Executive Analysis of Fire Service Operations in Emergency Management. Firefighter Rehabilitation. Jeffrey M. Stewart. Clark County Fire District 3

Transcription

1 Firefighter Rehabilitation 1 Running head: FIREFIGHTER REHABILITATION Executive Analysis of Fire Service Operations in Emergency Management Firefighter Rehabilitation Jeffrey M. Stewart Clark County Fire District 3 Brush Prairie, Washington June 2008

2 Firefighter Rehabilitation 2 Certification Statement I hereby certify that this paper constitutes my own product, that where the language of others is set forth, quotation marks so indicate, and that appropriate credit is given where I have used the language, ideas, expressions, or writings of another. Signed:

3 Firefighter Rehabilitation 3 Abstract The problem is Clark County Fire District 3 (CCFD 3) does not have a firefighter rehabilitation program. The purpose of this research is to determine what standards need to be addressed to develop and implement a firefighter rehabilitation program. The descriptive research utilized three research questions that evaluated how local fire departments were conducting firefighter rehabilitation, when should firefighter rehabilitation start and finish, and what standards exist for firefighter rehabilitation programs. The procedure used to conduct the research included a phone interview. The results revealed many agencies have common components within their rehabilitation programs but many rehabilitation program standards vary. The recommendations include increasing rehabilitation awareness through development of a rehabilitation program.

4 Firefighter Rehabilitation 4 Table of Contents Certification Statement... 2 Abstract... 3 Table of Contents... 4 Introduction... 5 Background and Significance... 6 Literature Review... 9 Procedures...12 Results...14 Discussion...24 Recommendations...26 References...27 Appendix A...29 Appendix B...30 Appendix C...33 Appendix D...34

5 Firefighter Rehabilitation 5 Fire Fighter Rehabilitation Introduction The fire service continues to be a very demanding profession physically and mentally. Even with the invention, production, and use of lighter, safer, and more efficient personal protective equipment, the same type of dangerous environments still exist for firefighters. The fire still produces heat today as it did 100 years ago and the human body still produces heat from the hard strenuous work being performed by firefighters to mitigate the emergency. The internal and external heat being produced is trapped under the personal protective equipment used by firefighters, creating a sauna effect. The sauna effect requires the body to rid itself of the excess heat by sweating. The release of sweat is the body s natural way of attempting to cool itself through evaporation of a fluid, consisting primarily of water as well as a smaller amount of sodium chloride (Wikipedia, 2008). The excessive heat and the strenuous working conditions may lead to over fatigue of firefighters, creating the potential for serious injury, medical condition, or death. Nearly half the fire fighters who die from duty-related deaths die not in fiery infernos or dramatic building collapses, but from heart attacks and coronary events, most within 24 hours of the time the fire alarm sounds. A total of 440 firefighters, or 43.7 percent of those who died on the job, had sudden cardiac death, a National Fire Protection Association study from 1995 to 2004 (The Orange County Register, 2008 p. 1). This research has been conducted to assist the personnel and incident commanders of Clark County Fire District 3 (CCFD 3) in determining when to appropriately rehabilitate personnel on the emergency scene and during training exercises. The problem is CCFD 3 does not have a firefighter rehabilitation program. The purpose of this research is to determine what

6 Firefighter Rehabilitation 6 standards need to be addressed to develop and implement a firefighter rehabilitation program. The questions used for this descriptive research were: How are local fire departments conducting firefighter rehabilitation? When should firefighter rehabilitation start and finish? What standards exist for firefighter rehabilitation programs? Background and Significance Clark County Fire District 3 (CCFD 3) provides fire protection and emergency medical services to an area of 83 square miles with an approximate population of 20,000. The District is comprised mainly of rural residential. Additional features include an elevation range of 300 feet to over 1600 feet, heavily forested areas, lakes, a river, a railway system, State Route Highways, public and private parks, schools, private airports, churches, farms, small businesses, and high dollar residential neighborhoods. CCFD 3 is an all risk agency responding to 1064 alarms in 2007 out of four fire stations with a staff 20 career personnel and 40 volunteers. A breakdown of the 2007 alarms can be found in Appendix C. In the early existence of the District, the landscape was mostly farm land in the lower elevations and forest lands in the higher elevations. Today, the farm lands are turning into multifamily residential neighborhoods and the forest lands have turned into view lots for minimansions. The increase in development has increased the population density. The increase has had a gradual impact on the number of alarms the District responds to each year. The type and duration of incidents vary depending upon the time of year. Information was gathered from the Firehouse data management system used by CCFD 3 to determine the number and types of alarms crews were on scene over two hours. Additional information of each alarm, such as wind speed, humidity, and temperatures was also derived from the Firehouse data management system. It was determined in 2007 that CCFD 3 crews were

