEMENT A. Confidentiality shall be followed in accordance with the Fire and Rescue Department’s protocols.

Medical information shall be protected from inappropriate disclosure in a manner that ensures full compliance with all relevant federal and state laws. Confidentiality applies to an employee’s medical file and to any other medical information.

WORK STATUS NOTIFICATION

DATE

SUPERVISOR

STATION:

EMPLOYEE:

ADDRESS:

PHONE: (W)

(H)

TO WHOM IT MAY CONCERN: The status of the above employee has been reviewed/evaluated by the Occupational Health Center and as of this date the employee has been placed on the duty status as noted below.

Injury or Illness leave Return to Full Duty Other (See Comments) Light Duty

Anticipated Duration:

Is condition work related? Yes No Uncertain

Comments:

Please contact the clinic at the address below if there are any questions:

Fairfax County Fire and Rescue Department Occupational Health Center

4080 Chain Bridge Road Fairfax, VA 22030 Phone (703) 246-4949

Fax (703) 352-0217 Physician Signature: Date: FRD-158 (Revised 6/02)

FAIRFAX COUNTY FIRE AND RESCUE DEPARTMENT STANDARD OPERATING PROCEDURE S.O.P. 02.00.05

SUBJECT: DISCRIMINATION PAGE 1 OF 7

CATEGORY: Personnel

SUBCATEGORY: General

APPROVED BY: EFFECTIVE DATE: April 23, 1991 REVISION DATE: May 3, 2004 Michael P. Neuhard CHIEF, FIRE AND RESCUE DEPARTMENT

FORMS REQUIRED: FRD-297, Investigative Warning Form; FRD-298, Firefighters’ and Emergency Medical Technicians’ Procedural Guarantees; FRD-403 EEO/AA Intake Forms; FRD-404 Agreement to be Interviewed; FRD-406 Individual’s Responsibility… NOTE: Current forms are located on the Department's Intranet

PURPOSE: To ensure all Department employees and volunteers a work environment that is free from any form of discrimination, harassment, intimidation, and/or retaliation, and to define and to identify the terms of discrimination in the work place. The term “employee” as used in this document applies both to the employees of the Fire and Rescue Department and to the members of volunteer fire departments. I. POLICY STATEMENT

A. Discrimination is a violation of Title VII of the Civil Rights Act of 1964, as amended, and is prohibited within the Fire and Rescue Department, and any of its organizations, sections, divisions, and affiliations including volunteer corporations.

B. The Fire and Rescue Department shall comply with all laws prohibiting discrimination to

include but not limited to federal, state and county ordinances, county personnel rules and regulations, standard operating procedures, and the Fairfax County Diversity Plan. Supervisors, acting supervisors, and officers shall take immediate action in accordance with any and all applicable policies to ensure that the Department meets it responsibility to its employees.

C. The Fire and Rescue Department maintains a “zero tolerance” policy. Any actions or conduct

that constitute discrimination shall be grounds for disciplinary action up to and including dismissal.

II. DEFINITION

A. Discrimination is any act which adversely affects the pay status or working condition of an employee or applicant for employment where such an act is based on the employee’s or applicant’s race, sex, color, religion, creed, country of national origin, age, disability, marital status, political affiliation, volunteer membership, or labor organization affiliation. Areas of concern in the context of employment discrimination include, but are not limited to: 1. Employment

Recruitment Conditions of Work Training Testing

SUBJECT: Discrimination

EFFECTIVE DATE: April 23, 1991 REVISION DATE: May 3, 2004

S.O.P. 02.00.05

CATEGORY: Personnel

SUBCATEGORY: General PAGE 2 OF 7

Leave Selection Promotions Assignment Discipline Pay Demotion Separation

2. Conduct

Verbal or physical conduct that is sufficiently severe or pervasive as to alter the conditions of a person’s employment, or creates an intimidating, hostile, or offensive working environment. Examples include, but are not limited to: a. Deliberate and/or repeated jokes, remarks, stories, gestures, slurs or

conversations which are offensive or derogatory to race, color, religion, creed, national origin, age, sex, marital status, disability, political affiliation, and volunteer or union affiliation.

