The Public Safety Annual Physical

As I walked up the stairs to our occupational health office, I realized how thankful I was for the opportunity to receive, as a volunteer paramedic, an annual physical from my place of work, the Alexandria (Va.) Fire Department (AFD). 

I signed in on the clipboard, printed my badge number, and settled in for the hours-long process that typically includes the physical exam, a treadmill stress test and EKG, the hearing test we all fear failing, a review of lab work, and that one thing where you have to breathe into a tube until you almost pass out. 

So when I was summoned into a room by a woman wielding an ultrasound probe in one hand and a flimsy paper robe in the other, I was surprised. “Is this a new part of the physical?” I asked her. She responded that her company, LifeScan Wellness, incorporates a full-body ultrasound scan in its public safety physicals.

She said she would be scanning, among others, my thyroid, heart, gallbladder, and reproductive organs for proper functioning as well as looking for tumors, masses, cysts, enlargements, and other critical conditions. 

As I lay down on the examining table, I realized this year’s physical was clearly going to be more comprehensive than most. Curiosity got my brain going, and I began to ask the tech a bunch of questions but soon realized that interrogating her while she was performing a medical exam probably wasn’t the best move for a journalist (or a patient). I decided to wait until I wasn’t mostly naked and covered in blue gel to get to the bottom of this unique version of the public safety annual physical. 

Here’s what I found. 

Origins

In 2019 Tony Washington assumed the role as AFD’s deputy fire chief of health, safety, and risk management. Throughout his 26-year career as a firefighter with the AFD, Washington has also served as deputy chief of training and himself has been through a physical each of those years. 

It was his stroll through the exhibit hall at a fire and EMS conference that would eventually bring the services of LifeScan Wellness to the more than 350 members of the AFD. At a booth Washington spotted a sign mentioning the high incidence of testicular cancer in the fire service, and his interest was piqued. 

“I was diagnosed with and treated for testicular cancer two years ago,” says Washington. “It had never been caught before in my annual medical physical for the fire department. My doctor classified it as Stage 3, which meant I had had it for a while.”

After surgery to remove the testicle and a course of chemotherapy due to cancer being found in his lymph nodes, Washington is now cancer-free.

Washington, of course, had stumbled upon the booth of LifeScan Wellness, whose advertising often focuses on emergency services’ higher-than-normal rates of soft tissue cancers like testicular, thyroid, and breast. The company touts the importance of early detection using tools like ultrasound scans.

This was important to Washington. Research has found that firefighters likely develop testicular cancer at a higher rate than the general population due to inhaling or absorbing carcinogens found in chemicals such as benzene, diesel engine exhaust, soot, and formaldehyde.  Washington’s doctor told him about possible causes like this at his appointment.

“Changing the annual physicals in AFD was a priority for me in my new role,” Washington says. “I went to the fire chief, and he gave me the green light to begin researching LifeScan Wellness as a new company to provide annual physicals for our members.”

Early Detection

Patricia Johnson is the cofounder and CEO of LifeScan Wellness. She and her husband, Mike, began the company in 1998. 

In the mid-1990s, Patricia had been working with a large imaging equipment company when Mike’s father had a near-fatal stroke. Patricia paid close attention to her father-in-law’s medical care and says she watched, frustrated, as doctors used only simple diagnostic tools like a stethoscope, and the prevention technique suggested was an unconstructive recommendation to “exercise more.”

“I thought to myself, There has got to be something better than a stethoscope to find artery blockages ahead of time,” Patricia Johnson says.

Johnson decided she could leverage her knowledge of imaging equipment like ultrasound to improve the detection and ultimately the care and possibly outcomes of patients with precancerous and cardiovascular conditions. Mike and Patricia put their heads together and in their research came across the National Fire Protection Agency’s (NFPA) Wellness-Fitness Initiative (WFI).

The NFPA establishes the standards for public safety physicals through its 1582 and 1583 guidelines. In 1997 the International Association of Fire Fighters (IAFF) and the International Association of Fire Chiefs (IAFC) partnered to create the Joint Labor Management WFI, working directly with the NFPA. The groups described their charge as being to “develop a holistic, positive rehabilitating and educational approach to wellness and fitness programs in the fire service.”