7 Firefighter Rehabilitation 7 on the scene of alarms for over two hours nine separate times. The longest duration alarm was a building fire in January where crews were on scene for four hours and nine minutes in temperatures near 42 degrees. The next longest on scene time was a brush/grass fire in August where crews were on scene for three hours and 17 minutes in 90 degree temperature with 30 percent humidity. Of the nine alarms determined to be over two hours in duration, four were building fires, three were brush/grass fires, one was an animal rescue, and one was a motor vehicle collision that involved a vehicle into a river. CCFD 3 is located in the Pacific Northwest, which has been well known for its cool and wet climate. However, information gathered from the National Climatic Data Center (NCDC) for year 2007 found a great variance in temperatures. The hottest day in 2007 was a temperature of 102 degrees on July 10 while the coldest day was January 16 with a temperature of 23 degrees. Months, May through September each had high temperatures over 90 degrees. Months, October through February each had low temperatures of 30 degrees and below. The data collected from NCDC found that CCFD 3 crews can be exposed to extreme temperatures, hot and cold, at all times of the year. In the early 1990 s, CCFD 3 operated and responded a donated 1986 ambulance converted into a rehabilitation apparatus. The apparatus was staffed with volunteer personnel who responded to any major or long duration incident. The apparatus was staffed while on scene with designated personnel who ensured the rehabilitation supplies were stocked and available for firefighters. The apparatus was a place for firefighters to seek shelter in cool or warm climates depending on the time of year. In 1998 the apparatus developed an engine fire while on the scene of a structure fire. The rehabilitation apparatus was never replaced. Instead, rehabilitation equipment was transferred to front line apparatus to ensure firefighter access. However, over the

8 Firefighter Rehabilitation 8 years the consistency in the amount and type of replenishment fluids and foods carried on the apparatus has diminished. Mutual and automatic aid agreements in Clark County are another significant firefighter rehabilitation issue. Since the mid 1980 s, CCFD 3 has been involved in a written mutual aid agreement with the rest of the Clark County fire agencies. The agreement allows agencies to request resources from neighboring agencies on an as needed basis. In 2005, the Clark County Fire Chiefs Association agreed to an automatic aid agreement for building fire response. The agreement allows for a minimum of four closest staffed engines to respond to a building fire. Due to the geographical layout of fire districts in Clark County, the makeup of four engines may be responding from four different agencies to a fire in CCFD 3. Training and county wide policies have helped with on-scene safety and fire ground operations. However, there is no county wide policy on firefighter rehabilitation. As indicated in the Appendix B phone survey results, all agencies have some form of firefighter rehabilitation but there is a lack of consistency amongst the agencies. The final significant influence of this research was the national movement in the Fire Service towards making firefighter rehabilitation a requirement. The 2007 National Institute for Occupational Safety and Health (NIOSH) alert indicated one way to prevent firefighter fatality due to heart attacks and other sudden cardiovascular events was to provide on-scene rehabilitation to monitor vitals signs for indication of excessive cardiovascular strain, and to cool and hydrate the firefighter (National Institute for Occupational Safety and Health [NIOSH], 2007). There has been discussion of a new Washington Administrative Code (WAC) surfacing in 2008 that emphasizes rehabilitation requirements for employees exposed to the extreme environmental elements. It has also been discussed that NFPA 1584, Standard on the

9 Firefighter Rehabilitation 9 Rehabilitation Process for Members During Emergency Operations and Training Exercises, has been updated and due to be published in early The impending rehabilitation standard changes as well as the other issues outlined in the background and significance has influenced the research and development of this paper. The research project was completed in accordance with the National Fire Academy s Executive Fire Program (EFOP) requirements. The research relates to the fifth United States Fire Administrations (USFA) operational objective which is to respond appropriately in a timely manner to emerging issues. In addition, the project relates to the issue of promoting fire personnel risk reduction, which was a topic of the Executive Analysis of Fire Service Operations in Emergency Management course for which the Applied Research Project (ARP) was written. Literature Review The purpose of this literature review was to research and examine new information to assist in the development of a firefighter rehabilitation program at Clark County Fire District 3 (CCFD 3). It is essential that the fire service decrease the number of deaths, injuries, and disabilities. To achieve this goal, a multipronged approach is necessary, including medical and fitness standards for hiring personnel, periodic medical evaluations for current personnel, health and safety programs, fitness programs, and on-scene rehabilitation (Smith & Haigh, 2006). As McEvoy (2007) states, it is said that firefighting has the greatest short-surge physiological demands of any profession. Its abrupt requirements are equivalent to marathon running, often after awakening from a sound sleep and with little or no ability to physically warm up. Despite spending only 10 percent of our time on the fireground, virtually 50 percent of all firefighter deaths and 66 percent of injuries happen on scene. McEvoy (2007) goes on to say, each department is responsible for developing and implementing rehabilitation standard

10 Firefighter Rehabilitation 10 operating guidelines. On scene, the Company Officer or supervisor must assess his or her crew to determine members in need of rehabilitation at least every 45 minutes. In addition, EMS staff must have the authority to detain members in rehabilitation or transport members when there are obvious indications preventing them from return to full duty. For many years recommended standards have been in place for firefighter rehabilitation. Rehab proves a logical step towards firefighter safety and well being and is recommended by National Fire Protection Association (NFPA) 1500, but many fire departments have not fully accepted rehab practices (Dickinson, 2003). Specifically, NFPA 1500 outlined the following areas for recommendation: 1. Rehabilitation concerns for operations during extremely hot weather should include moving personnel away from the hazardous area, removal of personal protective equipment, protection from direct sunlight, adequate air movement over personnel, fluid replenishment, and medical evaluation paying particular attention to personnel showing signs/symptoms of heat exhaustion, heat stroke, and dehydration. 2. Rehabilitation operations during extreme cold weather should include locating resting personnel away from the hazardous area, providing shelter from wind and temperature extremes, fluid replenishment, and medical evaluation paying particular attention to personnel showing signs/symptoms of hypothermia, frostbite, and dehydration. 3. Basic life support (BLS) equipment and personnel, as a minimum, should be on scene to assist with rehabilitation and provide immediate life support if necessary. In 2003, NFPA produced a specific recommended standard for firefighter rehabilitation. Recommended practices are advisory in nature and do not hold the same legal weight as a standard. The purpose of a recommended practice is to provide guidance and direction on an

