Gorham Fire Department

Gorham Fire Department	Standard Operating Procedure # 20	Emergency Incident Rehabilitation
To All Fire Department Members	Approved by SOP Committee: April 18, 2000	Approved by Officers: May 16, 2000
Approved by Town Manager:	Revised:	Accepted by Members:

Purpose:

To ensure the physical and mental condition of emergency service personnel operating at the scene of an emergency or a training exercise does not deteriorate to a point that affects the safety and integrity of the operation. This procedure shall apply to all emergency operations and training exercises where strenuous activity or exposure to heat or cold exists.

Responsibilities:

Duty Officer. The Duty Officer shall consider the circumstances of each incident and make adequate provisions for the rest and rehabilitation of all personnel operating at the scene. These provisions shall include: medical evaluation, treatment and monitoring; mental rest and relief from extreme climatic conditions and other environmental parameters of the incident.

Personnel: During periods of hot weather, members shall be encouraged to drink water and activity beverages throughout the day. During any emergency incident or training evolution, all members shall advise the Duty Officer when they believe that their level of fatigue or exposure to heat or cold is approaching a level that could affect themselves, their crew, or the operation in which they are involved.

Establishment of Rehabilitation Sector:

Responsibility: The Fire Department Incident Commander, in conjunction with the Crew Chief, shall establish a Rehabilitation Sector when conditions indicate that rest and rehabilitation is needed for personnel operating at an incident scene or training evolution. The Rehabilitation Officer shall report to the Logistics Officer in the framework of the Incident Command System (ICS). In the absence of a Rehabilitation Officer, the Crew Chief will assume the responsibility for these duties.

Location: The Incident Commander will designate the location for rehabilitation. If a specific location has not been designated, the Rehabilitation Officer shall recommend an appropriate location based on the site characteristics and designations below.

Site Characteristics:

It should be in a location that will provide physical rest by allowing the body to recuperate from the demands and hazards of the emergency operation or training evolution.

It should be far enough away from the scene that personnel may safely remove any protective gear.

It should provide suitable protection from the prevailing environmental conditions. During hot weather, it should be in a cool, shaded area. During cold weather, it should be in a warm, dry area.

It should enable members to be free of exhaust fumes from apparatus, vehicles, or equipment (including those involved in the rehabilitation operations) and upwind from the incident.

It should be large enough to accommodate multiple crews, based on the size of the incident.

It should be easily accessible by EMS crews.

It should allow prompt re-entry back into the emergency operation upon complete recuperation.

Site Designations:

A nearby garage, building lobby, or other structure.

A school bus, van or Lancaster Incident Command Trailer.

Spare fire apparatus, ambulance, or other emergency vehicle at the scene or called to the scene.

An open area in which a rehabilitation area can be created using tarps, fans, etc.

Resources: The Rehabilitation Officer shall secure all necessary resources required to adequately staff and supply the rehabilitation area.

Organizations.

1. Fire Department's Ladies' Auxiliary.

2. GEMS Association.

3. Local Business.

4. American Red Cross

Equipment.

Fluids - water, oral electrolyte solutions and ice.

Food - soup, broth, or stew in hot/cold cups.

Medical - BP cuffs, stethoscopes, oxygen administration devices, cardiac monitors, IV solutions, and thermometers.

Other - awnings, fans, tarps, smoke ejectors, dry clothing, heaters, extra equipment, flashlights, blankets, towels, traffic cones, generator and fire line tape (to identify the entrance and exit of the rehabilitation area).

Disaster Kit.

1. Shall remain in the fire station for easy deployment in any apparatus.

2. Shall be maintained by the Communications/Equipment Officer.

3. Water cooler is part of the Disaster Kit.

Guidelines:

Rehabilitation Sector Establishment: Any activity/incident that is large in size, long in duration, and/or labor intensive will rapidly deplete the energy and strength of personnel and therefore merits consideration for rehabilitation. Climatic or environmental conditions that indicate the need to establish a rehabilitation area are a heat stress index above 90 degrees F or a wind chill index below 10 degrees F.

