DoD FF Fitness Manual

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					    Draft – Not for Implementation




   DOD FIREFIGHTER
FITNESS AND WELLNESS
      PROGRAM




    Draft – Not for Implementation
                           TABLE OF CONTENTS

                                                           Page

FOREWARD

TABLE OF CONTENTS

REFERENCES

ABBREVIATIONS AND ACRONYMS

CHAPTER 1 - INTRODUCTION

      SCOPE
      PURPOSE
      BACKGROUND
      MISSION
      RATIONALE
      AUTHORITY
      ADMINISTRATION
      RESPONSIBILITIES

CHAPTER 2 - PROGRAM METHODOLOGY

      OBJECTIVES
      FITNESS AND WELLNESS PROGRAM COMPONENTS
      CYCLE ERGOMETER PROCEDURES
      COMPUTERIZED CARDIOVASCULAR CONDITIONING TRAINING
      MUSCULAR STRENGTH AND ENDURANCE

CHAPTER 3 - FIREFIGHTER FITNESS TRAINING PROGRAM

      FITNESS TRAINING
      CYCLE ERGOMETER
      ALTERNATIVE MODES OF FITNESS TRAINING
      WEIGHT LIFTING
      RECURRING FITNESS TRAINING

CHAPTER 4 - FIREFIGHTER OCCUPATIONAL FITNESS ASSESSMENTS

      GENERAL
      PRE-ASSESSMENT INSTRUCTIONS
      EQUIPMENT
      DESCRIPTION OF THE OCCUPATIONAL ASSESSMENT CIRCUIT
      SETTING-UP THE OCCUPATIONAL ASSESSMENT CIRCUIT


                                   2
        PRELIMINARY INSTRUCTIONS TO THE FIREFIGHTER
        PRE-SCREENING
        CONDUCTING THE OCCUPATIONAL ASSESSMENT CIRCUIT
        COMPLETING THE OCCUPATIONAL ASSESSMENT CIRCUIT
        CRITERIA FOR TERMINATING THE ASSESSMENT
        COOL DOWN PERIOD
        EMERGENCY PROCEDURES

CHAPTER 5 - WELLNESS COMPONENT

        INTRODUCTION
        GENERAL
        NUTRITION
        WEIGHT LOSS AND BEHAVIORAL MODIFICATION
        TOBACCO USE AND CESSATION
        SUBSTANCE ABUSE
        STRESS MANAGEMENT
        CHAPLAIN SERVICES FOR SPIRITUAL NEEDS
        SUMMARY

SAMPLES, FIGURES AND TABLES

Table 1. Sample Exercise Prescription Program for Firefighters Using the Monark 818E Cycle
Ergometer
Table 2. Sample Exercise Prescription Program for the Monark Stairmaster
Table 3. Sample Exercise Prescription Program for the Treadmill
Table 4. Sample Exercise Prescription for Strength Training




                                             3
                                     REFERENCES


Review of Firefighter Physical Fitness/Wellness: Options for the Military. B Palmer, J.W.
Carroll and A Mirza, Crew System Ergonomics Information Analysis Center. CSERIAC-RA-98-
003, 1998).

Firefighter Physical Fitness/Wellness Workshop Report. J.W. Carroll, S. Constable and B
Palmer, Crew System Ergonomics Information Analysis Center. CSERIAC-PR-98-001, 1998).

DoD Instruction 6055.6, Department of Defense Fire and Emergency Services Program,
(a) DoD Directive 1010.10, Health Promotion
(b) Promoting Health 2000: DoD Health Promotion and Disease Prevention Objective, May 1,
1992
(c) DoD Directive 1010.15, Smoke Free Workplace
(d) DoD Directive 1308.1, DoD Physical Fitness and Body Fat Program
(e) DoD Directive 1308.3, DoD Physical Fitness and Body Fat Program Procedures
(f) DoD 8910.1-M, “DoD Procedures for Management of Information Requirements,”
authorized by DoD Directive 8910.1
(g) AR 40-25/NAVMEDCOMINST 10110.1/AFI 44-141, Nutrition Allowances, Standards and
Education




                                            4
                   ABBREVIATIONS AND ACRONYMS

BHS     Behavioral Health Survey
CE      Cycle Ergometer
CISM    Critical Incident Stress Management
CPR     Cardiopulmonary Resuscitation
FITT    Frequency, Intensity, Time and Type
HAWCs   Health and Wellness Centers
HEARs   Health Enrollment Assessment Reviews
HIV     Human Immunodeficiency Virus
HRA     Health Risk Assessments
KP      Kilo Ponds
MO      Medical Officer
MTFs    Military Treatment Facilities
RPM     Revolutions Per Minute
RBP     Resting Blood Pressure
RHR     Resting Heart Rate
SCBA    Self-Contained Breathing Apparatus




                                     5
                                          CHAPTER 1

                                       INTRODUCTION


1.1. Scope. This manual provides implementation procedures for the DoD Firefighter Fitness
and Wellness Program. It applies to all DoD firefighters and interfaces with Department of
Defense Instruction (DoDI) 6055.6, Department of Defense Fire and Emergency Services
Program. Report any conflicts to HQ AFCESA/CEXF, 139 Barnes Drive Suite 1, Tyndall AFB,
Florida 32403-5319.

1.2. Purpose. It is well documented and widely acknowledged that the fire fighting profession
is one of the most physically demanding and hazardous occupations. The purpose of this
program is to enable fire protection managers to plan, execute, and evaluate the results of the
DoD Firefighter Fitness and Wellness Program. The DoD Firefighter Fitness and Wellness
Program consists of: a task-based evaluation, an exercise prescription, and counseling
components based on performance related physical fitness, health and wellness. It defines fitness
requirements and outlines procedures for testing and conditioning, which leads to the
development and maintenance of physical conditioning levels required to perform fire fighting
tasks. This document applies to all military, civilian GS-081s, and contractor personnel whose
position descriptions require participation in fire fighting operations. The Installation Fire Chief
ensures all firefighters participate in the conditioning program.

1.3. Background. This manual is an outcome of a rigorous science-based project to review the
DoD Firefighter Fitness Program. That project included a detailed review and analysis of all
candidate firefighter fitness programs (see A Review of Firefighter Physical Fitness/Wellness:
Options for the Military. B Palmer, J.W. Carroll & A Mirza. Crew System Ergonomics
Information Analysis Center. CSERIAC-RA-98-003, 1998). A panel of experts was then
convened and a group consensus process was used to recommend the new program outlined in
this manual (see Firefighter Physical Fitness/Wellness Workshop. J.W. Carroll, S. Constable & B
Palmer Crew System Ergonomics Information Analysis Center. CSERIAC-PR-98-001, 1998).

1.4. Mission. The mission of the program is to promote physical fitness and a physically active
lifestyle that will have a positive influence on job performance and general health. Physical
fitness and wellness evaluations are the cornerstone of a comprehensive program that involves
exercise prescriptions and health counseling for those firefighters who are identified as needing
further improvement. Standards are intended to ensure minimal readiness needed for job
performance and are not intended to be punitive in nature.

1.5. Rationale. A decision concerning an individual’s performance capability must be made on
the basis of a relevant and valid individual assessment. Such an assessment is defined as one that
accurately tests the capacities necessary to perform the job safely, efficiently, and reliably. A
valid assessment measures what it is intended to measure and is reliable because it consistently
gives the same results and is both accurate and precise. In order to ensure that assessment
procedures are not given on a selective and discriminatory basis, they are to be administered to
all firefighters in the same manner.


                                                 6
1.6. Authority. Department of Defense Instruction 6055.6, Department of Defense Fire and
Emergency Services Program, authorizes this program.

1.7. Administration. HQ AFCESA/CEXF, 139 Barnes Drive Suite 1, Tyndall AFB, Florida
32403-5319, is the Administration Center for this program.

1.8. Responsibilities

1.8. The Installation Fire Chief.

1.8.1. Evaluates firefighters failing to demonstrate minimum physical fitness levels or show
satisfactory progress in rehabilitation programs and may consider possible administrative action.
Administrative action cannot be initiated against a firefighter failing to meet the goal of 8
minutes or less when performing the task based fitness evaluation.

1.8.2. Determines if the firefighter is properly participating in rehabilitation programs and keeps
appropriate documentation of program participation.




                                                 7
                                            CHAPTER 2

                                 PROGRAM METHODOLOGY

2.1. Objectives. The DoD Firefighter Fitness and Wellness Program ensures that all DoD
firefighters achieve a level of physical conditioning and health required to safely and successfully
perform their assigned tasks. The program minimizes firefighter personal injuries and provides
visible results. The program is designed to improve the firefighter's muscular strength and
cardiovascular endurance. The assessment tool is a 10-station fitness circuit that is described in
Chapter 4 of this manual. Firefighters training to meet the requirements of the assessment are a
very close approximation of duty requirements. Rudimentary fitness may be gauged by using
aerobic (cycle ergometry or CE) and strength testing and exercise prescriptions. These two tests,
the cycle test (i.e., predicted aerobic capacity) and strength test, establish an individual's baseline
physical fitness level. The DoD Firefighter Fitness and Wellness Program can provide more
personalized training programs to ensure fitness improvement while minimizing the risk of
injury. People who have any suspicion of, or are suffering from, or have symptoms suggestive
of, cardiovascular disease (i.e. chest, arm, shoulder, or jaw pain, or shortness of breath) must
consult a physician prior to any participation in the program.

Components of the DoD Firefighter Fitness and Wellness Program. The three components
of the DoD Firefighter Fitness and Wellness Program are Fitness Training, Annual Occupational
Assessments, and Wellness:

(i) Evaluation – Consists of a health appraisal questionnaire, pre-test screening, and completion
of a 10 task fitness circuit. Also, selected, personal health & wellness survey instruments should
be incorporated as well.

(ii) Rehabilitative Health & Physical Fitness – Each firefighter should be provided with an
exercise program detailing the frequency, intensity, time, type of activities (FITT) to increase
physical fitness; and counseling or self help tools regarding personal health and wellness.

