5022 - Rehab At Emergency Incidents And Training Exercises

Question 1

Who shall be responsible for ensuring that all personnel have been trained in:

1. Implementation of a Rehab area
2. Recognition of heat, cold and fatigue related symptoms and injuries

Answer 1

The Assistant Chief of Training and Safety

Question 2

Who shall be responsible for:

1. Ensuring all precautions are taken to protect the health and safety of personnel operating at emergency scenes or participating in training exercises
2. Maintaining this document in consultation with the TFD Medical Advisor as appropriate

Answer 2

The Administrative Battalion Chief, Safety Division

Question 3

Who shall be responsible for:

1. Making adequate provisions for the rest and rehabilitation of all TFD personnel operating at an emergency scene or participating in a training exercise in accordance with the guidelines set forth in this document
2. Designating a Rehab Manager as indicated
3. Assigning ALS personnel to staff the Rehab area as needed

Answer 3

The Incident Commander

Question 4

Who shall be responsible for:

1. Maintaining an awareness of the physical and mental condition of personnel operating within his/her span of control
2. Ensuring that adequate steps are taken to protect personnel health and safety during emergency operations and/or training exercises
3. Requesting relief and reassignment of fatigued crews in accordance with the guidelines set forth in this document

Answer 4

The Company Officers

Question 5

Who shall be responsible for:

1. Setting up and managing the Rehab area in accordance with the guidelines set forth in this document
2. Ensuring personnel in the rehab area are evaluated and treated in accordance with the guidelines set forth in this document
3. Keeping the Incident Commander updated on:
   a. Crew availability to be re-assigned
   b. Condition status of any injured personnel
   c. Changing conditions that require relocation of the Rehab area

Answer 5

The Rehab Manager

Question 6

Who shall be responsible for:

1. Evaluating and treating personnel in the Rehab area in accordance with the guidelines set forth in this document
2. Arranging for transport of injured personnel to hospital emergency departments as necessary

Answer 6

The ALS personnel

Question 7

Who shall be responsible for ensuring that:

1. Battalion Chief vehicles are stocked with fresh water
2. The established Rehab area is fully operational
3. CO monitors are calibrated semi-annually

Answer 7

The Incident Safety Officer

Question 8

Indicators of Exhaustion or Overheating. Symptoms exhibited by an individual that include, but may not be limited to:

Answer 8

• Red face
• Excessive perspiration
• Pulse over 110
• Systolic blood pressure above 150 or below 110

Question 9

In regards to returning to duty, The Incident Commander shall ensure that:

Answer 9

a. Personnel are not required to return to duty before they are fully rested
b. There are fresh or fully rehabilitated crews in the staging area available for assignment.

Question 10

Who shall assume the role of Rehab Manager?

Answer 10

Only TFD personnel

Question 11

Personnel who are transported to a medical facility for treatment shall:

Answer 11

a. Be relieved of duty for the remainder of his/her shift
b. Call the Battalion Sick recorder to report the absence before the end of his/her duty period
c. Obtain a Medical Fitness Report recommending return to duty and signed by the treating physician
d. Complete a Supervisor’s Report of Injury (HRE 703)
e. Route completed reports to Fire Headquarters through his/her supervisor

Question 12

The Incident Commander and/or Incident Safety Officer shall assign to Rehab any firefighters who meet any one of the following:

Answer 12

a. S/he is exhibiting signs or symptoms of physical and/or mental fatigue
b. S/he has expended two (2) full 30 minute rated SCBA cylinders in succession
c. S/he has spent 45 minutes doing physical work

Question 13

During periods of hot weather, TFD personnel shall:

Answer 13

a. Drink adequate amounts of the following types of fluids throughout his/her work shift to maintain hydration
i. Water
ii. Electrolyte replacement beverages
b. Minimize intake of caffeinated beverages
i. Coffee
ii. Tea
iii. Soda

Question 14

While participating in an emergency incident or training exercise, TFD personnel shall:

Answer 14

a. Drink at least one quart of water per hour
b. Be aware of and monitor his/her own status for symptoms of fatigue and/or stress
c. Remain aware of the health and safety of surrounding personnel
d. Advise his/her officer upon becoming aware that his/her own physical condition could jeopardize the safety of his/her self, his/her crew members and/or the operation in which s/he is involved

Question 15

The Incident Commander shall, during the initial planning stages of an emergency incident, determine the need for a Rehab area based on the following:

