Division Ten Training Officers

1
Division Ten Training Officers present
Emergency Incident Rehabilitation
2
On-Duty U.S. Firefighter Fatalities for 2007/2008

• 2008
• 17 or 37.7 of Firefighter deaths were from
  overexertion/stress
• 2007
• 55 or 47.8 of Firefighter deaths were from
  overexertion/stress
• (https//www.usfa.dhs.gov/downloads/pdf/08-fatalit
  y-summary.pdf).

3
Heat Stress Awareness

• www.cityofmesa.org/fire/wellness/safetyandwellness
  .aspx

4
When Do We Rehab?

• Best case
• Every IDLH event
• High levels of exertion
• Weather extremes
• Typical applications
• 45-60 minutes in PPE
• 2 SCBA bottles
• During training events
• Locally
• All Div. 10 sponsored events

5
Rehab Group

• Primary responsibility is to ensure that
  firefighters are able to safely return to
  incident and to return home after their shift.

6
Safety Section

• Rehab function falls under the Safety Section in
  MABAS Division 10
• The REHAB Group will operate on IFERN, however,
  they will also need to monitor the primary fire
  ground channel.
• Consideration to Nextel or other local channel
  once SSO / PLANS have arrived

7
Staffing of Rehab Group

• At least one ALS ambulance and crew will be
  assigned to the rehab group
• The officer or senior paramedic will serve as the
  initial Rehab Officer for the incident
• This crew will remain in the rehab group unless
  an emergency condition requires immediate
  transport of personnel
• An additional Transport Ambulance will be
  assigned to transport anyone from the scene who
  needs emergency care
• This includes fire victims etc. as long as
  transport ambulance is replaced by Staging or
  Command

8
Site Location and Characteristics

• Rehab should be stationed out of the weather,
  uphill and upwind
• The location should be located safely away from
  the incident where crews can remove their
  protective clothing and have their vital signs
  checked while receiving fluids and rest.
• The location should be large enough to handle the
  needs of the incident.

9
Site Location and Characteristics

• The location should be easily accessible by
  ambulance.
• The location should be sufficiently remote and
  located in a safe haven.
• The Site location should allow for prompt
  personnel re-entry to the emergency operations
  after being evaluated and thoroughly rehabbed.
• Use of tobacco products in the REHAB area (s) is
  strictly prohibited.

10
Rehab Flow Chart

• Receive or Request Assignment to REHAB SECTOR
• Rehab Companies are to remain on primary fire
  ground channel.

Transport Ambulance Used Notify Dept by SSO
1
4
2

• Log-in to Group
• Check Mental Status
• Physical Appearance
• Check Baseline Vital Signs
• General Condition
• Removal of Turnout Gear and SCBA
• Medical Control Form

Add 15 minutes if vitals exceed baseline
After 20 minutes
3
11
Typical REHAB Flow
12
Rehab Operations

• All fire service personnel involved in emergency
  operations should be routinely evaluated in the
  rehab area as deemed necessary.
• Crews shall report to Rehab utilizing the
  Passport system.
• Assignment to the Rehab Group is to be considered
  an order as is any assignment given by a superior
  officer on the fireground.

13
(No Transcript)
14
Rehab Operations

• First and foremost, any person with complaints
  should be fully assessed. Additionally, persons
  with abnormal vital signs, or other emergent
  condition (s), shall be removed from active duty
  for further evaluation
• Remember to Treat the Symptoms
• In these cases, treatment should be initiated
  ensuring Emergency Medical Personnel follow and
  treat per their system protocol.
• The Rehab Group Officer shall direct all
  medically unstable personnel be transported to a
  hospital.

15
Rehab Operations

• Those found to be medical unstable and refuse
  transport to a medical facility shall be referred
  to the SSO.
• At the discretion of the SSO, that individual and
  the crew to which he/she is assigned will be
  relieved of duty and directed to return to their
  department.
• Consequently, the affected members department
  Chief or Duty Officer will be notified by the SSO
  or his designee of the reason for the companys
  return.

