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From rehab to prehab: 5 steps to a proactive action plan

Assess and improve the health of your team on a regular basis to combat the physical and mental demands of a career in firefighting/EMS

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Make it your mission to follow these five steps for firefighter prehab so you’ll be ready to face the demands of the job.

Photo/Joe Thomas of Greenbox Photography

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We’ve given great emphasis to on-scene firefighter rehabilitation for many years. So why have firefighter line-of-duty deaths stemming from medical causes become the No. 1 cause of firefighter LODDs?

On-scene firefighter rehab is necessary and beneficial. But, like many of our developments to improve firefighter safety, it’s reactive. Rehab doesn’t enter the picture until a firefighter has already been exposed to the mental and physical stressors of active emergency operations.

It’s time to implement proactive firefighter prehab.

Firefighter wellness: Threats from within

When firefighters go to work, their bodies are flooded with super-charging, all-natural chemicals like adrenaline that immediately boost the body into overdrive. And unlike with a professional athlete, there’s no warm-up before the game starts.

The brain starts its fight, flight or freeze protocol, which:

  • Increases the body’s heart rate and respiratory rate.
  • Increases the body’s rate of metabolism.
  • Shunts blood from non-essential body organs (primarily the digestive tract).
  • Dilates the blood vessels supplying the muscular system (e.g., arms, legs, back).
  • Starts tapping into the body’s stored energy reserves to meet the increased demands for energy to supply the muscular system.

This is where the train wreck can start in the firefighter who:

  • Is not in good physical condition.
  • Is even moderately dehydrated.
  • Is even moderately overweight.
  • Has an underlying medical condition (whether they know about it or not).

And that train wreck can manifest as a heart attack or stroke.

The environment inside the structural protective ensemble, our PPE, quickly reaches 100 degrees F (or greater) with 100 percent humidity just from our own body heat and perspiration.

Let’s not forget the additional weight of your turnout gear, SCBA, thermal imaging camera, Halligan bar and 100 feet of 1 3/4-inch hose on your shoulder.

One study found that after just 18 minutes of battling a fire, a firefighter can sweat so much that plasma volume declines by 15 percent. This reaction thickens the blood into a pro-coagulatory state, creating a physiological condition where a clot-induced heart attack or stroke can occur.

The extreme conditions firefighters face exacerbate those internal physiological actions being taken by the brain. That train moving down the track starts gaining speed.

5 steps to firefighter strength, agility and endurance

The most important piece of equipment for any firefighter is his or her body. They’ve got to be strong; they’ve got to be agile and they’ve got to have endurance.

Here are five steps for your prehab action plan:

1. Get an annual physical exam by a physician.

Obesity and diabetes are both on the rise in the general population, and firefighters are not immune. Be sure the physician conducting the exam is informed and educated about what a firefighter does, especially the physical demands of the job. Share a copy of FSTAR’s “A healthcare provider’s guide to firefighter physicals” with your physician.

2. Stay hydrated.

Your body needs water to perform. This holds true during your off-duty time as well – the water you drink today has a big impact on what you do tomorrow.

A simple rule of thumb: Your urine should always be clear. If it’s any shade of yellow, you’re not keeping your tank full.

Recent research has contradicted common wisdom that caffeinated beverages are not an acceptable form of liquid intake, but limiting your daily caffeine intake is not a bad thing – just ask your heart.

3. Start with small, incremental changes to your diet.

Your food intake matters, too. Choose foods that fuel your body and limit those known to be less than ideal for heart health.

Instead of revamping your entire diet, make a change in your breakfast (switch bacon and eggs to whole grain cereal) one day a week. As you discover newer and healthier breakfast fare items, incorporate them into your schedule – a new dish every week. Before long, you’ll be eating a healthier breakfast seven days a week. Then move on to lunch.

Take the same approach with your colleagues on the job. Don’t try to make wholesale changes, but instead agree upon a plan to replace your usual meals with healthier options a couple of times a month. Make it a contest to see who can discover the tastiest and healthiest meal option each month.

The IAFF developed the Fit For Survival program for making improvements in both your on- and off-duty diet.

4. Get physical.

Physically fit, that is. Just as with making dietary changes, if you are just getting started on improving your physical fitness, start small and build up. The key is to do something every day. Professional athletes continue to physically train daily, even during the off season. You’re an occupational athlete, and your playing season is 24/7/365.

5. Get some sleep.

Research is uncovering increasing evidence of the adverse toll sleep deprivation can take, both in the general population and within the fire service. The existing body of knowledge has already shown that sleep deprivation is directly linked to poor decision-making and decreased physical ability and communication skills.

A study published in the Journal of Clinical Sleep Medicine evaluated 7,000 firefighters from 66 fire departments for obstructive sleep disorder, insomnia, restless leg syndrome and shift work disorder. That study found that 37 percent of the study participants had one or more sleep disorders.

The researchers found that compared with sound sleepers (controlling for sex, race, body mass index and other factors), those with a sleep disorder were about twice as likely to have a motor vehicle crash, to nod off while driving and to have cardiovascular disease or diabetes. They were more than three times as likely to suffer from depression and anxiety.

We often hear firefighters say, “It’s not a job, it’s a calling.” I believe that’s true, to a large degree. So, with your calling in mind, make it your mission to follow these five steps for firefighter prehab so you’ll be ready to face the demands of the job.

Battalion Chief Robert Avsec (Ret.) served with the Chesterfield (Va.) Fire & EMS Department for 26 years beginning as a firefighter/EMT; he retired as an EMT-Cardiac Technician (ALS provider) certified by the Commonwealth of Virginia. During his career he was an active instructor, beginning as an EMT Instructor, who later became an instructor for fire, hazardous materials, and leadership courses at the local, state, and federal levels, which included more than 10 years as a Contract Instructor with the National Fire Academy. Chief Avsec earned his bachelor of science degree from the University of Cincinnati and his master of science degree in Executive Fire Service Leadership from Grand Canyon University. He is a 2001 graduate of the National Fire Academy’s Executive Fire Officer Program. Since his retirement in 2007, he has continued to be a life-long learner working in both the private and public sectors to further develop his “management sciences mechanic” credentials. He makes his home near Charleston, W.Va. Contact Robert at