B-114 Firefighter Rehabilitation

Question 1

A rehabilitation unit (designated as “REHAB” within the ICS structure) and rehabilitation area shall be provided under the following circumstances, or at the discretion of the Incident Commander:

Answer 1

1. Any working fire.
2. Any hazardous materials incident requiring encapsulation.
3. Any confined space or trench rescue incident.
4. Any prolonged incident requiring firefighters to work in bunker gear.
5. Any labor intensive or prolonged incident with climatic or environmental conditions indicates the need to establish a rehabilitation area (use of the Humidex and wind chill index can be used for recognition of climatic stress).

Question 2

When a rehabilitation area has been established by the Incident Commander, ____ will be responsible for the management and coordination of the rehabilitation area until this duty is reassigned by the Incident Commander or designee.

Answer 2

• the first two available paramedics

Question 3

Dispatch shall be responsible for announcement and group wide page alert of elevated ____ levels to increase awareness of on-duty personnel.

Answer 3

Humidex

Question 4

Personnel should actively hydrate prior to responding to emergency incidents or training evolutions, as well as hydrate throughout the day. During heat stress, personnel should consume ____

Answer 4

at least one quart of water per hour.

Question 5

Foods such as ____ provide supplemental forms of energy replacement. ____ foods should be avoided.

Answer 5

• apples, oranges, and bananas

* Fatty and/or salty

Question 6

Firefighters having worked for ____ shall be immediately placed in the rehabilitation area for rest and medical evaluation. This does not preclude an Officer from having emergency personnel evaluated if he/she deems appropriate.

Answer 6

one (1) full SCBA bottle, or thirty (30) minutes of strenuous activity

Question 7

Rest shall not be less than ____ and may exceed an ____ as determined by the Rehabilitation Officer.

Answer 7

• fifteen (15) minutes

* hour

Question 8

Personnel in the Rehabilitation Area should maintain a high level of hydration. Certain medications can impair the body’s ability to sweat and extreme caution must be exercised if personnel have taken ____ or has taken ____

Answer 8

• antihistamines (Actifed, Benadryl, etc.)

* diuretics or stimulants.

Question 9

Evaluation guidelines allow for two evaluation cycles of rehabilitating firefighters in the first ____ if no abnormal findings are present. If abnormal findings are present, or the responder complains of any symptom (dizziness, nausea, shortness of breath, chest pain/pressure,etc.) re-examination will occur ____. Abnormal finding examination will involve a minimum of:

Answer 9

• ten (10) minutes
• every three minutes

a. Behavior.
b. Coordination.
c. Gait.
d. Work of breathing.
e. Breath sounds.
f. Glascow Coma Score.
g. Blood pressure.
h. Heart rate.
i. Respiratory rate.
j. Temporal artery/tympanic membrane temperature.
k. Pulse oximetry.
l. Carboxyhemoglobin determination.
m. Skin condition.
n. Blood glucose level.
o. EKG/12-lead.
p. Orthostatic vital signs.

Question 10

In hot, humid conditions a minimum of at least ____ minutes (____ is preferable) of active cooling shall be applied following the use of the second and each subsequent SCBA cylinder.

Answer 10

• fifteen (15)

* twenty

Question 11

Personnel participating in live fire training evolutions shall receive pre-participation medical screenings that include the following:

Answer 11

i. Blood pressure.
ii. Heart rate.
iii. Respiratory rate.

Question 12

The following diagnostic examinations will be provided for every member entering rehab:

Answer 12

1. CO-Oximetry to Measure Carboxyhemoglobin Levels.
2, Pulse Oximetry.
3. Tympanic Membrane Temperature.
4. Heart Rate.
5. Respiratory Rate.
6. Blood Pressure
7. Rate of Perceived Exertion
8. Active Cooling
9. Replenishment

Question 13

Symptoms of carbon monoxide poisoning are nonspecific and easy to miss diagnostically; these include ____.

Answer 13

*headache, nausea, shortness or breath, flu-like symptoms, or gastrointestinal symptoms

Question 14

Ranges for CO monitoring.

Answer 14

i. Nonsmokers range 0-5%.
ii. Smokers range 5-10%.
iii. Personnel with COhb above 10% shall receive 100% oxygen via non-rebreather mask.
iv. Personnel with COhb levels higher than 5% shall not be allowed to leave the Rehabilitation Area.

Question 15

Personnel with oxygen saturation of less than ____ shall not be permitted to leave the Rehabilitation Area.

