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Emergency Incident Rehabilitation

Fri, 7 Jan 2011|

This training presentation from the Firefighters Support Foundation deals with the needs for rehab, basic functions of the operations, and more.



[BLANK_AUDIO] [BLANK_AUDIO] Good morning. Today's lecture we're gonna be discussing emergency incident rehabilitation. I wanna cover a couple of things. One of the things [UNKNOWN] discussing is how we define rehabilitation for emergency workers. Discuss the importance of rehab for fire and emergency services, and understand situations warranting and the criteria for initiating your rehabilitation. Throughout this lecture we're gonna learn different objectives. Some additional objectives we're gonna learn are the impacts of heat stress on emergency workers. And then the opposite, what's the wind chill impact on emergency workers? And we're gonna learn appropriate placement for a rehab area. Where are we gonna put these rehabs so we can have a safe operation? We're gonna learn reasons of State Emergency workers with medical evaluation. We're also gonna learn the criterias that should be met before emergency workers are re are able to return back to duty. And also we're gonna discuss reasons for not allowing injured personnel who return to work for activity duty and also this we'll learn reasons for transporting emergency workers to appropriate. Hospitals for further evaluations. Other objectives we're going to be discussing will be the physiological consequences of fluid loss for the fire service, and we're going to define osmolarity and discuss the importance of osmolarity and rehydration on the fire and rescue personnel. What is rehab, and why do we need it. Well background of rehab is for many years the fire service treated the elements of job related danger in a badge of courage. One with pride. Now firefighters would boast in the elements of danger when discussing the merits of various occupations. Now the last 20 years or so, the attitude of the fire service toward safety has changed dramatically. Fire fighters and department officials began to realize. The needless death and injuries are firefighters not the badge of courage, but indicators of problems. Firefighters extending beyond the safe operation periods, that results maybe stress, fatigue, related illnesses and injuries. Firefighters although. Uninjured, while be fatigued to a point where which they're unable to continue in the operation. And the mental and the physiological fatigue, firefighter, they make poor decisions at that scene and can get hurt and cause injuries. Also, what is rehab? When we think, I gotta go to rehab, what is rehab? And in emergency services, rehab, or rehab describes the process of providing rest. Rehydration, nutrtionment, and medical evaluation to responders who are involved in the extent of the extreme incident scene operations. Rehab operations are not only spons on the fire and emergency scene. Other other activities are involved that might necessitate rehab situations. Training exercises fire department are out there EMS personnel doing training exercises in the heat and the cold. We have to have a rehab area for them so they can put nutritions back into their system. Also, athletic events, a lot of communities are running marathons throughout. The towns. The fire service and EMS is standing out there for hours and hours and hours in the heat, they have to rehydrate their bodies properly. And parades and events. A lot of communities have events and the comm, towns, parades dignitaries responding to tasks you're gonna have to have a rehab area. So these firefighters and EMS personnel, can get rehab, and get, put nutritions back in their system. Over activity that the fire service is getting involved with, is assisting our fellow police officers in their training activities. There are days where they're out. Doing SWAT activities or live ammo shooting. They're gonna be out in the sun also, we'll be out there supporting them. So there are a lot of support activities that we'll be involved with that rehabs rehabs part of the situation. We're, we're supplying water to the PD, we'll be supplying water to our firefighters. These statistics were supplied to me by the National Fire Protection Association. Over 50% of all fire fighters deaths are due to some extent directly attributed to stress or over exertion. We're gonna discuss a little while what of the functions of a rehab operation. They're, they're a physical assessment. Assessments. You get done, you get sent to a rehab center you're going to be doing physical assessments of the firefighter. Revitalization. Rest. Rehydration. And nutritional support. Medical evaluation and treatment. Conditional monitoring of physical condition. You'll be getting your blood pressure taking. you'll be getting your heart monitored. And, and if, if you need to, you'll be transported for those requiring treatment at a hospital. At the rehab operations you will be getting done initial critical incidence stress assessment. Hopefully you will be able to watch the person to see if they are having any difficulties during that incident. And last but not least if during the rehab operation you get your reassignment. If they figure you're good enough to go