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RFS Mitigation Health Pre Screening Report 20 July 2021 (New South Wales)

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Mitigation Crew Review
Health Pre-screening
Prepared for NSW Rural Fire Service by Injurynet Australia Pty Ltd
20 July 2021
Contents
List of Abbreviations 3
Executive Summary 4
1. Purpose and Objectives 7
2. Scope 7
3. About Us 8
4. Context/ Background 10
5. Methodology 13
6. Medical screening tools 14
6.1 Medical Assessment 14
6.1.1 Relevance to medical suitability to perform Mitigation duties 14
6.1.2 Suitability as a screening tool for the Physical Tests 15
6.2 Medical Assessment – Strengthening focus on cardiac risk 17
6.2.1 Focused cardiac risk questioning 17
6.2.2 Use of the Cardiovascular Risk (CVR) Calculation 18
6.3 Current Health Screening – Day of Test 18
6.3.1 PAR-Q 18
6.3.2 Pre-Physical Testing 19
6.4 Physical Tests 20
6.4.1 Arduous Pack Test (APT) 20
6.4.2 Kinetic Assessment Tasks (KATs) 21
7. Future Pre-participation Screening and Real-time Monitoring 22
7.1 The Sports Medicine Australia Adult Pre-exercise Screening System (APSS) 22
7.2 Real-time monitoring during Physical Fitness Testing 22
7.3 Otherscreeningmodalitiesandsuggestionsbeforethedayofthephysicaltnesstest 23
7.4 Staffqualications 23
7.5 Findings 23
8. Summary of Review Findings 25
9. Recommendations 27
10. References 30
Appendices 31
Appendix 1 - Real-time Heart Monitoring 32
Appendix 2 - Other screening questionnaires considered but not preferred 33
Appendix 3 - APSS Screening Tool 34
Appendix 4 - Australian Absolute Cardiovascular Disease Risk Calculator 38
Page 2Mitigation Crew Review
Health Pre-screening Measures
Abbreviation Terminology
ABS Australian Bureau of Statistics
ACSM American College of Sports Medicine
AIDER Assist Inform, Disabled and Elderly Residents
APT Arduous Pack Test
APSS Adult Pre-exercise Screening System
CIFFC Canadian Interagency Forest Fire Centre
CSEP Canadian Society for Exercise Physiology
%CVL Relative Cardiovascular load
%CVS Relative Cardiovascular strain
CVR Australian Absolute Cardiovascular Disease Risk
GP General Practitioner
HR
L
Heart Rate Limit
HR
L sustained
Sustained Heart Rate Limit
KAT Kinetic Assessment Tasks
Kg Kilograms
Km Kilometres
mmHg Millimetres of Mercury
NFCC National Fire Chiefs Council
PAR-Q Physical Activity Readiness Questionnaire
PAR-Q+ Physical Activity Readiness Questionnaire for Everyone
RAF RemoteAreaFireghting
RFS NSW Rural Fire Service
VO
2
max Maximal oxygen uptake
List of Abbreviations
Page 3Mitigation Crew Review
Health Pre-screening Measures
Page 4Mitigation Crew Review
Health Pre-screening Measures
Executive Summary
Injurynet Australia (Injurynet) was engaged by the NSW Rural Fire Service (RFS) to
review the suitability of existing pre-screening measures for mitigation crew roles
and identify viable opportunities for improvement.
This review included a desktop review of existing pre-screening methods and
practices for the Physical Tests, the relevance and appropriateness of the
tests themselves, suggested improvements to the tests and recommended
improvements of the screening tools.
Thekeyndingofthisreviewwasthatthecurrentpre-screeningmethodsand
practices are safe and appropriate for mitigation roles
1
. While the risk of sudden
cardiac events is very low, suggestions are made to reduce the risk as far as is
practicable. Opportunities for improvement are predominantly in the Medical
Assessment, strengthening its use by focusing the doctor on the cardiac risks, and,
whereriskfactorsareidentied,directingthedoctortowardscalculatinga5year
Australian Absolute Cardiovascular Disease Risk (CVR) score. Where that risk score
is raised, referring the participant to their general practitioner for follow up and
further investigations if necessary.
While it is impossible to ensure that no serious cardiac events occur as a result
of Physical Testing, it is incumbent on the RFS to reduce the predictable risk and
preventable cardiac events to as low as is reasonably practicable.
Basedonthendingsofthisreview,itisrecommendedthattheRFS:
Strengthen the content of the RFS Medical Assessment – Specialist v1.0 by:
1. Guiding the examining doctor to understand the risks associated with the
ArduousPackTest(APT)andaskingthemtospecicallyaddressthecardiacrisk
of the participant undertaking it. In doing so the Medical Assessment becomes a
more useful method of evaluating and identifying any predictable and preventable
cardiac events, enabling appropriate medical follow up before Physical Testing is
undertaken.
2. Asking the examining doctor to complete a list of cardiac risk questions, and
instructing the doctor that any ‘yes’ answers would then require a calculation of
CVR score.
3. Obtaining a CVR score on all participants 45 years old and older (where
recommendation 2 applies).
4. WhereaCVRcalculationisperformed,thoseindividualswhohavea≥15%5year
CVR score, should be referred to their doctor for management of risk factors and
to a cardiologist for exercise testing. Evidence should be sought of the results of
this assessment prior to the new entrant or recertifying employee being permitted
to undertake the Physical Testing.
5. AmendingthesummarypageoftheMedicalAssessmentformtospecically
askforanopinionontnesstoundertakePhysicalTestingasisdoneinNSW
RFSMedicalClearancetoundertakeArduousPackTest&Fireghtingform.This
highlights the intensity of the APT to the doctor.
1 Pre-screening methods and practices are also safe and appropriate for other specialist roles which are currently subject to
physical testing by the NSW RFS.
The key nding of
this review was that
the current pre-
screening methods
and practices are safe
and appropriate
Page 5Mitigation Crew Review
Health Pre-screening Measures
6. Adding a CVR calculation at the time of each Medical Assessment. This is
considered a maximal recommendation.
Frequency of Medical Assessments:
7. Biennially until the age of 59 and annually for those 60 and older.
Align the timing of Physical Testing with the Medical Assessment:
8. The Physical Tests (APT and Kinetic Assessment Tasks) should occur within
3 months of a Medical Assessment for a new entrant and no longer than 2
years after a Medical Assessment for recertifying employees under the age of
60, and no longer than one year for those 60 and above.
Update the Screening Questionnaires by:
9. Replacing the Physical Activity Readiness Questionnaire (PAR-Q) with the
Adult Pre-exercise Screening System (APSS).
10. When using the APSS, both Stage 1 and Stage 2 components should be
completed and the forms reviewed by a health professional prior to the
participant being allowed to undertake the Physical Tests.
11. The APSS is required to be used if more than 3 months has passed since
a recertifying employee’s last completed Medical Assessment, and is not
applicable to new entrants who will have a Medical Assessment prior to
undertaking the Physical Testing.
Discontinue same day Pre-Physical Testing:
12. The pre-physical testing of blood pressure and pulse rate are not required if
the other control measures suggested in this report are adopted.
Maintain the Arduous Pack Test:
13. Maintain the Arduous Pack test (APT) for NSW RFS Mitigation Crew Member /
Crew Leader roles.
Maintain the Kinetic Assessment Tasks (KATs):
14. Maintain the KATs as a way of testing function for new entrant Mitigation
Crew and undertake regular reviews (minimum 5 yearly) to ensure that the
tests remain relevant to the duties.
15. The Kinetic Tasks should not be timed.
Real-time Monitoring should be considered for all APT
16. Real time monitoring of the heart rate may be considered in the APT and
would require pre-planning and screening of new entrants to determine their
heartratelimitsaswellastheir%CVLand%CVSin-eld.
Page 6Mitigation Crew Review
Health Pre-screening Measures
Maintain current rst-aid measures
17. Maintainthecurrentprovisionthatadebrillator,oxygenandsuitablyrst
aidqualiedpersonnelareimmediatelyavailablewhenPhysicalTestsare
undertaken.
Points highlighted in red are recommend as minimum requirements. The
recommendations in grey are believed to add value to the assessment of and
reduction in health and safety risk.
The recommendations in this report can also be applied to specialist roles
within the NSW RFS which are currently subject to APT as part of their entry and
recertication.Thisincludesoverseasandinterstatereghtingdeployments,
whereAPTisamandatoryrequirementasspeciedbyalliedagencies.
Page 7Mitigation Crew Review
Health Pre-screening Measures
1. Purpose and Objectives
The NSW Rural Fire Services (RFS) has engaged Injurynet Australia (Injurynet) to
review the suitability of existing pre-screening measures for mitigation crew roles
and identify viable opportunities for improvement. The review is aimed at reducing
the predictable serious adverse cardiac events to as low as is reasonably possible.
Thisreviewincludes,butisnotlimitedto:
‣ A desktop review of the existing pre-screening methods and documentation
‣ A literature search on the use of APT and its appropriateness for mitigation
crews
‣ An interview of a small group of RFS mitigation staff regarding the
appropriateness of the Kinetic Assessment Tasks
‣ Consultation with medical specialists
‣ Recommendations for changes or enhancements to existing practices that
may reduce health risks.
2. Scope
The scope of this project is to review whether the current pre-screening methods
and practices are appropriate to minimise the risk of serious cardiac events during
the assessment of suitability of new entrants for mitigation roles and for existing
employeesseekingrecerticationintheperformanceofmitigationcrewduties.