Answer 15

93%

Question 16

Tympanic membrane temperature readings may be as much as ____ than the actual core temperature.

Answer 16

two (2) degrees lower

Question 17

Initial tympanic membrane temperature readings at or above ____ degrees Fahrenheit shall receive immediate active cooling via forearm immersion.

Answer 17

103, or 100

Question 18

Patients with tympanic membrane temperatures at or above ____ degrees Fahrenheit shall not be permitted to leave the Rehabilitation Area until temperature reading returns to normal ____

Answer 18

• 100

* (less than 100 degrees Fahrenheit).

Question 19

Initial heart rate measurements above the 70% maximum target heart rate ((220-age) x .07) should initiate ____.

Answer 19

oxygen therapy via non- rebreather mask

Question 20

An initial heart rate at or above 100% of maximum heart rate should initiate ____. Personnel with these high heart rates should seek medical attention from a physician regardless of how quickly the pulse rate returns to the normal range.

Answer 20

• oxygen therapy via non-rebreather mask and active cooling measures via forearm immersion

Question 21

If after ____ of rest and oxygen the heart rate does not decrease to below ____ of the target heart rate, the responder will be relieved of duty for the remainder of the shift and advised to seek immediate medical attention.

Answer 21

• five (5) minutes

* 90%

Question 22

Personnel who have not achieved a heart rate of less than ____ beats per minute by the end of twenty (20) minutes of rehabilitation shall not be released from the Rehabilitation Area and should continue to be monitored and, if warranted, transported for further medical evaluation.

Answer 22

100

Question 23

Part of additional monitoring for abnormal findings shall include ____.

Answer 23

12 lead EKG, orthostatic pulse and blood pressure readings

Question 24

Personnel that have heart rates above the ____ target heart rate after five (5) minutes of rest and cooling shall have ____ performed. Any abnormalities will be reported to the unit Officer and the responder will be transported to the closest appropriate medical facility.

Answer 24

• 70%

* a 12 lead EKG

Question 25

A responder whose blood pressure is greater than ____ systolic and/or ____ diastolic shall not be released from the Rehabilitation Area

Answer 25

• 160

* 100

Question 26

Individuals with ____ during rehabilitation should be highly suspect for heat stress. ____ readings as well as ____ should be performed on these individuals to determine hypovolemia and indicate the need for more aggressive fluid intake (oral) and/or intravenous fluid challenge treatment.

Answer 26

• low systolic readings (hypotension)
• 12 lead EKG
• orthostatic vital signs

Question 27

Rate of perceived exertion measurement:

Answer 27

No Exertion 1 
Extremely Light 2
Very Light 3 
Light 4 
Somewhat Hard 5
6 
Hard/Heavy 7 
8
Very Hard 8.5
Extremely Hard 9.5
Maximum Exertion 10

Question 28

Twenty (20) minutes of strenuous firefighting activity can result in a ____ reduction in plasma volume and ____ reduction in cardiac stroke volume.

Answer 28

• 15%

* 40%

Question 29

Sweating can easily exceed ____ per hour in hot, humid conditions and continues even after work has stopped and the individual enters the Rehabilitation Area.

Answer 29

two liters (64 ounces)

Question 30

Personnel entering the Rehabilitation Area shall, at a minimum, consume at least ____ during rehabilitation and be encouraged to rehydrate after the incident is over and/or returning to personal life.

Answer 30

32 ounces of fluid

Question 31

Controls for heat stress include the following:

Answer 31

a. Fluid intake (hydration).
b. Work rotation.
c. Active cooling.
d. Rest.

Question 32

Heat Cramps - cause

Answer 32

Heavy sweating drains a person’s body of salt, which cannot be replaced just by drinking water.

Question 33

An ____, ____, and a ____ shall be completed on each fire fighter or other emergency responder when he/she ____

Answer 33

• EMS run report (patient care report), worker’s compensation first report of injury/illness and a supervisor’s injury report
• is not routinely returned to normal duties.

Question 34

All rehabilitation evaluation forms will be submitted to ____ at the conclusion of the incident and retained as part of the official documentation of the incident.

Answer 34

• the Incident Commander

Question 35

Personnel assigned to the Rehabilitation Group shall enter and exit the Rehabilitation Area ____

Answer 35

as a crew.

Question 36

Crews shall not leave the Rehabilitation Area until ____

Answer 36

authorized to do so by the Rehabilitation Officer.