Specifications include, but are not limited to: GROUP 1 - NEW RECRUITS’ PRE-PLACEMENT PHYSICAL EXAMINATION AND CONTROLLED SUBSTANCE TESTING The examinations performed by the selected firm will be based on criteria established by Dallas Fire-Rescue to determine the minimum physical standards for firefighter’s specific jobs and the activities as required by the NFPA standards. Additionally, physical examinations must include assessment of all Category A medical conditions of NFPA 1582. The controlled substance testing, including classes of drugs to be tested and the cutoff levels to be used in screening and confirming positive drugs, must be done in accordance with the current rules and regulations established under United States Department of Transportation as set forth in 49 CFR (Code of Federal Regulations) Parts 40 and 382. New recruit’s pre-placement physical examinations and the controlled substance testing is administered under the supervision of the Financial and Personnel Support Bureau, Fire-Rescue Human Resource Manager III. MEDICAL EVALUATION The medical evaluation shall include: a medical history complete physical examination: Vision Test Audiogram Mental Health questionnaire and discussion of results with a medical provider Spirometry Chest X-ray Blood Work Urinalysis 5 Panel Drug Test PSA for African American Stress Electrocardiogram Any laboratory test required to detect physical or medical condition(s) that could adversely affect his/her ability to safely perform the essential job tasks, as outlined in NFPA 1582. GROUP 2 – WELLNESS – FITNESS EXAM The Wellness – Fitness Program is administered under the supervision of the Safety Division Deputy Chief. Dallas Fire-Rescue seeks a medical group to perform medical exams on approximately 1800 certified firefighters. The department will work with the successful vendor to schedule 6-8 exams a day. While these exams will be mandatory, two important aspects of the program are that the confidentiality of the doctor-patient relationship be maintained as much as possible, and that the program be non-punitive. To accomplish these objectives, the only information the Department needs following the wellness exam and fitness evaluation is a form indicating that the member is or is not medically certified to perform the essential job tasks of a firefighter. The Department will provide a form to the physician requiring a classification for each firefighter as 1) Fit for Duty, 2) Conditional Duty (requires a specific time period/deadline for action and follow-up), or 3). Limited Duty. The results of the exam and assessment should be discussed with the member, and the firefighter should be given an individualized health improvement plan that addresses his/her specific needs. In the instances where a condition is detected that would preclude an individual from safely working as a firefighter, the Department needs only enough information from the physician to know whether the member is Conditional or Limited Duty and to be able to determine what needs to be done to return the individual to full duty, which is the goal of the program. If the problem is a medical condition that requires treatment, the member should be referred to his/her personal physician for follow-up and the department should be notified that the member has been advised to seek follow-up treatment. If the individual cannot be certified for full firefighting duty due to extremely poor physical condition, the Department should be provided with a specific deadline for members to return to re-test. The Department has a physical fitness coach who can assist the firefighter in preparing to meet the exam requirements, which will allow a return to full duty. While individual medical records should be kept confidential, the Department would like to receive aggregate data that will assist in monitoring the effectiveness of the program. Ideally, data will be presented using a virtual dashboard with reports that are customizable based on Department needs. Prospective vendors shall include samples of the types of reports they could provide to assist the department. OCCUPATIONAL PHYSICIAN The successful firm to provide this service shall designate a fire department occupational physician who is a licensed Doctor of Medicine or osteopathy who has completed residency training in occupational medicine and is American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA) board certified. This physician shall: Provide medical supervision for the fire department medical exam, fitness assessment, and physical conditioning programs as required by NFPA 1582. Assist the department in establishing protocols for medical evaluation and management of members in emergency incident rehab as required by NFPA 1500 and NFPA 1561. The physician designated to oversee