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Fireground Medical Operations
by Albert Einstein Medical Center

Barriers to an Effective Rehab Sector Part 3

Lack of Human Resources: Predictable and Preventable

By David Jaslow

The primary goal of emergency incident management is to mitigate the crisis situation as quickly and as safely as possible. One of the key objectives to meet that goal is efficient and effective resource management. Resources at an active fire-rescue incident can be divided into three groups those which are consumable, those which are not, and those which may be consumed dependent on the situation.

For example, the fire apparatus itself is not consumable. However, the need for refueling at long duration incidents may limit its effectiveness if a fuel tender is not available. Similarly, hose, ladders and much of the other equipment on the apparatus is generally not consumable at any particular incident, although the actual amount of these supplies may be limited.

Certain equipment and supplies may become consumable if the capability for replacement, repair or resupply does not exist at the scene. One such example is SCBA. If emergency apparatus with cascade capabilities are not present and empty cylinders can not be quickly shuttled back and forth to a fire station for refilling, even a large supply of bottles could become exhausted depending on the rate of consumption.

The most obviously consumable resource is water. Urban fire departments rely on hydrants for a continuous water supply. Therefore, out-of-service hydrants may spell disaster if the distance to area hydrants is significant. Rural fire departments depend on tanker shuttle operations to constantly refill portable dump tanks in lieu of a functional hydrant system. If a continuous water supply is not available via tanker at a working fire, the actual number of fire apparatus present may have no direct correlation with the ability to extinguish the fire.

Often overlooked as a consumable resource by fire officers are the emergency services personnel themselves. Human resources may not appear to be a consumable entity until the incident becomes uncontrolled or until an emergency occurs which leads to rapid consumption of personnel, such as a RIT activation, extension of the fire to adjacent dwellings, failure of Plan A for rescue, etc.

Manpower pool
The pool of human resources who are not assigned to a particular task at an incident scene is referred to as the manpower pool. These personnel represent the second wave of attack against a fire. They are typically ushered into action when the first wave becomes exhausted.

Whether or not a manpower pool exists is related to the total number of personnel on the scene, the intensity and duration of the incident, how many personnel are committed to specific tasks at any one time and the number of alarms which have been struck to bring in additional resources to the scene.
The philosophy of working ones firefighting ranks to exhaustion and then replacing them with fresh personnel is one which has existed in the U.S. fire service forever.

Arguments which defend this practice rather than cycling personnel out of the hot zone prior to complete exhaustion are beyond the scope of this article. However, if one follows this practice, additional human resources must be present very quickly so that the incident does not fall apart once the initial wave of human resources has been consumed.

Failure to accurately predict how many additional personnel may be needed in a timely manner may lead to two undesirable outcomes:

  •  Lack of creation of a functional rehabilitation and medical monitoring sector
  • A push to discount the importance of rehab

In the eyes of an unprepared IC, it is the rehab sector which is "guilty" of consuming his human resources, not the failure to order more personnel earlier in the incident. This perception may lead to premature cancellation of  "leave" in the rehab sector or a total denial of a "pass" to go there in the first place. Instead, personnel may be reassigned to another task with minimal or no rest.

Eventually, all personnel will become physically and/or mentally exhausted. They will be unable to continue to work without a rest period. The goal of the rehab sector is to combine this rest period with rehydration and medical monitoring for signs and symptoms of illness or injury.

Proper human resource management at an emergency incident may decrease the chances for the development of acute injury and will increase the chances that ill or injured individuals will receive early interventions to reduce morbidity. A good rule of thumb at an evolving incident is to strike additional alarms for manpower liberally: "Call early and call often." Incoming units can always be turned around and sent home, but they never arrive fast enough in a crisis.

Read Barriers to an Effective Rehab Sector Part 1

Read Barriers to an Effective Rehab Sector Part 2

Read Barriers to an Effective Rehab Sector Part 4


David Jaslow, MD, MPH, FAAEM is a board certified emergency physician who is fellowship trained in EMS and disaster medicine. He is the director of the Division of EMS and Disaster Medicine within the Department of Emergency Medicine at Albert Einstein Medical Center in Philadelphia. Dr. Jaslow is a state-certified Firefighter I and he is credentialed by the Pennsylvania Department of Health as a pre-hospital physician. He functions as a chief officer in several suburban Philadelphia fire and EMS agencies and provides medical oversight as the lead physician for the Bucks County Technical Rescue Task Force as well as Pa. Task Force-1 Urban Search and Rescue.

About the author

The Albert Einstein Medical Center. The Albert Einstein Medical Center is a teaching hospital offering a full range of advanced health services to the Philadelphia community and beyond. The center has more than 600 primary care doctors and specialists on staff, with an additional 1,200 affiliated physicians. The Department of Emergency Medicine at the center has staff trained in emergency medical services, special operations medicine, and disaster management. David Jaslow, director of the Division of EMS and Disaster Medicine at the center, and his team will offer a variety of columns on fireground medical operations. Ken Lavelle is an attending physician at Albert Einstein, and previously spent 14 years working as a firefighter and EMS provider. He serves as medical director for several agencies in Pennsylvania and New Jersey.



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