Fort Worth Fire Department Standard Operating Procedure PDF

# STANDARD OPERATING PROCEDURE ## HEALTH AND SAFETY, REHABILITATION **TITLE:** HEALTH AND SAFETY, REHABILITATION **NUMBER:** S 9207 R2 **EFFECTIVE:** AUGUST 17, 2018 **REPLACES:** S 9207 R1 (11.16.10) **ACCOUNTABILITY:** ADMINISTRATION **REVIEW CYCLE:** ANNUAL ### Purpose To provide guidance on t...

# STANDARD OPERATING PROCEDURE ## HEALTH AND SAFETY, REHABILITATION **TITLE:** HEALTH AND SAFETY, REHABILITATION **NUMBER:** S 9207 R2 **EFFECTIVE:** AUGUST 17, 2018 **REPLACES:** S 9207 R1 (11.16.10) **ACCOUNTABILITY:** ADMINISTRATION **REVIEW CYCLE:** ANNUAL ### Purpose To provide guidance on the implementation and use of a rehabilitation process as a requirement of the incident management system at the scene of a fire, training or other emergency. This document will ensure that the physical and mental conditions of personnel operating at the scene of emergency or training exercise do not deteriorate to a point that affects the safety of any member or jeopardizes the safety of the operation. It will also assure that personnel who might be suffering the effects of metabolic heat buildup, dehydration, physical exertion, and/or extreme weather receive evaluation and rehabilitation during emergency operations. ### Definitions * **Incident Management System (IMS):** A system that defines the roles and responsibilities to be assumed by responders and the standard operating procedures to be used in the management and direction of emergency incidents and other functions. This term can be used synonymously with the term Incident Command System (ICS). * **Canteen:** Is a vehicle that is specifically staffed for support of fire department personnel at incidents with food, water, ice and beverages. * **Medical Monitoring:** The ongoing evaluation of firefighters who are at risk of suffering adverse effects from stress or from exposure to heat, cold, or hazardous environments. * **Rehabilitation:** An intervention designed to mitigate against the physical, physiological, and emotional stress of firefighting or fire training in order to sustain a member's energy, improve performance, and decrease the likelihood of on-scene or training ground injuries. * **Rehab:** Is that area at a fire scene, emergency incident or training event where personnel are sent to rehydrate, rest, or rehabilitate in order to either return to the incident via staging, or to return to duty after the incident or training event. This unit may also be referred to as the Rehabilitation Unit or Group. This area is managed by the Rehab Unit/Group Leader (or Rehab Group Supervisor if established). * **Rehab Vehicle:** A vehicle that is specifically designated for firefighter rehabilitation and rehydration. This vehicle is air conditioned with seating for up to 10-12 personnel and is stocked with water, ice and beverages. ## General Information 1. Rehabilitation should begin when emergency operations or training exercises pose a health and safety risk. For specific training safety procedures, see S 8202 Safety Procedures for In-Service Training. ## The rehabilitation process shall include the following: * Rest * Hydration to replace lost body fluids * Cooling (Passive and/or Active) * Warming * Medical monitoring * Emergency medical care if required * Relief from extreme climatic conditions (heat, cold, wind, rain) * Calorie and electrolyte replacement * Accountability * Release ## Rehabilitation shall be established for: * Large-scale incidents * Long-duration incidents * Physically demanding incidents * Extreme temperatures ## It is inappropriate to send personnel from a hot environment directly into a cool/cold air conditioned environment. The body's cooling system can shut down in response to such external cooling. Shade and fans are the more appropriate method of cooling such persons. ## If an area is designated for rehabilitation of personnel, this area should be clearly marked. Fire line tape may be used to mark this area. ## In high-rise fire situations, the area of rehab will normally be located two floors below the fire floor. ## The Rehab Vehicle may be staffed at the request of any Incident Commander and dispatched to working fires or any incident where rehabilitation