Training Focuses on Rehab and Monitoring

Having worked in St. Louis, MO, for 25 years and now in Memphis, TN, I can testify to how hot it gets in the summer months of July and August. I can remember days when the heat and humidity combined (commonly known as the heat index) made it feel like 110 degrees or higher. Having been in Phoenix, AZ, and Las Vegas, NV, when it was over 110 degrees with low humidity, I can tell you there is a major difference. High humidity combined with high heat can make things downright miserable. However, whether it is high heat with or without humidity, any firefighting or EMS operation during days when the heat index is over 100 can be brutal and can be absolutely vicious on the body. It saps you of all your energy.

Each year, we lose over 100 firefighters to line-of-duty deaths. Approximately 50% of those deaths are due to cardiac events. What does this have to do with rehabilitation? More and more evidence now points to firefighters suffering some type of cardiac event after an operation where rehab and medical monitoring was less than optimal or they were exposed to high levels of carbon monoxide.

To combat this trend, the International Association of Fire Chiefs (IAFC), with the support of the Masimo Corp., has begun rolling out regional training programs focusing on the new 2008 National Fire Protection Association (NFPA) 1584, Standard on the Rehabilitation Process for Members During Emergency Operations and Training Exercises. In 2008, the NFPA updated the 2003 version of the 1584 standard. Based on the new standard, each IAFC member received a free book in the mail detailing best practices to be used in rehabilitating and medically monitoring firefighters during operations.

The rollout of the first regional training program was conducted at the Memphis, TN, Fire Department training center on Nov. 20, 2009. More than 100 individuals from 22 departments participated in the three-hour class given by EMS author and speaker Dr. Bryan Bledsoe and actor Randy Mantooth, who played Johnny Gage in the TV show "Emergency!"

The class began with a 45-minute talk from Mantooth on the need for firefighters to maintain their health and to live to an old retirement age. He summed it up by saying, "Firefighters should die well after they retire — not while working. They should dance at their daughter's wedding and enjoy everything else that life has to offer."

Mantooth, who was sickened by carbon monoxide poisoning years ago, stressed the importance of wearing a mask and being on air even during overhaul operations. Studies done in Pennsylvania of carbon monoxide levels of non-smoking firefighters during overhaul operations showed a significant difference between those wearing a mask and those not wearing a mask. Next, Bledsoe, through the use of PowerPoint slides and graphs, clearly outlined the evidence through the use of data and studies that demonstrate a distinct correlation between improper or no rehab and/or high levels of carbon monoxide and firefighter deaths.

Rehabilitation of firefighters is designed to restore them to a condition of good health. Rehab is designed to mitigate the effects of physical, physiological and emotional stress that can be found in firefighting and other emergency situations. Fire departments are urged to begin formal rehab of firefighters whenever emergency or training operations pose the risk of firefighters exceeding a safe level of mental or physical endurance. Rehab is not only reserved for periods of extreme heat and humidity, but during normal weather or cold conditions. The notion that firefighters need rehabilitation only during extreme heat is false.

Rehab should be activated at the order of the incident commander and should be easily accessible, yet far enough away from any operations or environmental conditions. Those who manage and operate the rehab sector should know their role in rehab and what should be medically monitored with firefighters.

Accountability is another component that is vitally needed when operating a rehab area. It is necessary to track who is in the rehab sector, monitor their condition and ensure they are ready to be released back to operations. The officer in charge of rehab should have the authority over when to release a firefighter back to operations. Firefighters should be released from the rehab sector only when rehab staff has determined that they are adequately rested, have been hydrated, and have responded to the care they received in the rehab area.

Rehab personnel should be alert to the firefighters who are taking longer than other firefighters to get their blood pressure and pulse back into a normal range or who are taking longer to cool down. These firefighters may have to be moved to the treatment sector for further evaluation.

Slowly but surely, the fire service is looking more closely at firefighter deaths and seeking more opportunities to drop the number of firefighter deaths each year below 100 or, dare I say, to zero.

To schedule or attend a free rehab class in your area, call Kristine Johnson at 949-297-7000.

GARY LUDWIG, MS, EMT-P, a Firehouse® contributing editor, is a deputy fire chief with the Memphis, TN, Fire Department. He has 32 years of fire-rescue service experience. Ludwig is chairman of the EMS Section for the International Association of Fire Chiefs (IAFC), has a master's degree in business and management, and is a licensed paramedic. He is a frequent speaker at EMS and fire conferences nationally and internationally, and can be reached through his website at