First Responders
An introduction to teaching students with type 1 diabetes while ensuring the protection of their safety and legal rights.
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Let's Get Started
Let's Get Started
Curious about becoming a first responder but worried that your diabetes will get in the way? No need to worry. In this video, you'll find a detailed walkthrough of what it takes to enter the field, how type 1 diabetes factors into the process, and the real-life experiences of people who have made it work. From medical requirements and workplace expectations to tips for managing long shifts and emergencies, this guide will give you a clear picture of what to expect and how to prepare.
Many people diagnosed with type 1, especially students, often wonder how it will affect their future job prospects. Fortunately, most careers remain accessible, and strong laws help ensure you can manage your blood sugar at work.
Becoming a first responder, however, can be more confusing, leaving many to question whether they can become a firefighter, police officer, or EMT. This article covers the major requirements, regulations, and processes for pursuing a first responder career with type 1.
Requirements and regulations can change, so this information may not always reflect the latest policies or those specific to your department. For the most accurate guidance, consult your prospective department’s human resources or administrative office directly.
The Bottom Line
The Bottom Line
Most departments across the United States and in other developed countries do not have definite, overarching rules that say whether you can or cannot become a first responder if you have type 1. Instead, departments often choose to assess each potential employee on an individual basis to ensure that they are fit and safe to work while managing their type 1.
The general consensus is that if your type 1 diabetes is well-managed and does not pose a potential risk to yourself or anybody else, then you are fully able to become a first responder just like anybody else.
As a second important note, since all of the regulations and policies surrounding this type of employment are very complex, vary by location, and are subject to change, please reach out to your local agencies for the most accurate information. This page is intended to serve as a place to start gathering general information and point you in the right direction to find out more about your specific situation.
Interviews
Interviews
Read our exclusive interviews with Constable Ian Barraclough of the Vancouver Police Department and Ben Blanco a firefighter in Arizona on their experiences working as first responders with type 1 diabetes.
Firefighters and Rescue
Firefighters and Rescue
In the United States, firefighting medical standards are often guided by the National Fire Protection Association (NFPA) 1582: the Standard on Comprehensive Occupational Medical Program for Fire Departments. This standard no longer automatically disqualifies individuals with type 1 diabetes, but requires case-by-case evaluation.
Key Medical Criteria
Key Medical Criteria
To qualify for firefighting duties, individuals with type 1 diabetes must satisfy several specific medical requirements:
Care under a knowledgeable physician, using a basal–bolus insulin regimen (including pumps or analogs).
Consistent and motivated diabetes self-management, with at least 6 months of stable control.
Eye health: no more than microaneurysms, and no advanced diabetic retinopathy.
Kidney function: normal renal function, with no significant proteinuria.
Neuropathy: absence of autonomic or peripheral neuropathy, confirmed through testing.
Cardiac fitness: no ischemia, and ability to achieve at least 12 METs on stress testing.
A signed letter from an endocrinologist confirming you meet the criteria and can fulfill firefighting responsibilities.
You can find more detailed information on the NFPA's website at nfpa.org/en and by reaching out to your department of interest. While you can purchase the current version of the NFPA 1582 from their website, you can also read an older (but still mostly current version) below.
NFPA 1582 (2013).pdfRelevant Documents
Relevant Documents
The document shown here is the 2013 version of NFPA 1582, which covers physical fitness and medical evaluations for firefighters. While it is an older edition, much of the information remains relevant.
Additional documents listed below provide further details on medical requirements for firefighters.
Navigating Department-Level Variations
Navigating Department-Level Variations
While NFPA 1582 provides a national guideline, individual fire departments make the final hiring decisions. Some may be more conservative, others more flexible, but none can reject solely on the basis of type 1 diabetes.
A few practical steps to improve your chances:
Be transparent with medical evaluators about your diabetes management strategies.
Train thoroughly for your department’s fitness test (such as CPAT).
Educate yourself and your department about your tools, like CGMs or insulin pumps.
Steps to Get Started
Steps to Get Started
There are several steps that you can take to prepare for your firefighting career with type 1.
Compile Medical Documentation: Gather eye exam, kidney tests, cardiac stress results, neuropathy screens, and an endocrinologist’s statement.
Improve & Maintain Control: Keep your A1C stable, with no severe hypoglycemia in the past year (and no more than one in five years).
