On-Scene Rehab

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Permalink Reply by Douglas DuBree on March 3, 2010 at 2:33pm

Gail, Send me your email address and I'll send you what I have in the way of powerpoints on Rehab. there have been some very good articles on Rehab in Fire Engineering in the past. One of our former firefighters who is now a Chief in the Chicago area does a presentation at FDIC annually. his name is Craig Haigh he's Chief of Hanover Park Fire Dept in Illinois. You may want to google his dept and contact him via email or phone. Send your email to me at dubree.douglas@rigov.org

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Permalink Reply by James Roger on March 3, 2010 at 5:53pm

ARLINGTON FIRE DISTRICT REVISION DATE
OPERATING GUIDELINES 03-26-2008
SUB DOCUMENT ICS
Rehabilitation PAGE 1 OF 9
AFD # 5-E
PURPOSE.
To ensure that the physical and mental condition of 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.
SCOPE.
It is the policy of the Arlington Fire District that no member will be permitted to continue emergency
operations beyond safe levels of physical or mental endurance. The intent of Rehabilitation (Rehab) is to
lessen the risk of injury that may result from extended field operations under adverse conditions. This
procedure is in no way intended to diminish initial fire attack aggressiveness. This procedure shall apply to
all emergency operations and training exercises where strenuous physical activity or exposure to heat or cold
exist.
Goal
To ensure a standardized rehabilitation process is in place when indicated to:
1. Provide medical evaluation and treatment
2. Provide food and fluid replenishment
3. Provide a standard crew rotation based on the duties assigned
4. Provide relief from extreme climatic conditions
Incident Management System (IMS)
This document outlines the incident management system rehabilitation component, including but not
limited to, the following:
1. Medical evaluation and treatment.
2. Food and fluid replenishment.
3. Relief from climatic conditions.
4. Rest and recovery.
5. Member accountability.
Assumptions
1. The member arrives and/or responds to duty rested, hydrated, nourished, without illness or injury,
and physically fit to perform the duties assigned.
2. The member has followed the pre-incident steps outlined in this document.
3. The member follows the operational steps outlined in the document.
RESPONSIBILITIES
Incident Commander
The Incident Commander shall consider the circumstances of each incident and make adequate
provisions early in the incident for the rehab 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 the other environmental parameters of the incident. The rehab shall
ARLINGTON FIRE DISTRICT REVISION DATE
OPERATING GUIDELINES 03-26-2008
SUB DOCUMENT ICS
Rehabilitation PAGE 2 OF 9
AFD # 5-E
include the provision of Emergency Medical Services (EMS) 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 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
During periods of hot weather, members shall be encouraged to drink water and activity beverages
throughout the work day. During any emergency incident or training evolution, all members shall advise
their supervisor 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.
The “two air bottle rule,” or 45 minutes of work time, is recommended as an acceptable level prior to
mandatory rehabilitation. Members shall rehydrate (at least eight ounces) while SCBA cylinders are being
changed. Firefighters having worked for two full 30 minute rated bottles, or 45 minutes, shall be
immediately placed in the Rehab for rest and evaluation
Role of Emergency Medical Services (EMS)
Emergency medical services should be available in the incident scene rehabilitation tactical level
management component for evaluation and treatment of members.
Basic life support (BLS) should be the minimum level of available care.
Advanced life support (ALS) personnel should be considered preferable where they are available.
EMS personnel should briefly question members arriving at rehabilitation to determine if they have any
symptoms of dehydration, heat stress, cold stress, physical exhaustion, cardiopulmonary abnormalities,
emotional/mental stress, and/or emotional/mental exhaustion and should utilize the Rating of Perceived
Exertion (RPE).
EMS personnel should assess and treat any member having signs or symptoms of heat
stress or cold stress.
ESTABLISHMENT OF REHAB
Responsibility
The Incident Commander will establish a rehab group when conditions indicate that rest and
rehabilitation is needed for personnel operating at an incident scene or training evolution. The radio
ARLINGTON FIRE DISTRICT REVISION DATE
OPERATING GUIDELINES 03-26-2008
SUB DOCUMENT ICS
Rehabilitation PAGE 3 OF 9
AFD # 5-E
designation REHAB GROUP shall be used to identify this group. It will be utilized to evaluate and assist