Answer 15

a. Environmental and/or other factors that may deplete the energy and strength of personnel and/or expose them to toxic gases such as—
i. Size of the incident
ii. Type of incident (e.g., brush fires)
iii. Duration iv. Labor intensity
v. Adverse weather or temperature conditions
b. Any time in the Incident Commander’s judgment the workload and/or temperature indicate a probability of heat/cold-related injury or illness

Situational examples include: 
• Heat Stress Index above 90 
• Extreme wind chill factor 
• Multiple alarm incidents 
• Working fires with extended duration 
• Hazardous materials incidents that require personnel to use encapsulating suits

Question 16

Once the need for Rehab has been established the Incident Commander shall designate:

Answer 16

a. A Rehab Manager

b. A TFD ALS company to provide EMS support in the Rehab area, as appropriate

Question 17

Unless the Incident Commander has already identified a location, the Rehab Manager shall select a suitable site for the Rehab area that has the following:

Answer 17

a. Located outside of the operational zone to allow for protective clothing, SCBA and other equipment to be removed safely
b. Good access for medic units, ambulances, utility truck and other mobile resources
c. Close proximity to the Staging area, when appropriate
d. Shaded or sheltered during hot or inclement weather

Question 18

Once the Rehab area site is selected, the Rehab Manager shall:

Answer 18

a. Announce the location on the assigned incident radio talk group
b. Assign adequate staffing, including TFD ALS personnel for ongoing assessment and treatment
c. Obtain water from the Battalion Chief vehicles
d. Assemble necessary supplies and equipment such as:
i. Additional fluids (water, oral electrolyte solutions and ice)
ii. Nourishment
iii. Medical items (blood pressure cuffs, stethoscopes, thermometers, cardiac monitors, oxygen bottles, nasal
cannulas and non-rebreather masks, CO monitor)
iv. Environmental mitigation items (awnings, shelters, dry clothing, fans, tarps, electric powered smoke ejectors, heaters)
e. Delineate the boundaries of the Rehab area with fire line tape whenever possible.
i. Divide the Rehab area into two sections as necessary; Treatment and Rest/Refreshment

Question 19

The Rehab Manager shall:

Answer 19

a. Place personnel passports on the accountability status board as companies report to the Rehab area
b. Assign ALS personnel to assess each individual
c. Direct personnel to either the Rest/Refreshment area or to the Treatment area, depending on his/her condition
d. Place personnel on a ready list for re-assignment as soon as s/he is able to actively participate in further operations
e. Coordinate with the Incident Commander regarding the release of personnel from Rehab
f. Return passports to personnel when s/he is released from Rehab

Question 20

The rehab manager shall Document the following information as it becomes available

Answer 20

i. Arrival time at Rehab
ii. Name of each crew member
iii. Medical status of each crew member
iv. Time each crew member becomes available for re- assignment

c. Provide updates to the Incident Commander regarding:
i. Companies that are available for re-assignment
ii. Status of injured personnel and/or those requiring further treatment

Question 21

ALS personnel shall ensure that each individual entering the Rehab area:

Answer 21

a. Rests at least 10 minutes
b. Removes his/her SCBA
c. Loosens or removes protective clothing
d. Drink at least 8 ounces of fluid while air bottles are being filled or changed

Question 22

PROCEDURE FOR USING THE CO METER

Answer 22

1. Use only at room temperature a. Allow to cool down/warm up as necessary prior to use
2. Install PP3 battery*
3. Insert non-disposable mouthpiece into unit
4. Insert disposable mouthpiece into plastic non-disposable mouthpiece
5. Turn unit on
6. Unit will display (20 second) countdown timer
7. Instruct patient to inhale and hold breath for 20 second countdown a. If patient is unable to hold breath for 20 seconds, until still may be used during the countdown phase
8. Unit will display (blow) indicator
9. Instruct patient to place lips around the tube and exhale slowly and fully
10. Suspect CO poisoning for any reading over 72 ppm or >12% COHb
11. If CO poisoning is suspected provide treatment and/or arrange for transport to a hospital emergency department for further evaluation and treatment as indicated

Question 23

CO monitor should be stored with battery removed to prolong battery life.
True or false?

Answer 23

True.

Question 24

Rehab guidelines for rest:

Answer 24

• • • 2 SCBA bottles in succession or 45 mins work = minimum 10 min rest!
Tympanic temp of >101.5 (must return to normal 35ppm or 6% COHb = O2 15L NRB + ALS assessment

Question 25

Look at heat stress index chart!

Answer 25

In policy.

Question 26

Look at wind chill index chart!

Answer 26

In policy?

Question 27

Look at CO poisoning index chart!

Answer 27

In policy?