Pre-duty medical assessment in fire-fighters requires modernization - relevance of exercise ECG is questioned

Medical assessment of Swedish smoke diving firefighters includes cardiac evaluation by maximal exercise testing with ECG recording. The exercise ECG procedure for firefighters was introduced in 1986, and remains consistent in the recently updated guidelines from 2019. Exercise ECG is a non-invasive and easily available method for detection of chronic coronary syndromes, but due to the declining population risk in high-income countries, its ability to accurately detect disease has decreased. Thus, the clinical relevance of exercise ECG in firefighters is questioned and the pre-duty medical assessment requires modernization.