MABAS DIVISION 5 Standard Operating Guideline SUBJECT: Emergency Incident Rehabilitation S.O.G. REHAB 2009 Approved: December 16, 2009 Revised: Standard Operating Guideline for Emergency Incident Rehabilitation MABAS Division V Page 1
MABAS DIVISION V REHABILITATION GUIDELINE Purpose To provide an opportunity for fire/rescue personnel to rest and rehydrate during fire and rescue activities. Scope This guideline should apply to all activities of MABAS Division V, including, but not limited to, fire ground operations, EMS operations, training exercises and drills where strenuous mental and physical activities or exposure to heat or cold exist. 1. Responsibilities 1.1 Incident Commander - The Incident Commander (IC) has the responsibility and authority to implement and monitor all provisions of this operational guideline. The Incident Commander should consider circumstances of each incident and make adequate provisions early in the incident for the rest and rehabilitation for all members operating at the incident. These provisions are to include: medical evaluation, treatment and monitoring; food and fluid replenishment; physical and mental rest; relief from extreme climatic conditions; relief from other extreme environmental factors caused by the incident. The rehabilitation should include provisions for Emergency Medical Services (EMS) at the Advanced Life Support (ALS) level. 1.2 Division/Group Supervisors and Company Officers - Division/Group Supervisors and Officers (CO) should maintain an awareness of each member operating within his/her span of control and ensure adequate steps are taken to provide for each member s health and safety. The Incident Command System (ICS) should be utilized to request relief and/or reassignment of working crews. 1.3 Line Personnel - Each member is responsible for his/her preparedness prior to an incident, including sufficient rest prior to reporting for duty, pre-hydration during hot days, proper dress during cold days and ensuring that protective clothing and equipment is present and in good working order. During any emergency incident or training activity, all members are to advise their supervisor when they believe that their level of fatigue or exposure to heat or cold is approaching a level that could affect themselves, their crew, or the operation in which they are involved. Members should remain aware of the health and safety of other members of their working crew. MABAS Division V Page 2
2. Establishment of Rehabilitation 2.1 Responsibility - The Incident Commander should establish a Rehab Group when conditions indicate that rest and rehabilitation is needed for personnel working at an incident scene or training exercise. The IC should designate a Licensed Paramedic as Rehab Group Supervisor. (Command should consider assigning a chief officer to assist with rehab) The Rehab Group Supervisor should then act within the ICS and report to the Medical Branch Officer or Logistics Chief if assigned. If no Medical Branch Officer or Logistics Chief is designated, the Rehab Group Supervisor is to report to the Operations Section. If the Operations Section has not been established the Rehab Group Supervisor should report to the IC. 2.2 The Incident Commander may establish a Rehab Group Supervisor during any other fire department activities at his/her discretion; climatic and environmental factors need not be the sole criteria or justification for establishing rehabilitation. 2.3 Rehabilitation should consider the scope of the incident, including the following: 2.3.1 Time. Extended use of turnout gear; extended exposure to weather conditions. 2.3.2 Complexity. Crime scenes, standoffs, search operations, mass gathering/public events, hazardous materials incidents and so on. 2.3.3 Intensity. Mental and/or physical stress on members such as major extrications, actual fire attack, or interior search and rescue. 2.3.4 Climatic conditions such as hot or cold weather. 2.3.5 Location 2.3.5.1 The Incident Commander will normally designate the location for the Rehabilitation. If a specific location has not been designated, the Rehab Group Supervisor should select an appropriate location based on the site characteristics listed below. 2.3.5.2 Multiple Rehab locations may be necessary if the incident is large or divided. In the event there is more than one Rehab location, they should be designated Rehab 1 and Rehab 2, etc. Each Rehab will have its own Rehab Group Supervisor who should report to the Medical Branch Officer or Logistics Officer if established. Each Rehab Group Supervisor should be a certified Paramedic. 2.3.6 Site Characteristics of a Satisfactory Rehab Area when selecting a site for rehab the following items should be considered: 2.3.6.1 In a location that will provide physical rest. MABAS Division V Page 3