Thereviewconsiderstheexistingpre-screeningmethodsincluding:
‣ Medical assessment
‣ Pre-testhealthscreening,specicallyPhysicalAptitudeReadiness
Questionnaire (PAR-Q) and health checks undertaken on the day of the Physical
Tests
‣ Physical(aptitude)Tests,specicallytheArduousPackTestandKinetic
Assessment Tasks.
Page 8Mitigation Crew Review
Health Pre-screening Measures
3. About Us
Dr David Milecki MBBS Dip Occ H FRACGP
Dr David Milecki has 32 years’ experience in primary medical
practice in occupational health, medical assessments and
general practice. He founded Injurynet in in 1998 and is
currentlytheChiefMedicalOfcer.
Dr Milecki has extensive expertise in developing and
managing system and outcomes based medical programs
and in training medical practitioners in a wide range of
medical assessments. He performs the Chief Medical
Ofceradvisoryroleforseverallargeorganisationsincluding
Ambulance Victoria, the Country Fire Authority, Boral
Australia, Melbourne Water, Holcim, Citipower/Powercorp
and Essential Energy. He has special interests in health
surveillance for workplace hazards, biological exposures
intheworkplace,tnessforduty,drugandalcoholissues,
injury management and return to work programs.
Hehasextensiveexperienceinreghtingtnessforwork
andiscurrentlytheBrigadeMedicalOfcerfortheCountry
Fire Authority. He is a member of the Australian Medical
AssociationandtheAustralianMedicalReviewOfcer
Association, and is a fellow of the Royal College of General
Practitioners.
Dr Gopaldasani is a Physician with over 15 years’ experience
in occupational diseases. He has worked for the healthcare,
reghtingandtheminingindustryandisnowatthe
University of Wollongong where he is the current Head of
Discipline OHS and the Director of the Centre for Occupational
Public and Environmental Research in Safety and Health
(COPERSH).
Dr Gopaldasani is currently undertaking research in the area of
respirable crystalline silica (RCS) exposure, thermoregulatory
capacityofreghterswhilewearingrespirators,totalworker
health, musculoskeletal disorders in workers, and health of
older Australian workers. He has received research grants
from industry, the NSW Department of Family and Community
Services and the Centre for WHS. He has conducted
quantitative and qualitative research.
Dr Vinod Gopaldasani MBBS MSc PhD
Page 9Mitigation Crew Review
Health Pre-screening Measures
Dr Ahmed Saafan is an occupational health doctor with long
experience in a broad range of occupational health roles. He
has worked across a variety of industries,
Dr Saafan has been published in Australian and international
medical journals on the topic of diverticular disease. He
is a member of the Australian Medical Association, the
Australian and New Zealand Society of Occupational
Medicine, the Australasian Telehealth Society and HL7
Australia. He is a senior medical advisor with a number
ofagencieswithreghtingresponsibilitiesincludingthe
Department of Planning, Industry and Environment (NSW),
Forestry NSW and played a major part in the Ambulance
Victoria Covid-19 response.
Dr Ahmed Saafan MBBS Dip Occ H
Dr Sugeesh Pathirana is an Occupational Physician with 16
years’ clinical experience.
Dr Pathirana’s professional background centres on
occupational and environmental medicine. He has
collaborated on Worker’s Compensation cases with
corporates and major insurers and has extensive expertise
ininjurymanagementandtnessforworkassessments.
He hold accreditations with a number of government bodies
to perform specialised medical assessments and provides
Independent Medical Examinations in his capacity as a
specialist Occupational Physician.
Dr Sugeesh Pathirana MBBS; FAFOM
Harry Papagoras is an experienced physiotherapist working
in the occupational health domain for 20 years. He has
designedtnessprogramsandtrainedphysiotherapists
in functional assessments. He has wide experience with
screeningtestingforphysicaltness.Heisaphysiotherapy
clinical advisor with WorkSafe Victoria, the Transport
Accident Commission and Comcare.
Harry Papagoras B Applied Science (Physio)
The report was written by Dr Milecki, Dr Gopaldasani and Dr Saafan and peer
reviewed by Dr Pathirana and Mr Papagoras.
Page 10Mitigation Crew Review
Health Pre-screening Measures
4. Context/ Background
TheNSWRuralFireService(RFS)isthelargestvolunteerreserviceintheworld
whoseworkforcecomprisesofover76,000volunteerreghtersandover1000
staff. Mitigation crews are RFS staff who undertake a variety of tasks including
hazard reduction tasks, the Assist Inform, Disabled and Elderly Residents (AIDER)
program, and state-wide specialist operational support.
New entrants seeking employment are required to undertake medical and physical
assessmentstohelpdeterminewhethertheyaresufcientlytandsafelyableto
perform the inherent requirements of the mitigation crew roles. Existing mitigation
employeesseekingrecerticationalsoundertakeregularmedicalandphysical
assessmentstodemonstratetheirongoingtness.Assessmentofmitigationcrew
membersinvolvesundertakingaphysicaltnesstestappropriateforarduousbush
reghtingorsimilarintenseandsustainedphysicalactivity.
The following are the key serious adverse health events that could occur as the
resultofparticipantsundertakingNSWRFSPhysicalTesting:
1. Cardiac; including sudden death
2. Respiratory
3. Metabolic
4. Musculo-skeletal
5. Other
In reality, most medical issues can be safely managed in the testing environment
exceptforsuddenunpredictedcardiacevents.Forexampleasignicantexercise
induced asthma attack can be managed with relieving sprays while awaiting an
ambulance. Musculoskeletal conditions are rarely life threatening. Metabolic
conditions including insulin dependent diabetes can be managed with adequate
planning.
On20May2021anexistingmitigationcrewmemberseekingrecertication
suffered a cardiac event while participating in the APT. The participant was
successfully resuscitated. In his message dated 21 May 2021, Rob Rogers,
Commissioner of the NSW RFS, outlined this review as being aimed at identifying
steps that could reasonably prevent a recurrence. The Commissioner emphasised
the RFS senior leadership’s absolute commitment to providing the safest possible
work environment for members.
Mitigationcrewsarerequiredtoundertakebushresuppressioninarduous
conditionsinsupportofspecialistoperations.Thetnesstoreghtisconsidered
for Mitigation Crew in this context. The tools discussed in this document are not
directlyusedtoaddresstnessforgeneralreghtingduties.
AreviewoftheinjuriesincurredduringtheAPTandKATsoverthelast5nancial
years at the RFS indicates that injury rates vary between 0 and 11 injuries each year.
Refer to Table 1 below for further details regarding the body parts affected and the
nature of the injuries incurred.
New entrants seeking
employment are
required to undertake
medical and physical
assessments
Mitigation crews are
required to undertake
bush re suppression
in arduous conditions
Page 11Mitigation Crew Review
Health Pre-screening Measures
Injury Summary
Body Part(s) Affected and
Nature of Injury
FY2020/21 FY2019/20 FY2018/19 FY2017/18 FY2016/17 Grand Total
Grand Total 11 2 10 3 0 26
Foot/toes 3 1 1 1 0 6
Minor wound (e.g. cuts, grazes,
bruising)
1 0 0 0 0 1
Muscle/tendon strain/
dislocation
2 1 1 1 0 5
Hand/ngers 0 1 0 0 0 1
Minor wound (e.g. cuts, grazes,
bruising)
0 1 0 0 0 1
Head/neck 1 0 0 0 0 1
Breathingdifculties 1 0 0 0 0 1
Internal organs 4 0 2 0 0 6
Breathingdifculties 0 0 1 0 0 1
Faint/dizziness/collapse 3 0 0 0 0 3
Heart related 1 0 0 0 0 1
Psychological 0 0 1 0 0 1
Leg/hip/knee 2 0 4 0 0 6
Minor wound (e.g. cuts, grazes,
bruising)
0 0 1 0 0 1
Muscle/tendon strain/
dislocation
2 0 3 0 0 5
Other/Multiple body parts 0 0 1 0 0 1
Muscle/tendon strain/
dislocation
0 0 1 0 0 1
Torso 1 0 2 2 0 5
Muscle/tendon strain/
dislocation
0 0 2 2 0 4
Other/Multiple injuries
(Breathingdifculties;faint/
dizziness/collapse)
1 0 0 0 0 1
Injury by Body parts and Nature of Injury over 5 nancial years
Upuntil2011noAustralianfatalitieshadbeenreportedasresultingfromtheAPT(BushreCRC2011).There
arereportsofcardiaceventsasbeingariskfromPackTests.AtleastsixU.S.wildlandreghtersdiedafter
suffering an adverse cardiac event following the APT from 2002 to 2008.
The statistics from NSW RFS show only one serious adverse event, a single cardiac case, which is the case that
promptedthisreview.Thisinformation,andthefewinternationalreports,conrmtheriskofseriouscardiac
events during the APT as being very low.
Consequently, this review will focus on the prevention of sudden onset cardiac events, including cardiac
END
arrest and death with the aim of reducing the risk of this occurring. Screening tools will be reviewed in this
context. Physical testing in general is a safe activity for most people, but the risk is greatest among individuals
performing unaccustomed physical activity, especially vigorously intense physical activity.