2.2. Cycle Ergometry. The cycle ergometer test safely estimates aerobic capacity from heart-
rate responses to a precise amount of exercise performed on a cycle ergometer. The validity of
this method in proving an accurate estimate of this parameter depends, in part, on the competence
of the test administrator as well as the quality of the test instruments. This manual specifies the
test equipment to be used to administer this program.

2.2.1. Equipment. All exercise equipment is available through the General Services
Administration. Official program support software (entitled "FitSoft”) is available from HQ
AFCESA/CEXF, 139 Barnes Drive Suite 1, Tyndall AFB, FL 32403-5319. One Pentium class
computer with 32 MB RAM, Network card, and Windows 95 or later operating system are
required to support the software program. The required cycle ergometer assessment equipment
consists of a cycle ergometer (Monark Model 818E), heart-rate monitor (Polar Pacer), and a
metronome. Substitutes are not permitted. Metronomes, gym mats, mirrors, etc., are local
purchase items.


                                                  8
2.2.2. Subject Preparation. The individual should get a good night's sleep and consume no
alcoholic beverages the night before the cycle ergometer assessment; consume no morning
caffeine, tobacco, food, or drink, other than water, the morning of the test; and must not engage
in any strenuous physical exercise for eight hours prior to the CE assessment. If the subject fails
to meet one or more of these conditions, the test may be invalid. Reschedule the assessment. If
the subject is recovering from an illness, postpone the test for several days. The subject must
wear gym clothing or loose-fitting street clothes.

2.2.3. Environmental Conditions. Conduct the test in a well-ventilated, reasonably cool (65-75
degrees), semiprivate room, with no spectators.

2.2.4. Cycle Ergometer Procedures.

2.2.4.1. Record the subject's seminude weight (wearing gym clothing, no shoes) and height.

2.2.4.2. Attach the Polar Pacer heart-rate monitor according to the instructions provided. Attach
the wristwatch-type receiver to the cycle handlebars to ensure it's within the 30-inch range of the
chest transmitter.

2.2.4.3. Adjust cycle seat height so the subject's feet can just reach the pedals at the low point of
the crank cycle. There should be less than a 10-degree bend in the knee when the pedal is in its
lowest position.

2.2.4.4. Calibrate the cycle ergometer according to instructions provided (i.e., subject seated
quietly on the cycle with both legs hanging at the sides and not in contact with the pedals, frame,
or floor).

2.2.4.5. After calibrating the ergometer, the subject sits quietly for two minutes with feet resting
comfortably on the cycle pedals.

2.2.4.6. The subject follows the instructions provided in the computer software and responds to
the questions appearing on the monitor.

2.2.4.7. The computer then determines the starting workload and the test begins and proceeds
according to instructions provided by the computer monitor. The firefighter candidate pedals at
exactly 50 revolutions per minute (RPM). This is ensured if the subject coordinates the
downward stroke of each foot in time to each beat of the metronome, which is set at 100 beats per
minute (i.e., two strokes equal one revolution of cycle crank). Instruct the subject to refrain from
conversation and concentrate on a relaxed ride at 50 RPM.

2.2.4.8. Enter heart rates between the 45th and 55th second of each minute. It is necessary to
visually check the load setting at frequent intervals, (i.e., every 15-20 seconds), and adjust, if
necessary, to maintain the exact workload.




                                                 9
2.2.4.9. Give the test for predicting aerobic capacity twice, on two separate days. The best score
is the one that best represents the subject's fitness level.

2.2.4.10. Calculation of Results. The computerized program calculates and displays the results
immediately upon completion of the test. The subject's predicted aerobic capacity, in milliliters
per kilogram of body weight per minute (ml/kg/min) will be used to build a more personalized
aerobic exercise prescription with values found to be normal (average) for the American sedentary
population.

2.3. Computerized Cardiovascular Conditioning Training. The submaximal exercise test on
the cycle ergometer provides a printed, personalized designed, 16-week training program for each
firefighter. A sample of this printout appears in Table 1. The following administrative
information is important to the implementation of this program:

2.3.1. Follow the 16-week training program exactly as provided. A minimum of three workouts
per week is required for the training to be effective. However, as the program progresses, five to
six times per week is recommended.

2.3.2. Exercise workloads should be tolerable the first few weeks. Subjects should have patience
and not significantly increase workloads during the first few weeks. Plan a conservative exercise
approach to prepare for later success at higher workloads. Although the training program proved
to be ideal for most firefighters, a few may find it too demanding, especially after the 10th to 12th
weeks. For example if it becomes impossible for a firefighter to keep up with the program's
progress, encourage him or her to ride a minute or two at the heaviest prescribed load and then
drop it by 0.5 kilo ponds (kp) and continue with the workout. Eventually, each firefighter will be
able to ride five or more minutes at the prescribed workload and be able to complete the suggested
program.

2.3.3. Occasionally, a firefighter may experience muscular or joint pain that makes hard exercise
very uncomfortable. If this occurs, the workload should be lowered gradually until the discomfort
subsides to a more acceptable level, then continue to exercise at that load until it becomes
comfortable, and eventually increase it to agree with the original training schedule.

2.3.4. If training is interrupted and the firefighter does not keep up with the three-times-per-week
requirement, some adjustment must be made. For example, following two weeks of illness, the
firefighter should revert to the training recommended for the two-week period before the onset of
that illness.

2.3.5. Reasons for stopping either the test or the training include excessive muscle fatigue or
cramping; heavy or labored breathing; pain in the chest; jaw, shoulder, or arm; or any bonafide
complaint of discomfort by the subject. If any of the above occurs, testing and training will
resume only with a physician's approval.

2.3.6. All test results shall become a permanent part of each firefighter's training records.
Essential information for the data disk at the front of each test includes social security number (or


                                                10
appropriate identification number), sex, age (birth date), civilian or military, smoker or
nonsmoker, height, weight (and percentage of body fat), test date, cycle ergometer workload, heart
rate during last minute of work, and aerobic capacity (printed as V02 max in ml/kg/min), along
with strength testing results, documented training logs and any health/wellness survey
instruments.

2.4. Muscular Strength and Endurance.

2.4.1. Strength Test Procedures. Give the following strength tests at the beginning of the
training program and at 16-week intervals throughout the training program:

2.4.2. Strength Training.

2.4.2.1. One-time Maximal Lift. Determine the initial strength for each of the four lifts (i.e.,
bench press, leg press, upright curl, and upright rowing). The firefighter continues to add weight
for repeated attempts until the maximum lifting weight is determined. This is then recorded as
the "one-time maximal lift." (See Table 4)

2.4.2.2. Repetitive Lift. Using a fixed barbell (weight 80 pounds), the firefighter performs
repeated bench presses in time to a metronome set at 60 beats per minute. When in position and
listening to the metronome, instruct the firefighter to lift the weight to full extension on one beat
and lower it to the chest on the other, (i.e., 30 lifts per minute at this pace). Continue the test
until the firefighter is unable to keep up with the metronome. Record the number of lifts
completed to that point. (See Table 4)

2.4.2.3. Basic Weight Lifting Exercises. As a minimum, firefighters should exercise the large
muscle groups of both the upper and lower body. These exercises are incorporated in the bench
press, leg press, upright curl, and upright rowing. Determine the initial lifting weight by
calculating approximately 50 percent of the one-time maximal lift for each of these exercises.
Perform each training exercise in two sets of eight repetitions each; i.e., lifting the weight eight
times, resting for 30 seconds, and then repeating the eight lifts. At the end of the second week
and after each succeeding week; increase the repetitions by one until two sets of 12 repetitions
each have been completed. Then the firefighter increases the weight to the next convenient level
(about five pounds heavier) and returns to two sets of eight repetitions, etc. A sample workout
schedule is provided in Table 4. Unlike the cycle ergometer exercise (which may be performed
one or more times per day), limit weight training of the same muscle group to every other day for
a maximum of three times a week.

2.4.2.4. Sit-Up Exercise. Perhaps the most important endurance conditioning exercise is the sit-
up. Sit-ups effectively improve the exercise capacity and muscle tone of the abdominal muscles,
which are considered to be the "keystone" muscles of the body. Avoid conventional sit-ups in
favor of safe and more effective "curls" (i.e., merely tensing the abdominal muscles so as to curl
the head and shoulders towards, but not reaching, the knees). Perform these on a padded surface
(mat) with the knees bent and hands either clasping the shoulders or with the arms crossed and
hands resting on the chest. Clasping the hands behind the head or neck may pull the head up


                                                 11
sharply during each lift and could cause a painful strain to the nerves in the cervical area.
Firefighters should do as many sit-ups as they can perform with comfort, rest 30 seconds, and
repeat a second set of the same number.




                                             12
                                          CHAPTER 3

                      FIREFIGHTER FITNESS TRAINING PROGRAM

Talk about cardiovascular conditioning and strength training.

3. Fitness Training

3.1. Cycle Ergometer. The fitness training program on the cycle ergometer improves and
maintains a reasonable level of cardiovascular endurance. The exercise sample shown in Table 1
shows individualized training programs developed according to each firefighter's present physical
condition.

Mode of exercise:                             Precision cycle ergometer.
Load intensity:                               Precisely set to require 60 to 65 percent
                                              of aerobic capacity to start and then gradually
                                              progressing to require 75 to 85 percent over a
                                              year's time.
Duration:                                     Minimum of 25 minutes of continuous exercise
                                              per workout.
Frequency:                                    Minimum of three times per week (every work shift,
                                              and additional workouts as needed to ensure at
                                              least three workouts per week).

