Emergency Incident Rehabilitation Unit 53 Emergency Incident Rehabilitation

Overview Fire ground hazards Emergency incident rehabilitation Medical monitoring Smoke and fire Heat exhaustion

Introduction Firefighting requires excessive physiologic demands Firefighters are at risk for illness, injury, and even death Role of EMT is to provide care and relief to firefighters to reduce injury and illness

Fire Ground Hazards Ordinary and expected hazards to firefighter Burning embers or falling objects Life threats on fire scene Toxic gases, heat exhaustion Fire rehabilitation intended to: Monitor for effects of toxins Prevent heat exhaustion

Emergency Incident Rehabilitation Firefighters at great risk for stress-related injury and illness Exhaustion can impair reaction times Overexertion and stress can lead to cardiovascular complications Emergency incident rehabilitation Helps mitigate adverse impact of fire ground operations and increase safety

Emergency Incident Rehabilitation (cont’d.) Occupational Safety and Health Administration (OSHA) States workplace (fire grounds) must be free from hazards Physical exhaustion and impact on fire operations is recognized hazard Medical monitoring and responder rehabilitation essential for safety

Emergency Incident Rehabilitation (cont’d.) National Fire Protection Association (NFPA) Requires development and maintenance of standard operating guideline (SOG) for rehabilitation section Criteria required to establish rehab section Large incident Long duration event Labor-intensive incident

Fundamentals of Emergency Incident Rehabilitation Two sections of rehab unit: Rest and recovery sector Medical monitoring sector Rehab sectors should be upwind of incident to limit smoke and fume exposure Rehab area should be in close proximity to command post

Figure 53.1 An ideal layout for a rehabilitation sector

Physical Plan Rehab sector should be: Large enough to accommodate all responders Free of smoke and exhaust from diesel engines Able to protect responders from natural elements (heat in summer, cold in winter)

Physical Plan (cont’d.) Three models for rehab units: Fixed facility: building used for rehab (e.g., fire stations, basements of churches, department stores) Apparatus-based rehab: mobile apparatus (e.g., school buses, ambulances, cabs of fire trucks) Portable shelters: can be outfitted with portable heaters or air conditioners

Rehabilitation Functions of rehabilitation sectors summed up by three Rs: Restoration: must recognize exhaustion of firefighter Rehydration: must replenish firefighter’s lost body fluids Refreshment: necessary to feed firefighters and emergency responders

Medical Monitoring Responsibility of safety officer and incident commander to ensure health of firefighters and emergency responders Out-of-shape firefighters with preexisting medical conditions are at increased risk for injury and illness

Medical Monitoring (cont’d.) Three threats to firefighters: Heat exhaustion, cyanide poisoning, and carbon monoxide poisoning EMT needs to obtain set of vital signs, including temperature, pulse, respirations, and blood pressure If vitals are abnormal, transportation may be required

Smoke and Fire Self-contained breathing apparatus (SCBA) protects firefighters from toxins (carbon monoxide and cyanide) Firefighters are occasionally exposed to toxins Symptoms: headache, impaired judgment, tachypnea, tachycardia, unconsciousness, coma, respiratory distress, death

Heat Exhaustion Must assess for dehydration to prevent heat exhaustion Body compensates for fluid loss by increasing heart rate If heart rate elevated from fluid loss, will stay elevated until fluids replaced Oral fluid intake or intravenous administration may be sufficient

Prevention of Heat Exhaustion On-scene cooling: effective at preventing heat exhaustion Methods of on-scene cooling: fans Misting Forearm immersion

Transport Criteria Firefighter can return to service if: Heart rate below beats/min Temperature than 100.6°F Blood pressure 130 systolic/90 diastolic

Transport Criteria Transport to emergency department if, after hour: Firefighter’s heart rate remains 120 beats per minute Tachycardia persists or Temperature to go below 100.6°F See Table 53-3 for additional guidelines

Figure 53.2 Triage tree for rehabilitation

Critical Incident Stress Firefighters and emergency responders experience mental stress EMT should observe for: Normal signs of , including venting and diffusing Signs of psychological and psychic breakdown

Conclusion Objective of emergency incident rehabilitation is to prevent illness and injury Organized plan of rehabilitation, along with assistance of EMTs trained in rehabilitation principles, can prompt safer emergency operation