Job-specific mandatory medical examinations for the police force

Abstract

Background

Mandatory medical examinations (MMEs) of workers should be based on the health and safety requirements that are needed for effectively performing the relevant work. For police personnel in the Netherlands, no job-specific MME exists that takes the specific tasks and duties into account.

Aims

To provide the Dutch National Police with a knowledge base for job-specific MMEs for police personnel that will lead to equitable decisions from an occupational health perspective about who can perform police duties.

Methods

We used a stepwise mixed-methods approach in which we included interviews with employees and experts and a review of the national and international literature. We determined the job demands for the various police jobs, determined which were regarded as specific job demands and formulated the matching health requirements as specific as possible for each occupation.

Results

A total of 21 specific job demands were considered relevant in different police jobs. These included biomechanical, physiological, physical, emotional, psychological/cognitive and sensory job demands. We formulated both police-generic and job-specific health requirements based on the specific job demands. Two examples are presented: bike patrol and criminal investigation.

Conclusions

Our study substantiated the need for job-specific MMEs for police personnel. We found specific job demands that differed substantially for various police jobs. The corresponding health requirements were partly police-generic, and partly job-specific.

Introduction

In the Netherlands, some 65000 police employees are employed in >90 different police jobs or specialisms. Currently, their medical fitness to work is assessed by means of pre-employment medical examination, but not periodically during their employment. From a preventive point of view, this is not an ideal situation.

The goal of mandatory medical examinations (MMEs) is to verify periodically if, from an occupational health point of view, the employee can still perform his or her job safely and without significantly increased health risk, given the working conditions [1]. In the Netherlands, the basic principles of periodic MMEs are operationalized in the Dutch guidance document ‘Mandatory Medical Examinations of workers during employment’ [2]. One of the key points in developing MMEs is that assessing a worker’s medical fitness for work should be based on the specific health and safety requirements that are needed to effectively and safely perform that job [1,3]. Health requirements can be related to physical, biomechanical, sensory, mental or emotional job requirements [4].

The idea that specific job demands and corresponding health and safety requirements should be the basis of MMEs is not yet widely applied. In the UK, for example, medical standards for police personnel consist of a list of illnesses, injuries and diseases and accompanying instructions on how fitness for work should be determined by the occupational health physician [5]. These accompanying instructions for doctors performing these examinations are, for example, ‘likely to require further information, investigation and assessment’. This type of broad instruction is generally accepted but is, however, of little help in determining whether a worker is fit for his or her police job. Implicitly, the occupational physician has to elicit what the consequences are for the worker’s performance on routine and emergency tasks. Moreover, it is plausible that this process will lead to considerable practice variation as doctors may have different opinions about the job demands that are associated with the job. The gap in knowledge that needs to be closed lies, in our opinion, in the direct interaction between workers’ health status and job demands.

This interaction between police workers’ health status and job demands is more comprehensive than is often assumed. Job demands related to physical aspects of police work are generally well known. But most forms of executive police work are sedentary with rare physically strenuous peak moments [6,7]. Besides, it is a misconception that only physically demanding work could pose a risk to the workers’ health and safety. Other risks are related to mental and emotional health requirements, or health requirements related to the exposure of airways, lungs and skin to hazardous substances [2].

A substantial number of the police officers in the Netherlands are also trained for special duties, such as dog patrols, the mounted police, water police, very important person (VIP) protection or for special jobs related to criminal investigation. Despite this diversity of police tasks and the different types of police jobs, this has not been translated into different, job-specific fit for work assessments for police personnel. There is a lack of insight into the specific health and safety requirements that apply for the various police jobs and, hence, the content of MMEs.

Our goal was to develop MMEs for the Dutch National Police Corps that will lead to valid and equitable decisions about who can perform police duties from an occupational health point of view. Ultimately, this will contribute to sustained work ability and employability. We aimed at providing a rationale and indication of the need for job-specific fit to work assessments for personnel. We formulated the following research questions: What specific job demands apply to different police jobs? What corresponding health requirements can be formulated?

Methods

The population in this study consisted of employees in 37 police jobs in the Dutch National Police Corps. These police jobs were chosen by the management of the police organization, based on the heterogeneity in tasks and activities (see Table 1). We answered the research questions by using various strategies. This study was not subject to the Medical Research Involving Human Subjects Act. The research complied with the institutional ethical approval requirements and was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments.

We used information retrieved from individual and group discussions with employees and interviews with experts from the National Police Corps. We used a structured interview guide that we had used previously in a similar way [4]. This structured interview guide has been found to provide comprehensive information on job demands. The following topics were discussed: job demands (current tasks and activities, where possible specified in terms of duration, intensity and frequency); the variety of tasks and activities on regular working days and differences between shifts and non-regular working days; the perceived load per task and/or activity and health and safety issues related to the task and/or activity; potential measures to reduce the exposure to work-related risks; health problems that affect healthy and safe job performance and potentially dangerous situations for workers and others that may arise due to these health problems. Then, questions on a total of 27 predefined specific job demands were systematically posed by the researchers. The interviews were recorded and transcribed, and job demands were, when applicable, formulated in size and number.

