FEDERAL INTERAGENCY WILDLAND FIREFIGHTER 

MEDICAL STANDARDS

ARDUOUS DUTY WILDLAND FIREFIGHTER 

The Federal Interagency Wildland Firefighter Medical Standards establish the levels of 

minimum medical fitness for arduous duty that the agencies have determined to be necessary for 

safe and efficient job performance based on 5 CFR Part 339 Medical Qualifications 

Determinations. These medical standards demonstrate the interagency fire community’s strong 

commitment to public and employee health and safety, while maintaining mission integrity. 

The Essential Functions and Work Conditions of a Wildland Firefighter are identified on page 

2. They are the basis for the interagency wildland firefighter medical standards and quantify the 

expectation that the firefighter can perform the full range of duties at any time and at any place, 

maintaining continuity of operations at all times. 

Medical examinations are required for arduous duty wildland firefighters. Each of the medical 

standards listed in this document are subject to clinical interpretation by a designated physician. 

Listed with the standards are examples of medical conditions and/or physical impairments that 

may be found to be disqualifying. Assessments will be made on a case-by-case basis to 

determine the individual's ability to meet the medical standards. 

PSYCHIATRIC STANDARD

The PSYCHIATRIC standard relates (A) the firefighter’s need for judgment, mental functioning, 

and social/behavior skills with (B) the essential functions and work conditions of a wildland 

firefighter, including working on small and large teams, flying in helicopters and fixed wing 

aircraft, and rapid pull out to safety zones under conditions that may include isolated or remote 

sites, snakes, close quarters with large numbers of other workers, limited and disrupted sleep, 

and long work hours. Some psychiatric conditions, including those listed in the standards, may 

not be compatible with safe and efficient performance of wildland firefighter duties under these 

conditions. 

The applicant/incumbent must have judgment, mental functioning, and social 

interaction/behavior that will provide for the safe and efficient conduct of the requirements of 

the job. This may be demonstrated by: 

 No evidence by physical examination and medical history of psychiatric conditions 

(including alcohol or substance abuse) likely to present a safety risk or to worsen as a 

result of carrying out the essential functions of the job (see page 4).

CONDITIONS WHICH MAY RESULT IN DISQUALIFICATION INCLUDE, 

BUT ARE NOT LIMITED TO, THE FOLLOWING EXAMPLES:
(All diagnoses must be consistent with the diagnostic criteria as established by the 

Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, DSM-IV.)

1. AMNESTIC disorders 

2. DELIRIUM (depending upon etiology and duration) 

3. DEMENTIAS (depending upon etiology) 

4. DISSOCIATIVE DISORDERS

5. KLEPTOMANIA

6. PANIC DISORDER and OTHER ANXIETY DISORDERS (depending upon 

 etiology, duration and severity of clinical expression) 

7. PYROMANIA

8. SCHIZOPHRENIA (Exceptions may be may in cases of a single episode of 

schizophrenic reactions associated with an acute illness capable of causing such 

 reaction.) 

9. ANTISOCIAL PERSONALITY DISORDER

10. PARANOID PERSONALITY DISORDER

11. SCHIZOID PERSONALITY DISORDER

12. ORGANIC BRAIN SYNDROME

13. Any other condition not otherwise listed that may adversely affect safe and efficient 

 job performance will be evaluated on a case-by-base basis.

PROSTHETICS, TRANSPLANTS, AND IMPLANTS STANDARD

The PROSTHETICS, TRANSPLANTS, AND IMPLANTS standard relates (A) the firefighter’s 

need to work safely and efficiently despite medical conditions that have led to the need for a 

prosthesis, transplant or implant with (B) the essential functions and work conditions of a 

wildland firefighter, including using shovels or other hand tools to construct fire lines, using 

personal protective equipment, engaging in arduous exertion, carrying heavy loads, walking and 

climbing, kneeling and stooping, and pulling out rapidly to safety zones, and doing so under 

conditions that may include very steep terrain, rocky, loose or muddy surfaces, wet leaves and 

grasses, isolated and remote sites, and very long assignments. For individuals with transplants, 

prosthetics, or implanted pumps or electrical devices, the examinee will have to provide for 

agency review documentation from his/her surgeon or physician that the individual (and, if 

applicable, his/her prosthetic or implanted device) is considered to be fully cleared for the 

specified functional requirements of wildland fire fighting.

The presence or history of organ transplantation or use of prosthetics or implants are not of 

themselves disqualifying. However, the applicant/incumbent must be able to safely and 

efficiently carry out the requirements of the job. This may be demonstrated by: 

• No evidence by physical examination and medical history that the transplant, the 

prosthesis, the implant, or the conditions that led to the need for these treatments are 

likely to present a safety risk or to worsen as a result of carrying out the essential 

functions of the job (see page 2).
Note: For individuals with transplants, prosthetics, or implanted pumps or electrical 

devices, the examinee will have to provide for agency review documentation from his/her 

surgeon or physician that the individual (and, if applicable, his/her prosthetic or 

implanted device) is considered to be fully cleared for the specified functional 

requirements of wildland fire fighting.

