Columns, Training

Calling Attention to Firefighter Incident Rehab

Issue 5 and Volume 41.

THE RESEARCH

Smith DL, Haller JM, Benedict R, et al. Firefighter incident rehabilitation: Interpreting heart rate responses. Prehosp Emerg Care. 2016;20(1):28-36.


THE SCIENCE

This study extracted the data of a separate study designed to assess firefighter crew size and ascent mode (i.e., stairs vs. elevator) in a simulated fire exercise. A fire was simulated on the 10th floor of an unoccupied, 13-story commercial building with trapped victims on the 10th and 11th floors.

The firefighters were outfitted with heart rate (HR) monitors that stored data internally and downloaded it at the conclusion of the clean-up activities.

Each firefighter was equipped with standard turnout gear and a 45-minute self-contained breathing apparatus (SCBA). Simulated firefighting activity ranged from 12-20 minutes, followed by a mandatory 15-minute period where they received routine monitoring, hydration and cooling in a designated rehabilitation area on the 8th floor. The data from the monitor was downloaded and assessed after the exercise and didn’t influence the rehabilitation period.

Upon entry to rehab, the average heart rate during the simulations was 173 ± 18 beats per minute (bpm) and 149 ± 24 bpm. After 15 minutes of recovery, the mean HR was 126 ± 23 bpm.

Not surprisingly, the higher HR was associated with more strenuous activity, higher ambient temperatures, greater movement during rehab, older age (≥ 45 years old), and higher body mass index (BMI). Based on current fire service recommendations, 88% of the 198 firefighters wouldn’t be released from rehab and allowed to resume firefighting.

DOC WESLEY COMMENTS

This is one of the first studies to examine, under near actual conditions, the impact of the National Fire Protection Association (NFPA) recommendations for release from rehab. It provides eye-opening insight into the potential impact of fire-ground activities.

Eighty-eight percent of firefighters wouldn’t be able to return to duty after 15 minutes of rehab? Well, we all know that won’t fly.

While it’s generally understood that the HR limits published in the NFPA 1584 were a consensus based on simulated models and controlled environments, I wonder what the HR measures would be in a real fire situation, where the stress of performance and life safety are higher?

Interestingly, the authors don’t state a clear conclusion in the abstract of the paper. Instead, they list it-in a somewhat politically correct manner-in the final three paragraphs of the paper. It questions the value of a single vital sign for rehab clearance and calls for additional studies to consider that returning to duty may require a “multifaceted approach to medical monitoring during rehabilitation that includes the use of vital signs to assist with medical decisions with the caveat that vital signs must be interpreted in context with the overall appearance and health status of the firefighter.”

Really? Does any anyone believe that an EMT or medic is going to assess the vital signs and BMI of the firefighter, take into account his age and medical status and tell him, “You just aren’t in shape for this”?

Perhaps the answer lies less with rehab standards, and more with prevention. Maybe firefighters should be required to train under stressful conditions on a regular basis to improve their cardiovascular response to the physical stresses of firefighting.

MEDIC WESLEY COMMENTS

There are some previously known facts regarding the profession of firefighting-it’s physically challenging, it’s emotionally challenging and it requires individuals to be in peak conditioning at all times. This study indicates that two out of three are constants. The variable is the peak conditioning. It can be addressed here, but to be honest, I feel the onus lies with the individual.

Failure to train the body to meet the demands of the mission can result in disability or death for someone in a stressful job. Unfortunately, it can also result in the disability or death of a co-worker. If those possibilities don’t persuade someone to work at maintaining their health, well, enough said.

The issue of quality rehab in firefighting seems to be in question in the study. Where’s the rehab occurring? Do those in rehabilitation sit down, or do they walk around? How do they get cooled and hydrated?

I would like to see a subsequent study that uses different methods of rehab. Perhaps longer rehab times, removal from the mission environment and supine position would produce different outcomes. It would be a worthwhile effort to improve health on the fire ground.

We know what the public safety professions require as far as fitness. Our bodies and minds have to go from zero to 60 in seconds when dispatched. The same response occurs multiple times during one mission. Are you willing to do what is needed to stay in the game? Like my lieutenant would say, “Are you mission ready?”