personnel who could be suffering from the effects of sustained physical or mental exertion during
emergency operations. Rehab will provide a specific area where personnel will assemble to receive:
1. A physical assessment
2. Revitalization - rest, hydration and refreshments
3. Medical evaluation and treatment of injuries
4. Continual monitoring of physical condition
5. Initial stress support assessment
6. Reassignment
A Rehab Team concept will be utilized wherever possible to establish and manage Rehab. This team will
consist of:
1. REHAB Officer
2. EMS Personnel
3. Ambulance
4. Scene Support personnel
5. Critical Incident Debriefing (CID) Team, as needed
Location
The location for Rehab will normally be designated by the Incident Commander. The initial Rehab
should be located, whenever possible, 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 but close enough to be managed. 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
1. 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.
2. 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.
3. 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.
ARLINGTON FIRE DISTRICT REVISION DATE
OPERATING GUIDELINES 03-26-2008
SUB DOCUMENT ICS
Rehabilitation PAGE 4 OF 9
AFD # 5-E
4. It should enable members to be free of exhaust fumes from apparatus, vehicles, or equipment
(including those involved in the Rehabilitation Group operations).
5. It should be large enough to accommodate multiple firefighters, based on the size of the incident.
6. It should be easily accessible by EMS units.
7. It should allow prompt reentry back into the emergency operation upon complete recuperation.
Resources
The Rehab Officer shall secure all necessary resources required to adequately staff and supply in Rehab.
The supplies should include the items listed below:
1. Fluids - water, activity beverage, oral electrolyte solutions and ice.
2. Food - soup, broth, or stew in hot/cold cups.
3. Medical - blood pressure cuffs, stethoscopes, oxygen administration devices, cardiac monitors,
intravenous solutions and thermometers.
4. Other - awnings, fans, tarps, smoke ejectors, heaters, dry clothing, extra equipment, floodlights, blankets
and towels, traffic cones and fire line tape (to identify the entrance and exit of the Rehabilitation Area).
At times, due to the incident size or geographic barriers, it may be necessary to establish more than
one Rehab Group. When this is done, each sector will assume a geographic designation consistent with the
location at the incident site or address, i.e, Rehab South, Rehab Main Street.
At incidents involving large life loss, or extended rescue operations (i.e., plane or train wreck), a
CID team should be contacted and be assigned to Rehab Group.
When summoned, a mobile canteen (Red Cross, Salvation Army) will also be assigned to this
sector. The Rehab area boundaries should be defined and have only one entry point. It will be divided into
the following sections:
ENTRY POINT
This is the initial entry point and decontamination area. The Rehab Officer or other assigned person
will collect accountability tags from members as they report through the Entry Point. The tags will be placed
on a status board and all personnel will be logged in and out on a ICS-211 form. Each member will have
an initial pulse rate measurement. Members with a pulse rate lower than 120 and that do not require medical
ARLINGTON FIRE DISTRICT REVISION DATE
OPERATING GUIDELINES 03-26-2008
SUB DOCUMENT ICS
Rehabilitation PAGE 5 OF 9
AFD # 5-E
attention will go to a Rest and Refreshment area. Any member who has a pulse rate greater than 120 or other
reported conditions or injuries, will report directly to Medical Evaluation and Treatment area, where they
will be treated appropriately.
Sample Rehab Group Area set up
REST AND REFRESHMENT
All personnel will be provided supplemental cooling, fluid and electrolyte replacement, and the
proper amount of nourishment. Drinks that contain caffeine should be avoided as these are diuretics and can
adversely affect a persons’ performance or recovery. Portable misting system and other rehabilitation
equipment should be deployed if available. An ambulance and or other equipped apparatus may also be
called to the incident scene to provide cooling. EMS Personnel will monitor, as required, members
following the EMS Guidelines and record the results on the EMERGENCY INCIDENT
REHABILITATION REPORT Form. Members released, who have only been in the Rest and Refreshment
area of Rehab after following the EMS GUIDELINES, are to report to Incident Staging. Initial CID support
will be provided in this section, if needed.
MEDICAL EVALUATION AND TREATMENT
This critical section determines a members readiness for reassignment. Personnel reporting here will
