1. Emergency Incident Rehabilitation
Unit 53
Emergency Incident
Rehabilitation

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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. Figure 53.1 An ideal layout for a rehabilitation sector

10. 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)

11. 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

13. 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

15. 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

17. 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

18. 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

19. 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

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

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

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

23. Figure 53.2 Triage tree for rehabilitation

25. 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

26. 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