b. The display or circulation of graphic or written materials that is offensive or

derogatory to race, color, religion, creed, national origin, age, sex, marital status, disability, political affiliation, and volunteer or union affiliation.

c. Acts of retaliation against an employee for reporting or complaining of

discriminatory behavior or acts. III. GENERAL PROCEDURES

Fire and Rescue Department employees are responsible for ensuring a non-discriminatory work environment. The individual’s responsibilities include being responsible for one’s personal conduct and for reporting inappropriate behavior to supervisory personnel. It is recommended that individuals who experience discrimination make it clear to the offending person that such behavior is offensive to them and upon its occurrence or repetition should bring the matter to the attention of appropriate officials. Direct action in some cases can stop the conduct. Victims of discrimination are encouraged (not required) to notify the offending party when an act or behavior is perceived to be disrespectful or offensive. Supervisors are required to take positive, corrective actions to ensure that discriminatory behavior or acts do not occur and are not repeated in the work place or in relationship to the work place.

IV. COMPLAINT PROCEDURE

A. In the event that an employee believes that he or she has been a victim of discrimination, the victim shall contact an EEO Counselor or the EEO Officer for guidance within 24 hours of the alleged incident. During the guidance meeting, the victim will select which process (Informal or Formal) to pursue to resolve the complaint. All complaints shall be submitted in writing on the EEO/AA Intake Form, FRD-403.



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B. When supervisors, acting supervisors, and officers witness or are otherwise notified of an alleged incident, they shall notify an EEO Counselor or the EEO Officer within 24 hours for direction.

C. While addressing complaints of alleged discrimination every effort shall be made to ensure

confidentiality and due process to protect the rights of all parties involved.

Informal Process 1. Step One involves efforts to resolve the complaint with or through the employee’s

immediate supervisor. The complainant has the option of approaching his or her supervisor or notifying an EEO representative of his or her choice within the Fire and Rescue Department. When notified, the EEO Officer or EEO Counselor will contact the appropriate supervisor of the affected work location, e.g., fire station, shift.

2. Step Two consists of a meeting with the complainant, the alleged respondent, the

supervisor, and the EEO Counselor. The purpose of the meeting is to discuss areas of agreement and conciliation of issues that afterward are identified in a Resolution Agreement. If the informal complaint cannot be resolved, the complainant has the option to file a formal complaint.

3. Step Three shall be the forwarding of the intake form and the resolution agreement by

the EEO counselor to the Fire and Rescue Department’s EEO Officer as soon as possible.

Testimonial and documentary evidence shall be gathered confidentially. The EEO counselor or EEO Officer shall review all available documents associated with the position of each party. When interviewing witnesses, the EEO Counselor or EEO Officer shall make it clear that the interview is voluntary and that the information given will be held in confidence to the extent possible. The EEO Officer or EEO Counselor shall take steps to ensure that each party becomes aware of the facts, which are reasonably well established and of each party’s perception of the facts. In this informal stage, the EEO Counselor or the EEO Officer is empowered only to inquire informally and to resolve the matter through a mutually satisfactory understanding or agreement. The EEO Counselor or EEO Officer is not empowered to make formal findings of fact.

