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Rehab Policies. When do you not allow a person to reenter?
What point to you force a crew to go to rehab and not allow them to go back in the fire? We have had this fight on many admin meetings. Right now after 2nd bottle you must go to rehab have medic check HR and BP pulse Ox and clear you to return to duty. I have suggested we change that to before the second bottle but then find I dont want to follow it..(yes thats ego and bad judgement) I am just wondering what other think and policies in place.
Replies to This Discussion
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Permalink Reply by Pablo J. de la Torre on
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My sqd is lucky in that we have a very good relationship with the fire companies in our area. The chiefs back us up 100% if we say you need rehap then you go to rehap. As for when, well we try to do a checkup after the second bottle or sooner if we see something we don't like. We take BP and pulse ox reading, we also have a new pulseox that gives us the co levels in the the blood. We then take our findings to the chief and advise him of our findings and suggest rehap. But most of all we talk to the firefighters and explain that we are not trying to take them out of the game but rather to help keep them safely in the game. The respond very well to this and come to us.
It's all in the way you present rehap to them, present the right way and you good a good respond.
Pablo
Pablo
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Permalink Reply by Coach on
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Our department has no written, or unwritten policy as to when to send personnel to rehab.
Our (volunteer) department is one of the largest in the county, gets fantasitic support from the local political fathers (whoops, and mothers), and has bulit a state of the art training facility. We are a department that tries to work well together (there will always be political differences among the companies), and takes a tremendous amount of pride in the services that we provide to the local community.
And yet, we have no formal rehab policy. The departments do not recognize a "Safety Officer" as a line officer, rather consider him somewhere below an engineer. The departments have no formal committee that investigates firefighter or vehicle incidents or accidents, trying to learn from them and prevent recurrence. I'm not even sure that I can recall a fire in which Command thought it may be wise to appoint a safety officer, or ensure that someone on the fire scene had the sole duty of firefighter safety. If we need a RIT, we do not use personnel trained in RIT. We take an apparatus not committed to firegound operations, and assign that unit RIT details. Command has no clue as to the manpower makeup of that unit, and wether or not those personnel can do the duties necessary. But hey, we hae a RIT assigned.
My passion is firefighter safety. As I sit here and reread this post, I think that my department is not near as progressive as I would like it to be. We need to learn from the erors and mistakes of others, but we don't. We should lead. Lately, we are merely a member of the pack. We can, and must, be better than that.
Everyone Goes Home. Catchy pharase? Or your departments mission on every run?
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Permalink Reply by Art "ChiefReason" Goodrich on
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I have noticed that many of the replies hinges on the "SCBA bottle" rule.
Keep in mind that many fire/EMS activities are done without SCBA.
I think any rehab policies needs to include a serious look at observation and surveillance of anyone at any given scene.
Obviously, you are looking at different factors that run the gamut from extreme hot to extreme cold. Type of activity will be a factor. Any strenuous, physical exertion, regardless of duration should be rehabbed.
But it shouldn't be the only cause for concern. The strenuous activity might have been catching the rig.
It's all about keeping an eye on it.
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Permalink Reply by ANDREW PARKS on
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i usually try to check firefihgters out after the second bottle and most of them realize that i am not going to just let them back in without it
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Permalink Reply by Engineco913 on
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Good Point Art, a persons physical capability may limit them to less than 2 bottles. It is important to know your own physical limitations on the fire ground. Sometimes a bottle of water a bottle change and 5 minutes time outside is all thats needed for rehab, other times its 1 bottle and done. (extreme heat or exertion) We all are differant in our making. Thats why most departments go with the 2 bottle MAX between rehab is to prevent the go getters from getting hurt because they don't want to take 10 and get themselves hydrated and a breather
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Permalink Reply by Rob on
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Each ff is sent to rehab section once they have gone thru a single bottle. A paramedic runs that section and after monitoring vitals makes the decision if the ff may return to manpower or needs to rest longer or is done for that incident!
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Permalink Reply by Deb RN/EMT on
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As a member of the rehab team in my department, this is often a question we have to decide. We generally say 2 bottles. However, if it is an intense fire and/or the weather is extremely warm we will pull at our discreation or the chiefs. a couple of years ago we had multiple brush fires on a hot summer day. Since no one was using SCBA's, we based it on the number of Indian tanks a person used. As for how we make our decision of when to send back, usually it is after minimum two bottles water/gatorade, pulse below 100 in less then 20 min, BP down by 20% or less then 130/80 unless we know the person's baseline. We don't use Pulse ox. When a person arrives in rehab, we generally make them remove their turnout gear while they are there. In the winter, we sometimes have to change our rehab policy, especially if we don't have a large interior area for rehab.
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Permalink Reply by catfish on
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our department has in its sog that after 2 bottles you rehab for 30 minutes.if you can get this put in an sog the argument will be over.
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Permalink Reply by 437B on
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Hey, good discussion here.
