Appendix J—Medical Considerations

Reproductive Risks

Wildland firefighters and field workers face many hazards in the conduct of their duties. Among these hazards are potential reproductive risks, such as exposure to toxic chemicals, heat, and other factors that can threaten someone's ability to conceive or bear a healthy child. These potential risks affect both men and women.

Smoke

While exposure to cigarette smoke has been linked to low birth weight, spontaneous abortion, still birth, preterm birth, and cleft palate, there is little information concerning the risks of exposure to toxic chemicals at levels measured in the breathing zone of wildland firefighters. Carbon monoxide has the potential to affect the developing fetus, but cigarette smokers are regularly exposed to levels of carbon monoxide several times higher than those occasionally experienced by firefighters. Prolonged exposure to fine particulate (PM2.5, smaller than 2.5 microns) can deaden ciliary action in airways and suppress immune function, opening the door to respiratory infections, bronchitis, pneumonia, and even heart disease.

Heat

Exposure to extreme heat has been linked to male infertility and possibly to birth defects in the offspring of exposed mothers. Although maternal illness with prolonged high fever has been associated with birth defects, sauna studies and case studies of pregnant runners have not revealed birth problems. In fact, the opposite has been true for women who remain active during pregnancy. And while wildland firefighting has the potential for heat stress, studies have not indicated severe heat problems, especially when firefighters are fit, acclimatized, and hydrated. Low humidity and wind enhance evaporative and convective cooling, lowering the risk of heat stress.

Pregnant women who are physically capable of performing the duties of their position may continue working at their discretion (U.S. Supreme Court: Automobile Workers v. Johnson Controls, Inc., 499 U.S. 187, 1991). While it is not the obligation of the employer to protect the fetus, the employer may be able to assign the worker to less hazardous duties when requested to do so. Workers who are pregnant, breast feeding, or attempting to conceive should consult their physician if they are concerned about the reproductive risks of firefighting or other duties. Pregnant firefighters who, on the advice of a physician, cannot continue working in any capacity, should request leave based on the existing pregnancy or on other leave policies of the agency they work for.

Stress Test

The American College of Sports Medicine recommends a medical examination for persons older than 40, for those with heart disease risk factors, and for those who have been sedentary before a major increase in activity. For many others, a simple health screening questionnaire provides assurance of the readiness to engage in training, work, or a job-related work capacity test. Use of the questionnaire substantially reduces the risk of taking work capacity tests or training for apparently healthy adults. Candidates for fitness training, firefighting, or field work should have a medical examination or complete the health screening questionnaire before taking a work capacity test or beginning strenuous training.

If you are 45 or older, have one or more heart disease risk factors (smoking, high blood pressure, elevated cholesterol), and have been inactive, your physician may recommend an electrocardiograph (ECG)-monitored exercise test. A progressive treadmill test (stress test) determines cardiovascular health.

Warning Signs

Here are some points to consider if symptoms or warning signs appear during work capacity testing, training, or work.

Group 1

These warning signs may be remedied without medical consultation. Report them if they occur frequently.

Side stitches are muscle spasms (intercostal muscles between the ribs or the diaphragm) that may be relieved by sitting, leaning forward, and pushing the abdominal organs against the diaphragm. Side stitches usually disappear as training progresses and fitness improves.

Breathlessness that lasts more than a few minutes after exercise stops may be relieved by training at a lower intensity or using the talk test (you should be able to carry on a conversation during aerobic exercise).

Nausea or vomiting during or after exercise may be relieved by waiting several hours after eating before exercising. Exercise moderately and extend the cool-down period.

Prolonged fatigue the day after exercise or insomnia can be relieved by reducing the intensity of training, then increasing training gradually.

Group 2

Try the suggested remedies for these warning signs. If they don't help, consult your physician.

Arthritic flareups during or soon after exercise can be relieved by rest, cooling the affected area with an ice pack, and taking aspirin or ibuprofen. Resume exercise gradually. Use cross training to reduce repetitive trauma.