of personnel may be necessary. This vehicle also maintains sport drinks, water and towels. ## Instructions/Procedures ### 1. Incident Commander: * **A:** The Incident Commander should consider the need for rehabilitation in his/her size up of the incident. * **B:** The Incident Commander shall consider the circumstances of each incident or training exercise and establish a Rehab Unit or Group (if necessary). The location of the rehab area will normally be designated by the Incident Commander. If a special location has not been designated, the Rehab Unit Leader/Group Supervisor shall select an appropriate site. * **C:** The Incident Commander should assure that adequate resources are committed to the rehabilitation function. This includes adequate levels of EMS care (i.e., Paramedics and MedStar personnel). * **D:** All members of a crew shall be sent to rehab following the use of two 30-minute SCBA cylinders, or one 45 to 60 minutes SCBA cylinder. Shorter times may be considered during extreme weather conditions. ### 2. Company Officers: * **A:** All officers shall maintain an awareness of the condition of each member operating within their span of control and ensure that adequate steps are taken to provide for each member’s safety and health. Each member of the fire department should be familiar with the signs and symptoms of heat and cold stress. * **B:** Requests for relief shall be made through Command. * **C:** Company officers are responsible for keeping their crews intact while assigned to Rehab. * **D:** Crews shall not leave the rehabilitation area until authorized to do so by the rehab officer. * **E:** Par tags of your crew shall be brought with you to Rehab. ### 3. Personnel: * **A:** During periods of hot weather, members shall be encouraged to drink water throughout the day. During any emergency incident or training evolution, all members shall advise their officer when they believe their level of fatigue or exposure to heat or cold is approaching a level that could affect them, their crew, or the operation. All personnel should remain aware of the health and safety of other members of their crew. * **B:** Throughout the day, personnel should consider hydration and drink water throughout the day in order to hydrate their body. * **C:** Each member of the fire department should be familiar with the signs and symptoms of heat and cold stress. * **D:** Promptly inform the company officer when members require rehabilitation and/or relief from assigned duties. * **E:** Maintain unit integrity ### 4. Rehab Unit Leader, or Group Supervisor if established (Usually TACMED): * **A:** If a specific location for rehab has not been designated by Command, an appropriate location shall be selected. The Rehab Unit Leader will be assigned under the Logistics Section if established. * **B:** Don the appropriate Leader/Supervisor vest. * **C:** Rehabilitation should be established in a location that would allow for mental and physical rest. This area should be: * Free from exhaust fumes, hazardous atmospheres and smoke. * Large enough to accommodate multiple crews. * **D:** Request additional resources (Fire Department paramedics, MedStar units, etc.) to assist in this Unit or Group (if established). * **E:** **Accountability** - Personnel assigned to the rehab Unit/Group shall enter and exit the rehab area as a crew. The crew designation, number of crew members, and the times of entry and exit shall be documented by the rehab Unit Leader or Group Supervisor (If established). The Unit Leader/Group Supervisor should report crews in/out of Rehab to the Incident Commander, Staging Officer, or the Accountability Officer if the Resource Status Unit is established. Crews shall not leave the rehab area until authorized to do so by the rehab officer. * **F:** **Medical Monitoring** - All personnel entering the rehab area shall receive a primary survey. EMS personnel should evaluate vital signs, examine members, and make proper disposition (return to duty, continued rehab, or medical treatment and transportation to a medical facility). * EMS personnel shall be aggressive in an effort to find potential medical problems early. * If a firefighter’s heart rate exceeds 110 beats per minute, an oral temperature