Operating A Rehab Area - Part 3: Selecting A Site For Rehab Operations

Most organizations will have directions for rehab area location contained within their standard operating procedures (SOPs). All command staff and other members of the organization may be responsible for making the site selection must be familiar with these SOPs.

Who Decides Where To Locate Rehab Area?

One of the first things that must be understood when choosing a rehab area location is exactly who makes the decision. Making a good initial choice for the Rehab Sector/Group is vital because trying to relocate the site in the middle of an emergency incident creates delays and confusion for both sector personnel and the crews who need its services.

Fire department SOPs on this matter usually show this decision resting in one of three locations:

Departmental SOPs - In some cases the departmental SOPs provide very specific requirements for where the rehab area will be located. This is particularly true for agencies that operate specialized apparatus that are dedicated solely to providing rehab service (see photo on previous page). The SOPs may dictate that rehab apparatus be located as close to the command post as possible.

If the SOPs do provide specific instructions on rehab location, they should always be followed as closely as possible. This is because personnel operating on the scene will have an expectation of where to find rehab when they need it. If it becomes necessary to deviate from the SOP, all personnel on the scene should be notified of the new location for the rehab area.

The incident commander - In some jurisdictions the location for rehab will be determined by the incident commander. The incident commander will select a site based on the available possibilities at the scene and the characteristics of the incident. Characteristics of the scene that may influence the selection of the rehab area include the portion of the scene where the most intensive work is being performed (good to locate close to that), upwind of any hazardous gases or smoke, and the potential for the incident to grow and possibly force the relocation of the rehab area.

If the incident commander does select the site, that information should be immediately provided to the person or company who will be responsible for organizing and managing the site, as well as to the rest of the personnel operating on the scene.

The rehab supervisor - Some agencies allow the rehab supervisor to select the site for the rehab area. Generally, in these cases the incident commander determines the need for rehab operations, appoints a person or company to initiate the rehab operations, and leaves the selection of the site to them. If this is the case, the rehab supervisor should notify command of the rehab site as soon as it is determined and this information should be passed on to the rest of the personnel operating on the scene.

Many jurisdictions prefer leaving this decision with the rehab supervisor as they have more time to make the decision and less other things on their mind then does the Incident Commander at that moment.

The Desired Location For The Rehab Area

There are two general schools of thought on what is the ideal location for the rehab area. In some jurisdictions it is felt that the best location is as close to the command post as possible. In other jurisdictions it is their goal to place rehab at a remote area that is as far from the incident operations as reasonably possible. Each theory has its advantages and disadvantages.

Those who choose to place rehab close to command do so in order to allow the incident commander to keep track of how many personnel are in rehab at any given time. It also makes it easier to anticipate when rehabbing companies will become available and ready for a new assignment.

Another advantage of placing rehab near the command post is the ability to cluster support vehicles at one location and take advantage of their equipment. For example, one power and floodlight unit will be able to illuminate and power both the rehab and command areas. This is especially important in jurisdictions with limited resources.

The philosophy of making the rehab area more remote is based on several simple principles. Some people feel that the farther the responders are from the incident, the more easily they will be able to rest and relax. As well, there will be less of a tendency to want to "jump back into the battle" before they are physically or emotionally ready. Some feel that it also reduces the temptation by command officers to place companies back into service too soon. This temptation can be hard to resist when the incident commander has a long list of things that still need to be done and he can see a couple of dozen firefighters sitting in the rehab area.

Rehab Area Site Characteristics

Given that we understand the two basic philosophies on rehab site selection described above, we can then set about choosing a specific location for establishing rehab operations at an emergency scene. The emergency incident rehab (EIR) area should be set up in a location that truly allows firefighters and rescue personnel to get physical and psychological rest. However, departmental SOPs and other incident-related factors will have a bearing on the selection of the exact site.

If the particular jurisdiction chooses to locate rehab close to the command post, there will be little leeway in the selection of the rehab site. Given this circumstance, the rehab group/sector supervisor should try to select an exact location that takes into consideration as many of the site characteristics listed below as possible. In some cases, the department will have a designated rehab vehicle that will be positioned near the command vehicle(s). This will pretty much lock in the rehab site location at that point.

