Date last updated: Monday, December 20, 9:59 PST

Rehab and Revitalize
with James Augustine

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Rehab reflections on 2010

It may seem a long time ago now, but it was a brutal summer, ending in the final week of September when Los Angeles posted an all-time record high temperature of 112 F. It was also around this time when the NFPA published the Loss of Life data for 2009, and the record shows a significant decrease in deaths related to fire rescue activities. We need to celebrate the success stories of decreasing fire rescue injuries and loss of life.

Incident rehabilitation was featured in dozens of local media pieces over the summer months on how workers were coping with the hot conditions, and many were accompanied by pictures of proud rescuers who were given the opportunity to briefly rest, cool, rehydrate, and be evaluated. This was occurring before they resumed work at that incident scene, or at the others that would occur before the shift ended.

I also watched this summer the rehabilitation that professional athletes utilize in hot weather during football, soccer, and baseball games. We should view ourselves and our operations as "more valuable." Why? Our job is actually much more difficult then theirs. Ours is completely unpredictable. The athletes know they don’t have to play another full game an hour from now. Our public safety personnel do not.

I witnessed an occasion this summer where five firefighters were brought from the same incident, fortunately none with life-threatening problems. What was the issue? Nothing particular to that individual fire scene, but due to the fact that three working incidents had been managed back-to-back by the crews, with the third being the most difficult, on the hottest day of the year.

And those crews were not even halfway through their shift yet! In extreme weather conditions, rehab must be diligently applied at the first incident, to enable our professionals to prepare for the incident or two or six that still may be coming.

Consider taking a picture of one of a group of your fire/EMS personnel rehabbing at a working incident or training, and pair it up with a photo of a football team cooling on the sidelines. Make sure everyone of your personnel understand the priority of team preparedness, and the physical benefits of optimal performance by every team member. Rehab is a vital part of professional sports, and of professional emergency operations.

In the agencies where I work, we had many hot weather incidents, and all were managed using an incident rehabilitation program that has evolved over the past few years.

What is notable is that we started with the process, and now we are moving to the "props" that will make it more effective and more professional. Agencies have invested in cooling systems, fans, shades, drink dispensers, icemakers, and other equipment that increase the effectiveness of the process. There are no "Gatorade" signs hanging around (and no commander gets a Gatorade shower at the end of the incident), but the rehab area is beginning to look more organized.

It is our opportunity at the end of summer operations to reinforce the benefits of incident rehabilitation within our organizations and with our members. Even as we prepare in many locales for cold weather rehabilitation, there is no time like the present to prepare for another hot summer starting in about six months.

Here's a five item list to consider.

  • Have you cooperated with your mutual aid and other nearby organizations to establish a consistent rehab process? Maybe even develop a regional rehab unit.
  • Have you extended your program to cover the law enforcement, utility, and media personnel who are sweating in the same sunshine as you are? This builds incredible positive public relations.
  • Have you considered and applied local donations of equipment and supplies to enhance the rehab operation? For those of us with the tightest budgets, it is worthwhile.
  • Is the rehab operation paperwork filed with the incident report? Does someone check the sheets to make sure all working crews received rehab, or is some other process in place to ensure compliance of all crews with the program?
  • Have you begun to use the rehab program as a bridge to other physical (and mental) well-being programs for your personnel? Some agencies have used the development of the rehab program to initiate an interaction with local universities, sports medicine programs, and nutritionists. That interaction then extended to other programs that brought routine fitness evaluations, nutrition training, and wellness programs into the organization.

Our personnel deserve the time, respect and attention to detail. The incident rehabilitation process is a critical process that ensures that each emergency operation can be carried out as safely as possible. And that detail will allow us to produce healthy retirees.

James J Augustine, M.D., is medical advisor for Washington Township Fire Department in the Dayton, Ohio, area. He is director of clinical operations at EMP Management in Canton and a clinical associate professor in the Department of Emergency Medicine at Wright State University. He formely served as Deputy Chief-Acting Medical Director for Washington, DC Fire EMS. He has served 27 years as a firefighter, and was the first Chair of the Ohio EMS Board. Contact him via email at

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