By Brandon Butler, Director/Chief Instructor, TRS
It’s long been a time for change in the concept of rehab for First Responders. The mindset of rehab (The word meaning rehabilitate) is essentially to bring back from injury or an unhealthy state to a productive state. This mindset should be looked at as scene health support, where we constantly maintain the health and productivity of our responders during incidents rather than use them to exhaustion, provide minimal support and facilitate their return back into the incident. This can create hazards, poor judgement and injuries. As an example, have you ever watched Monday night football and noticed all of the “support” personnel each team has? They have several coaches, medics, trainers, nutritionists, security and, of course, the water boy. A sports team sees keeping their players maintained as close to a state of high performance for short periods of time as a formula to win games, reduce injury and prolong athletic output. With sports as a guideline, why is it more response agencies haven’t taken this design and applied it to emergency scenes? I have been to many structure fires, disasters and extended emergency scenes, I cannot remember very many where we had more than stale water and the occasional hardened Gatorade packet to keep us going for hours on end.
Regardless of the shape you are in (yes, round is still a shape) you are an athlete when it comes to working on emergency scenes. Your body is expending fuel and burning calories that need to be replaced and, just like a pro-football team, we need to start seeing scene health support as being a worthwhile cause for which to fight. Keeping responders in good shape promotes good decision making and work skills. Even Command staff needs support; when you deplete your calories, or are fatigued, you make poor decisions regardless of what position you are assigned.
I was an adventure racing endurance athlete for many years. In that time I learned that in order for us to perform at our top levels we had to replace calories as we went through an event or we would not accomplish our goals. This is where Scene Health Support is vital. Our formula was simple: drink every 15 minutes and eat a bite of something every 30 minutes with a small meal every 2 to 3 hours.
The idea is to prevent what we called a “bonk”, or running out of calories, to keep us moving and thinking on our feet. Having on scene staff that can setup a support station and rotating crews at regular intervals is key. Remember that it takes only a few minutes of prevention to keep a responder in the game, but once they have gone past the point of no return, they will be out of the game for the duration. This causes more personnel to be assigned to a single incident than actually necessary. It is imperative to look at our responders as more than “disposable”, which is essentially what they are when you use a person up and then sit them out.
Support station supplies should be tailored to the department and have supplies for at least 24 hours. Below is a list of items to consider and reasons for each of them.
- Tent or Pop Up Canopy with walls – One of the first rules of survival is shelter; this is no different. Prolonged exposure to wet, cold or hot conditions can cause a myriad of issues.
- EMS Supplies- Always have a medical bag nearby, along with a stand-by EMS unit. Also consider what is needed to keep your responders in the fight. Basic supplies like band-aids, waterproof medical tape, and blister prevention (yes, blister prevention) go a long way.
- Air Monitoring Supplies – Air monitoring for hot zones and aid areas which require the use of SCBAs goes without saying, but what about the areas outside? Could your responders still be exposed to toxins? The answer is yes. Monitor the areas outside as a “warm” zone and make sure that the air is clean for them and that the air at your scene health support also has clean air.
- Fans/Heaters – Over heating and being too cold create plenty of issues.
- Folding Chairs – Having a place to sit in folding chairs allows for a comfortable working position not only for rest, but for the responders staffing the support station.
- Cleansing Wipes – New studies show how cancer can be prevented simply by wiping off areas prior to taking off gear. Take a minute and wipe down before taking off your gear and then wipe off again once out of your gear. It is preferable to have a hanging area for responders’ gear to dry and be out of the rehab area.
- Towels – Towels are handy to have for a few reasons. They can be used to cool by soaking them in water. When cold, they help to remove water that would otherwise evaporate and take body heat with it.
- Blankets – When responders come out of a work area to rest in cold or wet conditions, the goal is to gradually cool them. Simply leaving them exposed to harsh elements to cool quickly can cause collateral sickness.
- Coolers – For cool drinks and have ice available.
- Water – Bottled water stores the best and is easily dispensed to responders at the support station and around the scene. It never hurts to have the powdered flavor packets that can be added to a water bottle to keep them drinking.
- Sports Drink (use caution as too much can cause stomach issues.) – This replenishes electrolytes and fluids. Use with caution.
- Meal Ready to Eat (MRE) – These have a long shelf life and, although they may not taste the best, they do have the right nutrition to keep you going.
- Energy Bars- I don’t recommend any particular bar, but get a variety that keep for a few years. Responders won’t eat when they don’t like the bars.
- Specialized Foods – Some responders have allergies and health issues that need to be addressed with other kinds of foods. Some may be allergic to elements in food bars, so some pre-planning with your department will need to be done to have the right kind of food on hand.
This list is not all inclusive but it should give you a start. Build your rehab to fit your Agency’s needs, but don’t forget the most important part of having staff trained specifically to provide scene health support.
It is time for us and others to start thinking of our first responders differently. All responders are athletes when it comes to doing our jobs, lets start supporting them as such and I bet we will see a decrease in injury and sickness in our ranks. Traditions can be good, others can be bad. Lets change the bad and safeguard our future responders.