Strong survivors

Injured firefighters have access to their own specialist rehabilitation.

The deaths of firefighters James Shears and Alan Bannon in April, trying to control a blaze in a Southampton tower block, highlight the inherent dangers of the job. Many more firefighters become injured in the course of duty and, thanks to the Fire Fighters charity, are able to receive specialist rehabilitation. The charity, which supports firefighters at times of need, provides an intensive residential therapy programme at its recuperation centres – Harcombe House in Devon and the Jubilee Centre in Penrith, Cumbria. The self-referral programme combines physiotherapy, exercise therapy, health and lifestyle talks and relaxation, and runs for either one or two weeks. Therapy weekends are also offered for those needing follow-up support and participants can access the programme as many times as there is a clinical need. It is available to all fire service personnel, including retirees, non-uniform personnel and their direct dependents, and is funded by donations, a large proportion paid directly through firefighters’ wages. Physiotherapist Nicky Patton, clinical team leader at Harcombe House, describes the programme as ‘high-end rehabilitation’, designed to return firefighters to the necessary fitness levels in an environment catering to their specific needs. ‘It is very functional. We have all the equipment here in our purpose-built physiotherapy gym, including ropes, ladders and water tanks, to get them right to the end of their rehab, which is very rewarding,’ he says.

Dream client

The therapy programme teams, which comprise physiotherapists, exercise therapists, a sports massage therapist, and, at the Jubilee Centre, nurses and clinical assistants, have also trained on fire grounds to understand the physical demands clients are under. The programme is shaped by the defining characteristics of its client group, which are being highly motivated and great team workers. ‘They love their job and want to get back to work as soon as they can, and a lot of them are very fit and active outside of work,’ says Nicky Patton. ‘It’s an absolute dream as far as rehabilitating people because having a motivated client means they absorb what you are telling them,’ she says. Physiotherapist Chris Gould, clinical team leader at the Jubilee Centre, shares this experience: ‘You are struck by how caring they are as a profession. They tend to bond and support each other. It is a very friendly, jolly environment to work in. The only problem we have with them is that we have to try to calm them down. Whatever you say they’ll do it and 10 times over, so you have to rein them in a little bit.’ While therapy is group-based, ‘the programme is meant to be very individualised and flexible,’ he adds. At the beginning of their stay, the firefighters are assessed by a physio and exercise therapist and split into groups of high or low fitness levels, their goals are identified in plans and they have their own timetables. A typical 9am-5pm therapy day will consist of warm-ups, gym or hydrotherapy pool sessions, a walk in the centres’ spacious grounds, education and relaxation sessions, with at least one session a day specific to individual needs. Daily contact with clients means rehab approaches can be quickly adapted during their stay. Chris Gould found this to be a happy surprise after working in NHS acute and outpatient musculoskeletal departments. ‘I was used to working with patients in a cubicle for 10-15 minutes at a time. At the centre the ongoing contact is quite unique and means you can find things out about a client that you can work into therapy,’ he says. The opportunity to talk about themselves with therapists can be very helpful to physical recuperation, adds Nicky Patton. “They see a lot of horrible, nasty things in their work. To have an injury that prevents them from being active for months can be quite depressing and isolating. Clients cry on me sometimes. A lot of the time they off-load on walks. I am not trained in counselling but it helps that I can have time with the patient. Listening is a phenomenal tool.’ Currently, the centres do not have provision for clients who are actively suffering from post traumatic stress disorder, but the Jubilee centre is looking into offering this service and has nurses trained in dealing with psychological problems.

Holistic approach

There is also a strong emphasis on self management. ‘We are not just providing a programme of physiotherapy,’ stresses Nicky Patton. ‘We give them a range of health and lifestyle lectures, including nutrition and cardiac exercise, to make sure they understand why they are doing what they are doing. It would be pointless if they go away and don’t continue doing the right exercises.” A  pilot study at Harcombe House showed clients experienced an average improvement of 13 per cent in their physical condition three months after leaving the centre, she points out. To be accepted on to the programme clients have to be medically stable, so some may have to wait three months after an operation. Musculoskeletal injuries make up the majority of complaints, with knee injuries the most common, followed by back pain.  Other conditions include cardiac, neurological and general physical unfitness – for example, if clients are falling short of minimum fitness requirements. In some cases, the charity is providing clients with their first contact with physiotherapy, even at 12-weeks post-operation. Nicky Patton says: ‘For some people it is quicker to come to us than to access physiotherapy through the NHS. ‘We have noticed a trend in waiting lists increasing over the last two to three years. A lot of the clients we see haven’t had any physiotherapy post-op before they see us, so they are way behind on the rehab curve.’ Others may have received some NHS rehabilitation, but are struggling with particular functional aspects of their work. Says Chris Gould: ‘Clients come to us after they have had some NHS treatment and are looking to be pushed on a little bit. It gives them a chance to test their ability in work-related scenarios. Even though it’s a one week or two week programme, they can come a long way. It can give them a big boost confidence-wise. It is very satisfying to see them progressing.’ Nicky Patton, who also worked as an NHS musculoskeletal physiotherapist before joining the charity, says: . ‘I have never worked in a job where satisfaction is greater. It’s great working with people who do such an amazing job, and the quicker we can get them back to work the quicker they can help other people.’ fl

Case study

Firefighter Ryan Weir, now based at West Midlands fire and rescue service, was told he migh not be able to return to full duties after his leg was seriously broken when his fire engine collided with an articulated lorry on the way to an incident in 2003. ‘I knew I was seriously injured when I looked down and saw my boot pointing the wrong way and a lot of my shin gone. I was told that it was a serious break so not only was my career in jeopardy, but I’ve always been very active, snowboarding and mountain biking,’ says Ryan Weir. He had a 16-inch titanium rod put in his leg. ‘The bit of my recovery that I struggled with the most has been my knee where they put the nail in, where I get bad pins and needles. Part of me was very frustrated that it wasn’t the actual break that was giving me trouble.’ The accident had a huge impact on Ryan’s life. After being in hospital for two weeks, he was cared for by parents and his partner, who is now his wife. The ‘excruciating’ pain meant having to take pain killers hours before getting up each day.

Marathon runner

It was ten months before he could return to full duties, during which time he twice underwent the therapy programme at the Jubilee Centre. The benefit, he says, was that it was focused on a one-to-one basis. ‘It was brilliant. If you had any aches and pains you could report them and they were right there with another plan.’  It was also helpful to see other people progressing. ‘You end up helping people worse off than you and building up quite a friendship.’ ‘The injury doesn’t stop me doing anything now,’ he says. .’A couple of months ago I ran across the Sahara in the Marathon des Sables. And there are all sorts of challenges I fancy encountering. The Yukon Arctic Ultra, which is 430 miles and down to minus 30 degrees, sounds a little bit tempting.’  

Louise Hunt reports

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