SNFO 08 Rehabilitation Procedures.pdf

Southern Nevada Fire Operations STANDARD OPERATING PROCEDURES EMERGENCY OPERATIONS REHABILITATION PROCEDURES Effective date: Supersedes: SOP# SNFO-08 03/03/2016 02/23/2011 Page 1 of 8 PURPOSE To ensure the recuperation of fatigued personnel to a rested state by reducing the risk of physical an...

Southern Nevada Fire Operations STANDARD OPERATING PROCEDURES EMERGENCY OPERATIONS REHABILITATION PROCEDURES Effective date: Supersedes: SOP# SNFO-08 03/03/2016 02/23/2011 Page 1 of 8 PURPOSE To ensure the recuperation of fatigued personnel to a rested state by reducing the risk of physical and mental injury to emergency responders resulting from extended or hazardous incident operations and/or training in accordance with N.F.P.A. 1584 standards. This procedure shall apply to all emergency operations and training exercises where strenuous physical activity or exposure to excessive environmental elements exists. PROCEDURE GUIDELINES: A. Designation There are two types of incident rehabilitation: 1. SELF REHABILITATION - One unit, self-rehabilitation with the completion of a personnel assessment. 2. FORMAL REHABILITATION - Multi-unit rehabilitation involving the establishment of a Rehabilitation group, and the completion of a Medical Evaluation with documentation. a. Extended – Extension of Formal rehabilitation procedures on incidents requiring an extended amount of time and resources. Generally lasting several hours or spanning multiple operational periods. B. Rehabilitation Procedure Self Rehabilitation Company Officers or the Incident Commanders are responsible for ensuring the health status and readiness to respond for the crew members that they supervise. Self rehabilitation and personnel assessment procedures shall be performed when;  Crew members perform physically taxing activity such as but not limited to; auto extrication, hose line deployment, breaching operations, heavy workouts, etc.   Crew members don and use an SCBA Any time the Company Officer or Incident Commander deems necessary. Company Officers overseeing Self Rehabilitation will ensure that all crew members are given the opportunity to rehydrate and obtain nourishment as needed. Southern Nevada Fire Operations STANDARD OPERATING PROCEDURES EMERGENCY OPERATIONS REHABILITATION PROCEDURES Effective date: Supersedes: SOP# SNFO-08 03/03/2016 02/23/2011 Page 2 of 8 Crew members will perform a brief personnel assessment on each other checking for;   Signs/symptoms of illness or injury Fatigue or weakness that affects operational effectiveness Crew members who have any of the above signs or symptoms, will be treated in accordance with Southern Nevada Health District protocols and a Patient Care Record will be completed. Formal Rehabilitation Company Officers and Incident Commanders will consider Formal Rehabilitation for personnel during the initial planning stages of an emergency response. A rehabilitation group should be considered for any activity/incident that is;      Large in size (second alarm) Long in duration (greater than two hours) Emergency requires special operational tactics (Hazmat, TRT) Emergency operations or training exercises pose a safety or health risk to members Intense labor will rapidly deplete the energy and strength of personnel Any activity/incident that meets the following criteria shall have a rehabilitation group established:    Activities/incidents that go beyond 30 minutes with a heat index of 90 or greater. Completion of two work cycle while using a SCBA Completion of 40 minutes of work without a SCBA cylinder Any crew that meets the above criteria shall undergo Formal Rehabilitation: C. Hydration Each engine company will carry a five-gallon water cooler. This cooler is to be filled with ice and water at the beginning of the shift. The water may be mixed at full strength with an activity beverage (i.e., Gatorade) as needed. Rescues will carry 1,000ml of drinking water per SNHD regulations. Southern Nevada Fire Operations STANDARD OPERATING PROCEDURES EMERGENCY OPERATIONS REHABILITATION PROCEDURES Effective date: Supersedes: SOP# SNFO-08 03/03/2016 02/23/2011 Page 3 of 8 D. Nourishment The Department(s) will provide food (commercially prepared nutritional energy bars, cold sandwiches, soups, etc.) at the scene of a major incident. When the Incident Commander establishes Formal Rehabilitation for extended incidents, the Incident Commander should activate the Red Cross. Smaller incidents will be handled appropriately by the Rehabilitation Group Supervisor. E. Rest Crew members entering rehabilitation