An obese emergency responder

[PhilDoc]

I did an annual fitness for duty exam on a 60 yo male today. I was interested in your thoughts. He works as a field operations person at one of the strategic petroleum reserves. He has a past medical history of hypertension well-controlled with a single medication. He has OSA and uses CPAP nightly and denies EDS. His physical was overall normal except for a BMI of 39.5. His EKG was Within normal limits. His PFT showed a moderate restrictive defect at 70% of predicted with an FVC of 76% of predicted and a FEV1/FVC of 109%. CXR showed mild elevation of his left hemisphere-diaphragm most likely secondary to scarring from a previous pneumonia and empyema that required chest tube placement.

In talking with him, he states that he may have "some trouble keeping up with the younger fellows" during training.

I review some literature about BMI and firefighters and it definitely seems to increase the risk for accidents. I decided to clear him for his job, but not for the emergency response team. I just wouldn't want to have to rely on him to save my mother. Any thoughtS?

[Robert Swotinsky MD]

Congratulations on your mother's good health and determination that enables her to work at the strategic petroleum reserve despite her age!

Obesity is a potential source of reduced capacity. As physicians, we have limited tools for assessing the severity of obesity-related impairment. Consider an exercise treadmill stress test to measure peak exercise capacity. I don't know of standards for emergency response work, but you could compare this guy's capacity to standards for other jobs, e.g.,

- 6 METS for CMV operation per FMCSA
- 12 METS per ACOEM guidelines for law enforcement officers
- 12 METS per NFPA 1582 for fire fighters

[PhilDoc]

I have been reading research on firefighters that show for every point over a BMI of 30, there is a 5% increase for the risk of an accident.