On-Scene_Rehabilitation.pdf

Procedure 305 Chesapeake Fire Department Fire Procedure Manual Copyright Lexipol, LLC 2023/03/25, All Rights Reserved.Published with permission by Chesapeake Fire Department On-Scene Rehabilitation - 1 On-Scene Rehabilitation 305.1 PURPOSE AND SCOPE This document provides operational proce...

Procedure 305 Chesapeake Fire Department Fire Procedure Manual Copyright Lexipol, LLC 2023/03/25, All Rights Reserved.Published with permission by Chesapeake Fire Department On-Scene Rehabilitation - 1 On-Scene Rehabilitation 305.1 PURPOSE AND SCOPE This document provides operational procedures for Chesapeake Fire Department firefighter rehabilitation. This procedure shall be implemented any time the need for rehabilitation is identified. Examples include working fires, multi-alarm incidents, extended operations, training evolutions, and others Corresponding Policies: • 1023 Critical Incident Stress Debriefing • 907 Climate Extremes Program 305.1.1 DEFINITIONS Level 1 Rehab- Self-rehab conducted by each company on minor incidents (e.g. small brush fire, tree down, car fire). It also includes rehabilitation for training. Level 2 Rehab- Formal Rehab on incidents up to and including a single alarm will be conducted by an assigned unit (i.e. rehab may be accomplished within a medic or other area.) Level 3 Rehab- Formal Rehab on greater alarm incidents require the commitment of Rehab resources to accomplish the necessary Rehab tasks within a recognized Rehab Area. 305.2 RESPONSIBILITIES a. The Incident Commander shall: 1. Ensure that a rehabilitation group is established when indicated. 2. Assume the responsibility if it is not delegated. 3. 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. 4. Identify those resources to be used at an incident rehabilitation facility. b. The Rehabilitation Officer shall: 1. Be responsible for all rehabilitation. 2. Designate a responder rehabilitation location(s) and ensure it is communicated to the incident commander. 3. Request necessary medical personnel to evaluate the medical condition of personnel being rehabilitated. 4. Request necessary resources and rations for personnel rehabilitation, including feeding and hydration. 5. Release rehabilitated personnel for reassignment. 6. Release members needing additional medical care to EMS. Maintain the accountability of all personnel in the rehabilitation location. Chesapeake Fire Department Fire Procedure Manual On-Scene Rehabilitation Copyright Lexipol, LLC 2023/03/25, All Rights Reserved.Published with permission by Chesapeake Fire Department On-Scene Rehabilitation - 2 7. Maintain appropriate records and documentation. c. The Company Officer shall: 1. 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. 2. Ensure that members remain hydrated and that potable fluids are available. 3. Continuously assess their crew's mental and physical endurance at least every 30 minutes and more frequently when working in extreme conditions to determine their need for rehabilitation. d. Each Member shall: 1. Participate in rehabilitation services when instructed or assigned. 2. Maintain their hydration. 3. Advise their company officers when they believe their fatigue or exposure to the working climate is approaching a level that could negatively impact themselves, their crew, or the current operation they are engaged in. 4. Remain aware of the health and safety of the other crew members. e. The Training Division shall: 1. Develop nd maintain an annual training program on rehabilitation for the department. 2. Ensure all members understand the rehabilitation process. 305.3 FIRST FIVE MINUTES a. The Incident Commander (IC) shall determine whether operational needs and weather conditions require establishing a formal rehabilitation group. 1. Level 1 Rehab can be informal for training evolutions and routine incidents such as minor structure fires or small wildland fires. Informal rehabilitation is usually performed at the company level. The accountability system applies to both informal and formal rehabilitation. 2. Rehabilitation shall begin when emergency operations or training exercises pose a potential safety or health risk to members. b. During the 360 assessment and size-up, the IC should take notice of appropriate locations for rehabilitation operations. 1. Potential locations for a formal rehabilitation group shall be noted in the Initial Action Plan. 2. The rehabilitation group shall be positioned to best advantage outside the immediately dangerous to life and health (IDLH) area. c. Assign a rehabilitation officer, if required, as soon as resources permit. Chesapeake Fire Department Fire Procedure Manual On-Scene Rehabilitation Copyright Lexipol, LLC 2023/03/25, All Rights Reserved.Published with permission by Chesapeake Fire Department On-Scene Rehabilitation - 3 1. The IC is responsible for rehabilitation of members unless that duty is delegated to a rehabilitation officer. d. Call for any additional required resources. 