Clearwater Fire & Rescue Department Personnel Rehabilitation SOP 622 PDF

CLEARWATER FIRE AND RESCUE DEPARTMENT STANDARD OPERATING PROCEDURE S.O.P. 622 SUBJECT: Personnel Rehabilitation PAGE 1 OF 6 CATEG...

CLEARWATER FIRE AND RESCUE DEPARTMENT STANDARD OPERATING PROCEDURE S.O.P. 622 SUBJECT: Personnel Rehabilitation PAGE 1 OF 6 CATEGORY: SUBCATEGORY: Support Services Health & Safety APPROVED BY: EFFECTIVE DATE: 09/19/05 REVISION DATE: 09/21/18 REVIEWED DATE: 02/01/22 SIGNATURE ON FILE, APPROVED TO FORM THIS DATE BY SCOTT EHLERS, FIRE CHIEF, FIRE & RESCUE DEPARTMENT FORMS REQUIRED: NOTE: Current forms are located on the Department’s SharePoint. PURPOSE: To ensure that the physical and mental condition of personnel operating at an emergency incident, training exercise, or special event does not deteriorate to a point where it affects the safety of the individual, crew, or the integrity of the operation. SCOPE: This standard applies to all emergency operations, prolonged training exercises, and special events where strenuous physical activity or exposure to heat or cold creates the need for rehabilitation (rehab) of personnel. The goals and objectives of the rehabilitation process shall be to establish procedures for the following:  relief from extreme climactic conditions during emergency operations and prolonged training exercises and special events,  provide hydration and nutritional replenishment,  medical evaluation, recovery, and treatment if required. DEFINITIONS:  Level I Rehab, a.k.a “Informal Rehab”: To be used in situations of short duration. The Incident Commander (IC) may elect to use the LR and or an additional Rescue to staff the Rehab area. Level I supplies would include water and chairs that are carried on the LR vehicle.  Level II Rehab, a.k.a. “Formal Rehab”: To be used at situations that require a major time or personnel commitment. Resources shall include at least one EMS unit and a Supervisor appointed by the IC. Other resources may include the LR, additional rescues, Sunstar units, Sunstar Rehab unit, or other outside resources and vendors.  Recycle- This is an alternative for crews instead of going to a formal rehab. The SCBA’s that went into service in 2016 alarm at 1/3 of a cylinder; therefore, crews may experience a shortened work cycle. Crews may often just need to exit the building, change air cylinders, and intake some fluids before going back to work. Recycling will allow crews to continue to work without going through a formal Rehab. The decision to recycle vs. rehab must be SUBJECT: EFFECTIVE DATE: 09/19/05 S.O.P. 622 Personnel Rehabilitation REVISION DATE: 09/21/18 CATEGORY: SUBCATEGORY: PAGE 2 OF 6 Support Services Health & Safety made by the Company Officer and coordinated and communicated with the IC. Crews may recycle one or two times consecutively; however, after two recycles they should be sent to rehab. When crews are recycling it is critical that crews communicate exiting and reentry to the IC. SOP 606 “Personnel Accountability” must be strictly adhered to. 622.1 Responsibilities All Personnel shall maintain their physical conditioning to minimize the detrimental effects on the human body, resulting from emergency operations, training exercises, and participation in special events, and to optimize their performance under extreme conditions. Each employee has a personal responsibility to be aware that certain medications may impair their body’s ability to perspire and thermo regulate; extreme caution must be exercised. Personnel shall advise their Company Officers or Supervisors of any physical/mental condition or medication which may adversely affect them or their ability to perform their duties. All personnel shall maintain appropriate hydration and nourishment prior to, during, and following the incident, exercise, or event. All personnel shall maintain crew integrity when they are involved in the rehab process, unless instructed otherwise. Personnel shall also remain aware of the health and safety of other members of their crew. Company Officers shall maintain an awareness of the condition of each of their crewmembers. Company.Officers will ensure that adequate steps are taken to ensure the health and safety of their crew. The Company Officer will maintain crew accountability before, during, and after rehab. The Company Officer should encourage their crewmembers to properly hydrate and maintain proper nutrition prior to, during, and after incidents and scheduled training. Rehab Group Supervisor, established on all Level II Rehab operations, shall be responsible for the location, entrance, and exit tracking, accountability of all assigned Rehab personnel, and requesting additional resources through the Command Post. The radio designator for the Rehab Group Supervisor shall be termed “Rehab”. The Rehab Supervisor shall report directly to the IC unless an Operations or Logistics Section is established. The Incident Commander will determine the level of rehab that will