back to doing your duty. You get reassigned to your next task for the next period of time. And you'll see in this slide, it'll show you from the beginning to the end on what happens. When your physical assessment of that person, going through the medical evaluation, the revitalization. If he has to be transported, the continual monitoring for the conditions, and to start the initial conditional stress management on the individual. And then the reassignment. So you'll see on the slide a whole picture, and how the rehab operation works. What is physical assessment of a firefighter or an emergency service personnel? Basically, what happens as you get to that rehab center, they'll be doing basic vital signs, they'll be taking a medical evaluation of you, they'll be revitalizing, and they'll do your reassignment. What is revitalization? That's where you get a rest. You're taking a five, ten minute rest, so an adequate amount of time for core temperature and your vital signs to return to normal. Fluid replenishment, provide with appropriate fluid to replace those lost. We're all sweating a lot at the fire scene or the training activity, you've got to put that fluid back into your system. And nutrition, should receive some nutritionally sound food. Granola bars, peanuts, things like that. We're not chomping down hot dogs and foods that won't digest properly during that heat. We want to eat solid foods that you can nutritionally. Intake into your system. Medical evaluation and treatment. Fire fighters who appear ill or injured should be assigned to personnel in a medical evaluation treatment area rehab and he should not be delayed by providing with drinks and food unless the medical evaluation shows this to be a priority. Monitoring of physical conditions. Fire fighters in a rehab area should have their conditions continually monitored. Fire fighters that meet the criteria for release from rehab should reassign or for release for care. And fire fighters that do not respond to rest and medical attention may require more intensive intervention. No one should be released from rehab until he or she is medically sound and medically cleared, and is transported to a medical facility for further treatment if needed. Now, you as a firefighter, you must be honest with those taking your, your blood vitals and statistics, that if you're on certain medications. So those, so we have accurate readings. So we know if there is a situation going on. Knowing when to establish rehab. As I've been saying through this whole lesson the goals of emergency incident rehab is to lessen the risk of injuries that may result from extended operations. Which is carried out in adverse weather conditions. Other factors. The heat and things like that. So we're, when do we set this rehab set, center up. Ideally rehab operations should be commenced whenever emergency operation pose, pose a risk of pushing personnel beyond a safety level of physical and mental endurance. Extended fire incidents, haz-mat incidents, prolong rescue, adverse weather conditions, I was saying before, when you have to deal with crimes and working with the police department and and standoffs and other crime scenes, and search activities. We're going to be out there searching for people lost in the woods. People falling into rivers and lakes. We're doing search operations, you're gonna have to have a rehab area set up. Extended fire incidents, what are we facing out there? Structure fires, high rise structural fires and wild land fires. Weather conditions, hot weather, ambient temperature, relative humidity, direct sunlight, cold weather, ambient temperature and the big thing is the wind chill factors. Hot weather under the ideal condition's. Fryer hazmat answers and rescue operations place a variety of thermal risk on the responsible responder's operating at the scene. Let's face the fact we emergency workers we must frequently perform heavy physical labor in heated atmosphere's while wearing. Bulky, heavy equipment. In these ideal conditions, when responders have completed their assignment, they go to a safe area such as rehab, remove the equipment, and we're able to cool our systems down. You'll see on this next slide a picture of a firefighter wearing the equipment in that heat. Ambient air temperatures are related to humidity can be a factor together to create what is often called a heat index. Working in direct sunlight can add ten degrees fahrenheit to that heat, heat index. And working in full turnout equipment could add an additional ten degrees of fahrenheit on that heat index. And you'll see it on the next chart the complete hot temperature with the heat index. And how hot it can really get while you're doing this physical activities. On this slide you will see the injuries associated with heat stress. At what temperature whats, what happens to your system. And the injury threat you can get. It occurs from, from 60 degrees all the way to above 130 degrees. And what extreme danger or potentially heat stroke the use of firefighter could be facing. And heat stress index, the United States Fireman Administration, the USFA, they recommend that rehab operation be initiated whenever the heat stress index exceeds 90 degrees farenheit. That 90 degrees that I mentioned is, is the head index. So