Rehabilitation
Contents
Section 2 - EMERGENCY OPERATIONS
220.26 Rehabilitation
PURPOSE:
- To provide guidance on the implementation and use of a structured rehabilitation process as a requirement of the incident management system (IMS) at the scene of a fire, other emergency, or training exercise.
- To ensure that personnel who might be suffering the effects of metabolic heat buildup, dehydration, physical exertion, and/or exposure to extreme weather conditions as a result of their participation in the event receive mandatory evaluation and rehabilitation as needed.
SCOPE :
All personnel considered to be operating at risk while attending or operating at the scene of a fire/emergency, or training exercise, shall participate in any designated rehabilitation operation as directed by their supervisor. Mandatory establishment and participation in a structured rehabilitation system is critical to both long and short term firefighter health, safety, and welfare. Incident Commanders (IC) and crew supervisors should monitor the physical exertion levels of their personnel and be overly mindful of their condition.
RULES:
- Structured rehabilitation operations shall commence at the direction of the IC when fire/emergency operations and/or training exercises pose a potential health and safety risk to firefighters.
- Structured rehabilitation operations shall be established for any incident where the duration, climate conditions, or physical demands placed on the personnel clearly dictate the need for rehabilitation support.
- While not all incidents will require a structured rehabilitation process, the incident commander shall consider the establishment of a structured rehabilitation process according to the specific circumstances of the incident.
- A structured rehabilitation process shall include the following:
- Rest period
- Hydration to replace lost body fluids
- Cooling (passive and/or active)
- Warming
- Medical monitoring to include: A documented full set of vital signs (Heart Rate, Blood Pressure, Temperature, Respiratory Rate, Pulse Oximetry, Carbon Monoxide)
- Emergency medical care if required
- Relief from extreme climatic conditions (heat, cold, wind, rain)
- Calorie and electrolyte replacement
- Accountability
- Release back to the operation
RESPONSIBILITIES:
- The incident commander shall be responsible for the following:
- Include rehabilitation in incident/event size-up considerations.
- Establish a rehabilitation group to reduce adverse physical effects on firefighters while operating during fire/emergencies, training exercises, and extreme weather conditions.
- Designate a supervisor to serve as the rehabilitation group (Supervisor/Leader).
- Ensure sufficient resources are assigned to the rehabilitation group.
- Ensure EMS personnel are available for emergency medical care of firefighters as required.
- Consider requesting an additional transport unit (Ready Rescue) specifically assigned to the rehabilitation group.
- The rehabilitation group (Supervisor/Leader) shall be responsible for the following:
- Don the rehabilitation group (Supervisor/Leader) vest.
- Whenever possible, select a location for rehabilitation with the following site characteristics:
- Large enough to accommodate the number of personnel expected (including EMS personnel for medical monitoring).
- Have a separate area for members to remove protective equipment.
- Be accessible for an ambulance and EMS personnel should emergency medical care be required.
- Be removed from hazardous atmospheres including apparatus exhaust fumes, smoke, and other toxins. Consider being upwind, upstream, or otherwise removed as possible from any threat.
- Provide shade in summer and protection from inclement weather as necessary.
- Have access to a water supply (bottled or running) to provide for hydration and active cooling.
- Attempt to locate away from spectators and the media.
- Ensure personnel in rehabilitation “dress down” by removing all of their protective clothing to help promote cooling.
- Provide the required resources for rehabilitation including the following:
- Potable drinking water for hydration.
- Provide shelter from sun, if possible.
- Sports drinks (to replace electrolytes and calories) for long duration incidents (working more than one hour).
- Effective passive and/or active cooling (when available).
- Medical monitoring equipment (chairs to rest on, blood pressure cuffs, stethoscopes, check sheets, etc.).
- Food as needed and a means to wash or clean hands and face prior to eating.
- Consider blankets and warm, dry clothing for cooler months.
- Consider identifying available restroom facilities when possible.
- Time personnel in rehabilitation to ensure they receive a minimum of 15 minutes of rest. Additional rehabilitation time should be dictated by the environment and the level of exertion of the personnel.
- Ensure personnel rehydrate themselves.
- Ensure personnel are provided with a means to be effectively passively or actively cooled as needed.
- Maintain accountability and remain with the rehabilitation group until reassigned by Command.
- Document members entering or leaving the rehabilitation group.
- Inform the incident commander, accountability officer (resource unit), and EMS personnel if a member requires transportation to and treatment at a medical facility.
- Company officers shall be responsible for the following:
- Be familiar with the signs and symptoms of heat stress and cold stress.
- Monitor their company members for signs of heat stress and cold stress.
- Notify the IC when members require relief, rotation, or reassignment according to conditions.
- Provide access to rehabilitation for company members as needed.
- Ensure that their personnel are properly checked in with the rehabilitation group (Supervisor /Leader) and accountability officer (resource unit), and that the crew remains intact.
- Crew members shall be responsible for the following:
- Be familiar with the signs and symptoms of heat and cold stress.
- Maintain awareness of themselves and company members for signs and symptoms of heat stress and cold stress.
- Parameters to determine fitness/ability to return to firefighting activities
Body Temperature
Normal body temperature range from 98.6 to 100.6 degrees
Heart Rate (Pulse)
Normal resting heart rates range from 60 to 100 beats per minute. A fire fighter who has not achieved a heart rate of less than 100 beats per minute by the end of 20 minutes should not be released from rehabilitation, but should be further monitored, and if warranted, sent for further medical evaluation. Part of additional monitoring should include orthostatic pulse and blood pressure.
Respiratory Rate
Normal respiratory rate is 12 to 20 breaths per minute. By the end of the rehabilitation period, the fire fighter should have a respiratory rate within these parameters. If the rate is not within this range follow emergency medical protocols related to respiratory conditions.
Blood Pressure
A member whose blood pressure is greater than 160 systolic and/or 100 diastolic should not be released from rehabilitation.
Pulse Oximetry
Normal SpO2 readings are between 95 and 100 percent. Readings or 91 to 94 percent reflect mild hypoxemia; 86 to 90 percent reflect moderate hypoxemia; and below 85 percent indicate sever hypoxemia. If outside this range, follow emergency medical protocols.
CO Monitoring
Carbon Monoxide will be monitored anytime a firefighter is exposed to smoke or fire.
Initial CO Assessment Parameter
| 0 - 5% | Considered normal |
| 5 – 10% | Considered normal in a smoker |
| > 10% | Abnormal in any person – consider high flow oxygen |
| > 15% | Significantly abnormal in any person – treatment mandated |
CO Reassessment Parameters
| 0 - 5% | Acceptable for return to firefighting activities if medically cleared |
| 5 – 10% | Consider high flow oxygen until < 5% regardless of symptoms |
| > 10% | Abnormal, assess for symptoms, consider high flow oxygen |
| > 15% | Significantly abnormal, treatment mandated, consider transport |