Practice Physical Readiness: Train for relevant firefighting fitness exams (such as CPAT).
Communicate Proactively: Explain your monitoring tools, emergency protocols, and how you mitigate risks.
Research Departments: Contact HR or medical staff at your target fire departments for details on their process.
Emergency Medical Technicians
Emergency Medical Technicians
The regulations around becoming an emergency medical technician are somewhat less strict than those for firefighters or police since EMTs are generally less likely to be working in physically dangerous situations.
Key Medical Criteria
Key Medical Criteria
In the United States, the National Registry for Emergency Medical Technicians is responsible for certifying EMRs, EMTs, AEMTs, and paramedics. Although they conduct certification, they are less involved in creating policy, so that is often left up for individual departments to develop.
For a long time, some NREMT certifications had a requirement for a psychomotor exam; however, they revised their requirements in 2021 and began phasing that portion of the exam, with now entirely removed since 2023. While this is no longer required on a national level, many individual agencies will still require some sort of physical examination or test to ensure that EMTs are able to fulfill their duties.
As an example, Forsyth County in North Carolina requires a Physical Agility Test (PAT) that simulates many of the physically strenuous tasks that an EMT may be faced with.
An outline of this test (as an example) can be found in the document to the right.
While this is not an exam designed to look for any specific medical conditions, having type 1 may make this more difficult since these types of activities can cause rapid reductions in blood sugar.
This would be something that you would want to discuss with your supervisor or instructor to ensure that they are aware of your diagnosis and that they know you may need to treat your blood sugar during this process.
Since there are few national regulations regarding hiring, if you are interested in an EMT position it is best to reach out to your department of interest to find out about their specific policy.
Physical Agility Test.pdfTesting Accommodations
Testing Accommodations
Since the NREMT requires a lengthy written test in order to become certified, you may need to treat your type 1 during the testing period. NREMT offers ADA compliant accommodations to those who may need them during their test. More information can be found on their website here.
Ambulance Driver Certification
Ambulance Driver Certification
Receiving your basic EMT (or similar) certification should not be too difficult if you have type 1, but if you plan of becoming certified to drive an ambulance there will be more steps that you need to complete.
Each state and/or jurisdiction have their own rules about whether you are permitted to drive an ambulance with type 1. Some places do not require anything more than a doctors exam and letter stating that you diabetes is well managed and you are showing any side effects. Other jurisdictions may require you to comply with similar regulations to truck drivers.
Since the laws vary significantly, the best thing that you can do is reach out to the department of motor vehicles or department of transportation in the area where you wish to be certified. The instructors for the driving course may also know more about the process.
Police and Law Enforcement
Police and Law Enforcement
In the United States, police officer medical standards vary by department but are generally guided by recommendations from the International American College of Occupational and Environmental Medicine (ACOEM) and the Association of Chiefs of Police (IACP). ACOEM provides evidence-based medical guidelines for evaluating fitness for duty, including chronic conditions like type 1 diabetes. These guidelines emphasize case-by-case evaluation, rather than automatic disqualification, allowing qualified individuals with type 1 diabetes to serve safely in law enforcement.
Key Medical Criteria
Key Medical Criteria
Based on ACOEM and IACP guidance, individuals with type 1 diabetes seeking police employment should demonstrate:
Consistent diabetes management under a knowledgeable physician, with stable control for at least six months.
Good blood sugar control and ability to recognize and manage hypoglycemia, particularly in high-stress situations.
Eye health: no significant diabetic retinopathy or vision impairment that would interfere with duties.
Kidney function: normal renal function, with no significant proteinuria or other complications.
Neuropathy: absence of peripheral or autonomic neuropathy that could compromise safety while driving or using firearms.
Cardiovascular fitness: ability to meet department physical standards, including running, strength tests, and agility courses.
A letter from an endocrinologist, confirming you meet these criteria and are fit for duty.
ACOEM specifically notes that well-controlled type 1 diabetes does not inherently prevent safe performance of essential law enforcement functions, provided the officer is self-aware, trained, and equipped to manage glucose levels during duty. You can read the full version of the ACOEM here.
Navigating Department-Level Variations
Navigating Department-Level Variations
Similarly to firefighting, although ACOEM and IACP provide guidance, each police department sets its own medical clearance rules. Departments must consider qualified applicants individually, and automatic disqualification based solely on type 1 diabetes is generally inconsistent with best practices.
