20. Rehab.pdf

Standard Operating Procedure Lehigh Acres Fire Control and Rescue District Supplemental Manual 533 Rehabilitation 533.1 PURPOSE AND SCOPE: The purpose of this Standard Operating Procedure (SOP), is to establish guidelines for implementation of a Rehabilitation Group within the Incident Command Sys...

Standard Operating Procedure Lehigh Acres Fire Control and Rescue District Supplemental Manual 533 Rehabilitation 533.1 PURPOSE AND SCOPE: The purpose of this Standard Operating Procedure (SOP), is to establish guidelines for implementation of a Rehabilitation Group within the Incident Command System structure during emergency operations and implementation of Rehabilitation during training exercises. The objective is to provide proper Rehabilitation for all emergency personnel at any given time necessary that meets or exceeds NFPA 1584 Due to the nature of emergency services, we are unable to cease all activities during times of high heat. Furthermore, with Florida’s climate, we often experience heat indices that are considered extreme; however, certain precautions can be taken during emergency and non-emergency operations to reduce the risks to employees. It is the position of Lehigh Acres Fire Control and Rescue District to place all employees’ health and safety as our highest priority. A search of various resources, including NFPA 1584, indicates the most important measure to ensure firefighter safety is education. It ensures that personnel are aware of the precautions to take, the warning signs, and treatment of heat emergencies. 533.2 GENERAL: (a) NFPA 1584 defines Rehabilitation as an intervention designed to mitigate against the physical, physiological, and emotional stress of firefighting in order to sustain a member’s energy, improve performance, and decrease the likelihood of on-scene injury or death. Rehabilitation shall commence whenever emergency operations or training exercises pose a potential safety or health risk to members. (b) When performing live fire training, rehabilitation measures, no matter the outdoor temperature, Rehabilitation shall be implemented, and NFPA 1403 followed. (c) Heat Index is considered one of the best means of evaluating environmental heat conditions. Heat index is determined from a formula utilizing the ambient air temperature and the relative humidity or dew point. The following practices are to be implemented whenever temperatures are expected to exceed 100 degrees or whenever the combination of air temperature and humidity equal or exceed a heat index of 100: (d) 1. All non-emergency outdoor activities will be evaluated for their necessity, or ability to be moved indoors; 2. When possible, outdoor activities (training) will occur prior to 1000 hrs. or after 1600 hrs; 3. When possible, shade, cooling fans and/or misting devices will be employed, and; 4. All personnel will be closely monitored for proper hydration and rest periods. If an Excessive Heat Warning has been issued by the National Weather Service (NWS), all non-emergent outside activities will be canceled or postponed. Excessive heat warnings are issued if the daytime heat index is greater than or equal to 105. Copyright Lexipol, LLC 2023/05/22, All Rights Reserved. Published with permission by Lehigh Acres Fire Control and Rescue District Rehabilitation - 1 Lehigh Acres Fire Control and Rescue District Supplemental Manual Rehabilitation If outdoor activity will be performed wearing bunker gear/PPE, 10 points must be added to the heat index. If the activity is in direct sunlight, add an additional 10 points. Example: Heat Index = 80, bunker gear/PPE +10, direct sunlight +10 = 100. (e) Employees who are overweight, dieting, or of past heat casualties are more prone to heat injuries. As a result, their activities must be closely monitored. 533.3 COMMON SENSE APPROACH TO COMBAT HEAT: (a) Acclimatization: 1. (b) Fluid intake: 1. (c) (e) Infections, fever, recent illness, overweight, fatigue, drugs (cold medication), and previous heat injuries may increase the risk of heat stress. Work schedules: 1. If the situation allows heavy work and activities that require strenuous physical exertion should be scheduled for early morning or late evening. 