Type 1 Diabetes and fire service/emergency services

CF2712 said:

Hello

My husband has type 1 diabetes and has been applying to the fire service. A couple of years ago he made it to the final stage of the application (medical) and the doctor was very negative, stating that he didn't believe people with diabetes should work in this type of job as it is too dangerous etc. He then said my husband would be considered if his bloods reached a specific number (below 50 Hba1c) and not having any hypos. We are concerned about this because although he did reach this level, his diabetes nurse said that the lower the Hba1c, the more likely hypos are?

Is it right to ask him to have not had any hypos? Is this realistic? If so, how?

Anyway, he is applying again and I am planning ahead. I understand his rights e.g. he should be considered individually etc. However, I wondered if anyone could share their experiences of being in the emergency services with type 1? For example, I am worried about if he needs to go out on a job and his glucose levels are low - will he then not be allowed to go? What will happen? How do people manage this?

Just after some general tips/ideas of how my husband can have the best chance and experience please.

Many thanks
Chelsea

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We have a well known forum member @LooperCat who is a Paramedic with T1, I think she uses Constant Glucose Monitoring (CGM) to keep her levels under control and provide plenty of warnings of hypo's etc.

I was interacting with somebody in Hampshire (via a different forum) where the emergency services had flatly refused the job application so I think there are regional differences.

I would imagine that the Fire Service is quite demanding for a T1. You'd need to keep glucose in your pocket at all times and I don't know what you do if you feel you're starting to go hypo just as you enter a burning building - tricky one.

CF2712 said:

Is it right to ask him to have not had any hypos? Is this realistic? If so, how?

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Hello and welcome to the forum

Is it right - no it's not right but it is also virtually impossible, despite very careful management and monitoring for a type 1 to avoid them if leading an active and full lifestyle, exercise, stress, heat etc etc many factors affect glucose control.

Despite this a type 1 can do many jobs which would of probably been very difficult to navigate before tech, we have Scotty here who flies aircraft, Looper as a paramedic, many teachers, I would still get him to give it a shot, controlling type 1 now is much easier than it's ever been with the assistance of medical devices like the libre and Dexcom G6 to monitor glucose as well as pumps to micro manage insulin delivery.

If he was successful in getting in he would have to discuss his requirements with his boss, to ensure that his team are able to support and respond if needed and that his needs are met in the workplace, so regular breaks, places he can inject etc.

urbanracer said:

I don't know what you do if you feel you're starting to go hypo just as you enter a burning building - tricky one.

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Eat something on your way to the fire? I imagine you'd check your CGM as soon as the fire alarm goes, and if you have reason to think you might go low during the action you can shove a snickers in your mouth while running to the fire truck.

Antje77 said:

Eat something on your way to the fire? I imagine you'd check your CGM as soon as the fire alarm goes, and if you have reason to think you might go low during the action you can shove a snickers in your mouth while running to the fire truck.

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I wasn't really thinking about CGM when I wrote that. I was thinking more along the lines of whether the role would be possible without the electronic toys, bearing in mind how quickly blood sugars can drop sometimes. Then again, I would also imagine that on the way to a shout, the adrenaline might be pumping and the glucose levels raised if anything?

Thanks for the tags chaps, I’m not fully qualified as a paramedic yet, just halfway through my training.

How does he manage his diabetes? Injections and fingerpricks? That would be hard for and emergency services job tbh. I’ve built a DIY artificial pancreas based on my Dexcom G6 and Omnipod pump - it controls my levels really well about 95% of the time. I couldn’t do it without this, tbh. Working for the ambulance service and responding to 999 calls does have its challenges, as you literally never know what the day will bring. Add in the inevitable heat of a fire, and I’m not sure how a T1 would manage tbh. Heat can make my levels crash fast - so how you’d eat some dextrose tabs in the middle of a rescue in a burning building wearing all the gear is a problem I don’t have the answer to. It’s hard enough with the PPE I have to wear. If we get a red call for a cardiac arrest, I eat 2-3 dextrose tablets en route and drop my insulin to 50% for an hour - I actually have a “cardiac arrest” setting on my system

Driving would be another hurdle, I don’t know if all firefighters are trained to drive the trucks. In the ambulance service we take it in turns with our crewmate to drive. We need a C1 (7.5 ton) truck licence; I know they need the next one up in Fire.

I guess you need to persuade the occupational health people - or the doctor in this case.

Couldn't you persuade your husband to consider a less risky occupation?
You're not allowed to be a commercial airline pilot, or a class one goods driver, or a bus or coach driver with T1D, so I would have thought that a fireman was a no-no as well.

francesk said:

Couldn't you persuade your husband to consider a less risky occupation?
You're not allowed to be a commercial airline pilot, or a class one goods driver, or a bus or coach driver with T1D, so I would have thought that a fireman was a no-no as well.

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You can be a bus driver, I have a bus licence. I could also get a class one HGV if I wanted, just with extra medical checks. Not sure about the flying, although we do have a type one pilot on the forum, I just can’t remember their name.