1. If needed the IC or rehabilitation officer shall call for rehabilitation resources, including emergency medical service (EMS) units dedicated to rehab, early in an incident to allow time for the resources to arrive and set up the formal rehabilitation location. 305.4 RESOURCE DEPLOYMENT (a) Location 1. The rehabilitation group shall be positioned to its best advantage. 2. Primary considerations include, but are not limited to the following: (a) Sufficient space to accommodate the number of personnel expected. (b) Adequate space for a separate area to remove personal protective equipment (PPE). (c) Accessibility for EMS/medic units should medical treatment or transport be required.. (d) Away from hazardous atmospheres including apparatus exhaust, smoke, and other toxins. (e) Uphill and upwind from any gross decontamination area. (f) Ability to protect/mitigate from conditions; such as air conditioning or shade in the summer and protection from inclement weather (cold/rain/snow). (g) Accessibility to a water supply for decontamination, hydration, and active cooling. (h) Away from spectators and media whenever possible. (b) Personnel (Rehabilitation Team) 1. The rehabilitation team should have sufficient personnel to accomplish these functions: (a) Accountability for rehab check-in/check-out. (b) Overall operations of the Rehab unit. To include but not limited to: 1)Provision of hydration and nourishment, 2) Warming or cooling aids as required, and 3) Personal relief and hygiene as required. (c) EMS personnel for vital sign monitoring. (d) Critical Incident Stress Team (if required). 305.4.1 REHAB RESOURCES (a) Rehab resources can be requested on all working incidents or when requested by the IC. It will continue to be the responsibility of Incident Command to make an early Chesapeake Fire Department Fire Procedure Manual On-Scene Rehabilitation Copyright Lexipol, LLC 2023/03/25, All Rights Reserved.Published with permission by Chesapeake Fire Department On-Scene Rehabilitation - 4 determination of situations requiring the implementation of a Rehab Group. Given the time needed to assemble and deploy the necessary resources, the IC shall call for Rehab resources early (including the Rehab Unit). (b) Due to the incident size, weather conditions, or geographic barriers, it may be necessary to establish more than one Rehab Group. When this is initiated, each Group will assume a geographic designation consistent with the location at the incident site, i.e., Rehab South, Rehab North. (c) At incidents involving significant life loss or extended rescue operations (i.e., plane or train crash), the behavioral health group should be contacted and assigned to the Rehab Group for critical incident stress. 305.5 OPERATIONS (a) Entry Point 1. When practicable, company officers shall direct crews to rehab together. 2. Make an initial medical screening assessment for general signs and symptoms requiring treatment and an initial evaluation of vital signs. 3. Remove PPE and provide clean-up/decontamination resources. Gross decontamination techniques should be employed before contact is made with gear and equipment involved in suppression operations or a hazardous materials response in the hot zone. 4. If no further medical attention is required, direct crew members to hydration, replenishment, warming, or cooling resources. (b) Hydration and Replenishment • Members in rehab should:: (a) Have relief from climatic conditions. (b) Rest and recover. (c) Avoid carbonated or caffeinated drinks. (d) Avoid fried foods or high fat foods. (e) Eat easily digested foods. (f) Drink at least 8 ounces of fluid every 15 minutes. (c) Medical Treatment and Transport for Rehab 1. EMS members assigned to rehab must: (a) Provide a full medical screening assessment and take vital signs including: 1. Temperature 2. Blood pressure 3. Heart rate 4. Respiratory rate Chesapeake Fire Department Fire Procedure Manual On-Scene Rehabilitation Copyright Lexipol, LLC 2023/03/25, All Rights Reserved.Published with permission by Chesapeake Fire Department On-Scene Rehabilitation - 5 5. Pulse oximetry 6. CO Level 7. Skin Condition (b) Treat members exhibiting signs or symptoms requiring further assessment, vital signs exceeding EMS protocols and/or symptoms of heat/cold stress. (c) Treat minor injuries. (d) Arrange for patient transfer to other EMS crews for medical transport as needed. (e) Reassess each member's vital signs before returning to duty. (d) Return to Duty and Reassignment 1. The Company Officer is responsible is responsible for ensuring members and crews are adequately hydrated and receive medical treatment if required, rest and medical clearance before returning to duty or reassignment. 2. When performing Rehab, rest periods should be no less than 20 minutes under any conditions.They should be a minimum of 20 minutes after using a second self-contained breathing apparatus (SCBA) cylinder. 