Page 12Mitigation Crew Review
Health Pre-screening Measures
Pathway for recertifying employees
Current NSW RFS Screening Process
New Entrant
Medical
Assessment
Par-Q and
Pre-Physical
Testing
ALL CLEAR
NOT ALL
CLEAR
FAILED /
REFER TO GP
Kinetic Tasks
PASS
Arduous
Pack Test
Arduous
Pack Test
PASS
TESTING
FAIL PASS
Medical Advisor
Contact
FAIL
Pathway for new entrants
(where medical assessment is pending)
Re-Certifying
Employee
Medical
Assessment
Par-Q and
Pre-Physical
Testing
ALL CLEAR
NOT ALL
CLEAR
(where medical assessment remains valid)
PASS
END
Arduous
Pack Test
Arduous
Pack Test
PASS
TESTING
FAIL PASS
FAILED /
REFER TO GP
FAIL
Page 13Mitigation Crew Review
Health Pre-screening Measures
5. Methodology
The following NSW RFS documentation was reviewed to establish the steps
undertaken when recruiting a new candidate as a mitigation crew member or crew
leaderandthesubsequentconductoftheAPTandKATs:
‣ NSW RFS Role description – Mitigation Crew Member (RFS10216 July 2019)
‣ NSW RFS Role description – Mitigation Crew Leader (RFS202 16 July 2019)
‣ NSWRFSRoleProleReport–StateMitigationServices(May–June2013)
‣ NSW RFS Mitigation Crew Member / Crew Leader Medical & Physical Capability
Assessment Information Booklet (undated)
‣ NSW RFS Mitigation Crews Kinetic Assessment Tasks February 2015
‣ NSW RFS Physical Testing Pre-Screening Consent Form 2020
‣ NSW RFS Medical Assessment Specialist Form – Version 1.0 17 February 2015
‣ NSW RFS Physical Activity Readiness Questionnaire (PAR-Q) 2017
‣ NSW RFS Pre-Physical Testing Worksheet 2020
‣ State Mitigation Support Service (SMSS) APT Fail Suitable Duties Report (Ethos
Health)
‣ SMSS Physical capability Assessment Overall Score Sheet (undated)
‣ NSW RFS Message from the Commissioner 21 May 2021
Inadditiontotheabovespecicdocumentsformitigationcrews’recruitment,the
followingdocumentswerealsoreviewed:
‣ NSWRFSMedicalClearancetoundertakeArduousPackTest&Fireghting
(undated)
‣ NSWRFSArduousFireghterProgramme–BriengforParticipants
(December 2016)
‣ NSWRFSArduousFireghterProgramme–FacilitatorsguideDecember2016
‣ NSWRFSRemoteAreaFireghterFitnessTestingApril2004
A literature search on the use of the APT and its appropriateness for mitigation
crews was also conducted. Rapid bibliographic searches were performed to identify
empirical research from Google Scholar. Due to the time limitation for this report,
other databases such as ProQuest, Medline, Scopus, BioMed, Central Embase,
Web of Science, PubMed, CINAHL, and Access Medicine were not searched. Grey
literature such as the Canadian Interagency Forest Fire Centre website and the
National Fire Chiefs Council (UK) website were also searched.
Page 14Mitigation Crew Review
Health Pre-screening Measures
6. Medical screening tools
6.1 Medical Assessment
6.1.1 Relevance to medical suitability to perform Mitigation duties
The NSW RFS Medical Assessment - Specialist is primarily a tool for identifying
whether new entrants are medically suitable for the role of Mitigation Crew Member
or Leader, including whether they have any medical conditions that would limit them
from performing the inherent requirements of the role or whether performing the
role will place them in harms’ way.
The medical assessment is also undertaken 2 yearly for Mitigation Crew Members
orLeaderstomedicallycheckontheirongoingtnessfortherole.Inthiscase,
the examining doctor may identify new or worsened conditions that impact on an
employee’stnesstosafelyundertaketherole.
The NSW RFS Medical Assessment - Specialistiscomprisedofthreekeyelements:
1. Detailed medical questionnaire that is completed by the candidate or employee
prior to attending the assessment
2. Medicalexaminationincluding:
a. Comprehensive review of the medical questionnaire where the examining
medical practitioner explores and seeks more information regarding any issues
identiedinthequestionnaire
b. Routine medical testing
3. Summaryofthendingsoftheassessment
a. Clearance (or not currently) to undertake the role and the physical assess-
ment.
Specicmedicalassessmentformsareprovidedtotheexaminingmedical
practitioner to guide the assessment.
Page 15Mitigation Crew Review
Health Pre-screening Measures
Medical questionnaire
The medical questionnaire that is completed by new entrants or recertifying
employees prior to the Physical Testing consists of two main sections. The
rstsectioncontainsdemographicdetails,workandoccupationalhistory,and
the second contains the medical history with a focus on respiratory problems,
especially asthma. There are some questions regarding cardiovascular risk.
The examining doctor is asked to review the medical history questionnaire with
the candidate or employee, and to seek more information regarding any issues
identied.
Medical examination
The examination is comprised of routine components, with a particular focus on
the musculo-skeletal system.
Summary Page
The summary page is completed by the examining doctor who is asked to “carefully
consider” the risk of active and other relevant medical conditions including cardiac,
when determining the outcome of the assessment, that is, whether the participant
“cleared to undertake specialist functions and physical capability assessment” or
“not cleared…. Further medical assessments required”.
The summary page provides neither a place for the doctor to explain their decision
nor the option to state what assessments are recommended, if further assessment
is required. Injurynet has reviewed these forms on a number of occasions when the
doctor has declared “not currently cleared” and the reason/s for this outcome were
not apparent.
Findings
Most, if not all, emergency services jurisdictions nationally and internationally
undertake medical assessments on candidates prior to employment.
The NSW RFS Medical Assessment - Specialist for mitigation crew candidates and
employees otherwise has a broad ranging and appropriate questionnaire in order
to elicit relevant medical information and an examination that is thorough and
appropriate.
Themedicalassessment,whenperformedbyadoctorisappropriateandtfor
purpose as a tool for assessing medical suitability for Mitigation Crew work, both
priortoemploymentandasarecerticationmedicalwhenassessingongoing
tnessforwork.
The medical assessment can be strengthened by the recommendations in Table 3.
6.1.2 Suitability as a screening tool for the Physical Tests
The medical questionnaire has questions scattered throughout it that are relevant
to the risk of coronary events including a history of cardiovascular conditions,
diabetes, renal disease, smoking history and family history of coronary artery
disease.
The medical examination section also includes a number of features that are
relevant to the risk of coronary events such as recording the height, weight, blood
pressure, pulse rate, rhythm and heart auscultation.
Page 16Mitigation Crew Review
Health Pre-screening Measures
The summary page is completed by the examining doctor who is asked to “carefully
consider” the “cardiac risk, musculo-skeletal status and other active health
conditions”, prior to determining the outcome of the assessment.
Findings
It is not clear to the examining doctor that the Medical Assessment is a screening
tool for the Kinetic Tests and APT, and in particular, the requirement for intense
physicaleffortintheAPT.Wesuspectthattheinsufcientexplanationofthe
requirements of the APT and the lack of focus on cardiac risk tends to an under-
reporting of risk by the examining doctor. It is suspected that on occasion, people
with cardiac risk may be unsuitably “cleared”. It is recommended that the summary
pageshouldaskspecicquestionsaboutthepotentialrisksofthePhysicalTesting.
Thecurrentmedicalassessmentisgenerallytforitspurpose.Itprovidesasound
medicalbasisforensuringthatparticipantsaremedicallyttoundertakethe
Physical Tests. However, there are steps that can be taken to sharpen its focus on
the risks and to ensure the doctor addresses the cardiac risk/s more directly. Refer
to the improvements listed in the below table for further details.
Type Component Change
Timing Medical Medicals must occur before Physical Testing of new en-trants
and recertifying employees when 2 years have elapsed since
the last medical.
Timing Medical Physical Testing should occur ideally within 4 weeks after a
medical (when it is due) but can be undertaken up to 2 years
after the Medical provided there is no change to the medical
condition of the new entrant or recertifying employ-ee.
Content Body of forms Add a section to summarise medication.
Content Body of forms Group cardiac risk questions into a single location and ask to
doctor to address the risk more directly. Refer to Section 6.2.1
as example.
Content Body of forms More explicitly explain the Physical Assessments, in par-
ticular the APT noting the VO2 consumption required and the
endurance component.
Content Summary Page Instruct the doctor to recommend a CVR (see 6.2.2) calcu-
lation when any of the cardiac risk questions are answered
afrmatively
Content Summary page Allowing space for the doctor to explain the reasons if the
participant is not cleared
Content Summary page Expandtheoptionsregardingtness,toincludeseparate
eventualitiesi.e.unttemporarily,permanently
Content Summary page Ask the doctor what further assessments are recommended (if
they are)
Content Summary page Askthedoctortospecicallyandseparatelycommentonany
risk of performing the APT
Information Job Description Takestepstoensurethatthejobtaskproleandanyother
relevant information is available to the examining doctor
Additions Other services CVR calculation where parameters met
Recommended Improvements to the Medical Assessment
Page 17Mitigation Crew Review
Health Pre-screening Measures
As the Medical Assessment is recommended to remain the central screening tool
for identifying cardiac risk, the Physical Assessment should ideally follow a medical,
or at a minimum take place in the period when a Medical Assessment is “current”.
It is reasonable to consider a Medical Assessment as “current” for up to 2 years.
This is because cardiac risk changes gradually with age and 2 years is a common
intervalforitsreviewandreconsideration.Dependingonage,otherreservices
reassessmedicaltnessafteralongerdurationoftime.Forexample,Fireand
RescueNSWre-examinesmedicaltnesseveryonetoveyearsdependingon
age. A simpler regime is suggested with 2 yearly being conservative in keeping with
other industries and the aims of this report.
6.2 Medical Assessment – Strengthening focus on cardiac risk
6.2.1 Focused cardiac risk questioning
Based on our review, Injurynet recommends focusing the cardiac risk questions into
one location in the medical assessment and adding instructions to the doctor for
suitable follow up. An example of the questions is seen below in Table 2. This is a
sample list of questions to be answered by the examining doctor. The doctor would
be instructed that if the participant is 35 years old or above and has answered yes
to any of the questions in the table, that the participant should formally have their 5
year CVR score calculated. This will involve either reviewing recent pathology (lipids,
glucose, Hba1c) or ordering them anew and may include a resting ECG.