11 Firefighter Rehabilitation 11 important topic without being regulatory in nature (United States Fire Administration [USFA], 2008 pg 19). NFPA 1584, Recommended Practice on the Rehabilitation of Members Operating at Incident Scene Operations and Training Exercises (2003), became available to assist the fire service in the development of firefighter rehabilitation programs. There were five key elements to rehabilitation operations described in NFPA The five elements included medical evaluation and treatment, food and fluid replenishment, relief from environmental conditions, rest and recovery, and personal accountability. It wasn t until 2008 that a specific standard was published by NFPA pertaining to firefighter rehabilitation. The 2008 edition of 1584, Standard on the Rehabilitation Process for Members During Emergency Operations and Training Exercises, is broken down into seven major sections. The seven sections include Administration, Referenced Publications, Definitions, Preparedness, Rehabilitation Area Characteristics, Incident Scene and Training Rehabilitation, and Post-Incident Rehabilitation. There are nine key criteria for rehabilitation implementation found in the standard: 1. Relief from climatic conditions An area free of smoke and sheltered from extreme heat or cold is provided. 2. Rest and recovery Members are afforded the ability to rest for at least 10 minutes or as long as needed to recover work capacity. 3. Cooling or re-warming Active and/or passive cooling or warming as needed for incident type and climate conditions. 4. Rehydration (fluid replacement) Fluid replacement along with pre-hydration. 5. Calorie and electrolyte replacement When appropriate for longer duration events such as incidents exceeding three hours duration or situations where members are

12 Firefighter Rehabilitation 12 likely to work for more than one hour. 6. Medical Monitoring Specifies a minimum of six conditions that Emergency Medical Services (EMS) personnel assess in each member during rehabilitation. 7. EMS treatment in accordance with local protocol Available on scene for members who require treatment or transport. 8. Member accountability The personal accountability system must track members assigned to rehabilitation by Incident Command as they enter and leave. 9. Release Prior to leaving rehabilitation, EMS must confirm that members are able to safely perform full duty. History continues to repeat itself in the fire service with annual reports of injury and death of firefighters. Dickenson (2007) states, too often in public safety, personnel and administrators believe they responded well simply because no one was hurt or exhibited ill effects. These shortsighted individuals fail to examine their tactics and learn from their mistakes. Eventually, fate catches up with them, and someone gets hurt needlessly. Now that NFPA 1584 has transitioned from a recommendation to a standard and documents such as the one published in 2008 by the United States Fire Administration (USFA), Emergency Incident Rehabilitation, are available. It is up to each individual tied to the fire service to reflect on past close calls or mishaps due to firefighter over exertion and take the concept of firefighter rehabilitation seriously by building a strong rehabilitation program within their agency. Procedures The descriptive research method was used for this Applied Research Paper (ARP) in an effort to determine how local fire departments were conducting firefighter rehabilitation, when firefighter rehabilitation should start and finish, and to determine what standards exist for

13 Firefighter Rehabilitation 13 firefighter rehabilitation programs. A telephone survey data collection instrument (DCI) was used to interview Clark County fire districts about their rehabilitation program. Numerous hours were invested in conducting research in the Learning Resource Center (LRC) at the National Fire Academy (NFA) on the topic of firefighter rehabilitation. Numerous hours were also invested conducting research on State and National firefighter rehabilitation standards. The telephone survey DCI served as the primary means of collecting data from local fire districts in Clark County, Washington. The telephone survey was conducted in February of The target audience of the survey was the individual responsible for the firefighter rehabilitation program at each department. Ten questions were asked over the phone and recorded onto an actual DCI form found in Appendix A. Six fire departments were picked based on their proximity to CCFD 3 and potential to run mutual and automatic aid together. All six departments are combination departments with career and volunteer firefighters. The results, agencies, and contact personnel are contained in Appendix B. The LRC was a pivotal tool used to gather research information for this topic. Using the computers in the LRC to access the data base, the author was able to obtain a list of current data available on firefighter rehabilitation. The author was able to select the appropriate data that most directly applied to the topics for which the APR questions were focused. The author was then able to pull and review the resource material on site. Once a resource was determined to be an appropriate fit for the ARP, the author photo copied the selected articles or made a list of articles that could be requested through the interlibrary loan process. The resource material was transported home for use in developing the ARP. Other resources were obtained via the internet, subscription, word of mouth, and articles surfacing on the Western Fire Chiefs Association website. The internet was used to access

