Upper Leacock Fire Company SOG's

Section 10    Emergency Incident Rehabilitation Guideline
 

1.    Emergency Incident Rehabilitation (Rehab) - is to ensure that the physical and mental condition of the members operating at the scene of an emergency or a training exercise does not deteriorate to a point that affects the safety of each member or that jeopardizes the safety and integrity of the operation.

 2.    This procedure SHALL apply to ALL emergency operations and training exercises where strenuous physical activity or exposure to heat or cold exists.

 3.    Incident Command Responsibilities

• The Incident Commander 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 provisions of the Emergency Medical Services at the Basic Life Support level or higher.
• Line Officers SHALL maintain an awareness of the condition of each member operating within their span of control and ensure that adequate steps are taken to provide for each member's safety and health. The command structure SHALL be utilized to request relief and the reassignment of fatigued crews.
• Personnel bare the responsibility to drink water and activity beverages throughout the day when periods of hot weather exist. They also bare the responsibility to notify a Line Officer when they have reached a level of fatigue that puts themselves, other crews, or the operation at risk.

4.      Establishing a Rehabilitation Sector

5.    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 the 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 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 enable member to be free of exhaust fumes from apparatus, vehicles, 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 the EMS units.
• It should allow prompt reentry back into the emergency operation upon complete recuperation.

6.    Site Designations

• A nearby garage, building lobby, or other structure.
• Several floors below a fire in a high rise building.
• A school bus, municipal bus, or bookmobile.
• Fire apparatus, ambulance, or other emergency vehicle at the scene or called to the scene.
• An open area in which a Rehab area can be created using tarps, tents, fans, etc.
• Retired fire apparatus or surplus government vehicle that has been renovated as a Rehab Unit. This unit could respond by request or be dispatched during certain weather conditions.

7.    Resources needed at a Rehab Site

• Fluids such as water, activity beverage, oral electrolyte solutions, and ice.
• Food such as soup, broth, stews in hot/cold cups.
• Medical supplies such as blood pressure cuff, stethoscope, oxygen administrative devices, cardiac monitors, intravenous solutions, and thermometers.
• Awnings, fans, tarps, smoke ejectors, heaters, dryers, dry clothing, extra equipment, flood lights, blankets and towels, traffic cones and fire tape (to identify the entrance and exit to the Rehab Site).

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

9. Hydration

• A critical factor in the prevention of heat injury is the maintenance of water and electrolytes. Water must be replaced during exercise periods and at emergency incidents. During heat stress, the member should consume at least one quart of water per hour. The re-hydration solution should be a 50/50 mixture of water and a commercially prepared activity beverage and administered at about 40F. re-hydration 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. Alcohol and 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.

10. Nourishment

• The department SHALL provide food at the scene of an extended incident when units are engaged for three or more hours. A cup of soup, broth, or stew is highly recommended because it is digested much faster than sandwiches and fast food products. In addition, foods such as apples, oranges, and bananas provide supplemental forms of energy replacement. Fatty and/or salty foods should be avoided.

11. Rest

• The "two air bottle rule" or 45 minutes of work time, is recommended as an acceptable level prior to mandatory rehabilitation. Members SHALL re-hydrate at least six ounces while SCBA cylinders are being changed. Firefighters having worked for two full 30-minute rated air bottles, or 45 minutes, SHALL be immediately placed in the Rehab Area for rest and evaluation. In all cases, the objective evaluation of a member's fatigue level shall be the criteria for the Rehab time. Rest SHALL not be less than ten minutes and may exceed an hour as determined by the Rehab Officer. Fresh crews, or crews released from the Rehab Sector/ Group, SHALL be available in the staging area to ensure that fatigue members are not required to return to duty before they are rested, evaluated, and released by the Rehab Officer.

12. Recovery

• Members in the Rehab 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 antihistamine, such as Actifed or Benadryl, or has taken diuretics or stimulants.

13. Medical Evaluation

• 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 a medical facility). Continued rehabilitation should consist of additional monitoring of vital signs, providing rest, and providing fluids for rehydration. Medical treatment for members whose signs and. Or symptoms indicate potential problems, should be provided in accordance with local medical control procedures. EMS personnel SHALL be assertive in an effort to find potential medical problems.
• THE HEART RATE AND TEMPERATURE - the heart rate should be measured for 30 seconds as early as possible in the rest period. If a member's heart rate exceeds 110 beats per minute, an oral temperature should be taken. If the member's temperature exceeds 100.6F and the heart rate remains above 110 beats per minute, rehabilitation time should be increased. If the heart rate is less than 110 beats per minute, the chance of heart stress is negligible.
• DOCUMENTATION- All medical evaluations shall be recorded on the standard forms along with the member's name and complaints and must be signed dated and timed by the Rehab Officer or his/her designee.
• The Rehab sector will be divided by the Rehab Officer into three sections; Initial Receiving, Medical Monitoring, Rehabilitation and complete a visual assessment when personnel first arrive at the Rehab site. Personnel first arrive at the Rehab site. Personnel will then be directed to the medical monitoring location.
• Initial Receiving- EMS will log personnel on the check in sheet and complete a visual assessment when personnel first arrive at the Rehab site. Personnel will then be directed to the medical monitoring location.
• Medical Monitoring- EMS will assess vital signs and provide oxygen, IV's, Cardiac monitoring, bodily cooling or warming as needed. EMS will document vital signs and medical information on the rehab Report. EMS options at this stage SHALL be to transport a member to a medical facility, Remove a member form service for the balance of the incident, or Release the members to the Rehabilitation location.
• Rehabilitation -EMS will establish a location where members can take a 10-15 minute break to eat and drink fluids. A final set of vital signs will be taken and documented. Members cleared by the RMS crews in the Rehab site will report to the staging area. EMS will document times on the check out sheet when members leave the Rehab site.