2. Provide shade, fans, or misters to cool the working atmosphere, and avoid working in the direct sun, whenever possible. Clothing: 1. (f) Employees should drink adequate fluids before and during any outdoor operations or training exercise and avoid caffeinated beverages. Physical conditioning: 1. (d) It takes up to two weeks to become acclimatized. Therefore, personnel need to spend some active time outside each day to ensure that the body is adjusted to the current temperature. If the operation or training exercise requires the use of protective clothing, loosening or removing protective clothing elements should occur as soon and often as possible. Heat Index: 1. This procedure aims to establish guidelines and responsibilities for minimizing the effects of heat stress on department members. 2. Heat index is the best means of evaluating environmental heat. Officers must monitor the heat index and, if tactically possible, modify activities and monitor employees accordingly. 533.4 GUIDELINES FOR HEAT EXPOSURE LIMITS: (a) Always monitor the signs and symptoms of heat stress. Immediately discontinue any activity for any person when: 1. Rehab parameters listed in Lee County Common Treatment Guideline Emergency Service Personnel Rehabilitation protocol are exceeded. Copyright Lexipol, LLC 2023/05/22, All Rights Reserved. Published with permission by Lehigh Acres Fire Control and Rescue District Rehabilitation - 2 Lehigh Acres Fire Control and Rescue District Supplemental Manual Rehabilitation 2. Member complaints of sudden and severe fatigue, nausea, dizziness, lightheadedness, or fainting. 3. Periods of inexplicable irritability, malaise, or flu-like symptoms, or member complaints of muscle cramps or spasms. 533.5 REHABILITATION: (a) (b) Rehabilitation for emergency operations and training: 1. Relief from climatic conditions, in areas such as an ambulance, nearby garage, or make-shift rehabilitation structure. 2. Rest and recovery. 3. Active or passive cooling (or warming) as needed for the incident type and climate conditions. 4. Rehydration (fluid replacement). 5. Calorie and electrolyte replacement, as appropriate. 6. Medical monitoring, and 7. Member accountability. Remember to be alert to early signs of dehydration and heat illness. They forewarn of more severe casualties to come without intervention. Virtually all heat injuries are preventable. 533.6 REHABILITATION RESPONSIBILITIES: (a) Rehabilitation Responsibilities during Emergency Operations: 1. 2. Emergency Personnel: (a) Report to and participate in Rehabilitation when ordered to do so by a Commanding Officer. (b) Maintain proper rest/nutrition regimen. (c) Observe appropriate work/rest cycles. (d) Maintain hydration. (e) Inform supervisor of any ill effects. (f) Inform supervisor when any crew member needs rehabilitation. (g) Remain aware of the health and safety of other crew members. Company Officer: (a) Maintain an awareness of the physical and mental conditions of each member operating within their span of control and ensure adequate steps are taken to provide for each member’s safety and health. (b) Ensure members hydrate throughout the shift. Copyright Lexipol, LLC 2023/05/22, All Rights Reserved. Published with permission by Lehigh Acres Fire Control and Rescue District Rehabilitation - 3 Lehigh Acres Fire Control and Rescue District Supplemental Manual Rehabilitation 3. 4. (c) Continuously assess crew members when working in IDLH atmospheres. (d) Request relief and assignment to rehab following the use of a second 45-minute self- contained breathing apparatus (SCBA) or 40 minutes of intense work without SCBA, i.e., extrication. (e) Inform the Incident Safety Officer (ISO) or the Incident Commander (IC) when any crew member needs rehabilitation. (f) Evaluate crew members on wildland fires where rehabilitation has not been established for heat stress conditions and the potential of heatrelated illness. Incident Commander: (a) Ensure all personnel receive the proper medical evaluation, monitoring, and clearance. rest, refreshments, (b) Establish a rehabilitation group when indicated and assume responsibility if it is not delegated. (c) Rotate companies to rehabilitation