Tips for Effective Fireground Rehab

As we head into the peak summer months, with record-breaking heat already affecting much the country, it’s time to cover the importance of incident rehab with our members. Our first duty as company officers and training officers is to protect the health and safety of our personnel. Whether it’s on the fireground or at another type of incident, we must ask ourselves, are we doing everything we can to protect them? In some cases, you may very well be protecting them from themselves–nobody wants to be the first to quit, so members may push themselves beyond what’s safe just to feel like they’re carrying their fair share of the load.

There’s more and more information available about the importance replenishing our bodies with fluids and food after intense physical activities–and this doesn’t just pertain to sports, but also to emergency operations such as wildland fires, structure fires and auto extrications. Sports teams have led the way in all forms of on-site rehabilitation by recognizing the dangers of dehydration and understanding that proper hydration leads to better performance and quicker recovery times. Heat-related injuries can be severe and long-lasting, even causing death, as we see each year in the beginning of high school football season when players are exposed to extreme workouts during some of the hottest times of the year. One of the greatest differences between us and athletes: Our personal protective equipment (PPE) holds all that heat in, speeding up the process of dehydration and heat-related problems.

It wasn’t that long ago when we thought that good fireground rehab was taking a little break from the fire and drinking a Coke and eating a candy bar while sitting on the tailboard of the truck. We have made some great improvements in the items we provide during rehab; by now, we should know to avoid products with loads of sugar, like candy and soft drinks.

Let’s take a look at some of the other factors that influence rehab.

Rehab Starts Before the Incident
We never really know when we’ll be asked to give our all. One minute we can be performing station clean-up where it’s nice and cool, the next minute we could be going all-out in extreme temperatures.

A big part of any emergency responder’s duties is preparation before the incident, and it starts with our own fitness level. You can’t expect to operate successfully in hot conditions if you don’t spend some time outdoors when it’s warm. Use caution and start slow to build up while acclimatizing yourself. Remember: It’s not something you do in a day or two; it takes time for your body to get used to the heat.

Another important pre-incident routine is hydrating well before you have the next possible fire or emergency incident. If you wait until you have that fire on a hot day to start replacing lost body fluids, it’s already too late. It’s critical to stay well hydrated all the time so that you have a reserve.

Most of us are not as well hydrated as we should be because we just don’t drink enough water. Coffee and soft drinks don’t do the job. The human body is about 60% water, and we need to replenish it all the time.

How much water do you need? The “8 and 8 rule” recommends 8 ounces of water 8 times a day, which adds up to 1.9 liters. Some studies indicate that we need much more than this, somewhere close to 3 liters for men and 2.2 liters for women. Perhaps the best rule of thumb: Drink early and often.

One of the best ways to monitor your personal hydration level is by the color of your urine. Click here to see a urine color chart that’s used on the Brayton fire training field at College Station, Texas. This chart is posted in all the restroom areas and each instruction area to remind students to check their hydration levels throughout the day. Remember that hydration is just as important during our training sessions as it is on the fireground. Every year there are reports of injuries and deaths related to heat-related emergies during training.

Take Breaks
When we’re working on the fireground or emergency scene, or even during training, we all need to watch out for each other, looking for signs of fatigue and heat stress and taking breaks as needed. This should be a bottom-up approach, with firefighters watching each other and the company officer, the company officer watching the crew and division, and the incident commander (IC) watching companies under their command with respect to time committed to the incident, difficultly of tasks assigned and weather conditions.

It’s important to catch heat-related fatigue early. Keep the IC informed so that they may have ample reaction time to call for additional companies. The IC should always be aware of extreme weather conditions and provide relief companies as needed and monitor a cycle of hydration, rest and work rotation.

Get Out of Your Gear
During these hot summer days with high heat indexes, it’s extremely important to get your PPE off as soon as you get outside the hot/danger zone of the incident. You need to get your helmet and hood off because your head releases about 7 to 10% of your heat.

Get your coat off and find a place to sit down sit to allow you to push your bunker pants down, allowing air circulation around the legs. This allows the heat inside your PPE to dissipate much more quickly.

Medical Monitoring
Although we don’t have time to get baseline vitals on every firefighter before they enter a structure fire, we should be monitoring them in rehab. By taking blood pressure and pulse during these rest breaks we have more usable information on whether they should return to work.

Aggressive Cooling
In the past we thought just coming out of the fire and sitting down on the tailboard for a while was good rehab, but like a number of things in the fire service, we’re getting smarter all the time. For us to take better care of our people, we need to be much more aggressive in the ways we rehab.

Departments are finding ways to get their response personnel out of the elements and into a more environmentally controlled rehab area–specially designed trucks, buses and trailers, even old ambulances, can be used to aggressively cool members.

Whatever your department uses, always provide an ice chest with ample supplies of water and sports drinks so crews can take in fluids during their rest breaks. Restock the chest with additional ice and drinks during extended operations. Also provide an ice chest with towels that have been soaked in cool water that can be used to wrap heads and necks.

Aggressive cooling can also be aided by commercially produced cooling/misting fans to cool larger outside areas, in some cases lowering the ambient temperature 15 to 20 degrees in and around the rehab area. Commercially produced chairs that allow you to submerge your forearms in cool water are also available. Research has shown that immersion of the forearms in cool water allows the core temperature to be lowered much faster and allows those working in extreme conditions to recover more quickly than with passive rehab, extending their work cycle.

Don’t Get Beat
With the extreme hot temperatures throughout much of the country this summer, firefighter rehab on emergency scenes should be a major concern for each of us.

Take time to discuss the importance of aggressive rehab with your crews using the techniques outlined above. Review your department’s guidelines for incident rehab. There are several outstanding reference materials that you should review before training with your crew, including NFPA 1584: Standard on the Rehabilitation Process for Members During Emergency Operations and Training Exercises, and IFSTA’s Emergency Incident Rehabilitation.

Stay cool!