14. Accountability

• Members assigned to the Rehabilitation Sector/Group shall enter and exit the Rehab Area as a crew. The crew designation, number of crew members, and the times of entry to and exit from the Rehab Area SHALL be documented by the Rehab Officer or his/her designee on the Company Check-in/out sheet. CREWS SHALL NOT LEAVE THE REHAB AREA UNTIL AUTHORIZED TO DO SO BY THE REHAB OFFICER.

15. A Chief Officer or Incident Commander is the only member permitted to authorize that a Rehab Site be established during an emergency call, training even, or any other Fire Company event that warrants a need for Rehab.

16. Rehab boxes SHALL be stored in a visible location to the cab areas of Air 3-11, Engine 3-11-1, Engine 3-11-2, and Traffic 3-11. The Rehab boxes will contain all necessary personal medical information of ALL members who wish to have their personal medical information on file.

17. The Fire Company Safety Officer is responsible to see that all the medical information is kept up to date in the Rehab boxes and see that new members are given the opportunity to have their personal medical information written down and kept on file. The Safety Officer SHALL schedule a date and time before March 1 of every new calendar year, in which Leola Ambulance will come to our Fire Station and update/ revise all the Rehab information in the Rehab boxes.

18. No Fire Company Member is permitted to open or review any of the personal medical information contained in the Rehab boxes at anytime except a Chief Officer, Safety Officer, or a Fire Company Member that has obtained permission from a Chief Officer. A Chief Officer may give a Fire Company Member permission to open the Rehab boxes for the purpose of adding new member information or updating information on the personal medical cards that are already in the Rehab box.

19. NO ONE is permitted to release any Personal medical information contained in the Rehab boxes to anyone other then Emergency Medical Service Crews assigned to a rehab site UNLESS an emergency situation arises that may require personal medical information to be released for the care of an injured Fire Company Member regardless if a Rehab Site was established or not.

20. REHAB STEPS TO FOLLOW

• A Chief Officer or Incident Commander SHALL have at least one Basic Life Support EMS crew standing by at the Rehab Site or in charge of the Rehab Site.
• A Chief Officer or Incident Commander SHALL appoint a Rehab Officer in charge of the Rehab site.
• A Chief Officer or Incident Commander SHALL see that a Fire Company Member provides the Rehab Officer with the Rehab boxes that contain our members personal medical information. It shall be the responsibility of the Line Officers for each piece of apparatus to see that the Rehab boxes are returned to their apparatus prior to returning.
• A Chief Officer, Incident Commander, or their designee SHALL see that all necessary supply's needed in the Rehab Site such as water, food, are provided.
• Line Officers are RESPONSIBLE to see that their crews are sent to the Rehab Site for evaluation after the "two Bottle rule" or a 45 minute work time when a Chief Officer or Incident Commander has established a Rehab Site. The Line Officers and their crews should enter the Rehab Site together NOT individually.
• NO ON EIS PERMITTED TO LEAVE THE REHAB SITE UNTIL THE REHAB OFFICER AUTHORIZES YOU TO LEAVE. When Fire Crews are cleared for release from the Rehab Site they should report to the manpower staging area for possible reassignment.
• A Chief Officer or Incident Commander shall notify the Rehab Officer to see that all information is documented on the Fire Company approved Rehab Check In/ Check Out Worksheet and the Emergency Incident Rehab Report at the Rehab Site. All the reports SHALL be submitted to the Incident Commander or Chief Officer upon termination of the Rehab Site.
• A Chief Officer or Incident Commander SHALL have additional Basic Life Support or Advanced Life Support Units called into the scene when an injured Fire Company Member requires treatment, so that the original EMS Crew isn’t pulled away from the Rehab Site that they were assigned to.
• A Chief Officer or Incident Commander is the only person allowed to authorize the termination of a Rehab Site when an incident or training event is completed and everyone had been cleared for release by the Rehab Officer.

All Fire Company Members are encouraged to complete the Emergency Personnel Medical History Card to be kept on file inside the Rehab boxes on our Fire Company apparatus. Every effort will be made to keep your information confidential. Filling out this card is VOLUNTARY and is not MANDITORY. It is your responsibility to pass on information changes as they arise if you choose to have a card kept on file.

EMERGENCY PERSONNEL MEDICAL HISTORY REPORT

                                                         A                                                          B                                C   

REHAB OFFICER: ________________

REHAB CREW: ________________

DATE: ________TIME REHAB ACTIVATED: _______TERMINATED _____

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Page last edited: 03/12/06

© Upper Leacock Fire Company 2003