3. The rehabilitation officer will have the authority to adjust the time frames depending on work or environmental conditions. 4. A record of all members passing through rehabilitation will be maintained. The record must include the following: (a) Unit number (b) Member name (c) Badge Number (d) Vital signs (e) Time in/time out for members entering or leaving rehab (f) Disposition 5. The Rehab Officer must release any member in Rehab before returning to service. 305.5.1 CRITERIA FOR REPORTING TO REHAB a. Members will report to the Rehab Group as follows: 1. After using two SCBA cylinders. 2. After 20 minutes of intense physical labor. 3. After SCBA failure. Chesapeake Fire Department Fire Procedure Manual On-Scene Rehabilitation Copyright Lexipol, LLC 2023/03/25, All Rights Reserved.Published with permission by Chesapeake Fire Department On-Scene Rehabilitation - 6 4. After performing duties in hazardous materials encapsulating suits. 5. Other times as needed 6. The incident commander may adjust these parameters based on the incident and environmental conditions. b. Formal Rehab Process 1. Gross decontamination 2. Enter the Rehab area 3. Vital signs upon entry 4. Active cooling/heating/drying/defrosting 5. Hydration 6. Nourishment 7. Reassessment of vitals at the 20-minute mark 8. If all vitals are good, exit evaluation complete 9. The Rehab Officer will report to Command when a company is cleared c. Entry Evaluation 1. Before entering the rehab area, all members shall take steps to reduce contamination. Gross decontamination of PPE should be done on the fire ground using water streams, fans, and brushes. 2. Weather permitting, members should remove coats, helmets, gloves, and protective hoods and, if possible, stage them outside the rehab area. 3. Members must make every effort to hand wash before entering Rehab. 4. Rehab members will assess the following on all members: a) temperature, b) blood pressure, c) heart rate, d) respiratory rate, e) pulse oximetry, f) CO level, and g) skin condition 5. Any member with a temperature greater than 101.6 F will rest for 20 minutes, rehydrate, replenish carbohydrates, and perform active cooling and then be re-evaluated in the exit evaluation. d. Exit Evaluation 1. They will exit rehabilitation if they meet the evaluation benchmarks outlined in 305.5.2. 2. If they do not meet the evaluation benchmarks outlined in 305.5.2 after the initial entrance (1) and exit evaluation period (2), they will be transferred to Medical Treatment and Transport. Medical Control will be contacted and treated appropriately. 3. Transport should be considered to an appropriate medical facility for further evaluation and treatment of illness or injury: including any member with a temperature greater than 100 °F (37.7 °C) or a blood pressure less than 100 systolic. Chesapeake Fire Department Fire Procedure Manual On-Scene Rehabilitation Copyright Lexipol, LLC 2023/03/25, All Rights Reserved.Published with permission by Chesapeake Fire Department On-Scene Rehabilitation - 7 305.5.2 MEDICAL TREATMENT AND TRANSPORTATION (a) Members reporting here will receive evaluation and treatment for heat stress and other injuries or illnesses. A rehab form must be started for each member sent to this area. (b) The member(s) assigned to Medical Treatment and Transport will advise the Rehab Group Supervisor of the necessity of medical transportation and extended medical attention requirements of members. A department representative must accompany members who are transported to a medical facility. (c) The members in this Section will pay close attention to any of the following in accordance with the Regional Medical Protocol: 1. Pulse (over 110 bpm) 2. Sustained Pulse oximetry of 94% or BELOW 3. Blood pressure (systolic above 160 or diastolic above 100) 4. Body temperature excess of 100°F 5. CO levels above 3% 6. Obvious injuries or illness 305.5.3 RETURN TO DUTY AND REASSIGNMENT (a) Diligent efforts and face-to-face communication with the Rehab Group Supervisor must determine a crew's readiness for reassignment. Members staffing this area advise the Rehab Group Supervisor of the status of all companies for release from Rehab. This information is relayed to Command by the Rehab Group Supervisor. (b) The Rehab Group Supervisor must release members before they resume operations. (c) The Rehab Group Supervisor will update Command throughout the operation with pertinent information including the identities of companies in Rehab, the companies available for reassignment, and the status of injured/ill members. (d) The Rehab Group Supervisor will direct the crew to the appropriate areas. Company officers shall keep crews intact and report to the proper areas in rehab. However, the Company Officer ensures crew members receive refreshments, rest, and medical clearance.