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Rehabilitation and the Fire Service


Those who visited Fit to Survive in the past may recall the article, "ADAPT to Survive," on rehabilitation for injured fire fighters. While there are excellent physical therapists and physicians serving our communities, according to Orlando Gomez, a member of Portland, OR Local 43 and a physical therapist, there is a low rate of successful outcomes following treatment to prepare fire fighters to return to work.

As a physical therapist at Athletic Development and Performance Training (ADAPT) in Beaverton, Oregon, Gomez hopes to raise awareness and educate fire fighters and physical therapists alike about improving those outcomes and providing fire fighters with the rehabilitation they need.

As a career fire fighter for five years and a physical therapist for 15, Gomez realized that the rehabilitation world does not fully understand what it takes for a fire fighter to safely return to work. The issues of injury prevention and return to work in the fire service are significant ones.

The Cost of Injuries

"Injuries are costing the fire service millions of dollars annually," says Gomez, who estimates that a large number of these injuries are recurring injuries. "Fire fighters are not representative of the typical work population," he explains. "Our job demands are similar to those of an athlete. Studies have shown that exertion and VO2 max levels can reach extremely high levels quickly and for long periods of time."

Factoring in the impact and stress on joints as a result of carrying and wearing more than 50 pounds of PPE and gear Ė and with no time to warm up or stretch Ė itís no surprise that chronic and recurring injuries are far too prevalent.

ADAPT uses a five-level training model designed to ensure that the level of rehabilitation and training is appropriate for an individualís level of function. Each level represents a specific level of physical requirement, with corresponding exercises and techniques that are appropriate for individual physical limitations. In addition, physical tests are administered at the end of each level to determine the individualís functional ability to advance to the next level of training.

"This type of tool can be used by many health providers as a guide to ensure the proper level of rehabilitation and training, and as a screening test to return to work," explains Gomez.

Optimal Performance Levels

In his opinion, fire fighters need to function at Level Four before returning to work. "Anything less could leave a fire fighter with difficulty doing the job or at an increased risk of re-injury," he says.

Staph infections

Unfortunately, statistics and observation show that there is a significant number of fire fighters functioning at Level Two or Level Three Ė from either a fitness standpoint or due to injuries. "As a result, we arenít providing the 100 percent performance our communities are expecting," says Gomez.

As a therapist, Gomez admits to treating injuries for years by focusing on the body part in question and using a standard return-to-work protocol that allowed a fire fighter to return to work too soon. In many instances, doctors rely on the physical therapistís advice and discharge recommendations when deciding when a fire fighter is ready for discharge.

"Before I became a fire fighter, I did not truly understand the demand that the job places on the body," notes Gomez. "Now, with my experience as a career fire fighter, I realize fire fighters are returning to work too soon. Our job is more than lifting a crate filled with weights, pushing a cart or walking on a treadmill. An injured fire fighter needs to go far beyond just being pain free. Fire fighters need to be rehabilitated and then progressively trained to the level of an athlete, to ensure they have adequate range of motion in all joints and enough endurance and strength to do the job safely."

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