Formal Process Formal complaints can be filed in one of the following three distinct manners:

• Internal Within the Fire and Rescue Department • Internal Within the Fairfax County Government • External With the Federal Government



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Internal Within the Fire and Rescue Department The complainant can notify an EEO Counselor of his or her choice. The counselor shall then forward the complainant’s formal documentation of the complaint to the Fire and Rescue Department’s EEO Officer. The complainant has the option of reporting the complaint directly to the Fire and Rescue Department’s EEO Officer. Upon receipt of the formal complaint or notification of an alleged incident and after consultation with the Fire Chief, an administrative investigation shall be conducted. The EEO Officer will notify the appropriate Deputy Chief of the alleged incident or complaint. Upon completion of the administrative investigation, the EEO Officer shall forward the findings to the Fire Chief. Internal Within the Fairfax County Government Internal complaints are handled by the Fairfax County Office of Equity Programs located at 12000 Government Center Parkway, Suite 339 (703-324-2207). The Office of Equity Programs will attempt to conciliate the complaint in the formal process. Employees utilizing the internal process within the Fairfax County Government complaint procedure shall follow the Fairfax County grievance procedure as outlined in Chapter 17 of the Fairfax County Personnel Rules and Regulations and shall comply with time requirements and the completion of the appropriate forms. During any part of the process, a settlement can be reached. Upon resolution, a conciliation agreement will be completed finalizing the complaint process. External With the Federal Government The employee or volunteer may decline to use the County’s grievance procedure and may file a complaint with the U.S. Equal Employment Opportunity Commission at 800-669-4000.

V. PROCEDURAL GUARANTEES

A. When an investigation involves employees of the Fire and Rescue Department, the investigating officer shall comply with the Firefighters’ and Emergency Medical Technicians’ Procedural Guarantees as set forth in Va. Code 2.-116.9:1 to 2.1-116.9:5.

B. When an individual is subject to an administrative investigation, which could lead to

discipline, the investigating officer shall utilize the Firefighters’ and Emergency Medical Technicians’ Procedural Guarantees, FRD-298, to inform the employee of his or her procedural guarantees. The investigating officer also shall provide the employee with written notice in sufficient detail of the investigation in order to apprize the employee of the nature of the investigation. The Investigation Warning Form, FRD-297, shall be used for this purpose.



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C. EEO complaint investigations will be done in compliance with Standard Operating Procedure 1.3.03, Internal Investigations, where applicable.

VI. EMPLOYEE RIGHTS

A. The investigating officer shall provide the employee with written notice in sufficient detail of the investigation in order to apprize the employee of the nature of the investigation. The Investigation Warning Form, FRD-297, shall be used for this purpose. Unless there is a clear and compelling need to begin the investigation immediately, an individual shall be provided a minimum of five-calendar days’ notice prior to any interview or interrogation. The employee may waive the five calendar days if he or she chooses to do so. The Agreement to be Interviewed, FRD-404, shall be used for this purpose.

B. Department personnel conducting internal investigations that are strictly administrative in

nature are not required to allow the individual being interviewed to have an attorney, supervisor, or other representative present. This, however, shall not preclude the employee from seeking counsel prior to or after the interview.

C. If a transcript is made of the tape-recorded interview, a copy of the transcript will be given to

the employee. If a transcript is not made, the employee may review the tape recording(s) of his or her interview.

VII. RETALIATION

It should be made clear to all parties concerned that retaliation against an employee who has complained of discrimination or has participated in the complaint process is a violation of the Fairfax County Merit System Personnel Regulations and state and federal laws and will not be tolerated. Federal law prohibits retaliation against persons who have exercised their rights to inquire or complain about matters they believe may violate the law. Discrimination against persons who have cooperated in investigations also is prohibited. These protections apply regardless of the EEO Officer’s findings on the merits of the complaint.

VIII. INDIVIDUAL RESPONSIBILITY

A. Department employees shall cooperate fully with personnel assigned to the EEO Section or with any other person conducting administrative investigations. This includes the EEO Counselors. It shall be the responsibility of the employee to answer fully and truthfully all questions asked by the investigating authority pertaining to the investigation or subsequent violation.

