Civil disturbances

Rehabilitation (pg 1 of 6)


PURPOSE: To ensure that the physical and mental condition of firefighters operating at the scene of
an emergency or a training exercise does not deteriorate to a point that affects the safety of each
member or that jeopardizes the safety and integrity of the operation.
SCOPE: This procedure shall apply to all emergency operations and training exercises where
strenuous physical activity or exposures to heat or cold exist.
RESPONSIBILITIES:
a. Incident Commander
The Incident Commander shall consider the circumstances of each incident and make adequate
provisions early in the incident for the rest and rehabilitation for all members operating at the scene.
These provisions will include: medical evaluation, treatment and monitoring; food and fluid
replenishment; mental rest; and relief from extreme climatic conditions and the other environmental
parameters of the incident. The rehabilitation will include the provision of Basic Life Support (BLS)
level and or Advanced Life Support (ALS).
b. Company Officers
All Company Officers shall maintain an awareness of the condition of each member operating within
their span of control and ensure that adequate steps are taken to provide for each member's safety
and health. The command structure shall be utilized to request relief and the reassignment of
fatigued crews.
c. Firefighters
During periods of hot weather, members shall be encouraged to drink water and activity beverages
throughout the workday. During any emergency incident or training evolution, all firefighters must
take personal responsibility for their health and rehab needs, and shall advise their supervisor when
they believe that their level of fatigue or exposure to heat or cold is approaching a level that could
affect themselves, their crew, or the operation in which they are involved. Members shall also
remain aware of the health and safety of other members of their crew.

ESTABLISHMENT OF REHABILITATION GROUP/SECTOR:
a. Responsibility.
The Incident Commander will establish a Rehabilitation Sector or Group when conditions indicate
that rest and rehabilitation is needed for personnel operating at an incident scene or training
evolution. A member will be placed in charge of the sector/group and shall be known as the Rehab
Officer. The Rehab Officer will typically report to the Incident Commander or any other designated
officer in the framework of the incident management system. Summary of the Rehab Officers
responsibilities:
1) Location of rehab area if not already done
2) Allocate resources for set-up, medical supplies, nourishment, establishing a rehab representative
to monitor the bottle changing station
3) Ensure proper medical evaluations of personnel in rehab
4) Ensure accountability of personnel in rehab
5) Secure proper rehab documentation of personnel

Rehabilitation (pg 2 of 6)

b. Location The Incident Commander will normally designate the location for the Rehabilitation Area. If a specific location has not been designated, the Rehab Officer shall select an appropriate location based on the site characteristics and designations below. c. Site Characteristics (1) It should be in a location that will provide physical rest by allowing the body to recuperate from the demands and hazards of the emergency operation or training evolution. (2) It should be far enough away from the scene that members may safely remove their turnout gear and SCBA and be afforded mental rest from the stress and pressure of the emergency operation or training evolution. (3) It should provide suitable protection from the prevailing environmental conditions. During hot weather, it should be in a cool, shaded area. During cold weather, it should be in a warm, dry area. (4) It should enable members to be free of exhaust fumes from apparatus, vehicles, or equipment (including those involved in the Rehabilitation Sector/Group operations). (5) It should be large enough to accommodate multiple crews, based on the size of the incident. (6) It should be easily accessible by EMS units. (7) It should allow prompt reentry back into the emergency operation upon complete recuperation. d. Typical Site Designations (1) A nearby garage, building lobby, or other structure. (2) An open area in which a rehab Area can be created using tarps, fans, etc. (3) Fire apparatus, ambulance, disaster trailer, or other emergency vehicles at the scene or called to the scene. (4) A school bus or municipal bus. e. Resources The Rehab Officer shall secure all necessary resources required to adequately staff and supply the Rehabilitation Area based on the situation of the incident. The supplies should include the items listed below as appropriate for conditions: (1) Personal cleansing materials so that members can wash at least their hands and face before drinking or eating. (2) Fluids - water, activity beverage, oral electrolyte solutions and ice. (3) Food - soup, broth, or stew in hot/cold cups. Energy/Protein Bars. Fruit. (4) Medical - blood pressure cuffs, stethoscopes, oxygen administration devices, cardiac monitors, intravenous solutions and thermometers. (5) Other - awnings, fans, tarps, smoke ejectors, heaters, dry clothing, extra equipment, floodlights, blankets and towels, traffic cones and fireline tape (to identify the entrance and exit of the Rehabilitation Area).
Rehabilitation (pg 3 of 6)


