TFD Policy 5022: Rest and Rehabilitation

• Document 5022 establishes the TFD's policy on rest and rehabilitation for personnel during emergency operations and training.
• The document includes procedures for assignment to rehab and carbon monoxide (CO) monitoring.
• Document 5022 applies to all TFD personnel involved in emergency operations or training.
• TFD Policy 5022, dated 11/2001, regarding rehab at emergency incidents and training exercises is replaced

Associated Forms

• Several forms are associated with this document.
• Emergency Incident Rehabilitation Report
• Medical Fitness Report (MFR)
• Supervisors Report of Injury (HRE 703)
• Heat Stress Index
• Wind Chill Index
• CO Poisoning Index
• Calibration Instructions for Micro CO Meter

Responsibilities

• TFD Policy 5013, Reporting On-the-Job Injury and Illness, has related information.
• The Assistant Chief of Training and Safety ensures that all personnel are trained in the implementation of a Rehab area and the recognition of heat, cold, and fatigue-related symptoms and injuries.
• The Administrative Battalion Chief, Safety Division is responsible for specific tasks.
• The Incident Commander makes provisions for rest and rehabilitation of TFD personnel at emergency scenes or training exercises, designates a Rehab Manager, and assigns ALS personnel to staff the Rehab area.
• Company Officers maintain awareness of personnel's physical and mental condition, ensure steps are taken to protect personnel health and safety and request relief/reassignment of fatigued crews.
• The Rehab Manager sets up and manages the Rehab area, ensures personnel are evaluated and treated, and keeps the Incident Commander updated on crew availability, condition of injured personnel, and changing conditions that may require relocation.
• ALS personnel evaluate and treat personnel in the Rehab area and arrange transport to hospital emergency departments as necessary.
• The Incident Safety Officer ensures Battalion Chief vehicles have fresh water, the Rehab area is fully operational and CO monitors are calibrated semi-annually
• All TFD personnel are responsible for reading and following the guidelines set forth in the document.

Definitions

• ALS is defined as advanced life support.
• Ambulance is defined as a private ALS or BLS unit.
• Canteen services are food and beverages provided by Rehab 1 to on-scene personnel.
• CO is carbon monoxide.
• Company Officer refers to TFD personnel holding the rank of Lieutenant or Captain assigned to a TFD apparatus or medic unit.
• A Fire Buff is part of a volunteer corps that provides refreshments at extended emergency operations.
• Heat Stress Index is a comprehensive index reported by weather services that evaluates daily relative heat stress based on deviations from the norm for locations throughout the United States to help determine probability of heat related illness for TFD personnel engaged in heavy physical exertion.
• Indicators of Exhaustion or Overheating include symptoms such as red face, excessive perspiration, pulse over 110, or systolic blood pressure above 150 or below 110.
• Normal body temperature is 98.6 degrees Fahrenheit for most people.
• Rehab 1 is a canteen unit operated by Fire Buffs and may be part of the Rehab area.
• Rehab Area is the rest and rehabilitation area managed by TFD personnel to provide medical evaluation and treatment of personnel as needed at the scene of an emergency operation.
• Revitalization involves mental and physical rest, fluid replacement, and nourishment.
• SCBA stands for self-contained breathing apparatus.
• Staging area is the location to which incident personnel and equipment are assigned on an immediately available status.
• Tympanic thermometer is an instrument for measuring temperature at the tympanic membrane of the ear.
• Wind chill indicators is the measure of the rate of heat loss based on air temperatures and wind speeds.

Rules and Guidelines

• WAC 296-305-070 17 is a relevant reference.
• Pierce County Patient Care Protocols is another relevant reference.
• The Tacoma Fire Department shall ensure the physical/mental condition of personnel doesn't affect the safety of others or jeopardize the integrity of the operation.
• The Incident Commander ensures personnel are fully rested before returning to duty and fresh/fully rehabilitated crews are in the staging area.
• TFD personnel should not continue operations or training beyond safe levels of physical/mental endurance.
• A Rehab area is established to evaluate/assist personnel experiencing effects of sustained physical exertion.
• Only TFD personnel can be Rehab Managers.
• An individual's fatigue level determines the need/duration of rehabilitation.
• TFD ALS personnel perform Rehab evaluations and give EMS support and can detain personnel for medical reasons.
• Personnel transported to a medical facility are relieved of duty, must call the Battalion Sick recorder, obtain a Medical Fitness Report, complete a Supervisor's Report of Injury(HRE 703), and route completed reports to Fire Headquarters.
• A treatment area is established for individuals with signs/symptoms of extreme physical exertion/fatigue or obvious/suspected injuries needing medical attention.
• Fire Buffs provide canteen services only.
• The Incident Commander/Incident Safety Officer assigns to Rehab any firefighters exhibiting physical/mental fatigue, expending two full 30-minute rated SCBA cylinders in succession, or spending 45 minutes doing physical work.
• Rehab duration is not less than 10 minutes.
• The Incident Commander/TFD ALS personnel may require an individual to rehab for an hour or longer.
• Personnel in Rehab get a physical assessment by TFD ALS personnel, injury treatment as needed, revitalization, ongoing monitoring including CO, transport, and relief from extreme weather.
• TFD ALS personnel assess for overheating.
• TFD personnel with a temperature above normal, but below 100.5°F, increase rest time as instructed by ALS personnel.
• TFD personnel with a core temperature of 100.5°F or above cannot engage in physical activity until their temperature returns to normal.
• TFD personnel with a core temperature that does not return to normal after 30 minutes of rest and fluid replacement cannot engage in any physical activity for 24 hours.
• The Incident Commander can provide food at extended incidents.
• At extended incidents nourishment is highly recommended where personnel are engaged in strenuous activity or operations for 3 hours or longer
• Fatty or Salty foods should be avoided.
• Soups, broths, stews, apples, oranges or bananas are preferred.
• The Incident Commander coordinates with the Rehab Manager to ensure personnel are rested/medically cleared.

