Suburban Firefighting: Prehab Can Prevent Rehab

By Jerry Knapp

We turned down the street and the black column of smoke was pushing skyward. The radio reported people trapped. It was midday and still the fire had a good start on us. It was a congested neighborhood of single-family homes that now housed extended families. Along with these families there were a lot of belongings, too much for the buildings that contained it.

The first-in engine dropped a supply line. A couple of firefighters stretched the handline and had to extinguish fire on the narrow outside stairs that went up to the deck. The vinyl siding was going really well, and fire was extending into the attic through the plastic-vented soffit.

It was a hot summer day, about 90ºF and 90 percent humidity. The congested street allowed room for only one rig, so the truck and rescue were not close to the scene. The job started out as a long hot walk–a warm-up. Then climbing the steep and narrow steps just added to the preliminaries.

The primary search was negative; another false report of people trapped for which we all too willingly and unnecessarily risk our lives. The nozzleman knocked the fire on the deck and siding down quickly from the outside. That seemed to be it. It took a few minutes to determine that the fire had gotten into the attic just a bit. A pull of the ceiling and a wash from the line, and the fire was under control. By now the truck company was on the roof, ready to put a vent hole in if we needed it. Roof temperatures on the side facing the afternoon sun were around 130º F, and one look at their faces showed they were feeling it.

As they came down off the roof, the safety officer was on the deck, advising them to go to rehab. We backed the line down and were picking up when she came over to me and asked if I had gone to rehab yet. Sure I said, yesterday. “No, no today at this fire.” I put on my most honest-looking face and said, “I said I went to prehab yesterday. I ran my usual three miles just before sunset and the day before I was in the gym.” She said, “You know this is serious; one of our lieutenants is in the ambulance now with tachycardia and the medics are requesting he go to the hospital to just verify his heart is ok.”

My honesty was fading fast, and evaporated when I said, “Well if he went to prehab yesterday, he wouldn’t be in need of rehab today.

Have we missed the boat with rehab? I’m only a has-been paramedic, but it seems to me that rehab is a good thing. But how valuable is it, really? The safety officer continued, “The medics can tell if your blood pressure is high or if you are prone to a heart attack, heat exhaustion, heat stroke, or other serious malady.” I get it, that’s good. But isn’t it a little too late by then? Let’s look at the facts.

  • We know that heart attacks kill about 50 firefighters every year and put thousands out on permanent medicals. That surely disrupts every aspect of their lives and their families’ lives (assuming they survive the first heart attack).
  • We know that the micro climate inside our gear is 100º F and 100 percent humidity, just from our own body heat and sweat. If it were 100/100 outside, how hard do you expect to work in those conditions? Not long. But as firefighters, we often work for extended periods of time.
  • Couple the microclimate factor with the fact that we get no warm-up period like other athletes, and the stage is set for all kinds of injuries and cardiovascular trauma caused by physical stress alone.
  • To get you one step closer to the casket, let’s throw in super-charging, all-natural body chemicals like adrenaline, which immediately thrusts you into overdrive when you hear people trapped and that staffing is limited today. For even the fittest among us, this is a recipe for disaster.
  • Since we are not fully in costume yet, don’t forget your 30 pounds of self-contained breathing apparatus, a seven-pound thermal imager, and a 10-pound halligan—all in addition to the weight of your turnout gear. I’m not worried about getting burned. I’m more worried about the gear killing me.

So given all these common facts, why are we not putting more emphasis on prehab than rehab?


So what can you do? Here is what I would recommend.

First, recognize what we ask our bodies to do: no warm-up period. We go from 0-60 in seconds. You would not start your car and zoom down the road until you warm it up; it is bad for the car. We have little choice on this one, so we need to be in good shape to ward off the negative effects of this dangerous act.

Recognize that we are wearing a snowsuit to every call. To top that off, we add 30 pounds of breathing apparatus and other tools. If you are not overweight before you don your gear, you are now, by something like 80 pounds.

Recognize that our microclimate is 100º F and 100 percent humidity. If you are not in shape, it will increase the chances of killing you.

Second: Go to prehab every day. If we can get ourselves in shape, we can reduce the dangerous effects of the conditions noted above. You probably will not be able to go to prehab every day, but if you plan on it, you will get there more often than not. There are 24 hours in a day. Bottom line, one of those hours is for me (and me alone to work out). It’s my time. Period. I’m taking it. I deserve it, and my family deserves it. Try this–get a buddy. Every time you don’t go to prehab, you have to make an excuse to him or her. You know what kind of answers you will get from your buddy (“Shut up and run,” or “Stop whining, I’ll meet you in the gym,” etc.). Remember, getting started is the hardest part. It’s like taking your kids to Cub Scouts–they never want to go but have a great time after they are there.

Third: Don’t kill yourself in prehab. When you get tired, stop, slow down, and recover. You will feel the energy come back. If you make it too painful, you will not want to come back tomorrow. If you are running, run until you get tired, walk, and then start up again. Do this as many times as you need. None of us are going to the Olympics. But we are going to a life-and-death scene sooner or later. Prehab will make sure it is not your death scene.

Soon, you will not need to slow down so often or rest for so long a time. One day, you will say to yourself: Hey, this is where I usually stop, but I don’t need to today…prehab must be working! In the gym, the weight that was heavy a week ago now is not so bad, and soon you look for a heavier dumbbell. Yes, prehab is working, and your body is now working better. Think about how many heartbeats you can save if you can reduce your resting pulse by only two beats a minute. Two beats a minute is 120 beats saved per hour, which is1,680 beats per day. Will that extend your life? No one can say, but it sounds good to me.

Fourth: Eat better. No lecture here. You know exactly what you should and should not be eating. Start small. Replace one thing that is better for you. Here are a few things I did: cereal instead of an egg sandwich for breakfast; coleslaw instead of French fries; some good snack food in front of the chocolate chip cookies. Put things like fruit, nuts, etc. out in front of or within easy reach instead of candy or chips. Again, don’t deprive yourself; just make a few changes to get started. When you see success, make some more positive changes.

Prehab or Rehab

I’m no athlete. It’s just not in the genes for me. I’m not strong or fast. I’m a plodder, not a runner. In the weight room, I break a good sweat, but no records. On the hockey rink, I have a ton of fun on defense and try to be at least a minimal and mobile obstacle for real hockey players. But what scares me is that on the fireground, I can outwork most of our members in my department, and I’m twice their age and I’m not in the ambulance in tachycardia.

There are a lot of other guys in the fire service who hit the gym or track often to stay in shape. You can tell them apart from others on the fireground.

Start your PREHAB today to keep you out of rehab tomorrow.

Jerry KnappJERRY KNAPP is the assistant chief for the Rockland County (NY) Hazmat Team and a training officer at the Rockland County Fire Training Center in Pomona, New York. He is a 35-year veteran firefighter/EMT with the West Haverstraw (NY) Fire Department, has a degree in fire protection, and was a nationally registered paramedic. Knapp is the former plans officer for the Directorate of Emergency Services at the United States Military Academy in West Point, New York.


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