14 Firefighter Rehabilitation 14 information through numerous websites. The information gained through subscription was through the National Fire Protection Association website. Resources were obtained by word of mouth while conducting the phone survey DCI Finally, the author called the Washington Department of Labor and Industries to request all Washington Administrative Code material that pertained to rehabilitation or working in extreme environments. Results The first research question sought to identify how local fire districts were conducting firefighter rehabilitation. On February 18, 2008, a phone survey was used to answer ten questions about firefighter rehabilitation in six fire districts surrounding CCFD 3. The six districts selected had a combination of volunteer and career personnel with similar characteristics as CCFD 3. However, the districts selected were not exactly consistent in the number of personnel, number of alarms, apparatus type, and overall coverage area. The individuals interviewed were in some way tied to the development of their districts firefighter rehabilitation program. The phone survey can be found in Appendix A. The agencies, contact personnel, and results can be found in Appendix B. Question one of the survey, Does your department have a firefighter rehabilitation program? This question was used to determine if firefighter rehabilitation was the norm in the operations of each district. The question was also used as a potential tool to seek out and obtain written rehabilitation programs to use a model for CCFD 3. All six of the districts interviewed indicated that they do have some form of a firefighter rehabilitation program. Question two of the survey, What standards were used to develop the program? This question was used to determine what standards were being used as the base for rehabilitation

15 Firefighter Rehabilitation 15 programs. The question was also used to obtain standards that could be referred to as a base for a CCFD 3 rehabilitation program. East County Fire and Rescue (ECFR) indicated their rehabilitation program was developed from information found through the United States Fire Administration (USFA). Camas Fire Department (CFD), Washougal Fire and Rescue (WFR), Clark County Fire District 11 (CCFD 11), Clark County Fire District 6 (CCFD 6), and Vancouver Fire Department (VFD) all indicated their firefighter rehabilitation programs were developed from standards found in the Washington Administrative Codes (WAC) and the National Fire Protection Agency (NFPA). VFD indicated they also used language from other fire department rehabilitation programs outside Washington State to assist in the development of their program. Lastly, CCFD 11 indicated they also used information from the Revised Codes of Washington (RCW) to assist in the development of their program. Question three of the survey, Does your department have a rehabilitation apparatus? This question was selected to provide information on the types of vehicles being used as rehabilitation apparatus. The question was also used to determine the proximity of rehabilitation apparatus to CCFD 3. All six agencies indicated they either had their own apparatus or had access to an apparatus through a cooperation agreement. VFD, CCFD 6, and CCFD 11 indicated their districts each have a full size transit bus with a sink and toilet that had been converted to accommodate firefighter rehabilitation. ECFR, WFR, and CFD all belong to a cooperative agreement amongst the three agencies for the purchase and maintenance of a full size transit bus used as a firefighter rehabilitation and incident command. The author was unaware of an agreement between the three agencies. Question four of the survey, What alarm type requires the response of a rehabilitation apparatus? Due to the inconsistency of rehabilitation apparatus response in Clark County, this

16 Firefighter Rehabilitation 16 question sought to identify what individual agency policies were in place to trigger a rehabilitation apparatus response. ECFR will respond their apparatus to all structure fires, brush fires, and hazardous material incidents. CFD indicated their apparatus will respond on any second alarm assignment. WFR responds a rehabilitation apparatus on any first alarm assignment. CCFD 11 will respond a rehabilitation apparatus on second alarm structure fires or if firefighters are working in the elements for a long period of time. CCFD 6 responds their apparatus on any working structure fire, mass casualty incident, or in inclement weather. Lastly, VFD responds their rehabilitation apparatus on second alarm assignments, long duration incidents, or at the discretion of the incident commander. Question five of the survey, What equipment is carried on your rehabilitation apparatus? This question was aimed at indentifying equipment that may be needed for a future rehabilitation apparatus acquisition for CCFD 3. ECFR, CFD, and WFR all use the same rehabilitation bus. Their combined response to this question indicated they carry an on-board generator, fans, lights, toilet, personal protective equipment racks, wet towels for cooling, accountability boards, portable radios, an awning, food, water, and medical equipment. It was also indentified that the apparatus has air conditioning and heat. CCFD 11 carries medical equipment, fans, propane tanks, a refrigerator, an awning, and documentation equipment. CCFD 6 advised their apparatus has a toilet, a refrigerator, a sink, medical equipment, cooling chairs, air conditioning, and heat. Lastly, VFD carries electric thermometers, 12 lead electro cardio equipment, an electric blood pressure cuff, carbon monoxide monitors, air conditioning, a canopy, a bathroom, a misting machine, a microwave oven, and a rack to hang personal protective equipment outside the rehabilitation apparatus. Question six of the survey, What type of fluids and food do you carry on your

