REHAB UNITS AT WORK
by James Cline, Ed.D.
A rehab unit is a specially equipped truck that responds to major fires or emergencies at which the health and safety of the firefighters operating on the scene may be jeopardized by the nature or duration of the incident or the weather. The unit provides shelter, blankets, hot and cold beverages, and a place to cool off in the summer and warm up in the winter. Firefighters enter the unit for rest, hydration, food, and medical evaluation.
The National Fire Protection Association states in NFPA 1500, Standard on Fire Department Health and Safety Program, 1992 edition, “All supervisors shall maintain an awareness of the condition of members operating within their span of control and ensure that adequate steps are taken to provide for their safety and health.” The standard further states that on-scene rehabilitation shall include at least basic life support.
An understanding of the rehab terminology may be helpful. A rehab sector is an area set aside upwind from the incident where the rehab unit and rehab ambulance are located. A rehab unit is a fire department vehicle in which firefighters can seek shelter from the weather, rest, and have food and beverages. A rehab ambulance is a fire department or EMS vehicle within the rehab area that can provide basic life support. A rehab firefighter is designated to monitor the rehab unit and rehab ambulance, record the fire units cycled through, and monitor the condition of the firefighters and the time they need to recuperate. Entry to and exit from the rehab sector should be carefully controlled. Units should remain together for the duration of the rehab period. The critical incident stress debriefing (CISD) team may be located in this area during an extreme situation requiring their services. The need for the team`s early intervention may be determined by the IC or the rehab officer or may be requested by the fire officers or firefighters.
Generally, a rehab unit will carry cots, blankets, and pillows for rest. It may also carry fluids for hydration; fans and misters for cooling off; awnings, tarps, and towels; and racks to hang equipment.
The safety and welfare of the firefighters on the scene should be the primary concern of the incident commander. In this regard, sufficient rest and recuperation are essential to prevent injuries, exhaustion, and overexposure.
The rehab unit provides an exhausted firefighter a place to rest for 20 to 30 minutes. For cases of overexposure to heat or the sun, the unit provides shelter, fluids, fans, misters, or just shade under an awning for cooling down. For overexposure to the cold, the unit provides shelter, blankets, and hot fluids. A rehab ambulance allows for medical evaluation and treatment.
A REHAB UNIT IN ACTION
On Thursday, November 16, 1995, at 8:45 a.m., an unidentified female stopped her vehicle in the center of the Outerbridge Crossing, a bridge connecting New Jersey and New York, and jumped into the Arthur Kill. Fire department units arrived within minutes of the phone alarm and proceeded by boat to the location where the victim may have landed. Rescue 5 responded to the alarm, and two firefighters in wet suits entered the water to conduct a line search of the area to locate the victim. The rehab unit was called due to the 397F air temperature and the length of time (40 minutes) the firefighters were in the water. In addition, engine, ladder, and special tactical units waited on the shore to assist with water search tools and equipment. After an extended search and no rescue or recovery, the divers discontinued their operation. The rehab unit provided a welcome relief from the wind and cold, and the divers were given blankets and hot beverages. The woman`s body was recovered about one month later.
REHAB UNIT OPERATIONS
When called to an incident for firefighter rehabilitation, the rehab unit firefighter reports to the IC for record keeping and assignment. The IC should assign additional personnel as needed to properly and efficiently staff the rehab unit. The driver should confer with the IC and determine a safe position for the unit that is close enough to the scene but does not block other emergency vehicles and has plenty of space to accommodate firefighters selected for a rest period. The rehab unit staff should set up fluids and food, a section in the vehicle for rest and shelter, fans and misters, and any other appropriate equipment for the rehabilitation period.
It is essential that the names of personnel entering the rehab area be recorded along with the time spent there and their general condition. Firefighters showing signs of unusual fatigue, heat exhaustion, frostbite, or any other condition that may require medical attention should be escorted to the rehab ambulance.
Anticipate the need for a rehab unit. The assigned firefighter must have time to set up the equipment and beverages needed at the scene. This may require additional time to prepare and load the vehicle. The IC must consider factors such as the type of incident and its duration, the type of operation, the location of the fire or emergency, and the firefighters` physical condition. Firefighters already may have operated at other incidents prior to the present one and may not be in top physical condition for this alarm.
Assign sufficient rehab personnel. Depending on the factors encountered by the IC, sufficient staff must be available to assist the rehab unit firefighter. Assigning a rehab firefighter to coordinate the rehab sector activities and keep the IC advised as to the firefighters` condition and the need to call additional units is recommended.
Designate and identify a rehab sector. The IC should identify a safe location that is close to the scene and has sufficient space for the rehab unit, the rehab ambulance, and other vehicles necessary for the sector. The rehab location should be well-lit with portable lighting and clearly identified with a flag or warning lights.
Coordinate communications. Portable radio communication between the IC and the rehab officer and unit is necessary. Consider using cellular phones to expedite supplies, notify medical facilities or physicians, and make notifications to other department offices.
Track firefighters in the rehab sector and at the incident. Tracking firefighters at the scene of large incidents is very difficult and at times almost impossible. Using tags, riding lists, or other methods that accurately identify the firefighters working at the scene is necessary. The names of firefighters entering the rehab sector, the time spent, their condition, and their disposition should be recorded on a form by the rehab officer. In addition, the company officer should record the rehab data on the company fire report for future reference. See the sample form above.
REHAB FOR SAFETY AND EFFECTIVENESS
NFPA 1500 sets up the general guidelines for the establishment of the rehab unit. It is up to the individual fire department to determine the proper implemention of the guidelines. For some small departments, private buses or similar vehicles may offer the shelter necessary for firefighter safety. Many areas have access to relief services provided by fire buff organizations, the Red Cross, the Salvation Army, or a fire department auxiliary group. An adequate system of unit rotation for rest and recuperation (R & R) will enable the IC to manage the incident with the safety of the firefighters as a first priority. An efficient and effective rehab program will aid in reducing injuries and provide sufficient relief for the firefighters. The result will be a well-managed incident with few injuries and an effective firefighting team. n
City of New York (NY) Fire Department Rehab 1 unit parked at a recent second alarm in Manhattan. The 1983 Mack was formerly used as an ambulance. The unit has double rear doors and a side door for easy access and is placed close to the scene of fire operations. Liquids and other rehab aids are kept ready for firefighters reporting to the unit for rest at the scene of an incident. (Photos courtesy of author.)
JAMES CLINE, Ed.D., is a captain in the City of New York (NY) Fire Department. He is on the faculty of Rutgers University and Thomas Edison College; has served as a consultant for fire unions and major corporations; and has conducted seminars and workshops on assessment centers, rapid intervention, educational methodology, and professional development.