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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] Good morning. Today's lecture, we're going to be discussing emergency incident rehabilitation. And we're going to cover a couple of things. One of things we thought discussing, is how we define rehabilitation. For emergency workers. Discuss the importance of a rehab, for fire emergency services. And understand situations, warranting it, and the criteria for initiating rehabilitation. Throughout this lecture, we're going to learn different objectives. Some of them additionally objectives we're going to learn are the impact of heat stress on emergency workers. and then the opposite. What's the windchill impact on emergency workers. and we're going to learn appropriate placement for a rehab area. Where are we going to put these rehabs so we're going to have a safe operation? We are gonna want to reason the state emergency workers for medical evaluation. We're also gonna learn the criterias that should be met before emergency workers are able to return back to duty. And also we're gonna discuss reasons we're not allowing injured personnel to return to work or active duty and also list, we're gonna learn reasons to transport emergency workers to appropriate. Hospital for further evaluations. Other, other objectives we're gonna be discussing will be the physiological consequences of fluid loss for the fire service, and we're gonna define osmolarity, and discuss the importance of osmolarity in the rehydration of the fire and rescue personnel. What is rehab, and why do we need it? Well background a rehab is for many years of fire services, treated the ailments of job related dangers, a badge of courage worn with pride. Now fire fighters would boast on the elements of danger when discussing the merits of various occupations. In the last 20 years or so, the attitude on the fire service toward safety has changed dramatically. Fire fighters and the department officials began to realize. The needless deaths and injuries our firefighters not the badge of courage but indicators of problems. Fire fighters extending beyond the safe operation periods. That results maybe stress, fatigue, related illnesses and injuries. Firefighters although. Uninjured while we fatigue to a point where which you say unable to continue in the operation. and the mental and the physiological fatigued firefighter may make poor decisions at that scene, and he can get hurt an cause injuries. Also, what is rehab? When we say I've got to go to rehab, well what is rehab? In emergency services, rehab describes the process of providing rest. Rehydration, nutri, nutritionment and medical evaluation to respondents who are involved in extent of extreme incident scene operations. Rehab operations are not only in response to either fire on the emergency scene. Other, other activities are involved that might necessitate rehab sit situation. Training exercises. Fire departments are out there, and EMS personnel are out there doing training exercises in the heat and the cold. We're gonna have to have a rehab area for them so that they can put nutrition back in their system. Also athletic events. A lot of communities are wanting marathons throughout the. The towns. The fire service and EMS are standing out there for hours and hours and hours in the heat. They've got to rehydrate their bodies properly. And parades and events. A lot of communities have events in the com, in the town. Parades dignitaries respond to the town, so you're gonna have to have rehab area. So the firefighters and EMS personnel can get rehab and get the nutritions back in their system. Other activities that the fire service is getting involved with assisting our fellow police officers and their training activities. There are days when they are 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's a lot of support activities that we'll be involved with the rehab's, and rehab's part of the situation. We sup, we supply water to the PD. We'll be supplying water to our fire fighters. These statistics were supplied to me by the National Fire Protection Association. Over 50% of all firefighter deaths are due to some extent directly attributed to stress or overexertion. We're gonna discuss a little while what are the functions of a rehab operation? They're physical assessment. You get done, you get send to a rehab center. Where you'll be doing physical assessments as a fire fighter. Revitalization. Rest. Rehydration. And nutritional support. Medical evaluation and treatment. Conditional monitoring of physical conditions. Be getting your blood pressure taken, you'll be getting your heart monitored. And, if you need to, to be transparent for those requiring treatment at a hospital. After rehab operations, you'll be getting done initial clinical instrument stress assessment. Hopefully you'll be able to watch the person, see if they're having any difficulties during that incident. And last but not least, if as during a rehab operation, you get your reassignment, if you're, they're figuring, you're going to have to go back to doing your duty. You get reassigned for your next task, for your next period of time. As you'll see in this slide it shows you from the beginning to the end, of what happens when you physical assessment of that person, going into a medical evaluation, to revitalization, if he has to be transported, the continual monitoring for the conditions. And you start the initial conditional stress