17 Firefighter Rehabilitation 17 rehabilitation apparatus? CCFD 3 has carried water and a variety of sports drinks for many years on all front line apparatus. A small amount of dried fruit and granola bars has also been carried. This question sought to indentify what other agencies were using to replenish the lost fluids and energy of firefighters while working. ECFR, CFD, and WFR carry water, sports drinks, juice, coffee, tea, and hot chocolate for fluid replenishment. They carry granola bars, cookies, power bars, and beef stock to help restore energy loss. CCFD 11 carries water, Gatorade, hot chocolate, and coffee. Initially they provide granola bars but once a determination is made the incident will be long term, personnel staffing the rehabilitation apparatus will go to the store to purchase fresh fruits and vegetables. They advised no salty foods will be purchased. CCFD 6 carries water, sports drinks in liquid and powder form. They also carry power bars, cookies, and crackers. VFD carries water and sports drinks. Their firefighters are given one sports drink to two waters. They carry trail bars, trail mix, and nuts as initial food replenishment. Once the Rehabilitation Officer arrives on the scene, a determination is made of how much food will ne needed. The Rehabilitation Officer will send an assistant to purchase fresh fruit and ingredients to make sandwiches. The sandwich material is purchased free of condiments. The condiments are provided in packets to eliminate the potential for botulism. Question seven of the survey, Who responds the rehabilitation apparatus to the scene? On any major incident, CCFD 3 personnel are forced to respond all front line apparatus to the scene due to lack of staffing required for major incidents. This question sought to identify if each agency had adequate or identified personnel to respond their rehabilitation apparatus to incidents. ECFR, CFD, and WFR staff their rehabilitation apparatus with Citizen Emergency response Team (CERT) members. The CERT members are assigned pagers and respond to the emergency scene in the rehabilitation apparatus on designated incidents. CCFD 11 advised there is no one

18 Firefighter Rehabilitation 18 specifically assigned to respond but typically a volunteer will respond the apparatus. They also advised that they are in the transition of having the Emergency Medical Program Assistant respond during the work day and eventually evolve into being paged from home after the workday. CCFD 6 advised that the Emergency Medical Services (EMS) Officer will respond during the apparatus during the day. After 1700 hours, the rehabilitation apparatus is staffed by volunteers. CCFD 6 is considering placing the EMS Officer on-call for evening response. VFD has their on duty crew from the main station respond the apparatus or volunteers if available. Question eight of the survey, Who staffs the rehabilitation apparatus on the scene? In Clark County, an ambulance is dispatched to all structure fires to standby in the event of civilian or firefighter injury. In years past, the ambulance crew has inconsistently served as made up rehabilitation team for firefighters. Some assessments have been performed on firefighters and some help has been offered to assist. This question was used to identify if specific personnel are used to staff the rehabilitation apparatus. ECFR, CFD, and WFR staff the apparatus with CERT members. The members are a minimum of First Responder certified while some are Emergency Medical Technician (EMT) certified. CCFD 11 advised the EMS Administrator, the EMS Assistant, or a Paramedic will staff the apparatus. CCFD 6 will staff the apparatus with the EMS Officer during the day. After 1700 hours, the apparatus is staffed with volunteers. VFD indicated that the Division Chief of EMS is paged out to meet the rehabilitation apparatus on the scene. Question nine of the survey, Are firefighter conditions and vitals signs monitored while in rehabilitation? CCFD 3 has traditionally provided fluids, food, and rest periods for firefighters during major or long duration incidents. A specific focus of firefighter condition and vitals signs in rehabilitation hasn t always been the case. This question was developed to indentify if the other agencies were monitoring firefighters. ECFR, CFD, and WFR all indicated

19 Firefighter Rehabilitation 19 that firefighter conditions and vital signs were monitored in rehabilitation. ECFR advised the firefighters have an initial set of vitals signs taken followed by a second set 10 minutes later. CCFD 11, CCFD 6, and VFD all indicated that firefighter conditions and vitals signs were monitored while in rehabilitation. Question ten of the survey, Are firefighter conditions and vitals signs documented for future reference? This question was intended to indentify if personal information security measures were in place for each agency. ECFR advised that the documented results were placed in a sealed binder and then placed in a designated file cabinet. CFD advised that the information was written down and then forwarded to the incident commander. WFR was not aware of any documentation being kept for future reference. CCFD 11 advised that the firefighters are considered patients while in rehabilitation. The assessment log is placed on a spreadsheet for future reference and remains private. CCFD 6 places the documentation in the firefighter s personal file. VFD advised that the results remain confidential while placed under a database filing system. The only individual to have access to the information is the Division Chief of EMS. Research question two of the applied research project sought to indentify when firefighter rehabilitation should start and finish. This research project started prior to the release of the revised NFPA 1584, Standard on the Rehabilitation Process for Members During Emergency Operations and Training Exercises, 2008 Edition. The author was unable to find set standards on when rehabilitation should start. There was language found that indicated that on-scene emergency operation and training rehabilitation should be available with rest periods and fluids for firefighter rehydration.