IMMUNE SYSTEM/ALLERGIC DISORDERS STANDARD

The IMMUNE SYTEM/ALLERGIC DISORDERS standard relates (A) the firefighter’s need to be 

free of infectious disease, immune system, or allergy conditions likely to present a safety risk to 

self or others with (B) the essential functions and work conditions of a wildland firefighter, 

including arduous exertion, driving or riding for many hours, and providing rescue or 

evacuation assistance under conditions that may include isolated or remote sites, allergens, 

close quarters with large numbers of other workers, and long assignments. Some immune 

system/allergic conditions, including those listed in the standards, may not be compatible with 

safe and efficient performance of wildland firefighter duties under these conditions. 

The applicant/incumbent must be free of communicable diseases, have a healthy immune system, 

and be free of significant allergic conditions in order to safely and efficiently carry out the 

requirements of the job. This may be demonstrated by: 

• A general physical exam of all major body systems that is within the range of normal 

variation, including:

o no evidence of current communicable disease that would be expected to interfere 

with the safe and effective performance of the requirements of the job; and

o no evidence of current communicable disease that would be expected to pose a 

threat to the health of any co-workers or the public; and 

• Normal complete blood count, including white blood count and differential; and 

• Current vaccination status for tetanus; and 

• No evidence by physical examination and medical history of infectious disease, immune 

system, or allergy conditions likely to present a safety risk or to worsen as a result of 

carrying out the essential functions of the job (see page 2). 

CONDITIONS WHICH MAY RESULT IN DISQUALIFICATION INCLUDE, 

BUT ARE NOT LIMITED TO, THE FOLLOWING EXAMPLES:

1. HEREDITARY ANGIOEDEMA

2. GOODPASTURE’S SYNDROME

3. AUTOIMMUNE HEMOLYTIC ANEMIA

4. VASCULITIS

5. HASHIMOTO’S THYROIDITIS

6. MYASTHENIA GRAVIS

7. SYSTEMIC LUPUS ERYTHEMATOSUS

8. CHRONIC OR ACUTE ACTIVE HEPATITIS B OR HEPATITIS C A finding 

of unexplained elevated liver transaminases may require additional diagnostic studies 

before a final medical recommendation is rendered.
9. TUBERCULOSIS A history of TB that has been appropriately treated for longer 

than 6 months is not disqualifying, provided that documentation supports the 

treatment history and the person has a current chest x-ray showing no active 

disease. A person with a positive PPD or Mantoux skin test will be required to have a 

chest X-ray and, if indicated, a sputum culture. 

10. Any other condition not otherwise listed that may adversely affect safe and efficient 

job performance will be evaluated on a case-by-base basis.

MEDICATION STANDARD

The MEDICATION standard relates (A) the firefighter’s need for full physical and mental 

function and attention and a low risk of sudden or subtle incapacitation with (B) the essential 

functions and work conditions of a wildland firefighter under conditions that may include open 

holes and drop offs, isolated and remote sites, irregular meals, dehydration, and long work 

assignments. Some medications may not be compatible with safe and efficient performance of 

wildland firefighter duties under these conditions. 

The need for and use of prescribed or over-the-counter medications are not of themselves 

disqualifying. However, there must be no evidence by physical examination, laboratory tests, or 

medical history of any impairment of body function or mental function and attention due to 

medications that are likely to present a safety risk or to worsen as a result of carrying out the 

specified functional requirements. Each of the following points should be considered: 

 1. Medication(s) (type and dosage requirements) 2. Potential drug side effects 

 3. Drug-drug interactions 4. Adverse drug reactions 

 5. Drug toxicity or medical complications from long-term use 6. Drug-environmental 

interactions

 7. Drug-food interactions 8. History of patient compliance 

VISION STANDARD

The VISION standard relates (A) the firefighter’s need to be able to see (including binocular 

vision, visual acuity, depth perception, peripheral vision, and color vision) with (B) the essential 

functions and work conditions of a wildland firefighter, including the ability to read maps and 

printed materials in variable lighting conditions, driving, walking, climbing, constructing fire 

lines, and rapid pull out to safety zones under conditions that may include very steep terrain, 

rocky, loose or muddy ground surfaces, open holes or drop offs, and dim light or darkness. The 

limit for uncorrected far vision is set at 20/100 binocular, consistent with the National Fire 

Protection Association’s Standard on Medical Requirements for Fire Fighters (NFPA 1582, 

1997 Edition), and with a field assessment by the medical standards team in which different 

levels of acuity were considered in an operational setting related to the need for rapid or 

emergency movement under the conditions noted above. Long-term users of soft contact lenses 

are not subject to the uncorrected far vision standard. Corrected far vision is set at 20/40, and 

the color vision requirement is for red/green/amber (yellow), consistent with Department of 
Transportation regulations for commercial driving and the need for safe and efficient function 

under expected fire fighting conditions. Near visual acuity is set at reading printed material that 

is comparable to size 5 font, such as “This note is legal tender...public and private debts” found 

on all bills of American currency or other pre-printed material, with or without corrective 

lenses. Peripheral vision is set as 850 laterally, which is generally considered to be normal. 

Some vision conditions, including those listed in the standards, may not be compatible with safe 

and efficient performance of wildland firefighter duties under these conditions. 

