Letters to the Editor
To the Editor:
As a practitioner of Public Safety medicine for the past 20 years, I wish to thank Dr Ardaiz for his recent letter, which reviews the case law regarding medical standards for public safety applicants.1 I agree with the two main points of his letter. Firstly, that use of blanket standards to medically disqualify applicants without at least an attempt at an individualized assessment is a legally risky business. And secondly, that doing an individualized assessment that is evidence-based is extremely difficult.
To assist practitioners with this challenge, Dr Ardaiz recommended review of the work by Dr William Haddon, and provided an on-line reference to the Encyclopedia of Occupational Health and Safety published by the International Labor Organization (ILO).2 I attempted to look at this work on-line, but could not readily access it via the Web address provided. A search for Dr Haddon's name through the ILO Website yielded several references in French. Given that my high school French was over 30 years ago, I could not discern as to whether these would be worth trying to translate.
For readers who may have shared my frustration, let me recommend a resource I coauthored that is readily accessible on-line at no charge—the Medical Screening Manual for California Law Enforcement3 published by the California Commission of Peace Officer Standards and Training (POST). The goal of the Manual is to provide practitioners with transparent and evidence-based individualized guidelines for approximately 50 commonly encountered medical conditions. The challenge of accomplishing this goal is evidenced by the more than 30 pages necessary on the topic of diabetes alone. While designed for the assessment of peace officer applicants, practitioners may also find that portions have applicability to the evaluation of firefighters and other public safety applicants.
The greatest limitation of the Manual is that it was first published in its current format in 1993, and many of the topics have not been updated since that time. However, this is the bane of all published guidelines. Hopefully, the California POST will continue its long-term commitment to the Manual and support revision efforts in the near future.
R. Leonard Goldberg, MD, MSOM
Occupational Health Programs
County of Los Angeles
Los Angeles, CA
1. Ardaiz MJ. Blanket Disqualifications in Public Safety Medical Standards—Risky Business. J Occup Environ Med
3. Goldberg RL, Spilberg SW, Weyers SG. Medical Screening Manual for California Law Enforcement.
Sacramento: California Commission of Peace Officer Standards and Training (POST); 2004. Available at http://www.post.ca.gov/selection/medical.asp
Readers are invited to submit letters for publication in this department. Submit them to: The Editor, Journal of Occupational and Environmental Medicine, 605 Worcester Road, Towson, MD 21286-7834. Letters should be sent as hard copy with an accompanying diskette and should be designated “For Publication.”