management on the individual. And then the reassignment so you'll see on this slide the whole picture on how the rehab operation works. What is physical assessment of a firefighter or emergency service personnel? basically what happens is you get to that rehab center, they'll be doing basic vital signs, they'll be taking medical evaluation of you, they'll be revitalizing and do your reassignment. What is revitalization? That's where you get a rest, you've taken 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 at sweating a lot at the fire scene, or the training activity. You gotta put fluid back into your system. And nutrition. Should receive some nutritionally sound food: granola bars, peanuts, things of that. We're not hot and chompin' down hot dogs, and, and foods that won't digest properly during that heat. You wanna eat solid foods that you can nutritionally. Intake into your system. Medical evaluation and treatment. Firefighters who appear ill or injured should be assigned to personnel numerical evaluation treatment area rehab. And he should not be delayed by providing with drinks and food, or else the medical evaluation shows this to be a priority. Monitoring your physical conditions, firefighters in the rehab area should have their conditions continually monitored. Firefighters who meet the criteria for release from rehab should reassign or for release for care and firefighters who do not respond to rest and medical attention may require more intensive intervention. [INAUDIBLE] 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 reading. So we know, if there is a situation going on. Knowing when to establish rehab. As i've been saying through this whole action, the goal is emergency instant rehab. There's less of a risk of injuries. That may resolve from extended operations. Which are carried out in [UNKNOWN] weather conditions. Other factors, the heat and things like that. So when do we set this rehab center, center up? Ideally rehab operations should be commenced whenever emergency operations propose, pose a risk of pushing personnel beyond a safety level of physical and mental endurance. Extended fire incidence, hazmat incidence, prolonged rescue, adverse weather conditions. I was saying before, we have to deal with crimes and work with the police department, and and standoffs and other crime scenes, and search activities. We're gonna be out there searching for people lost in the woods. People falling in the rivers and lakes. We're doing search operations. You're gonna have to have rehab areas set up. Extended fire incidents. What are we facing out there? Structure fires, high rise structural fires, and wildland fires. Weather conditions, hot weather, ambient temperature, relative humidity, direct sunlight. Cold weather is ambient temperature, and a big thing is the wind chill factors. Hot weather under the ideal climate conditions fire hazmat instances nad rescue operations place a variety of thermal [UNKNOWN] on responders operating on the scene. Let's face the fact. We emergency we must frequently perform heavy physical labor in heated atmospheres while wearing. Bulky heavy equipment. In these ideal conditions, when a responders have completed their assignment, they go to safe areas such as rehab, we remove the equipment, and we're able to cool our systems down. You'll see in 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 in, heat index. And working a full turnout equipment can add ten degrees on 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 those physical activities. On this slide, you'll see the injuries associated with heat stress. At what temperature, what s-, what happens to your system. And the injury threat you can get. Lifting cars from 60 degrees. Or to a [UNKNOWN] on 130 degrees. And what extreme danger of a potential heat stroke that a firefighter can be facing. And heat stress in the [UNKNOWN] United States Fire Administration, USFA. They recommend that rehab operations are to be initiated whenever the heat stress index exceeds 90 degrees Fahrenheit. That 90 degrees that I mentioned is, is the heat index. So let's be realistic. If it's a 70 degree day outside, with the 10 degrees in the sunlight, and add another 10 degrees farenheit wearing turnout equipment, we're hitting that 90 degree mark. So that 90 degree is the, is the heat index that we have to worry about. We 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, in low temperature conditions for a long period of time. Cold weather possesses different rehab challenges to the emergency responders than the warm weather scenarios do. We talked, what we talked about earlier, the potential threat to the well being of emergency workers from them, however, is just as great, in 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 hypothermia. The most common cold weather injuries among emergency responders are localized cold injuries, commonly called frost bite, and frost nip. These injuries occur when particular parts of the body exposed. To the extreme cold, for extremely long p, 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 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 windchill factor drops to ten degrees farenheit. Or lower and you'll by that chart it's really not that hard to accomplish with the wind and the temperature. We can hit that 10 degree mark very fast and very rapidly. As I mentioned before there are other situations that we have maybe necessary, crime scenes and standoffs, working with