20 Firefighter Rehabilitation 20 The initial concept researched found rehabilitation actually started prior to the beginning of the work day or shift. Pre-hydration was found to be the means of early rehabilitation. Although there were no set standards on pre-hydration prior to the release of NFPA 1584, numerous articles were found that captured this concept. This concept of staying pre-hydrated was to limit the use of stimulants such as caffeine, maintaining physical fitness, and keeping yourself adequately hydrated throughout your shift are ways to stop dehydration before it starts (Williams, 2006). Additionally, pre-hydrating begins the day before your shift. If engaging in physical activity during your day off, it is vitally important to stay hydrated. Drinking alcohol or large amounts of caffeine before a shift will potentially affect your performance when called to duty (Williams, 2006). The 2008 edition of NFPA 1584 addresses pre-hydrating for scheduled event, pre-hydration shall include an additional 16oz of fluids within 2 hours prior to the event (National Fire Protection Association [NFPA] 1584, 2008). Once the new NFPA 1584 standard became available, knowing when to start rehabilitation operations became much clearer. Rehabilitation operations shall commence whenever emergency operations or training exercises pose a safety or health risk to members (NFPA 1584, 2008). The standard goes on to identify when rehabilitation of firefighters will commence, members shall undergo rehabilitation following the use of a second 30-minute selfcontained breathing apparatus (SCBA) cylinder, a single 45 minute or 60-minute SCBA cylinder or 40 minutes of intense work without SCBA (NFPA 1584, 2008). Once firefighters have met the criteria for rehabilitation, a rest and recovery time has been identified as members entering rehabilitation for the first time shall rest for a minimum of 10 minutes and longer where practical. If members were using SCBA prior to rehabilitation, the rest and recovery times increase, members shall rest for a minimum of 20 minutes following the use a second 30-minute

21 Firefighter Rehabilitation 21 self-contained breathing apparatus (SCBA) cylinder, a single 45-minute or 60 minute SCBA cylinder, or 40 minutes of intense work without SCBA (NFPA 1584, 2008). This research found that rehabilitation must stay in effect for members while the incident poses a safety or health risk. Once the emergency operation has been mitigated or training exercise completed, it is at the discretion of the incident commander to disband the Rehabilitation Unit. However, rehabilitation is an on going process after the incident for the firefighters who engaged in heavy activity. NFPA 1584 recommends supervisors shall encourage members to continue fluid intake after the incident (NFPA 1584, 2008). The United States Fire Administration (USFA) recommends firefighters who received the services of rehabilitation operation must monitor their own well-being. Make sure they complete the necessary rehydration, rest, and nourishment required to bring them back to a total state of well-being (USFA, 2008). The results of the research to question two found that much of the responsibility for personal well-being in rehabilitation falls on the individual. New standards have been established for on-scene rehabilitation requirements and responsibilities of fire agencies. However, much of the information found is directed towards the importance of pre-hydration and post-hydration. To bring the information together, individual rehabilitation starts prior to shift assignment through pre-hydration and rehabilitation is finished when the individual is back to a normal state of wellbeing. Research question three sought to identify what standards exist for firefighter rehabilitation programs. The author initialized the research to this question by first addressing the pertinent standards found in Washington State. The Washington Industrial Safety and Health Act (WISHA) programs were researched. WISHA is administered by the state s Department of

22 Firefighter Rehabilitation 22 Labor and Industries and is monitored by the Federal Occupational Safety and Health Administration (OSHA). The OSHA requires state plans to be at least as effective as OSHA requirements. WISHA standards are released through Revised Codes of Washington (RCW) and through Washington Administrative Codes (WAC). The first obvious code researched was WAC , Emergency Fireground Operations for Structural Firefighting. The only language slightly addressing firefighter rehabilitation was found in section 13; officers at emergency scenes shall maintain an awareness of the physical condition of members operating within their span of control and ensure that adequate steps are taken to provide for their safety and health. The command structure shall be utilized to request relief and reassignment of fatigued crews (Washington Administrative Code [WAC], 2003) The next WAC addressed was WAC , First Aid for Wildland Firefighters. Section one states, at wildland fires, members shall be provided with a minimum of one quart per two-hour time period of electrolyte drinks or potable water (WAC, 2003). Section two of this WAC advised, officers at wildland fires shall be trained in the symptoms of heatrelated disorders and shall observe their crews for such behavior. Appropriate action shall be taken in the event a crew member displays such symptoms (WAC, 2003). The information found in the previous Codes were vague and did not offer direct on-scene rehabilitation operational responsibilities or requirements. The author called the Washington Department of Labor and Industries to seek out additional Codes that may pertain to firefighter rehabilitation. The author discussed the issue with Carla Robertson on March 13, She was unaware of any WAC specific to firefighter rehabilitation. However, she did advise of a new seasonal/temporary WAC used for employees

23 Firefighter Rehabilitation 23 working in extreme outdoor temperatures. The WAC was a temporary warm weather seasonal code in a trial state due to the dislike of the employers. Carla sent the author a copy of the WAC via . The author researched WAC , Heat-related illness in the outdoor environment, and found language pertaining to firefighters. The WAC addressed employees working in extreme outdoor temperatures while wearing turn out gear. The WAC goes on to address employer responsibilities in minimizing heat-related illnesses through identification of heat-related illnesses, provisions for rest breaks, and frequent consumption of fluids (WAC, 2003). The WAC did not address specifics for implementation of on-scene firefighter rehabilitation. The next course of action was to research National Fire Protection Association (NFPA) standards. The author researched the 2006 edition of NFPA 1500, Standard on Fire Department Occupational Safety and Health Programs. NFPA 1500 provided information on safety and health issues in all aspects of fire department operations, including training, emergency response, station safety, and related safety and wellness programs for members of the department. The standard also contains specific requirements for fire departments to provide rehabilitation services during emergency operations. The standard listed a number of requirements for fire departments to implement. The 2003 edition of NFPA 1584, Recommended Practice on the Rehabilitation of Members Operating at Incident Scene Operations and Training Exercises, was researched and found to be a good base for developing a rehabilitation program. However, the information provided in this edition served as a recommended practice only. In March of 2008, the author obtained the revised 2008 edition of NFPA 1584, Standard on the Rehabilitation Process for