The American Heart Association recommends three workouts per week for a fitness program to
be effective. Exercising five to seven times per week achieves more rapid improvement. When
away from the fire station, substitute 20 to 30 minutes of vigorous walking, swimming, or
cycling. Firefighters who jog, play sports, swim, etc., can continue these activities, adding the
cycle ergometer exercise to their daily regimen. Those who fully participate in this program can
expect a 15 to 20 percent improvement in their cardiovascular endurance during the first four
months, significantly improving their ability to perform strenuous fire fighting tasks. The
cardiovascular conditioning program is a valid evaluation of a firefighter's initial fitness level.

3.2. Alternate Modes of Fitness Training. The training principles described in paragraph 3.1
were originally incorporated for guiding the on-duty use of a precision cycle ergometer for
improving cardiovascular health and fitness. Although stationary cycling remains unique in
being essentially injury-free while providing a high degree of precision in achieving
cardiovascular conditioning objectives, the same training principles can surely be applied quite
successfully to a great variety of activities, both on and off duty. Certainly, off-duty jogging can
be one of these except for those whose aging joints may eventually succumb to the so-called
"high impact" nature of this activity. Although, there are many types of exercise machines that
supposedly support on-duty cardiovascular conditioning programs, only those that demonstrate
acceptable precision and safety characteristics will be recommended here. These include better
quality stair-stepping machines and motor-driven treadmills. (Notably absent from this
recommended list are machines that simulate either rowing or skiing exercises (as are those


                                                13
cycling machines with fan-type resistance where the capability to change the workload is limited
to changing speed of pedaling). Although both of these modes of exercise can be very effective
in safely achieving fitness objectives, laboratory studies suggest their disappointing lack of
precision in load setting precludes their use in a program demanding quality control with respect
to adhering to a personalized training prescription.

3.2.1 Stair-Stepping Exercise. Workloads can be adjusted by changing stepping speeds as
indicated by the electronic display unit provided on a quality machine. It should be remembered
that the handrails are for safety only and any pressure applied to them during the exercise
compromises the precision of the workout provided in the 16-week personalized training
prescription. An example of a training prescription for a stair-stepping machine, with units of
work described in watts, is provided in Table 2.

3.2.2. Treadmill Exercise. It is obvious that a simple fall can result in injury when exercising
on a motor-driven treadmill. Therefore, a crash mat should be positioned to cushion a fall off the
end of the moving belt, and exercise should be limited to brisk walking or slow jogging speeds.
Workloads can be accurately adjusted by changing the incline (usually represented in units of
percent grade). An example of a training prescription for treadmill exercise is provided in Table
3. (Note: The front and side rails on a quality treadmill are provided for safety only. One should
exercise with arms swinging free (as in normal walking/jogging). Any pressure on the rails
reduces the work and compromises the effectiveness of the exercise).

3.3. Weight lifting. Weight lifting also improves muscular strength and endurance. It can be
effectively accomplished by engaging in relatively short bouts of exercise three times per week,
using any equipment that incorporates safety in applying the overload principle to develop
muscular strength. A multistation lifting facility offers the required safety and desired
convenience to support this program. Free weights are also acceptable, but participants must
exercise great care to ensure their safety.

3.3.1. An unlimited number of techniques that can be used to effectively strengthen individual
muscles and muscle groups. First, consider individual desires and time constraints when
selecting specific techniques. Second, every workout must include the major muscle groups
represented by the four basic lifts presented in this program as they form the core of the lifting
program.

3.3.2. This conditioning program determines the safe maximal lift capabilities (without
competitive strain) for bench press, leg press, upright curl, and upright rowing. (muscle strength
effectively increases when repeatedly lifting weights equal to or greater than 50 percent of one's
maximal weight-lifting capability.)

3.3.3. During the first week initiate the beginning weight to be lifted--eight repetitions followed
by a 30-second rest, then another set of eight repetitions. In the second week, initiate two sets of
nine repetitions until the firefighter successfully completes two sets of 12 repetitions by the end
of the fifth week. The load gradually increases to the next level (commonly two to five pounds),
and the process is repeated. Table 4 provides an example.


                                                14
4.1. Recurring Fitness Training. The fire department program administrator must conduct
fitness-training evaluations in the morning before participants consume food, tobacco, or
caffeine. Participants will use heart-rate monitors (manufacturer's pamphlet contains donning
instructions) while sitting quietly for a minimum of two minutes (after adjusting the seat height
to the ideal riding position). The designated administrator begins the ergometer test that lasts six
to nine minutes. Upon completion of the test, the test administrator provides the firefighter with
a personalized 16-week training exercise prescription to guide the firefighter in an on-duty fitness
training and conditioning program (similar to the example shown in Table 1).

Table 1. Sample Exercise Prescription for Firefighters Using the Monark 818E Cycle Ergometer.


Week        Time        Load       Time         Load       Time        Load      Time           Load

            (Min)        (kp)      (Min)        (kp)       (Min)       (kp)      (Min)          (kp)

 1          5           2.5        10           3.0        10          2.5       0              0.0

 2          5           2.5        15           3.0         5          2.5       0              0.0

 3          5           2.5        15           3.0         5          2.5       0              0.0

 4          5           3.0        10           3.5        10          3.0       0              0.0

 5          5           3.0        10           3.5        10          3.0       0              0.0

 6          6           3.0        10           3.5        10          3.0       0              0.0

 7          5           3.0        15           3.5         5          3.0       0              0.0

 8          5           3.0        15           3.5         5          3.0       0              0.0

 9          5           3.5        10           4.0        10          3.5       0              0.0

10          5           3.5        10           4.0        10          3.5       0              0.0

11          5           3.5        15           4.0         5          3.0       0              0.0

12          5           3.5        15           4.0         5          3.5       0              0.0

13          5           3.5        15           4.0         5          3.5       0              0.0

14          5           3.5        15           4.0         5          3.5       0              0.0

15          5           3.5          5          4.0         5          4.5       10             4.0

16          5           3.5          5          4.0         5          4.5       10             4.0




                                                      15
Table 2. Sample Exercise Prescription for the Monark Model #4000PT Stairmaster (NSN 7830-01-328-8135).

                               Monark Stairmaster                               AirDyne
Week       Time                Kp           Watts                     kcal/hr        RPM
1          2                   3.0             l50                     640            64
           20                  4.0             200                     820            83
           3                   3.0             150                     640            64
2          2                   3.0             150                     640            64
           20                  4.0             200                     820            83
           3                   3.0             150                     640            64
3          2                   3.0             150                     640            64
           20                  4.0             200                     820            83
           3                   3.0             150                     640            64
4          2                   3.0             150                     640            64
           20                  4.0             200                     820            83
           3                   3.0             150                     640            64
5          2                   3.5             175                     730            74
           10                  4.5             225                     920            93
           10                  3.5             17S                     730            74
6          5                   3.5             175                     730            74
           10                  4.5             225                     920            93
           10                  3.5             175                     730            74
7          5                   3.5             l75                     730            74
           10                  4.5             225                     920            93
           10                  3.5             175                     730            74
8          5                   3.5             175                     730            74
           10                  4.5             225                     920            93
           10                  3.5             175                     730            74
9          5                   3.5             175                     730            74
           15                  4.5             225                     920            93
           5                   3.5             175                     730            74
10         5                   3.5             175                     730            74
           15                  4.5             225                     920            93
           5                   3.5             175                     730            74
11         5                   3.5             175                     730            74
           15                  4.5             225                     920            93
           5                   3.5             175                     730            74
12         5                   3.5             175                     730            74
           l5                  4.5             225                     920            93
           5                   3.5             175                     730            74
13         2                   3.5             175                     730            74
           20                  4.5             225                     920            93
           3                   3.5             175                     730            74
14         2                   3.5             175                     730            74
           20                  4.5             225                     920            93
           3                   3.5             175                     730            74
15         2                   3.5             175                     730            74
           20                  4.5             225                     920            93
           3                   3.5             175                     730            74
16         2                   3.5             175                     730            74
           20                  4.5             225                     920            93
           3                   3.5             175                     730            74




                                                  16
Table 3. Sample Exercise Prescription for the Treadmill (NSN 7830-01-275-8053).

                        Treadmill                       Walk/Jog                  Target
Week             MPH           Grade                    Miles                     Heart Rate
1               6               l%                      3                         127-137
                6               3%                                                127-137
                6               1%                                                127-137
2               6               l%                      3                         127-137
                6               3%                                                127-137
                6               1%                                                127-137
3               6               1%                      3                         127-137
                6               3%                                                127-137
                6               1%                                                127-137
4               6               1%                      3                         127-137
                6               3%                                                127-137
                6               l%                                                127-137
5               6               2%                      3                         134-144
                6               5%                                                134-144
                6               2%                                                134-144
6               6               2%                      3                         134-144
                6               5%                                                134-144
                6               2%                                                134-144
7               6               2%                      3                         134-144
                6               5%                                                134-144
                6               2%                                                134-144
8               6               2%                      3                         134-144
                6               5%                                                134-144
                6               2%                                                134-144
9               6               2%                      3                         134-144
                6               5%                                                134-144
                6               2%                                                134-144
10              6               2%                      3                         134-144
                6               5%                                                134-144
                6               2%                                                134-144
11              6               2%                      3                         134-144
                6               5%                                                134-144
                6               2%                                                134-144
12              6               2%                      3                         134-144
                6               5%                                                134-144
                6               2%                                                134-144
13              6               2%                      3                         134-144
                6               5%                                                134-144
                6               2%                                                134-144
14              6               2%                      3                         134-144
                6               5%                                                134-144
                6               2%                                                134-144
15              6               2%                      3                         134-144
                6               5%                                                134-144
                6               2%                                                134-144
16              6               2%                      3                         134-144
                6               5%                                                134-144
                6               2%                      3                         134-144




                                                   17
Table 4. Sample Exercise Prescription for Strength Training.

Name: _____________________________________ Start Date: __________________________

Strength Test Results: (One-time maximum lift weight, lbs)

Bench Press: 140 lbs                   80 lb bench press: 18 repetitions

Leg Press: 350 lbs

Upright Curl: 80 lbs

Upright Rowing: 80 lbs

Sit Ups: ________       _________



Week     Sets   Repetitions   Bench Press    Leg Press      Upright Curl   Upright Row