for the first time shall rest for a minimum of 10 minutes. For all subsequent trips to rehabilitation the members shall stay for a minimum of 20 minutes. Additional rehabilitation time will be allocated by the Rehabilitation Group Supervisor as needed up to 1 hour. In all cases, an objective evaluation of a member's fatigue level shall be the criteria for rehabilitation time. Crews released from the Rehabilitation Group by the Rehabilitation Group Supervisor shall be sent to the Staging Area to await reassignment. F. Stress Management When mental stress is a factor, CISM/incident stress debriefing shall be activated immediately. G. Medical Evaluation 1. Triage position - May be staffed by a Firefighter at the EMT level or higher. Triage shall evaluate:         Signs/symptoms of illness or injury Fatigue or weakness that affects operational effectiveness Respiratory rate Heart rate Blood pressure Tympanic temperature Pulse oximetery Carbon monoxide oximetery Continued rehabilitation shall consist of additional monitoring of vital signs, providing rest, providing fluids and food. Personnel, whose signs and/or symptoms indicate potential serious medical/traumatic problems, will be treated in accordance with Southern Nevada Health District protocols and transported to a hospital based on those clinical findings. Southern Nevada Fire Operations STANDARD OPERATING PROCEDURES EMERGENCY OPERATIONS REHABILITATION PROCEDURES Effective date: Supersedes: SOP# SNFO-08 03/03/2016 02/23/2011 Page 4 of 8 2. Medical Criteria - Below is a list of objective measurements that the crew member must meet before being released from rehabilitation.    Respiratory rate of 12-20 bpm Heart rate not to exceed 100 bpm Systolic blood pressure of less than 160 and a diastolic blood pressure of less than 100  Tympanic temperature no higher than 100.6 degrees Fahrenheit  Pulse oximeter reading of 95% or greater  Carbon monoxide oximeter less than 5% The crew member must meet all objective criteria before being released from the rehabilitation area. If the crew member fails to meet one or more of the criteria listed above, he/she will remain in rehabilitation until he/she meets the established criteria. In addition to this, the crew member’s subjective feelings must be taken into account. Any crew member that doesn’t feel fit to return to work will be given additional time in rehabilitation. If at the end of a ONE hour rehabilitation period, the crew member is still unable to meet all of the objective criteria, the crew member will be required to be evaluated by a physician and obtain a medical release prior to returning to full duty. 3. Disposition - After the medical evaluation, the Rehabilitation Group Supervisor will determine a proper disposition:  Return to duty  Continued rehabilitation  Transport to medical facility 4. Documentation - All Medical Evaluations shall be recorded on the Emergency Incident Rehabilitation Form. These forms will be submitted to the Incident Commander after the incident. Southern Nevada Fire Operations STANDARD OPERATING PROCEDURES EMERGENCY OPERATIONS REHABILITATION PROCEDURES Effective date: Supersedes: SOP# SNFO-08 H. 03/03/2016 02/23/2011 Page 5 of 8 Accountability Personnel reporting to the Rehabilitation Group shall enter as crews and present themselves to the Rehabilitation Group Supervisor. Crew members shall exit as crews when possible. If any member is detained in Rehabilitation for evaluation or medical treatment, the Rehabilitation Group Supervisor shall notify that crew member’s superior officer. The remaining crew members shall be available in the staging area. The Rehabilitation Group Supervisor or his/her designee shall document on the Emergency Incident Rehabilitation Form: Crew designation Crew members names Vital signs (RR, HR, BP, Temp, Oxygen Sat, Carbon Monoxide %) Associated problems Times of entry to and exit from the Rehabilitation Area Individuals shall not leave the Rehabilitation Area until authorized to do so by the Rehabilitation Group Supervisor. RESPONSIBILITY A. Incident Commander The Incident Commander must 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. These provisions should include the 7 basic functions of rehabilitation: 1. Rest. 2. Revitalization (hydration and nutritional support). 3. Medical evaluation (respiratory rate, pulse rate, blood pressure, temperature, pulse oximetry, carbon monoxide oximetry). 4. Continual monitoring of physical condition and treatment, if necessary, provided by a Basic Life Support (BLS) level or higher. 5. Transportation for those requiring treatment at a hospital. 