The WFI includes recommendations for fire departments and EMS agencies to use for areas like medical, fitness, injury rehab, behavioral health, and data collection, among others. A popular recommendation that came out of the WFI was the guidelines for the Candidate Physical Ability Test (CPAT) program. Since its release in 1999, more than 900 jurisdictions have used the WFI to guide their fitness and wellness programs. 

LifeScan Wellness’s first customer back then was the Jacksonville (Fla.) Sheriff’s Office. It soon expanded to other public safety departments. After a few years in business, Patricia says they began to see their exams were actually saving lives. They now provide physicals to more than 500 departments across the county.

“We were shocked by the results,” she says. “But early detection and prevention has been our goal from the beginning. In the late ’90s, after all, it was still a badge of honor to have a dirty helmet—the dirtier, the better, right?”

Comprehensive Evaluations

Chief Rhoda Mae Kerr spent 10 years as fire chief of the city of Austin, Tex. The Austin Fire Department was one of the original departments to participate in the WFI. It is still going strong. In Kerr’s time there and still now, Austin has a full-time medical doctor on staff solely devoted to occupational health for its 1,200 firefighters. 

When Kerr changed jobs and was sworn in as chief of Fort Lauderdale Fire Rescue (FLFR) in July 2018, she brought with her the knowledge of the WFI’s reach and its positive effects she experienced in Austin. 

“As a chief, I always have two main priorities,” Kerr says. “The first is to take the very best care of my personnel, and the second is to provide the very best service to the community. If I don’t do the first successfully, I can’t do the second.”

With a history of breast cancer in 2014 for which she was treated solely with an estrogen blocker, Kerr is proud of her own good health and wellness. She exercises regularly, eats healthful foods, and, at 72, takes only a daily thyroid medication.

“I believe it is incumbent upon us as fire chiefs to lead by example when it comes to our health,” Kerr says. “Too many times we see people in positions of leadership in public safety who are out of shape, not paying attention to their own health. That it is ridiculous, especially when we know that in our industry, the leading cause of death is cardiovascular disease.” 

FLFR was already using LifeScan Wellness as its physical provider when Kerr arrived. She was familiar with the company’s work when, in October, she completed her second FLFR physical. 

“So I’m doing the treadmill test, and the technician tells me I’m in atrial fibrillation. I was so surprised. I had no palpitations, no shortness of breath,” she says.

Kerr wasn’t allowed to finish the test, despite her protests that she felt fine. She became a patient in the local hospital that same day.

“I called our deputy fire chief and told her what was going on, quickly took a shower, and got dressed. Do you think I was going to the hospital in my sweaty workout clothes?” Kerr’s team swiftly toted her off to the emergency department.

After an uneventful stay, Kerr underwent a successful ablation on October 28. Kerr is not alone in her experience with this dysrhythmia: Recent research has shown an increased risk of a-fib for firefighters. The cardiac risks of the job are well-known: exposure to pollutants, the strenuous physical demands, and the emotional stress combine to make heart disease the No. 1 cause of on-duty death for firefighters. 

Kerr is on blood thinners now for the short term and says she wants to share her story so it can help others.

“I feel great, actually, but I didn’t know I was feeling bad until I felt better,” she says. “I am less fatigued than I was before.”

Kerr has no problem convincing her personnel of the value of early detection. She says FLFR providers all realize the value of the comprehensive physical. She is proud her department recently received a grant for a comprehensive fitness program for all members to use.

“When I was the chief in Austin, every year we detected early 10 or 12 diseases out of 1,200 providers’ physicals,” Kerr says. “We’ve identified so many diseases with this physical that there’s no reason not to have it.”

Saving Lives

Another chief in Florida, across the state in St. Petersburg, has his own story of what happens when you find cancer early. 

Ian Womack is now division chief of rescue for St. Petersburg Fire Rescue (SPFR). In 2009, at the tender age of 30, Womack says he was in the best shape he’d ever been as a firefighter, “hitting on all cylinders.”

SPFR had been using LifeScan Wellness for a number of years, and Womack was told during his scan that year that there were some nodes on his thyroid. 

“They finished the scan and put me at ease with some chitchat,” he says. “I went for the exam with the physician assistant, and I think they did such a good job not worrying me that I didn’t give it a second thought, and I failed to follow up with my own doctor.”