 1       2       8            70 lbs         175 lbs        40 lbs         40 lbs

 2       2       9            70 lbs         175 lbs        40 lbs         40 lbs

 3       2      10            70 lbs         175 lbs        40 lbs         40 lbs

 4       2      11            70 lbs         175 lbs        40 lbs         40 lbs

 5       2      12            70 lbs         175 lbs        40 lbs         40 lbs

 6       2       8            75 lbs         180 lbs        45 lbs         45 lbs

 7       2       9            75 lbs         180 lbs        45 lbs         45 lbs

 8       2      10            75 lbs         180 lbs        45 lbs         45 lbs

 9       2      11            75 lbs         180 lbs        45 lbs         45 lbs

10       2      12            75 lbs         180 lbs        45 lbs         45 lbs

11       2       8            80 lbs         185 lbs        50 lbs         50 lbs

12       2       9            80 lbs         185 lbs        50 lbs         50 lbs

13       2      10            80 lbs         185 lbs        50 lbs         50 lbs

14       2      11            80 lbs         185 lbs        50 lbs         50 lbs

15       2      12            80 lbs         185 lbs        50 lbs         50 lbs

16       2       8            85 lbs         190 lbs        55 lbs         55 lbs



                                                       18
                                          CHAPTER 4

            FIREFIGHTER OCCUPATIONAL ASSESSMENT PROCEDURES

4.1. General. The occupational fitness assessment component of the DoD Firefighter Fitness
and Wellness Program is comprised of a circuit consisting of 10 simulated fire fighting tasks that
must be completed in a continuous and consecutive manner. Rest intervals consisting of walking
either a distance of 50 or 100 feet are incorporated between each task representing tasks typically
conducted at fire scenes. During the occupational assessment process, firefighters are required to
wear full protective clothing (firefighter boots, gloves, helmet, bunker pants, and a coat) and a
fully operational self-contained breathing apparatus (SCBA).

4.2. Pre-Assessment Instructions. To create credibility and enhance the potential for
compliance, the fire department’s occupational fitness assessment monitor must be physically fit
and present a professional image. The assessment procedures have been standardized to ensure
safety and consistent results. Clinical judgment and common sense must, nevertheless, be
exercised throughout all components of the DoD Firefighter Fitness and Wellness Program. The
program administrator must be open and sensitive to information that is considered private about
the firefighter. Rapport with the individual firefighter is important in order to gather information
with respect to lifestyle habits, current levels of physical fitness activity, activity preferences,
barriers to participation in training programs, job demands, etc.

4.3. Equipment. The following equipment must be available to conduct the occupational
assessment:
 a. One stethoscope                    i. Task #1 – one 50 foot section of 2 ½ or 3 inch
                                       hose
 b. One aneroid sphygmomanometer       j. Task #2 and #9 – one 12 or 14 foot ladder
 c. One chair with arm rests           k. Task #3 – two 50 foot sections of 1 ½ or 1 ¾ inch
                                       charged hose with a nozzle
 d. Two stop watches                   l. Task #4 and #8 – one 24 foot ladder with the 10th
                                       rung marked with colored tape
 f. One 50 or 100 foot tape measure    m. Task #5 – one 100 foot section of 4 or 5 inch
                                       hose and one 50 foot section of 2 ½ or 3 inch hose
                                       tied together, and two 60 foot lengths of half inch
                                       rope
 g. One roll of colored duct tape or   n. Task #6 – one 10RX22.5 14 ply rubber tire (for a
 equivalent                            3 ton stake truck), weighted with sandbags for a total
                                       weight of 225.5 lbs; one 10 lb sledge hammer; one
                                       30 inch high picnic table; one (4 by 8 foot) sheet of
                                       1/2 inch plywood
 h. Emergency communications system o. Task #7 – one rescue randy mannequin weighing
                                       145 lbs
                                       p. Task #10 – one spreader tool or piece of fire
                                       fighting equipment that weighs 80 lbs



                                                19
4.4. Description of the Occupational Assessment Circuit. The circuit consists of 10 simulated
firefighting tasks that must be completed in a continuous and consecutive manner on a smooth
concrete slab floor in 8 minutes or less. Rest intervals consisting of walking a distance of either
50 or 100 feet are incorporated between each task, representing tasks that are conducted at the
fire scene. Walking between tasks permits firefighters to recover their breathing pattern and
allows them to cool down. The tasks that make up the occupational fitness assessment circuit are
as follows:

4.4.1. Task #1: One Arm Hose Carry. The firefighter carries one 50 foot section of rolled 2 ½
or 3 inch hose in one hand a distance of 50 feet, touches the finish line with at least one foot and
returns the same distance, carrying the hose in the other hand. The hose is then safely placed on
the start line when at least one foot touches the line. This task simulates the requirement of
carrying a rolled hose from a fire truck to a fire hydrant or to the fire scene. The candidate then
walks 50 feet to begin Task #2.

4.4.2. Task #2: Ladder Raise. The firefighter picks up a 12 or 14 foot ladder from the floor,
carries it a distance of 50 feet and raises it against a wall at a predetermined position. This task
simulates the requirement of removing a ladder from a truck, carrying it to the fire scene, and
raising it against a wall. After completing this task the candidate walks 50 feet to begin Task #3.

4.4.3. Task #3: Charged Hose Drag. The firefighter picks up the nozzle end of a 100 foot
section of 1 ½ or 1 ¾ inch charged hoseline and drags the hose a distance of 100 feet. The
firefighter then places the nozzle end of the charged hoseline at the 100 foot mark when at least
one foot touches the line. At fire scenes, firefighters must drag sections of charged hose from the
fire truck to the fire scene. After completing this task the candidate walks 50 feet to begin Task
#4.

4.4.4. Task #4: First Ladder Climb. This task requires the firefighter to climb 10 rungs up
and 10 rungs down on a 24 foot extension ladder. This process is repeated 3 times for a total of
30 rungs up and 30 rungs down. The firefighter must place both feet on the 10th rung prior to
descending. The firefighter must place both feet on the ground prior to ascending. The fire
department assessment monitor must call out the number of rungs climbed to assist the firefighter
performing this task (i.e. one, two, three, etc). It is important to only call out the rungs completed
so as not to pace the firefighter by voice command. The firefighter being evaluated must
determine their own pace. This task represents the requirement to climb and descend three
flights of stairs, which is the average number of floors serviced by DoD firefighters. A ladder is
used to perform this task since our fire stations do not have three flights of stairs. After
completing this task the candidate walks 100 feet to begin Task #5.

4.4.5. Task #5: High Volume Hose Pull. The firefighter is required to pull a 100 foot section
of 4 or 5 inch hose and one 50 foot section of 2 ½ or 3 inch hose tied together for a total distance
of 100 feet. The firefighter must use a hand-over-hand, one or two hand pull technique. This task
commences with the firefighter pulling the hose from the “50 foot mark” to the “start” line.
Once the hose reaches the “start” line, he/she walks 50 feet to the “50 foot mark,” picks up the
rope and pulls the hose back towards himself/herself until the hose reaches the “50 foot mark.”


                                                 20
This task must be completed on a smooth concrete slab floor, which is common in most
apparatus stalls. This task simulates the requirement to pull equipment onto a roof or into a
burning building utilizing a hand-over-hand technique. For safety reasons, this task is simulated
on the floor vice having the firefighter actually pull equipment onto a roof. After completing this
task the candidate walks 50 feet to begin Task #6.

4.4.6. Task #6: Forcible Entry. The firefighter is required to move a rubber tire weighing
225.5 lbs a distance of 12 inches across a 30 inch high picnic table, by hitting the tire with a 10
pound sledgehammer. The tire lies on a piece of plywood that lies on top of the picnic table. The
sledgehammer may be held in any manner and the firefighter is permitted as many hits as
required to move the tire 12 inches. The tire must be completely across the line. This task
simulates forcible entry into a building by either knocking down a door or a wall. The height of
the tire from the ground realistically represents the height at which a sledgehammer is normally
swung and the height of a door latch/handle. Moving the weighted tire 12 inches correlates
scientifically with the forces required to knock down structures (doors/walls) in order to obtain
access. After completing this task the candidate walks 50 feet to begin Task #7.

4.4.7. Task #7: Victim Drag. Using an appropriate carry, the firefighter is required to drag a
rescue mannequin weighing 145 pounds a total distance of 100 feet. The mannequin cannot be
dragged by its clothing. Using a belt at the upper torso (under the arms) is permitted. The
mannequin is dragged from the 50 foot line to the start line. Once the firefighter touches the start
line with at least one foot, he/she must turn around and drag the mannequin back to the 50 foot
line. The mannequin is placed on the 50 foot line when the firefighter places at least one foot on
the line. This task simulates the evacuation of a casualty from a burning structure. After
completing this task the candidate walks 50 feet to begin Task #8.

4.4.8. Task #8: Second Ladder Climb. The firefighter is required to climb 10 rungs up and 10
rungs down twice. This task is identical to Task #4 except the firefighter only climbs up and
down the ladder twice instead of three times. If necessary, the firefighter may stop and rest
during this task, however, for safety reasons, the firefighter should be encouraged to rest prior to
his or her second ascent, and should be discouraged from resting on the 10th rung. Two feet must
be placed on the 10th rung and on the ground as described in Task #4. After completing the task
the candidate walks 100 feet to begin Task #9.

4.4.9. Task #9: Lower Ladder. The firefighter is required to lower the 12 or 14 foot ladder
using any approved technique. He/she is then required to carry the ladder a distance of 50 feet,
touch the line with at least one foot, and then safely lower the ladder. This task simulates
moving a ladder from one location at the fire scene to another or carrying a ladder from the fire
scene back to the truck. The candidate then walks 50 feet to begin Task #10.

