Medical monitoring is the foundation of rehab. In the past, medical monitoring and emergency care were not emphasized as much as in the current standard. Rest and relaxation are great, but it is critical to monitor the well-being of the personnel working at the incident scene.

You need to emphasize the reason for medical monitoring at the scene. Start by looking at the number of firefighter fatalities that occur in the United States every year. Since data was first collected, we are averaging 100 firefighter deaths every year. Over 50 percent of these fatalities are a result of heart attacks. If we start monitoring the medical condition of firefighters on the scene and continue with appropriate emergency medical care, we can hopefully reduce the number of firefighter deaths. Emphasize these numbers and give the foundation of why medical monitoring is so important during your training session. The scene is not the place to establish the reason for medical monitoring.

Training should include the role of BLS and ALS care and the role each play. Additionally, you should discuss the signs and symptoms to be alert for. This is good to present not only to your medical providers, but also to the firefighters in the class. By discussing the signs and symptoms, hopefully individuals can self-identify any of these symptoms and seek medical care early into the medical event. Early recognition with treatment is the key element in successfully treating medical conditions.

Depending on the group in your class, practice with vital signs and CO oximetry monitoring is can be essential. The more practice, the better they get. I recently conducted a two- day rehab training session in South Tongass Fire District in Ketchikan, Ark. The second day we spent outside doing mock rehab scenarios. Allowing personnel to practice taking vital signs and using the Rad 57 for CO monitoring was invaluable for personnel who were not accustomed to using these skills on a regular basis.

The last area to cover in this part of your training is how to handle individuals who are symptomatic or have abnormal findings and then the treatment for those individuals. This can be the most difficult to deal with, simply because most firefighters do not want to be taken from the fireground — they want to stay to do their job. Go back through and read the findings of the death of firefighters. In many instances the firefighter who died was released from the rehab sector despite not feeling well, or the incident was wrapping up and rehab dismissed the firefighter only to return to the fire station to have a lethal result. If there are firefighters having symptoms or abnormal findings, they need to have follow-ups and in many instances treatment. Personnel should be trained to know they will not be released and should not be released in these scenarios. These individuals need medical care and should be followed-up with — even after the incident has been cleared.

Medical monitoring and treatment needs to be covered in depth in your training. Firefighters need to have an understanding of what to expect on the scene and an appreciation that if they have symptoms or abnormal findings, medical care is essential — no questions asked. Rehab personnel need to practice their skills of assessment in advance of establishing a rehab sector on the scene of an incident. In addition, they need to know what to look for and what to do when there are firefighters who are symptomatic or with abnormal findings. Like any other training, your performance on the scene of an incident reflects how you practice in training.