By Brad Van Ert
Rehab is an important component of all emergency operations when personnel are required to exert themselves physically. By monitoring vital signs and ensuring adequate hydration, we can reduce fatigue and prepare personnel to re-engage in emergency operations.
It’s easy to forget that rehab is equally important during training exercises.
Training exercises expose our bodies to the same extreme conditions we experience when operating at an emergency scene and the tendency to become complacent must be avoided. During training, we are usually wearing the same PPE and SCBAs that we wear during emergency operations. We may be operating in hot or cold weather conditions and performing many of the same tasks we do while firefighting.
Unlike an emergency scene, training exercises are often run one after another, with minimal time between scenarios to recuperate.
The following Near-Miss report stresses the importance of rehab while training.
“Students were preparing for live-fire training at a facility using gas-fed props. Vitals were taken in accordance with NFPA 1401 and NFPA 1403, and students were briefed on how the scenarios would be conducted.
During the second scenario, one of the firefighters exited the structure and stated that his facepiece on his SCBA did not have a proper seal. He was assisted in removing his gear and directed to take a break in the rehab area.
After a couple of minutes, the safety officer asked him how he was feeling. He stated he was OK and said, ‘I just need to catch my breath.’ We allowed him to rest for another five minutes while taking his vitals and giving him water. He was telling us he was OK and that he was just tired. However, the rehab sector officer decided that it was more than just being tired and he began following our local firefighter rehab protocol.
While taking the firefighter’s pulse a second time, he noticed an irregular heartbeat, which the firefighter said he did not have. At this point, the firefighter was still in defiance that there was anything wrong with him. We initiated ALS procedures and put him on an EKG monitor which showed that the firefighter had a heart rate of 120 with over 20 PVCs a minute scattered throughout his EKG. After this was noted, we started to call for a transport unit to take the firefighter to the local hospital for further evaluation.”
The firefighter insisted he was alright and tried to convince rehab personnel that he would just sign a release and go see his doctor the next day. Staff insisted he seek immediate medical attention and eventually he was persuaded to go to the hospital by ambulance. He was seen by a cardiologist and a stent was placed into a blocked coronary artery.
The lesson that we learned during this near miss is that firefighter rehab is not just for water and cooling down; it is a serious place for looking at vitals and other signs and symptoms. We might discover something that has been missed for years or catch a new onset of something that has just started. The key is rehab should be taken seriously, not only by the people running it, but the firefighters coming into it. You should have a strong rehab officer that will follow the guidelines and does not care what the firefighter is trying to say to get out of rehab. This could save their life.”
This near miss resulted in spite of the fact that everything appears to have been done properly in terms of implementing a thorough rehab process during training activities. Had it not been for proper rehab procedures, we may have been reading of another line-of-duty death.
Rest and rehab needed after any strenuous activity
The physical and mental abuse our bodies take while involved on the emergency scene is well documented. We enter super-heated atmospheres where temperatures can exceed one thousand degrees, while wearing heavy clothing and equipment weighing up to 60 pounds, and perform dangerous, strenuous physical activity to the point of fatigue.
In addition to these challenges, we may then have to deal with weather extremes of cold or hot temperatures coupled with high humidity, rain, snow or wind while we are trying to recover. The burst of adrenalin our body receives in these situations places additional stress on our cardiovascular system. In many situations, we leave rehab to go back into the building for another round. These facts underscore the importance of staying physically fit, eating a healthy diet and providing for proper rest and rehab after any extremely strenuous activity.
Rehab can involve anything from taking a break and having a drink of water after a quick knockdown of a small single room and contents fire, all the way up to a more formal process that addresses hydration, dry clothing, active cooling (or heating), removal from the emergency scene and medical monitoring after prolonged firefighting operations.
These same conditions also come into play during training evolutions when adrenalin can push us to work harder and longer, exposing our bodies to their upper limits before we realize it. Rehab guidelines and policies must be in place and personnel must be aware of their importance before we respond to emergency scenes or participate in strenuous training activities.
If your agency does not have rehab policies, or if it has been a while since they were updated, the best place to seek guidance is NFPA 1584: Standard on the Rehabilitation Process for Members During Emergency Operations and Training Exercises. By following these guidelines, you can ensure you are taking important steps to protect the health and safety of your people through the use of scientifically proven monitoring and rehabilitation procedures.
About the Author
Brad Van Ert has 39 years in the fire service. He served for 32 years with the City of Downey (California) Fire Department as a firefighter, paramedic, captain, training officer, and EMS coordinator. He is now the EMS Division Chief with the Northern Lakes Fire Protection District in Hayden, Idaho. Van Ert earned a bachelor’s degree in occupational studies and a master’s degree in emergency services administration at California State University, Long Beach. He has been an advisor with the IAFC Near-Miss Reporting System since 2005.
This article, originally published in February 2019, has been updated.