shall be taken. If the firefighter’s oral temperature exceeds 100.4°F, they should not be permitted to wear protective clothing. Personnel should not be allowed to return to duty until their heart rate and temperature have recovered. * A firefighter who has a sustained Heart Rate of greater than 100 after 20 minutes of rest and rehabilitation should remain in Rehab. Transportation to a medical facility should be considered. * A firefighter whose blood pressure is greater than 160 systolic, and/or greater than 100 Diastolic, should not be released from Rehab and should be continually monitored and treated. Transportation to a medical facility should be considered. * **G:** When units are engaged for three or more hours, arrangements for food and toilet facilities should be made. Normally, the canteen is assigned to the rehab Unit/Group on major incidents. ### 5. General Considerations: * **A:** Active cooling (mist fans) shall be applied where temperatures, conditions, and/or workload create the potential for heat stress. * **B:** In hot, humid conditions, a minimum of 10 minutes (20 minutes preferred) of active cooling shall be applied following the use of the second and each subsequent SCBA cylinder. * **C:** Personnel in rehab shall rest for at least 10 minutes to 20 minutes prior to being reassigned or released. * **D:** The Rehab Unit Leader/Group Supervisor shall assure that on-going medical monitoring and any emergency medical care needed takes place for all personnel who are assigned to rehab. * **E:** If any member is demonstrating abnormal vital signs, he or she shall be monitored more frequently during rehabilitation. * **F:** Personnel who are weak or fatigued with pale clammy skin, low blood pressure, nausea, headache, or dizziness shall be assessed by TACMED (or by an on-scene paramedic) and medical transport should be considered. * **G:** Personnel experiencing chest pain, shortness of breath, dizziness, or nausea shall be transported to a medical facility immediately. * **H:** Personnel who are transported to a medical facility for treatment must be accompanied by a fire department representative. * **I:** Members should drink water during rehabilitation. After the first hour, a sports drink containing electrolytes should be provided. Soda and caffeinated and carbonated beverages should be avoided. * **J:** Nutritional snacks or meals shall be provided as required during longer duration incidents. * **K:** No tobacco use shall be permitted in or near rehab. ### References: NFPA 1584 (2008) Standard on the Rehabilitation Process for Members During Emergency Operations and Training Exercises. **KEN STEVENS, SR.** **FIRE CHIEF** ## Heat Stress Index | Temperature °F | 10% | 20% | 30% | 40% | 50% | 60% | 70% | 80% | 90% | |---|---|---|---|---|---|---|---|---|---| |104 | 98 | 104 | 110 | 120 | 132 | | | | | | 102 | 97 | 101 | 108 | 117 | 125 | | | | | | 100 | 95 | 99 | 105 | 110 | 120 | 132 | | | | | 98 | 93 | 97 | 101 | 106 | 110 | 125 | | | | | 96 | 91 | 95 | 98 | 104 | 108 | 120 | 125 | | | | 94 | 89 | 93 | 95 | 100 | 105 | 111| 122 | | | | 92 | 87 | 90 | 92 | 96 | 100 | 106 | 115 | 122 | | | 90 | 85 | 88 | 90 | 92 | 96 | 100 | 106 | 114 | 122 | | 88 | 82 | 86 | 87 | 89 | 93 | 95 | 100 | 106 | 115 | | 86 | 80 | 84 | 85 | 87 | 90 | 92 | 96 | 100 | 109 | | 84 | 78 | 81 | 83 | 85 | 86 | 89 | 91 | 95 | 9 | | 82 | 77 | 79 | 80 | 81 | 84 | 86 | 89 | 91 | 95 | | 80 | 75 | 77 | 78 | 79 | 81 | 83 | 85 | 86 | 89 | | 78 | 72 | 75 | 77 | 78 | 79 | 80 | 81 | 83 | 85 | | 76 | 70 | 72 | 75 | 76 | 77 | 77 | 77 | 78 | 79 | | 74 | 66 | 70 | 73 | 76 | 75 | 75 | 75 | 76 | 77 | **Note:** Add 10°F when protective clothing is worn and add 10°F when in direct sunlight. | Humiture °F | Danger Category | Injury Threat | |---|---|---| | Below 60° | None | Little or no danger under normal circumstances. Fatigue possible if exposure is prolonged and there is physical activity. | | 80° - 90° | Caution | Heat cramps and heat exhaustion possible if exposure is prolonged and there is physical activity. | | 90° - 105° | Extreme Caution | Heat cramps and heat exhaustion likely if exposure is prolonged and there is physical activity. | | 105° - 130° | Danger | Heat stroke imminent | | Above 130° | Extreme Danger | |