4.4.10. Task #10: Tool Carry. The firefighter is required to lift a spreader tool or piece of
firefighting equipment weighing 80 pounds from the “start line” and carry it to the 50 foot line,
and then turn around and carry the tool back to the start line and place the spreader tool back on
the ground. The clock stops when the tool is safely placed back on the ground. This task
represents carrying a tool to the scene.


                                                21
4.5. Setting-Up the Occupational Assessment Circuit. The circuit has been designed so that it
can be conducted in fire department apparatus stalls and should not require any additional
equipment or modifications to the stall area. However, the exact circuit set-up may vary from
one installation to another as station designs may vary. A schematic of the circuit layout is
provided in Figure 1. The equipment used to complete the circuit is standard firefighting
equipment that is commonly found in all fire stations throughout the DoD. The circuit is laid out
as follows:

4.5.1. Start line or 50 foot line

4.5.1.1. Mark the start line with colored tape at one end of the stall.

4.5.1.2. Measure a distance of 50 feet from the start line and mark the spot with colored tape.
This is the “50 foot” line. Measure 50 feet from the start line in the opposite direction and mark
the spot with colored tape. This is the “100 foot” line.

4.5.1.3. Place the following equipment on the floor at the start line: one 50 foot section of rolled
2 ½ or 3 inch hose; one spreader tool or piece of firefighting equipment weighing 80 pounds.

4.5.1.4. Near the start line area: mark the place on wall where the 12 or 14 foot ladder will be
raised; set up the forcible entry task; and identify the location where the 24 foot ladder will be
raised and secured.

4.5.1.5. On the 50 foot line, place the following equipment on the floor: one 12 or 14 foot
ladder; one charged 1 ½ or 1 ¾-inch hose with nozzle; one 145 lb rescue mannequin; one 100
foot section of 4 or 5 inch hose with one 50 foot section of hose rolled and tied together with two
60 foot lengths of rope. One length of rope is tied to each side of the bundled hoses. The hoses
must be placed completely behind the 50 foot line.




                                                 22
Figure 1 SCHEMATIC OF OCCUPATIONAL ASSESSMENT CIRCUIT LAYOUT




                        50 feet

          100 ft one arm hose carry                       Forcible entry

          12 or 14 ft ladder carry for 50 ft and raise    100 ft rescue mannequin victim drag

          100 ft charged hose drag                        24ft ladder climb up/down 10 rungs x 2

          24 ft ladder climb up/down 10 rungs x 3         12 or 14 ft ladder lower and carry for 50 ft

          100 ft hose pull                                80 lb tool or equipment carry for 100 ft



4.5.2. Setting up the forcible entry task (Task 6). One end of the picnic table is placed against a
wall. A sheet of plywood, is placed on top of the picnic table with the edge of the plywood being
in line with the edge of the picnic table, which is not placed against the wall. A distance of 12-
inches is measured in from the end of the picnic table furthest from the wall, and a line is drawn
across the sheet of plywood at the 12-inch mark. The tire is then weighted appropriately with the
sandbags secured in the front half of the tire and the tire is placed on the plywood with the edge
of the tire in line with the edge of the plywood. Do not place the sandbags at the rear of the tire,
as the sandbags are required to absorb the impact of the sledgehammer against the tire. If the
sandbags are placed in the rear of the tire, the sledgehammer will bounce off of the tire and could
injure the firefighter.

4.5.3. Set-up of the 24 foot extension ladder (Tasks 4 and 8). The top of the ladder must be
secured to the roof or wall. Extend the ladder so that the 10th rung is the first doubled rung. To
ensure that the ladder is extended at the proper angle, stand in front of the ladder, facing the wall
and ladder, with your toes touching the base of the ladder. Extend your arms straight out in front
of your body. If you can grasp the rungs, the ladder is positioned at the correct angle. If you
cannot, move the base of the ladder away or towards the wall as applicable.

4.6. Preliminary Instructions to the Firefighter. In order to ensure accurate evaluation results,
firefighters shall be given preliminary instructions at least 48 hours prior to their occupational
assessment evaluation.




                                                         23
4.6.1. Prior to their evaluation the firefighter should not:

4.6.1.1. Exercise the same day.

4.6.1.2. Consume alcohol for at least six hours.

4.6.1.3. Eat, smoke, or drink tea, coffee or other caffeine beverages for a least two hours prior to
the assessment.

4.6.2. The firefighter shall bring the following personal gear to the evaluation:

4.6.2.1. Coveralls or gyms shorts and a tee shirt.

4.6.2.2. Firefighter gloves.

4.6.2.3. Firefighter boots.

4.6.2.4. Firefighter helmet.

4.6.2.5. A SCBA with a mask.

4.6.2.6. Firefighter bunker pants and a coat.

4.7. Pre-Screening

4.7.1. Health Appraisal Questionnaire. The Health Appraisal Questionnaire is a screening
device used to identify firefighters for whom evaluation and physical activity might be currently
inappropriate. Firefighters must read the Health Appraisal Questionnaire carefully and answer all
questions honestly. Firefighters with only “no” responses on the questionnaire are cleared to
participate in the assessment evaluation. Firefighters with one or more yes responses shall not be
evaluated, and will be automatically referred to a Medical Officer (MO) or their family physician,
as appropriate. The MO will then determine if the firefighter is medically fit for duty evaluation
and subsequent physical fitness training. Firefighters referred to a MO or civilian doctor should
be told that there is no cause for alarm, because the health appraisal questionnaire is designed to
work as a safety precaution. Do not attempt to diagnose or discuss in detail why the firefighter
has a yes response.

4.7.1.1. Questions pertaining to what kinds of medication may affect an individual’s ability to
undertake a physical fitness evaluation have always existed and caused concern for the evaluator.
To alleviate this concern, a list of medications, which affects a member’s ability to undertake an
evaluation, has been developed by the Chief of Health Services Branch. If a firefighter responds
yes to question 8 on the Health Appraisal Questionnaire, ask the firefighter to write the name of
the drug(s) that he/she is taking in the space provided under question 8. Check the list of
medications provided at Annex C and if the drug appears on the list, refer the firefighter to a MO
or their family physician, as appropriate. Do not evaluate firefighters who are taking drugs which


                                                   24
appear on the list. If the drug(s) the firefighter is taking does not appear on the list, the firefighter
may proceed with the evaluation. If the evaluator is in doubt, the firefighter must be referred to
the MO or family physician, as applicable.

4.7.2. Observations. Although the Health Appraisal Questionnaire will identify most concerns
that would make the assessment evaluation inappropriate, the evaluator must also make some
general observations during the screening process. The evaluation shall be postponed and
rescheduled, if firefighters demonstrate difficulty breathing at rest; cough persistently; are ill or
have a fever; have lower-extremity swelling; ignored the preliminary instructions (i.e. have just
eaten a heavy meal, alcohol on breath, just smoked, etc.)

4.7.2.1. These concerns should be dealt with in a similar manner to a yes response on the Health
Appraisal Questionnaire. Firefighters should be encouraged to see their family physician or a
MO about the concerns (persistent cough, lower extremity swelling) or simply return at the re-
scheduled time when the concerns are no longer relevant (i.e. preliminary instructions regarding
alcohol, food, exercise, or smoking have been followed).

4.7.3. Vital Signs. The protocols for the measurement of resting heart rate and resting blood
pressure will be utilized.

4.7.3.1. Resting heart rate is influenced by many factors. Nervousness in anticipation of the
evaluation may elevate the firefighter’s heart rate. A few minutes of informal chatting can do
much to calm apprehensive firefighters.

4.7.3.2. The firefighter should be seated comfortably in a chair with arm supports, and rest with
their feet flat on the floor for at least five minutes before the resting heart rate is measured.

4.7.3.3. To determine the resting heart rate, a stethoscope should be utilized. The stethoscope
should be positioned so the earpieces point forward. The diaphragm of the stethoscope should be
placed either on the sternum or over the second intercostal space on the left side. Should it not
be possible to utilize a stethoscope, resting heart rate may be measured by palpating the radial
artery. For this procedure, the index and middle fingers should be used to gently apply pressure
on the inside of the wrist just above the thumb. The resting heart rate (RHR) is determined using
a 15-second count and the first beat is counted as “zero.” The total number of beats in the 15-
second count is then multiplied by 4, and recorded in beats/minute in the appropriate space
provided.

4.7.3.4. In the event that the RHR exceeds 100 beats/minute, wait an additional five minutes and
repeat the procedure. Should the RHR still exceed 100 beats/minute on the second reading, the
firefighter shall be referred to the MO or family physician, as applicable. The firefighter shall not
perform the evaluation or receive an exercise program until appropriate medical clearance is
received.

4.7.3.5. Measurement of the resting blood pressure (RBP) is an integral part of the screening
process. Many conditions can cause RBP to be elevated above the average resting value.


                                                   25
Anxiety can cause a transient increase in blood pressure. A firefighter’s anxiety may be
minimized by taking the time to explain the evaluation procedure and answering questions.

4.7.3.6. When conducting RBP, a stethoscope and sphygmomanometer shall be used. An
appropriate size blood pressure cuff should be used and applied to the firefighter’s left arm. The
cuff should be firmly and smoothly wrapped around the left arm with the lower margin of the
cuff, one inch above the antecubital space. The arm should be comfortably supported at an angle
of 10 to 45 degrees from the trunk, with the lower edge of the cuff at heart level. The brachial
artery should be located by palpitation and noted. Rapidly inflate the cuff to a level 20 to 30
mmHg above the radial palpatory pressure and quickly position the stethoscope over the brachial
artery, ensuring that the diaphragm is in complete contact with the skin and not touching the cuff
or its tubing. Release the cuff pressure at a rate of approximately 2 mmHg per second. The
systolic pressure is determined by the first perception of sound. The diastolic pressure is
determined when the sounds cease to be tapping in quality and are fully muffled. The cuff is then
deflated to zero pressure and removed from the firefighter’s arm.