Hydration: A critical factor in the prevention of heat injury is the maintenance of water and electrolytes. Water must be replaced during exercise periods and at emergency incidents. During heat stress, the member should consume at least one quart of water per hour. The rehydration solution should be a 50/50 mixture of water and a commercially prepared activity beverage and administered at 40 degrees F. Rehydration is important even during cold weather operations where, despite the outside temperature, heat stress may occur during fire fighting or other strenuous activity where protective equipment is worn. Alcohol and caffeine beverages should be avoided before and during heat stress because both interfere with the body's water conservation mechanisms. Carbonated beverages should also be avoided.

Nourishment: Food should be provided at the scene of an extended incident when units are engaged for more than three hours. A cup of soup, broth, or stew is highly recommended because it is digested much faster than sandwiches and fast food products. In addition, foods such as apples, oranges and bananas provide supplemental forms of energy replacement. Fatty and/or salty foods should be avoided.

Rest: The "two air bottle rule" or "45 minutes of work time" is recommended as an acceptable level prior to rehabilitation and evaluation. Personnel shall rehydrate (at least 8 ounces) while SCBA cylinders are being changed. In all cases, the objective evaluation of a member's fatigue level shall be the criteria for rehabilitation time. Rest shall not be less than ten minutes and may exceed 10 minutes if, a need is determined by the Rehabilitation Officer, after consulting the Incident Commander.

Recovery: Personnel in the rehabilitation area should maintain a high level of hydration. They should not be moved from a hot environment directly into an air conditioned area because the body's cooling system can shut down in response to the external cooling. An air conditioned environment is acceptable after a cool down period at ambient temperature with sufficient air movement. Certain drugs impair the body's ability to sweat and extreme caution must be exercised if the member has taken antihistamines, such as Actifed or Benadryl, or has taken diuretics or stimulates.

Medical Evaluation: Emergency Medical Services (EMS) - EMS shall be provided and staffed by the most highly trained and qualified EMS personnel on the scene (at a minimum of EMT level). They shall evaluate vital signs, examine personnel, and make proper disposition after consulting Incident Commander (return to duty, continued rehabilitation, or medical treatment and transport to a medical facility). Continued rehabilitation should consist of additional monitoring of vital signs, providing rest, and providing fluids for rehydration. Medical treatment for personnel whose signs/symptoms indicate potential problems, should be provided in accordance with protocols. EMS personnel shall be assertive in an effort to find potential medical problems early.

Heart rate, blood pressure and temperature - The heart rate should be measured for 30 seconds as after a short rest period. If a person's heart rate exceeds 110 beats per minute, an oral or tympanic temperature should be taken. If a member's temperature exceeds 100.6 degrees F, he/she should remove protective equipment and be rechecked every 5 minutes. If it is below 100.6 degrees F and the heart rate remains above 110 beats per minute, rehabilitation time should be increased. If the heart rate is less than 110 beats per minute, the chance of heat stress is negligible.

Documentation: All medical evaluations shall be recorded on the Rehabilitation Sheet, along with the individual's name and complaints and should be signed, dated, and timed by the Rehabilitation Officer and his/her designee.

Accountability: Personnel assigned to the Rehabilitation Sector shall enter and exit the area at the designated location. the time of entry and exit from the area shall be documented by the Rehabilitation Officer or his/her designee on the Rehabilitation sheet. Personnel shall not leave the rehabilitation area until authorized to do so by the Rehabilitation Officer.

Conclusion: Rehabilitation is necessary in any prolong incident for the health of the firefighter and to keep the firefighter work in a safe and aware state of mind. Without rehabilitation firefighter can become fatigued and unable to continue after a short period of time. Rehydration and rest is also necessary for firefighters that are not using SCBA’s, the Incident Commander needs to relieve all firefighter for rehabilitation at some point during extend incident. This can be achieved by rotating fire-fighters though staging.

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