The applicant/incumbent must be able to see well enough to safely and efficiently carry out the 

requirements of the job. This requires binocular vision, far visual acuity, depth perception, 

peripheral vision, and color vision, which may be demonstrated by: 

• Far visual acuity uncorrected of at least 20/100 in each eye for wearers of hard contacts 

or spectacles; and

• Far visual acuity of at least 20/40 in each eye corrected (if necessary) with contact lenses 

or spectacles; and

• Near visual acuity of the ability to read printed material that is comparable to size 5 font, 

such as “This note is legal tender...public and private debts” found on all bills of 

American currency or other pre-printed material, with or without corrective lenses; and

• Color vision sufficient to distinguish at least red, green, and amber (yellow); and

• Peripheral vision of at least 85o laterally in each eye; and

• Normal depth perception; and

• No ophthalmologic condition that would increase ophthalmic sensitivity to bright light, 

fumes, or airborne particulates, or susceptibility to sudden incapacitation. 

Note: Contact lenses and spectacles are acceptable for correction of visual acuity, but 

the user must be able to demonstrate that the corrective device(s) can be worn safely and 

for extended periods of time without significant maintenance, as well as being worn with 

any necessary personal protective equipment. Successful users of long-wear soft contact 

lenses are not required to meet the “uncorrected” vision guideline.

CONDITIONS WHICH MAY RESULT IN DISQUALIFICATION INCLUDE, 

BUT ARE NOT LIMITED TO, THE FOLLOWING EXAMPLES:

1. CHRONIC CONJUNCTIVITIS 

2. CORNEAL ULCERS This condition must be treated and cleared by an 

Ophthalmologist before a medical clearance can be granted.

3. RETINAL DETACHMENT

4. NIGHT BLINDNESS 

5. Any other condition not otherwise listed that may adversely affect safe and efficient 

job performance will be evaluated on a case-by-base basis.

HEAD, NOSE, MOUTH, THROAT AND NECK STANDARD
The HEAD, NOSE, MOUTH, THROAT AND NECK standard relates (A) the firefighter’s need to 

be able to move the head without restriction, breath freely, wear personal protective equipment, 

and communicate clearly with (B) the essential functions and work conditions of a wildland 

firefighter, including working on small and large teams, flying in helicopters and fixed wing 

aircraft, and fighting fire under conditions that may include high (and changing) altitudes, 

allergens, varied climates, and isolated and remote sites. Some head, nose, mouth, throat, and 

neck conditions, including those listed in the standards, may not be compatible with safe and 

efficient performance of wildland firefighter duties under these conditions 

The applicant/incumbent must have structures and functions of the head, nose, mouth, throat, and 

neck that are sufficient for the individual to safely and efficiently carry out the requirements of 

the job. This may be demonstrated by:

• A physical exam of the head, nose, mouth, throat, and neck that is within the range of 

normal variation, including: 

 normal flexion, extension, and rotation of the neck; and 

 open nasal and oral airways; and 

 unobstructed Eustachian tubes; and 

 no structural abnormalities that would prevent the normal use of a hard hat and protective 

eyewear; and

• Normal conversational speech; and

• No evidence by physical examination and medical history of head, nose, mouth, throat, or 

neck conditions likely to present a safety risk or to worsen as a result of carrying out the 

essential functions of the job (see page 2).

CONDITIONS WHICH MAY RESULT IN DISQUALIFICATION INCLUDE, 

BUT ARE NOT LIMITED TO, THE FOLLOWING EXAMPLES:

1. MUTISM/APHONIA

2. NASAL POLYPS THAT SIGNIFICANTLY OBSTRUCT BREATHING

3. RESTRICTED RANGE OF MOTION IN THE NECK

4. Any other condition not otherwise listed that may adversely affect safe and efficient 

job performance will be evaluated on a case-by-base basis.

HEARING STANDARD

The HEARING standard relates (A) the firefighter’s need to hear verbal communications and 

both natural and manmade warning sounds with (B) the essential functions and work conditions 

of a wildland firefighter, including working on small and large teams, driving, rapid pull out to 

safety zones, and providing rescue or evacuation assistance under conditions that may include 

isolated and remote sites, falling rocks and trees, trucks and other large equipment. The hearing 

standard is set at an average threshold of no greater than 40 dB at 500, 1000, 2000, and 3,000 

Hz in each ear, consistent with the DOT regulations for commercial drivers. This level is more 

lenient than that allowed by the NPFA 1582 standards (30 dB average threshold at these 

frequencies), or what is considered to be “normal” hearing (25 dB), but is felt to provide a 

reasonable hearing threshold level where louder than normal communications may be expected. 

Hearing aides are not permitted in meeting this standard, due both to the limitation in 
directional hearing afforded by hearing aides, and to the risk of dislodging of a hearing aid 

during critical or emergency periods when hearing must be acute. Some ear and hearing 

conditions, including those listed in the standards, may not be compatible with safe and efficient 

performance of wildland firefighter duties under these conditions. 

The applicant/incumbent must be able to hear well enough to safely and efficiently carry out the 

requirements of the job. This requires binaural hearing (to localize sounds) and auditory acuity, 

which may be demonstrated by: 

• A current pure tone, air conduction audiogram, using equipment and a test setting which 

meet the standards of the American National Standards Institute (see 29 CFR 1910.95); 

and 

• Documentation of hearing thresholds of no greater than 40 dB at 500, 1000, 2000, and 

3000 Hertz in each ear; and 

• No evidence by physical examination and medical history of ear conditions (external, 

middle, or internal) likely to present a safety risk or to worsen as a result of carrying out 

the essential functions of the job. 

