Ethical dilemmas in firefighter rehab

We know that firefighters and emergency service personnel have a determined attitude, which is good but can also be deadly

In my previous column, I used the analogy of football. In this column, I want to take this a step forward. In October, the college football world was rocked by the news from Pennsylvania State University.

I am not going to get into the debate of rights and wrongs or analyze the situation; rather, I think we can take away many lessons from the events that occurred.

Rehab is slowly becoming a part of our incident scenes and training ground activities, and I say "slowly" as I question whether it has truly evolved to match the intent for which it was designed. As members of the rehab section, we have to make tough decisions. Should personnel return to the incident scene or continue with training? Are personnel being rehabbed to the level they need in order to return to the fireground or training ground?

We know that firefighters and emergency service personnel have a determined attitude, which is good but can also be deadly. None of us wants to deny fellow firefighters the ability to fight fires or improve their skills by training. But are we jeopardizing our personnel by allowing them to go back to duty if they are not physically able to perform the job?

This is a tough question. On paper, it is relatively simple as we know we don't want anyone to be harmed or in danger, yet it happens every day, and in some instances, officers command rehabbed firefighters to go back.

This column seems to be asking more questions than answering them. Quite frankly, when it comes to ethical situations, we need to ask more questions. The answers are not always clear and, in some cases, will put you in a difficult predicament.

You have to ask yourself the bottom-line question: Are your actions or inactions jeopardizing your reputation and putting you at risk of liability? You have to make some tough decisions if your officer is not handling the situation as you would expect him or her to.

A great activity for rehab-focused training is to talk about a few scenarios and how to respond to them.

You are assigned as the rehab officer. You have a battalion chief who is sent to rehab. Per rank, she outweighs you. Her blood pressure is 190/110, and even though she appears to be symptomatic, she will not admit to any other symptoms. She orders you to release her back to the fireground. In addition, the incident commander agrees with releasing her. How would you handle this situation?

Situations like this are tough to deal with. There comes a point when you are not able to convince some individuals to seek medical help; we know this to be the case in EMS with the patients we respond to. The best defense in these situations is to provide as much information as possible about the risks. If they are still not convinced and you are overruled, you must document very thoroughly. Unfortunately, there will be adverse outcomes at times, and you need to do your best in presenting the risks and then documenting the events.

The dilemmas you encounter may not be the same magnitude as the events at Penn State, where criminal activity was involved; however, you might have to make ethical decisions that could be the difference between life and death. Based on the circumstances, you need to take the appropriate course of action. This may mean that you will need to call outside agencies to investigate.

Thorough documentation to protect yourself and the organization is paramount. Looking the other way just once could erase a lifetime of accomplishments.

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