B. During the course of an administrative investigation, an employee does not have the right to

refuse to answer any question(s) concerning his or her performance of duty, adherence to departmental rules and regulations, or suspected misconduct. If an employee refuses to answer questions relating to an administrative investigation, or the person is untruthful in answering questions, the person shall be subject to Department charges that could result in



S.O.P. 02.00.05

CATEGORY: Personnel


disciplinary action up to dismissal. Any statement made, however, cannot be used against the person in criminal prosecution.

Volunteers will be subject to discipline as stipulated in their Constitution and By-Laws or any other Rules and Regulations regarding violations or untruthfulness. Career and volunteer management will collectively agree on the appropriate disciplinary action to be taken if a volunteer is found to be in violation.

C. In order to facilitate the EEO investigation or inquiry, employees placed on administrative

leave during the course of an investigation shall contact the EEO Officer daily unless directed otherwise by the investigating authority.

D. Confidentiality is necessary to maintain the integrity of the investigation. Confidentiality also

helps to ensure the privacy of all individuals involved, reduce rumors, and prevent retaliation. Therefore, employees who have been interviewed shall not discuss any aspects of the interview or case or investigation with anyone within the Fire and Rescue Department. This does not exclude the employee from discussing the case investigation with a representative should the employee choose to do so.

To ensure that all parties involved are made aware of their responsibilities regarding confidentiality, all parties shall read and sign FRD-406, Individual’s Responsibility During An EEO Investigation, in acknowledgment.

IX. CLASSIFICATION

A. Upon completion of an investigation, its findings shall be classified as shown below: 1. Unfounded: Based on a preponderance of credible evidence, the allegation is without

merit.

2. Not Sustained: There is insufficient evidence either to prove or to disprove the allegation.

3. Sustained: The allegation is supported by a preponderance of credible evidence.

B. Each allegation of sexual harassment, discrimination, or other misconduct investigated shall

be classified. Upon classification as sustained, appropriate disciplinary action shall be taken if necessary.

X. FOLLOW-UP ON THE COMPLAINT

A. After the complaint has been settled, whether formally or informally, it is the Fire and Rescue Department’s responsibility to see that whatever caused the complaint is corrected promptly.

B. If the complaint was found not to be justifiable, steps shall be taken to clarify the rules so that

employees will understand management’s rights as well as their own.



S.O.P. 02.00.05

CATEGORY: Personnel


XI. REPORTING

A. Upon completion of the investigation, the final report shall include the items shown below:

1. Summary of events.

2. Disposition of the investigation, i.e., resolution, discipline administered, transfer, etc.

3. Recommendations, where appropriate, as to modification of Department rules, regulations, policies, established practices, and training.

4. Classification of the findings as described in Section VIII. When sustained, it shall

indicate the rule and/or regulation violated and the nature of the violation.

B. If an authority other than the EEO Officer conducts the Fire and Rescue Department’s investigation, the report shall be forwarded to the Fire Chief. Upon receipt of the report, the EEO Officer shall be responsible for the security of the material.

C. Final reports shall not be delayed because of any pending court action.

D. The results of an administrative investigation shall be released only to the fire chief or to

persons designated by the fire chief as identified below:

• Chief or Assistant Chiefs • Deputy Chiefs as authorized by the Fire Chief • Volunteer Liaison or designated representative as authorized by the Fire Chief when the

incident involves volunteer personnel • EEO Officer or the EEO Officer’s designated representative as authorized by the Fire

Chief • The investigating authority, if other than the EEO Officer

The employee shall have the opportunity to meet with the fire chief or the respective assistant chief. The volunteer may request to meet with the volunteer liaison or respective volunteer fire department chief. The charging party and the respondent shall be provided with a copy of the findings of the investigation in writing as they pertain to the individuals. Witnesses will receive notification in writing that the investigation for which they gave testimony has been completed.