Note: The use of a hearing aid(s) to meet this standard is not permitted.

CONDITIONS WHICH MAY RESULT IN DISQUALIFICATION INCLUDE, 

BUT ARE NOT LIMITED TO, THE FOLLOWING EXAMPLES:

1. MENIERE’S DISEASE

2. ACOUSTIC NEUROMA

3. OTOSCLEROSIS

4. Any other condition not otherwise listed that may adversely affect safe and efficient 

job performance will be evaluated on a case-by-base basis.

DERMATOLOGY STANDARD

The DERMATOLOGY standard relates (A) the firefighter’s need for intact and healthy skin with 

(B) the essential functions and work conditions of a wildland firefighter, including use of 

personal protective equipment, extensive walking and climbing, under conditions that may 

include highly variable climates, extreme ultraviolet light exposure, extreme heat, allergens, and 

isolated or remote sites. Some dermatologic conditions, including those listed in the standards, 

may not be compatible with safe and efficient performance of wildland firefighter duties under 

these conditions. 

The applicant/incumbent must have skin that is sufficient for the individual to safely and 

efficiently carry out the requirements of the function. This may be demonstrated by: 

• A physical exam of the skin that is within the range of normal variation; and

• No evidence by physical examination and medical history of dermatologic conditions 

likely to present a safety risk or to worsen as a result of carrying out the essential 

functions of the job (see page 2).
CONDITIONS WHICH MAY RESULT IN DISQUALIFICATION INCLUDE, 

BUT ARE NOT LIMITED TO, THE FOLLOWING EXAMPLES:

1. ALBINISM

2. KAPOSI’S SARCOMA

3. CHRONIC DERMATITIS

4. Any other condition not otherwise listed that may adversely affect safe and efficient 

job performance will be evaluated on a case-by-base basis.

VASCULAR SYSTEM STANDARD

The VASCULAR SYSTEM standard relates (A) the firefighter’s need for a healthy vascular 

system (including a lack of phlebitis, thrombosis, venous stasis, or arterial insufficiency) with (B) 

the essential functions and work conditions of a wildland firefighter, including arduous exertion, 

driving or riding for extensive periods, flying in helicopters and fixed wing aircraft, and 

extensive walking and climbing under conditions that may include isolated or remote sites, and 

long work assignments. Some vascular conditions, including those listed in the standards, may 

not be compatible with safe and efficient performance of wildland firefighter duties under these 

conditions. 

The applicant/incumbent must have a vascular system that is sufficient for the individual to 

safely and efficiently carry out the requirements of the job. This may be demonstrated by: 

• A physical exam of the vasculature of the upper and lower extremities that is within the 

range of normal variation, including: 

o no evidence of phlebitis or thrombosis; and 

o no evidence of venous stasis; and 

o no evidence of arterial insufficiency; and

• No evidence by physical examination and medical history of peripheral vasculature 

conditions likely to present a safety risk or to worsen as a result of carrying out the 

essential functions of the job (see page 2).

CONDITIONS WHICH MAY RESULT IN DISQUALIFICATION INCLUDE, 

BUT ARE NOT LIMITED TO, THE FOLLOWING EXAMPLES:

1. CHRONIC VENOUS INSUFFICIENCY

2. DEEP VEIN THROMBOSIS

3. CHRONIC THROMBOPHLEBITIS

4. INTERMITTENT CLAUDICATION

5. Any other condition not otherwise listed that may adversely affect safe and efficient 

job performance will be evaluated on a case-by-base basis.

CARDIAC STANDARD

The CARDIAC standard relates (A) the firefighter’s need for a healthy cardiovascular system 

and a low risk of sudden or subtle incapacitation with (B) the essential functions and work 

conditions of a wildland firefighter, including arduous exertion, lifting and carrying heavy loads, 
extensive walking and climbing, and rapid pull out to safety zones under conditions that may 

include very steep terrain, isolated and remote sites, extreme heat, dehydration, and long work 

assignments. Some cardiac conditions, including those listed in the standards, may not be 

compatible with safe and efficient performance of wildland firefighter duties under these 

conditions. The standard for blood pressure was set at below 140/90 (with or without 

medication). At or above this level is considered to be hypertension (high blood pressure), a 

condition associated with increasing risk of cardiovascular morbidity and mortality. 

The applicant/incumbent must have a cardiovascular system that is sufficient for the individual 

to safely and efficiently carry out the requirements of the job. This may be demonstrated by: 

• A physical exam of the cardiovascular system that is within the range of normal 

variation, including:

o blood pressure of less than 140 mmHg systolic and 90 mmHg diastolic; and

o a normal baseline electrocardiogram (minor, asymptomatic arrhythmias may be 

acceptable); and

o no pitting edema in the lower extremities, and 

o normal cardiac exam.

• No evidence by physical examination and medical history of cardiovascular conditions 

likely to present a safety risk or to worsen as a result of carrying out the essential 

functions of the job (see page 2).