Risk Questions YES NO
Currently performing moderate intensity exercise (at least fast walking) for
less than 90 minutes total per week?
Recent history of chest pain, dizziness, SOB, palpitations
Familyhistoryofheartdisease(rstdegreerelative<55yearsold)
Smoker (or quit within the last 12 months)
Have they been told that they have raised cholesterol
Diabetes
Raised blood pressure (above 140/90 – either level)
Any abnormalities of the pulse, heart or cardiovascular system found on
exam
BMI > 30
Sample of focused heart risk questions
The Physical
Assessment should
ideally follow a
medical, or at a
minimum take place
when a Medical
Assessment is current
Page 18Mitigation Crew Review
Health Pre-screening Measures
6.2.2 Use of the Cardiovascular Risk (CVR) Calculation
Discussion
In Australia, the calculator in common use for estimating the risk of cardiovascular
events, based on Framingham Risk Equation, is the Australian Absolute
CardiovascularDiseaseRisk(CVR)Calculator.TheCVRCalculator helpshealthcare
professionals calculateaperson’sriskofsufferingacardiovasculareventinthe
next ve years.Itcanbeappliedtoindividualsbetweentheagesof35to74without
existing cardiovascular disease or not already known to be at increased risk of
cardiovascular disease.
Therisksofanindividualcanbestratiedintolowrisk(<10%absoluteriskofCVD
events over 5 years), moderate risk (10-15% risk over 5 years) or high risk (>15% risk
over5years).Thisriskstraticationisusedbymedicalpractitionersintheirclinical
practice to educate patients about their risk and to inform their management
regarding other interventions including, further testing to prevent cardiovascular
events.
Thescoreisbasedonseveralfactorsincludingageandgender(non-modiablerisk
factors), blood pressure, smoking, diabetes, total cholesterol, HDL cholesterol and
thepresenceofleftventricularhypertrophy(modiableriskfactors).
Knowledge of a participant’s risk level provides additional information about who is
more likely to be unsafe in a situation of intense exercise such as the APT. It could
identify which participants would need additional screening or clearance prior to
undertaking the physical tests after being referred to their GP.
The follow up required for different risk strata can include referral to the GP for risk
factor management and to a cardiologist for an exercise test.
ThebenetofCVRcalculationisthatitisaquantitativetoolthathasthresholds
which can indicate that further actions should be taken. Compared to qualitative
questioning in a medical history, it is relatively objective. CVR calculation is
most commonly undertaken by doctors, simply because they have access to the
patient’s history and pathology results. If the pathology results (valid within the last
6 months) are known, then using a simple questionnaire, anyone can perform the
calculation via entering the information at https://www.cvdcheck.org.au/calculator/.
6.3 Current Health Screening – Day of Test
Introduction
In the current process, the Physical Activity Readiness Questionnaire (PAR-Q) is
completed on the same day as the Physical Testing. It is an important part of the
screening process. In some cases where a Medical Assessment is pending, it is the
key screening tool for the Physical Testing.
6.3.1 PAR-Q
The Physical Activity Readiness Questionnaire (PAR-Q) is a short, simple
form designed to identify major cardiovascular, respiratory, metabolic and
musculoskeletal diseases and conditions that may be aggravated by physical
activity. It has been validated for use in anyone aged between 15 and 69 years,
however, above 69 years of age the PAR-Q has a high rate of false positives
and false negatives (Maranhao-Neto et al., 2013). The use of a Physical Activity
Readiness Questionnaire is recommended in the AFAC Guidelines 2002 in the
PhysicalPerformanceAssessmentssection(AppendixF:BPage10).
Knowledge of a
participant’s risk level
provides additional
information about who
is more likely to be
unsafe in a situation of
intense exercise
Page 19Mitigation Crew Review
Health Pre-screening Measures
Findings
Although the PAR-Q can be used to assess whether it is safe to engage in the
physicaltnesstest,itdoesnotprovideanyindicationoftheriskofdeveloping
an adverse health event such as a stroke, heart attack or pulmonary arrest. It
alsodoesnotcollectinformationonthespecicmedicationstheparticipantmay
be using which could affect readings of blood pressure or even affect the ability
to participate in the physical test. The PAR-Q also does not elicit when the last
medical check-up was completed, an important piece of information required to
assess currency of the answers provided in the questionnaire. Lastly, the PAR-Q is
conservative, leading to a high number of false positives, (Warburton et al., 2011)
which defeats the purpose of the screening exercise. Its continued use is not
supported.
6.3.2 Pre-Physical Testing
Onthedayofthephysicaltnesstest,theRFSutilisesapre-physicaltesting
worksheet where the heart rate, heart rhythm and blood pressure measurements
are taken for each participant. The document states a cut-off systolic blood
pressure of 160 mmHg and a diastolic blood pressure of 95 mmHg. This is a
higher cut-off than the American Heart Association guidelines which re-categorises
hypertension as a systolic blood pressure of greater than 130 mmHg and a
diastolic blood pressure greater than 80 mmHg (Whelton et al., 2018). The last
Australian Bureau of Statistics (ABS) National Health Survey 2017-2018 used the
WorldHealthOrganisationdenitionofhypertensionofasystolicbloodpressure
greater than or equal to 140 mmHg or a diastolic blood pressure greater than or
equal to 90 mmHg (ABS, 2018).
It is noted that the same day pre-physical testing was instituted as a means to
exclude recruits who had not undergone a Medical Assessment prior to the day
of the Physical Tests based on parameters of blood pressure >160/95 (thereby
determined to have a risk factors for the presence of cardiac disease) and pulse
rate greater than 100 beats per minute (indicating that their pulse rate may be
too high and close to their maximum safe heart rate). The pre-physical testing
is not used for recertifying employees performing the regular Physical Testing,
irrespective of when their last medical had occurred. More recently, the same day
pre-physical testing has been used informally for all new recruits, whether or not
they have undergone a Medical Assessment.
Findings
TheMedicalAssessmentincludesidenticationofthosewithundiagnosedor
poorly controlled hypertension and cardiac rhythm disturbances. It is unsafe to
subject a new entrant or a recertifying member to Physical Testing including the
APT without consideration of such diagnoses. The Medical Assessment is the best
way to assess these conditions by obtaining a history including review of current
medication and take blood pressure and pulse readings. The assessing doctor is
wellplacedtodiagnosesuchconditionsandtodetermineiftheyaresignicant
enough to warrant follow up prior to Physical Testing.
The pre-physical testing has provided basic health parameters in circumstances
where no medical has been performed and the safe thresholds are exceeded,
it would be considered unsafe for the participant to undertake an APT. It is
acknowledged that this is a less comprehensive test than the Medical Assessment
and does not include diagnosis of any conditions that may exist. It nevertheless
was useful for the situation where the Medical Assessment was pending to exclude
those with high blood pressure and an unexplained tachycardia from undertaking
The PAR-Q does not
provide any indication
of the risk of
developing an adverse
health event
Page 20Mitigation Crew Review
Health Pre-screening Measures
the Physical testing.
Thereislittleadditionalbenetfromconductingthesamedaypre-physicaltesting
if adequate medical screening has been done by the completion of a Medical
Assessment prior to the Physical Testing.
6.4 Physical Tests
Introduction
Physical tests are key parts of the NSW RFS testing protocols. Both components
need to be successfully completed at recruitment and at annual intervals thereafter.
6.4.1 Arduous Pack Test (APT)
The APT is one of three work capacity tests developed by the United States Forest
Servicetoassessthetnessofrecruitsacrossthedifferentworkareasinvolved
inwildlandreghting(BushreCRC,2011).TheAPTinvolveseldworkrequiring
a high level of endurance and physical conditioning and was developed to assess
thetnessofrecruitstoactivelyengageinreghtingtasks.TheAPTrequiresa
4.8km walk while carrying a 20.4kg weight and must be completed in 45 minutes,
ifparticipantisunder68kgsa15.4kgweightiscarried.TheVO₂Maxforthistest
is quoted as being 45ml/kg/min (RFS Medical Clearance to Undertake APT &
Fireghtingform),whichrequiressignicantexertionforasustainedperiod.The
othertwotestsarethemoderateeldtestandthelightwalktest.
Lordetal.(2012)validatedtheuseoftheAPTandtheeldwalktestagainstfour
criticalbushresuppressiontasksnamelyhosedrag,rakehoe,blackouthose
dragandblackoutrakehoeandfoundthatboththeAPTandtheeldwalktest
overestimated the work intensity of the tasks, thus questioning the acceptability
of the level of overestimation to the health and safety risk posed by the tests.
Both tests had strong correlations to the four critical tasks thus being suitable as
ascreeningfortnessofactivereghters.ThisndingissupportedbyParker,
BayneandClifford(2014)whointerviewedruralrepersonnelinNewZealand.
TheyfoundthattheruralreofcerssupportedtheAPTforactivereghters,
however, did not support it for other crews.
On reviewing the role description of the RFS Mitigation Crew Member and the RFS
Mitigation Crew Leader, it is clear that the primary purpose of the mitigation crew is
hazard reduction works, the AIDER program and specialist operational support. The
roledescriptionindicatestherequirementforactivereghtingbymitigationcrew
in the essential requirements section where it is stated “A level of physical tness
appropriate for arduous bush reghting or similar intense and sustained physical
activity”.