FAIRFAX COUNTY FIRE AND RESCUE DEPARTMENT STANDARD OPERATING PROCEDURES.O.P. 02.03.09

SUBJECT: PHYSICAL FITNESSPAGE 31 OF

CATEGORY: Personnel


APPROVED BY: EFFECTIVE DATE: December 1, 1988 REVISION DATE: March 23, 2005 Michael P. Neuhard CHIEF, FIRE AND RESCUE DEPARTMENT

FORMS REQUIRED: Fairfax County FRD Wellness Program Participation Agreement NOTE: Current forms are located on the Department's Intranet

PURPOSE: The career of a firefighter is one of the most physically demanding occupations in the world. It requires high levels of aerobic capacity, muscular strength, and endurance to perform safely and effectively in the fire service. Maintaining physical fitness levels is critical to a firefighter’s performance. The Fire and Rescue Department (FRD) will continue to provide workout scheduling, resources, support, and/or access to on-duty resources in order to support a fitness program. I. GENERAL PROGRAM REQUIREMENTS

A. The health, fitness, and wellness of all uniformed personnel must be maintained as a priority. Dedicated time for exercising while on duty shall be provided for all uniformed personnel. Supervisors will be held responsible for scheduling and providing time for personnel to workout. Day shift personnel are allowed 90 minutes, two to three times per week, to workout.

B. The Work Performance Evaluation (WPE) was developed by the Occupational Health and

Safety Program (OHSP) in 1995 and validated by a private contractor, Human Performance Systems. The intent of the WPE is to determine whether a firefighter can meet the demands of the job in a safe and effective manner. All FRD personnel that are assigned to Operations or subject to perform duties in Operations will be required to complete the bi-annual Work Performance Evaluation. The successful completion of the WPE is defined as safely accomplishing all events within the established time parameters of 6.00 to 10.47 minutes. If personnel are unsuccessful in meeting the standard requirements set for the WPE, they will be referred to the Public Safety Occupational Health Center (PSOHC) for evaluation. Upon completion of the PSOHC evaluation and based on their recommendations, the individual will be evaluated monthly by a Peer Fitness Trainer (PFT) for progress and completion of the WPE up to six months from the initial unsuccessful attempt. If that individual is not successful in meeting the WPE standard requirements within that six month period, they could be considered for termination.

C. All uniformed personnel are required to participate in a mandatory and regular fitness

program.

SUBJECT: PHYSICAL FITNESS

EFFECTIVE DATE: December 1, 1988 REVISION DATE: March 23, 2005

S.O.P. 02.03.09

CATEGORY: Personnel SUBCATEGORY: Occupational Health and Safety PAGE 2 OF 3

1. Individuals may be granted exception to physical fitness training on a day-to-day basis by the station commander/work location supervisor for up to three consecutive workdays.

2. Uniformed employees who are assigned to field operations that refrain from physical

fitness training for reasons determined or undetermined for more than 3 consecutive work days is a performance issue. This issue may require a fitness for duty evaluation (detailed in SOP 02.04.03) which could result in that employee being assigned to a light duty position.

II. DEPARTMENT PEER FITNESS TRAINERS

Peer fitness trainers are selected on the basis of an application process and will be certified in a nationally recognized certification process, such as the IAFF/IFAC/ACE Peer Fitness Trainer Certification. They also must fulfill continuing education requirement classes in the fitness field. The role of a peer fitness trainer is to provide exercise leadership through guidance and supervision and to encourage safety and participation in regular physical fitness programs. The trainers will be available upon request to set up individual (customized) fitness programs. These programs will be based on evaluating and measuring an employee’s current fitness level and individual needs and comparing those needs to an established level of fitness for job performance. A. A Peer fitness trainer shall be assigned to personnel when:

1. Assistance is requested through the Wellness/Fitness Coordinator in the Safety and Personnel Services Division.

2. Fitness for duty evaluation requires peer fitness counseling 3. An employee fails to pass the Work Performance Evaluation

B. In order to ensure the credibility and safety of the Fire and Rescue Department’s physical

fitness program, uniformed personnel may be referred to the PSOHC by a peer trainer.