this program should have specific expertise and experience relating to the needs of fire department members and a thorough knowledge of the physical demands involved in fire department emergency operations. The fire department physician shall be a specialist in the field of occupational medicine. To reduce the number of false positives on the stress EKG, the results shall be interpreted by a board-certified cardiologist, who would also assist in consultation regarding the need for more definitive diagnostic tests. Dallas Fire-Rescue desires to have a primary relationship with at least one officially designated physician. This physician can serve as the primary medical contact and, in turn, deal with a number of other physicians and health care specialists. In any case, the option to consult with a physician who is particularly aware of the medical needs of firefighters, and who is available on an immediate basis, is highly desirable. MEDICAL EVALUATION The medical evaluation shall include: a medical history complete physical examination blood tests -- SMAC 26/CBC/Lipid Panels/ if 40 and older or medical HX deems necessary A1C-if members have DM or glucose >100. A1C/ if members have DM or glucose >100. CRP-Hs /TSH urinalysis vision test audiogram spirometry complete visual check of skin for skin cancer a comparative review of previous exam results. Behavioral health screenings for: substance abuse suicide risk PTSD insomnia anxiety and depression Ultrasound imaging of: heart and valves liver pancreas gall bladder spleen kidney bladder Cardiac Calcium Scoring Test HIV base line test – voluntary Chest x-ray - The Department has established a baseline chest x-ray on all members; the chest x-ray will only be done on an as-needed basis, based upon risk factors, symptoms, or physical findings. stress electrocardiogram (EKG) – maximal stress exercise test with 12-leads (using Bruce Protocol Stress test specifications with METS calculations, or a test which provides an estimate to the VO2Max score) Annually: 40 and older; CAD/CVD/PAD,HTN; Type 1 or 2 DM; Left Ventricular Hypertrophy (seen on EKG, CXR or Echo); Tobacco Use (20+ pack-year history or current tobacco use); or Prior abnormal stress test Biannually (Every other year): Age 30-39; family HX of premature CAD/CVD Every 3 years: Age 29 and younger; and none of the above clinical criteria present Stress EKG results will include a measurements of METS or an estimate to the VO2Max score, and the firefighter must meet the Department’s designated minimum performance standard, in order to be classified as Fit for Duty. Aggregate data on performance (in METS by age and gender) will be reported to the Department. Stress Echo Cardiogram (follow up) - Due to the chance of false positives from a stress EKG, the department would like a separate quote on the cost of an echocardiogram stress test as a follow-up for those individuals who have a positive stress EKG. Cancer screening PSA for males over age 40, or males over age 40 with positive family history, African-American, or if otherwise clinically indicated Mammograms for females over age 40; CA 125 for females to test for ovarian cancer 40 & over; CA 19-9 to test for pancreatic cancer for member 40 & over FIT or fecal test for colon cancer for members over 40 & and All test results including lab work, vision, hearing, spirometry, physical, behavioral health screen, and stress test must be presented to the member. Blood must be drawn in sufficient time prior to the medical exam in order for the results to be available for the physician to review. The successful vendor must have the ability to draw the blood at designated fire stations between 0630 and 0800, so that firefighters who have fasted can eat their regular meals during the shift. As per NFPA 1582, the components of the medical evaluations shall conform to all applicable U.S. OSHA standards, including 29 CFR 1910.120, “Hazardous waste operations and emergency response”; 29 CFR 1910.134, “Respiratory protection”; 29 CFR 1910.95, “Occupational noise exposure”; and 29 CFR 1910.1030, “Bloodborne pathogens.” The medical evaluations will be performed on approximately 700 uniformed firefighters each year. Dallas Fire-Rescue Wellness Fitness Coordinator will schedule personnel for their annual medical/fitness exams. It will be necessary to work closely with the Fire-Rescue representative to schedule these exams. The location for performing the exams ideally would be centrally located within the City (if they are not being conducted at fire station sites). Off-street parking for at least two fire apparatus (engine or ladder truck) should be provided. FITNESS EVALUATION For the scope of this contract, the fitness evaluation will only consist of the METS measurement during the stress EKG or a VO2Max estimate.