CONDITIONS WHICH MAY RESULT IN DISQUALIFICATION INCLUDE, 

BUT ARE NOT LIMITED TO, THE FOLLOWING EXAMPLES:

1. PACEMAKERS or PROSTHETIC VALVES may be disqualifying. 

Documentation from the individual’s cardiologist, stating that the individual is stable 

and can safely carry out the specified requirements of the function, under the 

specified conditions, will be necessary before a clearance can be granted.

2. CORONARY ARTERY DISEASE A successful completion of an exercise stress 

test, or documentation from the individual’s cardiologist acknowledging the 

requirements of the function and the work conditions, may allow a clearance despite 

this diagnosis. 

3. HYPERTENSION that cannot be controlled to a level less than 140/90, or requires 

the use of any medication that affects the ability of the individual to safely and 

effectively carry out the requirements of the function, may be disqualifying.

4. LEFT BUNDLE BRANCH BLOCK.

5. MYOCARDITIS/ ENDOCARDITIS/ PERICARDITIS (Active or recently 

resolved cases). 

6. History of MYOCARDIAL INFARCTION. Documentation from the individual’s 

cardiologist, stating that the individual is stable and can safely carry out the specified 

requirements of the function, under the specified conditions, will be necessary before 

a clearance can be considered.

7. VALVULAR HEART DISEASE such as mitral valve stenosis, symptomatic mitral 

valve regurgitation, aortic stenosis etc. Exceptions may be granted depending upon 

the current clinical findings and diagnostic studies. 

8. DYSRHYTHMIAS: such as ventricular tachycardia or fibrillation, Wolff-ParkinsonWhite syndrome, and Paroxysmal Atrial Tachycardia, with or without block. 
9. ANGINA PECTORIS or chest pain of unknown etiology. 

10. CARDIOMYOPATHY from any cause.

11. CONGESTIVE HEART FAILURE

12. Any other condition not otherwise listed that may adversely affect safe and efficient 

job performance will be evaluated on a case-by-base basis.

CHEST AND RESPIRATORY SYSTEM STANDARD

The CHEST AND RESPIRATORY SYSTEM standard relates (A) the firefighter’s need for a 

healthy respiratory system and residual aerobic capacity with (B) the essential functions and 

work conditions of a wildland firefighter, including arduous exertion, carrying heavy loads, and 

extensive walking and climbing under conditions that may include very steep terrain, high 

altitudes, airborne particulates, and allergens. Some chest and respiratory conditions, including 

those listed in the standards, may not be compatible with safe and efficient performance of 

wildland firefighter duties under these conditions. The stated standards of 70% of predicted 

values for forced vital capacity (FVC), forced expiratory volume at 1 second (FEV1), and the 

ratio of FEV1/FVC are intended as screens for further evaluation, not mandatory values. The 

requirement for agency review when inhalers are used is based on both the general 

incompatibility of inhalers and high heat or fire (according to guidance from inhaler 

manufacturers) and concern regarding the degree of respiratory sensitivity an individual may 

bring to a setting of high irritant exposure. 

The applicant/incumbent must have a respiratory system that is sufficient for the individual to 

safely and efficiently carry out the requirements of the job. This may be demonstrated by: 

• A physical exam of the respiratory system that is within the range of normal variation; 

and 

• A pulmonary function test (baseline exam) showing: 

o forced vital capacity (FVC) of at least 70% of the predicted value; and

o forced expiratory volume at 1 second (FEV1) of at least 70% of the predicted 

value; and

o the ratio FEV1/FVC of at least 70%; and

o No evidence by physical examination and medical history of respiratory 

conditions likely to present a safety risk or to worsen as a result of carrying out 

the essential functions of the job (see page 2).

Note: The requirement to use an inhaler (such as for asthma) requires agency review. 

CONDITIONS WHICH MAY RESULT IN DISQUALIFICATION INCLUDE, 

BUT ARE NOT LIMITED TO, THE FOLLOWING EXAMPLES:

1. SIGNIFICANT OBSTRUCTIVE OR RESTRICTIVE PULMONARY 

DISEASE.

2. ASTHMA must be considered on a case-by-case basis.

3. ACTIVE PULMONARY TUBERCULOSIS (TB): A history of confirmed TB that 

has been treated for longer than 6 months is acceptable provided that documentation 

supports the treatment history. 
4. HISTORY OF CHRONIC BRONCHITIS ASSOCIATED WITH DECREASED 

PULMONARY FUNCTION

5. LUNG ABSCESS

6. SPONTANEOUS PNEUMOTHORAX (if recurrent)

7. EMPHYSEMA (if associated with impaired pulmonary function test results)

8. SARCOIDOSIS (if associated with an impaired pulmonary function test results)

9. PULMONARY EMBOLISM

10. PULMONARY INFARCTION

11. PNEUMONECTOMY (if associated with impaired pulmonary function)

12. Any other condition not otherwise listed that may adversely affect safe and efficient 

job performance will be evaluated on a case-by-base basis.

ENDOCRINE AND METABOLIC SYSTEM STANDARD

The ENDOCRINE AND METABOLIC SYSTEM standard relates (A) the firefighter’s need for 

normal body function and maintenance and a low risk of sudden or subtle incapacitation with 

(B) the essential functions and work conditions of a wildland firefighter, including arduous 

exertion under conditions that may include isolated and remote sites, hunger and irregular 

meals, dehydration, irregular hours, and long assignments. Some endocrine and metabolic 

conditions, including those listed in the standards, may not be compatible with safe and efficient 

performance of wildland firefighter duties under these conditions. 