as needed or requested. (d) Ensuring Lee County Common Treatment Guideline Emergency Service Personnel Rehabilitation protocol is followed. (e) Utilize the practice of first company in, first company out routine. (f) Consider the circumstances of each incident and make adequate provisions early in the incident for the rest and rehabilitation of all members operating at the scene. Rehabilitation Officer: (a) Ideally, a paramedic should be assigned the Rehab Officer role. (b) Report directly to the Incident Commander (IC) or the Incident Safety Officer (ISO); (c) Report to the IC or ISO and obtain rehabilitation requirements; (d) Locate and establish a rehabilitation site; (e) Identify the EMS personnel requirements and request additional personnel to assist as required; (f) Provide required resources for rehabilitation; (g) Check vital signs, monitor for heat stress, and signs of medical issues; (h) Document medical monitoring on Lee County Common Treatment Guidelines Incident Rehabilitation Worksheet; (i) Provide medical care and transportation to medical facilities, as required; (j) Inform the IC and ISO when personnel require transportation to the treatment at a medical facility. (k) Inform the IC and ISO when personnel cannot be released from rehab, and Copyright Lexipol, LLC 2023/05/22, All Rights Reserved. Published with permission by Lehigh Acres Fire Control and Rescue District Rehabilitation - 4 Lehigh Acres Fire Control and Rescue District Supplemental Manual Rehabilitation (l) (b) Ensure documentation of any medical care provided: any and all injuries/ illnesses will require a Patient Care Report to be completed. Rehabilitation Responsibilities during Training Exercises: 1. 2. Members: (a) Participate in rehabilitation when assigned; (b) Maintain proper rest/nutrition regimen; (c) Observe appropriate work/rest cycles; (d) Maintain hydration; (e) Inform supervisor of any ill effects to heat; (f) Remain aware of the health and safety of other crew members. Company Officers: (a) Act as the “Safe Person” during company training. (b) Maintain an awareness of the physical and mental conditions of each member operating within their span of control and ensure adequate steps are taken to provide for each member's safety and health; (c) Ensure members remain hydrated and potable fluids are available; (d) Implement work/rest cycles (i.e., 45-minute work, 10-minute rest); (e) Monitor crew members when training in PPE every 45 minutes and more frequently when wearing SCBA to determine the need for rehabilitation; (f) Monitor the heat index, modify activities, and monitor employees accordingly. 533.7 ESTABLISHING A REHABILITATION AREA: (a) (b) Location: 1. If a specific location has not been designated by the IC or ISO, the Rehabilitation Officer shall select an appropriate location based on site characteristics and designations such as fire apparatus, ambulance, nearby garage, or make-shift rehabilitation structure. 2. The Rehabilitation Officer shall immediately notify the IC or ISO where the rehabilitation area has been established. Site Characteristics: 1. Far enough away from the hot zone/tactical area that members may safely remove their turnout gear and SCBA, preferably upwind; 2. Large enough to accommodate the number of personnel expected with a separate area for members to remove Personal Protective Equipment (PPE) prior to entering rehab; Copyright Lexipol, LLC 2023/05/22, All Rights Reserved. Published with permission by Lehigh Acres Fire Control and Rescue District Rehabilitation - 5 Lehigh Acres Fire Control and Rescue District Supplemental Manual Rehabilitation (c) (d) 3. Provide shade away from exhaust fumes. 4. Provide access to SCBA replenishment/refill equipment; 5. Easy entrance and exit routes for ambulances. 6. Prompt re-entry back into the emergency operation upon completion of rehabilitation; 7. It is helpful if restroom facilities are a part of the rehab area or nearby away from spectators and the media. Site Setup: 1. Use safety cones/tape, if available; 2. Single entry/exit point; 3. Medical Monitoring area; 4. Medical evaluation/treatment area. Resources: 1. Fluids/food - Potable drinking water, sports beverages, ice, food, and snacks (for long duration incidents); 2. Medical monitoring equipment; 3. Tarps; 4. Water supply for active cooling (wet towels, misting fans, ice vests, forearm immersion chairs); 5. Blankets and warm, dry clothing for winter months; 6. Chairs (if available). 