For the first 18 jobs, two researchers (J.S.B. and J.K.S.) interviewed three to six employees per job during semi-structured group discussions of maximally 150 min. All employees were experienced in the job and had been employed long enough in the job to have a complete overview of all tasks and activities. For the other 19 jobs, J.S.B., J.K.S., C.T.J.H. and/or M.H.W.F.-D. interviewed one or two experts (a senior employee or team leader) for each job. The input for these 19 jobs was different and the experts were informed about the specific job demands found for the first 18 jobs. The rationale for this strategy was that the first 18 jobs would provide sufficient insight into police-generic job demands and health effects, and that for the remaining 19 jobs an interview strategy involving fewer employees would be suitable to gain insight into the job-specific demands and health effects. Participants were invited by the Dutch National Police Corps, based on their job expertise and availability on the selected dates and timeframes.

Furthermore, J.S.B. and J.K.S. interviewed experts from the National Police including psychologists, human resources staff and occupational physicians of the National Police during a semi-structured interview of up to 60 min. The following key questions were addressed: What are the tasks/activities that are potentially detrimental to the health and safety of the worker? What are the consequences (impact on health and/or safety) for the employee, by performing his/her job? What health problems, medical or psychological problems are there that may impose health and/or safety risks?

Occupational physicians were further asked about the health problems that they encounter in employees who cannot perform their regular duties. Furthermore, the occupational physicians were asked about medical or psychological health issues that, in their opinion, would be a reason for employees to stop working temporarily.

In addition to the information from the workers themselves, we used information from scientific literature, national literature and Dutch laws/regulations, standards and guidelines. These sources were searched for information about job demands, risks for adverse health effects and/or safety issues and applicable health or safety standards. We searched MEDLINE to retrieve police-specific scientific literature. We used search terms for the concept ‘Police’ and combined these with search terms for the concepts ‘tasks’, ‘exposure’ and ‘health effects’. The following constraints were used: written in Dutch, English or German; published in the period 2005 to date (July 2015); full-text version of the study is available electronically; study conducted in a Western country (non-Western countries are defined as: Turkey, Africa, Latin America and Asia, excluding Indonesia and Japan).

National literature was retrieved by using Google as a search engine and asking experts from the National Police for recent (published in 2008 or later) background information, literature and/or reports about the Dutch police force.

All data were used in a stepwise procedure, presented in Figure 1. The output of the first step was an overview of the necessary information that was needed as input for the second step. In the second step, we defined which of the job demands could be defined as specific job demands following Law [8] and professional guidance on medical examinations [2] by verifying if: (i) the identified job demands exceed health or safety standards or entail an increased risk for adverse health effects and/or safety issues and (ii) exposure to the job demands cannot be reduced or eliminated using conventional technical or organizational measures, given the level of current knowledge and professional services [2]. The output of this second step was a matrix of specific job demands and the police jobs for which they were found applicable.

In the third and last step, we formulated as specifically as possible the corresponding health requirements with reference to the specific job demands for each police job. The end product of the third step was an overview of health requirements that are either police-generic in nature (i.e. apply to other police jobs as well) or job-specific (i.e. specific for the job at hand).

In the Results section, the outcomes of our stepwise approach were described at an aggregated level and illustrated by two examples of police jobs that varied in nature: bike patrol and criminal investigation. Information about the other police jobs was described in a Dutch report [9].

Results

In step 1, we found that 21 of the 27 predefined specific job demands occurred in at least one of the selected jobs (Table S1, available as Supplementary data at Occupational Medicine Online). For the bike patrol, a total of 18 job demands were described as the output of the first step. In the second step, eight job demands were confirmed as specific job demands for the bike patrol. Those job demands exceeded health or safety standards or imposed an increased risk for the health and safety of the employee or other persons. In Table S1 (available as Supplementary data at Occupational Medicine Online), all specific job demands are listed with accompanying definitions. These definitions contain information on the minimum exposures that are considered to impose an increased health or safety risk to the worker and/or third parties. For the criminal investigators, steps 1 and 2 resulted in four specific job demands.

Only one job did not include any specific job demands: the job ‘Garage employee’. For this job, no risks were found for adverse health effects and/or safety issues that could not be reduced or eliminated. For some of the specific job demands, rather large differences existed between jobs concerning the exact content of the demand. For example, the demand ‘Long-term driving (most of the working day) and/or driving to emergency calls’ included driving a car, motorcycle, bicycle, horse or boat, depending on the police job. In the third step, when formulating health requirements, these differences were taken into account.

For some of the specific job demands, for example ‘Kneeling or squatting’ or ‘Violence’, the content of the demand was found to be the same for a large proportion of the selected police jobs. Hence, these were considered police-generic demands. Since the employer insists that all executive personnel should be able to provide assistance and/or provide first aid to a victim on the ground and take care of their safety, kneeling and squatting are defined as the specific job demands for all executive police jobs.

