Earlier this year, fire departments across the country marked the Firefighter Safety Stand Down. The theme of the event was “rebuilding rehab”—a reflection on the critical role rehab plays in mitigating the physiological and mental impacts of a long and intense incident.
For most firefighters, rehab is something we do to help us recover and be ready to respond to the next emergency. We probably don’t think a lot about it. But like every operation on the fireground, the quality of rehab matters, especially when it comes to the food and drink options provided. Let’s take a look at some of the important aspects of incident rehab—beginning even before the incident occurs.
Before the Incident
Rehab starts well before the incident happens. The first step in providing good rehab is ensuring members are physically fit and medically cleared to perform firefighting operations. Firefighters who have higher levels of fitness will adapt to and recover from the physical requirements of firefighting operations more efficiently than unfit individuals—just one more reason to focus on promoting health and fitness within the fire service.
Make sure you and your department have programs and resources that promote functional health and fitness and your members understand the correlation between being fit and recovery. A good fitness culture will help members in rehab. Here are some great ways to promote a healthy culture:
- Provide usable and functional fitness-related resources
- Create a workout standard operating guideline (daily workouts
- Require annual medical evaluations
- Require yearly skills evaluations
One of the best ways to ensure you are ready for the incident is to be well hydrated before it occurs. Dehydration increases the risk of heat emergencies and can cause physical and cognitive impairment to a firefighter, increasing the chance of an adverse fireground event.
Hydration should begin well before you even step on the rig. We all must remember that what we do when we are off duty can affect our performance when we are on duty. A good rule of thumb to follow is to drink half your body weight in ounces of water per day. For example, if you weigh 180 lbs., you should be drinking 90 ounces of water every day, in normal conditions. If you are active through the day, working in excessive heat conditions or dehydrated from previous shifts, you may need to increase your intake even more. It may seem like a lot, but considering the demands we put on our bodies and the heat stress we can experience during an incident, it is well worth the insurance.
Carry a water bottle with you on the rig and in the firehouse to remind you of the importance of hydration. And do not count on thirst to remind you. Our bodies often don’t warn us in time when we are low on fluids. Start hydrating the day before your shift and continue throughout it. The best way to know you are well hydrated is your urine should be pale yellow.
Hydration at the Incident
Other than attending to recognized medical needs, rehydration is the most important function carried out in a formal rehab operation. Firefighters should be required to begin drinking fluids as soon as they report to rehab. Fluids should always be readily accessible within the rehab sector and encouraged as the member rests and regulates their temperature.
The amount and type of fluids firefighters in rehab will require depends on several variables, including the firefighter’s individual metabolic needs, the level of exertion they were operating at, ambient conditions and their level of thirst. On average, firefighters who have been active prior to entering rehab will require anywhere from 12 to 32 ounces of fluids during their rehab period. These amounts may be increased for larger members or during operations in extreme hot or cold temperatures.
Rehab begins with a fit and healthy individual; this also applies to the food choices made during rehab.
One thing to note is to not drink so much fluid that you become uncomfortable and bloated. This could lead to other medical emergencies and impair future performance. Make sure to monitor how you feel as you are in rehab—physically and emotionally.
What to Drink in Rehab
When it comes to hydration in rehab operations there is a lot of discussion on what should we be drinking. My research as well as my personal experience has helped me develop some general rules of thumb to consider when choosing rehab fluids.
The best and most common fluid that should be available at any incident and always carried on rigs is water. Water is the first line of defense for dehydration. At most incidents, water will be sufficient. Longer incidents (over an hour) as well as more work-intense incidents will require some electrolyte mix to help firefighters replenish electrolytes and glucose. If electrolytes such as sodium and or potassium get too low, serious health consequences can occur. You need a carbohydrate (e.g., glucose) to fuel the cell’s sodium pump. Try half-strength sports drinks (half water mixed with your choice of sports drink) to replenish missing electrolytes yet avoid possible bloat and stomach discomfort from the full dose. There are a lot of drink mixes on the market today, the best thing to do is research the product and its cost/benefit for your department. And, make sure you test the mix during training to see if members will drink it and if it works.
Then there’s the debate over whether cold drinks are better for hydration than room temperature. Ice water can reduce core temperature, but it also results in a decrease in sweat production (also a cooling process), especially in dry and windy environments. Based on the research I found, the best temperature for hydration—the easiest to digest and quickest to absorb—is around 60 degrees Fahrenheit, which is about the temperature of tap water. Far more beneficial than searching for the ideal water temperature is to stay hydrated and place emphasis on consuming fluids prior to, during and post-firefighting operations to promote an appropriate level of hydration and performance.
Avoid the Energy Drinks!
Research has linked energy drinks—which contain a mixture of caffeine and other energy-boosting ingredients—to health problems, including abnormal heart rhythm, heart attack and sudden cardiac arrest. Excessive use of energy drinks has been linked to ER visits (especially when combined with alcohol) and in rare cases, even death. In large amounts, energy drinks also act as a diuretic, which will cause you to lose fluid through excess urination—the last thing you want to do if you are sweating and trying to regulate body temperature.