Findings
MitigationCrewarerequiredtoundertakebushresuppressioninarduous
conditionsinsupportofspecialistoperations,andbeyondgeneralreghting
requirements. This includes operating in steep and heavily vegetated terrain away
fromthesupportofreghtingappliancesforanentireshift,andhandtoolcontrol
linepreparationinextremelyhotandsmokyconditionsadjacenttores.Overall,
this review has shown that Mitigation Crew work is heavy and at its peak requires
physicaleffortatthelevelofarduousreghting,whichismoreakintoRemote
AreaFireghtingTeams(RAFT).Consequently,theAPTisanappropriate
testandistforitspurpose.
Mitigation Crew work
is heavy and at its
peak requires physical
effort at the level of
arduous reghting
Page 21Mitigation Crew Review
Health Pre-screening Measures
6.4.2 Kinetic Assessment Tasks (KATs)
The KATs developed by Ethos Health (February 2015) are a series of 13 physical
activities that were designed to simulate the physical activities and functional
physical requirements of the Mitigation Crew role. In general, the tasks test range
of movement, strength of various muscle groups, core strength, balance and
coordination.Severalofthetasksaretimed,therebygivinganindicationoftness
and endurance. The tests are scored using a bespoke scoring method.
ManyreghtingorganisationsinAustraliaundertakeKineticTestingonnew
recruits.Thetestsarefairlystandardforreghtersbutarealsousedforhazard
reduction workers such as RFS Mitigation Crew staff. The tests are the same as
reghtersforthesegroups.
In order to understand if KATs are relevant to the Mitigation Crew and Leader roles
one of our panel interviewed a small number of senior staff who are experienced
in the day to day work of the crews and are familiar with the KATs. Due to limited
timeframes in preparing this report the consultation with current RFS staff was
restricted to a small sample group.
All interviewees agreed that the various activities within the Kinetic Tasks do
simulate the actual role to a high degree, despite some of the tasks not being one
for one simulations.
One interviewee commented that he did not think that the timing of some of the
tasks is relevant, as in reality the work is not paced and failing to complete tests
within the designated time was therefore not important. All thought the Kinetic
Tests provided meaningful information about ability to perform the required tasks
for the Mitigation role.
Findings
Based on this assessment, from interviewing a small number of RFS staff, it is
apparent that the KATs do simulate several of the key physical requirements of
therole.TheKineticTestsarerelevantandappropriateforassessingtnessfor
Mitigation Crew and Leaders roles who are candidates for employment. They do
not have a meaningful role in assessing existing employees, who can have their
ability to complete their work tasks assessed by their work performance.
The Kinetic Tests should remain part of the recruitment testing for Mitigation roles.
Timingofsomeofthetasksmakesthemdefactotnesstests,whereastheyare
better used as tests of function. Fitness and endurance testing is better undertaken
using other methods. Hence it is recommended that the timing requirement of
the Kinetic test is removed. It is important that the Kinetic Tests are reviewed on
a regular basis to ensure that they remain relevant to the role. 5 year minimum
reviews are recommended.
The various activities
within the Kinetic
Tasks do simulate the
actual role to a high
degree
Page 22Mitigation Crew Review
Health Pre-screening Measures
7. Future Pre-participation Screening and Real-time
Monitoring
Introduction
Injurynet considered the use of other pre-exercise screening tools and
questionnairesinordertoidentifywhichmightbeofbenetinthefuturestateof
screening. We also considered the use of real-time monitoring during the APT to
monitor for measurable parameters exceeding safe limits.
7.1 The Sports Medicine Australia Adult Pre-exercise Screening
System (APSS)
The APSS is a screening tool designed to identify people who may have a medical
condition that puts them at an elevated risk of an adverse health event occurring
whenundertakingaphysicaltnesstest(SMA,2019).Itconsistsoftwostages:
‣ Stage 1 – This is a compulsory stage aimed at identifying individuals with a
known disease, and/or signs and symptoms of disease that would put them at
a high risk of an adverse health event due to physical exertion while undertaking
aphysicaltnesstest.Italsoincludesaquestiononthecurrentphysical
activity status of the individual which would in turn determine the allowed
physical activity intensity. This stage may be self-administered or administered
by a competent health professional.
‣ Stage 2 – This is a recommended stage aimed at identifying the level of
exertion(physicalactivitytypeandintensities)thatindividualswithidentied
risk factors and/or other conditions could be exposed to without the risk of
an adverse health event occurring. Information provided by the applicant in
this stage is to be reviewed by a competent health professional. This includes
exercise physiologists and other similarly trained exercise professionals, nurses,
physiotherapists and doctors.
Injurynet prefers the use of the APSS as the preferred pre-exercise screening test
because of its additional focus on cardiac risk. Please refer to Appendix 3 for full
details of the APSS.
7.2 Real-time monitoring during Physical Fitness Testing
Despite the best possible pre-physical testing and screening, the risk of adverse
events cannot be completely mitigated. The use of real-time monitoring devices
whilstundertakingthephysicaltnesstestwouldaddtothemitigationefforts.
Themostpracticalreal-timemonitoringdeviceduringphysicaltnesstestsisthe
heart rate. Heart rate monitoring is a useful indicator of cardiovascular strain (See
Appendix 1 for full details). It is noted that implementing the use of real-time heart
monitoring will incur an initial capital expense for the RFS and may limit the number
of participants able to undertake the test at one time.
The use of real time ECG monitoring is cumbersome and requires medical expertise
thatwouldmakethisoptionimpracticableforuseintheeld.Similarly,oxygen
saturation, measurement of respiratory function and blood pressure monitoring has
not been proven as practical and useful in monitoring of exercise, particularly in an
outdoor setting used for the Physical Testing.
Despite the best
possible pre-physical
testing and screening,
the risk of adverse
events cannot be
completely mitigated
Page 23Mitigation Crew Review
Health Pre-screening Measures
7.3 Other screening modalities and suggestions before the day
of the physical tness test
The RFS Mitigation Crew Member / Crew Leader Medical & Physical Capability
Assessment Information Booklet recommends a preparation and training plan to
assist in undertaking the APT. This includes an 8-week plan that builds participants’
capability to undertake the APT. Information on the suggested training program
should be made available to candidates in job advertisements and in website
information for prospective candidates.
7.4 Staff qualications
MedicalAssessmentsshouldbeundertakenbyqualiedmedicalpractitioners.
Follow up of cardiac risk scores, when undertaken should also be completed by
trained medical practitioners, since the results will need to be conveyed to the
participant and their treating doctors.
ResultsoftheAPSS,whenused,shouldbereviewedbyqualiedhealth
professionals. This includes exercise physiologists and other similarly trained
exercise professionals, nurses, physiotherapists and doctors.
Real-timetestingofheartrateduringtheAPTcanbeundertakenbytrainedrstaid
staff with the use of a training guide.
7.5 Findings
APSS
The APSS is primarily designed to help exercise professionals determine a suitable
and safe exercise program for clients taking into account recent exercise levels
and health risk factors. In contrast, its proposed use for the RFS is to identify those
who have risk factors and require further assessment of their risk prior to them
undertaking the Physical Tests.
The APSS should be used when more than 3 months has passed since the most
recent Medical Assessment, or as routine prior to participation in physical testing.
It is not required for new entrants as it does not adequately replace the Medical
Assessmentasariskassessmenttool.Whereevidenceofriskisidentiedbythe
APSS review, the case should be escalated to the RFS Health & Wellbeing Team
for a health professional review. Health & Wellbeing would then review the case,
including checking prior Medical Assessments to identify if the problem is new or
something that has been previously addressed. The RFS may obtain the assistance
of a Medical Advisor if the case is more complex. If the information is new or of any
concern, the participant would be sent for a further Medical Assessment prior to be
considered safe to undertake the Physical Tests.
The proposed use of
the APSS for the RFS
is to identify those
who have risk factors
and require further
assessment of their
risk
Page 24Mitigation Crew Review
Health Pre-screening Measures
Timing of APSS
Currently the PAR-Q is completed on the day of the Physical Tests and the
results are reviewed by health professionals currently available onsite. If an
issueisidentiedbythePAR-Q,thenthenewentrantorrecertifyingemployee
does not undertake the Physical Testing and may be excluded from successfully
commencingorcontinuingintherole.Notallwhowillhaverisksidentiedintheir
APSS response are actually unsafe to undertake the APT, so there are potential
benetsofnotlosingsuitablecandidatesiftheAPSSwereundertakenseparately
and prior to the day of the Physical Testing. The number of unnecessary exclusions
would be minimised by use of Stage 2 of the APSS that has several additional
questions that are not included in the version of the Par-Q currently in use by the
RFS.
Injurynet recommends that the APSS is completed and received by the RFS at
least 2-3 weeks prior to the Physical Testing. Tests with no positive answers can
be considered low risk and allowed to participate in the Physical Testing without
further review. Those with yes answers should be reviewed by a health professional
from the RFS Health and Wellbeing team. The Health and Wellbeing staff will
determine if the person is safe to undertake the Physical Testing or that the
participantneedstoobtainfurthermedicalinformationandconrmationofsafety
priortomakingadeterminationontnesstoparticipate.Thisprocesswillallow
adequate time for some participants to safely participate who might otherwise
have been excluded.
Real-time heart monitoring
This is recommended for use during all APTs. Training documentation and technical
details will need to be prepared prior to implementation.
Training Log Book
Review of adequate participation in a preparatory training will help encourage
participants to prepare adequately. A log book will be helpful in promoting suitable
training. Other measures can be used including arranging group training sessions
for existing staff.
