We are all aware that heart attacks are the leading cause of fire service fatalities. Stress is a huge factor in precipitating a cardiac event. Studies abound that say that no extraordinary physical activity should simply be terminated; "cooling down" afterwards is important to allow the body to "de-stress" and return to normal. Personnel should have the opportunity to replenish lost body fluids, add nourishment, give the body a chance to heal, and to be monitored for any adverse effects of exposure.
Managing the resources actually involved in the rescue are given a lot of attention and are the focus of our efforts, but rehabilitation of the personnel involved in these incidents seem often like an afterthought. Planning for the provision of personnel rehabilitation ahead of time will allow more efficient and effective rehabilitation of personnel operating at the rescue scene.
Personnel assigned duties and functions at technical rescue incidents and training should be afforded emergency operations rehabilitation procedures as specified in NFPA 1500, Standard on Fire Department Occupational Safety and Health Programs :
- The fire department shall develop standard operating procedures that outline a systematic approach for rehabilitation.
- The incident commander shall consider the circumstances of each incident and initiate rest and rehabilitation in accordance with the standard operating procedures and with NFPA 1561, Standard on Emergency Services Incident Management System.
- On-scene rehabilitation shall include at least basic life support care.
- Each member operating at an incident shall be responsible to communicate rehabilitation and rest needs to their supervisor.
- A process shall be established for the rapid replenishment of water supplies.
Pre-planned rehabilitation programs are essential for the health and safety of members. The rehabilitation plan should be flexible enough to be implemented for small incidents as well as large-scale ones. Medical evaluation and treatment, food and fluid replenishment, team rotation, and shelter from extreme environmental conditions should be part of the plan.
Particularly in technical rescue, weather can impact the safety and health of members. Where these factors involve prolonged scene times or heavy exertion, personnel risk increases. Part of the rehabilitation procedure should provide for this contingency. Shelter can range from existing buildings or structures, to commercially produced tents or specialized vehicles. If resources are available regionally, find out what they are capable of and establish memoranda of understanding so that you can use them when the time comes. Apparatus can be used, but sometimes space in those vehicles, even in ambulances, is limited.
The assignment of an ambulance crew dedicated to REHAB is essential during long-duration or heavy-exertion incident operations. This crew can be designated to perform rehabilitation functions, as well as be available to provide medical care for personnel. This assignment should be independent of medical treatment and transport for victims. Medical evaluation and treatment in the rehabilitation area should be conducted according to EMS protocols developed by the fire department in consultation with the fire department physician and the EMS medical director. Especially since there is the likelihood of needing ALS for certain exposures (to provide intravenous therapy and cardiac monitoring), paramedical care is preferred to BLS.
Monitoring of personnel should include a cursory baseline pre-entrance evaluation of entry personnel. This data should then be compared against the post-entrance medical monitoring to determine whether personnel have suffered any immediate effects of exposure to hazardous materials or the environment and to determine individual health status for future assignment during or following incident. The monitoring should include physiological and psychological evaluations.
Components of the monitoring protocol should include the member's relevant history, particularly symptoms of hazardous material exposure, environmental exposure, or a cardiac event. Vital signs including blood pressure, pulse rate and quality, respiratory rate, temperature, and an EKG should be assessed. Furthermore, checking the member's entry and exit weight, evaluating their skin, and evaluating their mental status will aid in determining their immediate condition.
A follow-up evaluation of each person in REHAB should be performed every five to ten minutes until the member's pulse lowers back to 85% of maximum pulse rate. If after ten minutes, the member's pulse has not returned to 10% of the baseline, REHAB and/or Medical personnel should perform orthostatic vital sign evaluation and consider transport of the member to a medical facility.
Rest time for team members should equal at least minimum entry time and may require more time for oral re-hydration. The plan should also provide some sort of method of nutrition; Power Bars or similar food are relatively inexpensive, keep fairly well and don't require preparation. While the personnel are in the REHAB area, they should also be briefed to possible signs and symptoms of exposure, while on scene, or afterward in quarters or at home. Affected personnel should be encouraged to seek medical evaluation if signs or symptoms present themselves.
Obviously, by planning in advance, the appropriate resources can be summoned early in the game and be in place by the time the first entry teams are ready to exit. A simple REHAB plan can be put in place and after training all of your personnel in how to implement it, can prove to be a significant asset.
Rehabilitation plans for technical rescue fail for several reasons; personnel fail to "buy in" on the value of the program, participants don't want to show perceived weakness, or there is little effort to allocate the appropriate resources. Rescuers need to understand that the concept of rehabilitating themselves after participating in a strenuous event can possibly save their lives by detecting problems ahead of time. Resting and putting fluids and nutrients back in your body is smart. You would never see a professional athlete declining to take fluids or nutrients if they needed them.
A good REHAB plan will increase morale; it sends the message that your personnel are your most valuable resource and you want them taken care of. REHAB of personnel is vital; just as we wouldn't run a tool without properly maintaining it, we shouldn't be killing ourselves by denying our bodies the ability to recover after technical rescue operations.
