Rehabilitation

Section 2 - EMERGENCY OPERATIONS

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:

1. Rest period
2. Hydration to replace lost body fluids
3. Cooling (passive and/or active)
4. Warming
5. Medical monitoring to include: A documented full set of vital signs (Heart Rate, Blood Pressure, Temperature, Respiratory Rate, Pulse Oximetry, Carbon Monoxide)
6. Emergency medical care if required
7. Relief from extreme climatic conditions (heat, cold, wind, rain)
8. Calorie and electrolyte replacement
9. Accountability
10. Release back to the operation

RESPONSIBILITIES:

• The incident commander shall be responsible for the following:

1. Include rehabilitation in incident/event size-up considerations.
2. Establish a rehabilitation group to reduce adverse physical effects on firefighters while operating during fire/emergencies, training exercises, and extreme weather conditions.
3. Designate a supervisor to serve as the rehabilitation group (Supervisor/Leader).
4. Ensure sufficient resources are assigned to the rehabilitation group.
5. Ensure EMS personnel are available for emergency medical care of firefighters as required.
6. 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:

1. Don the rehabilitation group (Supervisor/Leader) vest.
2. 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.
3. Ensure personnel in rehabilitation “dress down” by removing all of their protective clothing to help promote cooling.
4. 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).