be required on any given incident. If it is determined that a Level II Rehab is needed, then a REHAB Group Supervisor shall be assigned. The Rehab Supervisor will consider the circumstances of each incident in order to make adequate provisions for the rehabilitation of all personnel. These provisions include, but are not limited to: hydration, rest from environmental conditions, medical evaluation, and treatment if required. Rehab that is part of any scheduled training activity shall be the responsibility of the Instructor In Charge (IIC) of the evolution. Any rehab at training evolutions shall be in accordance with CFR SOP 310P and the CFR Training Center Manual. Rehab that is part of any special events shall be the responsibility of the fire department officer in charge of the event. SUBJECT: EFFECTIVE DATE: 09/19/05 S.O.P. 622 Personnel Rehabilitation REVISION DATE: 09/21/18 CATEGORY: SUBCATEGORY: PAGE 3 OF 6 Support Services Health & Safety 622.2 Location of Rehab A. The location of rehab should be sufficiently distanced from the effects of the operation so that members can safely remove their personnel protective equipment and SCBA. B. Personnel should be afforded mental rest from the stress and pressure of the emergency operation or training evolution when feasible. C. Rehab should not be located within close proximity of the incident activity, and if possible out of the immediate view of the incident. D. The rehab area should be located upwind and away from the products of combustion and apparatus and equipment exhaust fumes. E. The rehab location should provide suitable protection from the prevailing environmental conditions. F. Other buildings and facilities that may provide a more suitable environment should be considered if available. G. The site should be large enough to accommodate multiple crews and expanded operations if needed. H. Level II Rehab areas shall also meet the following criteria: 1. Must be entry controlled for accountability. 2. Must have a separate area designated for the removal of PPE and SCBA, so that it is not doffed in the area actively used for rehabbing personnel. 3. Must have a clearly defined and staffed medical treatment area adjoining the rehab area. I. In the case of rehab at the scene of a high rise fire, rehab shall be established in accordance with CFR SOP 615, which designates the rehab to be established on the staging floor typically two floors below the fire. 622.3 Equipment A. The type, size, and duration of an incident, evolution, or event, will determine the resources and equipment needed for rehab. The rehab equipment may include: 1. Fluids- water, sports drinks, oral electrolyte solutions, and ice. 2. Food- Firefighters are considered occupational athletes and as such, the Health and Safety Bureau shall determine proper foods for nutrition and performance. The Logistics Bureau shall be responsible for maintaining basic supplies needed and a periodic inventory to maintain and update stock. 3. Medical supplies- BP cuffs, stethoscopes, O2, cardiac monitor with pulse ox, thermometers, IV fluids, and drug box. 4. Other- fans, tarps, awnings, generator, heaters, cooling devices, fire line tape to designate entrance and exit, cones, accountability boards, and rehab tracking sheets. SUBJECT: EFFECTIVE DATE: 09/19/05 S.O.P. 622 Personnel Rehabilitation REVISION DATE: 09/21/18 CATEGORY: SUBCATEGORY: PAGE 4 OF 6 Support Services Health & Safety 5. Potential resources that may provide the above listed equipment may include but are not limited to: a. The LR vehicle b. All rescue units c. Logistics Bureau d. Sunstar Rehab Unit and Sunstar Supervisor on activation of working fire file e. Salvation Army f. Other private sector sources and vendors 622.4 Implementation A. Establishment of a Rehab Operation 1. A Rehab Operation should be considered during the initial stages of an incident, and the need should be reevaluated as part of the ongoing incident assessment. It should also be considered during any extended or physically demanding training evolution, and all special events during extreme weather. 2. Any incident because of its size, duration, environmental conditions, labor intensity, or when deemed appropriate by the IC will warrant some level of rehab to be determined by the IC. 3. During routine incidents, a rehabilitation group may not be necessary. Under these conditions crews are expected to conduct self rehabilitation. This can be the result of their own initiative or an informal order to “take a break”, provided all accountability procedures are followed. Crew rehabilitation may occur during a cylinder change, the transition from fire attack to overhaul, or other similar situations. Crew integrity remains vital and accountability and command procedures shall be strictly adhered to during any form of rehab (formal or informal). B. LEVEL I REHAB OPERATION Level I Rehab should include but is not limited to the following objectives: 1. Removing or adding clothing and PPE to regain normal body temperature of personnel. 