Rehabilitation for Emergency Operations

Rehabilitation for Emergency Operations

Establishing and implementing a strong rehabilitation process for firefighters during emergency operations is extremely important and creates numerous benefits. Due to overexertion on the fireground, combined with the existing temperature and humidity of the 2023 summer season, firefighters face a variety of risks including dehydration and electrolyte imbalances.

In an effort to better protect your personnel from the known and predicted associated risks, it is imperative that your respective agencies develop and enforce an organized approach towards the rehabilitation process for personnel actively working during emergency operations.

Many departments and organizations are governed by different entities (NFPA, OSHA, etc.), NFPA’s 1584 Standard (Standard for Rehabilitation Process for Members During Emergency Operations and Training Exercising) creates a solid foundation that most departments can easily adapt to benefit their operational needs.

The following guideline is staffing dependent and outlines the core structure of on scene personnel and their associated responsibilities regarding the wellbeing of those operating on scene.

1. Incident Commander (IC):

- Recognize and offer an adequate level of resources for the rest and rehabilitation of personnel actively working on scene.

- When warranted, ensure that mental health avenues are available to ALL personnel impacted from the incident.

 2. Company Officer (Captain/Lieutenant):

- Keep a constant level of awareness of both the physical and mental conditions of your personnel and subordinates.

- Ensure that hydration is provided and is a priority on shift, at an incident, and post call for service.

3. Rehabilitation Manager (Safety Officer/EMS Liaison):

- Identify an on scene rehabilitation location.

- Acquire EMS personnel to provide evaluation of personnel.

- Acquire necessary accommodations for hydrating and feeding of personnel.

- Establish transportation capabilities for those needing further medical care.

- Establish and maintain accountability for ALL personnel in the designated rehabilitation location.

- Generate and maintain record keeping (documentation) of personnel treated/transported.

4. Firefighter (on scene personnel):

- Assist with rehabilitation location when assigned to.

- Hydrate before, during and after an incident.

- Make Company Officers aware of fatigue or exposure to extreme temperatures (both hot and cold) that pose a risk to the safety and wellbeing of themselves or respective crew.

Terminology/Definitions: *definitions taken from NFPA 1584*

1. Rehabilitation: An intervention designed to mitigate against the physical (body), physiological, and emotional (mind) stress of firefighting to sustain a member’s energy, improve performance, and decrease the likelihood of on-scene injury or death.

2. Recovery: The process of returning a member’s physiological and psychological (mind) states to levels that indicate the person is able to perform additional emergency tasks, be reassigned, or released without any adverse effects.

3. Active Cooling: The process of using external methods or devices (e.g., hand and forearm immersion, misting fans, ice vests) to reduce elevated core body temperature.

4. Passive Cooling: The process of using natural evaporative cooling (e.g., sweating, doffing personal protective equipment, moving to a cool environment) to reduce elevated core body temperature.

There are a plethora of proactive approaches we could take with implementing rehabilitation efforts with most of them being little to NO cost and comprised from items already at our disposal. The bullet points below include common practices, but the list is NOT limited to these points solely.

Rehabilitation Efforts:

• Remove personnel from extreme climate (heat or cold) and/or the incident conditions presented.

• Provide rest and recovery for personnel operating on scene of an active incident.

• Provide adequate means of hydration.

• Provide a means of replenishing lost calories and/or electrolytes (e.g., Gatorade, Cliff Bars, etc.).

• Provide means of active or passive cooling as warranted (type of incident and climate will dictate).

• Establish adequate EMS personnel to provide medical evaluation and monitoring of personnel actively working on scene.

• Release personnel back to operations or decide to transport.

With a rehabilitation location established on scene, the following outlines what vital signs are recommended by NFPA 1584 to be obtained by EMS personnel assigned to operate at the rehabilitation location:

- Temperature   - Respiratory Rate   - Pulse Oximetry   - Heart Rate   - Blood Pressure

Personnel attending the designated rehabilitation location should be transported and receive further medical treating if the following signs/symptoms are present:

            - Chest Pain/Discomfort                     - Headache

            - Dizziness                                           - Signs/Symptoms related to heat/cold stress

            - Shortness of Breath                          - Noticeable change in baseline (speech/behavior)

            - Weakness                                          - NOT alert to person, place or time

            - Nausea                                              - Localized Complaints (cramps, aches or pain)

For documentation purposes and in the event an illness or injuries arise following an incident, pertinent information MUST be obtained for each person being seen in the rehabilitation location. At a minimum, the following should be documented accordingly:

            - Name (AB Turenne)                          - Apparatus Assignment (Truck 34)

            - Time into Rehab (1105 hours)          - Time Out of Rehab (1135 hours)

            - Rehab Disposition (returned for work)

It is imperative that your department’s designated Safety Officer should be dispatched to respond for any and all calls for service that warrant the need for a rehabilitation to be established (e.g., Structure Fire, Brush Fire, Hazardous Materials, Dive Response). The Safety Officer, being equipped with a service vehicle should respond, provide and deploy the following equipment at the discretion of the Incident Commander (IC): 

            - Small Folding Table              - Two (2) Folding Chairs

            - Pop Up Tent/Canopy            - Water Misting Fan

            - Water Bottle x 24                 - One (1) Gallon jug of water

            - Cold Packs x 24                    - Hot Packs x 24

With a rehabilitation location established and set up appropriately, the Incident Commander (IC) should then be responsible for requesting and assigning EMS personnel to staff the rehabilitation location.

At the request of the Incident Commander (IC) or designated Safety Officer, further means of EMS care, transportation or warming/cooling of personnel and those displaced from the incident will be requested via your respective Emergency Communication Center (e.g., local school or public bus, Red Cross, commercial ambulance service).

Understanding and implementing the above identified areas is a proactive approach with ensuring the safety and wellbeing of your personnel is met at calls for service that expose responders to overexertion. In return it will provide an added level of preemptive measure in preventing lost time due to illness and/or injuries sustained while performing hazardous duties.

AB Turenne is a 25-year veteran of the fire service and is currently the Captain of Training and Safety with a career department in Middlesex County Connecticut. As a Certified Level III Fire Service Instructor, AB's training curriculum has proven to be conducive with the operational needs of those he teaches and in turn has improved the human capital knowledge of many. A graduate from the Master of Public Administration program at Anna Maria College, AB has continued his efforts in training and education by contributing to the Fire Engineering Training Community.