Kent County Chiefs Association

Standard Operating Guidelines &

Standard Operating Procedures

Subject: Emergency Incident Rehabilitation

SOG # 1-6

Approved

January 2000

Approved by: President Bruce Neal

Revised

1. Purpose

To ensure that the physical and mental condition of members operating at the scene of an emergency or a training exercise does not deteriorate to a point that affects the safety of each member or that jeopardizes the safety and integrity of the operation.

2. Scope

This procedure shall apply to all emergency operations and training exercises where strenuous physical activity or exposure to heat or cold exists.

3. Responsibilities

A. Incident Commander.

The Incident Commander shall consider the circumstances of each incident and make adequate provisions early in the incident for the rest and rehabilitation for all members operating at the scene. These provisions shall include: medical evaluation, treatment and monitoring; food and fluid replenishment; mental rest; and relief from extreme climatic conditions and the other environmental parameters of the incident. The rehabilitation shall include the provision of Emergency Medical Services (EMS) at the Basic Life Support (BLS) level or higher.

2. Supervisors

All supervisors shall maintain an awareness of the condition of each member operating within their span of control and ensure that adequate steps are taken to provide for each member’s safety and health. The command structure shall be utilized to request relief and the reassignment of fatigued crews.

3. Personnel

During periods of hot weather, members shall be encouraged to drink water and activity beverages throughout the workday. During any emergency incident or training evolution, all members shall advise their supervisor, 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. Members shall also remain aware of the health and safety of other members of their crew.

4. Establishment of a Rehabilitation Sector

A. Responsibility

The Incident Commander will establish a Rehabilitation Sector or Group when conditions indicate that rest and rehabilitation is needed for personnel operating at an incident scene or training evolution. A member will be placed in charge of the sector/group and shall be known as the Rehab Officer. The Rehab Officer will typically report to the Logistics Officer or the Incident Commander if the Logistics Officer position is not staffed.

2. Location

The Incident Commander will normally designate the location for the Rehabilitation Area. If a specific location has not been designated, the Rehab Officer shall select an appropriate location based on the site characteristics and designations below.

1. Site Characteristics

a. 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.

b. It should be far enough away from the scene that members

may safely remove their turnout gear and SCBA and be

afforded mental rest from the stress and pressure of the

emergency operation or training evolution.

2. 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.

d. It should enable members to be free of exhaust fumes from

apparatus, vehicles, or equipment (including those involved

in the Rehabilitation Sector/Group operations).

e. It should be large enough to accommodate multiple crews,

based on the size of the incident.

6. It should be easily accessible by EMS units.

g. It should allow prompt reentry back into the emergency

operation upon complete recuperation.

2. Site Designations

a. A nearby garage, building lobby, or other structure.

2. A school bus, municipal bus or similar type vehicle.

3. Fire apparatus, ambulance, or other emergency vehicles at the scene or called to the scene. (Consider Special

Operations Trailer 8)

4. An open area in which a Rehab Area can be created using tarps, fans, etc.

3. Resources

1. The Rehab Officer shall secure all necessary resources required to

adequately staff and supply the Rehabilitation Area. The supplies

should include the items listed below:

a. Fluids- water, activity beverage, oral electrolyte solutions

and ice.

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

3. Medical- blood pressure cuffs, stethoscopes, oxygen administration devices, cardiac monitors, IV solutions, thermometers, ice and heat packs.

4. Other- awnings, fans, tarps, smoke ejectors, heaters, dry clothing, extra equipment, floodlights, blankets and towels, traffic cones and fire line tape (to identify the entrance and exit of the Rehabilitation Area)

5. Guidelines

A. Rehabilitation Sector/Group Establishment

1. Staff officers should consider rehabilitation during the initial

planning stages of an emergency response. However, the climatic

or environmental conditions of the emergency scene should not be

the sole justification for establishing a Rehabilitation Area. 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.