let's be realistic. If it's a 70 degree day outside with the ten degrees in the sunlight and add another ten degrees farenheit wearing carrying equipment. We're hitting that 90 degree mark. So that 90 degree is the, is the heat index that we have to worry about. I just talked about heat index and the hot weather. Let's reverse that to the other side, cold weather conditions. Often overlooked when determining the need for rehab operations are the effects of cold weather on responders who must operate in low temperatures and low temperature conditions for a long period of time. Cold weather possesses different rehab challenges to your emergency responders than warm weather scenarios do. Do talk, what I talked about earlier. The potential threat to their well-being of the emergency workers for them, however, is just as grave as cold weather. An emergency worker insufficiently protected against the cold may have had their body core temperature lowered. To a dangerous level under extreme circumstances. And this condition is called hyperthermia. The most common cold weather related injuries among emergency responders are localized cold injuries, commonly called frostbite and frost nip. These injuries occur when particular parts of the body are exposed. To the extreme call for extremely long pe, periods of time. Just as heat and humidity combine to increase the impact of heat, cold and wind combine to impact the effects of cold upon human bodies. The combination effects of cold and wind is referred to as the wind chill factor. This chart will show you the temperature and with the wind what the actual temperature is and that's called the wind chill factor. The USFA, United States Fire Administration recommends initiating rehab operations whenever the wind chill factor drops to 10 degrees farenheit. Or lower and you'll see by that chart, it's really not that hard to accomplish with the wind and the temperature. We hit that ten degree mark very fast and rapidly. As I mentioned before there are other situations that we have maybe necessarily. Crime scenes and standoffs, when working with the police department. On their, on their activities. Search activities. We're looking for lost hikers or people or, lost in lakes. Public events. Parades. Dignitaries who are coming to communities. And the big one is training events. Crime scenes and standoffs. What, what happens is bomb squad members have been operating for a long period of time, and they're wearing heavy protective equipment. We're out there working with them on that. And police tactical units may have been operating in their positions for a long period of time as well. They're gonna be needing rehab so we're gonna have to be assisting them both out in the field and during rehab. Search Check. There are these large areas searching for people who have wandered away from their homes. We had it in this community where we had a person with Alzheimer's actually left their house. And it was 12 degrees out. So, we had personnel out in the woods, out on the streets looking for this woman. We had to set up rehab so they could get some warmth into their system, urban search and rescue incidents following natural and manmade disasters and they're gonna out there for hours at a time. They're gonna need rehab. And searching for climbers and hikers and others involved in sporting or recreational activities. Swimmers who get lost, they're gonna have to have rehab setup for the emergency services personnel while looking for these people. Public events. Communities have fairs, carnivals and other festivals. A lot of fire departments run them. So while you're doing these, most of the time they're at night or, during the hot humid weather during the summer. You're going to have a rehab set up for the people walking around doing their EMS work or doing fire watch. Auto raises, a lot of communities have auto raises. Parades, concerts, major sporting events, political rallies. You have now all these big political rallies going on. If your EMS and fire service out there protecting the public, they're gonna have to have rehab area set up. And large scale religious ceremonies. These are done in communities where the fire, once again, a fire and EMS personnel are out there assisting those who might need it during these rallies. You're gonna have to have a rehab area set up. In regard to dealing with law enforcement. They're not used to our setting up rehab or dealing with rehab situations. So you as an incident commander might wanna talk to that local sergeant or police sergeant who's in charge of the operation and tell them this is how we work, and we've got to set up a rehab, so their members are safe, as well, and join us during, getting our bodies replenished. Establishing and managing a rehab area. The first five minutes of an incident can dictate the outcome of the next five hours. Once the need for rehab has been established, the most important decision, and one that must be made almost immediately, is to where to locate that rehab center. Make a good initial choice for location of rehab is vital. Try and relocate rehab later in the incident can be very difficult to nearly impossible. So once you got that location set up, you don't wanna be taking it down and putting it over to another location. Once