We just implemented the two (2) bottle rule ourselves. However, based on the SO or line officers recommendation you can be sent to rehab sooner. Basically, after two your sitting for 20 minutes and being evaluated by the med-team and hydrating. If they clear you to return you can only do one more bottle for the event. That was the tuff one to get by. Requires mutual aid to keep enough interior FF in the rotation and if you are operating that long, it is a big event anyway. Alot has to do with each FF and the level of Fitness they are at also when making these decisions. Better to error on the side of caution.
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Permalink Reply by roy yoder on
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tow shots at this. we don't have a rehab policy but we do have officers that look after and know the firefighters and a good feel for each in the hunt. at a training live burn aquired structure, burning all morning with 95% of the guys there. it was warm 80 to 85 degrees and a good house. most had a least 4 runs into the house and we were just getting to lunch when the tones go off for a grass fire. large black smoke said something different and it was. tires, cars, trash and junk in the woods and tired firefighters. getrdone showed up and in they went. we sent 5 to the hospital with heat related problems and 3 still suffered effects about 1 year later. a couple got iv's and bounced back pretty quick. the other one is a mill fire in the middle of the night and a little short of manpower. the fire was in the 2 story basement and took a toll on us. couple of new guys tried to over due themselves but we caught them in time and with ems on scene set some iv's flowing. i am asst. chief and was running interior and being pretty drained took an iv and in so doing the others that really needed it did so to. peer pressure in the positive way. i have notrouble out of those men now as far as rehab they really saw the results. not super firefighters, just real men doing super stuff and needing the pickup to do it again later.
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Permalink Reply by Ben Waller on
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Our rehab starts out based on prevention. We encourage avoiding caffeine drinks and stress hydration with water and the occasional sports/electrolyte drink during the shift.
We also use the heat index flag system as a guide for when we need to be more aggressive with rehab.
Example sof the system can be found at: http://cap.mdickinson.com/safety_heat.htm
http://cap.mdickinson.com/safety_heat.htm
http://www.iiimef.usmc.mil/wx/HeatIndex.htm
We carry a laminated 8.5-inch x 11 inch laminated sheet with the heat index chart on one side and the rules for each color on the other on every dispatchable resource - engine, truck, medic, etc. We color-coded each cell with the flag color to make interpretation quick and intuitive.
Our basic rehab policy is two cylinders and rehab. We shorten this to one cylinder for black flag conditions and the high end of red if the incident is prolonged, a very hot fire, or other extenuating circumstances. Members are allowed to return to the firefight after rehab if their vitals return within set limits after 20 minutes or less. If the vitals don't meet the limits, the firefighter is kept in rehab. If the firefighter has a more severe medical complaint - chest pain, shortness of breath, or signs/sypmtoms of heat exhaustion or heat stroke, the firefighter gets transported to the ED for further evaluation.
We are in the process of updating our rehab SOG to include a RAD 57 Carbon Monoxide pulse monitor (similar to a pulse oximeter). We run a light utility that provides air refill and rehab from one vehicle, and we have a full-scale rehab bus that we utilize on larger incidents.
Our rehab group always includes at least one firefighter-paramedic, and the group leader is usually a paramedic officer. We provide large quantities of iced water and iced Gatorade or Powerade, full-scale BLS assessments including a tympanic thermometer, and ALS capability from a medic or the bus. We also have cool-mist fans and use icewater towels on the firefighters' heads to promote cooling after hard work, especially when it's really hot or in high heat index conditions.
For hazmats, we dress the entry teams in the bus, and the backup team sits in the air conditioning in a "half suited" status unless needed. Half-suiting includes boots and gloves on, suit unzipped to the waist, SCBA worn but not on air. It takes us about 60 to 90 seconds to deploy the backup team if they're needed. That slight delay is well worth not beating the backup team up with unnecessary heat stress.
We occasionally have some cold-weather firefighting here - the palm trees actually shiver occasionally. :-)
We provide a warm rehab area on the bus and heated drinks for those.
The NFPA has an excellent standard (1584) on Incident Rehab. It can be found at: http://www.nfpa.org/aboutthecodes/AboutTheCodes.asp?DocNum=1584&...
Remember, it's not about how tough or macho we are, it's about EVERYONE GOES HOME.
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There's a way to avoid having the white hats have to force individual firefighters to go to Rehab. If the Incident Commander sends each company to Rehab as an intact unit, you avoid that problem.
If you keep the company together, even in Rehab, you:
1) Avoid the chance of freelancing
2) Maintain 100% personnel accountability
3) Keep the company officer in charge of his/her company
4) Maintain the chain of command and don't require strategy-level officers (chiefs) to skip the tactical level (company officers) to handle problems with specific task-level firefighters
5) Have an officer that knows the firefighters with them to help the medics make re-entry or non-re-entry decisions
6) Return the company to the firefight as an intact, functional unit
These are an expectation for everyone in my department
In fact, the company officer MUST give the company accountability passport to the Rehab officer, and doesn't get it back until everyone in the company is deemed ready to go back to firefighting. Our rule is "If you don't have your passport, your company doesn't get to play."
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