Respiratory protection guidelines. This official statement of the American Thoracic Society was adopted by the ATS Board of Directors, March 1996.

A Thermal Stress Treadmill Walk for Clinic Evaluation of Candidates for Hazardous Materials (HazMat) Duty

“…The perceived exertion was also recorded during TSTW, using the Borg index: 6 = nil, 11 = light, 13 = somewhat hard, 15 = very hard, 20 = maximum tolerable [17]. The Borg scale (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) was displayed on the wall facing the exercising subject so that it was visible at all times, and the subject could readily respond with a numerical value when asked at 10-min intervals. Since only the physician and nurse were present during the one-subject BPTE and later TSTW, the Young index and Borg scale responses remained confidential.…”

“…While the content of such evaluations is left up to the examiner, stress testing has been recommended by the American Academy of Family Physicians, American Thoracic Society, the American College of Cardiology and American Heart Association, and the U.S. Preventive Services Task Force in accord with U.S. federal guidance, since heat strain is often found in hazmat exercises [8,9,10,11]. Our interest in this issue was spurred by heat illness in three hazmat responders who previously completed maximal Bruce protocol treadmill electrocardiography (BPTE) to levels of 13-15 metabolic equivalent of task (MET) without difficulty.…”

Stress Testing in the Medical Evaluation for Hazardous Materials Duty: Results and Consequences in Three Groups of Candidates

“…With the advent of compressed air cylinders enabling work durations of an hour or more, the likelihood of hyperthermia increases. In accordance with published guidance of federal agencies in the United States 1-3 and the recommendation of the American Thoracic Society, 28 our medical evaluation program therefore included GXT. Some recommendations such as those of the American College of Cardiology/ American Heart Association, American College of Physicians, and American College of Sports Medicine do not favor the use of GXT as a screening device in low-risk adults.…”

“…4,5,28 In a literature search, we could find no published evidence that heat stress is created by this protocol. We therefore measured ear canal temperatures in 26 subjects undergoing Bruce testing to seek evidence of such stress 32 with negative results.…”

Respiratory protective devices: Rates of medical clearance and causes for work restrictions

“…Medical evaluations currently range from self-administered questionnaires to physician interviews, physical examinations, spirometry, and exercise testing. Despite extensive work on the physiologic and psychologic effects of respirator use, there are few data on rates of medical clearance for respirator use following medical evaluations (Harber, 1984(Harber, , 1988Harber et al, 1996;Hodous, 1986;Louhevaara, 1984;Morgan, 1983;Raven et al, 1979). In addition, the physician-determined causes for work restrictions have not been well characterized in industrial settings.…”