you have a designated spot, maintain that spot. Maintain that area for the rehab. Locating the rehab. Close to the incident command. More easily kept track of who's in rehab. And it's easy to anticipate when people will be ready to go back to doing their jobs and assignments. A more efficient use of the equipment. A way from the incident commander, it's easier for the personnel to relax. And there are fewer dist, distractions [UNKNOWN] And you'll see in the next slide, a whole setup of a house fire where rehab, where the apparatus is setup and where the rehab area is setup. And you'll see in this slide, the rehab's set up in an area that's a really good location. Close to the command, so command can see who's going in and out. Who's available, but yet it's far enough away from everybody. It's easy access for the squad, the ambulances to leave in and out of the area without being blocked by the fire apparatus and the fire apparatus aren't tripping over the EMS people. What could be wrong setting up the rehab? It could be too close to the operation, where we're interfering with the [UNKNOWN] and the commander or sometimes I've seen it where they put the rehab. Upwind, so when all the smoke's blowing from the fire into the rehab tent. So you gotta make sure you pick a location where it's not going to be interfering, nor being affected by the fire. Once command decides to have a rehab section, the person in charge will be the rehab officer, he ought to make a decision as where this tent or where the rehab area is going to be, and we're just discussing that. The second issue is that more importantly that all firefighters must attend. They cannot bypass going through rehab. Policy will be created and policy will be enforced, and once you get done at that operation, you must go through rehab and be, and be evaluated. A lot of departments, a lot of members have that macho image that we don't need to go through rehab, but you have to go through it. Site characteristics for the rehab center. The site should be large enough to accommodate all those that need rehab. The site should be free of vehicle exhaust. We don't need exhaust from the trucks and our apparatus blowing onto us when we're trying to get rehab. And the site should be as quiet as possible, so we can relax while we're getting our blood pressures taken. Access to the site by the media, should be restricted. The last thing we need, is the media taking pictures of us. While getting all vitals being done. And a site should provide [UNKNOWN] plenty of replenishment and refill. They should be able to change your bottle, for the SCBA at the rehab center. Also the site should have an easy access and exit routes for the ambulance, we don't want to block them, they have to take us to the medical hospitals or other facilities. The site should have a supply of running and drinking water, preferably a lot of drinking water and it's helpful if the restroom facilities are part of the rehab. If the incident involves recovery of fatalities. Your rehab area should be out of the view of the work area. We don't wanna have the people being rehabed near people being brought out for, for fatalities. We don't wanna mix them. We wanna keep them separated from each other. This chart is a schematic of a floor plan of a rehab center. You'll see where an easy ent, single entrance to comes in, place to hang your gear, SCBA Support there, a medical treatment area and an ambulance staging area. This is a perfect one to be set up for a rehab area. Staffing a rehab area. The most highly trained and qualified EMS personnel on a scene should provide medical evaluation and treatment in a rehab area. EMTs must ensure that the sector provides a safe area which fire rescue personnel can rest and receive rehydration. EMTs must identify fire and rescue personnel entering the rehab area who are at risk for heat or stress related injuries or illnesses. The role of rehab staff is EMT's must, should have a AED reliably available if an unlikely, but statistically event that a fire rescue personnel experience cardiac, cardiac arrest during a rehab and EMT's must ensure accountability for the fire and rescue personnel who enter and exit rehab. EMTs must medically monitor crews to determine whether they are fit to return to activity for the fire and rescue operation. Require additional hydration and rest. And require transportation to the emergency department for further evaluation. One of the most important roles that an EMT does during a rehab operation is they give reports and updates to the incident commander, the safety officer on the progress and their, and health of each firefighter who has been trough the rehab section. The amount of time that a responder will require in a rehab will vary depending on a varies of conditionings. Number one is the responders level of physical conditioning. Is that firefighter in good shape. Number two, the atmospheric conditions, the heat, the cold, the nature of the activities responsibly performed prior to entering rehab. Was it a very stressful situation, confined space, was he climbing high rise steps and the time needed for the adequate rehydration. Rest during rehab. It is recommended the department establishes a minimum amount of time a rescue fire person will spend