III. PHYSICAL FITNESS RESOURCE MATERIALS Each work location will be supplied with fitness materials that will have information on health and exercise.

IV. EQUIPMENT

A. The Wellness/Fitness Section, by direction of the Wellness Fitness Coordinator, will purchase and arrange installation of selected fitness equipment in all FRD facilities that will be selected based on available space and particular fitness needs. Requests will be reviewed for each FRD facility through the Wellness/Fitness Program for practicality of purchase.

SUBJECT: PHYSICAL FITNESS

EFFECTIVE DATE: December 1, 1988 REVISION DATE: March 23, 2005

S.O.P. 02.03.09

CATEGORY: Personnel SUBCATEGORY: Occupational Health and Safety PAGE 3 OF 3

B. All equipment shall be serviced annually or as necessary. Personnel assigned to stations are responsible for cleaning and disinfecting all equipment in order to extend the life span and enhance the safety of users. Station captains or shift supervisors will notify the Wellness/Fitness Coordinator when equipment requires calibration, servicing, or repair.


REFERENCES/BIBLIOGRAPHY Agnew, J., McDiarmid, M.A., Lees, P.S.J, & Duffy, R. (1991). Reproductive hazards of fire fighting I. Non-chemical hazards. American Journal of Industrial Medicine, 19:433-445. Allen, S. (Reprint not dated). Nutrition and pregnancy: The seven commandments. Brandt-Rauf, P.W., Fallon, L.F., Jr., Tarantini, T., Idema, C., & Andrews, L. (1988). Health hazards of fire fighters: Exposure assessment. British Journal of Industrial Medicine, 45:606-612. Cohen, M.A., & Guzzardi, L.I. Inhalation of products of combustion. Annals of Emergency Medicine, 12:628-632. Evanoff, B.A., & Rosenstock, L. (1986). Reproductive hazards in the workplace: A case study of women firefighters. American Journal of Industrial Medicine, 9:503-515. Graham, T., Lessin, N., & Mirer, F. (1993). A labor perspective on workplace reproductive hazards: Past history, current concerns, and positive directions. Environmental Health Perspectives Supplement 101. Guidotti, T.L., & Clough, V.M. (1992). Occupational health concerns of firefighting. Annual Review-Public Health, 13:151-171. Human Toxic Chemical Exposure: The Bulletin of Pacific Toxicology Laboratories (Reprint not dated). Pollutants in human breast milk. Lowry, W.T., Peterson, J., Petty, C.S., & Badgett, J.L. (1985). Free radical production from controlled low-energy fires: Toxicity considerations. Journal of Forensic Science, January 1985. McDiarmid, M.A., Lees, P.S.J., Agnew, J., Midzenski, M., & Duffy, R. (1991). Reproductive hazards of fire fighting II. Chemical hazards. American Journal of Industrial Medicine, 19:447-472. Milunsky, A., Ulcickas, M., Rothman, K.J., Willett, W., Jick, S.S., & Jick, H. (1992). Maternal heat exposure and neural tube defects. Journal of the American Medical Association, 268(7):882-885. National Institute of Occupational Safety and Health (1999). The effects of workplace hazards on female reproductive health (DHHS/NIOSH Publication No. 99-104). Cincinnati, OH: Publications Dissemination, EID, NIOSH.


