|Editor's note: Jeffrey Lindsey's series on training for rehab is built on a course lesson plan, which gives the instructor all the ingredients for a successful training session. You can read the lesson plan here, and over the coming months, Lindsey will build upon it to create a comprehensive training program for personnel involved in rehab.
The motto "be prepared" has stuck in my mind ever since my days in the Boy Scouts. As much as I understood the phrase back then, it has become clearer through time just how much this phrase really affects everything we do. The profession of firefighting and EMS seems to really exemplify this phrase. We are not always sure what we should be prepared for, but nonetheless we need to have some semblance of preparation for anything we may face.
The second part of our lesson plan in incident rehab is preparedness. It is fitting that we discuss preparedness early on in the class. If you recall the first thing we did was establish the terminology for the course so we have a foundational understanding of any terms associated with incident rehab. The next part is to look at being prepared whenever we need to implement our rehab sector.
Guidelines and protocols
We should begin by pulling out our SOG manual and reviewing the SOG that pertains to incident rehab. I can hear some of you saying, ‘We don't have a SOG on incident rehab.' Guess what? If you don't have one, now is the time to write it. We are not going to get into how to develop SOGs in this series, but will take for granted that you have a SOG in place. The SOG is our foundation for establishing the rehab sector. Guidelines are designed to be flexible and should be designed to change. One of the purposes to training on an SOG, besides having a template for the class to follow, is to find areas of the SOG that may need to be enhanced or revised. If you find that the SOG does not work, revise it. If things should ever go wrong, the SOG serves as the document for procedures at the rehab sector. If your organization does not follow the SOG, you are deviating from an established procedure which may incur a liability on the organization and the person whose decision it was to deviate from the SOG.
Medical protocols are another area to cover for maximum preparedness. Like SOGs, medical protocols are established as the standard of care for personnel at rehab. Medical protocols should be evaluated and signed-off on by the organization's medical director. It may even be a great move to have your medical director review this portion of the class. Any medical procedures at the rehab sector should follow the medical protocols. If personnel deviate from the protocols, they could be subjecting themselves and the organization to unwanted liability.
The preparedness section of your course should also include learning to anticipate heat and cold stresses. We are subjected to many different environmental factors. Fighting fires does not happen at the best time of year or day. They happen any time, whether it is 100 degrees Fahrenheit or below zero with wind blowing snow. Our bodies are incredible and have a way to compensate for temperature changes. But there are limitations. The limitations are individual, dependent on conditions, and each person may be affected a little differently. Therefore, it is important to be able to recognize the signs, symptoms, and controls for heat and cold stress. When planning for this section of the course it may be advantageous to have a medically trained individual to present the material. There are a variety of resources available. You can use an EMT or paramedic text for the material. Many of these texts have a PowerPoint that covers both heat and cold emergencies and can be adapted rather easily to present in the classroom.
Health-related fitness programs are an essential part of preparing personnel for responding to incidents. Firefighters are very similar to athletes. The expectation of exertion and workload is very similar, yet a firefighter may not take fitness programs as seriously as an athlete. Please make no mistake: there are many agencies that put a lot of emphasis on fitness and I applaud their efforts; however, the initiative is not yet universal. It is important to provide a solid educational foundation for fitness programs. There should be a correlation between having a well-established fitness program and the ability of personnel to rehab on the scene of an incident. The difference between a firefighter and an athlete is the athlete knows when his game starts and has a pretty good idea of how long it is going to last. Firefighters do not when they will be put into their game or how long it is going to last. Emphasis should be placed on a well-defined fitness program. The IAFC-IAFF has a fitness program designed for firefighters and there is a recognized peer fitness trainer program that can be taken advantage of to prepare personnel.
As noted in the previous paragraph, it is critical that personnel should prepare themselves prior to the incident ever occurring. After all, we noted that we may be dispatched to an incident at any time. Emphasis should be placed on proper hydration and nutrition. You may want to consider having a nutritionist come to the department and talk about good nutrition. They will be able to provide a plan for how much fluid and food personnel should consume on a regular basis, as well as rationale for understanding what is beneficial and what is not. This should transfer over to the scene and inform decisions about the best food sources for personnel.
Just because personnel are not at an incident does not mean they are not exerting energy. The rehab class should discuss some of the events planned throughout the day and the effects the events may have on personnel, as an example of everyday exertion. If personnel are out doing hydrant testing all day long, this can have an effect on their bodies. It is just as important to ensure proper hydration and nutrition throughout the day as on the fireground.
In conclusion, personnel need to be prepared before the incident ever occurs. As part of the training session it is essential to start the program on a good foundation. That foundation includes the SOGs and medical protocols in place that pertain to rehab. In addition, it includes proper hydration, nutrition and fitness.
Lindsey, J. (2007) Fire Service Instructor Prentice Hall, Upper Saddle River, NJ
NFPA 1584 Standard on the Rehabilitation Process for Members During Emergency Operations and Training Exercises (2008) National Fire Protection Association Batterymarch, MA