Any excess or deficiency in hormonal production can produce metabolic disturbances affecting 

weight, stress adaptation, energy production, and a variety of symptoms or pathology such as 

elevated blood pressure, weakness, fatigue and collapse. The applicant/incumbent must have 

endocrine and metabolic functions that are sufficient for the individual to safely and efficiently 

carry out the requirements of the job. This may be demonstrated by: 

• A physical exam of the skin, thyroid, and eyes that is within the range of normal 

variation; and

• Normal fasting blood sugar level; and 

• Normal blood chemistry results; and

• No evidence by physical examination (including laboratory testing) and history of 

endocrine/metabolic conditions likely to present a safety risk or to worsen as a result of 

carrying out the essential functions of the job (see page 2).

CONDITIONS WHICH MAY RESULT IN DISQUALIFICATION INCLUDE, 

BUT ARE NOT LIMITED TO, THE FOLLOWING EXAMPLES:

1. ADRENAL DYSFUNCTION (in the form of Addison's Disease or Cushing's 

Syndrome). 

2. THYROID DISEASE (uncontrolled or associated with current complications).

3. PITUITARY DYSFUNCTION

4. INSULIN DEPENDENT DIABETES MELLITUS

5. HYPERGLYCEMIA without a history of diabetes will require additional tests, 

including, but not limited to a glycohemoglobin (or hemoglobin A1C) and fasting 

glucose before a final medical determination is made. 

6. DIABETES INSIPIDUS. 
7. Any other condition not otherwise listed that may adversely affect safe and efficient 

job performance will be evaluated on a case-by-base basis.

THE CONDITION OF PREGNANCY

The CONDITION OF PREGNANCY does not become an issue under most circumstances since 

the condition is not a disability, and is a time-limited condition. If a female applicant or 

incumbent raises the issue of pregnancy as the basis for a request for a special benefit, a change 

in duty status, or job restrictions, then justification and clarifying information for that request 

must be provided by the woman’s obstetrician or primary care physician, along with the 

estimated time period the special conditions are expected to apply.

If a female applicant or incumbent raises the issue of pregnancy as the basis for a request for a 

special benefit, a change in duty status, or job restrictions, then justification and clarifying 

information for that request must be provided by the woman’s obstetrician or primary care 

physician, along with the estimated time period the special conditions are expected to apply. 

HEMATOPOIETIC SYSTEM STANDARD

The HEMATOPOIETIC SYSTEM standard relates (A) the firefighter’s need for a healthy blood 

and blood producing system and a low risk of sudden or subtle incapacitation with (B) the 

essential functions and work conditions of a wildland firefighter, including arduous exertion 

under conditions that may include high altitudes, isolated and remote sites, extreme heat, close 

quarters with large numbers of other workers, dehydration, and long assignments. Some blood 

and blood producing conditions, including those listed in the standards, may not be compatible 

with safe and efficient performance of wildland firefighter duties under these conditions.

The applicant/incumbent must have a hematopoietic (blood and blood-producing) system that is 

sufficient for the individual to safely and efficiently carry out the requirements of the job. This 

may be demonstrated by: 

• A physical exam of the skin that is within the range of normal variation; and 

• A complete blood count (including hemoglobin, hematocrit, platelets, and white blood 

count, with differential) that is within the normal range; and

• No evidence by physical examination (including laboratory testing) and medical history 

of hematopoietic conditions likely to present a safety risk or to worsen as a result of 

carrying out the essential functions of the job (see page 2). 

CONDITIONS WHICH MAY RESULT IN DISQUALIFICATION INCLUDE, BUT 

ARE NOT LIMITED TO, THE FOLLOWING EXAMPLES:

1. ANEMIA-- Generally considered as: 

hematocrit of less than 39% and a hemoglobin of less than 13.6 gm/dl for males

hematocrit of less than 33% and a hemoglobin of 12 gm/dl for females

(If anemia does exist but physical performance levels and pulmonary function are 

normal, this condition may be acceptable.) 

2. HEMOPHILIA
3. CHRONIC LYMPHANGITIS

4. THROMBOCYTOPENIA OR CLOTTING DISORDER

5. SICKLE CELL ANEMIA

6. SPLENOMEGALY

7. Any other condition not otherwise listed that may adversely affect safe and efficient 

job performance will be evaluated on a case-by-base basis.

MUSCULOSKELETAL SYSTEM STANDARD

The MUSCULOSKELETAL SYSTEM standard relates (A) the firefighter’s need for strength, 

flexibility, range of motion, and joint stability with (B) the essential functions and work 

conditions of a wildland firefighter, including arduous exertion, extensive walking and climbing, 

kneeling and stooping, lifting and carrying heavy loads, and rapid pull out to safety zones under 

conditions that may include rocky, loose, or muddy ground surfaces, thick vegetation, wet leaves 

and grass, and falling rocks and trees. Some musculoskeletal conditions, including those listed in 

the standards, may not be compatible with safe and efficient performance of wildland firefighter 

duties under these conditions. 

