Date last updated: Thursday, March 29, 10:21 PST

The Rehab Zone
with Ken Lavelle

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Prepare in the worst settings

If you are anything like me, even when you go on vacation you still have your antennae up and your eyes open looking at all the potential disasters that could occur. My wife can glance at me and know when I am 'disaster planning' — I guess I get a certain look in my eye.

Even in paradise, things go wrong. The crew and passengers of the Costa Concordia recently found that out the hard way.

What was noteworthy about that situation was that crew members reported that they had a hard time evacuating because the power went out and the ship was listing to the side. It seems reasonable that during a disaster involving a cruise ship, the power could indeed go out and the ship might list to the side.

Didn't they plan for this possibility? Didn't they train on different contingencies? 

Relaxing drill
Then I thought about the life-boat drills on the different cruise ships I have taken on vacations. These drills are usually held while still at dock and on the first day, in sunny weather.

Passengers are often already enjoying their vacation, and bring their 'Drink of the Day' with them. In some cases, they are no longer required to even bring a life vest. The drills are made as brief as possible to get everyone back to the party.

The cruise industry does not train for the worse-case scenario, but rather the 'perfect' scenario of a fine weather, daytime evacuation from a ship docked upright. They don't train how they fight, or may have to fight.

So, do we do a better job in emergency services? Not always. 

An average day
Some working fires that require the establishment of a rehab sector occur on sunny days in beautiful weather. But many of us have had to provide medical support at night, in 10°F weather or during a rain storm. Space may be limited and light may be non-existent.

We need to practice in that environment, so when it does happen, we will have identified the challenges. In addition to environmental challenges, there are operational issues that affect how we train.

Sitting around a classroom taking vital signs is inherently different from trying to take vitals at a fire scene where all the firefighter wants to do is get back to the fireground. They don't want to sit down and can be highly impatient.

Keeping it real
There are ways to make a more realistic training experience for our rehab staff.

Practice during actual fire operations. The next time your local fire department or your company is having a live burn, plan to set up a rehab sector.

To make it even more realistic, have your staff arrive on the scene just like they were dispatched, forcing them to select a site and set up quickly and efficiently. Throw additional curve balls at them with reported entrapment, so a crew needs to be ready to treat a victim as well.

Practice in all types of weather. How well does your pulse Ox or Co-oximeter work in 20-degree weather? How easy is it to get monitor leads to stick to a chest on a 95-degree day? Will your tools and supplies stay put in the wind? These are all questions that you will not be able to answer until you actually experience these situations. 

Practice taking vitals quickly on impatient people. It is important to assess firefighters and take their vitals quickly, otherwise they get frustrated and may simply leave the sector. Make sure there are enough people in the rehab sector to force the staff to divide and conquer, and obtain the information needed quickly and accurately.

One department for which I serve as medical director had its rookies take blood pressures on every person that walked in the firehouse on a warm summer night. They got to be very good at taking blood pressures and convincing people to allow them to do so.

Practice communication in difficult situations. Your staff should practice how they talk to firefighters and chief officers when in rehab and having to tell them they are not cleared to return or need to go to the hospital. Disagreements and even arguments can result in these situations; practicing in advance can often diffuse the issue.

Practice with mutual-aid departments. At a large fire in a non-urban environment, one EMS agency may not be able to fill all the positions with its own staff.

Your staff may be able to operate smoothly, but that does not mean the outside departments will be familiar with your operation. Invite them to your drills and trade information and policies.

If you are a training officer, you know that setting up challenging practical evolutions can be difficult. But they are worth the time when the 'stuff' really hits the fan at the big one. I am sure the crew and passengers of the cruise ship off Italy wishes they had practiced before they had their big one.

Stay safe.

The Rehab Zone. Kenneth G. Lavelle, MD, FACEP, FF/NREMT-P, is Clinical Instructor of Emergency Medicine at Jefferson Medical College, Philadelphia, and Attending Physician at CapitalHealth, Trenton, N.J. He was previously an attending physician at Albert Einstein Medical Center, and previously spent 14 years working as a firefighter and EMS provider.

Ken can be contacted via e-mail at

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