Factoring in Time and Temperature for Rehab

Fire rehabilitation isn't about the fire you're fighting now – it's about the next fire, EMS incident, or rest of the shift. 

The work exertion can be comparable to a sports event, such as a football game, a basketball shootout, or even a marathon. Problem is, unlike the athlete that gets to shower, dress, eat and entertain, the firefighter may immediately be forced to manage another emergency, fight another fire, or carry a victim down eight flights of stairs. Then there's the rest of the shift …

Fire rehabilitation standards are being formulated to acknowledge the importance of this activity in fireground management. These standards allow all departments, regardless of geography and incident type, to prepare a rehabilitation program that maximizes safety practices. 

Standards across this broad range of incident activities are very difficult to specify. The fire service almost always has its greatest activity during extremes of weather, particularly conditions that are unusual for that area. So, essentially, all departments have to develop a rehabilitation program that functions across time and temperature, and takes in such things as moisture, humidity, wind direction, icing, and availability of natural shelter.

There's another variable to add to the rehabilitation equation – what is the condition of the firefighters as they enter the firefight? Were they just fed, watered, showered, and rested, or sitting patiently in a classroom? They may enter the scene hungry or hypoglycemic; thirsty or carrying a full bladder; in clean or soaking wet uniforms; well rested or dog tired. Human factors of individual firefighters may be different on each piece of apparatus. 

The bottom line is the rehabilitation program must accomplish the function of safety for firefighters across all environmental and physiological factors. Sometimes they all come 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.

Appropriate to the scene, the rehab sector must include these elements:
• Shelter to include seating
• Fluid and calories
• Equipment rehabilitation
• Health evaluation and therapy
• Mental decompression

Clearly each incident drives the priorities for each of these elements. Warm environment operations have tended to dominate the policies for rehabilitation, but this clearly does not match the geography of this country.

Warm conditions generate the need for extra hydration, shelter from sun, prevention of burns on hot asphalt, and cooling therapies. Hot weather conditions often reduce firefighters' appetites, and make turnout gear a furnace. Smoke often lifts better in warm air, as does vehicle exhaust. 

Cold weather, especially mixed with precipitation, creates some of the most dangerous firefighting conditions. I can remember fighting an apartment fire one frostbitten day, where the firefighters were covered in ice in the first minute of operations, and almost begged to let the fire burn for a few minutes to let their gear thaw.

Cold weather operations produce the need for wind shelter, relatively smaller amounts of fluid, more calories, and thawing heaters for gear. Rehabilitation must be located away from vehicle exhaust. Health evaluation at prolonged incidents include frostbite checks, while  key pieces of equipment may include dry socks and boots. 

Walking areas around the fire scene must have a continual evaluation for ice, as slips and falls are a high risk, with a real potential for broken limbs and severely injured backs. 

As a department develops functional rehab procedures, it must cover time, temperature and stuff falling out of the sky. With ongoing firefighter safety as the goal, the elements are selected to match needs. Over time at a long incident, those elements will evolve – and, also, don't forget the bathroom facilities!

Good rehabilitation programs are a big step to prevent acute injuries and the fatigue or thirst that can cau|se judgment errors. They allow firefighters to manage the next incident safely, or go home to their families without being completely exhausted and  perhaps even play a game of basketball with the kids. 

Rehab Sector Elements

Cold Weather

Hot Weather

Shelter to include Seating

 Wind-shielded, may need warmers. 

Sun-shielded, may need coolers.

Fluid and Calories Appropriate beverages, at lukewarm temps, or warm beverages as workload winds down. Calories beneficial, soups, stews encouraged.Extra fluid encouraged, lukewarm or cool. Food may not be priority, but should contain fruits, starches.
 Equipment RehabilitationThaw and dry and warm. Prevent SCBA malfunction and icing. Boots if wet may cool feet to frostbite conditions. May become sweat-soaked.  Needs dried to prevent molding.

Health Evaluation and Therapy

Observation for frostbite to extremities.  Encourage hoods, ear coverage, warm feet, dry gloves. Relatively higher risk of CO poisoning.

Observe for signs of heat stress. Cool body with water over head, neck, wrists.

Mental Decompression

Warm environment will enhance revitalization.

Cool shaded area will enhance revitalization.

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