EMS Tips Uncategorized

Hydration Tips for Operational Athletes during Hot and Prolonged Operations

I have always like the term “operational athlete” (I believe introduced to me by Bryan Fass) to describe paramedics, firefighters, and police officers. In many situations emergency responders need to rapidly transition from a period of non-activity to either a burst of anaerobic energy, like lifting a patient, or to a sustained aerobic effort, like climbing several flights of stairs. Or depending on your fitness and activity a combination of both.

During this unusually hot summer there have been a lot of articles about staying cool and hydrated on the job. I want to add some of my experience, tips, and opinions to the conversation.

In his post, Firefighter Pre-Hydration – fight fire like a marathon runner, Chris Kaiser makes many apt comparisons between fire fighting and endurance sports. Because firefighters may be in sustained operations of an hour or more, often in a high heat environment, while wearing turnouts fluid loss and hyperthermia can become significant. Thus the importance of initiating rehab on incidents and regularly circulating companies through rehab following the NFPA rehab guidelines.

Chris writes about “pre-hydration” which I think can many things. As a marathon runner I pre-hydrate by:

  • Drinking 8-12 ounces of water as soon as I can after waking up
  • Before a run or cycling workout I will drink to quench my thirst
I don’t down a water bottle just before running as I don’t like the uneasy feeling of water sloshing around my stomach while awaiting absorption.
Chris also offers this advice, ” Marathon runners are taught to drink 20 to 32 ounces of water 2 to 3 hours before running and then to drink 8 to 10 ounces of water every 20-30 minutes before they run. While actually running, they are advised to drink 8-10 ounces of water every 20-30 minutes as well. “

To me that recommendation sounds like a lot of water for a marathon runner or an operational athlete. Drinking a quart to a quart and a half each hour is a lot to drink and might be more water than my GI system can absorb. Even though I may be perspiring two liters per hour my body can’t absorb water as fast as I am losing it.

Near the finish of the 2011 Green Bay Cellcom Marathon

While running distances of 6 to 26.2 miles I let my thirst guide my water intake. If I am thirsty I take a pull from my water bottle or a cup from a water station. The prevailing wisdom in most marathon training resources I am reading is to drink for thirst.

Pre-hydration and over-hydration can cause hyponatremia. Running race medical directors are also advising runners to drink to quench their thirst.

Hydration is just part of the puzzle for sustainment and rehab of the operational athlete. As I do while marathon running, emergency responders/operational athletes should:

  • Minimize time in hot environments
  • Seek out shade, fans, and misting water sprays during rehab/rest periods
  • Remove heat retaining layers of clothing (which are preventing cooling)
After the race or incident operational athletes need to have time to refuel and rehydrate. For me the most effective recovery drinks are water, coffee (if I didn’t have before a morning run), and ice cold chocolate milk. After a long run, 10-20 miles, I generally let my hunger cravings determine what I eat. But instead of having a huge meal I like to have lots of snacks and try to consume extra portions of fruits, vegetables, and nuts.
Heat Illness 
Dr. Jeff Lindsay recently contributed this article to, How to Recognize and Treat Heat Illness. Being able to recognize the symptoms of heat illness is critical for operational athletes. The real challenge is that on any prolonged incident almost everyone, just like finishers at a running race, will be fatigued, hungry, over heated, and dehydrated. The real challenge is to differentiate the sick from the not sick. Signs that an operational athlete is SICK include:
  • Altered mental status or reduced level of consciousness
  • Vital signs that don’t return to normal or near normal with rest
  • Inability to self rehab (drink fluids and consume electrolytes)
I read lots of firefighter notification of line of duty death notices. After an incident I would be especially alert for co-workers that makes a complaint like, “I don’t feel well I am going to my bunk to rest.”
A co-worker that is not recovering from an incident as rapidly as others or as rapidly as expected should be invited (strongly encouraged) to have a medical evaluation. Find out more about their complaint, pain, vital signs, and activities since the incident. Treat what you find with the tools and training you have.

When I run a 6-13 mile training run or race I generally expect to have a regular day afterwards. Within 30-60 minutes of the race I expect to be able to play with my kids, do chores around the house or yard, or engage in another physical fitness activity. Likewise operational athletes because of a good foundation of fitness, in incident hydration, and post incident food and hydration should be back to normal 60 minutes after a 1-2 hour incident. If you are wiped out for the rest of the day is it because of a chronic problem – poor underlying health and fitness – or an acute problem related to the activity?

Sports Drinks – Lots of Hype and Little to No Evidence

Chris, Dr. Lindsay, the entire US Olympic Team, and almost every other amateur and professional athlete on the planet encourage us to consume sports drinks – sweet and salty water – before, during, and after exercise. Despite decades of hype and becoming a multi-billion dollar business there is almost no evidence that sports drinks make any difference.

A British Medical Journal July 2012 research review offers this summary of the research, “There is a striking lack of evidence to support the vast majority of sports-related products that make claims related to enhanced performance or recovery, including drinks, supplements and footwear.

On runs or bike rides more than 90 minutes my anecdotal and personal experience  is I feel better if I eat and drink calories around the 1 hour mark and every 30 to 60 minutes after that. Thus I drink gatorade and eat whatever I might have stuffed into my pockets before I left the house. But instead of fancy energy packs or bars I bring bananas, hard candy, chewy candy, peanut butter and jelly sandwiches, granola bars, and any other types of snacks that are easy to eat while running or biking.

I think so many children, teens, and adults reach for a cold sports drink during and after exercise because we have bought into the marketing hype and we have trained our bodies to crave sweet drinks by drinking too much soda and artificially sweetened juice. Our bodies need water and can find the nutrients and electrolytes we need from a well balanced and healthy diet. A bottle of energy drink after 45 minutes of 8 year old soccer is no more necessary than after a 45 minute run around the neighborhood or a 45 minute extrication response on the highway. Drink some water and get some sugar from an apple, orange, or a banana.

Other bloggers dish on energy drinks:

What works for you as an operational athlete? How do you stay fit, hydrated, and well fed while working in fire, EMS, or law enforcement? 

By Greg

Elearning designer, writer, podcaster, blogger, presenter and paramedic. To relax I run and bike as far and as fast as I can. Also like to read a lot and fast.