2. Climatic or environmental conditions that indicate the need to

establish a Rehabilitation Area is a heat stress index above

90F (see table 1-1) or a wind-chill index below 10F (see table 1-

2).

a. Hydration

1. 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 re-hydration

solution should be a 50/50 mixture of water and a

commercially prepared activity beverage and administered

at about 40F. Dehydration is important even during cold

weather operations where, despite the outside temperature,

heat stress may occur during firefighting or other strenuous

activity, when 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.

b. Nourishment

1. The department shall provide food at the scene of an extended incident when units are engaged for three or more 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.

c. Rest

1. The “two air bottle rule,” or 45 minutes of work time, is

recommended as an acceptable level prior to mandatory

rehabilitation. Members shall re-hydrate (at least eight

ounces) while SCBA cylinders are being changed.

Firefighters having worked two full 30 minutes rated bottles, or

45 minutes, shall be immediately placed in the Rehabilitation

Area for rest and evaluation. In all cases, the objective

evaluation of a member’s fatigue level shall be criteria for

rehab time. Rest shall not be less than 15 minutes and may

exceed and hour as determined by the Rehab Officer.

d. Recovery

1. Members in the Rehabilitation Area should maintain a

high level of hydration. Members 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 a diuretic or stimulants.

1. Medical Evaluation

1. Emergency Medical Services (EMS)- EMS should be provided

and staffed by the most highly trained and qualified EMS

personnel on the scene (at a minimum of BLS level). They

shall evaluate vital signs, examine members, and make

proper disposition (return to duty, continued rehabilitation, or

medical treatment and transport to a medical facility.

2. All fire fighters are to report to rehabilitation after emptying

their second SCBA bottle, 45 minutes of working time, if

they have chest pain, respiratory distress or show signs of

physical/mental stress. Personnel are to remove their

turnout gear and have initial vitals taken. Medical personnel

will fill out a rehabilitation form for each person entering the

rehabilitation area.

3. Any fire fighter, whose initial vital signs are outside the

range charted below, must be reevaluated before they

are permitted to leave the rehabilitation sector.

Heart rate > 140

Blood pressure:

Above 160 systolic

Above 100 diastolic

Below 100 systolic

1. Even if the initial vitals are normal, all personnel are to rest for 15 minutes and drink non-carbonated and caffeine free fluids. (Water or activity drinks). After that resting period, personnel whose initial vitals signs were within the above limits are placed back into service.

b. The fire fighters, whose initial vitals were outside of

those limits, will be reevaluated after the 15-

minute rest. If their vitals are not within the limits

listed below, they must rest an additional 15 minutes.

Note that temperature is added to this

second evaluation.

Heart rate <100

Blood pressure:

Below 160 systolic

Below 100 diastolic

Above 100 systolic

Temperature:

< 100.6^o F

3. If at anytime the fire fighter has any of the following signs or symptoms they shall be transported to hospital.

CHEST PAIN

RESPIRATORY DISTRESS

ALTERED MENTAL STATUS

HOT SKIN DRY

PULSE ABOVE 140 AFTER COOL DOWN

SYSTOLIC B/P ABOVE 200

DIASTOLIC B/P ABOVE 130

TEMPERATURE > 101^o F

4. Firefighter Contests Medical Evaluation- If the Rehab Officer does not believe that the firefighter’s physical condition permits him/her to continue with fire fighting activities, the Logistics Officer or Incident Commander will be contacted. This Fire Officer will have the final decision whether or not the firefighter returns to fire fighting activities. This decision will be made after the EMS provider gives a detailed medical report to the Fire Officer. In these cases, The Rehab Officer or a designee will write a detailed narrative.

Sources

FEMA- United States Fire Administration- FA114/July 1992, “Emergency Incident Rehabilitation”.

Dickinson, Edward, Fire Service Emergency Care, Brady, 1999 Prentice Hall, Inc. pp. 699-714.

Betterton Volunteer Fire Company, Inc.

Chief James L. Price, Sr.

Chestertown Volunteer Fire Company, Inc.

Chief F. Bruce Neal

Community Volunteer Fire Company of Millington, Inc.

Chief Jesse Downey, Sr.

Galena Volunteer Fire Company, Inc.

Chief John W. Dwyer

Kennedyville Volunteer Fire Department, Inc.

Chief Phillip Lott

Kent & Queen Anne’s Rescue Squad, Inc.

Chief Eric Jackson

Rock Hall Volunteer Fire Company, Inc.

Chief A. Coleman II

Kent County Emergency Service Board

Chair Charlene Perry

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