the police department. On their, on their activities. Search activities. We're looking for lost hikers, or, people who are 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 positions, for a long period of time as well. They are gonna be needing rehabs. So, we're gonna have to be assisting them, both out in the field and during rehab. Search activities, large areas, searching for people who have wandered away from their homes. We had it in this community, where we had a person who had Alzheimer's, actually left their house. And it was 12 degrees out. So, we had, we had personnel out in the, out in the woods, out on the streets, looking for this woman. We had to set up rehab, so we, they could get some warmth into their system. Urban search and rescue incidents, following unnatural man-made disasters, and they're going out there for hours at a time, they're gonna need rehab. And searching for climbers and hikers and others involved in sporting and recreational activities. Swimmers will get lost. You're going to have to have rehab setup for the emergency services personnel who are out 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 gonna have to have a rehab set up for the people walking around doing their EMS work or doing fire watch. Auto races, a lot of communities have auto races. Parades, concerts, major sporting events, political rallies. You have now all these big political rallies going on. [UNKNOWN] EMS and fire service out there back in the public, they are going to have rehab areas setup. [UNKNOWN] religious ceremonies. These are done in the communities where the fire was [UNKNOWN] EMS personnel or out there assisting those who might need it during those rallies. Youre going to have to have [UNKNOWN] area setup. In regard to dealing with the law enforcement, they're not used to out-setting a rehab or dealing with a rehab situation. So, you as the [UNKNOWN] 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 got the separate rehab. So their members are safe as well and join us, to, getting our bodies replenished. [SOUND] Establishing or managing a rehab barrier, the first 5 minutes of an incident can dictate the outcome of the next 5 hours. Once the need for rehab has been established, the most important decision, and one that must be made almost immediately, is where to locate that rehab center. Making a good initial choice for the location of rehab is vital. Trying to relocate rehab later in the incident can be very difficult to nearly impossible. Once you got that location setup, you don't want to 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. Away from the incident commander it's easy for the personnel to relax and they're a fear of, of distraction. You'll see in the next slide a whole set up of a house fire where we have, with the apparatuses set up or the rehab area is set up. And you'll see in this slide that we have set up an area that is 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 squads, 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 it's interfering with the incident commander. Or sometimes I've seen it where they put the rehab. Up wind. So now all of the smoke is blowing into the fire up from the rehab tent. so you got to make sure you pick a location where it is 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 often will make a decision of where the tent or where the rehab area is going to be. And we were just discussing that. The second issue is, and more importantly, that all firefighters must attend. They can not bypass going through rehab. Policies will be created, and policy will be enforced. And once you get done at that operation, you must got through rehab and be, and be evaluated. A lot of departments, a lot of members that have that macho image, that we don't need to go through rehab, but you have to go through it. Site characteristics of 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 while we're trying to get rehab. And as, the site should be as quiet as possible, so we can relax while we're getting our blood pressures taken. Access to this site by the media should be restricted. The last thing we need is the media taking pictures of us while getting our vitals being done. And the site should provide SCBA replenishment refill. You should be able to get a change of bottle for your SCBA at the rehab center. Also, the site should have easy access, with exit area routes for the ambulance. We don't wanna block them. They have to take us to the medical hospital 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 rescue facilities are part of the rehab. If the insurance was recovery for fatalities. Your rehab area should be out of the view of the work area. We don't wanna have, people being rehabbed, you know, people who being brought out for their fatalities. We don't wanna mix them. You wanna keep them separate from each other. This chart is a schematic of a floor plan of a rehab center. You'll see where easy single entrance 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 in a rehab area. The most highly trained and qualified EMS personal on the scene should provide medical evaluation and treatment in the rehab area. EMTs must assure that the sector provides a safe area which fire/rescue personal can rest and receive rehydration. EMTs must identify fire/rescue personal entering the rehab area who are at risk for heat and stress related injuries or illnesses. That all the rehab staff is EMTs should have an AED readily available if an