Article for the
Month of May 2008
Prepared for Steel
Valley Fire by Chief Jack Jones
Bedford County
Department of Fire & Rescue
1305 Falling Creek Rd.
Bedford, Virginia 24523
Phone: (540) 587-0700
Fax: (540) 586-2176
Email: j.jones@co.bedford.va.us
Emergency Incident Rehabilitation
I think back to when I began in this business, when one of the guys, (we were all guys back then) was sent to REHAB it meant that there was now an opening on a shift for a few weeks and more often then not a lot of damage to one of the rigs. Not so the case in our current Fire and Rescue operations, today the mention of REHAB conjures up all types of thoughts such as, Gatorade, BP cuffs, misting fans, lawn chairs with the attached ice bags and any number of other gadgets. In some systems we dispatch a REHAB component on the initial dispatch and in others we wait until everything is darkened down before the first plastic bottle is cracked open.
What I have found lacking in many systems is the command level directive, “Thou Shall Go To REHAB” and perhaps more importantly that it will consist of the following components. In today’s fire service there is no reason for a lack of direction in regards to the establishment of REHAB. The National Fire Protection Association (NFPA) has a standard which, if embraced will be of great value to the fire & emergency services. NFPA 1500 clearly states that “The Fire Department shall develop standard operating guidelines that outline a systematic approach for the rehabilitation of members operating at incidents.” (1)
Think about it yourself, in some systems you go to REHAB after one air bottle, in others after two, three etc. If you as a Firefighter are in need of REHAB after one bottle without extenuating circumstances (medical complaint – entrapments - flashover- extreme environmental conditions) then maybe you are not in the right business, or if we are still aggressively fighting this fire in attempts to save life and property (kinda our core mission) with real potential to save that L&P should we all be doing the Gatorade Parade to the Sally Wagon? It would be great if every member understood how the REHAB process worked and what to expect each time. (I personally hate removing my gloves once they are wet, if REHAB consists of handing me a bottle of Mongahalia water, I would leave them on my hands).
Other than a break away from the action, a temperature appropriate environment (cool or hot) and the beverage of choice, what actions should appropriately be occurring in the REHAB area and why? Think about it, the vital sign assessment is very important, but which ones are priorities and what parameters are acceptable? To get to the heart of the matter, which standards will the Fire Chief enforce when EMS reports that certain members should not be cleared to return to duty? Now that is the central part of this issue isn’t it? Firefighters getting mad when they are sidelined or EMS providers working from a potentially flawed or nonspecific set of guidelines and the resulting sidelining of necessary suppression personnel with decrease in the available firefighting force, and the added conflict between two disciplines of the same team. Our goal must be to do what is right, for the collective good; rest assured that if a member wants to get mad at the Chief they will find something, let’s not make it a health and safety issue if we can avoid it.
In this day and time we are often regulated by the powers above and as firefighters that just rubs us the wrong way, after all we know when we need a break, and what about individual responsibility? Doesn’t our experience count for anything in terms of ensuring a successful outcome to an incident? NFPA 1500 has a section specifically addressing this – Section 8.6.4 “Each member operating at an incident shall be responsible to communicate rehabilitation and rest needs to their supervisor.” Now this adds a key component to the successful development of an SOG, the input from the guy on the nozzle. (2)
To be successful each agency or group of agencies must develop a Standard Operating Guide (SOG), reviewed and approved by all parties specifically a Medical Director and Fire Department Health & Safety Officer or Risk Manager (a complication is not the time to find out that the local insurance will not cover a LODD due to hypertension, etc). There are few standards available to guide vital sign parameters, one suggests initial heart rate greater then 120 beats per minute, blood pressure of greater then 200 mm hg or less the 90 mm hg systolic or greater then 110 mm hg diastolic and any signs and symptoms of injury are indicators to refer the subject to future medical treatment versus remaining in the REHAB area. (3)
This SOG should clearly define what vital sign parameters are acceptable, lets face it all of us get a little excited when we get to dance with the red devil; however, physiologically (I know that is a big word but I am a graduate of the Center for Emergency Medicine) we should not display the S&S of hypertension simply from a room and contents fire, nor do we want to suffer a heart attack, stroke or other potentially avoidable complications if at all possible. This is where a Medical Director who is familiar with the functional job description of a firefighter is beneficial by developing an SOG based on the skill sets required of a firefighter, weight of equipment and other known factors a set of acceptable and appropriate parameters can be established.
As with any draft SOG it must be reviewed by all involved parties. Will the Chief support and enforce it? Can EMS accomplish the tasks required, do they have the requisite knowledge, skills and ability and personnel available and is there additional equipment that is required and who pays for it? Do the firefighters view this as a benefit or a detriment? Do the surrounding Fire Companies support this as far as providing Mutual Aide when your members are sidelined and will they adhere to your SOG as the IC?
Far too often REHAB has been viewed as a place to get a drink and catch up on old times. We have been denying ourselves a good rest, brief medical review and opportunity for re-hydration, all key components of a comprehensive member rehabilitation operation.