16
Rehab Operations

• The Rehab Officer, SSO or Incident Commander
  should ensure that at least one ALS ambulance is
  always dedicated to Rehab for transportation of
  firefighting personnel.
• 1 ambulance for triage
• 1 dedicated for transport.

17
Documentation

• The names of all personnel passing through Rehab
  shall be recorded on the Medical Rehab Check
  Sheet, as well as all patient data.
• This document shall be given to the stricken
  department and become part of the incidents
  permanent record.
• For all situations where medical treatment was
  initiated, the appropriate Patient Care Report
  (s) (PCR) shall be utilized following EMS System
  protocols.

18
(No Transcript)
19
General Rehab Considerations

• Firefighting crews should be recycled through
  Rehab on a regular basis, ensuring assigned crews
  stay together.
• Most Firefighters are under hydrated prior to
  response.
• Crews in Rehab shall receive 32 oz of water,
  medical evaluation and rest. Additionally,
  cooling and or warming as appropriate
• All Groups/Officers shall maintain an ongoing
  awareness of the condition of their personnel and
  use Rehab to combat excessive fatigue and
  exhaustion.
• Core body temperature can continue to rise while
  in Rehab

20
General Rehab Considerations

• Fluid Intake is imperative to proper rehab of
  personnel, it insures that fluids that are lost
  are replaced and that proper cardiovascular
  function is maintained.
• It is important that cooler fluids be used to
  enhance the cooling capacity of the fluids to
  help regulate temperature in the body in hot
  weather.
• During long-term operations, fluids with
  electrolytes and carbohydrates should be
  available to enhance the fluid replacement
  process in the body.

21
General Rehab Considerations

• Personnel not Involved in Actual Firefighting
• Incident Commander
• Group Officers
• Pump Operators
• Rehab Personnel
• NEED TO BE EVALUATED AS CONDITIONS WARRANT!

22
Vital Signs Guidelines

• When crews arrive at Rehab, they should be given
  fluids as soon as possible and a complete set of
  vital signs shall be taken.
• Mental status shall be determined using typical
  EMS protocols for orientation to person, place,
  and time.
• If any emergent conditions exist, the triage crew
  will immediately coordinate transportation of the
  injured firefighter using a transport ambulance
  from the scene.
• The supervisor of the injured/exposed firefighter
  will be notified by the SSO.

23
Vital Signs Guidelines

• Vital signs will be taken by IDPH Licensed Triage
  personnel upon entry into the group. Accordingly,
  information will be documented on the Medical Log
  
• After 20 minutes in rehab, vital signs will be
  re-evaluated by Triage Personnel, in view of
  that, if vital signs are within acceptable
  ranges, personnel will be made available through
  the Rehab Group to Staging for a reassignment. As
  a result, the Company does not have to physically
  report to Staging, but the assignment or
  available status can take place from Rehab the
  area.

24
Guidelines for RELEASING Personnel from Rehab for
Incident Assignment

• Prior to Release
• Gear should be removed
• Rehydration with at least 32 oz of water
• Minimum of 20 minutes in Rehab
• VITAL SIGNS
• Systolic B/P less that 160
• Diastolic B/P less than 100
• Heart rate less than 110
• Oral temperature less than 100.6
• Any personnel who exceed these limits must stay
  in Rehab an additional 15 minutes.
• Release to scene through Staging (Directly from
  REHAB)
• Return PASSPORT to company officer 

• General Considerations
• Mentally prepared to return
• Oriented
• No C.I.S. symptoms
• Turnout gear in good condition
• SCBA refilled/checked
• Entire crew prepared and ready

25
Guidelines for TRANSPORTATION of personnel to
hospital (After 30 minutes in Rehab)

• ANY emergency condition shall be treated and
  transported as soon as possible
• VITAL SIGNS
• Diastolic B/P greater than 130
• Systolic B/P greater than 200
• Diastolic B/P greater than 110 and symptomatic
• Diastolic B/P less than 110 and symptomatic
• Heart rate above 140 or less than 60 with
  hypotension
• Oral temperature greater than 100.6
• Symptoms of CO exposure
• Any other emergent condition not described above
• Procedure
• Crew is considered to be out of service until
  manpower is evaluated by SSO
• Notification of the patients immediate supervisor
  by SSO
• Treat/transport per system SOG 

26
Rehab Officer Qualifications

• The Rehab Officer will be assigned by the
  Incident Commander or the Safety Section Officer.
  