Dehydration

• During hot weather, TFD personnel drink adequate amounts of water/electrolyte replacement beverages and minimize caffeinated beverages
• While participating in an emergency incident or training exercise, TFD personnel drink at least one quart of water per hour, and be aware/monitor for symptoms of fatigue/stress and for the health of surrounding personnel
• The officer must be advised when a team-member is not fit for purpose for safety reasons.
• Company Officers take appropriate measures to avoid heat, cold, or fatigue-related injuries, including medical evaluation,treatment/monitoring, fluid replenishment, rest, and CO monitoring during training.

Rehab Area Requirements

• The Incident Commander determines the need for a Rehab area during the initial planning stages based on incident size, type, duration, labor intensity, and weather.
• Situational examples include excessive heat stress index, extreme wind chill factor, multiple alarm incidents, extended working fires, and hazardous materials incidents
• The Incident Commander designates a Rehab Manager and a TFD ALS company to provide EMS support.
• The Rehab Manager selects a suitable site outside the operational zone with good access for medic units/ambulances, close to staging, and shaded/sheltered from weather.
• The Rehab Manager announces the location, assigns staffing, obtains water, and assembles supplies (fluids, nourishment, medical/environmental mitigation items)
• Boundaries are delineated with fire line tape, dividing into Treatment and Rest/Refreshment.
• During hot weather, the Rehab Manager uses tarps for shade and fans for cooling, and avoids gasoline-powered smoke ejectors.
• The Rehab Manager considers requesting fire buff support for hydration/nourishment during extended operations.
• The Rehab Manager places personnel passports on the accountability status board and directs to rest/refreshment or treatment based on their condition. updates the incident commander regarding companies/injured.
• ALS personnel assess each individual and the Rehab Manager places personnel on a ready list for re-assignment and coordinates releases with the Incident Commander.

Personnel Evaluation and Procedure

• ALS personnel conduct an initial exam including general appearance, skin vitals, heart rate, blood pressure, respiration rate, mental status, and CO monitor reading; document on the Emergency Incident Rehabilitation Report; and take serial vital signs. Initial vital signs and complaints for each person are recorded.
• ALS personnel ensures each person entering Rehab rests at least 10 minutes, removes SCBA, loosens/removes clothing, and drinks at least 8 ounces of fluid. Fluid is provided while air bottles are filled/replaced.
• If there is an indication of exhaustion or overheating, ALS personnel instruct the individual to remove protective clothing/equipment, conduct a comprehensive assessment and arrange transport to a hospital as indicated.
• Company Officers request rehab through the command structure, advising of crew position, condition, and need for replacement and should only report when instructed.
• Company Officers check in with the Rehab Manager and relinquish passports, ensuring all crew members are evaluated by ALS personnel, rest for at least ten minutes, and have SCBA bottles filled/replaced.
• When medically cleared, crew members report to the Rehab Manager and obtain their passports, then return to service.
• All personnel report to Rehab as instructed, check in with the Rehab Manager, relinquish passports, remove SCBA/clothing, and undergo evaluation by ALS personnel.
• All personnel drink at least 8 ounces of fluid and rest at least 10 minutes/longer if instructed.
• When medically cleared, personnel report to the Company Officer, check out with the Rehab Manager, obtain passports, and return to service.

Carbon Monoxide Meter Procedure

• The CO meter is used at room temperature, cooled/warmed as necessary.
• A PP3 battery is installed.
• Non-disposable and disposable mouthpieces are inserted.
• The unit is turned on, displaying a 20 second countdown timer.
• The patient is instructed to inhale/hold their breath for 20 seconds.
• The unit will display a blow indictor.
• The patient places lips around the tube and exhales slowly.
• Suspect CO poisoning if any reading is over 72 ppm or >12% COHb.
• If CO poisoning is suspected treatment/transport is provided or arranged.
• If repeat measurement is necessary, the unit is turned off, the mouthpiece is removed for one minute, and steps 7-9 are repeated.
• The unit should be stored with the battery removed.