Practical strategies for success include:
Transparency with medical evaluators regarding your management plan, including insulin regimen, CGM or pump use, and hypoglycemia prevention.
Physical preparation for agility tests, defensive tactics, and cardiovascular challenges.
Understanding duty-specific risks, including driving, firearms, and high-stress encounters, and demonstrating readiness to handle them safely.
Steps to Get Started
Steps to Get Started
Compile Medical Documentation: Include eye exams for night and peripheral vision, kidney function tests, cardiovascular stress tests, neuropathy screenings, and a letter from your endocrinologist stating you are fit for active duty, including driving, foot pursuits, and use of firearms.
Maintain Consistent Blood Sugar Control: Monitor your glucose carefully in scenarios that mimic police work—like shift work, physical activity, or high-stress situations—to ensure you can safely manage hypoglycemia on the job.
Train for Police Physical Requirements: Practice physical requirements (often on the PAT or POPAT) or department-specific agility courses, including running, stair climbing, obstacle navigation, and defensive tactics that simulate real policing scenarios.
Communicate Effectively with Recruiters and Training Staff: Be upfront about your diabetes, your self-management strategies, and your readiness to handle emergencies safely. Demonstrate knowledge of how to manage blood sugar during high-stress situations.
Sources and Further Reading
Sources and Further Reading
Sunsetting the EMS Psychomotor Exam: 'About Time' or 'Big Mistake'
This article discusses the National Registry's decision to phase out the Advanced Life Support (ALS) psychomotor exam, exploring the implications for EMS education and certification.
Read the full article here
The National Registry’s ALS Examination is Evolving
The National Registry outlines updates to the ALS certification examination, including the introduction of new testing formats and content areas to better assess clinical judgment and decision-making skills.
Learn more about the changes
Living with T1D as an EMT
This personal account provides insights into the challenges and strategies for managing type 1 diabetes while working as an Emergency Medical Technician, highlighting the importance of self-care and workplace accommodations.
Read the full story
NFPA 1582: Standard on Comprehensive Occupational Medical Program for Fire Departments
This standard provides guidelines for fire departments to establish comprehensive occupational medical programs, ensuring the health and safety of their personnel.
Access the full standard here
Firefighters and Diabetes Discrimination
The American Diabetes Association discusses the rights of firefighters with diabetes, emphasizing that diabetes should not be an automatic disqualifier but assessed on a case-by-case basis.
Learn more here
Fighting Fires with Type 1
Andrew Thomas shares his experience as a firefighter living with type 1 diabetes, providing insights into managing the condition in a demanding profession.
Read Andrew's story
My Journey Fighting Fires and Type 1 Diabetes
John Cutter Jr., a fifth-generation firefighter, discusses his journey managing type 1 diabetes while serving in the fire service, offering insights into resilience and adaptation.
Read John's journey
Can You Be a Firefighter with a Disability?
This article examines the challenges and considerations for individuals with disabilities aspiring to become firefighters, offering insights into accommodations and career pathways.
Explore the article
Firefighters and Diabetes Discrimination
The American Diabetes Association discusses the rights of firefighters with diabetes, highlighting legal protections against discrimination and the importance of individualized assessments.
Learn more about ADA protections
Firefighter Insider: Disability and Firefighting
This article examines the challenges and considerations for individuals with disabilities aspiring to become firefighters, offering insights into accommodations and career pathways.
Read the full article
Beyond Type 1: Fighting Fires with Type 1 Diabetes
Andrew Thomas shares his experience as a firefighter living with type 1 diabetes, providing a personal perspective on managing the condition in a demanding profession.
Read Andrew's story
Firefighter Nation: My Journey Fighting Fires and Type 1 Diabetes
John Cutter Jr., a fifth-generation firefighter, discusses his journey managing type 1 diabetes while serving in the fire service, offering insights into resilience and adaptation.
Read John's journey
ACOEM Police Fitness-for-Duty Guidelines
The American College of Occupational and Environmental Medicine (ACOEM) provides comprehensive guidelines on fitness-for-duty assessments for police, emphasizing the importance of medical evaluations in ensuring safety and performance.
Read the full guidelines here
IACP Police Medical Standards
The International Association of Chiefs of Police (IACP) outlines medical standards and evaluations pertinent to law enforcement officers, promoting health and safety within police agencies.
Explore the IACP resources
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