The Importance of Rehabilitation

Post by Ron Gruening, president of the International Fire Relief Mission

During a recent trip to the Dominican Republic, we made a startling discovery regarding the heart healthiness of one city’s firefighters. And some of what we learned there can be put into use by volunteer fire departments here in the United States.

For those unfamiliar with The International Fire Relief Mission, it is 501(c)(3) nonprofit humanitarian organization that collects donated fire and EMS equipment in the United States and delivers it to fire departments in developing countries with chronic funding and training problems. We also dispatch a team to the recipient fire departments to show them the safe and proper use of this new equipment. This instruction is as critical as the equipment itself.

Earlier this year, an IFRM team was in the Dominican city of San Pedro de Macoris, a southern costal city about a 45-minute drive from the capital Santo Domingo. The San Pedro fire department operates out of two stations and is staffed with 15 full-time paid firefighters and about 70 volunteer firefighters; all of the firefighters were men. Although most of the firefighters were young, the ages ran the gamut from late teens to mid 50s. Some were clearly overweight, but most appeared physically fit.

IFRM delivered a 40-foot shipping container packed with equipment including numerous sets of turnout gear, SCBA bottles, brackets and masks, tools, hoses, nozzles, cots and defibrillators. There was enough equipment to outfit San Pedro and several small, rural fire departments. In most countries we visit, and San Pedro is no exception, the donated gear marks the first time the firefighters have worn full PPE and SCBA. When the IFRM team demonstrates the safe and proper use, we focus on the abilities and limitations of the PPE.

One of those limitations is the added stress wearing full PPE places on the human body. And in the Dominican Republic, where nearly every day is hot and humid, it was vital to teach them the importance of adequate rehab for their firefighters. While these firefighters are accustom to working in the heat, they are equally unaccustomed to wearing PPE. Despite having prepared materials translated into Spanish and having a fully fluent interpreter, the rehab message was not taking root. The San Pedro firefighters scoffed at the notion of resting during a working fire. Many of the firefighters, it seemed, believed themselves invincible. Others said that they may not have the personnel on scene to afford such rest breaks. When asked how long they could work before rehab, many said they could go at least 20 minutes.

We devised a plan to demonstrate the importance of rehab. The plan called for taking resting heart-rate and blood-pressure measurements for all of the firefighters. They would then don full PPE, including SCBA, and perform a modest amount of work. We laid out a course that involved climbing two flights of stairs, carrying hose, crawling under a structure, simulating overhead work, and walking about 50 yards. Each firefighter would have his heart rate and blood pressure taken after completing the exercise to illustrate the sharp elevations brought on by a modest workload.

The U.S. Fire Administration recommends that each firefighter who works for 45 minutes should rest a minimum of 10 minutes, yet that rest period can exceed one hour depending on the firefighter’s condition. USFA also recommends that firefighters entering rehabilitation with heart rates at 110 beats per minute or higher are in danger of heat stress and require additional rehabilitation.

And here’s where the startling part comes in. Most of the firefighters had elevated blood-pressure and heart-rate readings at rest; those who looked the fittest had some of the highest readings. For example, some of the younger, fit-looking men had resting heart-rate and blood-pressure readings of 66 and 130/70, 50 and 120/80, and 50 and 130/90. Many of these men fell into what the Mayo Clinic lists as pre-hypertension or stage 1 hypertension categories (visit to see the full chart).

Given these elevated ratings neither the IFRM team nor the two expatriated medical students who serve as volunteer San Pedro firefighters felt that the original obstacle course was safe. We modified the exercise and had the men fully dress in PPE and SCBA, carry one bundled 50-foot section of two-inch hose about 30 feet, set the hose down and belly crawl under a table, pick up the hose and carry it another 30 feet to the starting point. The men were told to walk at a comfortable pace and the exercise was not timed; we didn’t want the men competing with one another to the point of overexertion. On average, each man took about three minutes to complete the evolution.

Immediately after completing the courses, heart-rate and blood-pressure readings were taken. Here are some of those readings: 108 and 140/80, 117 and 140/70, 60 and 150/80, and 60 and 160/100. Most of the men were breathing and sweating heavily after the evolution as they had their readings taken.

Even the two medical students were taken aback by the consistently high readings, as was the chief who observed the exercise. At the evolution’s conclusion, the firefighters were reassembled and we again went over the importance of hydration, rest, aerobic and anaerobic exercise, and proper diet. And although the post-evolution message was the same as that delivered before the exercise, their attention to the message was sharply increased. The interest shown by the fire chief and the two medical students was the most encouraging.

San Pedro’s fire chief vowed to continue this exercise periodically to help the firefighters keep on top of their own heart health. This simple exercise that we conducted with the Dominican firefighters can easily be replicated by most volunteer fire departments here in the United States during a regular training night. In addition to helping firefighters reduce the risk of heart failure, this exercise also will help officers know individuals’ risk levels when assigning fireground tasks.

This simple heart-healthy tool can go a long way in helping reduce the incidents of heart attacks in the fire service.

For more information on the International Fire Relief Mission, visit and follow along on Twitter at IFRM2007.


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