Put simply, energy drinks are not something you want dehydrated firefighters with elevated heart rates knocking back in rehab. Energy drinks and mixes should not be served during any rehab or fireground operations. Similarly, it’s best to avoid coffee due to the caffeine, although small amounts will not act as a diuretic. Hot cocoa may be suitable for prolonged cold incidents, but keep in mind cool or room temperature drinks are best for hydration because they’re easier to drink quickly.
Food for Rehab Operations
The provision of food to firefighters and other emergency workers who are operating at extended duration incidents is a tradition that dates back almost as far as organized fire protection in the United States. Back in the day, food was provided at the emergency scene in an impromptu manner by well-meaning citizens and the spouses and families of the firefighters on the scene. In some parts of the country, this is still in practice.
Regardless of how and who provides the food there is a common theme that needs to be followed: The food provided needs to be nutritious, palatable, and easily digested.
When to provide food in firefighter rehab: Food is not required at every incident in which rehab operations are established. Jurisdictional approaches vary for when food operations should be established, but most departments typically plan offer food when the incident will last more than 2 to 3 hours. This may be adjusted based on weather conditions, the time of day of the incident and location. Food services may also need to be provided earlier in an incident if the firefighters were likely to have missed a meal just prior to responding to the emergency.
Selecting foods for rehab operations: There is almost an endless variety of choices when it comes to selecting food to support incident rehab operations. The exact types of food to be served at the incident will depend on the service capabilities of the provider, the duration of the incident and the preferences of the members of the fire department.
As mentioned earlier, rehab begins with a fit and healthy individual; this also applies to the food choices made during rehab. Foods should provide good nutritional value to help replenish lost nutrients and fuel future activity. Every effort should be made to ensure the food used at the incident is healthy, nutritional and appropriate.
Some great options at short-term incidents (1 to 2 hours):
- Granola or power bars
- Small turkey or ham sandwiches
For longer incidents (over 2 hours), consider:
- Hot/cold soups, broths or stews provide easily digestible nutrition.
- Apples, oranges and bananas provide supplemental forms of energy and nutrition and should always be available.
- Fatty foods like hot dogs, hamburgers and pizza—though tasty—should be avoided due to the high fat content, which can lead to lethargic performance.
Preparation Is the Key to Rehab Success and Safety
The overarching objective of firefighter rehabilitation is to get members back to work as safely and efficiently as possible. To do this departments must have a plan. During the incident is not the time to scramble for food, drink and places to safely get your members out of the elements.
Know the foods that are needed for longer incidents and have a process to get them to the scene. Have drink mixes readily available and get in the habit of offering them during training to get feedback from the field on the effectiveness of these mixes.
Lastly, build a healthy culture within your crew and department. Encourage conversations about fitness and health and get department-wide dedication to fitness and rehab practices.
- Almond C, Shain A, Fortescue E et al. (2005). Hyponatremia among runners in the Boston Marathon. N Engl J Med. 2005 Apr 14;352(15):1550–6. Accessed 11/12/21 from: https://www.ncbi.nlm.nih.gov/pubmed/15829535.
- Gatorade Sports Science Institute. (2018) Cold water and ice slurry ingestion for reducng body temperature during exercise in the heat. Accessed 11/22/21 from https://www.gssiweb.org/sports-science-exchange/article/cold-water-and-ice-slurry-ingestion-for-reducing-body-temperature-during-exercise-in-the-heat.
- Horn G, DeBlois J, Shalmyeva I et al. (2012) Quantifying dehydration in the fire service using field methods and novel devices. Prehosp Emerg Care. Jul-Sep 2012;16(3):34 –55. Accessed 11/12/21 from: https://www.ncbi.nlm.nih.gov/pubmed/22443314.
- Hostler D, Bednez J, Kerin S et al. (2010) Comparison of rehydration regimens for rehabilitation of firefighters performing heavy exercise in thermal protective clothing: A report from the Fireground Rehab Evaluation (FIRE) trial. Prehosp Emerg Care. 2010 Apr 6; 14(2): 194–201. Accessed 11/12/21 from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2867093/.
- IAFC, NVFC, NFPA. 2021 Safety Stand Down Resources. Accessed 11/12/21 from: https://www.safetystanddown.org/resources.
- NFPA. (2021) NFPA releases new NFPA 1584 fact sheet to assist fire departments with 2021 Safety Stand Down “Rebuild Rehab” training and education. Accessed 11/12/21 from https://www.nfpa.org/News-and-Research/Publications-and-media/Blogs-Landing-Page/NFPA-Today/Blog-Posts/2021/06/07/NFPA-releases-new-NFPA-1584-fact-sheet-to-assist-fire-departments.
- U.S. Fire Administration. (2008) Emergency Incident Rehabilitation. Accessed 11/21/21 from: https://www.usfa.fema.gov/downloads/pdf/publications/fa_314.pdf.