If the rehab group/sector supervisor is not locked into placing rehab adjacent to the command post, the immediate vicinity around the scene may be searched for the best rehab area location. In addition to ideal site characteristics, there are a number of considerations the rehab group/sector supervisor should keep in mind when selecting a rehab site. Some of these include:

The estimated number of responders that will need to be rehabbed. On a small incident with a few companies on scene, it is likely that only one company will need to be rehabbed at a time. This can be accomplished in the climate-controlled cab of an apparatus, back of an ambulance or similar location. Larger numbers of responders means that a larger location will be required.

Weather conditions. If the weather is mild and dry, it may not be necessary to select a location that shelters the responders. However, if it is excessively hot or cold, or if precipitation of any type is falling, it will be necessary to seek a site that provides shelter.

The duration of the incident. If the incident is going to last for the better part of a day, or longer, it may be desirable to locate a building in which rehab may be housed. However, if this building is a place of business, tying it up for that period of time could be disruptive (and harmful) to the owner/occupant. Try to select a location that does not have an adverse effect on members of the public.

With these issues in mind, the rehab group/sector supervisor can then set out to pick the rehab site location.

The following list contains some of the more important site characteristics that must be considered:

• The site should be outside and upwind of the operational hazard area or "hot zone." This allows personnel to remove their turnout gear and self-contained breathing apparatus (SCBA) safely.
• The site should permit prompt re-entry into emergency operations when personnel have completed rehabilitation. The rehab area should not be so remote that the responders have to expend excessive energy traveling back to the scene.
• The site should provide protection from environmental extremes, if necessary. Locations such as shaded, cool areas in hot weather conditions and warm, dry, protected areas during cold weather operations are preferred.
• The site should be large enough to accommodate all those who may need rehabilitation. Remember when laying out the site that crews in rehabilitation will need room to sit or lie down. As well, in previous articles we highlighted several functions (medical evaluation, treatment, fluid replenishment, etc.) that need to be carried out in a rehab area. Each of these may require their own space, particularly on larger incidents.
• The site should be free of vehicle exhaust. If running vehicles are a part of the rehab operation, they should be positioned so that there exhaust discharges downwind of the rehabbing personnel.
• The site should not be immediately accessible to the media. Tired, hungry, thirsty, stressed personnel generally do not make your best media spokespersons. If necessary, assign law enforcement personnel to the rehab area to dissuade off any media that try to interfere with personnel in that location.
• The site should provide access to SCBA replenishment/refill equipment. Apparatus that carry large numbers of spare SCBA cylinders, or that have cascade systems or breathing air compressors should be located at the rehab area.
• The site should have easy entrance and exit routes for ambulances. This will be important in the event it becomes necessary to transport a responder to the hospital for further evaluation and treatment becomes necessary.
• The site should have a supply of running and drinkable water. This simplifies ongoing rehydration operations. It also enables rehab crews to set up a cooling water spray in hot conditions.
• It is helpful if restroom facilities are a part of the rehab area or close to it.
• If the incident involves the recovery of fatalities, the rehab site should be out of view of the work area. This will make it easier for rehabbing personnel to relax and take their mind off of the difficult conditions they are operating within.

Accountability Issues

Once the site is selected, its location should be made known to all incident participants. In large-scale incidents, more than one rehab sector/group may be needed. If more than one area is established, rehab crews at each site must keep accurate logs of the entries and exits of crews in order to assure proper fireground accountability. If the departments involved use a formal accountability system (such as passports), make sure all standard procedures for collecting and returning the identifiers are followed.

It is widely recognized that making a sound size-up and forming an accurate action plan at the beginning of an incident increase the chances of success for an incident commander. The same is true for establishing a rehab operation. If a sound location for the rehab operation is established from the beginning and a good action plan is initiated from the start, the chances of conducting a successful rehab operation are greatly increased.