24 Firefighter Rehabilitation 24 Members During Emergency operations and Training Exercises. This document was developed as a standard and proved to be the complete package needed to develop a firefighter rehabilitation program. The information provided in the document superseded all other standards researched as it was specific to the development of firefighter rehabilitation program. In February of 2008, the United States Fire Administration (USFA) released a document titled, Emergency Incident Rehabilitation. The author obtained this document via the USFA website in early April of The document was developed in part due to the heightened awareness of injury and death in the fire service community. A sound firefighter rehabilitation program has been identified as one way to reduce line injury and death. This document contains all pertinent federal standards for firefighter rehabilitation program requirements and proved to be a good foundation in developing a program. Discussion When comparing the results of the local phone survey and NFPA 1584 (2008), the author was pleasantly surprised at how the local agencies interviewed had already implemented many of the requirements found in the standard. Although much of the base for the programs were previously derived form NFPA 1500 (2006) and NFPA 1584 (2003), they were fairly consistent with the new NFPA 1584 (2008) standard. It was obvious that firefighter rehabilitation is a recognized priority within their organizations. Another interesting point that came from the phone survey was the abundance of rehabilitation apparatus within Clark County. Vancouver Fire Department (VFD), Clark County Fire District 6 (CCFD 6), and Clark County Fire District 11 (CCFD 11) staff, stock, and respond their own rehabilitation apparatus. These agencies share a mutual-aid agreement as with the rest of the fire districts in Clark County. However, their programs are set up for individual

25 Firefighter Rehabilitation 25 rehabilitation apparatus response. East County Fire and Rescue (ECFR), Camas Fire Department (CFD), and Washougal Fire and Rescue (WFR) have a shared ownership agreement in which each agency contributes to the maintenance of the apparatus and equipment costs. Per the agreement, the apparatus is housed in ECFR and responds to all requests made by the three agencies. With most of the agencies in Clark County being relatively close to one another, this type of agreement would be beneficial to all fire districts. Such an agreement within Clark County would allow every agency to work from one standard and share in the overall costs of firefighter rehabilitation. The research to questions two and three of this applied research project began in January of 2008 while the author was at the National Fire Academy. Much of the material gathered pertained to NFPA 1584, Recommended Practice on the Rehabilitation of Members Operating at Incident Scene Operations and Training Exercises (2003). The information was based on a recommended practice. In March of 2008 the author received the new 2008 edition of 1584, Standard on the Rehabilitation Process for Members During Emergency Operations and Training Exercises. Once the new 2008 NFPA 1584 standard was reviewed and compared with the 2003 NFPA 1584 recommended practice, it was obvious that the seriousness of firefighter rehabilitation had been carefully researched and a document produced that will benefit the fire service for years to come. The implications for Clark County Fire District 3 (CCFD 3) may come as a result of being negligent to the standard operating guidelines of the 2008 NFPA 1584 standard. Firefighter safety and well-being has always been a priority with CCFD 3. However, CCFD 3 must ensure that rehabilitation guidelines are developed and in place to comply with NFPA It is then

26 Firefighter Rehabilitation 26 the responsibility of all members to understand the need for firefighter rehabilitation and to take every action necessary to comply with guidelines set forth by CCFD 3. Recommendations In response to the results of this research, three primary recommendations can be elicited. The recommendations being addressed are to provide a means for Clark County Fire District 3 (CCFD 3) to develop a sound firefighter rehabilitation program. The first recommendation is for CCFD 3 to establish a sound firefighter rehabilitation program consistent with the 2008 National Fire Protection Agency (NFPA) 1584 standard. A draft Administrative Guide can be found in Appendix D. The second recommendation is for CCFD 3 to purchase a designated rehabilitation apparatus or to convert an existing apparatus into a designated rehabilitation apparatus. The purchase would also include the necessary supplies and equipment identified in NFPA Lastly, it is recommended that CCFD 3 investigate the possibility of a mutual aid agreement with neighboring fire districts for a shared response of an established rehabilitation program as it applies to NFPA 1584.

27 Firefighter Rehabilitation 27 References Dickinson, E. (2003). Ready for more. Fire Rescue. 21(2), Dickinson, E. (2007). Small town, big fire. JEMS. 32(12), Haigh, C. & Smith, D. L. (2006). Implementing Effective On-Scene Rehabilitation. Fire Engineering, 159 (4), McEvoy, M. (2007). Fire Rescue 1 News. Making Rehab a Requirement: NFPA Retrieved December 12, 2007 from National Climatic Data Center. (2008) Weather. Retrieved February 26, 2008 from National Fire Protection Association. (2006). NFPA 1500, Standard on fire department occupational safety and health program, 2006 edition. Quincy, MA: National Fire Protection Association. National Fire Protection Association. (2003). NFPA 1584, Recommended practice on the rehabilitation of members operating at incident scene operations and training exercises, 2003 edition. Quincy, MA: National Fire Protection Association. National Fire Protection Association. (2008). NFPA 1584, Standard on the rehabilitation process for members during emergency operations and training exercises, 2008 edition. Quincy, MA: National Fire Protection Association. National Institute for Occupational Safety and Health. (2007). Preventing Fire Fighter Fatalities Due to Heart Attacks and Other Sudden Cardiovascular Events. Cincinnati, OH: NIOSH The Orange County Register. (2008). Hydration Study Alters Firefighters Approach to Safety, Recovery. Retrieved February 21, 2008 from

