Steps to rehab at 'the big one'

Large-scale incidents produce a new set of problems for rehab and medical resource management; plan well before the event


If you are reading this column, you are likely a student of fire rehab, someone who reads and learns and is a leader in the field within your community. I bet you can set up a rehab sector at a routine fire without much difficulty at all. 

But things change a bit with large-scale incidents. These incidents are unusual in terms of size or duration, and they have different demands than that of a routine fire that is completed in a few hours.

As I write this, there is a 10-alarm fire at the boardwalk in Seaside Heights, N.J. Two weeks earlier, a similar size fire engulfed the Dietz and Watson distribution facility in Delanco, N.J. Both of these incidents required a different degree of planning and preparation than a routine incident. 

Command
Remember the I-300 and I-400 classes? Fascinating weren't they? Well, now all of that information and practice is going to come into play. 

That is why these classes are either required or strongly recommended for EMS chiefs and those who could find themselves in a command position at an incident. That information is especially valuable when outside resources are coming in to assist and you need to communicate with the same language.

It will become clear that you might be in over your head when you have no idea what an IAP is.

Pre-incident planning
I have said before and stand by it still: EMS does a lousy job of pre-incident planning. Fire departments routinely preplan large properties and facilities. Doing so allows them to be familiar with the property and the resources and challenges involved. 

EMS needs to do the same. We need to identify potential rehab locations, entrance and exit routes for ambulances and other logistical resources.

If we never go look at these venues and buildings in advance, we will have to become oriented on the fly while the incident is unfolding.

Operational periods
With these larger incidents, EMS branch directors needs to think about how they will provide rehab and EMS coverage, not only in an hour or two, but 12 and 24 hours from now.

If your EMS resources are primarily volunteer, this can be quite difficult to schedule as many volunteers show up right away. The branch director may need to send some staff home so they can return later, fresh and ready to go.

Career staff coverage locally can be even more difficult as there are often fewer people to use. Most career departments have just enough staff to cover their regular workload — a major incident can stress resources.

Local coverage
It makes no sense to pull every EMS truck in the county to your incident. If there is a significant medical emergency in your jurisdiction or a neighboring one at the height of the incident, there will be no ambulance available. 

It sounds good to think you will be able to pull a crew off the fire ground, but there will be delays in accomplishing this. And there might be "debate" with the assigned crew who would prefer to remain on scene at the big fire instead of going to a routine medical call.

A better option is to keep local coverage in place, but off the scene and posted at a local hospital or a central EMS station. When pulling crews to your incident, leapfrog some, leaving crews in place that can cover several areas. Discuss this with the other agencies beforehand so they are aware of what you are doing and why.

Support and supplies
At shorter rehab assignments, the medical care provided is typically related to emergent injuries and illnesses. However, we must be prepared for a variety of other routine medical problems at longer incidents. 

These can include managing blisters, allergies and even rashes. We also should get involved in preventative care by supplying things like sunscreen and insect repellent.

The average EMT and paramedic is not taught about these topics, so care of them may be difficult. Consider using advanced providers to assist, such as your medical director or nurses who are members of a department or a taskforce.

Don't forget about all the other resources you may need if staff are on scene for 12 to 24 hours or more. The list includes batteries for portables and medical equipment, fuel for ambulances and generators, portable restrooms for obvious reasons, quality food to maintain strength and energy, and so on.

Brainstorm with your staff ahead of time to develop a plan for “the big one.” Figure out where you will get these items and, if applicable, who will pay for them.

Additionally, if there are ways to help the incident commander to allow him or her to concentrate on fire suppression, we should do so. This could mean taking on the responsibility for most of the health and wellness of all of the staff on location.

This is a heavy responsibility that requires training and pre-incident planning. Get started now.

Stay safe.

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