• Persons assigned as a Rehab Officers should be a
  MABAS Division 10 Company Officer or higher.
• Company or Line Officers may also serve in this
  function as long as all duties and
  responsibilities of the position are known and
  completed.
• Additional qualified personnel may be designated
  by the MABAS Division 10 Safety Committee.

27
Documentation

• All care and treatment in Rehab is protected
  under the HEALTH INSURANCE PORTABILITY AND
  ACCOUNTABILITY (HIPAA).
• Patient care information should not be released
  outside of the confines of the chain of command
  and patient care standards.
• WWW.HIPAA.org

28
Face-to-face discussions between providers

• Despite the new focus on privacy, the law does
  not prohibit health care providers from having
  discussions involving patient information when
  necessary for the treatment of the patient.
• However, when it comes to discussing patient
  information with others who are not involved in
  the treatment of the patient, the rules become
  more stringent.
• Providers are not allowed to discuss individually
  identifiable patient information with friends,
  coworkers, or family members.

29
Face-to-face discussions between providers

• Although HIPAA has ushered in a new era of
  privacy, health care providers still have wide
  latitude to discuss or broadcast patient
  information with others when necessary for the
  treatment of the patient. In other circumstances,
  more restrictions apply.
• Ambulance providers need to take reasonable steps
  to ensure that they are disclosing health
  information only when appropriate because, in
  todays environment, the penalties for privacy
  violations can be serious.

30
RAD-57

• Non-invasive medical device used to monitor blood
  levels of substances such as methemoglobin and
  carboxyhemoglobin.
• Firefighter Rehab video

31
(No Transcript)
32
Triage and Transportation Group Duties
33
Ambulances Assigned to REHAB

• 2 per box alarm
• TRIAGE
• TRANSPORT
• Report to REHAB Group Leader or SSO if REHAB not
  on-scene
• Position TRIAGE Amb. near incident scene and 1528
  for access to equipment
• Position TRANSPORT Amb. in a manner to be used to
  quick exit from incident scene
• If unable to locate directly at REHAB Group,
  stretcher and equipment should be relocated to
  Group area in event a member must be transported

34
Medics and REHAB Unit

• 1528 and 1888 have identical REHAB Kits available
  for your use
• Thermometers
• Pulse/CO Monitor
• Report forms
• TRIAGE Vest
• Blue REHAB Area Barricade Tape
• Spare vital signs equipment

35
Triage Group Process

• May initially function as the REHAB Group Leader
• Senior medic
• Perform triage of firefighters reporting into
  area
• Visual appearance
• General impression on physical / mental status
• Begin log-in procedure using MABAS 10 Medical
  REHAB Control form

36
Triage Group Process (cont.)

• Instruct crews to remove appropriate levels of
  PPE based on environmental conditions and shelter
  availability
• Assess baseline vital signs for entire crew
• Record initial signs
• 20 minutes thereafter unless initial signs
  warrant earlier reassessment
• Begin REHAB Process
• Rest
• Rehydrate
• 32 oz of fluid if possible
• Water then electrolyte replacement
• Re-nourish as needed
• Refill and recharge SCBA and equipment

37
General REHAB Area Principles

• TRIAGE crew is responsible for assessing the
  functional capacity of the members in REHAB area
• Protect their well being by proper and thorough
  assessment of condition
• It is more important to treat/evaluate SYMPTOMS
  over SIGNS
• An overexerted / exhausted firefighter may have
  acceptable vital sign values
• Side with SAFETY
• The firefighters family is counting on you

38
Troubleshooting REHAB

• Concerns
• Bypassing of vital sign assessment
• Early release request by crew
• 1 member not within acceptable limits