SOG #101 - Emergency Incident Rehabilitation

PURPOSE

To insure that the physical and mental condition of firefighters operating at the scene of an emergency or a training exercise does not deteriorate to a point that affects the safety of each member, the safety of the crew or the integrity of the operation.

SCOPE

This procedure shall apply to all emergency operations and training exercises where strenuous physical activity, or exposure, to heat or cold exists.

RESPONSIBILITIES

INCIDENT COMMAND

Incident command shall consider the circumstances of each incident and make adequate provisions early in the incident for the rest and rehabilitation for all members operating at the scene. These provisions shall include medical evaluation, treatment and monitoring, food and fluid replenishment, mental rest and relief from extreme climatic conditions and other environmental parameters of the incident. The rehabilitation shall include the provision of Emergency Medical Services at the Basic Life Support (BLS) level or higher.

OFFICERS

All officers shall maintain an awareness of the condition of each member operating within their span of control and ensure the adequate steps are taken to provide for each member’s safety and health. The command structure shall be utilized to request the reassignment of fatigued crews.

PERSONNEL

During periods of hot weather, members shall be encouraged to drink water or other beverages throughout the incident. During any emergency incident or training evolution, all members shall advise the officers when they believe that their level of fatigue or exposure to heat or cold is approaching a level that could affect themselves, their crew, or the operation in which they are involved. Members shall also remain aware of the health and safety of other members of their crew.

ESTABLISHMENT OF REHABILITATION SECTOR

RESPONSIBILITY

The Incident Command will establish a rehabilitation sector when conditions indicate that rest and rehabilitation is needed for personnel operating at an incident scene or training evolution. A member will be placed in charge of the sector and shall be known as the Rehab Officer.

LOCATION

The location for the Rehabilitation Area will normally be designated by the Incident Command.  If a specific location has not been designated, the Rehab Officer shall select an appropriate location based on the site characteristics and designations below.

SITE CHARACTERISTICS

·         It should be in a location that will provide physical rest by allowing the body to recuperate from the demands and hazards of the emergency operation or training evolution.

·         It should be far enough away from the scene that members may safely remove their turnout gear and SCBA and be afforded mental rest from the stress and pressure of the emergency operation or training evolution.

·         It should provide suitable protection from the prevailing environmental conditions. During hot weather, it should be in a cool, shaded area. During cold weather, it should be in a warm, dry area.

·         It should enable members to be free of exhaust fumes from the apparatus or equipment (including those involved in the rehabilitation sector/group operations).

·         It should be large enough to accommodate multiple crews, based on the size of the incident.

·         It should be easily accessible by EMS units.

·         It should allow prompt re-entry back into the emergency operation upon complete recuperation.

SITE DESIGNATIONS

·         A nearby garage, building lobby, or other structure.

·         A school bus.

·         Fire apparatus, ambulance, or other emergency vehicles at the scene or called to the scene.

·         An open area in which a Rehab Area can be created using tarps, fans, etc.

RESOURCES

The Rehab Officer shall secure all necessary resources required to adequately staff and supply the Rehabilitation Area. The supplies should include the items listed below:

·         Fluids - water, activity beverage, or ice.

·         Food – granola bars.

·         Medical - blood pressure cuffs, stethoscopes, oxygen administration devices, cardiac monitors, intravenous solutions and thermometers.

·         Other - awnings, fans, tarps, chairs/benches, traffic cones and fire line tape.

GUIDELINES

REHABILITATION SECTOR ESTABLISHMENT

Staff officers during the initial planning stages of an emergency response should consider rehabilitation. However, the climatic or environmental conditions of the emergency scene should not be the sole justification for establishing a Rehabilitation Area. Any activity/incident that is large in size, long in duration, and/or labor intensive will rapidly deplete the energy and strength of personnel and therefore merits consideration for rehabilitation.

HYDRATION

A critical factor in the prevention of heat injury is the maintenance of water and electrolytes. Water must be replaced during emergency incidents and training evolution’s. During heat stress, the member should consume at least eight ounces of water per hour. Rehydration is important even during cold weather operations where, despite the outside temperature, heat stress may occur during fire fighting or other strenuous activity when protective equipment is worn. Caffeine beverages should be avoided before and during heat stress because both interfere with the body’s water conservation mechanisms. Carbonated beverages should also be avoided.

REST

The “two air bottle rule,” or 45 minutes of work time, is recommended as an acceptable level prior to mandatory rehabilitation. Firefighters having worked for two full 30 minute rated bottles, or 45 minutes, shall immediately be placed in the Rehabilitation Area for rest and evaluation. In all cases, the objective evaluation of a member’s fatigue level shall be the criteria for rehab time. Rest shall not be less then ten minutes and may exceed an hour as determined by the Rehab Officer. Fresh crew, or crews released from the rehabilitation sector/group, shall be available in the staging area to ensure that fatigued members are not required to return to duty before they are rested, evaluated, and released by the Rehab Officer.

RECOVERY

Members in the Rehabilitation Area should maintain a high level of hydration. Members should not be moved from a hot environment directly into an air conditioned area because the body’s cooling system could shut down in response to the external cooling. An air conditioned environment is acceptable after a cool-down period at ambient temperature with sufficient air movement. Certain drugs impair the body’s ability to sweat and extreme caution must be exercised if the member has taken antihistamines, such as Actifed or Benadryl, or has taken diuretics or stimulants.

MEDICAL EVALUATION OF PERSONNEL

Emergency Medical Services - EMS should be provided and staffed by the most highly trained and qualified EMS personnel on the scene (at a minimum of BLS level). They shall evaluate vital signs, examine members, and make proper disposition (return to duty, continued rehabilitation, or medical treatment and transport to medical facility). Continued rehabilitation should consist of additional monitoring of vital signs, providing rest, and providing fluids for rehydration. The physical examination should include, at a minimum the following:

1.         Vital signs (blood pressure, pulse, breathing rate, etc)

2.         Assessment of lung sounds

3.         Oxygen Saturation

4.         Skin condition and color

5.         Body temperature

If EMS personnel note abnormalities in the physical examination, as outlined below, the firefighter should not be permitted to wear protective equipment and/or re-enter the active work environment, until all parameters are within normal range.

Re-examination should occur at ten-minute intervals. EMS personnel should record examination results on the fire ground evaluation board. Treatment shall be in accordance with local EMS region protocols.

ACCOUNTABILITY

Anyone entering the Rehab area should have their names, time of entry to and exit from the Rehab Sector documented by the EMS staff.

Physical Examination Abnormal Parameters

1. Vital Signs:
            A. Blood Pressure
                        a. Systolic Greater Than (>)           160
                        b. Systolic Less Than (<)                  90
                        c. Diastolic Greater (>)                     100
            B. Pulse
                        a. Greater Than (>)                          110
                        b. Less Than (<)                                 60
                        c. Respiratory Rate
                        d. Greater Than (>)                            20
                        e. Less Than                                       10
            C. Lung Sounds
                        a. Presence of:
                                    Rales
                                    Rhonchi
                                    Wheezing

2. Oxygen Saturation
                        a. Less Than (<)                               95%

3. Skin Condition and Color
                        a. Flushed
                        b. Pale
                        c. Cyanosis
                        d. Cold Diaphoresis

4. Body Temperature
                        a. Greater Than (>)                          100.6F
                        b. Less Than (<)                                97.6F