Rapid Rehab for Back-to-Back Calls

"It was a Dark and Stormy Night"
Incident: Actually, it started in the afternoon, and went through the night. The incidents began with lightning strikes and trees on houses and power lines. Essentially the entire department was running calls one after the other. The first calls came when the weather was still bad, with heavy rain, wind and lightning. Crawling around in attics was a very hot and sticky job, but fortunately the first series of calls had no working fires. Several of the tree-down calls required heavy work by the crews as they cut through the trees and searched houses for victims.

Are rehab sector operations needed if crews are working one incident after the other?

The NFPA 1584 Standard on Rehabilitation Process for Members During Emergency Operations outlines the goals and scope of rehabilitation during emergency operations. Several elements of the Standard are: 

  • It will ensure that personnel who might be suffering the effects of metabolic heat buildup, dehydration, physical exertion, and/or extreme weather receive evaluation and rehabilitation during emergency operations.
  • Scope: All personnel attending or operating at the scene of a fire/emergency or training exercise.
  • Rehabilitation shall commence when fire/emergency operations and/or training exercises pose a health and safety risk.
  • Rehabilitation shall be established for large-scale incidents, long-duration and/or physically demanding incidents, and extreme temperatures.

On a busy day, rehabilitation operations should not delay or impair the ability of rescuers to provide service to the public. As we have defined it in the past, fire rehabilitation isn't about this fire you are fighting now; it is about the next fire, EMS incident, or rest of the shift. It is also designed to improve the safety of operations at all scenes. On a day with back-to-back calls, it is even more important to have the incident rehabilitation system prepared and implemented.

To utilize the rehab program on a busy day, the department will need to have established a "Rapid Rehab" capability, which would place appropriate equipment and training in the hands of fire officers and firefighters. Rapid Rehab might contain these elements: 

  • Implementation earlier in the incident operations, with quicker flow through the rehab area
  • Placement of rehab operations in the quickest area to implement and take down
  • Supplies ready to go to facilitate rapid implementation
  • Use of domestic water sources for drinking and cooling and cleaning
  • Forms prepared for documentation that minimizes the time required for reporting. Whatever documentation will be completed on the incident and can be given to command at the end of the operation
  • Sources of fluid and calories that can be consumed "on the run" between calls
  • Provisions for toileting that are appropriate for the rescuers
From Plan to Action
Planning for these busy days, a department would develop the pieces of the program through excellent day-to-day operations. Supplies and equipment can be purchased and stashed in appropriate places to facilitate ease of use. Appropriate to the department's service area, weather, and resources there may need to be portable chairs, shelters, cooling equipment, food, fluids, and documentation packets. Some caches of this equipment may be on the front-line vehicles and others may be stored on resource vehicles or at the stations.

As the department's officers were preparing an action plan to address the rapid sequence of calls from a storm line, they would need to communicate to all incident officers that "Rapid Rehab" would need to take place at all operations. That would allow incident command officers to focus some attention on making sure that the entire emergency mitigation process is taking place in a time-efficient manner, and all personnel working the scene to realize that they need to rehab quickly as part of the operation.

Command would choose a site for rehab that is easy to implement and take down and appropriately sheltered from the weather. In bad weather, it is always nice to use community resources for shelter, water, and toileting. A plan to ask a neighbor, adjacent business, or another building site to use their facilities for the care of the firefighters can be implemented (most neighbors are more than willing to help, as long as the rescuers are respectful, neat, and clean up after themselves). A domestic hoseline can provide the water needed for drinking, cleaning gear, and cooling the firefighters. The minimum amount of equipment can be pulled off the apparatus to perform the rehab functions, or at some locations, rehab will just need to take place inside the emergency vehicles. Keeping all supplies and equipment near the apparatus allows the rehab site to be taken down quickly when the operation is complete and the crews need to move to the next call. Preprinted documentation on the rehab function facilitates quick work by the rehab officer. To complete the incident, thank the neighbors for their assistance, and complete paperwork to give to Command for recordkeeping.

When time is really compressed, it may be necessary to give the firefighters the food and fluid needed for their maintenance to consume between calls. Rehab personnel can put a quantity of bottled fluids and quick energy foods in the response vehicles while the operation is still going on. At the scene, don't forget to feed and water the apparatus operators and command officers, who are not going to be able to eat and drink as they drive to the next incident!

Case Management
The firefighters all realize the intensity of the storm line on this day, and prepare for a large number of responses. Rapid Rehab operations take place from the first set of calls. The working incidents are, of course, going to occur hours after the first calls from the storm. That is when people are cooking or lighting the house with candles, using their generators close to the house, exploring the rapid flows of water on roads or in creeks, testing downed power lines to see if they are live or not, or driving accidentally into downed trees.

That incident day all those emergencies occurred, and fire crews were not exhausted from responses to the earlier calls. The early planning gave all the responders the resources needed for late evening fire operations. Fire officers need that opportunity to focus on safety at a time when scene lighting, natural end-of-the-day fatigue and the stress of incidents earlier in the day make safety planning a priority.

One important customer service note: Don't forget about the vital utility workers, law enforcement, and media personnel assisting at the incident scenes, who are under pressure with the same set of incidents. Building relationships with all these groups by offering them shelter and fluids and checking their vital signs will benefit the department in the long run.

The rehabilitation program must address the safety of firefighters across all environmental conditions, including back-to-back incident days. Pre-planning and resource placement are essential for those times, and are facilitated by an efficient operation of rehab on a day-to-day basis. Incident rehab requires leaders to address ongoing challenges to maintain a safe work environment. This works to achieve the long-term goal: be a healthy retiree!

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