The applicant/incumbent must have a musculoskeletal system that is sufficient for the individual 

to safely and efficiently carry out the functional requirements of the job. This may be 

demonstrated by: 

• A physical exam of the upper and lower extremities, neck, and back that is within the 

range of normal variation for strength, flexibility, range of motion, and joint stability; and

• No evidence by physical examination and medical history of musculoskeletal conditions 

likely to present a safety risk or to worsen as a result of carrying out the essential 

functions of the job (see page 2).

Note: For individuals who require the use of a prosthetic device, the examinee will have to 

provide for agency review documentation from his/her surgeon or physician that the 

individual (and, if applicable, his/her prosthetic device) is considered to be fully cleared for 

the essential functions of the job. 

CONDITIONS WHICH MAY RESULT IN DISQUALIFICATION INCLUDE, 

BUT ARE NOT LIMITED TO, THE FOLLOWING EXAMPLES:

1. ARTHRITIS (any etiology) if there is a limitation of major joint motion, and/or pain 

that prevents the full range of required performance activities.

2. AMPUTATIONS OF AN EXTREMITY OR DIGITS will be evaluated on a caseby-case basis.

3. ANKYLOSING SPONDYLITIS. 

4. MUSCULAR DYSTROPHY

5. LUMBOSACRAL INSTABILITY: pain or limitations of flexibility and strength 

causing an inability to stand, bend, stoop, carry heavy objects or sit for long periods 

of time.

6. SCIATICA OR OTHER NEUROPATHIES
7. CHRONIC LOW BACK PAIN (by medical history) without demonstrable 

pathology must be considered on a case-by-case basis. Each case will be reviewed in 

context of the original history or etiology, the response to therapeutic regimes, 

frequency of recurrence, exacerbating factors, and lengths of disability associated 

with the recurrences combined with the current clinical presentation.

8. A history of a CHRONIC SPRAIN OR STRAIN OF THE NECK limiting 

mobility or causing recurring cephalgia (headaches). 

9. Any evidence of a CERVICAL NEUROPATHY, including numbness, tingling or 

loss of motor strength in the upper extremities.

10. Any other condition not otherwise listed that may adversely affect safe and efficient 

job performance will be evaluated on a case-by-base basis.

CENTRAL AND PERIPHERAL NERVOUS SYSTEM AND VESTIBULAR SYSTEM 

STANDARD

The CENTRAL AND PERIPHERAL NERVOUS SYSTEM and VESTIBULAR SYSTEM standards 

relate (A) the firefighter’s need for balance, sensation of surroundings and self, and a low risk of 

sudden or subtle incapacitation with (B) the essential functions and work conditions of a 

wildland firefighter, including use of hand and power tools, flying in helicopters and fixed wing 

aircraft, and extensive walking and climbing under conditions that may include isolated and 

remote sites, very steep terrain, rocky, loose, or muddy ground surfaces, wet leaves and grass, 

heights, open holes and drop offs, falling rocks and trees, trucks and other large equipment, and 

high heat. Some sensory conditions, including those listed in the standards, may not be 

compatible with safe and efficient performance of wildland firefighter duties under these 

conditions. 

The applicant/incumbent must have a nervous system that is sufficient for the individual to safely 

and efficiently carry out the requirements of the job. This may be demonstrated by: 

• A physical exam of the cranial and peripheral nerves and the vestibular and cerebellar 

system that is within the range of normal variation, including:

intact cranial nerves, I-XII; and

normal vibratory sense in the hands and feet; and 

normal proprioception of the major joints; and

 normal sensation of hot and cold in the hands and feet; and 

 normal sense of touch in the hands and feet; and 

normal reflexes of the upper and lower extremities; and 

 normal balance (e.g., heel-toe walk; Romberg; balance on one foot); and 

• Normal basic mental status evaluation (e.g., person, place, time, current events); and 

• No evidence by physical examination and medical history of nervous, cerebellar, or 

vestibular system conditions likely to present a safety risk or to worsen as a result of 

carrying out the essential functions of the job (see page 2). 

CONDITIONS WHICH MAY RESULT IN DISQUALIFICATION INCLUDE, 

BUT ARE NOT LIMITED TO, THE FOLLOWING EXAMPLES:

1. ATAXIA from any etiology 

2. VESTIBULAR NEURONITIS
3. VERTIGO & PAROXYSMAL FUNCTIONAL VERTIGO

4. EPILEPSY*

5. MULTIPLE SCLEROSIS

6. MUSCULAR DYSTROPHY

7. NARCOLEPSY

8. NEUROFIBROMATOSIS

9. PARKINSON’S DISEASE

10. CEREBROVASCULAR ACCIDENT (STROKE)

11. TRANSIENT ISCHEMIC ATTACKS

12. SENSORY DYSFUNCTION (smell, touch, taste, proprioception) 

13. MIGRAINE

14. CEPHALGIA

15. SEIZURE DISORDERS*

16. Any other condition not otherwise listed that may adversely affect safe and efficient 

job performance will be evaluated on a case-by-base basis.

*In order to be considered for a medical clearance to perform arduous duty wildland 

firefighting, an individual with a history of one or more seizures must provide the 

following written information from a physician who is board certified in neurology. 