2. Rest of personnel for 10 minutes or more based on conditions. 3. Hydration 4. Self monitoring of personnel and seeking further medical treatment for any individuals as needed. C. LEVEL II REHAB OPERATION LEVEL II Rehab shall include all the objectives in Level I, as well as the objectives listed below: SUBJECT: EFFECTIVE DATE: 09/19/05 S.O.P. 622 Personnel Rehabilitation REVISION DATE: 09/21/18 CATEGORY: SUBCATEGORY: PAGE 5 OF 6 Support Services Health & Safety 1. An entry check in and exit check out process shall be established and documented by the Rehab Group Supervisor. a. The Company Officer will check in with the Rehab Group Supervisor upon entry with a PAR report. b. The Rehab Group Supervisor shall record the unit reporting to Rehab, including time in and number of personnel. 2. Accountability shall be in accordance with the CFR Command Manual and SOP 606. Rehab shall be considered an assignment, and crews shall remain there until reassigned by the Rehab Supervisor and/or IC. D. MEDICAL EVALUATIONS 1. At least one pair of EMS personnel shall be present at the Level II Rehab, one of which must be a Paramedic. 2. A minimum of two sets of vitals shall be taken during each rehab rotation, one set upon entry and one prior to exit. 3. Medical evaluation shall include a pulse rate (measured for 30 seconds) taken as soon as possible upon entry in rehab. This should be followed by blood pressure, pulse oximeter, temperature if available, and an assessment of skin color and condition. 4. EMS personnel should briefly question members arriving in rehab to evaluate for any symptoms of dehydration or temperature stress. This may include changes in gait, speech, or behavior, and alertness/orientation to person, place and time. 5. Personnel must meet the all of following criteria to be eligible to be released from rehab. a. Heart rate < 100 bpm b. Systolic blood pressure < 160 mmHg and a diastolic pressure < 100 mmHg c. Must have the approval of the Rehab Supervisor 6. If the heart rate remains above 110 bpm, the person’s temperature should be taken if possible. If the temperature is above 100.6°F, all protective clothing shall be removed. If the temperature is below 100°F and the heart rate remains above 110 bpm, the rehab time should be increased. If the heart rate is below 110 bpm, the chance of heat stress is negligible. 7. Personnel outside of the normal range of established parameters shall be recycled through another approximately 20 minute rehab period and then reevaluated. 8. Personnel who remain outside of one or more of the ranges listed above shall be directed to the medical treatment component of the Rehab Group. Once this process has begun the employee shall be considered a “patient”. All medical treatment shall be in accordance with Pinellas County MOMS protocols. SUBJECT: EFFECTIVE DATE: 09/19/05 S.O.P. 622 Personnel Rehabilitation REVISION DATE: 09/21/18 CATEGORY: SUBCATEGORY: PAGE 6 OF 6 Support Services Health & Safety 9. It shall be understood there is a clear separation between medical evaluation and medical treatment. If there is any question as to whether an employee is healthy enough to return to their duties at an incident scene, the decision shall be made by the IC after consulting with the Rehab Supervisor and/or Paramedics who evaluated and/or treated the employee. At training evolutions it shall be up to the IIC, and at special events the OIC. While Pinellas County EMS protocols give a patient the right to refuse treatment and transport, this shall not be confused with the right and duty that Supervisors have to ensure the health, safety, and well being of all employees; as well as maintain operational readiness. All patient care shall require documentation and notification in accordance with CFR SOP 202. E. EXIT 1. All crewmembers shall enter and exit as a crew. The only exception should be a member of a company who requires additional rehab or medical treatment, but the company still has the ability to operate without the member. Any changes in staffing of the companies shall be reported to the IC for accountability. 2. The Rehab Supervisor shall record the exit time of each crew, and notify the IC as to any changes in crew resource status. 3. If crews are released from rehab to return to work, they shall report back to the IC for their assignment. Crews being released from the incident scene shall check with the IC prior to leaving and retrieve their unit passport. All accountability and command procedures shall be strictly adhered to. REFERENCES:  CFR Command Manual  CFR Standard Operating Procedures – SOP 310P, SOP 615, SOP 606, SOP 202  National Fire Protection Association. NFPA 1584, Standard on the Rehabilitation Process for Members During Emergency Operations and Training Exercises.  Pinellas County Fire Department Standard Operating Procedures, No. 600-12 Rehabilitation, Pinellas County Florida.  CFR Training Center Manual