Womack’s 2010 physical showed the nodes had gotten larger. The tech said, “Ian, you really need to get those checked.”

Womack had a needle biopsy. The results came in, and Womack’s doctor told him he had papillary carcinoma, the most common form of thyroid cancer. 

“I was at a buddy’s house when I got the call, and I don’t think it fully registered that Hey, that’s cancer!” he says. A few months later he was under the knife, undergoing a partial thyroidectomy. But in testing after the surgery, Womack’s cancer levels were still elevated, and his whole thyroid was subsequently removed.

Continued monitoring showed the levels were still abnormal—not what his medical team expected after removing the whole organ. The saga repeated itself: After nuclear scans, Womack was found to have cancer in his lymph nodes and neck structures. And the treatment this time was even more unpleasant.

“I ended up having two radical neck dissections,” he says. “It’s pretty much where they make a long incision across your neck and flip you open like a Pez dispenser to access the diseased areas.”

Surgeons removed cancer from Womack’s lymph nodes, upper chest, and along the vocal cord nerve. The recovery was difficult. 

“After a 10-inch incision across your neck, there’s no lifting allowed, or really using your arms,” Womack says. “I had two neck drains for four weeks and had to keep a low-salt diet that tasted like cardboard.” Womack was thankful to be working day shifts in the training division at SPFR so he could convalesce from home. 

After about four months he had healed as much as possible, endured some radiation treatments, and now, like Kerr, takes a thyroid medication.

“I guess the only lingering effect is the scar on my neck,” says Womack. He goes for checkups every six months and sometimes ponders whether the job caused his cancer.

Ongoing Mission

A study begun in 2014 found a causal relationship between the exposure to fires and the incidence of lung cancer and leukemia. In fact, testing showed PPE surfaces, as well as the hands and the neck, were most prone to retaining polycyclic aromatic hydrocarbons (PAHs). Decontamination using soap, water, and scrubbing helps remove these pathogens and prevents the toxic substances from accumulating.  

“I worked in the busiest firehouse in the county. For the first 12 years of my career, my gear was always dirty, our gear room smelled like a fire, and I stored my hood inside my dirty boots,” Womack says. “I don’t think the fire service helped, but I don’t have definitive evidence that it was the firefighting.”

Now that Womack is in a position of leadership, he thinks a bit differently about human behavior, as well as his own behavior as a young firefighter. 

“It was clear there was sort of a personal normalization of deviance, even though my employer always gave me great gear and was progressive in safety measures. I’d actually say we should be proud of how quickly the fire service as an industry has recognized cancer risks,” he says.

Mainly Womack thinks about what his fire chief, James Large, said to him. Womack asked him what he thought his 46-year legacy would be, and the chief replied, “Geting LifeScan for our members. I can tangibly measure saving the lives of my personnel.”

Womack knows public safety leaders often say that “people are our No. 1 asset.” Still, he’d challenge them to put their money where their mouths are. 

“What would we think of an organization that still uses horses or filter cartridges because they are less expensive or because it’s too hard to change?” he asks. 

With a story like Womack’s, it’s not surprising he touts the benefits of early detection and calls for a policy change. In his view, if the NFPA standards don’t require what LifeScan is scanning for, “the requirements need to be updated.”  

Resources

1. LeMasters GK, Genaidy AM, Succop P, et al. Cancer Risk Among Firefighters: A Review and Meta-analysis of 32 Studies. J Occup Environ Med, 2006 Nov; 48(11): 1,189–202.  

2. International Association of Fire Fighters. Wellness-Fitness Initiative (WFI) Resource, www.iaff.org/wellness-fitness/wfi-resource/. 

3. Williamson L. Fighting fires raises risk for irregular heartbeat. American Heart Association News, 2020 Nov 9; www.heart.org/en/news/2020/11/09/fighting-fires-raises-risk-for-irregular-heartbeat#:~:text=But%20new%20research%20shows%20there's,heart%20failure%20and%20other%20problems. 

4. U.S. Fire Administration. Clean your PPE and skin post-fire to reduce chemical exposure risk, 2018 Mar 22; www.usfa.fema.gov/current_events/032218.html. 

Hilary Gates, MAEd, NRP, is the senior editorial and program director for EMS World.