unlikely but statistically important event that a fire rescue person experiences cardiac arrest or in a rehab and EMTs must share accountability for the fire 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 ret and require transportation to the emergency department for further evaluation. One of the most important roles of the EMT does during the rehab operation is they get reports and updates to the incident commander and the safety officer on the progress and the health of each firefighter who's been through the rehab section. The amount of time that a responder will require in a rehab will vary depending on various conditionings, number one is the responder's level of physical conditioning. Is that firefighter in good shape. Number two are the atmospheric conditions, the heat, the cold. The nature of the activities responsibly fallen, befallen prior to their 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 departments establish a minimum amount of time that a fire rescue personnel spend their rehab. This will vary with the atmospheric conditions and the number of personnel available, during an operation. But a good rule of thumb is that every personnel will spend at least 20 minutes in rehab. The hydration that occurs in a rehab is very important to the responder's recovery. Personnel perform heavy work under stressful conditions, we're wearing heavy coats, heavy equipment, we're, we're subject to extensive fluid loss. While fluid loss is obvious in hot weather conditions, do no overlook 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. As you'll see in this chart how easy it is for us to go from a two per, losing 2% body weight to up to 6% and then severity and how dangerous that is. At a different sev, different types of injuries that we can incur. In this part of the lecture we're gonna be talking about osmolarity. And that can be defined as the thickness of a, a fluid is 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 it's recommended the rehydration solutions do not exceed the osmolarity of 350 milligrams. Per leader and you'll see on his file and chart that they have the whole listing from all different types of liquids that we're out there and osmalary of each one. As you'll see in our chart the last column has the osmalary of all the different drinks from our sports drinks down to water. You see the importance how great water is. Only ten to 20% with some of these sports drinks and sodas are very high in numbers. And unfortunately, when we go to rehabs, that's what we're usually getting is the sodas and the sport drinks. That's why it's important to have a rehab center set up where there's available, water is available most times. Medical evaluation. On entry to rehab, each fire rescue personnel should be triaged to determine if the medical treatment or transport is necessary. On entering any fire rescue personnel, with a following should be sent immediately to the treatment area or rehab. A blood pressure greater than 200/110, or 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 greater than 160/90 or a top number falls below 100. All right. No fire rescue personnel should return to active duty, if they're presented with an injury that may be worse than by return to duty. Or, if an injury that might in any way impair the performance of the injury. We don't really wanna send you back out there, back on a job, if your injury is gonna 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 have come down with chest pains, shortness of breath, alerted mental status. If you're not being yourself, if you're acting a little weird, or things aren't going perfect for you, you should be sent to the hospital. Skin that is hot or either moist or dry. And most importantly an irregular pulse. Any fire rescue personnel should be considered for transportation to the hospital, if she or he have an oral temperature of greater than of 101 or a pulse of more than 150 beats per minute or a pulse of more than 140 beats per minute, after a cool down. So, if you're resting, after 20 minutes, and your blood pressure is your beats per minute is still at 140, you should be taken to the hospital. Any fire rescue personnel we consider for transport to the hospital. If he or she presents with a blood pressure 200 over 130. Or, any emergency worker should be considered if they are unable to orally re-hydrate. To nausea and 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 length. Bring back to your firehouse, go back in the back room. Discuss this with your officers and answer these questions. This will make it easier to 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 of rehab area should work. So in summary, I would like to just capitalize a few of the issues. We decided when and when and where to initiate rehab and decide whether where to set it up and the decisions I must make easy, early and easy on in the beginning of the incident. Them. Rehydration and constant monitoring of the fire rescue personnel is the most important thing that rehab people do do for us. And following accepted guidelines for returning emergency workers back to their duties while will aid both returning fit workers to do duty while at the same time keeping stress and injured fire workers from risking causing further harm to themselves. All the firefighters. And that's basically what we all want. We all want to be safe at the operation and when we're done operation. [BLANK_AUDIO]

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