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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- Food and fluid replacement — Cold water should be provided at incidents. Firefighters are at risk for dehydration due to the work environment. Dehydration increases the risk of heat emergencies and can cause physical impairment to a firefighter, increasing the chance of an adverse fireground event. Additionally, when people perspire, it is not just water on their skin. Electrolytes (salt) are also excreted with water. This can cause firefighters to be at risk of electrolyte imbalances that increase fatigue. Sports drinks are an option for electrolyte replacement. If sports drinks are used, they should be diluted by half to match the physiologic electrolyte concentrations of the body. Physical labor requires energy, and energy comes from food intake. Provisions for food should be made at prolonged incidents to provide firefighters with nourishment to continue operations.
Medical monitoring and treatment — This is an important aspect of rehab, since the majority of firefighter deaths are due to overexertion. The rehab sector must be adequately staffed with personnel trained to look for physiologic signs or symptoms that a firefighter may need transport to a hospital for further medical evaluation and or treatment. This includes persistent tachycardia (heart rate greater than 120), persistent hypertension (systolic blood pressure above 140), chest pain, shortness of breath, respiratory distress, cool and clammy skin, extreme fatigue, extreme diaphoresis, altered mental status and body temperature over 100.5 Fahrenheit (see Table 2). These are all signs that the firefighter may be at risk for physiologic decompensation due to overexertion and should be transported to a medical facility.
Increased heart rate and blood pressure are a normal response to work and firefighters may have elevated blood pressures and heart rates initially during the rehab process. However, after a period of rest, the firefighters' vital signs should start to normalize and these firefighters do not need to be transported to a medical facility. Fire departments should have standardized criteria that indicate who should be transported to the hospital for further evaluation and what criteria must be met before the firefighter can return to operations (see Table 3). Qualified personnel should be in the rehab sector to treat minor injuries or have EMS transport available should members need transport to a medical facility.
- Accountability — There are two aspects of accountability regarding rehab. The first aspect is that all members are tracked on scene and assigned to the rehab sector at appropriate times. The second aspect is that rehab personnel monitor all firefighters in the rehab sector and the firefighters do not leave the sector until released. All firefighters should be monitored periodically for the need to access the rehabilitation sector. Company officers should monitor members for signs of fatigue or overexertion. Every personnel accountability report (PAR), typically 20-minute benchmarks during the incident, is an excellent reminder to assess your members. NFPA 1584 recommends that firefighters need to enter a formal rehab sector after consuming two 30-minute self-contained breathing apparatus (SCBA) bottles, after consuming one 45-minute SCBA bottle, after wearing a fully encapsulating suit or after 40 minutes of intense physical activity.
Additionally, command should ensure that a rehab sector is established and that enough resources are on scene so that operations can continue while members have adequate time in rehab. Command should ensure that all members operating at the scene are rotated through the rehab sector. For example, the Engine 1 officer notifies command that members of Engine 1 are entering the building after changing their bottles. The incident commander notes that the Engine 1 members are on their second bottles. When Engine 1 notifies command that the company is exiting the building, command will know the firefighters are due for rehab since they each have finished two bottles.
A defined entry point should be made into the rehab sector and all personnel entering the rehab sector should be documented, along with time entered and initial vital signs. This will help identify companies that have been rehabbed and companies that probably will need rehab. This also helps ensure that personnel have a sufficient period of rest, as some aggressive firefighters may try to get in and get out to continue with operations before they are appropriately recuperated.