4.7.3.7. The resting systolic and diastolic pressures are recorded to the nearest 2 mmHg.

4.7.3.8. In the event the resting systolic blood pressure is greater than 140 mmHg and/or the
resting diastolic blood pressure is greater than 90 mmHg, have the firefighter rest quietly for five
minutes before repeating the measurement. If after two readings, the firefighter’s resting systolic
blood pressure is still greater than 140 mmHg and/or the resting diastolic blood pressure is
greater than 90 mmHg, the firefighter shall not be permitted to undertake the evaluation, and
shall be referred to the MO or family physician.

4.8. Conducting the Occupational Assessment Circuit

4.8.1. Practice Run. If they have not been using the circuit as part of their unit or individual
fitness training program prior to the annual evaluation, firefighters should be encouraged to
complete a practice run in full turnout gear no more than 72 hours and no less than 48 hours
preceding the actual test. This will assist the firefighter in determining their appropriate pace for
the annual evaluation.

4.8.2. Warm Up. Prior to the evaluation, all firefighters should be given an instructed general
warm up session. Due to the nature of the evaluation, the general warm up should be thorough
and concentrate on all major muscle groups. Additionally, firefighters should be provided with
an opportunity to conduct their own specific warm up.

4.8.3. Pre-Evaluation Instructions to the Firefighter. Each firefighter shall be instructed as to the
conduct of the evaluation, criteria for terminating the evaluation, and emergency procedures.
Each of these areas is expanded upon independently.

4.9. Completing the Occupational Assessment Circuit. The circuit consists of 10 simulated
fire fighting tasks which are to be completed as quickly as possible, without running, in a
continuous and consecutive manner on a concrete slab floor. Each task in the circuit must be


                                                 26
completed prior to the start of the next task, and the tasks must be completed sequentially. The
firefighter may stop and rest between or during tasks as required. Rest intervals consisting of
walking a distance of either 50 or 100 feet have been incorporated between tasks. For safety
reasons, it is imperative that firefighters do not run while completing the occupational assessment
circuit.

4.9.1. Prior to starting the evaluation, the evaluator shall walk the firefighter through the circuit
and explain how each task is to be conducted. Instructions with respect to circuit performance,
safety, timing, and criteria for termination shall be given to each firefighter.

4.9.2. For performance on the circuit, firefighters are required to wear full protective clothing
consisting of firefighter boots, gloves, helmet, bunker pants and jacket. Firefighters are also
required to wear and use a fully operational self-contained breathing apparatus (SCBA) with
mask. The circuit is designed to be completed on one bottle of breathing air, therefore, quickfills
or changing air bottles is not permitted.

4.9.3. Prior to the start of the circuit, it is imperative to ensure that the firefighter is properly
dressed and that no loose straps or belts are hanging. The evaluator must ensure that the air tank
being utilized is full as indicated on the dial. In order to conserve oxygen, the mask hose for air
should not be attached to the regulator until the firefighter is ready to perform the circuit. Just
prior to commencing the circuit, the mask hose should be attached to the regulator, and the air
bottle should be turned on. The evaluator should check to ensure that the firefighter is getting air
from the tank.

4.9.4. During performance on the circuit, it may be necessary for the evaluator to “coach” the
firefighter so that he/she may complete the circuit. It is important to stress that the 50 and 100
foot “walks” between tasks are designed to permit the firefighter to rest. Should the firefighter
be unable to complete the circuit, remove the air hose from the tank, and immediately assist the
firefighter in removing his/her helmet and mask. This will permit the firefighter to breathe fresh
air. The air tank should then be turned off so the candidate does not waste his/her breathing air.

4.9.5. Upon completion of all 10 tasks, and once the firefighter reaches the finish line, stop the
stopwatch and record the time taken to complete the circuit. Failing to complete each task in the
circuit or failing to complete the entire circuit constitutes a failure. To pass this goal-based
occupational assessment the candidate must complete the occupational assessment is 8:00
minutes or less.

4.10. Criteria for Terminating the Assessment. The circuit is terminated when any of the
following occur:

4.10.1. If a firefighter complains of or experiences dizziness, chest pain, tightness in the chest,
nausea, severe pain or weakness in limbs, mental confusion, or any other severe pain.

4.10.2. If a firefighter stops and determines that he/she does not wish to continue.




                                                 27
4.10.3. If a firefighter staggers, has marked breathlessness or cyanosis (blue discoloration of the
skin due to lack of oxygen).

4.10.4. If at any time, the evaluator becomes concerned with the firefighter’s safety.

4.11. Cool Down Period. It is important that firefighters do not leave the evaluation area after
completing the circuit until their post exercise heart rate is less than 100 beats per minute. Prior
to commencing a supervised cool down, firefighters should remove their SCBA and fire fighting
gear as this will facilitate cooling of the body. A supervised cool down should then be
conducted, concentrating on all of the major muscle groups.

4.12. Emergency Procedures. An appropriate emergency protocol shall be developed in
conjunction with the Installation Fire Chief. All evaluators shall be trained in CPR and be aware
of the emergency protocols and procedures for their specific fire department.




                                                28
                                          CHAPTER 5

                                 WELLNESS COMPONENT

5.1. Introduction. The Department of Defense established provisions for a health promotion
element within its organizations with the publication of DoD Instruction 1010.10, Health
Promotion, May 8, 1994. Each Military Service was directed to implement plans and programs
to address tobacco use (smoking) prevention and cessation, physical fitness, nutrition, stress
management, alcohol and drug abuse, and early identification of hypertension. Since 1994,
health promotion efforts have grown to address the prevention of cardiovascular disease and
cancer. This chapter also addresses spiritual needs and other resources available to DoD
firefighters. All DoD fire departments must have a wellness program that addresses, at a
minimum, the above five major focus areas of health promotion in addition to the fitness
program.

5.2. General. While there is no universally accepted definition for health promotion or
wellness, the two terms will be used interchangeably. For the purposes of this chapter, the DoD
definition of health promotion will be used, i.e., “Any combination of health education and
related organizational, social, economic or health care interventions designed to facilitate
behavioral and environmental alterations that will improve or protect health.”

5.2.1. Health Risk Assessments (HRAs) or Health Enrollment Assessment Reviews (HEARs), if
available, must be administered to all firefighters (civilian, military, and contractors) annually.
Information gathered in these surveys will be used to determine individual and composite health
risks and needs or assess changes in those risks and needs over time. These forms are available
at military medical treatment facilities (MTFs) or health and wellness centers (HAWCs).

5.2.2. Fire Chiefs must internally appoint a representative to ensure the proper dissemination of
HRA or HEAR results, in coordination with a local medical point of contact, to all surveyed
firefighters either by mail or personal consultation. Interventions for identified risk factors
should be discussed privately between the medical representative and the individual firefighter to
ensure patient confidentially and privacy. Guidelines for improvement must be provided either
in writing or verbally to firefighters.

5.2.3. Health programs must be designed by local health promotion managers or coordinators
within MTFs or HAWCs to meet the needs and interests of local firefighters and implemented
within the limits of available resources. Measuring outcomes from these programs is essential to
designing effective and efficient lifestyle-change programs and meeting the wellness needs of
individual firefighters.

5.3. Nutrition. Nutrition guidelines are specifically addressed by instruction or regulation in all
military services and emphasize the importance nutrition plays in overall health and fitness. (See
Attachment 1 for service-specific regulations or instructions.) The demands DoD firefighters
face on the job are great and the fuel necessary to meet these demands is found in the individual’s
diet. Proper nutrition is a must. To meet wellness objectives, DoD firefighters must strive to


                                                29
strengthen their mental, physical, and emotional dispositions to withstand the stresses and strains
of living both inside and outside the workplace. Proper nutrition enhances performance and the
quality of life of all firefighters.

5.3.1. Nutrition for Performance. Aside from the limits imposed by heredity and the physical
performance improvements associated with training, no factor plays a bigger role in exercise
performance than nutrition. Benefits of a well balanced diet include:

      Feeling better day-to-day.
      Having more energy to exercise harder and for longer durations.
      Quicker recovery after workouts and after difficult incidents.
      Improved resistance to diseases.

5.3.2. Nutrition for Health. The high levels of stress, high physical demands, long-term
exposures to chemicals and disease, and past nutritional habits all contribute to the elevated risks
of heart disease and cancer in the fire service.

5.3.2.1. Heart Disease. Several of the risk factors for heart disease (high cholesterol, obesity,
hypertension, and diabetes) can be reduced by dietary intervention. A diet low in total fats,
saturated fats, cholesterol and salt but high in fresh fruits, fresh vegetables, and whole grain
fibers has been shown to reduce the risk of heart disease. Whole grains include such foods as
whole-wheat flour, oatmeal, high fiber cereals containing bran, and bread products made with
whole wheat or whole grains.

5.3.2.2. Cancer. It is believed that diet plays a role as a predisposing factor to cancer. It has
been reported that a diet high in fat may add to the risk of pancreatic and colorectal cancer. Diets
high in fresh fruits, fresh vegetables, and whole grains have been shown to have a protective
effect against cancer.

5.3.3. The Need for Fluids. Current research has shown that working firefighters can lose more
than 2.6 liters of body fluid per hour. Loss of body water from sweating beyond 2% of their body
weight will significantly impair a firefighter’s endurance capacity through the elevation of body
temperature and decreased cardiac output. It is critical to address proper hydration throughout
the firefighter’s tour of duty, especially during rehabilitation.

5.3.3.1. During prolonged work, as the body loses water via sweat and respiration, there tends to
be a gradual decrease in heart stroke volume and body cooling capacity. This produces an
elevated heart rate response while encouraging the accumulation of body heat. Dehydration and
increased body temperature (hypothermia) amplify the sense of exertion and accelerates the rate
of fatigue. In addition, dehydration and hypothermia predispose an individual to irregular
heartbeats, heart attacks, loss of consciousness, stroke, and sudden death. Drinking about one
liter of fluid per hour helps prevent these life-threatening health effects and makes it easier to
continue performing. Drinking water in excess of this amount may lead to water intoxication but
in these circumstances this would be a very rare event.



