Reasons for rejection: why people fail to qualify as firefighters

In the decade beginning 1 January 1985, 916 individuals (including five females) were medically examined with a view to joining the full-time service of Strathclyde Fire Brigade (SFB). One hundred and nine (11.9%), including two females, were rejected. The five main causes of failure were: ocular (n = 46, 42.2%); lack of stamina (n = 21, 19.2%); 'others' (n = 12, 11.0%); cardiovascular (n = 9, 8.3%) and orthopaedic (n = 6, 5.5%). Thirty-two had chest X-rays. One abnormality was found -an azygous lobe-but it played no part in the decision to decline the applicant. There was little life- or health-threatening pathology found. The most serious cases were murmurs consistent with mitral stenosis and regurgitation (one each), one case of ocular melanoma, four cases of hypertension and two cases of haematuria/ proteinuria (++). This study shows that potentially serious findings can occasionally be detected in a population of 18-30 year olds who might be expected to be of better than average fitness, and that routine chest X-rays are not helpful in the selection process.