6. Initial Critical Incident Stress assessment and support. 7. Reassignment. Southern Nevada Fire Operations STANDARD OPERATING PROCEDURES EMERGENCY OPERATIONS REHABILITATION PROCEDURES Effective date: Supersedes: SOP# SNFO-08 03/03/2016 02/23/2011 Page 6 of 8 B. Company Officers The command structure shall be utilized to request relief and reassignment of fatigued crews. Incident commanders should staff the rehabilitation group with a complete engine company and assign the Company Officer as the Rehabilitation Group Supervisor if resources permit. Additional resource may be assigned as needed. C. Personnel All crew members will be responsible for pre-hydration (pre-hydration shall include an additional 16oz (500 mL) of fluids within 2 hours prior to the event) and advising their supervisor when their level of fatigue or exposure to the elements is unmanageable. During rehab:  In order to effectively cool down, members will remove both coat and trousers to allow sufficient air flow across the body.  Members will utilize handi-wipes/moist towels to wipe off their face, neck, ears, and hands at a minimum after a fire incident. REHABILITATION GROUP A. Responsibility When resources are available, the engine company officer should be placed in charge of the group and will be known as the Rehabilitation Group Supervisor. The Rehabilitation Group Supervisor will typically report to the Logistics Section Chief in the framework of the incident command system. In the event a Logistics Section Chief is not assigned to the incident, the Rehabilitation Group Supervisor will report to the Operations Section Chief. If the Operations section is not formally established then the Rehabilitation Group Supervisor will report directly to the Incident Commander or designee. B. Location The Incident Commander will designate the location for the Rehabilitation Area. If a specific location has not been designated, the Rehabilitation Group Supervisor shall select an appropriate location based on the site characteristics and designations below. C. Site Characteristics The Rehabilitation area should: 1. Be in a location that will provide physical rest. 2. Be far enough away from the scene that members may safely remove their P.P.E. and be afforded mental rest from the stress and pressure of the emergency operation or training evolution. 3. Provide suitable protection from the prevailing environmental conditions. Southern Nevada Fire Operations STANDARD OPERATING PROCEDURES EMERGENCY OPERATIONS REHABILITATION PROCEDURES Effective date: Supersedes: SOP# SNFO-08 03/03/2016 02/23/2011 Page 7 of 8 4. Enable members to be free of exhaust fumes from apparatus, vehicles, or equipment, (including those involved in the Rehabilitation Group operations). 5. Be large enough to accommodate multiple crews, based on the size of the incident. 6. Be easily accessible by EMS units. D. Resources  Fluids – Water, activity beverage, and ice.  Food – Commercially prepared nutritional energy bars, cold sandwiches, soups, etc.  Medical – Blood pressure cuffs, stethoscopes, tympanic thermometer, pulse oximeter, carbon monoxide oximeter, oxygen administration devices, intravenous solutions.  Other – Awnings (EZ Ups), fans, tarps, floodlights, blankets and towels, chairs, small traffic cones and fire-line tape (to identify the entrance and exit of the Rehabilitation Area). Heat Index Chart (Apparent Temperature) The Heat Index (HI) is the temperature the body feels when heat and humidity are combined. The chart below shows the (HI) that corresponds to the actual air temperature and relative humidity. (NOTE: This chart is based upon personnel being in the shade with light wind conditions, wearing normal clothing.    Exposure to direct sunlight can increase the HI by up to l5°F. Exposure to dry, hot winds will increase the HI as well. Wearing of PPE during these conditions increases HI by 10 degrees! Due to the nature of the heat index calculation, the values in the table below have an error of +/- 1.3F.) Updated chart on next page: Southern Nevada Fire Operations STANDARD OPERATING PROCEDURES EMERGENCY OPERATIONS REHABILITATION PROCEDURES Effective date: Supersedes: SOP# SNFO-08 03/03/2016 02/23/2011 Page 8 of 8 Heat stroke likely! Sunstroke, muscle cramps and/or heat exhaustion likely. Heatstroke possible with prolonged exposure and/or physical activity. Sunstroke, muscle cramps and/or heat exhaustion likely. Heatstroke possible with prolonged exposure and/or physical activity. Fatigue possible with prolonged exposure and/or physical activity.