28 Firefighter Rehabilitation 28 United States Fire Administration. (2008). Emergency Incident Rehabilitation. Retrieved April 14, 2008 from Wikipedia. (2008). Perspiration. Retrieved February 26, 2008 from Williams, D. (2006). Firefighter hydration during rehab. Fire Engineering. 159(12), Washington Administrative Code. (2007). WAC , Heat-related illness in the outdoor environment. Retrieved March 16, 2008 from Washington Administrative Code. (2003). WAC ,Emergency fireground operations - structural. Retrieved February 18, 2008 from Washington Administrative Code. (2003). WAC ,First aid for wildland fire fighters. Retrieved February 18, 2008 from

29 Firefighter Rehabilitation 29 Appendix A Local Fire Department Phone Survey Phone Survey Questions: 1. Does your department have a fire fighter rehabilitation program? 2. What standards were used to develop the program? 3. Does your department have a rehabilitation apparatus? 4. What alarm type requires the response of a rehabilitation apparatus? 5. What equipment is carried on your rehabilitation apparatus? 6. What type of fluids and food do you carry on your rehabilitation apparatus? 7. Who responds the rehabilitation apparatus to the scene? 8. Who staffs the rehabilitation apparatus on the scene? 9. Are fire fighter conditions and vital signs monitored while in rehabilitation? 10. Are fire fighter conditions and vital signs documented for future reference?

30 Firefighter Rehabilitation 30 Appendix B Phone Survey Results East County Fire and Rescue th St. Washougal, WA (360) Contact: Chief Scott Koehler Question 1 Yes Question 2 United States Fire Administration (USFA) Question 3 Yes, a full size transit bus. The front two thirds is set up for rehabilitation with AC/Heat and the back is set up as a incident command post. Question 4 Structure fires, brush fires, and hazmat incidents. The bus is available to agency in the County. Question 5 An on-board generator, fans, lights, toilet, PPE racks, wet towels for cooling, accountability board, portable radios, awning, and medical equipment. Question 6 Water, sports drinks, juice, coffee, tea, and hot chocolate. Granola bars, cookies, power bars, and beef stock. Question 7 Staffed by CERT members. Question 8 Staffed by CERT members who are First Responder of EMT certified. Question 9 Yes, an initial set is taken followed by a second set 10 minutes later. Question 10 Yes, the results are placed in a sealed binder and then placed in a designated file cabinet. Camas Fire Department 616 N.E. 4 th Ave. Camas, WA (360) Contact: Firefighter/Paramedic Paul Bennet Question 1 Yes Question 2 Mainly the Washington Administrative Codes (WAC) and some National Fire Protection Association (NFPA). Question 3 No Question 4 Second alarm assignment. The rehabilitation apparatus comes from ECFR per a mutual aid agreement. Question 5 It s a bus that carries water, fans, air conditioning, and medical equipment. Question 6 Water Question 7 Volunteers Question 8 Volunteers Question 9 Yes Question 10 Yes, the information is written down and forwarded to the Incident Commander.

31 Firefighter Rehabilitation 31 Washougal Fire and Rescue 1400 A St. Washougal, WA (360) Contact: Captain Larry Saari Question 1 Yes, but not in writing. It s understood that after two bottles, the fire fighters go to rehab. Question 2 WAC and NFPA. Question 3 The rehabilitation apparatus is co-owned between Camas, Washougal, and ECFR. Question 4 Any first alarm assignment. Question 5 Fluids, snacks, medical equipment, AC, and heat. Question 6 Water and sports drinks. No food. Question 7 Volunteers trained to operate the rehab. The volunteers carry pagers and are dispatched on any first alarm structure fire. Question 8 The dame volunteers who respond the rehabilitation apparatus staff the apparatus on the scene. Question 9 Yes. Question 10 Unknown. Clark County Fire District N.E. 72 nd Ave. Battle Ground, WA (360) Contact: EMS Assistant Airen Elizabeth Question 1 Yes. Question 2 WAC, Revised Codes of Washington (RCW), and NFPA. Question 3 Yes, an airport shuttle bus. Question 4 Second alarm structure fire or if fire fighters are working in the elements for a long period of time. Question 5 Medical equipment, fans, propane tank, refrigerator, awning, and documentation equipment Question 6 Water, Gatorade, hot coco, and coffee. Granola bars. Once on the scene, the personnel staffing the rehabilitation apparatus will go to the store to purchase fruits and vegetables. Salty foods will not be purchased. Question 7 Volunteers. No one is specifically assigned to respond. They are in transition to have the EMS Assistant respond during the work day and eventually evolve into being paged from home to respond after the workday. Question 8 The EMS Administrator, the EMS Assistant, or a Paramedic. Question 9 Yes, twice. Question 10 Yes, the fire fighters are considered patients while in rehab. The assessment log is placed on a spreadsheet for future reference and remains private.