GUIDELINES:
a. Rehabilitation Sector/Group Establishment
Rehabilitation should be considered by staff officers during the initial planning stages of an
emergency response. However, the climatic or environmental conditions of the emergency scene
should not be the sole justification for establishing a Rehabilitation Area. Any activity/incident that is
large in size, long in duration, and/or labor intensive will rapidly deplete the energy and strength of
personnel and therefore merits consideration for rehabilitation. Climatic or environmental conditions
that indicate the need to establish a Rehabilitation Area is a heat stress index above 90F (see table
1-1) or wind-chill index below 10F (see table 1-2).
b. Hydration
A critical factor in the prevention of heat injury is the maintenance of water and electrolytes. Water
must be replaced during exercise periods and at emergency incidents. During heat stress, the
member should consume at least one quart of water per hour. The rehydration solution should be a
50/50 mixture of water and a commercially prepared activity beverage (Gatorade) and administered
at about 40F. Rehydration is important even during cold weather operations where, despite the
outside temperature, heat stress may occur during firefighting or other strenuous activity when
protective equipment is worn. Alcohol and caffeine beverages should be avoided before and during
heat stress because both interfere with the body's water conservation mechanisms. Carbonated
beverages should also be avoided. Firefighters fighting wildland fires will be provided 2 quarts of
water every hour.
c. Nourishment
The department shall provide food at the scene of an extended incident when units are engaged for
three or more hours. A cup of soup, broth, or stew is highly recommended because it is digested
much faster than sandwiches and fast food products. In addition, foods such as apples, oranges,
and bananas provide supplemental forms of energy replacement. Fatty and/or salty food should be
avoided.
d. Rest
The "One Bottle Rule" (or 45 minutes of work time) - It is recommended that Firefighters who have
worked for one bottle or 45 minutes be placed in the Rehabilitation Area for rest and evaluation.
Members must rehydrate (at least eight ounces) while SCBA cylinders are
being changed. After a member has changed bottles they must have a verbal clearance from the
Rehab Officer or designee prior to returning to the fire ground.
The "Two Bottle Rule" - It will be mandatory that any member having gone through two air bottles
will report to rehab for rest and evaluation. In all cases, the objective evaluation of a member's
physical condition and fatigue level shall be the criteria for the amount of rehab time. Rest shall not
be less than ten minutes and may exceed an hour as determined by the Rehab Officer. Members
released from the Rehabilitation Sector/Group, shall return to the Staging Area. The Rehab Officer
has authority to retain members in rehab or release them back to active duty status.

Rehabilitation (pg 4 of 6)

e. Recovery.
Members in the Rehabilitation Area should maintain a high level of hydration. Members should not
be moved from a hot environment directly into an air conditioned area because the body's cooling
system can shut down in response to the external cooling. An air-conditioned environment is
acceptable after a cool-down period at ambient temperature with sufficient air movement. Certain
drugs impair the body's ability to sweat and extreme caution must be exercised if the member has
taken antihistamines, such as Actifed or Benadryl, or has taken diuretics or stimulants to include
workout supplements.
f. Medical Evaluation.
(1) Emergency Medical Services (EMS) - EMS personnel will be provided and staffed by the most highly trained and qualified available EMS personnel on the scene (at a minimum of BLS level). They shall evaluate vital signs, examine members, and make proper disposition (return to duty, continued rehabilitation, or medical treatment and transport to medical facility). Continued rehabilitation should consist of additional monitoring of vital signs, providing rest, and providing fluids for rehydration. Medical treatment for members whose signs and/or symptoms indicate potential problems, should be provided in accordance with local medical control procedures. EMS personnel shall be assertive in an effort to find potential medical problems early. (2) Heart Rate and Temperature - The heart rate should be measured for 30 seconds as early as possible in the rest period. If a member's heart rate exceeds 100 beats per minute, an oral temperature should be taken. If the member's temperature exceeds 100.6F, he/she should not be permitted to wear protective equipment. If it is below 100.6 and the heart rate remains above 110 beats per minute, rehabilitation time should be increased. If the heart rate is less than 100 beats per minute, the chance of heat stress is negligible. (2) Documentation - All medical evaluations shall be recorded on standard forms along with the member's name and complaints and must be signed, dated and timed by the Rehab Officer or his/her designee. Members assigned to the Rehabilitation Sector/Group shall enter the Rehabilitation Area as a crew if possible. The crew designation, number and name of crew members, and the times of entry to and exit from the Rehabilitation Area shall be documented by the Rehab Officer or his/her designee on the Company Check-In/Out Sheet. Crews or individuals shall not leave the Rehabilitation Area until authorized to do so by the Rehab Officer.
Rehabilitation (pg 5 of 6)


Rehabilitation (pg 6 of 6)

Source: http://vandenbergfire.us/main/management/Ops%20-%20SOP's/SOP%20-%20Rehabilitation.pdf