How to nurture a firefighter rehab culture

Encouraging firefighters to be more focused on rehab requires leadership, training and reinforcement

This article first appeared on, sponsored by Masimo.

By EMS1 Staff

Changing or influencing the culture in the fire service has been the subject of enough books and seminars to fill a library, and rightly so. Effecting change across a loosely connected industry spread over most of North America is no small task.

But it can be and has been done. That firefighters and fire chiefs have embraced safety equipment and safer practices is evident in the reduction of line-of-duty deaths on the fireground.

While the fire service’s safety culture has made profound strides in the past decades, it is still a work in progress. Firefighter rehab is one of the next phases of that cultural shift.

Given the number of firefighters who die of cardiac arrest and the known relationship between firefighting and cardiac stress, rehab is a life-safety issue. A true rehab culture is one where firefighters go to rehab because they want to and don’t have to be forced or told to go.

To get a better handle on this problem, we turned to experts in cultural change, firefighter rehab and our own readers.

Leadership and peer pressure

In her article “3 Keys to Changing Fire Service Culture,” Linda Willing writes, “Whenever I do a presentation about changing fire service culture, I inevitably get some pushback from at least a few participants. ‘You can't change the fire service,’ they say, ‘Tradition is too strong, and that tradition is important. Fire service culture is what it is.’”

She goes on to say that “firefighters can change, both as individuals and as a group. They just have to understand the value of that change and be effectively led in achieving it.”

She offers three things that must happen for culture to change:

1. The change must be supported and mandated from the top down.
2. The change has to make sense for people to embrace it.
3. There needs to be a consistency of purpose over the long haul.

In another piece, “How Your Company Officer Influences Firefighter Behavior,” Willing discusses how powerful fire officers’ actions are in determining how firefighters will behave. Firefighters look to their officers for cues, like when to remove SCBA masks and when to fully don PPE, she writes. She also examines a study, albeit it one with a small sample size, that shows a correlation between peer pressure and firefighter PPE use.

In short, getting firefighters and company officers to make rehab part of a normal fire scene means getting consistent buy-in from the top down and consistent execution — or example setting — by on-scene officers.

‘Flipping the Classroom’

At the more tactical level, getting firefighters to understand how, when and why to use rehab – as well as training medical staff on setting it up and running it – can be enhanced by flipping the classroom. Rehab and education expert Jeffrey Lindsey dives into how making the students the teachers can improve learning in his piece “Fire Instruction: How to Make What you Teach Stick.”

Information retention in a traditional lecture setting is about 5 percent, Lindsey writes. However, when the students are tasked with teaching a skill or subject matter, the retention level jumps to 90 percent.

Lindsey used this technique in his Paramedic I class and saw positive results once some initial resistance to the method was overcome. He says the method applies to any subject, including rehab training.

“If the learners become involved in the delivery process of the course, their retention will increase,” he writes. “Flipping the classroom forces the learner into the books and materials for the course in order to teach the material. It allows the opportunity to interact with their peers. … Emergency personnel are mostly Type A personalities who need involvement and activity in the classroom in order to learn best.”

In his article “Practical Evolution for Rehab,” Lindsey writes: “The one thing that has stood out most in each of the rehab training classes I conducted is the practical evolution. This is when you can see the pieces of the puzzle come together and the lightbulbs going off on the realization of just how important it is to incorporate rehab training in what we do.”

One thing he emphasizes is to establish the rehab sector at the start of the incident during training and real life. In training, he recommends that those portraying the first-in fire crew come to rehab soon. This forces those training in the rehab sector to be prepared from the start. It also conditions firefighters and officers to use rehab early in the event.

Wisdom from the field

Shifting the fire service culture to be more focused on rehab will take top-down policies and actions, as well as smart training and reinforcement. Here’s a look at suggestions made by our readers:

- "So the problem is we are all Type A personality people. All go, no quit. So, to foster a rehab way of thinking is tough. The first step is talking to your crews and leading them to the understanding that you are not ‘wimping out’ when you go to rehab. The same rule applies at the station after a hard training or work day. It may be necessary to take your engine out of the rotation for a while to let the crew rehab so they are not behind the eight-ball when the big call comes." — Chris McMaster

- "My department preaches ‘Be the solution, don't become part of the problem.’ There are different rules for different situations. Comes down to if told to rehab, then you rehab, no excuses." — Katherine Sellers Robinson 

- "Make sure everyone goes home. From experience, a firefighter of mine found out he had high blood pressure and didn't know it. If we didn't do rehab, who knows how long it would have gone unfound/untreated.” — Matt Wedge

- “Most firefighters are more than happy to go to rehab for hydration and nutrition, but when you throw in the medical monitoring piece, that's where the challenge comes. They tend to have that little voice in the back of their head saying, ‘What if I can't clear and be released? I'll be stuck in rehab and not on the incident scene where I need to be.’ The biggest challenge is to change the mindset … that going to rehab for medical monitoring is not punitive, but is for the health and welfare of the firefighter, as well as for safe emergency operations as a whole." — Cheryl Zane Evosevich

In the end, the fire service culture shifts slowly. But it does so with constant, steady pressure. Keeping firefighters safe and healthy on the fireground and well into retirement requires a robust rehab presence — and that requires a culture of health, safety and rehab.

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