Barriers to an Effective Rehab Sector – Part 2

By Scott Bahner and David Jaslow

AP Photo/Matt York Firefighters rest in a shaded area after tackling a wildfire in Arizona in June 2005.

If you have been to enough professional sporting events or watched them on television, you have undoubtedly seen one or more trainers evaluating an injured player on the field or the sidelines.

In addition, they also address fitness for duty and whatever treatment or interventions may be necessary during the game to enable exhausted or dehydrated players to return to a state of readiness.

It is not a stretch to draw parallels between firefighter rehabilitation and the role of the football, boxing or soccer trainer in preparing the professional sports player to go back into the game.

It’s interesting to examine the percentage of time that professional trainers are present at particular sporting events versus the percentage of time that a rehabilitation and medical monitoring sector is not only deployed, but deployed appropriately and according to guidelines.

How many boxing matches have you ever watched in which the boxers went to their respective corners at the end of the round and were left to their own devices to dress their wounds, hydrate and evaluate whether or not they’re OK to return to the ring? If you answered zero, you are correct.

Next, how many professional football games are played in which the trainer staff is absent or unable to perform the necessary duties as detailed in their job description? How many times will there be an inadequate supply of drinking water and/or Gatorade, or not individuals present whose job it is to ensure that the players have easy access to hydration? Again, if you answered zero, you are correct.

The State of Pennsylvania Interscholastic Athletic Association requires on-site trainers as well as emergency medical services to be present for every high school football game, or else the game is cancelled. How is it that we mandate better medical screening and care at high school football games than we do for potentially life-threatening fireground incidents?

Inadequate deployment
In many predominately volunteer fire protection districts, especially in the northeast portion of the United States, and in more career fire departments than it should occur, the rehabilitation and medical monitoring function at “working” emergency incidents is deployed late, inadequately or not at all.

Why does this disparity exist? The workload is clearly equivalent and the need is clearly there. But firefighting, hazardous materials mitigation, technical rescue and other special operations incidents present even greater physical danger to emergency services personnel than to the football players who are tackled by their opponents.

Second, professional sports players who engage in extreme physical exertion are typically in excellent physical condition. There are fitness markers and performance indicators that they have to meet if they wish to remain on active status, else they’ll be sent to the minor league or farm team.

The trainers work with the players on a daily basis to maintain this degree of physical conditioning and preparedness for the next mission or game. Every aspect of the players’ health and fitness regimen is monitored including their diet and exercise routine.

All too often at the opposite end of the spectrum is the fire service. Our personnel often don’t engage in the degree of physical exertion or exercise needed to maintain top physical condition, which will reduce the chances of illness or injury.

But while professional athletes have the option to sit out a game if they do not feel well enough or are judged by the trainer to be less than capable of performing their duties, firefighters — especially volunteers — must respond to every alarm. They often have to disregard their own personal medical issues in doing so.

Few have coaches to watch everything from their diet to their cardiac risk factors and to ensure that they receive annual fitness for duty exams. How many firefighters have access to the top physicians at a moment’s notice to determine the nature of their ailment and how rapidly they can safely return to duty?

Medical screening
A prime concept of fireground rehabilitation and medical monitoring is that in lieu of these luxuries, trained out-of-hospital medical personnel can administer a form of medical screening exam.

This detects whether a potentially life threatening condition exists which underlies physical exhaustion and simultaneously provide basic fluid and nutritional supplements to return the firefighter to a state of physical readiness for their next assignment.

Lastly, professional sports trainers are present in part because they are part of a risk management plan to preserve the tremendous investment in personnel that are made by the team owners. Do our nation’s firefighters not deserve the same investment in health and safety as part of an overall risk management plan? NFPA 1500 series guidelines certainly say so.

If you really stop and think about this, we do an incredible disservice to emergency responders whenever we do not exert every effort to protect their health and safety. It is the least we can do for personnel, many of whom perform their activities for no direct compensation, and who respond to an emergency to take care of our health and safety without the least concern for the potential harm to themselves.

It’s time to take a lesson from professional sports and do whatever is necessary to train and equip a cadre of medical providers whose responsibility it is to evaluate, protect and maintain the physical and mental well-being of emergency response personnel on the fireground.

Neither the training nor the equipment required to perform these tasks are difficult to acquire, but the will to see this concept put into place at every incident is something that requires leadership and motivation.

Scott Bahner is the chief of the Bucks County Rescue Squad in Bristol, Pa., and sits on the regional firefighter safety committee. He is also a medical specialist with the Bucks County Technical Rescue Task Force and Pennsylvania Task Force-1 Urban Search and Rescue teams and an adjunct instructor with Albert Einstein Medical Center’s Center for Special Operations Training (CSOT). Dr. Jaslow is the deputy chief for clinical affairs and EMS medical director for Bucks County Rescue Squad under contract through CSOT. He is an advisor to area fire companies on health and safety issues and has been through the U.S. Fire Administration health and safety officer train-the-trainer program.