Nominated medical practitioners resources

FRNSW Health Standard

The FRNSW Health Standard has been developed by the appropriate medical specialists, taking into consideration the unique physiological and physical demands required of FRNSW firefighters. As a resource, the Health Standard is designed to clearly outline the inherent requirements for firefighters in FRNSW, the associated health attributes and the subsequent health standards required to be met to ensure as far as practicable the firefighters’ safety and that of those who rely on them. It also seeks to ensure consistency and transparency in the assessment of health conditions in the context of high-risk firefighting work.

Click here to download the FRNSW Health Standard for firefighters (PDF)

Summary of operational tasks for firefighters:

The unique physical and psychological demands of firefighting, along with the critical safety aspects of the role, necessitate that health practitioners are thoroughly informed before assessing or treating firefighters.

The below video aims to familiarise health practitioners with the essential functions of firefighting, with a particular focus on the following key areas:

Musculoskeletal Demands
Cardiovascular Demands
Psychological Demands
Medication Considerations
Respiratory Demands

The above key areas have been set up as chapters in the video and the time bar can be used to skip to areas of interest.

FRNSW Health Standard provides an in-depth outline of the following operational tasks:

Driving the fire appliances are medium rigid class (or above) vehicles. They are driven in emergency mode at high speed while exercising exemptions to normal road rules provided to drivers of emergency vehicles.
Structural firefighting work includes rapidly entering buildings and climbing stairs, rescuing victims, hauling hoses, extinguishing fires, and salvage, ventilation and overhaul activities. Rescued victims may be unconscious, burnt, deceased or distressed. Work is conducted in hot and densely smoky conditions.
Wildfire firefighting differs from structural firefighting in that the fire front is rapidly moving through bush or grasslands. The ambient environment is extremely hot. The work requires extensive walking and carrying of hoses and other equipment across difficult terrain, and vigorous use of hand tools.
Hazmat work involves the containment and clean-up of dangerous goods and other hazardous materials. The work may require the firefighter to wear a fully encapsulated hazmat suit, which is resistant to external fluids and gases, but limits the ability for sweat to evaporate.
Rescue work involves rescuing victims who are trapped in cars or on cliff faces, involved in industrial accidents, and so on. The work varies greatly with the situation. It involves applying first aid to the victim and using a wide range of equipment for freeing and transporting the victim – often in awkward situations and on difficult terrain. The work is conducted in variable environmental conditions. Victims may be unconscious, injured, deceased or distressed.

What is my role as the NMP conducting a firefighter Health Screen:

The following documents must be provided by the firefighter to enable completion of the Health Screening Assessment. Please ensure all documents are available prior to, or at the time of, the consultation:

FRNSW-issued pathology and 12-lead ECG referral forms
Ordinary Duties Form specific to the firefighter being assessed (completed by FRNSW)
Health Screening Briefing for Nominated Medical Providers (NMPs) (PDF)
Essential Functions of a Firefighter document (PDF)
Health Screening Assessment Report
Fitness for Duty Advice Form

Step 1:

During the initial consultation (appointment 1) complete the referral provided by FRNSW to the firefighter for firefighter’s pathology and 12-lead ECG (with report). The referral forms are included in the Health Screening pack provided to the firefighter. Please use these forms and advise the firefighter on how to arrange their tests. If your practice can conduct the ECG and/or pathology blood sample collection, please arrange this during the initial consultation.

Step 2:

Once the pathology test and ECG are complete, the firefighter should schedule a follow up appointment with you (appointment 2) (approximately 10 days after testing) to review the results and conduct a physical examination. This appointment is used to complete the Health Screening Assessment Report. When completing the Health Screening Assessment Report, please ensure that:

all sections are completed;
you have documented all details relating to the assessment; and
you and the firefighter have signed and dated the last page.

Arranging necessary referrals:

Note that FRNSW only supports certain referrals as part of the Health Screening Assessment. Please ensure all referrals comply with the FRNSW Health Standard and if unsure whether a referral is supported, clarify with FRNSW before proceeding.
FRNSW does not support invasive investigations such as formal Coronary Angiography, Electrophysiological Studies or Biopsies, for the purpose of occupational risk assessments. If such investigations are clinically indicated please arrange them through usual patient care pathways.
FRNSW will not be liable for any payment relating to referrals made by your practice that constitutes usual patient care.
If subsequent referrals are required as part of usual medical care these should be made through usual care pathways. Such referrals or consultations for treatment or ongoing management may be eligible for Medicare rebates, but associated costs will not be covered by FRNSW.
When arranging a specialist referral please clearly indicate the type of referral being made (i.e. supported under the FRNSW Health Standard or usual patient care)

Step 3:

Complete the Fitness for Duty Advice Form. The form allows you to categories the firefighter as category one, two or three, with the definitions clearly stated on the form. It is important you clearly communicate your determination directly to the firefighter.

If the firefighter is certified unfit for their ordinary duties, it is the firefighter’s responsibility to notify their supervisor as soon as practicable to ensure they are not continue with their duties until they are deemed fit for duty, or until appropriate modifications to their duties are made. Please remind the firefighter of this obligation.

Category One

Firefighter is fit without requirements or restrictions to perform the full range of their duties.