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Olshan, A.F., Teschke, K., & Baird, P.A. Birth defects among offspring of firemen. American Journal of Epidemiology, 131(2) pp 312-321. Paul, M.E. (1994). Disorders of reproduction. Occupational Health, 21(2):367-384. Perrolle, J.A. (1993) Reproductive hazards: A model protection policy for the chemical industry. In D.M. Headapohl (Guest Ed), Occupational Medicine: Women Workers, 8(4):755-786. Reuters Health (2004). Shift work may have small effect on pregnancy. (Article obtained on the internet: http://www.ucsfhealth.org). Sprenger, N., & Bates, G.M. (2003). Pregnant pause. Fire Chief, 47(4), pp 36-39. Treitman, R.D., Burgess, W.A., & Gold, A. (1980). Air contaminants encountered by firefighters. Journal of the American Industrial Hygiene Association, (41) pp 796-802. Whitehead, A.K., Bollon, V.J. & Duffy, R.M. (1995). Reproductive hazards and fire fighting. Washington, DC: Department of Occupational Health and Safety, International Association of Fire Fighters. Whitehead, A.K., Bollon, V.J. & Duffy, R.M. (1993). Fire fighters’ environment. Washington, DC: Department of Occupational Health and Safety, International Association of Fire Fighters. Whitehead, A.K. & Bollon, V.J. (1992). IAFF Executive Board Policy on Reproductive Hazards. Washington, DC: Department of Occupational Health and Safety, International Association of Fire Fighters. Youakim, S., Hoffman, H.E., & Shanner, L. (1999). The pregnant worker. The Canadian Journal of CME, October 1999, pp 175-190.


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APPENDIX 1

FAIRFAX COUNTY PUBLIC SAFETY OCCUPATIONAL HEALTH CENTER

4080 Chain Bridge Road Fairfax, Virginia 22030

Tel (703) 246-4949 Fax (703) 352-0217 Donald F. Stewart, M.D., M.S Praveen Gupta, M.D Michael Ardaiz, M.D. Mary Anne Alexander, M.D. Nancy Kane Cross, PA-C Medical Director Staff Physician Staff Physician Staff Physician Physicians Assistant

PATIENT: DATE: SSN: Dear Doctor: I am writing on behalf of the Fairfax County Public Safety Occupational Health Center (PSOHC) and your patient, ______________________. The PSOHC is tasked with providing occupational and preventive care for all County fire fighters. As Medical Director of the PSOHC, I would like to give you a brief overview of the job requirements for professional fire fighters, and a sense of the physical and mental demands placed on them. Professional fire fighters in the Fairfax County Fire and Rescue Department who become pregnant while on active duty are protected by departmental, state and federal policies and laws with respect to their work status options during pregnancy. The Department does, however, support the recommendation of the International Association of Fire Fighters (IAFF) “that pregnant fire fighters should not participate in fire suppression, hazardous material and EMS operations from the time pregnancy is confirmed and that pregnant fire fighter candidates should defer training.” This recommendation is based on the best available scientific and medical research to identify risks associated with pregnancy. As the provider for this patient, you will provide care during pregnancy and delivery, and will, be asked to give counsel regarding work status decisions. It is important to note that the final decision regarding work status (in this case – to stay in the field or accept a light duty assignment for the duration of the pregnancy) is the employee’s. Our intent is to ensure – to the extent possible – that the decision is an informed one. Attached you will find a chart titled “Fire Fighter Abilities Requirements.” This chart provides a summary of the basic abilities required to be a professional fire fighter for Fairfax County. It does not, however, provide any details regarding potential exposures (thermal, mechanical, chemical, or infectious disease). If you desire additional information on this topic, your patient can make available our Reproductive Health Plan. This document is a comprehensive review of the issues, concerns, and available medical literature on this topic. This Plan is intended to give employees an overview on what is known (and not known) about the reproductive hazards of employment in fire and rescue operations.

I appreciate you taking the time to read this information. Please give me a call if you have any questions or if I may be of further assistance. Sincerely, Donald F. Stewart, M.D., M.S. Medical Director, PSOHC In accordance with the protocol set up in the Department-approved Reproductive Health Plan, we are requesting that you sign and return a copy of this letter to the PSOHC for inclusion in the employee’s personal medical file. This verifies that you were provided a copy of the essential job duties of a fire fighter/EMT. (Primary care provider’s signature) (Date)


APPENDIX 1 FIREFIGHTER ABILITIES REQUIREMENTS

ABILITY DEFINITION EXAMPLE TASK

Muscular Strength The ability to use muscle force for a single task that involves: lifting, pushing, pulling, holding, or carrying objects.