533.8 REHABILITATION PROCEDURE: (a) (b) Entry: 1. Collect accountability passport(s)/tags; 2. Place on status board; 3. Log names on the Rehabilitation Worksheet (when used for training, document “Training” as the Incident Location on the top of the form); 4. Dress-down incoming personnel; 5. Assign to seating area. Initiate Incident Rehabilitation Worksheet using vital sign parameters below: 1. Temperature – between 98.6°-100.6° Fahrenheit; 2. Heart Rate – < 100bpm; 3. Respiratory Rate – between 12-20 breaths/min; Copyright Lexipol, LLC 2023/05/22, All Rights Reserved. Published with permission by Lehigh Acres Fire Control and Rescue District Rehabilitation - 6 Lehigh Acres Fire Control and Rescue District Supplemental Manual Rehabilitation (c) (d) 4. Blood Pressure – Systolic <160 and Diastolic <100; 5. Pulse Oximetry (SpO2) – 95-100% on room air; 6. CO Levels (SpCO) – < 10% of baseline level. Life Threatening Signs & Symptoms (If you detect any of these conditions, transport to a medical facility is recommended; follow the current Lee County Common Guidelines for treatment): 1. Chest Pain; 2. Shortness of Breath; 3. Altered Mental Status; 4. Dizziness; 5. Nausea. Cooling (Active is preferred if equipment is available): 1. 2. (e) Passive: (a) Removal of PPE; (b) Remove to a cooler environment. Active: (a) Cold packs; (b) Cool, wet towels; (c) Forearm immersion; (d) Misting fans; (e) Ice vests. Hydration: 1. Water/fluids should be provided. 2. Caffeine and carbonated beverages should be avoided. (f) Members entering rehab shall consume fluids, regardless of thirst, during rehabilitation and continue hydrating after the incident. (g) Rest: 1. Minimum of 10 minutes rest. 2. If vitals are within normal limits, may be released. 3. Additional 10 minutes of rest required if vitals are not within normal limits. 4. If vitals remain outside of normal limits, move to the Medical Treatment Area. (h) Ideally, members should be provided with rehabilitation following the use of a single SCBA cylinder or a 20-minute work cycle. (i) Release: Copyright Lexipol, LLC 2023/05/22, All Rights Reserved. Published with permission by Lehigh Acres Fire Control and Rescue District Rehabilitation - 7 Lehigh Acres Fire Control and Rescue District Supplemental Manual Rehabilitation 1. Any individuals that cannot be cleared shall be reported to the IC and ISO. 2. All personnel leaving rehabilitation shall retrieve their Passports from the Rehabilitation Officer. 3. All completed Incident Rehabilitation Forms shall be given to the IC or ISO upon completion of rehab. 533.9 TRAINING PHYSICAL PREREQUISITES: (a) Training Safety: 1. All training activities will occur with heat indices considered. When the heat index is between 90 and 120, heat stress precautions will be put into place. When a high heat warning is issued by the National Weather Service (NWS), all training will be postponed until the heat index lowers. 2. If outdoor activity will be performed wearing bunker gear/PPE, 10 points must be added to the heat index. If the activity is in direct sunlight, add an additional 10 points. 3. In order for the employee to participate in the training, their vital signs must be taken prior to and after the training exercise. In order for the employee to participate in the training, their vitals must be: (a) Blood pressure less than 160/100; (b) Heart rate less than 100; (c) Respiratory Rate between 12-10/min; (d) Pulse Oximetry greater than 95% on room air; (e) Temperature less than or equal to 100.6F. 4. Members exposed to fire and smoke during live fire training shall also have their carbon dioxide levels assessed before and after training; CO Levels (SpCO) – < 10% of baseline level. 5. If an employee's vital signs exceed either of these parameters, allow the employee to rest for an additional 10 minutes then retake the vital signs; follow Exposure Emergencies /Hyperthermia Lee County Common Treatment Guideline for treatment if necessary. 