Incident Rehab

Nearly half of on-duty firefighter deaths are due to overexertion. This includes deaths from heart attacks as well as heat stress. Rehabilitation should be part of any department's health and safety program, as a proper incident rehab program can...


Nearly half of on-duty firefighter deaths are due to overexertion. This includes deaths from heart attacks as well as heat stress. Rehabilitation should be part of any department's health and safety program, as a proper incident rehab program can help reduce adverse events to the health of the...


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Nearly half of on-duty firefighter deaths are due to overexertion. This includes deaths from heart attacks as well as heat stress. Rehabilitation should be part of any department's health and safety program, as a proper incident rehab program can help reduce adverse events to the health of the firefighters operating at the scene. The goal of the rehab sector is to let responders return to a state of readiness to operate safely during an incident.

Originally, National Fire Protection Association (NFPA) 1500, Standard on Fire Department Occupational Safety and Health Program, recommended that fire departments perform rehab services at emergency incidents. However, this standard offered little guidance on how fire departments were to carry out this recommendation. As a result, NFPA 1584, Standard on the Rehabilitation Process for Members During Emergency Operations and Training Exercises, was released in 2008 to assist with developing rehab procedures. NFPA 1584 outlines essential components to a rehab program listed in Table 1.

An incident rehab program is only one component of a health and safety program. Ensuring that members are physically fit and medically cleared to perform firefighting operations is essential to reducing adverse events for firefighters. This will reduce the chance that firefighters with medical conditions predisposing them to adverse events while performing firefighting activities are present and operating at emergency incidents. Firefighters who have higher levels of fitness also have physiologic characteristics that will allow them to adapt to and recover from the physical requirements of firefighting operations more efficiently than unfit individuals. The following offers suggestions to organize and run a rehab sector at an incident.

  • Relief from environmental conditions — The rehab sector must have the ability to take away environmental factors of the scene, whether it is cold or heat. This is a physical application. In general, the rehab sector should be placed away from vehicle exhaust and smoke from the incident. The rehab sector should be large enough to accommodate the members operating at the scene comfortably. It should have a defined perimeter and defined entry and exit points for accountability purposes.

    During fires, we usually are concerned about heat exposure to firefighters. Placing the rehab sector in a shady area, using cooling fans or providing a climate-controlled shelter (an air-conditioned vehicle or tent) are suggestions that will give firefighters relief from heat exposure. In certain areas of the country, the opposite may be true: rehab must provide shelter from the cold. Again, this could be a heated tent or a heated bus or other vehicle requested to the scene specifically for rehab. An adjacent (non-exposed) lobby could also be used. Crew cabs can be used, but they are not ideal due to limited space.

  • Rest and recovery — Firefighting is physically intense. Typical structural firefighting operations require members to exert themselves at high levels for prolonged periods. Rest is essential for firefighters to regain their strength and be able to operate efficiently and safely on the fireground. NFPA 1584 recommends a minimum of 20 minutes rest after consuming two 30-minute air bottles.

  • Cooling or re-warming — This lets firefighters relieve the stress of environmental factors on their bodies. Bunker gear not only keeps heat from the environment out, it keeps heat close to the skin and when properly worn can keep heat in and raise the core temperature of firefighters. Bunker gear should be removed to let their bodies cool. Ice packs, cool water or sports drinks should be offered to help cool their bodies.

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