Rapid heart rate during or shortly after vigorous exercise can be relieved by training at a lower intensity and increasing exercise intensity slowly. Avoid exercising in the heat.

Wheezing and phlegm during or soon after exercise may be relieved by warming up gradually, reducing exercise intensity, avoiding cold, dry air, or by using a mask to warm cold air.

Group 3

If any of these occur, STOP EXERCISE. Consult your physician before resuming exercise.

Pain or pressure in the middle of the chest or in the arm or throat, precipitated by exercise or occurring soon after exercise.

Abnormal heart action during or soon after exercise. Abnormalities include irregular or fluttering pulse, palpitations in the chest, a sudden burst of rapid heart beats, or a sudden drop in heart rate.

Dizziness, light-headedness, sudden loss of coordination, confusion, cold sweat, glassy stares, pallor, blueness, or fainting. Stop exercising. Sit with your head between your legs or lie down with your feet elevated.

Things To Avoid

Sudden vigorous exercise without warming up can cause cardiac abnormalities. Warming up and cooling down reduce the likelihood of cardiac complications.

Downhill running has been called a "crime against the body" by experienced crew leaders. Running down steep grades increases the impact and the risk of chronic knee problems.

While uphill hiking or running is good for training, minimize the amount of downhill running. Hike or jog slowly on the downhills or use hiking poles to reduce impact.

Straight leg situps don't help stomach muscles and they can aggravate back problems. Do bent-knee crunches or curlups with the arms folded across the chest.

Full squats with weights can aggravate knee problems. Use leg press machines or squat with a spotter. Don't go beyond a 90-degree knee bend.

Neck circles and the backover (lying on your back, raising your legs over your head to touch the floor) may be stressful for those at risk of neck injuries. Standing toe touches can aggravate the lower back when the legs are straight. Use a seated toe touch with the knees slightly bent.

Exercise Problems

Minor exercise problems should be viewed as symptoms. Here are some common problems and some possible solutions.

Blisters can be prevented with properly fitted shoes, good socks (two pairs or a double-layer pair), and lubrication (Bag Balm). Blisters can be treated with moleskin or duct tape.

Muscle soreness can be minimized by warming up and stretching, gradually progressing with exercise intensity, and avoiding fast or eccentric movements (where a lengthening muscle is contracted). Delayed onset muscle soreness occurs a day or more after vigorous effort (especially after downhill running). Stretching and anti-inflammatory agents such as ibuprofen relieve the discomfort or soreness.

Muscle cramps are powerful involuntary contractions that may be caused by dehydration, electrolyte (sodium, potassium, calcium) imbalance, or both. Avoid cramps by warming up and by replacing fluids and electrolytes. Relieve cramps by stretching and massaging the cramped muscle.

Bone bruises on the feet can be avoided by careful foot placement, running on soft surfaces, and good footwear. Treatment includes ice, padding, and cross training to allow recovery.

Shin splints (pain on the front of the shins) have many possible causes. Preventing shin splints includes gradually changing training intensity or distance, running on softer surfaces, wearing good footwear, stretching, and performing strengthening exercises. Other effective treatments may include rest, ice, massage, taping your shins, and putting heel pads in your shoes to cushion impact. A persistent point of pain could indicate a stress fracture. Persistent diffuse pain could signal increased pressure on the muscle on the front of the shin. See an athletic trainer or sports medicine specialist.

Knee pain could be due to a number of factors. Use rest, ice, and anti-inflammatory agents (such as ibuprofen) to reduce discomfort. Resume activity with new footwear. If problems persist, see a podiatrist. If the problem is an old injury with associated arthritis, try rest, ice, and anti-inflammatory agents to reduce the pain. Resume activity with exercises to strengthen the thigh muscles (weightlifting, bicycling). If the problem persists, see a sports medicine specialist.

Lower back pain can be due to poor posture, inactivity, lack of flexibility, or weak abdominal and back muscles. Preventing lower back pain requires paying attention to each possible cause and to proper lifting technique. Treatment involves rest, but only until pain subsides, followed by a gradual return to activity.