Emergency Incident Rehab

Question 1

Who tracks the nature/causes of firefighter fatalities?

Answer 1

United States Fire Admin (USFA)

Question 2

What are the leading causes of death for firefighters?

Answer 2

1. Heart attacks/stress and overexertion (59.2%)
2. trauma (14.8%)
3. asphyxiation and burns (7.4%)

Question 3

Who partnered to formulate the wellness-fitness initiative?

Answer 3

IAFF and IAFC

Question 4

What is the Wellness-Fitness Initiative?

Answer 4

• improves medical screening
• physical fitness programs
• healthier diet, rest, proper hydration (rehab)

Question 5

What is the NFPA Standard for Rehab?

Answer 5

NFPA 1584: Standard on the Rehabilitation Process for Members During Emergency Operations and Training Exercises

Question 6

What is the goal of NFPA 1584?

Answer 6

mitigating the physical, physiological, and emotional stress of firefighting in order to sustain a member’s energy, improve performance, and decrease the likelihood of on-scene injury or death.

Question 7

Rehab Requirements - Training Evolutions

Answer 7

• pre-entry screening:
  — everyone involved in training medically screened against rehab criteria
  — if they fail, participation barred until they have passed/met the criteria
  — continued failure = referral to SAFO
• ongoing screening:
  — all persons participating are provided a rehab period after each two evolutions in which the person participated

Question 8

Responsibilities of IC for Rehab

Answer 8

• make adequate provisions early in the incident for rest/rehab, including: medical evaluation, treatment and monitoring, food and fluid, replenishment, mental rest, and relief from extreme climatic conditions/environmental parameters
• ensure ALS resources are on scene / available to be committed to rehab at all times
• be cautious/aware if there is only one ALS resource on scene (if a patient is identified, you lose your unit!)

Question 9

Company OIC’s Responsibilities

Answer 9

• maintain an awareness of the physical/mental condition of members operating within their span of control

Question 10

ER Services Personnel Responsiblities

Answer 10

• hot weather = drink water and full strength activity beverages
• emergency incident/training evolution = maintain hydration; advise company officers when level of fatigue/exposure to heat or cold is impacting them/could impact the event
• look out for health/safety of the other members of the crew

Question 11

ESTB of Rehab Ops

Answer 11

• IC assigns responsibility of rehab to appropriate unit; they report to IC
• EMS provider is in charge of rehab (ALS provider preferred)

Question 12

Location of Rehab

Answer 12

• provides physical rest, shelter from environmental conditions
• far enough away for removal of bunker gear
• free of exhaust fumes
• large enough to accommodate multiple crews
• easily accessible by EMS units (egress considered)
• allow for prompt reentry for crews

Question 13

Resources (Rehab)

Answer 13

• fluids
• food
• medical
• admin supplies
• other

Question 14

Staffing of Rehab

Answer 14

• 1:5 ratio (rehab personnel : members being evaluated)

Question 15

Level One Rehab

Answer 15

• single, dedicated EMS unit (ALS or BLS)
• incidents up to and including a first alarm assignment / incident
• units operating less than one hour

Question 16

Level Two Rehab

Answer 16

• multiple dedicated resources with a designated supervisor
• incidents greater than first alarm
• also need to consider increasing number of providers AND supervisors

Question 17

Level Three Rehab

Answer 17

• multiple dedicated resources with a designated supervisor
• long term/campaign incidents (hazmat, large brush fires)
• should be managed under logistics section of the ICS

Question 18

Forms associated with Rehab

Answer 18

• Check in/Check Out Form
• Rehabilitation tracking form

Question 19

Rehab Group Establishment

Answer 19

• any activity / incident large in size, long in duration, labor intensive merits consideration of rehab
• heat stress index > 90 degrees
• wind chill index < 10 degrees

Question 20

Hydration

Answer 20

• critical factor in the prevention of heat injury (electrolytes + water)
• avoid caffeine and carbonated beverages

Question 21

Nourishment

Answer 21

• consider when > 3 hours
• soup, broth or stew highly recommended
• avoid fatty/salty foods

Question 22

Rest

Answer 22

• 30 mins SCBA use or 45 min work time, rest recommended
• worked two 30 min bottles or 45 minutes = required rehab

Question 23

Recovery

Answer 23

• don’t move from any extreme to another (hot to cold)
• antihistamines/diuretics/stimulants interfere with body’s ability to sweat.

Question 24

NFPA 1584 recommended guidelines for passing rehab

Answer 24

• Pulse = < 100 bpm
• BP = <160 mmHg systolic / <100 mmHg diastolic
• temp = greater than 98.6; less than 100.6
• SPCO = < 5%
• SPO2 = > 95%
• RR = < 20

Question 25

Documentation

Answer 25

• must track all employees who go through rehab (either form, or survey123)
• turned over to IC once incident completes

Question 26

Accountability

Answer 26

• track units via passport
• document: crew designation, number of crew members, times of entry to and exit from rehab
• cannot leave until rehab sup says so

Question 27

Failed Rehab

Answer 27

• considered “failed” when unable to be released back to full ops status
• failed criteria:
  — altered LOC, persistent headache, chest pain, trouble breathing/respiratory hunger, etc.
  — any vital signs that remain outside the range identified earlier
  — any emerging/progressing injury (burns, soft tissue injury, cramping/spasming) despite rehab
  — evidence of injury from environmental extremes / any minor injury that requires monitoring prior to return to duty