STANDARD OPERATING GUIDELINE

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1 STANDARD OPERATING GUIDELINE OPERATIONS REHAB EFFECTIVE: 11/26/2012 REVISED: S.O.G #: 320 PAGE: 1 of Objective 1.1 To ensure the physical and mental conditions of personnel operating do not deteriorate to a point where they may jeopardize the safety of the individuals, groups or operations. 2.0 Policy 2.1 This Guideline shall apply to all emergency and non-emergency operations where physical activity or exposure to heat or cold exists, or as deemed necessary by the Incident Commander (IC), Incident Safety Officer (ISO), or lead Drill Instructor (DI). 3.0 Responsibility 3.1 It is the responsibility of all MABAS Division 3 members to be familiar with this Guideline. Any IC, ISO, or DI shall be responsible for implementing this Guideline as appropriate for the situation. 3.2 All Personnel: During all operations, any person shall advise his/her Officer when he/she believes his/her level of fatigue or exposure to heat or cold is approaching a level that could adversely affect the individual, his/her crew, and/or the operation. All personnel shall watch out for the health and safety of all other personnel at the operation. Any and all injuries shall be immediately reported to IC/ISO/DI, as well as the effected person s company officer. 3.3 Incident Commanders and Company Officers: Each Officer shall maintain an awareness of the condition of all personnel operating within the officer s span of control, and shall ensure adequate steps are taken to provide for the health and safety of the personnel. The incident command system should be utilized to request relief and the reassignment of fatigued crews/members. 3.4 Incident Commander (IC) / Incident Safety Officer (ISO) / Drill Instructor (DI): The IC/ISO may establish a Rehab Group, assuring the designation of a Rehab Officer, for any of the following circumstances: Medical Evaluation and Treatment Fluid replacement/hydration Mental and Physical rest Relief from the environment(s)

2 OPERATIONS REHAB S.O.G #: 320 Page 2 of Procedure 4.1 Staffing of Rehab Group Rehab Officer Implements the use of the Rehabilitation Medical Record Assigns units and personnel to monitor vital signs, hydration, etc Assigns ancillary duties for the Rehab site Tracks companies in and out of rehab, reporting availability to IC when companies are available Secures all resources needed to establish and maintain the Rehab area. Consideration should be given to assign a Chief Officer to the position of Rehab Officer Emergency Incidents: Obtains and assigns two ambulances and crews for Rehab purposes: One Advanced Life Support (ALS) ambulance and crew for rehab and one additional ALS ambulance and crew dedicated for transport. If the local jurisdiction staffs the Rehab group with other personnel (such as Medical Reserve Corps), then only one ambulance need be committed to Rehab, for transport purposes. Once the transport ambulance becomes committed with a patient, an additional ambulance will be summoned to stand-by at Rehab Training: Obtain and assign one ambulance for Rehab purposes: One Advanced Life Support (ALS) ambulance and crew for rehab. If the local jurisdiction staffs the Rehab group with other personnel (such as Medical Reserve Corps), then one ambulance is still needed for transport purposes. Once the transport ambulance becomes committed with a patient, an additional ambulance will be summoned to operate Rehab The following supplies should be obtained from the ambulances, engines and/or other outside resources: Fluids, including water and activity drinks, which should be cooled with ice during warm weather Medical B/P cuff, cardiac monitor, IV fluids, thermometer, hot packs, cold packs, etc Tarps, fans, heaters, blankets, floodlights, extra gloves, towels and other equipment/supplies deemed necessary Food and like items Emergency Medical Services: Rehab personnel should evaluate vital signs, examine operational personnel, and make recommendations to the Rehab Officer regarding the condition of personnel: return to duty, continue Rehab, or seek further medical attention. Continued Rehab should consist of a 15-minute recheck of vital signs, including temperature. Any personnel in Rehab should be evaluated for potential medical conditions. If further medical attention is recommended, the