2.3.6.2 It should be far enough away from the scene that personnel may safely remove their turnout gear and SCBA. 2.3.6.3 Provides suitable protection from environmental conditions. During hot weather, it should be in a cool, shaded area. During cold weather, it should be in a warm, dry area. 2.3.6.4 Free of exhaust fumes. (Including those used in the Rehab Group). 2.3.6.5 Large enough to accommodate several crews. 2.3.6.6 Easily accessible by EMS vehicles. 2.3.6.7 Allows prompt re-entry to the incident. 2.3.7 Resources 3. General Operational Principles 3.1 Establishment 2.3.7.1 One Advanced Life Support Ambulance. 2.3.7.2 One Licensed Paramedic or EMT-B for every 10 people undergoing rehabilitation in the Rehab location. 2.3.7.3 Potable water, oral electrolyte solution, ice and food. 2.3.7.4 Tarps, lights, fans, blankets, towels, traffic cones, fire-line tape, etc 3.1.1 Climatic or environmental conditions that indicate the need to establish Rehab are a heat stress index above 90 degrees Fahrenheit or wind-chill index below 10 degrees Fahrenheit. However, the working conditions should also be considered and not just the ambient temperature. 3.2 Hydration 3.2.1 During heat stress, each personnel should replace at least one quart of water per hour. Plain water should be used for the first hour of the operations and then supplemented with a commercially prepared beverage such as Gatorade. 3.3 Nourishment 3.3.1 Food should meet the digestive and exertion level needs of the firefighters on the scene. MABAS Division V Page 4
3.4 Rest 3.4.1 Rest should be provided after the two bottle rule or 45 minutes, which ever comes first. 3.4.2 Personnel should re-hydrate at least 12 ounces of water during a SCBA bottle change. (1 bottle of water for each SCBA bottle) 3.4.3 Rest should be no less than 10 minutes and may in some cases exceed 30 minutes as determined by the Rehab Group Supervisor. Personnel requiring rest periods of 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. 3.4.4 Personnel released by the Rehab Group Supervisor are to report to the Staging Area, Planning and/or Operations as determined. 3.5 Medical Evaluation 3.5.1 Rehab should be staffed with 1 Paramedic/EMT-B for every 10 firefighters in Rehab. 3.5.2 Rehab medical evaluation should consist of a minimum of a mental status evaluation. 3.5.3 Any member who exhibits a consistent pulse rate of > 110bpm should not be permitted to wear full protective clothing, including SCBA and should require additional rehabilitation. 3.5.4 Any member(s) who receives any treatment(s) other than fluid, food, and/or rest should be treated and documented as an injury to personnel. As an example, ice for sprains or strains should be considered injuries rather than rehabilitation. 3.5.5 All Rehab evaluations should be documented on the MABAS Division V Rehab Form and submitted to the IC at the conclusion of the incident. 3.5.6 All injury reports should remain part of the employee s protected medical file and treated as other confidential medical records. 3.5.7 Any/all Rehab reports involving Mutual or Auto Aid personnel should be made available to their respective departments. MABAS Division V Page 5
4. Accountability 4.1 Personnel assigned to Rehab should enter and exit the Rehabilitation Area as a crew. The crew designation, number of crew personnel, and the times of entry/exit should be documented by the Rehab Group Supervisor, or his/her designee on the MABAS Division V Rehab Form. 4.2 Crews should not leave the Rehabilitation Area unless authorized to do so by the Rehab Supervisor. 5. Medical Assessment Criteria 5.1 Follow EMS Protocol 5.2 Observe for normal mental status 5.3 Hemodynamically stable firefighters can be released from rehab. Consider the following: Mental Status: Alert and Oriented X 3 Skin Condition: Not pale, cyanotic, red, hot, dry or profusely sweaty HR: ( 50-110) Respirations: ( 10-20) B/P: ( 90/60-150/90) MABAS Division V Page 6
REHAB FLOW CHART ACTIONS 1. Collect Passport 2. Document: Firefighters Name and Time In 3. Remove Protective Equipment (Be sensitive to environmental conditions and sheltering) 4. Baseline assessment: Mental Status Skin Condition Vitals: Pulse, Blood Pressure, Respirations Medical Assessment within Medical Assessment not within 1. Hydrate orally with 12 oz of fluid. 2. Implement passive cooling measures with sensitivity toward environment. 3. Rest for 10 minutes 4. Medical Assessment within normal limits? 1. Consider the need to move to EMS Protocol. 2. Implement active cooling. 3. Hydrate with 32 oz of fluid. 4. Rest for 20 minutes 5. Medically reassess every 5 minutes until baseline assessment returns to normal. Release from Rehab Medical Assessment within Medical Assessment not within Release from Rehab 1. Consider the need to move to EMS Protocol. 2. Continue active cooling. 3. Continue hydration adding a commercially prepared sport drink. 4. Rest for 10 minutes 5. Assess Glucose level If hypoglycemic, provide nourishment 6. Medically reassess every 5 minutes until baseline assessment returns to normal. Medical Assessment within Medical Assessment not within Release from Rehab 1. Move to EMS Protocol 2. Transport for medical evaluation at E.R. 3. Notify I/C with name of FF and Department MABAS Division V Page 7
Firefighters returning for a second round of rehab should be hydrated with sports drinks and provided nourishment. MABAS DIVISION 5 REHAB FORMS These documents must be turned over to the local authority having jurisdiction / incident commander. These documents are to be considered confidential medical records and should NOT be filed with the final incident report. McHenry County MABAS Division V MABAS Division V Page 8
MABAS DIVISION V Incident Rehab - Individual Rehabilitation Report Incident Location Date Time Rehab Officer Name/Department/Company Time In/Out # SCBA Cylinders Exam Period BP Pulse Resp Skin MEDICAL COMPLAINTS Trans. Y / N. MABAS Division V Page 9 Rehabilitation Policy 5/07
MABAS DIVISION V Incident Rehab - Individual Rehabilitation Report Incident Location Date Time Rehab Officer Name/Department/Company Time In/Out # SCBA Cylinders Exam Period BP Pulse Resp Skin MEDICAL COMPLAINTS Trans. Y / N. MABAS Division V Page 10 Rehabilitation Policy 5/07
Extra Page No Information MABAS Division V Page 11 Rehabilitation Policy 5/07