Injurynet recommends
that the APSS is
completed and
received by the RFS at
least 2-3 weeks prior
to the Physical Testing
Page 25Mitigation Crew Review
Health Pre-screening Measures
8. Summary of Review Findings
The RFS conducts Medical Assessments and Physical Testing on new entrants
andrecertifyingMitigationCrewMembers&Leaderstoensurethattheyaretto
undertake their duties. The Physical Tests require a high level of physical effort
(estimated to be 45 mL/kg/min) for a sustained period of up to 45 minutes. The
testing itself poses health risks, most acutely seen in sudden cardiac events.
The available information indicates that the APT has led to a very low rate of
cardiacevents.Onlyonecardiaceventhasoccurredinthelastveyearsduring
RFS APTs. Given the low rate of serious adverse events, it is recommended
that simple steps that have the potential to reduce the risk even further, while
acknowledging at the same time that no screening tests can prevent 100% of
events.Coronaryarterydiseasecanoccurinthosewithminimalornoidentiable
risk factors.
The Medical Assessment, Screening Tools and the Physical Tests themselves
have been reviewed. Overall, the current Medical Assessment and screening tests
are considered appropriate and safe to lower the risk of physical injury but can be
improved to help reduce the risk further.
The Arduous Pack Test is an appropriate test for this cohort if they are required to
reght.TheKineticTaskareconsideredrelevantandappropriate.Itisimportant
that the Kinetic Tasks are reviewed on a regular basis to ensure that they remain
relevant to the role. 5 year minimum reviews are recommended. As the last review
was undertaken in 2015, this should be done in the near future. The screening
tools used for safely undertaking the physical load of the APT and the work itself
are reasonable but have room for improvement to reduce even further the risk of
adverse events.
The main recommendations made include obtaining a better understanding of the
participant’s risk of suffering a cardiac event by having the Medical Assessment
more directly address this and initiating a calculation of the 5 year cardiovascular
riskwithfollowupofthoseidentiedasbeingpotentiallyatrisk.
The current practice is to undertake the APT annually and a medical assessment
biennially. It is considered safe and reasonable to continue this practice until
the age of 60 when annual medical assessments are recommended. The risk of
cardiovasculardiseaseincreaseswithageandismorelikelytobesignicantover
the age of 60. Younger women have a lower risk of cardiac disease but not at a
level to exclude them from undertaking biennial assessments. Over 50, women
have similar increases in risk to men.
In addition, we have recommended updating the qualitative screening tool used
to become the APSS. This is to be used when more than 3 months has elapsed
since a Medical Assessment has been undertaken for recertifying Mitigation
Crew. The APSS should be reviewed by a health professional. Where evidence
ofriskisidentiedbytheAPSSreview,thecaseshouldbeescalatedtotheRFS
Health & Wellbeing team. They would then review the case, including checking
prior Medical Assessments to identify if the problem is new or something that
has been previously addressed. The RFS may obtain the assistance of a Medical
Advisor if the case is more complex. If the information is new or of any concern, the
recertifying employee would be sent for an updated Medical Assessment.
The APT has led to
a very low rate of
cardiac events
The current practice is
to undertake the APT
annually and a medical
assessment biennially
- it is considered safe
and reasonable to
continue this practice
until the age of 60
Page 26Mitigation Crew Review
Health Pre-screening Measures
Encouraging participant training prior to undertaking the Physical Testing (in
particular for new entrants) and real-time monitoring of the heart rate, ensuring that
safe maxima are not exceeded, will further enhance the safety of undertaking the
Physical Tests.
In the recent cardiac case involving a Mitigation Crew member, a vehicle was onsite
andhadseveraltrainedrstaiders,oxygenandadebrillatorreadilyavailable.The
combinationoftrainedandcompetentstaffandadebrillatorlikelysavedthis
employee’slife.Asisthecurrentpractice,trainedrstaidersshouldbepresentand
debrillatorsandoxygenshouldbeimmediatelyavailableatthestagingareafor
APTs.
Page 27Mitigation Crew Review
Health Pre-screening Measures
9. Recommendations
Basedonthendingsofthisreviewthefollowingrecommendationsforchange
and enhancements to existing practices are recommended to be considered for
implementation to reduce risk, so far as is reasonably practicable.
Basedonthendingsofthisreview,itisrecommendedthattheRFS:
Strengthen the content of the RFS Medical Assessment – Specialist v1.0 by:
1. Guiding the examining doctor to understand the risks associated with the Arduous
PackTest(APT)andaskingthemtospecicallyaddressthecardiacriskofthe
participant undertaking it. In doing so the Medical Assessment becomes a more
useful method of evaluating and identifying any predictable and preventable
cardiac events, enabling appropriate medical follow up before Physical Testing is
undertaken.
2. Asking the examining doctor to complete a list of cardiac risk questions, and
instructing the doctor that any ‘yes’ answers would then require a calculation of
CVR score.
3. Obtaining a CVR score on all participants 45 years old and older (where
recommendation 2 applies).
4. WhereaCVRcalculationisperformed,thoseindividualswhohavea≥15%5year
CVR score, should be referred to their doctor for management of risk factors and
to a cardiologist for exercise testing. Evidence should be sought of the results of
this assessment prior to the new entrant or recertifying employee being permitted
to undertake the Physical Testing.
5. AmendingthesummarypageoftheMedicalAssessmentformtospecically
askforanopinionontnesstoundertakePhysicalTestingasisdoneinNSW
RFSMedicalClearancetoundertakeArduousPackTest&Fireghtingform.This
highlights the intensity of the APT to the doctor.
6. Adding a CVR calculation at the time of each Medical Assessment. This is
considered a maximal recommendation.
Frequency of Medical Assessments:
7. Biennially until the age of 59 and annually for those 60 and older.
Align the timing of Physical Testing with the Medical Assessment:
8. The Physical Tests (APT and Kinetic Assessment Tasks) should occur within
3 months of a Medical Assessment for a new entrant and no longer than 2
years after a Medical Assessment for recertifying employees under the age of
60, and no longer than one year for those 60 and above.
Page 28Mitigation Crew Review
Health Pre-screening Measures
Update the Screening Questionnaires by:
9. Replacing the Physical Activity Readiness Questionnaire (PAR-Q) with the
Adult Pre-exercise Screening System (APSS).
10. When using the APSS, both Stage 1 and Stage 2 components should be
completed and the forms reviewed by a health professional prior to the
participant being allowed to undertake the Physical Tests.
11. The APSS is required to be used if more than 3 months has passed since
a recertifying employee’s last completed Medical Assessment, and is not
applicable to new entrants who will have a Medical Assessment prior to
undertaking the Physical Testing.
Discontinue same day Pre-Physical Testing:
12. The pre-physical testing of blood pressure and pulse rate are not required if
the other control measures suggested in this report are adopted.
Maintain the Arduous Pack Test:
13. Maintain the Arduous Pack test (APT) for NSW RFS Mitigation Crew Member /
Crew Leader roles.
Maintain the Kinetic Assessment Tasks (KATs):
14. Maintain the KATs as a way of testing function for new entrant Mitigation
Crew and undertake regular reviews (minimum 5 yearly) to ensure that the
tests remain relevant to the duties.
15. The Kinetic Tasks should not be timed.
Real-time Monitoring should be considered for all APT
16. Real time monitoring of the heart rate may be considered in the APT and
would require pre-planning and screening of new entrants to determine their
heartratelimitsaswellastheir%CVLand%CVSin-eld.
Maintain current rst-aid measures
17. Maintainthecurrentprovisionthatadebrillator,oxygenandsuitablyrst
aidqualiedpersonnelareimmediatelyavailablewhenPhysicalTestsare
undertaken.
Points highlighted in red are recommend as minimum requirements. The
recommendations in grey are believed to add value to the assessment of and
reduction in health and safety risk.
The recommendations in this report can also be applied to specialist roles
within the NSW RFS which are currently subject to APT as part of their entry and
recertication.Thisincludesoverseasandinterstatereghtingdeployments,
whereAPTisamandatoryrequirementasspeciedbyalliedagencies.
Pathway for recertifying employees
Pathway for new entrants
Page 29Mitigation Crew Review
Health Pre-screening Measures
Enhanced Model for Re-Certifying Staff
Existing
Mitigation Crew
2 yearly Medical
Assessments
> 3 months
since Medical
Assessment?
APSS with health
professional
review
ALL CLEAR
NOT ALL
CLEAR
Health &
Wellbeing Team
Medical Advisor
Arduous
Pack Test
NO
Medical
Assessment
PASS
PASS
TESTING
END
FAILPASS
FAIL
Proposed Model for New Entrants
New Entrant
Medical
Assessment
(Focused)
Arduous
Pack Test
PASS
(within 3 months)
Kinetic Tasks
PASS
PASS
TESTING
END
FAIL FAIL
YES
Page 30Mitigation Crew Review
Health Pre-screening Measures
10. References
‣ American College of Sports Medicine (2015), ACSM’s Exercise Prepar-
ticipation Health Screening - Retrieved 01/06/2021 https://www.acsm.
org/docs/default-source/default-document-library/read-research/
acsm-risk-stratication-chart.pdf?sfvrsn=7b8b1dcd_6
‣ Australian Bureau of Statistics (ABS) (2018), National Health Survey
2017-2018 - Retrieved 02/06/2021https://www.abs.gov.au/statistics/
health/health-conditions-and-risks/national-health-survey-rst-results/
latest-release
‣ Bredin, S. S., Gledhill, N., Jamnik, V. K., & Warburton, D. E. (2013), PAR-Q+
andePARmed-X+:newriskstraticationandphysicalactivityclearance
strategy for physicians and patients alike, Canadian Family Physician,
59(3), 273-277.
