A Simple Guide To The Firefighter Medical Exam

Part of becoming a firefighter is have a medical exam.  But, if you’ve ever wondered what to expect during a firefighter medical exam, you’re not along.

In this article, I want to give you a quick run-through of some of the different aspects of the physical exam in the hiring process. This can help you prepare for what is to come. I will also talk about some other expectations and medical disqualifications. Finally, I want to talk about the likelihood of ongoing physicals while working at your new fire department.

Basic Requirements of a Firefighter Medical Exam:

  • Vital signs
  • Vision test
  • Hearing test
  • Blood work
  • Urinalysis
  • Chest X-ray
  • Pulmonary tests
  • Treadmill test (stress test)
  • Functional movement screening
  • General medical history

Many departments will add a physical exam to their healthcare package for new employees. In most cases, it is a way to help them with their health and well-being in dangerous occupations.

Most will also use physical exam when hiring to be sure that candidates are right for the role. Firefighting is one such profession and, as you might expect, the physical is pretty extensive because of the stress and dangers of the profession.

When you apply for a role in the fire service and pass your initial application process and interviews, a medical assessment isn’t far behind. This is an essential screening measure to make sure that applicants are fit enough to proceed. The test typically consists of 10 key processes.

While different departments may have different requirements, this list gives you a good idea of what to expect.  Let’s further break down what to expect with each exam.

Vital Signs

This one is pretty straightforward. They need to know your vital signs, such as your blood pressure, heart rate and oxygen level (pulse ox) as an indication of your general fitness level. Poor results here could indicate poor physical fitness but also underlying health issues that may need medical intervention.

Physicians and department officers need to decide whether those issues could harm your performance on the job.

Another vital sign that some departments may look at is body composition. They need to know your body mass index (BMI) and will use skinfold tests for a ratio of fat to muscle. Not only does this indicate the physical fitness of a candidate at the time of hiring them, but physicians can also see improvements over the years.

Vision Test

Good vision is essential in firefighting for dealing with incidents with poor visibility or night-time work. Many departments will allow firefighters to sign up if their vision can be corrected to appropriate standards with no impairment on the job.

There can be a disqualification for those with monochromatic vision, far visual acuity that is less than 20/40 binocular vision or a peripheral vision less than 110 degrees.

Hearing Test

Recruits need to hear instructions and indications of dangers on the scene in loud, confusing situations. Therefore, the hearing test is essential.

The test is simple with a series of responses to stimuli in a soundproof room. Those that underperform at the different frequencies may struggle on-site. There are also disqualifications for conditions that could prove dangerous, such as uncorrected tinnitus, Meniere’s syndrome or labyrinthitis.

Blood Work

You will have blood taken 48 hours before the physical exam so that doctors can have the results ready. The blood work is vital in highlighting possible health risks.

Doctors can look at white and red blood cell counts as well as glucose levels. These can indicate diseases that are perhaps undetected or poorly managed. It is also a good way to test alcohol levels for substance abuse.


You might think that the urinalysis is primarily for drug tests. Fire departments will have strict policies on the use of drugs – especially those in states with legalized marijuana. But, there is more to this test. The compounds and consistency of the fluid can indicate major diseases and small infections.

Chest X-Ray

A chest x-ray gives doctors an up-close look at the health of your lungs and heart. This means checking the lungs for damage or obstruction, spotting potential problems with the heart and looking at the major blood vessels. This is the perfect chance to locate something small that could end up being a ticking time-bomb.

Pulmonary Tests

It isn’t enough to see inside your lungs for visible indicators of disease. Breath tests with spirometers determine a candidate’s lung function through inhalation and exhalation. A poor rate could be dangerous in a smoke-filled room even with a mask on.

Hiring officers may not be interested in hiring those with asthma or those with any other reactive airways disease that has required bronchodilator or corticosteroid treatment for more than 2 months in the past 2 years.

Treadmill Test (Stress Test)

This one is a classic that never seems to go out of fashion. The treadmill is the perfect way for physicians to gauge the cardio and respiratory function of their new applicants. This one is as much about endurance as anything else. Can you maintain the right heart rate and performance for your age during long tasks?

Functional Movement Screening

Functional movement essentially means the way that your body can move with the range of motion of the limbs, flexibility of the joints and perhaps also the strength of the muscles. The tests involved can vary between departments, so it is best to practice a lot of exercises and get your range of motion and flexibility up to the right standard.

Flexibility is essential in the hamstring muscles, lower back, and shoulders. It helps firefighters move around dangerous areas and handle equipment with less risk of injury.

There are different ways to test this. Participants can be made to sit against a wall with their legs and knees flat. They then reach out toward their feet to see how far they can get. There are also leg raises, hurdle step-overs, deep squats and other tests.

General Medical History

Finally, the physician will want to go over your medical history and run some additional tests as needed. This is the final phase where all of the numbers, samples and red flags come together.

They will get to know your previous medical history and risks within the family. This could help them analyze the samples and results and make their recommendations. It is important to be honest at this point when answering all the questions. Failure to do so could put you and your crew at risk.

This list is a good starting point when hiring applicants. But, the NFPA has high standards and additional clauses.

The NFPA has a list of 1582 medical requirements for firefighters to make the grade. This may sound excessive, but we have to remember how physically demanding the role is.

I can’t go into full details about each of the 1582 requirements here. Just be aware that many additional disabilities and illnesses could prove to be a reason for disqualification.

For example, there are neurological conditions that would not be tested for in this physical. Any neurological condition that could affect the safety of others, concentration on the job or short-term physical ability is an issue. Anyone with epilepsy is expected to have had it under complete control for at least 5 years.

Firefighter Medical Exams Shouldn’t End There…

Ideally, your fire department should also have the funding and support to provide regular medical screenings on the job. Regular screening can help medical professional spot any signs of disease caused by the profession.

This means a more general physical examination of the body, limb function and response. But, there should also be screenings for cancer and chest x-rays.

This is another reason why those tests for vital signs and stats from the previous tests are so important. The information gathered in the hiring procedure does just highlight current physicality for new recruits. It can also highlight declines in health later on.

For example, doctors may a drop in some vital signs, chest function or on the treadmill test year on year. The stats can also flag up any sudden changes in x-rays, vision and hearing tests or the blood work that may require further help.

Unfortunately, fire departments don’t all work to the same standards and practices.

The problem is that there is no national standard here where every department has to conform to the same procedures. Some states will go out of their way to ensure that recruits and crew members undergo regular, thorough medical testing. Others won’t.

This is a concern in a professional that is so dangerous with so many cancer risks. Firefighters are urged to seek out regular testing either on the job or through their own healthcare provider. Tell your own doctor about your profession and any recent incidents and exposures as a precaution.

I hope this article gave you an idea of what to expect during a firefighter medical exam.  There is a lot to prepare for when you enter the hiring process and a lot of physical tests. But, each one of these procedures is essential for both you and the department.

They can highlight risk factors that you weren’t aware of that may have an impact on your ability to work as a firefighter. Failure to do so could put you and those in your crew at risk.

If you know that you have underlying medical issues, be honest during the firefighter medical exam, and try and show that they won’t be an issue. If doctors disagree, respect that decision for the good of the department. If you know that you aren’t quite fit enough yet, work on that fitness before you apply to improve your chances.