3 OPERATIONS SAFETY OFFICER S.O.G #: 320 Page 3 of 6 Rehab Officer shall notify the IC/DI immediately. A dedicated Advanced Life Support ambulance will transport for further medical attention. Monitor ambulance availability and request additional ambulances from the IC/DI Location/Characteristics/Designations of Rehab Group Location The Rehabilitation Group site will be established by the IC/ISO/DI and the Rehab Officer Desirable Site Characteristics An area where personnel are able to remove SCBA and gear Provide protection to personnel from prevailing environmental conditions (cool shade in the summer, warm and dry in the winter) An area free of vehicle exhaust fumes Easily accessible by EMS units Allow for the prompt return to the incident or training site upon completion of rehabilitation Obstructed sight-lines to the incident/drill so that personnel will be mentally removed from the incident/training and will be able to relax Use of tobacco products in this area is strictly prohibited Desirable Site Locations A nearby garage, building lobby or other structure should be selected, with the owner s permission Three floors below the fire floor in a high rise operation Fire apparatus or another vehicle on the scene or called to the scene Canteen, bus or other similar vehicle Open area in which tarps, fans, etc. can be used. 4.2 Rehab Operations (Flow of Personnel) Company/Crew Self-Rehabilitation After use of one 30-minute SCBA cylinder, or 20 minutes of intense work without SCBA, a crew should self-rehabilitate (at least 15-minutes rest with hydration). The company officer shall ensure that all members in the company or crew seem fit to return to duty Coordinated Rehab Group : The IC/ISO/DI shall establish a Rehab Group when: Environmental/Climatic conditions are as follows: Heat/Stress Index greater than 90 F Wind Chill Index less than 10 F After two 30 minute SCBA bottles, or one minute SCBA bottle, are used or 40 minutes of intense work, crews shall report to Rehab. Rehab may be required more often at the discretion of the IC/ISO/DI. In all cases, the objective evaluation of personnel/crew fatigue levels should be the criteria for Rehab time. Rest should be no less than 20 minutes and can last as long

4 OPERATIONS SAFETY OFFICER S.O.G #: 320 Page 4 of 6 as the Rehab Officer deems necessary using the Medical Assessment Criteria guidelines. No personnel shall be released from the Rehab Group until approved for release by the Rehab Officer or transported to the hospital Fluids/Food Fluid replenishment should occur related to the fact that the average fluid loss while on air is 1 liter/scba bottle utilized Food should be considered for operations that will be lengthy in nature Vital Signs Guidelines Blood pressure, heart rate and temperature should be obtained as soon as possible after personnel enter Rehab. An individual with a temperature greater than F should not be permitted to wear protective clothing until their temp is less than F, Personnel shall meet all of the following criteria before return to duty" approval will be granted: Alert and oriented Heart rate less than Skin flushing or dry - alleviated Temperature less than F Blood pressure less than 160 systolic and less than 100 diastolic Minimum of 20 minutes in Rehab Respiratory rate less than Oximetry/Non-Invasive Carbon Monoxide Measurements, if available less than 10% CO An individual who exceeds these limits must stay in Rehab an additional 15 minutes, and will then be re-evaluated Personnel requiring rest periods greater than 30 minutes should be closely monitored for medical conditions. Those who exhibit problems with their baseline medical assessment after 30 minutes should be treated under EMS protocol and transported to a medical facility Documentation All members should be logged into Rehab using the Rehabilitation Medical Report Form and the Company Level Check In/Out Document The Company Level Check In/Out Document and Rehabilitation Medical Report Form shall be completed with all required information. Before personnel are released from the Rehab Group, the Rehab Officer must ensure that all Rehab medical information is properly documented When personnel are returned to duty, the Rehab Officer shall sign personnel out and notify the IC All Company Level Check In/Out Documents and Rehabilitation Medical Report Forms shall be forwarded to the IC/DI at the end of the operation.

5 OPERATIONS SAFETY OFFICER S.O.G #: 320 Page 5 of The Rehab operations should be evaluated as part of the postincident critique General Rehab Considerations Communications : Upon arrival, the unit assigned to establish Rehab should acknowledge such to the IC, e.g., Ambulance is on the scene, establishing Rehab The unit establishing Rehab should confirm the set-up location (as determined by IC/ISO/DI/Rehab Officer). The unit establishing Rehab should advise the IC when Rehab is ready, e.g., Rehab has been established at (setup location) Personnel not involved in strenuous Operations (e.g.; Incident Commander, Group Officers, Pump Operators/Engineers, Rehab Personnel) need to be evaluated as conditions warrant Accountability: Crews shall remain together until the IC/DI approves any reassignments. At this point, all Passport boards shall be changed to reflect any reassignments, as applicable Recovery: Personnel in the Rehab area should maintain a high level of hydration. During operations in a hot environment, personnel should not be moved into an air-conditioned area until they have cooled down in an ambient temperature. Air conditioning will cause the body to shut down its internal cooling systems. Heaters should be used during cold months to prevent cold-related injuries. Removal of wet clothing will speed the warming process Hydration: Personnel must replace fluids lost during heavy exertion to prevent dehydration and heat-related problems. This includes cold weather operations. Personnel should consume one quart of fluids per hour during times of exertion. Water or activity drinks, cooled, will adequately hydrate personnel. Caffeine and soda beverages should be avoided, as both interfere with the body s water conservation mechanisms. It is recommended that each front-line piece of fire apparatus carry a cooler of water that is refreshed on a daily basis Nourishment: During extended operations, food may be needed to supplement fluids. Broth, stews and like items should be requested by the Rehab Officer. It should be noted that fast foods and the like are slow to digest, not affording a rapid absorption Termination; the IC/ISO/DI/Rehab Officer will announce the termination of any Rehab Group when it has been determined that Rehab is no longer needed for the incident/drill At the conclusion of the incident/training and prior to release, all companies actively operating shall be evaluated in Rehab. 4.3 Rehab During Training Exercises: This policy shall be enforced during any extended Fire Department, NIPSTA, or MABAS Division 3 training exercise. Members involved in the training exercises will be assigned to the Rehab Group in the same manner as they would be during an actual emergency incident. All components of this policy will be required during the training rehab process in extreme heat, extreme cold, and in training exercises that require strenuous or prolonged physical activities.