Category Two

If a firefighter requires more frequent review and it is covered under the Health Standard, a Category Two determination may be provided. FRNSW refers to this process as Fit, Subject to Review (FSTR).

Alternatively, if a firefighter already has requirements or restrictions noted on the Ordinary Duties Form, and you agree that these restrictions should remain, please ensure you document these in writing on the Fitness for Duty Advice Form.

With the consent of the firefighter, relevant health information already held by FRNSW will be made available you to assist you in completing the firefighter’s assessment.

Category Three

If you recommend restrictions to ensure the firefighter is safe when undertaking their ordinary duties, and these restrictions are not already detailed on the Ordinary Duties Form provided, then a ‘temporarily unfit’, category three, determination must be issued on the Fitness for Duty Advice form.

**Note:

If you are unable or would prefer not to provide a fitness for duty determination, please discuss this with the firefighter. If a determination cannot be issued for the firefighter, the Program allows for the baseline health screening assessment to be initially conducted by you, and then with the firefighters consent, forwarded to a FRNSW Occupational Physician for review and oversight. Once consent is obtained their Health Screening Records (including pathology, ECG, Health Screening Assessment Report and any subsequent results or reports) can be sent to the FRNSW Occupational Physician for review. The Occupational Physician will then complete the Fitness for Duty Advice form. Documentation can be sent to FRNSW via healthscreening@fire.nsw.gov.au.

Step 4:

Retain a copy of the pathology, ECG and Health Screening Assessment Report for the firefighter’s medical record at your practice. Please ensure the firefighter also receives a copy of all paperwork, including the Fitness for Duty Form. If you have provided a fitness for duty determination, the firefighter will be responsible for submitting their Fitness for Duty Form to FRNSW.

Step 5:

Please invoice FRNSW for the cost of the Health Screening consultations. Please note that these consultations cannot be billed to Medicare as it is an occupational assessment. There is no Medicare Item number for these consultations, including the ECG. They are all billed directly to FRNSW (not to the firefighter.)

Questions and Feedback

If you have any enquiries relating to the Health Screening process, please speak to the Health Check Coordinator on (02) 9265 2800 or email healthcheckcoordinator@fire.nsw.gov.au

Identification of Medical Restrictions

Please note, if you recommend restrictions on the tasks the firefighter can undertake in their role to ensure their safety, and these restrictions are not already detailed on the Ordinary Duties Form provided, a category three (3) determination must be issued.

If restrictions are noted on the Ordinary Duties Form, and these restrictions should remain, please ensure you provide a category two (2) determination and confirm in writing the restrictions required for the firefighter’s safety.

With the consent of the firefighter, relevant health information already held by FRNSW (e.g., existing Fit Subject to Review information) will be provided to you to assist with the firefighter’s Health Screen.

Such requests should be sent via email to healthcheckcoordinator@fire.nsw.gov.au by either the firefighter or yourself as the Nominated Medical Practitioner.

FRNSW Background

Fire and Rescue NSW (FRNSW) is one of the world’s largest urban fire and rescue services and is the busiest in Australia. Our overriding purpose is to enhance community safety, quality of life, and confidence by minimising the impact of hazards and emergency incidents on the people, property, environment and on the economy of NSW. Our capabilities extend far beyond fighting fires. FRNSW firefighters are among the most highly trained in the world. Our teams provide fire prevention, they respond to hazardous materials incidents, natural disasters and medical emergencies. Our teams also undertake counter terrorism and urban search and rescue operations. We are prepared for anything – helping anyone, anywhere, anytime.

Fire and Rescue NSW (FRNSW) delivers essential emergency services to the community throughout NSW.

FRNSW is responsible for protecting 90% of the state’s population from fire,
100% of the state from hazardous materials emergencies,
While performing more than 75% of all rescues in NSW.

FRNSW also assist other agencies including the Rural Fire Service at bushfires outside FRNSW districts; the State Emergency Service with floods and storm damage, and the Ambulance Service of NSW with emergency medical responses.

FRNSW currently has an operational workforce of approximately 6, 800 firefighters. The FRNSW organisation comprises of:

Permanent Firefighters,
Retained Firefighters,
Operational Support Firefighters,
Administrative and trades personnel and;
Volunteers in Community Fire Units.

Permanent Firefighters:

All firefighters hold a rank which gives them lawful authority to command others who hold a lower rank. The table below outlines the various PFF ranks within FRNSW from the highest tier to recruit level. The majority of responses by PFFs are from FRNSW Stations, however senior officers are on call for IMT duties.

Rank - Abbreviation

Commissioner - Com
Deputy Commissioner - DCom
Assistant Commissioner - ACom
Chief Superintendent - CSupt
Superintendent - Supt
Inspector - Insp
Leading Station Officer - LSO
Station Officer - SO
Leading Firefighter - LF
Senior Firefighter - SF
Qualified Firefighter - QF
Firefighter - FF
Recruit - RecF

On-call (Retained) Firefighters:

On-call Firefighters provide a high standard of response to fire and emergency situations. On-call Firefighters are essentially on-call to respond to fires and a variety of emergency incidents in their local community. They may respond from home, other workplaces or from other locations within the local community.