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
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.
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.
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
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.
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.
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.
- Drink Cold Fluids
The colder the better down to about 40 degrees F.
- 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).
- 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.
- 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.
- 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.
- Do Not Drink Hot Beverages
- 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.
- Do Not Consume Solid Food
Especially hot, solid food.
- 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.
- Do Not Consume Beverages Which Contain Either Caffeine
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
- Do Not Rehydrate in the Vicinity of the Fire/Emergency
If possible you should rehydrate and recover in an environment
that is devoid of direct sun, heat, smoke, loud noise, and
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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
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
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
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
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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Dr. Kerry Kelly
Chief Medical Officer
Dr. David Prezant
Deputy Chief Medical Officer
Director, FDNY CSU
Mary T. McLaughlin
Director, FDNY BHS