‣ BushreCRC(2011),TherelevanceofthepackhiketestforAustralian
bushrereghters-Retrieved02/06/2021https://www.bushrecrc.
com/sites/default/les/managed/resource/pack_hike_test_re_note.pdf
‣ Ismaila, S. O., Oriolowo, K. T., & Akanbi, O. G. (2013), Cardiovascular strain
of sawmill workers in South-Western Nigeria, International journal of
occupational safety and ergonomics, 19(4), 607-611.
‣ ISO9886:2004(2004),Ergonomics–Evaluationofthermalstrainby
physiological measurements - Retrieved 01/06/2021 https://www.iso.
org/standard/34110.html
‣ Lord, C., Netto, K., Petersen, A., Nichols, D., Drain, J., Phillips, M., & Aisbett,
B.(2012),Validating‘tforduty’testsforAustralianvolunteerreghters
suppressingbushres,Appliedergonomics,43(1),191-197.
‣ Maranhao-Neto, G. A., Luz, L. G. O., & Farinatti, P. T. (2013), Diagnostic ac-
curacyofpre-exercisescreeningquestionnaire:emphasisoneducational
level and cognitive status, Archives of gerontology and geriatrics, 57(2),
211-214.
‣ Myers, J., Kaminsky, L. A., Lima, R., Christle, J. W., Ashley, E., & Arena, R.
(2017),AreferenceequationfornormalstandardsforVO2max:analy-
sis from the Fitness Registry and the Importance of Exercise National
Database (FRIEND Registry), Progress in cardiovascular diseases, 60(1),
21-29.
‣ Parker,R.J.,Bayne,K.,&Clifford,V.R.(2014),Minimumtnessrecom-
mendationsforruralrepersonnel,Wellington:NewZealandFireService
Commission - Retrieved 02/06/2021 https://www.researchgate.net/pro-
le/Karen-Bayne/publication/269987934_Minimum_Fitness_Recommen-
dations_for_Rural_Fire_Personnel/links/5500bd3d0cf2d61f8210bccf/
Minimum-Fitness-Recommendations-for-Rural-Fire-Personnel.pdf
‣ Riebe,D.,Franklin,B.A.,Thompson,P.D.,Garber,C.E.,Whiteld,G.P.,
Magal, M., & Pescatello, L. S. (2015), Updating ACSM’s recommendations
for exercise preparticipation health screening
‣ Petersen, A., Payne, W., Phillips, M., Netto, K., Nichols, D., Aisbett, B, Validi-
tyandrelevanceofthepackhikewildlandreghterworkcapacitytest:a
review, Ergonomics Oct 2010
‣ National Fire Chiefs Council (UK), Managing Physical Fitness - http://
www.cfoa.org.uk/18592
‣ National Heart Foundationhttps://www.heartfoundation.org.au/condi-
tions/fp-absolute-cvd-risk-clinical-guidelines
Appendices
Appendix
Page 32Mitigation Crew Review
Health Pre-screening Measures
Appendix 1 - Real-time Heart Monitoring
The heart rate can be monitored using a chest strap device such as the Polar
H10 heart rate monitor (left) which can be paired to a smartphone or tablet
to provide real-time monitoring of the heart rate. This allows the normal
heart rate limit (HR
L
) and the sustained heart rate limit (HR
L sustained
) to be
monitored in real time. The normal Heart Rate Limit (HR
L
) can be predicted
forindividualsbasedontheirageusingtheformula:
HR
L
= 185 – 0.65 x age(ISO9886:2004)
Similarly, the sustained heart rate limit over an activity period should not
exceed:
HR
L sustained
= 180 – age(ISO9886:2004)
The above heart rate limits are practical and easy to determine prior to
commencingthephysicaltnesstestandthusmonitoredduringthetness
test.
More advanced use of the heart rate data would be in the calculation of the
relative cardiovascular load (%CVL) which is an indicator of aerobic strain,
and the relative cardiovascular strain (%CVS) which is an indicator of the
intensity of the physical exercise (Ismaila, Oriolowo & Akanbi, 2013). These
canbecalculatedusingthefollowingformulae:
%CVL = 100% × [(HR
work
– HR
rest
) / HR
max
(8h)]
where HR
work
=meanheartratewhileundertakingvarioustasks,HR
rest
=heart
rate at rest, HR
max
(8h)=maximumacceptableheartrateover8h,calculated
as 1/3 × (220 – age) + HR
rest
.
The%CVLisinterpretedas:<30%=acceptablelevel,noactionrequired;30%–
59%=moderatelevel,peakloadsshouldbereducedwithinafewweeks;
60%–99%=highlevel,peakloadsshouldbereducedwithinafewmonths;
100%=intolerablehighlevel,peakloadsshouldbereducedimmediatelyor
the activity must be stopped.
%CVS = 100% × [(HR
work
– HRr
est
) / HR
rest
]
where HR
work
=meanheartratewhileundertakingvarioustasks,HR
rest
=
heartrateatrest.The%CVSisinterpretedas:0%–50%=acceptable,no
actionrequired;51%–80%=moderate,actionrequiredwithinafewmonths;
81%–120%=high,actionrequiredwithinafewweeks;121%–150%=very
high,actionrequiredwithinafewdaysand151%–180%=intolerable,action
required immediately.
A Microsoft Excel spreadsheet would help with the above calculations such
that only the real time heart rate data needs to be entered e.g. during each lap
of the APT.
Polar H10 Heart Rate Sensor
Page 33Mitigation Crew Review
Health Pre-screening Measures
Appendix 2 - Other screening questionnaires considered but
not preferred
The 2021 Physical Activity Readiness Questionnaire for Everyone (PAR-Q+)
(Appendix 3)
The PAR-Q+ was designed to overcome the limitations of the original PAR-Q.
It aims to identify restrictions and limitations on physical activity as well as
obtaining more details information around each medical condition declared
by the initial screening questions (Warburton et al., 2021). Effective use of the
PAR-Q+ could lead to as few as 1 per cent of participants being referred for
additional medical screening thus reducing false positive (Bredin et al., 2013).
On the other hand, the reduction in false negatives could identify participants
who would be at an increased risk of an adverse health event while
undertakingthephysicaltnesstest.Thetestwasdesignedwiththeaimof
reducing barriers for low to moderate intensity physical activity for everyone.
It is less relevant to more intense activity. The PAR-Q+ is considered a
suitable test for screening NSW RFS Mitigation recruits and staff.
The American College of Sports Medicine (ACSM) Pre-participation Health
Screening
The ACSM pre-participation health screening is based on the individual’s
current level of physical activity, the presence of signs and/or symptoms
of cardiovascular, metabolic or renal disease, and the exercise intensity.
Like the APSS, the ACSM screening is based on the current level of physical
activity that the individual is currently engaged in (light, moderate or vigorous
intensity). Once this is established, a logic model is then followed which
determines whether medical clearance is required or not, and what intensity
physical activity/exercise can be tolerated (Riebe et al., 2015, ACSM, 2015)
The Canadian Society for Exercise Physiology (CSEP) Get Active
Questionnaire
The CSEP Get Active Questionnaire is similar to the APSS as it also focuses
on the current physical activity level of the participant. However, it does not
go beyond this in terms of interpretation unlike the APSS. The interpretation
is left to trained exercise physiologists to make suitable recommendations
on the intensity of physical activity allowed. An added advantage of this
questionnaireisthescreeningforrecentinjury,acuteare-upsofexisting
diseases like arthritis or back pain that would affect the participant’s ability to
engageinaphysicaltnesstest.
1
ADULT PRE-EXERCISE
SCREENING SYSTEM (APSS) V2 (2018)
7. Describe your current physical activity/exercise levels in a typical week
by stating the frequency and duration at the different intensities.
For intensity guidelines consult gure 2.
Intensity Light Moderate Vigorous/High
Frequency
(number of sessions per week) _________ _________ _________
Duration
(total minutes per week) _________ _________ _________
Weighted physical activity/exercise per week
Total minutes = (minutes of light + moderate) +
(2 x minutes of vigorous/high)
TOTAL = _________ minutes per week
I believe that to the best of my knowledge, all of the information I have supplied within this screening tool is correct.
• If your total is less than 150 minutes per week then light to moderate intensity exercise is recommended. Increase your volume and
intensity slowly.
• If your total is more than or equal to 150 minutes per week then continue with your current physical activity/exercise intensity levels.
• It is advised that you discuss any progression (volume, intensity, duration, modality) with an exercise professional to optimise your results.
1
ADULT PRE-EXERCISE
SCREENING SYSTEM (APSS)
This screening tool is part of the Adult Pre-Exercise Screening System (APSS) that also includes guidelines (see User Guide) on how
to use the information collected and to address the aims of each stage. No warranty of safety should result from its use. The screening
system in no way guarantees against injury or death. No responsibility or liability whatsoever can be accepted by Exercise & Sport
Science Australia, Fitness Australia, Sports Medicine Australia or Exercise is Medicine for any loss, damage, or injury that may arise from
any person acting on any statement or information contained in this system.
Full Name:
Date of Birth: Male: Female: Other:
To identify individuals with known disease, and/or signs or symptoms of disease, who may be at a higher risk of an
adverse event due to exercise. An adverse event refers to an unexpected event that occurs as a consequence of an
exercise session, resulting in ill health, physical harm or death to an individual.
This stage may be self-administered and self-evaluated by the client. Please complete the questions below and refer to
the gures on page 2. Should you have any questions about the screening form please contact your exercise professional
for clarication.
STAGE 1 (COMPULSORY)
AIM:
1. Has your medical practitioner ever told you that you have a heart condition or have you ever
suffered a stroke?
2. Do you ever experience unexplained pains or discomfort in your chest at rest or during physical
activity/exercise?
