The best firefighter rehab is strong 'pre-hab'

Taking care of these four areas of overall firefighter health will improve fireground performance and reduce recovery time

This article first appeared on, sponsored by Masimo.

By EMS1 Staff

Proper firefighter rehabilitation starts long before the tone drops or the first firefighters exit the structure, drop their SCBA and plop down for a breather. Firefighter performance is largely dictated by how well they “pre-hab.”

Preparing your body before a firefight is arguably just as important as caring for its needs during and after the fire.
Preparing your body before a firefight is arguably just as important as caring for its needs during and after the fire. (Photo/Pixabay)

Preparing the body before a firefight is arguably just as important as caring for its needs during and after the fire. Pre-hab can be broken down into four main categories: food, water, sleep and fitness.

Plan ahead for healthy meals

Fitness expert Bryan Fass says the secret to eating healthy on duty and on the go is planning. Once you are hungry, all bets are off and bad food choices likely.

Fass says he likes to make turkey wraps with whole wheat grains, spinach, mustard and cheese. These are always quick and easy to eat on the go, and one wrap is a perfect portion. Yogurt has around 6 to 8 grams of protein and contains healthy bacteria, which also provides a good choice.

In addition, he recommends:

  • A few handfuls of trail mix make a good snack on the go, but beware of trail mixes with added sugar and oils that completely negate any health benefit.
  • Leftovers from dinner are a good bet for lunch the next day, but if no leftovers are available, take a can of tuna (in water) and add it to some brown rice and veggies or spinach. Instant brown rice is a great carbohydrate to add to any protein.
  • As a back-up option, keep a meal replacement bar on hand for the busy shifts that don't allow time to eat a prepared meal. There are many kinds; find one you like and keep it on hand for emergencies.

Healthy snacking or small meals are also a good strategy. Eat every three hours, but eat half what you normally do. Fiber makes you feel full, so whole grains, veggies, beans and dried plums – aka prunes – are great snack choices.

Make hydration a habit

It’s also important to drink a lot of water. Jim Upchurch says water is the mainstay for adequate hydration: Women should drink around 70 ounces daily and men 100 ounces. This accounts for 80 percent of our daily water requirement; the rest is provided in the foods we eat.

Using a urine color chart can help. If your urine is clear or very light yellow, you are excreting a normal amount of water, which reflects an adequate amount of water in your system. As the color gets progressively darker, the urine is becoming more concentrated due to dehydration.

Source: Lucozade Sport Science Academy

A general rule is to use water alone for mild exertion and minimal sweat loss, then add sports drinks to your water consumption as exertion and sweating increases. In addition to water, sports drinks contain varying amounts of salts (sodium, potassium, magnesium, calcium) and one or more carbohydrates (sucrose, glucose, fructose, maltodextrin). Some brands also contain protein.

It’s best to avoid drinks containing caffeine or alcohol, as they have a diuretic effect and can cause you to lose water.

Ken Lavelle says it is important to maintain proper hydration throughout the day. We need to maintain adequate water intake on any routine day, with additional fluids before exercise. Once we are thirsty we already have some degree of dehydration, and our abilities can suffer.

Manage your sleep cycle

Research shows that impairment from sleep deprivation is similar to that of alcohol. Firefighters will experience compromised decision-making and motor skills when they don’t get enough sleep — and both can be deadly on the fireground.

Linda Willing offers seven suggestions for ways fire departments can improve firefighters’ quality of sleep:

1. First and most importantly, departments must recognize that adequate sleep is a wellness and performance issue equal to other priorities such as strength, fitness, diet and agility.

2. Evaluate current logistics for sleep and consider changes. Some positive changes can be made quite simply — installing fans or white noise machines in common dorms, for example. Other changes are more costly, such as retrofitting common dorms into individual sleeping pods.

3. Assess the current state of sleep fitness among members. Gather data anonymously to get an honest picture of how department members manage sleep both on and off the job.

4. Allow appropriate naps on duty. Numerous studies have shown that brief naps of 30 minutes or less can make a positive difference in cognition and reflexes.

5. Make resources available for those who suffer from sleep disorders. Do not stigmatize the use of these resources.

6. Reconsider shift scheduling and overtime rules to diminish the effects of sleep deprivation on emergency response.

7. Consider technology to help manage sleep and performance. The Army is developing a wristwatch-style sleep monitor for all soldiers that will monitor sleep/wake cycles and can be directly linked to predicted performance. They expect these devices to be standard-issue gear by 2020.

Increase fitness with heat training

While a mix of strength and cardio training are often recommended for firefighters, conditioning with heat may make a firefighter more resilient to the heat stresses of firefighting, says Bruce Evans.

One study from the University of Oregon tracked the performance of cyclists over a 10-day training period in 100-degree heat. Another control group did the exact same exercise regimen in a 55-degree room. Both groups worked in 30 percent humidity.

The results showed that the cyclists who worked through the heat improved their performance by 7 percent, while the control group did not show any improvement.

What it means from a rehab perspective is the need for workouts that use heat for acclimation versus cooled gyms and rooms in the station. Acclimatizing to heat can take anywhere from seven days to three weeks depending on a person's risk factors for heat stress.

In the past, working out, running or doing drills in the heat was seen as reckless, but the discovery of heat and cold shock proteins has given us a look at how the body adjusts to temperature fluctuations. Heat shock proteins are part of the body's protective mechanism to defend against heat and some other triggers of inflammation, and temperature fluctuations can have the same damaging effects as exposure to benzene, carbon monoxide, cyanide and other free-radical chemicals.

Tossing pre-hab into the rehab mix is key to keeping firefighters alive and healthy. Focusing on overall health and paying particular attention to food, water, sleep and fitness will minimize the negative impacts of firefighting. A fit firefighter will be able to perform better on the fireground and bounce back faster from the physical stresses of firefighting.

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