                                                30
5.3.3.2. Adequate water intake under the extreme conditions faced by firefighters is critical to
continued performance. To maximize performance and minimize the potential for heat illness
and injury, it is highly recommended firefighters enhance their efficiency and capacity for
evaporative cooling (sweating) by maintaining a high level of fitness, acclimatizing the body to
working in a hot environment, decreasing body fat and attaining and maintaining the highest
level of hydration possible.

5.3.4. A Balanced Diet. Firefighter personnel are encouraged to pursue healthy diets. A
balanced diet fuels the body for exercise, strenuous work, and a healthy lifestyle.

5.3.4.1. The preparation, selection, and eating of fire station meals can be a healthy experience.
Firefighters must be continually updated on food choices, on the necessity of a healthy diet, and
on the preparation of nutritious meals. Firefighters are encouraged to seek and become educated
on healthy choices so that healthy eating becomes an expectation and norm within each fire
station.

5.3.4.2. Most experts agree that a well balanced diet can meet all of the required nutritional
needs. However, the exact amounts necessary from each nutritional category can be
controversial. The widely accepted contribution to the total caloric intake of carbohydrates,
proteins, and fats are as follows:

      Carbohydrates – 55% to 60%
      Proteins – 10% to 20%
      Fats – 30% or less (depending on weight loss objectives or medical restrictions)

5.3.4.3. In addition, the following guidelines will help lead to a healthy diet:

      Eat 5 or more servings of fresh fruits and fresh vegetables (if available), otherwise fresh
       frozen.
      Reduce the amount of cholesterol, salts, and fats, particularly saturated fat.
      Replace high fat meats with lean cuts.
      Reduce the amount of processed foods (high in salt and hydrogenated oils).
      Increase the amount of fiber (about 20-30 grams of fiber daily).
      Drink plenty of non-caffeinated and alcohol free beverages.

5.3.4.4. The development of a sound nutritional program requires food choice variety and meal
planning. Dietitians at each MTF or HAWC (if available) are valuable resources and are
available to support the fire department with their efforts to develop a sound nutritional program
and provide firefighter educational opportunities in this area.

5.3.5. Nutritional Counseling. A registered dietitian is a valuable asset to any wellness program.
The field of nutrition is plagued with fads and misinformation. Members, senior leaders,
supervisors, and peer fitness trainers need the expertise that a qualified dietitian can offer. These
experts are available at the MTFs or HAWCs (or by contract, depending on budgetary



                                                 31
constraints) to conduct classes or cooking demonstrations on site or at individual fire stations.
Some of the benefits of a dietitian include the following:

      Developing weight loss management programs.
      Analyzing individual diets.
      Customizing diet prescriptions (e.g., pregnancy, weight gain, or illness).
      Educating peer fitness trainers, supervisors, members, and recruits.
      Developing specialized meals for nutritional replenishment after incidents.
      Meeting with counselors to assist obese members seeking behavioral modification
       interventions.

5.4. Weight Loss and Behavioral Modification. DoD Instruction 1308.3 requires each
Military Service to establish body fat control policies and procedures. Each Service has
implemented differing programs to identify or assist its personnel in maintaining approved
weight or body fat standards. Integral to this instruction is the availability of weight management
programs that firefighters can access if they near or exceed established body fat standards. Fire
Chiefs and supervisors are encouraged to establish a culture that is fully supportive of attendance
and participation in these programs when needed or when individuals are self-identified for
assistance/counseling. Attendance should not be limited to active duty firefighters. Civilian
firefighters should also be encouraged to attend local weight management classes or have self-
paced programs available if they are exceeding healthy body fat standards. A collaborative effort
on the part of the Army, Navy, and Air Force Health Promotion Offices has produced a technical
guide entitled, Weight Management Self-Study Guide, and is available through normal military
service publication offices. Further information on weight loss programs can be obtained from
MTF dietitians or Wellness Centers.

5.5. Tobacco Use and Cessation. DoD Instruction 1010.15, Smoke-Free Workplace, strongly
encourages all uniformed personnel to be tobacco free, as well as establishing tobacco-free
workplaces. Medical data clearly shows that tobacco use is not compatible with a healthy fire
service. Further, tobacco use is damaging to the benefits secured by otherwise healthy lifestyles
in the firefighter community, i.e., regular exercise, good nutrition, and weight control. Extensive
research has now clearly proven that the use of tobacco is damaging to many organ systems and
the use of tobacco, whether through smoking or spit tobacco products, is contrary to the
philosophy of all Military Services. Fire Chiefs and supervisors must actively support tobacco
cessation efforts within their fire stations and lead by example. Tobacco cessation classes are
available on many military facilities or are available in local civilian communities and the use of
tobacco cessation adjuncts such as nicotine gum, nicotine patches, or clonidine (Zyban) is highly
encouraged.

5.5.1. Tobacco Cessation Programs. A number of tobacco cessation programs have been well
studied and have been found to be safe. Success rates appear to improve when tobacco users
who are family members (e.g., spouses), close friends, or co-workers (e.g., other firefighter
personnel) stop smoking at the same time. Types of programs currently include: hypnosis,
acupuncture, nicotine chewing gum, nicotine patch, and Zyban. All such programs have been
found to be far more effective when coupled with counseling for behavioral modification. Thus,


                                                32
the best tobacco cessation programs represent a joint effort between the physician, other health
care providers, and trained counselors.

5.5.2. Many tobacco users are concerned about weight gain following tobacco cessation. This
concern is justified, as many studies have documented a 5 to15 pound weight gain following
smoking cessation. This weight gain occurs regardless of the type of smoking cessation program
and is due to changes in metabolism as well as increases in food intake. Weight gain must be
addressed by tobacco cessation programs because weight gain influences enrollment rates,
success rates, and the ability to perform successfully on the job. All programs should include
follow-up counseling and re-enrollment of individuals in the original program or in another type
of tobacco cessation program whenever necessary.

5.6. Substance Abuse. Alcohol is by far the most abused substance in the general population.
Alcoholism has been recognized as a treatable disease by the American Medical Association
since 1956. Because it is a progressive illness, it takes time for alcoholism to become a chronic
problem resulting in deteriorating job performance. Whenever possible, troubled workers should
receive early intervention with referral to a credible substance abuse program. Early intervention
will benefit the alcoholic, the alcoholic’s family, and the fire department. Successfully treating
alcohol problems costs ten times less than the current cost of alcohol problems to society.
Responses on the Health Risk Assessments or HEARs can help identify problem alcohol
consumption or individuals with “binge” drinking habits. Successful intervention strategies can
then be discussed on an individual basis to increase awareness levels or prevent future job
degradation.

5.6.1. Drug abuse also is a concern within many occupations today. Despite the fact many
corporations have drug-testing programs in place, some employees continue to abuse drugs on
and off the job. The drug-abusing employee may not be able to remain free of the influence of
their substance or substances at the workplace. Work function will be impaired from off-duty
substance abuse.

5.6.2. Department policies must reflect a strong commitment to a workforce free of substance
abuse. The use of illegal substances or the abuse of legal and/or controlled substances in the fire
service will be tolerated. The organization’s policy regarding substance abuse should be made
clear to all new personnel. Substance abuse education should be an ongoing part of a
department’s substance abuse program. Treatment is available to those who require or request it
from the installation substance abuse offices.

5.6.3. A functional and credible substance abuse program is necessary if a department hopes to
intervene with a troubled employee in a timely manner. Fire Chiefs must support the treatment
and rehabilitation of an individual and foster an environment in which the troubled employee can
come forward to request help. A substance abuse program is most effective if specialized help is
available and readily accessible.

5.7. Stress Management. An effective stress management program can significantly enhance
firefighter job performance by minimizing work and personal stresses. Stress management


                                                33
programs are available from mental health helping professions or HAWCs at each military
installation. Civilian firefighter personnel can seek assistance from available civilian sources or
from internal discussion groups, as appropriate. Such programs may utilize self-management or
professional sources of help, depending on the levels of stress and type of assistance required.
Stress management programs for the fire service should address issues such as job stress, family
relations, financial or legal concerns, and personal concerns or fears related to issues such as
infectious disease exposure.

5.7.1. Prevention programs are the most logical means of reducing the effects of stress on the
emotional health of firefighters. Stress prevention efforts may be provided through the
behavioral health component in many ways.

5.7.1.1. Incorporate on-going stress management refresher courses into annual training
requirements.

5.7.1.2. Emphasize the value of exercise as a stress reduction tool.

5.7.1.3. Make available periodic psychological testing for stress indices to identify personnel
with high levels of stress and offer appropriate services. Such testing should include the
Behavioral Health Survey (BHS) instrument available from mental health offices or HAWCs.

5.7.2. Sources of Stress. The following are sources of stress that can adversely affect work
performance and an employee’s long-term health status. Every effort should be made by Fire
Chiefs and supervisors to support a culture that recognizes the importance of identifying stress
factors and modifying risk factors.

5.7.2.1. Job Stress. The work of a firefighter is characterized by long hours, shift work, sporadic
high intensity situations, strong emotional involvement, life and death decisions, and exposure to
extreme human suffering. This work may eventually impose undue stress upon the individual
and the individual’s family. Often, a firefighter can have great difficulty dealing with certain
situations on their own and it becomes a disability. Stress is now recognized as a major
contributor to a variety of individual health problems. Fortunately, stress management programs
relieve these pressures by providing counseling, critical incident stress management, and
education to prevent the debilitating effects of stress.

5.7.2.2. Family Relationships. The demands of the fire service profession may eventually take
its toll upon marriages and families. Psychological stress, substance abuse, and emotional unrest
can be displaced onto the family. One study reported a high divorce rate among firefighters,
increasing with rank and, presumably, with years of service.

