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Considerations for Implementing Rehab

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 program. This article focuses on incident scene and training rehabilitation.

This section has two different audiences when you present the material. There are the medical personnel who will be providing the care and there are the firefighters who will not necessarily be conducting the medical aspect of rehab, but need to understand the importance of the components.

When implementing rehab there are a number of items that need to be taken into consideration. The first is to determine when to commence rehab. One method for teaching this is to have a set of scenarios and ask the participants at which incidents they would commence rehab. It is important to stress to participants that they need to consider rehab early in the incident. It takes time to get personnel and equipment to the scene to establish a rehab sector.

Another factor to take into account is who will be assigned to rehab. Typically, personnel on the initial alarm will not be enough to establish rehab and conduct a rehab sector. In the same vein, if the incident is not of a magnitude to call additional resources, there may be sufficient personnel on scene to manage rehab at a lesser scale. The incident commander will ultimately be the individual who designates personnel or companies to establish a rehab sector.

Budget cutbacks
In today’s world of budget cutbacks and staffing issues, utilizing the EMS personnel at an incident to establish rehab makes great sense. However, you can't expect EMS personnel to show up on the scene and be able to know what to do. Chief officers should work with the local EMS agency if EMS is not part of the fire department. Training needs to be conducted with EMS personnel prior to the event. This is where the fork in the training road comes into play: EMS personnel should be trained in rehab and fire personnel should be trained on why they need to go through rehab and what the value of rehab is for them.

One of the most difficult tasks for the rehab personnel is keeping firefighters in rehab. As part of the training, the amount of time firefighters will be spending in rehab should be clearly explained. They feel they are there to fight a fire, not sit in rehab. An analogy that could be used is to compare a firefighter to an athlete. For example, if you watch a football game, there is nothing more a football player wants to do than to be in the game. However, that is not always possible.

Even when the offense is in, not all the offensive players get to go out on the field. Depending on the previous play and the strategy of the game, personnel are rotated. Even the best need to be rotated to get a chance to take a breather and rehab with rest and fluids. Firefighters are not any different. They need to come out of the game, typically for a 15 minute period, for rest, hydration and monitoring. Unlike athletes, firefighters are called into action without the benefit of a proper warm up. Hence, they need rehab even more than the athlete might.

Understanding the necessity of rehab is an essential element of this portion of your rehab training. Personnel from both EMS and fire should be included in order to understand the elements of an effective rehab sector.

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  2. Fire Rehab

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