3. Do you ever feel faint, dizzy or lose balance during physical activity/exercise?
4. Have you had an asthma attack requiring immediate medical attention at any time over the
last 12 months?
5. If you have diabetes (type 1 or 2) have you had trouble controlling your blood sugar (glucose)
in the last 3 months?
6. Do you have any other conditions that may require special consideration for you to exercise?
IF YOU ANSWERED ‘YES’ to any of the 6 questions, please seek guidance from an appropriate
allied health professional or medical practitioner prior to undertaking exercise.
IF YOU ANSWERED ‘NO’ to all of the 6 questions, please proceed to question 7 and calculate your typical weighted physical activity/
exercise per week.
Client signature: ______________________________ Date: ___________________
ADULT PRE-EXERCISE
SCREENING SYSTEM (APSS) V2 (2019)
NOYES
Please tick your response
2
ADULT PRE-EXERCISE
SCREENING SYSTEM (APSS) V2 (2019)
NO
CURRENT PHYSICAL ACTIVITY/EXERCISE
YES
EXERCISE PROGRESSION:
It is advised that you discuss any progression (volume, intensity, duration, modality) with an exercise professional to optimise your results.
FIGURE 1: Stage 1 Screening Steps
FIGURE 2: Exercise Intensity Guidelines
40 to <55% HRmax*
VERY LIGHT TO
LIGHT RPE
#
1-2
• An aerobic activity that does
not cause a noticeable change
in breathing rate
• An intensity that can be
sustained for at least 60
minutes
LIGHT
55 to <70% HRmax*
MODERATE TO
SOMEWHAT
HARD RPE
#
3-4
• An aerobic activity that is
able to be conducted whilst
maintaining a conversation
uninterrupted
• An intensity that may last
between 30 and 60 minutes
MODERATE
70 to <90% HRmax*
HARD
RPE
#
5-6
• An aerobic activity in which
a conversation generally
cannot be maintained
uninterrupted
• An intensity that may last up
to 30 minutes
VIGOROUS
≥ 90% HRmax*
VERY HARD
RPE
#
7
• An aerobic activity in which
it is difcult to talk at all
• An intensity that generally
cannot be sustained for longer
than about 10 minutes
HIGH
* HRmax = estimated heart rate maximum. Calculated by subtracting age in years from 220 (e.g. for a 50 year old person = 220 - 50 = 170 beats per minute).
# = Borg’s Rating of Perceived Exertion (RPE) scale, category scale 0-10.
Modied from Norton K, L. Norton & D. Sadgrove. (2010). Position statement on physical activity and exercise intensity terminology.
J Sci Med Sport 13, 496-502.
Did you answer yes to any question in stage 1?
STAGE 1 (COMPULSORY)
INTENSITY CATEGORY HEART RATE MEASURES
PERCEIVED EXERTION
MEASURES
DESCRIPTIVE MEASURES
TOTAL WEIGHTED PHYSICAL
ACTIVITY/EXERCISE <150 MIN
Light to moderate intensity exercise is
recommended. Increase your volume
and intensity slowly.
TOTAL WEIGHTED PHYSICAL
ACTIVITY/EXERCISE ≥ 150 MIN
Continue with your current physical
activity/exercise levels.
Please seek guidance from an
appropriate allied health professional
or medical practitioner prior to
undertaking exercise.
3
ADULT PRE-EXERCISE
SCREENING SYSTEM (APSS) V2 (2019)
CLIENT DETAILS GUIDELINES FOR ASSESSING RISK
8. Demographics
Age: _____________
Male Female Other
Risk of an adverse event increases with age, particularly males ≥ 45 yr and
females ≥ 55 yr.
9. Family history of heart disease (e.g. stroke, heart
attack)?
Relationship (e.g. father) Age at heart disease event
___________________ ___________
___________________ ___________
___________________ ___________
A family history of heart disease refers to an event that occurs in relatives
including parents, grandparents, uncles and/or aunts before the age of 55 years.
10. Do you smoke cigarettes on a daily or weekly basis or
have you quit smoking in the last 6 months?
Yes No
If currently smoking, how many per day or week?
__________________________________
Smoking, even on a weekly basis, substantially increases risk for premature
death and disability. The negative effects are still present up to at least 6
months post quitting.
11. Body composition
Weight (kg) ________ Height (cm) ________
Body Mass Index (kg/m
2
) ________
Waist circumference (cm) ________
Any of the below increases the risk of chronic diseases:
BMI ≥ 30 kg/m
2
Waist > 94 cm male or > 80 cm female
12. Have you been told that you have high blood pressure?
Yes No
If known, systolic/diastolic (mmHg)
_______________________________
Are you taking any medication for this condition?
Yes No
If yes, provide details
___________________________________
Either of the below increases the risk of heart disease:
Systolic blood pressure ≥ 140 mmHg
Diastolic blood pressure ≥ 90 mmHg
13. Have you been told that you have high cholesterol/
blood lipids?
Yes No
If known:
Total cholesterol (mmol/L) ____________
HDL (mmol/L) ____________
LDL (mmol/L) ____________
Triglycerides (mmol/L) ____________
Are you taking any medication for this condition?
Yes No
If yes, provide details __________________________
Any of the below increases the risk of heart disease:
Total cholesterol ≥ 5.2 mmol/L
HDL < 1.0 mmol/L
LDL ≥ 3.4 mmol/L
Triglycerides ≥ 1.7 mmol/L
This stage is to be completed with an exercise professional to determine appropriate exercise prescription based
on established risk factors.
STAGE 2 (RECOMMENDED)
AIM:
4
ADULT PRE-EXERCISE
SCREENING SYSTEM (APSS) V2 (2019)
CLIENT DETAILS GUIDELINES FOR ASSESSING RISK
14. Have you been told that you have high blood sugar
(glucose)?
Yes No
If known:
Fasting blood glucose (mmol/L) ____________
Are you taking any medication for this condition?
Yes No
If yes, provide details
__________________________________________
Fasting blood sugar (glucose) ≥ 5.5 mmol/L increases the risk of diabetes.
15. Are you currently taking prescribed medication(s)
for any condition(s)? These are additional to those
already provided.
Yes No
If yes, what are the medical conditions?
__________________________________________
Taking medication indicates a medically diagnosed problem. Judgment is
required when taking medication information into account for determining
appropriate exercise prescription because it is common for clients to list
‘medications’ that include contraceptive pills, vitamin supplements and other
non-pharmaceutical tablets. Exercise professionals are not expected to have
an exhaustive understanding of medications. Therefore, it may be important
to use common language to describe what medical conditions the drugs are
prescribed for.
16. Have you spent time in hospital (including day
admission) for any condition/illness/injury during
the last 12 months?
Yes No
If yes, provide details
__________________________________________
There are positive relationships between illness rates and death versus the
number and length of hospital admissions in the previous 12 months. This
includes admissions for heart disease, lung disease (e.g., Chronic Obstructive
Pulmonary Disease (COPD) and asthma), dementia, hip fractures, infectious
episodes and inammatory bowel disease. Admissions are also correlated to
‘poor health’ status and negative health behaviours such as smoking, alcohol
consumption and poor diet patterns.
17. Are you pregnant or have you given birth within the
last 12 months?
Yes No
If yes, provide details
__________________________________________
__________________________________________
__________________________________________
During pregnancy and after recent childbirth are times to be more cautious
with exercise. Appropriate exercise prescription results in improved health
to mother and baby. However, joints gradually loosen to prepare for birth
and may lead to an increased risk of injury especially in the pelvic joints.
Activities involving jumping, frequent changes of direction and excessive
stretching should be avoided, as should jerky ballistic movements.
Guidelines/fact sheets can be found here: 1) www.exerciseismedicine.com.au
2) www.tness.org.au/Pre-and-Post-Natal-Exercise-Guidelines
18. Do you have any diagnosed muscle, bone, tendon,
ligament or joint problems that you have been told
could be made worse by participating in exercise?
Yes No
If yes, provide details
__________________________________________
__________________________________________
Almost everyone has experienced some level of soreness following
unaccustomed exercise or activity but this is not really what this question is
designed to identify. Soreness due to unaccustomed activity is not the same
as pain in the joint, muscle or bone. Pain is more extreme and may represent
an injury, serious inammatory episode or infection. If it is an acute injury
then it is possible that further medical guidance may be required.
Important Information: This screening tool is part of the Adult Pre-Exercise Screening System (‘APSS’) and should be read with the APSS guidelines (see User Guide) on how to use
the information collected and to address the aims of each stage. This does not constitute medical advice.This form, the guidelines and the APSS (together ‘the material’) is not intended
for use to diagnose, treat, cure or prevent any medical conditions, is not intended to be professional advice and is not a substitute for independent health professional advice. Exercise
& Sports Science Australia, Fitness Australia, Sports Medicine Australia and Exercise is Medicine (together ‘the organisations’) do not accept liability for any claims, howsoever
described, for loss, damage and/or injury in connection with the use of any of the material, or any reliance on the information therein. While care has been taken to ensure the
information contained in the material is accurate at the date of publication, the organisations do not warrant its accuracy. No warranties (including but not limited to warranties
as to safety) and no guarantees against injury or death are given by the organisations in connection with the use or reliance on the material. If you intend to take any action
or inaction based on this form, the guidelines and/or the APSS, it is recommended that you obtain your own professional advice based on your specic circumstances.
Appendix 4 - Australian Absolute Cardiovascular Disease Risk Calculator
https://www.cvdcheck.org.au/calculator/
Cardiovascular disease risk calculator inputs
Sample score
Page 38Mitigation Crew Review
Health Pre-screening Measures
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