Pulmonary Disorders: Asthma

Evaluation of Asthma Effect on Ability to Perform Essential Job Functions

Evaluation for any adverse effect of asthma on the ability of a person to perform physically demanding essential job functions has the highest validity if simulated tasks are used for the test. While there are a number of job functions likely to be required by any agency, there is no standardized set of LEO essential job functions. Thus, agencies wishing to evaluate LEOs with asthma would need to either adopt and adapt a physical task challenge test used by another agency or develop one of their own that would withstand legal challenge.

Essential job duties of law enforcement officers involve both aerobic and anaerobic activities. Many law enforcement activities are short duration, high strength activities such as pushing, pulling or lifting against resistance as in pulling or pushing resisting persons, moving a barrier or dragging an incapacitated person from danger. Ability to safely and effectively execute such actions is primarily dependent on muscle mass that can be engaged in high-power, short-duration mostly anaerobic activity. However, many law enforcement activities are associated with aerobic activity such as running to arrive at the place where the officer will engage in those high-power anaerobic activities. Compared to athletes performing many of the same types of activities such as running or grappling with another person, law enforcement officers have the added component that the success or failure of the needed activity may affect their own survival.

Physical Activity Testing in Law Enforcement: Correlation to Essential Job Tasks
Ability to exert to a specified level for a specified time is dependent on several factors, of which bronchial air exchange, the component of primary concern in asthma, is only one. Inability to perform essential job functions may also be due to other disorders affecting muscle function or to inadequate general fitness.

Job Task Simulation Testing
Throughout this document, job task simulation testing (JTST) was recommended for evaluation of LEOs regarding any adverse effect asthma might have on the ability to perform essential job functions. This recommendation was made for two reasons: 1)we are not aware of studies that correlate any surrogate or fitness testing with the ability to safely and effectively perform the essential job functions of a law enforcement officer; and 2) essential job functions may vary significantly from one agency to another.

One example of a JTST is the Southeastern Pennsylvania Transit Authority (SEPTA) which requires all police officers, male and female, to be able to complete a 1.5 mile run in 12 minutes. This is intended to demon-strate an aerobic capacity of 42.5mL/kg/min. This requirement is based on a study of essential job functions in this specific agency. SEPTA’s standard has been challenged and SEPTA prevailed (Lanning v SEPTA).

Many law enforcement training academies or in-service training facilities have the ability to place individuals in simulations of various job tasks. A physician consulting with a police department may need to work closely with the department’s training division in order to craft a set of simulations that would assess adverse effects of asthma on performance of essential job functions.

Surrogate Testing for Adverse Effect of Asthma
If it is not possible to use a test incorporating essential job function activities, surrogate testing to a level consistent with the maximum aerobic demand likely to be encountered performing essential job functions may be necessary.

No literature has been identified reporting direct assessment of the oxygen consumption or of physiological work load of law enforcement officers performing essential job functions while on-duty. Correlations have been made to published listings of energy expenditure, measured in metabolic equivalents (METs), for other tasks that are similar to components of essential law enforcement job functions. The activity-MET list offered by Jetté was generated by expert opinion and a collection of information from members of a panel whose agenda was disability assessment. This activity listing of MET equivalents has been maintained and expanded slowly with increasing numbers of activity-associated MET levels being measured directly. Although this list does not offer direct evaluation of incumbent LEOs performing physical LEO tasks, it does offer a number of activities that are likely representative of functions performed by LEOs. Many of these activities have been assigned MET ratings in the range of 12 METs.

Job descriptions for LEOs have also been developed and made public by at least two agencies, most notably Massachusetts Human Resources Division and California Police Officers Standards and Training (POST) Commission. Chapter 3 of this ACOEM guidance for LEOs delineates a set of essential job functions that was developed in conjunction with law enforcement organizations and officers as subject matter experts.

One small study has measured energy expenditure during simulation of a foot chase and apprehension of a resisting person as a part of designing an occupation-specific cardiac rehabilitation program (see Table 4). The peak METs were 14.0 (±2.2) with the mean working MET level was 10.5 (±3.2). Unfortunately, although subjects were fitted with facemasks to measure oxygen consumption, VO2 data were not presented. Additionally, times for completing the task set were not provided. The components of this simulation as presented in Table 3 might serve as a guide for developing an essential-job-function-based physical activity challenge test.

Table 4: LEO Job Function Simulations for Energy Expenditure

In a live field operation, the actual energy expenditures are likely to be higher than those attributed to surrogate tasks based on the presumption of higher degrees of activity and the added physiological demand from psychological factors.

Whether evaluation is performed using job task simulation or surrogate testing, it is not the role of the police physician to make the determination of whether failure is due to a medical condition or to inadequate conditioning.

On-going Monitoring of LEOs with Asthma
Asthma in adults generally does not resolve. Asthma is frequently a progressive disorder. Thus, it is imperative to monitor the status of the LEO with asthma.