It might actually be YOUR fault they don't want to go! But WearARMR can help.
Firefighters don't want to go to rehab.
This is an axiom in fire and EMS, so much so that for many agencies the idea of getting their firefighters to WANT to go to rehab on their own is about as realistic as firefighters sprouting wings. Their FOMO (fear of missing out) is strong, for sure. Even if you do think it's possible that they'd want to go, EMS agencies generally think it's completely outside of their control and solely up to the fire side of things. That is NOT true.
It's at least partially your fault.
Whether firefighters want to go to rehab is not solely up to the fire side of the house. There are things we can be doing in EMS to help make firefighters want to go to rehab, even though there are definitely things they can be doing to help.
Make it Effective.
How often do you see construction signs on the highway? Those bright orange diamonds that say "construction ahead" or on smaller roads "flagger ahead." The one that says, "give us a brake, SLOW DOWN!" has definitely made me pause; I don't want to inconvenience anyone, maybe I should just slow down?
But how often have you seen those same construction signs on the highway ONLY TO LATER FIND THERE'S NO ONE THERE? In this case the signs actually do more harm than good! I feel cheated and the signs have taken a massive hit to their credibility. Do they ACTUALLY mean there's construction workers here that I need to help protect? Or was someone too lazy to take down the sign? The signs themselves may have the right intentions, but their warnings hardly seem credible after I've proved they're inaccurate.
Firefighters are often told about the importance of rehabilitation starting in their basic training courses. "The #1 killer of firefighters is heart attacks," a well-meaning instructor might opine, "You need to go to rehab!" If you have a good agency, they may even be told by their officers on a scene to report to rehab.
But if you're a firefighter and you go to "rehab" only to find it's some people standing around handing out bottles of water, you are significantly less likely to think rehab is important in any way. This is especially true when rehab looks so different depending on the incident and who's running it. If you think rehab is getting a bottle of water, then you're much more likely to get angry at the Rehab Manager who insists you sit down while someone takes your vitals.
Rehab needs to be effective, and this is an area that EMS can control. If you have no rehab system that guarantees high-quality rehab every single time (regardless of the incident, who's running rehab, etc.), then of course firefighters won't want to go. WearARMR standardizes rehab so that it always looks the same and it's always effective.
Make it Efficient
Many teachers (especially in public schools) get annoyed at anything approaching overreach on the part of the government, parents, and administrators. Why? Because as they see it, all of these restrictions get in the way of their being able to teach. In the same vein, we can hardly blame people with the title of "fire fighter" to be annoyed when we don't let them fight fires. Teachers want to teach, firefighters want to fight fires. This should not be surprising.
On "the big one," firefighters do not want to be sitting down drinking water while some EMT with a Napoleonic complex makes himself feel better by asserting dominance. Not only is their FOMO (fear of missing out) strong, but they're much more likely to buck authority if they feel it's keeping them from the fight. EVERYONE on a fire scene's job should be to keep firefighters IN the fight, and that's rehab's actual goal as well.
Rehab's goal is not to take firefighters FROM the fight, it's to keep them IN the fight. High-quality rehab helps support firefighter health in the short term (by preventing and catching cardiac arrest) AND the long term (by decreasing the effects of overexertion and lengthening service years).
Firefighters have checklists for seemingly everything, something the Fire Hero Learning Network is happy to help provide. Yet most agencies don't have rehab checklists for anything other than lists of equipment you need to pack and bring with you. Lists are not a system in the same way that a list of ingredients isn't a recipe. A system is how you implement the equipment and (much like a recipe) it should look pretty much the same every time, and it should be efficient.
Educate Everyone
It's said that it takes 17 years for medical evidence to change practice in the field. It's no surprise there are so many people have their rehab knowledge stuck in the late 2000s, especially since there are few (I couldn't find any) required firefighter rehabilitation classes for EMTs in any state. I combed through the 12th edition of the ~$400, 1600+ page textbook Emergency by the AAOS and found approximately 12 paragraphs in the entire book that explicitly talk about firefighter rehab and EMS operations on a fireground (pages 58-59, 1479, 1495).
How then do EMTs learn about rehab? They rely on knowledge passed down to them from others in their agency. It's no surprise that the information is so often wrong! One of the pieces of advice I hear all the time is, "You have to load the equipment on the rig as quickly as possible so you can bury it close to the fire." Burying rigs makes sense if you don't want to carry things, but it makes almost no sense if you've learned (correctly) that transportation is the #1 responsibility of EMS on a fireground. From when the tones drop until the last vehicle is back at the station, EMS needs to be able to transport an injured or ill firefighter.
That education about rehab reasons (why) and procedures (how) needs to be done agency-wide, especially to firefighters who will be going through rehab. If firefighters understand that rehab helps keep them IN the fight and that you're using an effective and efficient system to help keep them there, they are much more willing to comply. You wouldn't want to go somewhere if you thought they were just holding you hostage, and firefighters are the same way.
Enforce the Standards
Have you ever seen a department that fails to enforce the no-beards rule on their firefighters who are fit enough to wear an SCBA? Of course not, because letting them have a beard (and a poor SCBA seal) puts their life, and the lives of all their crew, at risk.
How often does your Chief review accountability documents from the rehab area post-incident to verify if specific firefighters attended rehab? Likely never. It's even less probable that the Chief prevents firefighters who should have attended rehab but didn't from participating in the next incident. If rehab is important to the agency, then it needs to be enforced as strictly as anything else the agency finds important (like beards). Why? Because avoiding rehab puts a firefighter's life at risk, and also endangers the lives of all their crew.
What are we telling firefighters if we harp on about their facial hair, but don't even check to see if they went to rehab? We're telling them that rehab isn't important. Use their FOMO to our advantage: no rehab, no fire.
At this point when I'm talking to chiefs, I often hear cries about manpower shortages. "We can't afford to have a firefighter sit out of a fire, we're strapped as it is." The more likely you are to hold people accountable, the less likely you are to NEED to do so. All it would take is enforcing the rule a few times and you'd likely never have to enforce it again. The firefighters also don't need to sit out of the incident entirely, just move them to hauling hose or driving a rig (and make sure they go to rehab after 40 minutes of intense activity without an SCBA as per NFPA 1584 22.1.4).
Effective, Efficient, Educate, Enforce.
If you don't have an effective or efficient rehab system, then educating on procedures and enforcing the standards will not be enough. Likewise, if you have an effective and efficient rehab system that no one knows about and nobody is forced to go to, then it also won't work. You need all four Es, and WearARMR's system and training can take care of at least three of those Es with you.
The WearARMR system helps you effectively evaluate firefighters for cardiac and exertion-related symptoms, provides an efficient framework for EMTs and other medical personnel to use their best medical judgment, and guarantees that your rehab looks the same every time regardless of who's running it. WearARMR training helps your agency become NFPA compliant and makes sure everyone's on the same page with why and how rehabilitation happens on the fireground.
Let's make the fireground safer for firefighters. Let's do the job right. WearARMR.
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