Coronary Artery Disease

Appendix B: Medical Fitness for Duty vs. Physical Fitness

It is important to recognize the difference between 1) medical fitness for duty (i.e., medical qualification) determination, 2) physical ability to perform the essential job function, and 3) health and wellness promotion.

• A medical fitness for duty evaluation aims to assess the risk of sudden incapacitation and/or ability to perform essential job functions due to a medical condition. This is a function that should be performed by the agency’s medical provider.
• Physical ability to do the job is an assessment that is done by the department (training or management). This can be done with a job task simulation test (e.g., Candidate Physical Abilities Test (CPAT) or similar test), routine training exercises, and/or assessment by management of on-the-job performance. This is not a task for the agency’s medical provider.
• Health and wellness programs encourage diet, exercise, and medical surveillance.  While the agency’s medical provider may be asked to participate in developing these programs, this role is separate from the medical fitness for duty.

The Task Group recognizes that some public safety agencies include a minimum metabolic equivalent (METs) requirement for those who are or want to become public safety workers. No pre-defined aerobic capacity thresholds have been demonstrated to predict PSW’s ability to perform essential job functions. Instead of any pre-defined aerobic capacity thresholds, the Task Group proposes that individuals who need cardiac stress testing for any reason should have a “maximal effort” (symptom-limited) exercise stress test.

Any decision to use a specific number of METs (or aerobic capacity measure) as a hiring or retention criterion is a management decision and not a medical decision. The Task Group recommends further discussion between the agency’s medical provider and management.