Firefighter rehab lessons from a triathlon

Working the medical tent at an endurance event shows similarities and differences to firefighter rehab


I recently had the pleasure of providing medical support at a New Jersey Ironman event. While working in the medical tent at the end of the 1.2-mile swim, 50-plus-mile bike ride and 12-mile run, it struck me how in many ways it was similar to a rehab sector at a major fire.

But upon further consideration, there were some significant differences as well.

First, I noticed how varied the participants were in terms of physical condition. I expected most or all to be in excellent physical shape to participate in the event. But there were many who were somewhat overweight — but they finished. 

We experience the same at a fire scene. Some firefighters are in excellent shape and others could use a bit more diet and exercise. As medical providers, we need to be able to treat individuals of all shapes and sizes. But I will note that at this athletic event, the overweight participants were not the fastest, but they also in general did not need our medical services.

"I did not prepare"
The participants that did need medical evaluation had an almost universal statement: "I did not prepare or train as much as I should have." 

We can all take a lesson here. We need to prepare ourselves for the task at hand, whether it be running a marathon or making a grab at a working structure fire.

Athletes have the advantage of knowing when they are going to compete. We do not.

Career firefighters' call to duty may be anticipated by shift, but in reality we need to be ready to go any time the bells go off. We need to train and prepare ahead of time so we can be of service to our community and not a burden to our fellow firefighters.

Guerrilla triage
Operationally, we found it quite valuable to station a couple EMTs at the finish line. Our tent was close, but these "triagers" were able to eyeball each participant and assess whether medical treatment was needed or if the runner was simply tired. 

This is exactly the role I tend to assume on the fireground as a fire department physician. As firefighters are walking around, doing their assigned task or approaching the rehab sector, I look them in the eye and watch how they walk.

I am looking for a purposeful gaze, a steady gait and clear speech. They can be tired, but they should not have an alteration in mental status. Those that show these signs are engaged for further assessment. 

Just as at a fire scene, the environmental conditions play a significant role in the number of individuals that presented for care. On this day, it was cloudy with temperatures in the 70s. This was ideal and certainly lessened the impact of the exertion.  

On the fire scene we need to be aware of the conditions as well. A hot day with high humidity results in significant exertion even at a non-working fire scene. Awareness and anticipation allow us to be better prepared to care for those that need it.

Difference in focus
Again, there are a number of differences between the triathlon and the fire ground. Now I understand that what I describe below may not happen everywhere, but I have seen examples enough times that we must acknowledge they occur.

None of the triathlon athletes were embarrassed for needing medical evaluation and care. They did not try to minimize complaints or issues and they were honest with the medical providers, even if they had to stop in the middle of the race.

Too often I see firefighters (and tactical operators, law enforcement and other athletes) minimize their complaints with a goal of getting back in the fight. This is noble, but we must admit that it may be a bit selfish.

If you are hurt more than you let on, you could be a liability to your department, your mission, or your team. Be honest with us and let us help you get back on your feet to fight, even if it has to be on another day.

Perhaps this was a unique group of people, but these tri-athletes really seemed to work with us. As a result, we were able to effectively treat them and the number that had to go to the hospital during and after the event was very small.

What's in a name?
Obviously the other major difference was the overall situation. In one case we have a recreational athletic event, and in the other someone may have lost a home, occupants or fellow responders may have been injured or even killed. The stress level is inherently different. 

This may explain the denial of complaints seen at fire rehab; rather than a conscious decision, firefighters may not realize how injured they are due to their focus. In addition, staffing can be an issue. 

The athletic event was planned months in advance and staffing was known. The fire scene is unplanned, and staffing may be stretched on both the fire and EMS side, limiting our ability to be efficient in the rehab sector.

These two situations seemed similar, but in many ways were not. Even the name was different — we were medical or Athlete Medical Support.

I wonder if our thoughts (and sometimes prejudices) about the activities going on in a firefighter rehab sector would be different if we called it Firefighter Medical Support. Perhaps the term rehab has a negative connotation — implying that something is wrong with you that has to be fixed, like physical rehab, drug rehab, rehabbing an old house for example.

Stay safe.

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