5.7.2.3. Infectious Disease Issues. On the job, firefighters may come in contact with individuals
who have been exposed to or are infected with contagious diseases such as hepatitis B,
tuberculosis, and HIV/AIDS. The exposed or infected individual may be a coworker.
Counseling and educational workshops for firefighters and their families can help alleviate stress.
A U.S. Presidential Commission on the HIV epidemic stated that education is one of the most


                                                34
formidable weapons for attacking the anxiety, hostility, fear, and ignorance associated with HIV-
infected individuals, maintaining a calm work environment, and stopping the spread of HIV
infection. Fire Chiefs are strongly encouraged to support annual briefings conducted by qualified
MTF personnel on the prevention of the infectious diseases mentioned above.

5.7.3. Critical Incident Stress Management (CISM). CISM includes pre- and post-incident
activities, particularly education and debriefing. Major incidents often require an on-scene
assessment of personnel and diffusing of stress. Critical incident stress reactions from an event
have the power to temporarily overcome a firefighter’s usual coping abilities. CISM can bolster
the emergency responder’s normal coping mechanism to help prevent burnout or post traumatic
stress disorder. On a proactive basis, pre-exposure training emphasizes the normalcy of feeling
stress in abnormal situations. Training should focus on the practices of effective approaches to
stress and avoidance of ineffective behaviors. Fire Chiefs should be aware of local resources or
CISM teams that can act as the primary providers for stress counseling intervention and pre-
exposure training.

5.7.4. Comprehensive Counseling Services. Installation chaplains may also provide valuable
guidance to those members who may be emotionally or spiritually in need. Chaplains should be
able to address issues using a non-denominational approach and direct personnel to various
sources of help. Chaplains must be able to recognize signs of stress and implement effective
methods to help firefighters cope with daily pressures.

5.8. Chaplain Services for Spiritual Needs. Military installations have chaplains of various
denominations assigned to serve the needs of active duty, dependents, and other eligible
beneficiaries as needed. These chaplains are available to handle emergency situations within the
fire station as needed, such as:

      Line of duty deaths.
      Notification of family members for serious injuries or fatalities.
      Suicides involving fire department members and their families.
      Counseling.

5.8.1. Two important functions of the chaplains are: to help firefighters and their families in
times of crisis and to help them with their spiritual needs.

5.8.2. Chaplains can serve as spiritual liaisons in addressing the stresses of the job.

5.8.3. Chaplains may comfort the bereaved and offer positive direction to the victims’ families
and, thereby, greatly enhance the firefighter’s emotional response to a particular incident.

5.8.4. Chaplains also frequently provide visitation to injured personnel during in-hospital stays.

5.9. Summary. Health is no longer confined to the absence of illness or disease. True well
being encompasses the broader spectrum of physical, emotional, mental, and spiritual health.
Robust wellness programs must seek to integrate, at the level of the individual, all forms of


                                                 35
prevention that will ensure firefighter personnel are able to perform the strenuous duties
demanded of the profession and continue that ability throughout their careers and on into
retirement. A firefighter who is physically and emotionally fit is the foundation of the fire
service and its ability to deliver the services military installations must have to safely carry out its
missions. Full support of health promotion programs and wellness efforts by all levels of
leadership within every fire station is essential to the success of the wellness program outlined in
this chapter.




                                                  36
           FIREFIGHTER PHYSICAL FITNESS MAINTENANCE PROGRAM

SECTION A: SERVICE PARTICULARS
Surname Init SN or PRI Unit UIC Tel
Rank DOB Age Gender

SECTION B: PRE-SCREENING HEALTH APPRAISAL QUESTIONNAIRE:
This questionnaire is a screening device to identify personnel for whom fitness evaluation and
physical activity might be inappropriate at this time

To the best of your knowledge:
1. Do you have a medical condition that restricts you from participating in a fitness evaluation or
a progressive training program? Yes ___ No ___

2. Do you have arthritis or any other recurring problems with your shoulders, elbows, wrists,
pelvis, back, hips, knees, ankles or feet which may prevent you from participating in a fitness
evaluation or a progressive training program? Yes ___ No ___

3. Do you experience pain, tightness, squeezing or a heaviness in your chest when you exercise?

4. Do you ever get dizzy or faint when you exercise? Yes ___ No ___

5. Have you ever had a heart attack, a stroke or other heart-related problem? Yes ___ No ___

6. Do you suffer from such things as asthma, bronchitis, emphysema, diabetes, hypoglycemia,
epilepsy, high blood pressure, or cancer? Yes ___ No ___

7. Are you pregnant or do you believe you might be? Yes ___ No ___

8. Are you taking medication (prescribed or otherwise) that could affect your ability to undertake
a fitness evaluation? If Yes, please provide the name of the medication. Yes ___ No ___

9. Is there any other reason you would like to talk to a physician prior to your fitness evaluation
or training program? Yes ___ No ___

I HAVE READ, UNDERSTOOD AND COMPLETED THIS QUESTIONNAIRE. ANY
QUESTIONS I HAD WERE ANSWERED TO MY SATISFACTION.

Date: _____________ Signature of Firefighter: _____________________________________

VITAL SIGNS: RESTING BLOOD PRESSURE

Systolic ______________ Diastolic ______________ Resting pulse (bpm) _______________




                                                 37
SECTION C: CIRCUIT PERFORMANCE
CIRCUIT COMPLETED: Yes ___ No ___ MET STANDARD: Yes ___ No ___
CIRCUIT PERFORMANCE TIME: ____ minutes ____ seconds

SECTION D: EXERCISE PRESCRIPTION

AEROBIC FITNESS PROGRAM
Frequency:
Intensity:
Time:
Type of Activities:

MUSCULAR STRENGTH AND ENDURANCE PROGRAM
Frequency:
Intensity:
Time:
Type of Activities:

SECTION E: CERTIFICATION OF EVALUATION AND PROGRAMMING
CFPSA Fitness Instructor Signature:

SECTION F: CERTIFICATION OF UNDERSTANDING
I acknowledge the above fitness prescription and the requirement to maintain an up to date
training record for aerobics and muscular strength and endurance.

Signature of Firefighter: _____________________________________Date: _______________

SECTION G: PROGRAM APPROVAL
The above fitness assessment and prescription have been reviewed and approved

Signature of Fire Chief: _____________________________________Date: _______________




                                               38
                                          ANNEX C

                                 LIST OF MEDICATIONS

Firefighters reporting for evaluation and exercise prescription could be on a wide variety of
medications. To complicate matters, many medications are known by several different “Brand”
names. The “brand” names are in bold and listed in alphabetical order for ease of reference. The
“non proprietary” names are shown in brackets ( ) behind each brand name. Anyone taking any of
these medications should be referred to his/her medical staff prior to any fitness assessment or
exercise prescription.

Apo-Acebutolol(Acebutolol hydrochloride)            Novo-Metoprol (Metoprolol tartrate)
Apo-Atenolol (Atenolol)                             Novo-Nadolol (Nadolol)
Apo-Metoprolol (Metoprolol tartrate)                Novo-Pindol (Pindolol)
Apo-Metoprolol (Type L)(Metoprolol tartrate)        Novo-Pranol (Popranolol hydrochloride)
Apo-Nadol (Nadolol)                                 Novo-Timol (Timolol maleate)
Apo-Pindol (Pindolol)                               Nu-Atenolol (Atenolol)
Apo-Propranolol(Popranolol hydrochloride)           Nu-Metop (Metoprolol tartrate)
Apo-Timol (Timolol maleate)                         Nu-Pindol (Pindolol)
Apo-Tomop (Timolol maleate)                         Nu-Propranolol(Popranolol hydrochloride)
Betaloc (Metoprolol tartrate)                       Nu-Timolol (Timolol maleate)
Betaloc Durules (Metoprolol tartrate)               PMS-Metoprolol-B(Metoprolol tartrate)
Betapace (Sotalol hydrochloride)                    Rhotral (Acebutolol hydrochloride)
Beta-Tim (Timolol maleate)                          Sectral (Acebutolol hydrochloride)
Blocadren (Timolol maleate)                         Slow-Trasicor(Oxprenolol hydrochloride)
Corgard (Nadolol)                                   Sotacor (Sotalol hydrochloride)
Corzide (Nadolol–Bendroflumethiazide)               Syn-Nadolol (Nadolol)
Dentosol (Popranolol hydrochloride)                 Syn-Pindolol (Pindolol)
Gen-Atenolol (Atenolol)                             Taro-Atenolol (Atenolol)
Gen-Pindolol (Pindolol)                             Tenoretic (Atenolol/chlorthalidone)
Gen-Tomolol (Timolol maleate)                       Tenormin (Atenolol)
Indéral (Popranolol hydrochloride)                  Tim-Ak (Timolol maleate)
Indéral-LA (Popranolol hydrochloride)               Timolide (Timolol maleate/
Indéride (Popranolol                                hydrochlorothiazide)
hydrochloride/hydrochlorothiazide)                  Trasicor (Oxprenolol hydrochloride)
Lopresor (Metoprolol tartrate)                      Viskazide
Monitan (Acebutolol hydrochloride)                  (Pindolol/hydrochlorothiazide)
Novo-Atenolol (Atenolol)                            Visken (Pindolol)




                                               39
                                           ANNEX D

                 PRELIMINARY INSTRUCTIONS FOR FIREFIGHTERS

Name of Firefighter: ___________________________________

Date of Evaluation: __________________

Time of Evaluation: __________________

Please adhere to the following conditions for the evaluation:

Dress Requirements: Coveralls or gym gear, firefighter bunker pants and jacket, helmet,
gloves, boots, and SCBA with full tank of breathing air.

Food and Beverages: Do not eat for at least two hours prior to your evaluation. Also refrain
from drinking caffeine beverages for two hours and alcoholic drinks for six hours prior to the
evaluation.

Smoking: Do not smoke during the two hours prior to the appraisal.

Physical Activity: Strenuous physical activity should be avoided the same day as the evaluation.
Note: Failing to adhere to the above conditions may affect your results negatively.




                                                40

				
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