THE NEWSLETTER OF THE BUREAU OF HEALTH SERVICES • COUNSELING SERVICES UNIT • FDNY Vol.1 • No. 9• June 2003

Maximum Hydration
Now that it's summer, hot weather means that all firefighters and emergency medical field forces must pay closer attention to the potential dangers of physical stress and overheating. When temperatures exceed 90 degrees, or on hot humid days, it is especially important to keep hydrated. As explained in the article which follows, drinking plenty of liquids before, during and after a call or run is the first step to staying fit.

One effective way to delay the onset of the detrimental effects of dehydration is by increasing your total body water and blood plasma volumes. Described below are four simple ways to significantly increase your capacity to carry water.

Frequent Exercise:
Recent studies show that by engaging in almost any type of physical exercise on a regular basis you will realize, in very short order, as much as a 10-12% increase in your circulating blood plasma volume. Current research also indicates that with continued training, especially aerobic type training, their results an increase in the efficiency, the effectiveness, and the working capacity of the body's cooling mechanisms, especially the sweat mechanism.

As a direct effect of training, the well tuned Firefighter/EMT/Paramedic will carry more water, sweat less while achieving greater cooling, and lose less salt via sweat enabling him or her to rehydrate more quickly, and completely.

A Carbohydrate-Rich Diet:
Carbohydrate is the Performance Fuel for Firefighters, EMTs and Paramedics. This Foodstuff Fuel provides firefighters, emts and paramedics with energy to work, and the water to sweat. By consuming a diet that is rich (60%) in carbohydrates, fruits, vegetables, breads, cereals, grains, rice and pasta, you can increase your capacity to store carbohydrate by over 100%, and right along with it, significantly more water. Additionally, most fruits, and vegetables contain large amounts of water (up to 96%), and therefore, represent an excellent source of both fuel, and water to enhance performance, and facilitate recovery.

Decreased Body Fat:
Muscle tissue contains about 75% water, and fat cells contain less than 25% water. Consequently, the less lard, and more lean mean muscle tissue that you feature, the greater your percentage or, volume of water.

Fat also acts as a tremendous insulator, and excess fat imposes an absolutely useless additional burden upon your body. The consequences of an increase percentage of body fat are a less efficient cooling mechanism, and an increased absolute workload. The results are an increased risk of injury, and an elevated rate of fatigue.

Acclimatization:
The adage that has been applied to athletics for generations is that, "if you want to perform in the heat, then you better train in the heat." The physiological basis for this old coaching tip is that by subjecting your body to an increase heat load, especially by working, or exercising in a heated, or hot and humid environment, that your body will adapt; increasing blood plasma volume, and improving the efficiency of your cooling mechanisms, especially the sweat mechanism.

The benefits to be reaped from acclimatizing to heat are very similar to those obtained through training. In fact, the most dramatic improvements are realized in those humans that combine the two; exercising in the heat. However, before you begin exercising in the heat, you should first consult the F.D.N.Y. Health and Fitness Unit at 1-212-860-9252 for guidelines on training safely, and intelligently in heated environments.

Rapid Rehydration
The constant replacement of bodily water lost via sweat, and respiration is absolutely essential for the maintenance of circulating blood plasma volume, physiologic function, health, and performance. Generally, this is an easy task for the hydration-conscious firefighter, emt and paramedic, however, while in the performance of duty there are frequently times when continued, or, immediate rehydration is impossible. While operating at fires, emergencies, extended operations, or even when confined within an apparatus while responding to a series of alarms, firefighters, emts and paramedics are not afforded the opportunity to rehydrate themselves, yet, current research shows that they can lose bodily water at rates that exceed 2.5 quarts per hour! Marked dehydration can result, and for reasons of personal health, and safety must be remedied as soon as physically possible. Listed, and described below is the "DOs", and "DON'Ts" of Rapid Rehydration designed to enable you to replace lost fluids as quickly, and safely as possible.

DO's

1. Drink Cold Fluids
   The colder the better down to about 40 degrees F.



2. Drink Dilute Beverages
   Most common beverages, and some so-called "replacement fluids" contain much too high a concentration of sugar, or, some other nutrient to move swiftly from your stomach to the primary site of absorption in the small intestine. You can facilitate the process by diluting your chosen beverage with water. Ideally, your replacement fluid should contain less than about 8% glucose, sucrose, or glucose polymer, and a small measure of salt, (about 1/3 teaspoon of table salt; sodium chloride, per quart of fluid).



3. Drink Until Nearly Full
   At your first opportunity, you should fill your stomach to about 75-80% of capacity by drinking approximately 20-or-so ounces of your chosen replacement fluid.



4. Continue Drinking
   After initially filling your stomach to the point of being nearly full, you should supplement your initial intake by consuming an additional 6-8 ounces every 10-15 minutes. All totaled, during periods of exposure to heat stress, and while in recovery, your should ingest of at least between 1-2 quarts of fluid per hour.



