Background and Methods From a statewide medical examination program, we identi-®ed ®re®ghters who were deemed un®t for duty by attending physicians (ATTENDING FAIL, n 9) and those who would have been disquali®ed by the application of selected numerical criteria from the 1997 National Fire Protection Association (NFPA) guidelines (NFPA FAIL, n 27) and criteria from a Medical Workshop (WORK FAIL, n 16). The subjects who were un®t for duty or failed numerical criteria were compared with those who were ®t for duty and passed all objective criteria (FIT group, n 302). All subjects were given an overall morbidity rating by a board certi®ed internist. Comparisons on two surrogate measures of ®tness, VO 2 max predicted and predicted coronary heart disease (CHD) risk, were also performed.
Results
We found a signi®cant tendency towards worse results (e.g. higher blood pressure or lower spirometric function) among the three FAIL groups compared with the FIT group. The FAIL groups shared only a small overlap, however, with the ®re®ghters with the highest morbidity ratings, lowest predicted VO 2 max, and highest CHD risks. Increasing morbidity was associated with higher age, lower spirometric function, lower predicted VO 2 max, increasing cholesterol, greater BMI, and higher predicted 10 year CHD risk. Conclusion Although the presence of a single serious or poorly controlled condition may render an individual un®t for safe performance as a ®re®ghter, examination of our cohort suggests that multiple risk factor models or overall clinical assessments are superior means of identifying ®re®ghters with poor health status and increased CHD risk.