We found a number of differences, depending on the speciality or additional tasks of the employee. For example, some of the police officers within the group ‘Crowd control’ are trained to work at height so that they can bring down protestors from a roof, for example. Consequently, ‘Working at height’ should be considered as a specific job demand but does not necessarily apply to all police officers performing ‘Crowd control’.

In the third step, we formulated for all specific job demands the accompanying health requirements. This resulted in both police-generic requirements and job-specific requirements (Table 2). The police-generic health requirements that applied for both bikers and criminal investigators were, for example: no restrictions on kneeling or squatting for a few minutes, no limitations of eyesight at various distances and no restrictions of vigilance and clear judgement.

Additional job-specific health requirements for bikers were, for example: no restrictions for cycling; no restrictions for performing both longer periods of aerobic work on the job and a submaximal physical effort for up to 3 min; no restrictions to move or remove people, and normal lung function; and no risk due to the presence of infectious diseases. For criminal investigators, no other specific job demands applied.

For the specific job demands ‘Driving a vehicle’, ‘Energetic load’ and ‘Vigilance and clear judgment’, we formulated different health requirements for some jobs, as the content of the specific job demands was substantially different.

Some jobs looked similar at first sight, but differences were revealed in steps 1 and 2 leading to the formulation of different medical fitness criteria. On the one hand, for employees working in the Emergency Communication Centre, the job-requirement ‘Vigilance and clear judgement’ included the criterion to be able to detect and distinguish colours on the computer screens correctly, including red, green and yellow. For employees working in Intake and Service on the other hand, this was not the case.

Discussion

Our study found a total of 21 specific job demands pertaining to periodic MMEs for police personnel including several physical, emotional, psychological/cognitive and sensory demands. The type and content of these demands and matching health requirements differed substantially for the various distinct police jobs. We found that police work was more heterogeneous than usually assumed and therefore may require a new focus in MMEs.

One of the strengths of this study is that we took all possible specific job demands into consideration. We used a strategy that allowed us to gather information on 37 jobs within 1 year. We made efficient use of time and resources and described a strategy that is feasible to carry out, e.g. by occupational physicians who are involved in developing up-to-date and job-specific MMEs for other sectors, industries or occupations. Our three-step approach allows practitioners to reason logically from job demands to specific health requirements. There is no need to specify which illnesses, injuries or diseases could affect safe work performance: verifying whether a worker is able to meet the health requirements, is sufficient.

The strategy we used in defining health requirements that are based on specific job demands is not new in itself. Previous work by Bos et al. [10] described how to define specific job demands concerning lifting, pushing and pulling. Gouttebarge et al. [11] illustrated how a stepwise approach based on specific job demands and related health requirements can be used in developing a pre-employment medical examination for the construction industry. Moreover, the content of job-specific worker’s health surveillance programmes for fire fighters [12], construction workers [13,14] and hospital physicians [15] were developed in a similar way. These surveillance programmes have been found to be feasible, acceptable [16] and effective [17], and therefore it would be possible to study these aspects of job-specific MMEs for the police force as well.

In addition to the research effort described in this article, we facilitated the use of the MMEs in practice by selecting screening instruments (validated screening instruments, questions on work limitations and practical tests) for each health requirement. The instruments and accompanying decision scheme allow the occupational physician to decide whether or not the worker can meet the health requirements of the job. We hypothesized that occupational physicians who use the proposed instruments and decision scheme will make transparent and equitable decisions about who can safely and effectively perform their routine and emergency police duties. Of course, this needs to be verified in practice.

The better the fit to work assessment is tailored to the job, the more likely it is that an occupational physician can provide individually tailored advice and job-specific, relevant interventions [17]. In the end, we believe this will affect the usefulness of MMEs, as those workers who need it will be offered the interventions from which they will benefit most. We matched interventions to the health requirements following the formulation of health requirements and as a final part of the project described in this study. We selected the interventions based on evidence when available and on current best practices of police-specific caregivers. These interventions are not shown in this article, but are available upon request from the authors.

Another next step that needs to be taken is gaining more insight into valid and reliable diagnostic instruments to assess whether or not the police employee is able to meet the health requirements of his or her job [10,11]. Job-specific tests have been developed, such as physical performance tests [18,19]. We encourage the use of these tests when relevant, that is, only for those police officers who face the physical activities during their work. The results of the present study do not substantiate the idea that police officers in general have physically demanding jobs. Actually, the specific health requirements matched to ‘Exposure to peak emotionally stressful situations’ and ‘Vigilance and clear judgement’ apply to the majority of police jobs. These specific job demands should receive more attention than currently seems to be the case in many countries.

We have presented a strategy to design MMEs for 37 different police jobs. These job-specific MMEs will allow for a more accurate assessment of health requirements and specific treatment plans for specific groups of workers.

Funding

This work was supported by the Dutch National Police (number 2015-0159).

Conflicts of interest

The authors declare that they have no conflict of interest.

References