The recently introduced NFPA 1584 mandates that all departments, regardless of incident type, geography and staffing, prepare a rehabilitation program that promote safe scene and training operations. This Standard results from the work of the U.S. Fire Administration, which recognized the benefit of on-scene recovery of fire personnel in relation to firefighter safety.
Fire departments often have their greatest activity at the extremes of weather, so it's essential that rehab programs are developed that function across time, temperature, moisture, humidity, wind direction, and availability of natural shelter. Sometimes these extremities all come together on the same incident. Many departments start the firefight in the cold early morning hours, and finish the most difficult portion of overhaul in the heat of the afternoon.
When emergency responders become fatigued, their ability to operate safely is impaired. Reaction time is compromised and their ability to make critical decisions diminishes. Department leaders and incident commanders must ensure that the physical and mental condition of members operating at the scene of an emergency or training exercise does not compromise the safety of each member, or the integrity of the operation. Appropriate to the scene, the rehab sector must include these elements:
Shelter to include seating
Fluid and calories
Health evaluation and therapy
Documentation of the rehabilitation operation
Some departments have the staffing to perform the rehab operation internal to the organization. For departments that do not have internal EMS resources, the pathway to develop the program is an inter-agency agreement with the local EMS provider. Some smaller EMS and fire organizations will only be able to implement their rehab program with a plan that includes mutual aid agreements with neighboring departments and EMS agencies.
In planning across the involved agencies, the rehab process, protocol and paperwork should be standardized, and the necessary equipment and "props" purchased and placed for timely deployment. There are opportunities to develop and share best practices in purchasing equipment to perform the rehab function, and the process of using it on a day-to-day basis. Many departments are facing financial difficulties at this time, and the cost of implementation must be considered against other funding priorities. Fire service leaders in many areas have the opportunity to use regional grant sources to assist in funding of the rehab program.
Rehab operations should be used at the scene of an emergency operation or training exercise when strenuous physical activity is involved or there's exposure to heat and/or cold conditions. The rehab operation in prolonged operations may even use a couple of tools not routinely utilized in patient care or firefighter fitness programs.
There are a number of pop-up shelter concepts, which come in a variety of sizes. They can serve as shelters, decontamination areas, field hospitals, command centers, triage areas and dressing areas. Most departments are going to purchase them and make available for the wide variety of uses for emergency personnel or citizens.
When it comes to equipment at the rehab scene, don't forget to tap into domestic sources for water, shade and wind shelter. Domestic sites of use include homes, garages, yards and building lobbies.
And, when purchasing equipment, looks for things that have multiple uses such as tents and pulse CO-Oximeters.
Use equipment that is hard to lose or leave behind
Have equipment stamped, engraved
Utilize equipment that is not dangerous when used or misused. For example, hydrocarbon-powered heaters, that can produce carbon monoxide
Specify equipment that is quick to set up and take down and that is designed to be used for most incidents
Use materials that are durable and weather-ready. Chairs, documentation materials must be useable in bad weather conditions
Budget for disposables such as like sunblock, cups, drink mixes
Use mutual aid opportunities, particularly for areas with specialized needs
Look for opportunities to cooperate with other agencies with similar interests in performance improvement. These include sports medicine organizations, pro or college sports, occupational health agencies, and EMS organizations
About the author
James J Augustine, M.D., is medical advisor for Washington Township Fire Department in the Dayton, Ohio, area. He is director of clinical operations at EMP Management in Canton and a clinical associate professor in the Department of Emergency Medicine at Wright State University. He formely served as Deputy Chief-Acting Medical Director for Washington, DC Fire EMS. He has served 27 years as a firefighter, and was the first Chair of the Ohio EMS Board. Contact him via email at James.Augustine@FireRescue1.com.
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