6 OPERATIONS SAFETY OFFICER S.O.G #: 320 Page 6 of The DI of the training exercise shall be responsible for the inclusion of the rehab component into the training objectives and lesson plan. Further, the DI shall be responsible for defining the guidelines for implementation and rehab procedures to be used for the exercise and also for instructing the training participants in these procedures. 4.4 Medical Assessment Records: All medical assessment records and other related medical information will be maintained and stored by the host Fire Department. 5.0 Definitions 5.1 None 6.0 References 6.1 Region X Carbon Monoxide/Smoke Inhalation SOG 7.0 Attachments 7.1 Incident Rehab Company Level Check In/Out Document 7.2 Medical Assessment Criteria 7.3 Region X Carbon Monoxide/Smoke Inhalation SOG 7.4 MABAS Division 3 Rehabilitation Medical Report Form

7 MABAS Division 3 Incident Rehab Company Level Check In/Out Document Incident Location Incident Date Rehab Officer Department Unit Crew Size Time In Time Out Department Unit Crew Size Time In Time Out

8 Medical Assessment Criteria Mental Status Alert and orientated on arrival in Rehab If any alteration in mental status Provide Immediate Transport Heart Rate: Normal = Beats per Minute (BPM) Greater than100 BPM after 20 minutes, individual should NOT be released from Rehab: Close monitoring required by Rehab staff Normal = less than 100 BPM five minutes after arrival in rehab Skin Condition Face may be flushed on arrival Should improve in five minutes after arrival in Rehab If skin remains flushed or is unusually dry, monitor patient for signs of heat stress or stroke Blood Pressure Systolic Pressure less than 160 and Diastolic Pressure less than100 is desired Systolic Pressure greater than 160 and/or Diastolic Pressure greater than 100 requires close monitoring by Rehab staff Normal: Systolic Pressure less than 140 and Diastolic Pressure less than 90 five minutes after arrival in Rehab Abnormal: Systolic Pressure greater 140 or Diastolic greater than 90 after fifteen minutes in rehab: consider transport Respirations: Normal = Breaths per Minute Less than 26 = Within normal limits upon arrival in Rehab Less than 20 = normal after five minutes in Rehab Abnormal: Greater than 26 after five minutes in rehab Temperature: Normal = 98.6 F F Greater than F up to F= Close monitoring by rehab staff Greater than 101 F = Transport Provide Immediate Transport Rate of Perceived Exertion 1 No exertion at all 2 Extremely light 3 Somewhat light 4 Light 5 Somewhat hard 6 Hard 7 Hard heavy 8 Very hard 9 Extremely hard 10 Maximum exertion

9 CARBON MONOXIDE/SMOKE INHALATION Adult Routine Medical Care of Pediatric Routine Medical Care OXYGEN at 100% Vomiting precautions NON-INVASIVE CARBON MONOXIDE MEASUREMENTS: Measurement Signs and Symptoms Less than 5% None (Normal for non-smoker) 5-9% Minor Headache (May be normal for smoker) 10-19% Headache, Shortness of breathe 20-29% Headache, nausea, dizziness, fatigue 30-39% Severe headache, vomiting, vertigo, altered LOC 40-49% Confusion, syncope, tachycardia 50-59% Seizures, shock, apnea Greater than 59% Coma, death, cardiac dysrhythmias NOTE: If indicated, consider Adult or Pediatric Drug Assisted Intubation. Do not rely on pulse oximetry to indicate degree of hypoxia. Consider cyanide poisoning in presence of smoke/fire situations.

10 MABAS Division 3 Rehabilitation Medical Report Form Incident: Date: Name Time In/Out # SCBA Bottles Exam Period Initial B/P Pulse Resp. Temp. Skin Cooling Heating Hydration Nutrition Non- Invasive C/O RPE Scale Min Initial Initial Min Initial Min Initial Min

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