6. If Advanced Life Support (ALS) treatment (i.e., intravenous therapy, medication administration, etc.) is initiated and the employee’s vital signs still exceed the listed parameters, the employee will be transported to the appropriate facility for evaluation by a physician. 7. The employee and his or her immediate supervisor must fill out an injury report and an incident report. The on-duty Battalion Chief(s) must contact the Division Chief(s) of Operations/Training and Human Resource Manager to advise of employee illness and transport. If the employee refuses treatment or transport, worker’s compensation benefits are forfeited. Copyright Lexipol, LLC 2023/05/22, All Rights Reserved. Published with permission by Lehigh Acres Fire Control and Rescue District Rehabilitation - 8 Lehigh Acres Fire Control and Rescue District Supplemental Manual Rehabilitation 533.10 APPENDIX A & B: See attachment: Rehabilitation Appendix A-B.pdf Copyright Lexipol, LLC 2023/05/22, All Rights Reserved. Published with permission by Lehigh Acres Fire Control and Rescue District Rehabilitation - 9 Attachment Supplemental Manual Rehabilitation Appendix A-B.pdf Rehabilitation Appendix A-B.pdf Copyright Lexipol, LLC 2023/05/22, All Rights Reserved. Published with permission by Lehigh Acres Fire Control and Rescue District Rehabilitation Appendix A-B.pdf - 11 Appendix A – Heat Stress Index Temperature Relative Humidity 10% 20% 30% 40% 50% 60% 70% 80% 90% 104 102 98 97 104 101 120 117 132 100 98 95 93 99 97 110 108 105 101 120 110 132 96 94 92 90 91 89 87 85 95 93 90 88 98 95 92 90 110 106 104 100 96 92 108 105 100 96 120 111 106 100 122 114 122 95 92 128 122 114 106 100 96 88 86 82 80 86 84 87 85 89 87 93 90 89 86 83 80 91 89 85 81 95 91 86 83 109 99 95 89 85 84 82 80 78 78 77 75 72 81 79 77 75 83 80 78 77 85 81 79 78 86 84 81 79 76 74 70 68 72 75 76 77 77 77 70 73 74 75 75 75 Add 10°F when protective clothing is worn. Add 10°F when in direct sunlight. 78 76 79 77 125 125 106 100 115 Humiture °F Danger Category Above 130° Extreme Danger Heat stroke imminent! 105° to 130° Danger Heat cramps or exhaustion likely, heat stroke possible if exposure is prolonged and there is physical activity. 90° to 105° Extreme Caution Heat cramps and heat exhaustion possible if exposure is prolonged and there is physical activity. 80° to 90° Caution Fatigue possible if exposure is prolonged and there is physical activity. Below 80° None Rehabilitation Injury Threat Little or no danger under normal circumstances. Appendix B Emergency Services Personnel Rehabilitation Lee Countr Co1n1non Incident Rehab \IVorkshe,et INCIDIENT LOCATION: INCIDENT NUMBER: I IN!ame Assig;ned Uni, DATE: In itial Evaluation Time B!lcod Pressure P'u[se Rate I I Respirations Temper.alu:re ll\lmpamh:l lfc1Jr,eJ &or.am Clrele SiP02 Level SipC-0 level SiPM.'eI Le�·e.l .. 'nhlries. C,fQillness FF Hydraled? y N y y y N N N 2nd Eva.L Time [1D m1m11� rr0011 Initial] I I I y N y y y M M N y y y y N N N N y N y y y y N N N y y y H N N N y N y y y N N N Bllcod Pressure P'u[se Rate Resoirat ions Tynip.;mic Temp. Sio02 Level SIPCO level SiPM'elt Le•,•·el .. lrd Eva L Time j2>!) m1n11tea fl'Om 111rttal) Blood Pressure P'u[se Rate Respirations Tym-p.anic Temp. Sip02 Level SioCO level· SiPll.1.'el Le•,·el .. Return to Work Time [I:ni�als oflG re·�us·ng rec□ mendafo sJ "If ,l.'edica.I Tx ,g(v,en see Pa ien .. If Eq ipme t Av- "le'b c- re Rep I , ParameteB '!hat must be met to be released Temperat.ure: � OD.8 f F Heart Rate,: <1 bp ResIpiratory Ra.1:e:: Be .Yee 12-20fmi Blood Pn!ss11Jr'e: Systo c ·<100 s:nd Diastolic <1 Pl!llrse Oximetry (Sp02): >91% on ro001 a·· CO Le-veils (SpCO),: <10% o· baseli e Nausea Any .s.igns oi- .symptom.s o:11t.side· thes-e• peramete s'1all be .se.nt to T.rea•tment Are.a •••NO i'ERSON SHOULD BE RELEASED FRO' I REIHAB llNJTIL CLEARIED BY THE RIEHAB OFFICER • ,As I ide Co ender I am oveuid i · he rec , mends,t"□ s made by ihe Re b O "icer by ·ni1ia ing o.·e• and talk ··u11 rE!<Sjpon "b ifiy o· my act·cns b,y s· ing here: ____________ pJ1r.': ___________ Rehab O icer: (Prin!) ____________ (Signal e) __________ Page_ o _ Rehabilitation Lee County Common Treatment Guidelines 200.13[3]