their rehab. This will vary with the atmospheric conditions and the number of personnel available during the operation. But the good rule of thumb is each personnel will spend an average of twenty minutes in rehab. The hydration at a cars in a rehab is very important to the responders recovery. Personnel perform heavy work under stressful conditions wearing heavy coats, heavy equipment. We're subject to extensive fluid loss. While fluid loss is obvious in hot weather conditions do not over look the fact that dehydration can occur. In the cold climates. Maintaining sufficient levels of water and electrolytes in our body can greatly aid in the prevention of heat or stress-related illnesses and injuries. Now you'll see in this chart how easy it is for us to go from a 2%, losing 2% body weight to up to 6%, and it's severity and how dangerous that is. And the different scene, different types of injuries that we could incur. In this part of the lecture, we're gonna be talkin about osmolarity, and that can be defined as the thickness of a, of a fluid as determined by the electrolytes and carbohydrates contained in that beverage. The higher the osmolarity, the longer the time it takes, will take to absorb that fluid in your system. So, in general, as recommended, the rehydration solutions do not exceed the osmolarity of 350 milligrams. Per liter and you'll see on this following chart that they have the whole listing of them. All different types of liquids that were out there and the osmolarity of each one. As you'll see in our chart, the last column has the osmolarity of all different drinks from our sports drinks down to water and you see the importance and how great water is only ten to twenty percent. With some of these sports drinks and sodas are very high in numbers. And unfortunately when we go to rehabs that's what we usually get is the sodas and the sport drinks. That's why it's important to have the rehab center set up with water available most times. Medical evaluation. On entry to the rehab each fire and rescue personal should be triaged to determine if medical treatment or transport is necessary. On entry any fire rescue personnel with the following should be sent immediately to the treatment area rehab. A blood pressure graded at 200/110 or a top number below 90. No fire rescue personnel should return to active duty after 20 minutes of rest if he or she presents with a blood pressure graded at 160/90 or a top number falls below 100. No fire rescue personnel should return to active duty if they are presented with an injury that may be worsened by return to duty. Or if an injury that might be in any way impair the performance of their injury. We don't want to send you back out there or back on the job if your injury is gonna per, interfere with your performance and make things worse not only for yourself but for someone else. Any fire rescue personnel should be considered for transportation to a hospital if they are coming out with chest pains, shortness of breath. alerted mental status. If you're not being yourself, or you're acting a little weird. Or things aren't going q, perfect for ya, you should be sent to the hospital. Skin that is hot or either moist or dry. And the most important irregular pulse [NOISE] Any fire rescue personnel should be considered for transportation to a hospital if she or he has an oral temperature of greater than 101, or a pulse of more than 150 beats per minute, or a pulse more than 140 beats per minute after a cool down. So if you're rested after 20 minutes, and your blood pressure, you beats per minute is still at 140, you should be taken to the hospital. Any fire/rescue personnel should be considered for transport to the hospital if he/she presents with a, a blood pressure of 200 over 130. Or any emergency worker should be considered if they are unable to orally rehydrate through nausea or vomiting. If you can't put fluids in your system and you're throwing it back up, you should be taken to the hospital right away. As you'll see the next few slides covers what we just talked about in Blend. Bring back to your fire house, go back into the back room discuss this with your officers and answer these questions. This'll make it easier for you to understand the rehab policy, to understand how, what rehab's all about, and how to perform rehab. In this program of rehab, we discussed a lot of things. And discussed the whole, different way how rehab area should work. So, in summary, I would just like to capitalize a few of the issues. We decided when, and when, and where to initiate rehab. And decide whether and where to set it up. And the decisions I must make, easy, early and easy on, in the beginning of the incident. Rehydration and constant monitoring of fire rescue personnel is the most important thing that rehab people do, do for us. And finally accepted guidelines for returning emergency workers back to their duties. While will a both returning fit workers to duty while at the same time keeping stressed and injured fire workers from risking, causing further harm to themselves. And to all the firefighters. And that's basically what we all want. We want everybody to be safe at the operation and when we're done operation. [BLANK_AUDIO]

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