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19/04/23Dr Tok Hussain
Medical Fitness for Work in UK Fire Services
Dr Tok HussainConsultant Occupational Physician –
Healthwork LtdALAMA Fire Services Representative
19/04/23Dr Tok Hussain
Standards – pre 2004
Godber report 1968 Joint working party appointments
provisions 1988 Blanket bans ALAMA
Influences
DDA 1995 (as amended 2005) Oct 2004
Fire Service Act 1947 replaced by Fire and Rescue Services Act 2004 (Oct 2004)
2004 DCLG ‘Medical and Occupational Evidence for Recruitment and Retention in the Fire and Rescue Service’
Evolving consensus based standards – ALAMA Equal ops and employment rights
19/04/23Dr Tok Hussain
19/04/23Dr Tok Hussain
Problems with standards
Discriminatory if too prescriptive Non-individualised Blanket bans discriminatory Diversity issues Can lead to over-rejection and
excessive IHR
Why have standards?
Uniformity of medical advice Easier to select and manage individuals Operational efficiency Risk reduction?
19/04/23Dr Tok Hussain
19/04/23Dr Tok Hussain
Current Practice
Individualised approach Evidence based Risk based Multi-disciplinary involvement including
management Functional tests More flexible approach – not old rigid
approach
19/04/23Dr Tok Hussain
Doc is he fit?
Chronic conditions Chronic back pain
Fit but sickness absence of 4 episodes per year of 2 weeks per time
Is work likely to make him worse? Asthma BA use
Acceptability of risk Epilepsy seizure risk
19/04/23Dr Tok Hussain
Diabetes Type 1 and type 2 Hypoglycaemia Diabetes UK
Survey and guidelines ALAMA, CFOA, DRC, DUK, FBU Guidelines launch Oct 2008
Driving Coping strategies Importance of general fitness
19/04/23Dr Tok Hussain
Asthma
BA use Exposure to smoke and fumes Restricted BA use Individual assesment based on asthma
control Ongoing work – Paul Cullinan (Brompton) Concerns in current asthmatics or
severe/moderate childhood asthma Exercise testing for asthma
19/04/23Dr Tok Hussain
Vision
2002 Review (ODPM fire division, CFOA) Corrected VA 6/9 binocularly minimum 6/12
worst eye Uncorrected standard 6/18 and 6/24 Aids to vision
Contact lenses Colour vision Laser eye surgery
19/04/23Dr Tok Hussain
Hearing
Audiometry and questionnaire 3 yearly Functional testing
validation
Epilepsy
Risk assessment DVLA 2% per annum risk of seizure
acceptable in group 2 drivers
19/04/23Dr Tok Hussain
19/04/23Dr Tok Hussain
Mental Illness
PTSD Strict diagnostic criteria CBT or EMDR Usually recover
CISD Nice guidelines
19/04/23Dr Tok Hussain
Joint Replacements
Knee problematic
Hip Birmingham
Spinal disc
Wear of joint is a concern
19/04/23Dr Tok Hussain
Medical management of ill health
Early OH assessment Early interventions
Physio, counselling, etc Funded investigations Funded treatment
Case conference approach
Rehabilitation
Early rehabilitation Other duties Reduced hours, reduce duties Graded return to work Alteration of duties temporary Reasonable adjustments
Permanent alteration of duties IHR
19/04/23Dr Tok Hussain
ANY QUESTIONS ?
19/04/23Dr Tok Hussain