This information is to be provided on the physician’s own letterhead, and must 

include: 

1. the physician’s printed or typed name (i.e., legible), signature, and date; 

2. confirmation that the physician has reviewed and is familiar with the Essential 

Functions And Work Conditions Of A Wildland Firefighter (the job table 

developed for arduous duty wildland firefighters); 

3. a summary of all current medications, along with any known side effects 

experienced or expected to be experienced by the firefighter; 

4. the known or suspected triggers or factors that may lead to seizure activity for the 

firefighter;

5. the results of the most recent diagnostic testing, such as an EEG,

6. the firefighter’s overall medical prognosis, related to his/her seizure disorder; and

7. the estimated risk or likelihood of future seizure activity the firefighter might 

experience, of any degree of severity. 

GASTROINTESTINAL SYSTEM STANDARD

The GASTROINTESTINAL SYSTEM standard relates (A) the firefighter’s need to be able to 

consume adequate nutrition and calories, and to have a low risk of sudden or subtle 

incapacitation, with (B) the essential functions and work conditions of a wildland firefighter, 

including arduous exertion, driving or riding for many hours, and flying in helicopters and fixed 

wing aircraft under conditions that may include isolated or remote sites, close quarters with 

large number of other workers, hunger and irregular meals, and long assignments. Some 

gastrointestinal conditions, including those listed in the standards, may not be compatible with 

safe and efficient performance of wildland firefighter duties under these conditions. 
• The applicant/incumbent must have a gastrointestinal tract that is sufficient for the 

individual to safely and efficiently carry out the requirements of the job. This may be 

demonstrated by: 

A physical exam and evaluation of the gastrointestinal tract that is within the range of 

normal variation; and

• Normal liver function and blood chemistry laboratory tests; and 

• No evidence by physical examination (including laboratory testing) and medical history 

of gastrointestinal conditions likely to present a safety risk or to worsen as a result of 

carrying out the essential functions of the job (see page 2).

CONDITIONS WHICH MAY RESULT IN DISQUALIFICATION INCLUDE, 

BUT ARE NOT LIMITED TO, THE FOLLOWING EXAMPLES:

1. ACUTE AND CHRONIC ACTIVE HEPATITIS

2. ACUTE VIRAL HEPATITIS (After being asymptomatic for three (3) months an 

applicant may be re-evaluated).

3. CROHN’S DISEASE / ULCERATIVE COLITIS / REGIONAL 

ENTERITIS/SPRUE or IRRITABLE BOWEL SYNDROME (these conditions, 

controlled with surgical and/or medication treatments, will be reviewed on a case-bycase basis).

4. COLOSTOMIES, unless the precipitating condition has stabilized and the 

applicant/incumbent demonstrates successful management of the colostomy, 

considering the requirements of the function and the work conditions.

5. ILEITIS, either recurrent or chronic.

6. CHOLECYSTITIS (chronic or recurring). 

7. DIVERTICULITIS (symptomatic).

8. CIRRHOSIS OF THE LIVER (depending upon the degree of severity and the 

etiology).

9. INTESTINAL OBSTRUCTION from any cause. 

10. ESOPHAGEAL VARICES

11. PANCREATITIS

12. UNTREATED (OR UNSUCCESSFULLY TREATED) INGUINAL, 

INCISIONAL OR VENTRAL HERNIA that is associated with symptoms 

13. ACTIVE GASTRIC OR DUODENAL ULCER

14. GASTRIC OR BOWEL RESECTION, if there is any evidence (historical or 

physical) of pain, hemorrhage, fainting episodes or dietary restrictions that could 

interfere with the performance of the job.

15. Any other condition not otherwise listed that may adversely affect safe and efficient 

job performance will be evaluated on a case-by-base basis.

GENITOURINARY SYSTEM STANDARD

The GENITOURINARY SYSTEM standard relates (A) the firefighter’s need for a healthy 

genitourinary system and a low risk of sudden or subtle incapacitation with (B) the essential 

functions and work conditions of a wildland firefighter, including arduous exertion, driving or 

riding for long periods, and flying in helicopters and fixed wing aircraft under conditions that 
may include isolated or remote sites, hunger and irregular meals, dehydration, and long 

assignments. Some genitourinary conditions, including those listed in the standards, may not be 

compatible with safe and efficient performance of wildland firefighter duties under these 

conditions. 

The applicant/incumbent must have a genitourinary system that is sufficient for the individual to 

safely and efficiently carry out the requirements of the job. This may be demonstrated by: 

• A normal clean catch urinalysis; and

• No evidence by physical examination and medical history of genitourinary conditions 

likely to present a safety risk or to worsen as a result of carrying out the essential 

functions of the job (see page 2).

CONDITIONS WHICH MAY RESULT IN DISQUALIFICATION INCLUDE, 

BUT ARE NOT LIMITED TO, THE FOLLOWING EXAMPLES:

1. POLYCYSTIC KIDNEY DISEASE

2. ACUTE or CHRONIC RENAL FAILURE

3. NEPHROTIC SYNDROME 

4. SYMPTOMATIC URINARY CALCULI

5. NEUROGENIC BLADDER

6. HISTORY OF RENAL VEIN THROMBOSIS

7. UNCORRECTED OBSTRUCTIVE UROPATHIES

8. RENAL TOXICITY FROM ANY CAUSE

9. Any other condition not otherwise listed that may adversely affect safe and efficient 

job performance will be evaluated on a case-by-base basis.