5. Move About
   The mechanics of moving about casually while in the period of recovery may actually facilitate the movement of fluid, and enhance the rate of rehydration.

DON'Ts

1. Do Not Drink Hot Beverages



2. Do Not Drink Concentrated Beverages
   Fluids that contain relatively high concentrations of sugar, starch, protein, or fat tend to sit in your stomach, and retard the process of rehydration.



3. Do Not Consume Solid Food
   Especially hot, solid food.



4. Do Not Continue Working at a High Relative Intensity
   Working at intensities that exceed 75% of your maximum aerobic ability will retard the passage, and absorption of ingested fluids, slowing the rehydrative process.



5. Do Not Consume Beverages Which Contain Either Caffeine or Alcohol
   Alcohol, and caffeine are two drugs that work decidedly against you. The consumption of caffeine, or alcohol via food, drink, or drugs (prescription, or non-prescription), will contribute towards Dehydrating you as opposed to Rehydrating you!



6. Do Not Rehydrate in the Vicinity of the Fire/Emergency Operation
   If possible you should rehydrate and recover in an environment that is devoid of direct sun, heat, smoke, loud noise, and excessive activity.

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HOW TO MONITOR YOUR HYDRATION LEVEL
Because even a seemingly minor drop in bodily hydration level can have a rather dramatic impact on your perception of effort, cardiovascular function, ability to dissipate heat, and physical work capacity, it is recommended that you monitor your hydration level frequently.

Described below are two methods with which you may evaluate your hydration level daily.

1. The "ABC's" of Morning Maintenance:

• Pass Water
• Weigh Yourself
• Rehydrate

Probably the easiest way to monitor your daily state of hydration is by weighing yourself. As described above, each morning you should get up, pass water, weigh yourself, and then rehydrate as need be. You will obtain the most reliable readings if you follow this routine, starting first thing each morning, using the same scale, and wearing approximately the same amount of clothing.

If upon weighing yourself you notice that you have dropped 2,3 or 4 pounds compared to your last few weigh-ins, remember, that a 200 pound firefighter, emt or paramedic doesn't burn a full pound of fat running the NYC Marathon, so, in spite of your best wishes, the weight that you have lost is much more likely an indication of water loss (dehydration), than anything else. For each pound of water weight lost, you need to consume approximately sixteen ounces (2-8 ounce cups, or, one 16 ounce pint) of either water, or some other suitable replacement fluid.

2. Maintenance Check for the PM Period:
During the day, or throughout your tour of duty, evaluation of hydration level by weight is less reliable because body weight can fluctuate independent of hydration level due to meals, and other variables. Evaluation of hydration level via the thirst mechanism is also inappropriate, because in most cases you do not develop the sensation of thirst until you are already significantly dehydrated.

The best bet is to start the day well hydrated; employing the "AM ABC's", and then continue to take in fluids via beverages, fruits, and vegetables throughout the day. Then if you steer clear of, or minimize your intake of alcohol, and caffeine, you can be reasonably assured of an adequate level of hydration provided you continue to pass water on a regular basis.

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9/11 Mental Health Care Program

Most rescue and recovery workers respond to disasters without ever developing any significant psychological problems. Having a tough constitution is a necessary part of the job. But a devastating and terrifying event, such as the September 11 attacks, can make even battle-hardened professionals vulnerable to Acute Stress Disorder (ASD) or Post Traumatic Stress Disorder (PTSD). Some first responders may even turn to drugs and/or alcohol in an attempt to medicate their painful feelings.

The 9/11 Mental Health Care Program, created by the American Red Cross and The September 11th Fund, provides complete or partial payment for many mental health and substance abuse treatment services for those directly affected by the September 11 disaster anywhere in the U.S.A. FDNY employees can now benefit from the care provided by the program, in addition to the benefits already enjoyed under their current plans.

This exceptional program was based on the successful mental health model implemented to assist fire and rescue workers after the Oklahoma City Bombing. Gary Marrs, Oklahoma City Fire Chief from 1992-2002 during the Oklahoma City Bombing says, "After the attack in Oklahoma City, the Red Cross quickly made all their resources available to those that needed them. They understand where the problems are and the service is completely confidential. All these years have passed and the Red Cross is still here providing support".

The 9/11 Mental Health Care Program covers unmet treatment expenses up to $3,000 or 32 visits to a licensed practitioner. Treatments also covered by the program include:

• Outpatient mental health treatment, including individual, group, couples and family counseling
• Psychotropic medications
• Alcohol or substance abuse detoxification, counseling, or outpatient rehabilitation
• Inpatient hospitalization and/or substance abuse treatment (applicable to some clients)
  The program can cover costs retroactively as far back as September 11, 2001 as well.
  Enrollment in the 9/11 Mental Health Care Program is simple and confidential. Interested individuals can call the FDNY Counseling Service Unit for more information.

I strongly encourage those that even think they need to talk to someone to do so, says Marrs. "In the long run, people will be much more productive in their job-and when it's time-be able to enjoy retirement without all that stress.

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