Roll and lift 50-foot sections of 2.5” hose (60-65 lb) and place them on an engine or truck. With assistance, remove ladders (36-80 lb) from truck and carry (50-150 ft) to fire scene. With assistance, carry/drag victim (90-200 lb) from building.

Muscular Endurance The ability to use muscle force for single or multiple tasks lasting two or more minutes that involve: lifting, pushing, pulling, holding, or carrying objects.

This ability also involves supporting one’s own body weight. It represents muscular endurance and emphasizes the resistance of the muscles to fatigue.

With assistance, and wearing air pack (25 lb), drag 1.75” line in a confined space or up stairs. Climb stairs (2-3 flights) while carrying equipment (e.g.,highrise pack - 60 lb, axe).

Equilibrium The ability to maintain or regain one’s body balance or to stay upright when in an unstable position.

With assistance, ascend/ descend stairs in building while carrying victim (90-200 lbs) on full backboard, stretcher, stair chair, or Stokes basket.



ABILITY DEFINITION EXAMPLE TASK Equilibrium (Continued)

The ability to maintain or regain one’s body balance or to stay upright when in an unstable position.

Climb ladders (12-24’) while carrying equipment, e.g. axe, flashlight, pike pole.

Cardiovascular Endurance

The ability to continue working for more than five minutes while performing physically demanding tasks. The ability of the circulatory and respiratory systems to perform efficiently.

With assistance, and wearing air pack (25 lb), crawl through smoke-filled structure dragging charged line to extinguish fire. Climb stairs (1-3 flights) while carrying equipment, e.g. highrise pack.

Hearing The capacity to detect or discriminate sounds, e.g. focus on a single auditory source.

Communicate over two-way radio or telephone. Detect location of sounds, e.g. victim’s moans, crackling sounds, at incident scene.

Speech Clarity The ability to communicate orally in a clear fashion. Advise owner, occupants, or tenants of hazards existing and recommend necessary precautions. Notify firefighting and other personnel (EMS, volunteer) of emergency and non-emergency information.



ABILITY DEFINITION EXAMPLE TASK Far Vision The capacity to see distant images. Visually survey scene to identify dangerous

conditions (e.g., flammable liquids) or probable mechanisms of injury. Drive engine or ladder truck to alarm scene through congested traffic.

Near Vision The capacity to see close images. Operate power tools (e.g., Hurst tool = 50 lb) during firefighting or rescue operations. Read department and outside training materials, log books, reports, manuals, and books. Complete reports (e.g., incident report).

Color Vision The capacity to match or discriminate between colors.

Drive engine or ladder truck to alarm scene through congested traffic.




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APPENDIX 2



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ACKNOWLEDGEMENTS The Fairfax County Fire and Rescue Department would like to express our sincere gratitude to all those who played a role in the development of the Department’s first Pregnancy Reproductive Health Plan. We appreciate your efforts on behalf of the Department, the Union, and the employees we serve.

Diane Christensen

Public Safety Occupational Health Center

Donald Stewart, M.D., M.S. Medical Director

Fairfax County Public Safety Occupational Health Center

Lieutenant Rodney S. Vaughan Fairfax County Fire and Rescue Department

Safety and Personnel Services Division, Wellness-Fitness Coordinator

Sandra Witt Fairfax County Fire and Rescue Department

Safety and Personnel Services Division, Light Duty Coordinator

Special Thanks to: Darlene Clark

Maria Teel Captain Richard Sweatt Captain Sandra Caple Captain Cheri Stroup

Lieutenant Karrie Boswell Firefighter Janet Norko

William Spencer Martha Villanigro-Santiago

Roscoe G. Hager, Sr.

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