receive evaluation and treatment for heat stress and injuries. Diligent efforts and face-to-face communication
ARLINGTON FIRE DISTRICT REVISION DATE
OPERATING GUIDELINES 03-26-2008
SUB DOCUMENT ICS
Rehabilitation PAGE 6 OF 9
AFD # 5-E
with the Rehab Officer are required. Personnel manning this section advise the Rehab Officer of all
members status. This information is relayed to Command by the Rehab Officer. The EMS personnel
assigned will advise the Rehab Officer of the necessity of medical transportation and extended medical
attention requirements of personnel due to physical condition. Members released from or who were in the
Medical Evaluation and Treatment Area, may be released to report to Incident Staging or Demobilized as
the Rehab Officer deems appropriate.
EMS GUIDELINES
The following guidelines should be used by Emergency Medical Technicians to determine when
a firefighter may return to duty. Deviation from these guidelines should only be made after consultation with
a Paramedic and having them sign off on the release of the firefighter back to active duty at the fire scene.
Members in Rest and Refreshment Area, must sit for 10 minutes after entry before they are reevaluated
starting at Step 1 and there after as determined by the below guidelines. Members who have been
placed into the Medical Evaluation and Treatment Area due to a pulse rate higher than 120, will be
evaluated upon arrival and re-evaluated after 5 minutes at Step 3.
Step 1 - Vitals
Pulse >60 but < 120 If Available:
Systolic BP >100 Pulse OX >92%
Diastolic BP <100 *CO OX<5% Non Smoker
Respirations < 24 <8% Smoker
Temperature < 100.6 F
If YES L RETURN TO SERVICE
If NO L Rest for another 5 minutes, drink 8-16 oz. fluids
ARLINGTON FIRE DISTRICT REVISION DATE
OPERATING GUIDELINES 03-26-2008
SUB DOCUMENT ICS
Rehabilitation PAGE 7 OF 9
AFD # 5-E
Step 2 - Reassess. If vitals are:
Pulse >60 but < 120 If Available:
Systolic BP >100 Pulse OX >92%
Diastolic BP <100 *CO OX<5% Non Smoker
Respirations < 24 <8% Smoker
Temperature < 100.6 F
If YESLRETURN TO SERVICE
If NOT L Move to EMS EVALUATION AND TREATMENT AREA Rest for
another 5 minutes, drink 8-16 oz. fluids
Step 3 - Reassess. If vitals are:
Pulse >60 but < 120 If Available:
Systolic BP >100 Pulse OX >92%
Diastolic BP <100 *CO OX<5% Non Smoker
Respirations < 24 <8% Smoker
Temperature < 100.6 F
If YESLMove to REST AND REFRESHMENT and Step 1
If NOT L Rest for another 5 minutes, consider ALS evaluation
Step 4 - Reassess. If vitals are:
Pulse >60 but < 120 If Available:
Systolic BP >100 Pulse OX >92%
Diastolic BP <100 *CO OX<5% Non Smoker
Respirations < 24 <8% Smoker
Temperature < 100.6 F
If YESLRepeat Step 3
If NOT L Consider ALS intervention and transport to Hospital
* A CO OX detector reading more than 12% indicates moderate carbon monoxide inhalation, and a reading
of more than 25% indicates severe inhalation of carbon monoxide. Members with a CO level of more than
8% but below 15% must be given the opportunity to breathe ambient air for five minutes, and the result
repeated. If still above 8%, they should be given oxygen via a mask until the value drops below 5%.
Workers showing any value of more than 15% need to be given oxygen via a mask until the value drops
below 5%. Any value of more than 25% must be completely evaluated and removed to a hospital.
EMS Guidelines Flow Chart
The Rehab Officer will update Command throughout the operation with pertinent information. All
personnel leaving Rehab will retrieve accountability tags from the Rehab Officer and report to Incident
Staging for reassignment or demobilization. The Rehab Officer will direct the members to the proper
ARLINGTON FIRE DISTRICT REVISION DATE
OPERATING GUIDELINES 03-26-2008
SUB DOCUMENT ICS
Rehabilitation PAGE 8 OF 9
AFD # 5-E
sections; however, it is the Company Officer's responsibility to make sure crew members receive
refreshments, rest and a medical clearance.
Climatic or environmental conditions that indicate the need to establish a Rehabilitation Area are a heat
stress index above 90 F or windchill index below 10F.
ARLINGTON FIRE DISTRICT REVISION DATE
OPERATING GUIDELINES 03-26-2008
SUB DOCUMENT ICS
Rehabilitation PAGE 9 OF 9
AFD # 5-E

Gail this is our operating guidelines for rehab hope they help Jim

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Permalink Reply by Gail Sawyer on March 4, 2010 at 4:41pm

Thank you James! A question for me to ask-When you are involved in training exercises, do you also set up a rehab area?
Gail Sawyer

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Permalink Reply by James Roger on March 7, 2010 at 8:57pm

Gail we set one up if weather dictates or if we will be running a long training operation.

Gail Sawyer said:

Thank you James! A question for me to ask-When you are involved in training exercises, do you also set up a rehab area?
Gail Sawyer

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