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.
I think it should be rehab after the 1st bottle and whenever conditions present that indicate it might be needed...also 2 other things we do.....Add a temperature to the vital signs...and the #1 thing...the rehab officer has FINAL say...if He/She says NO...then it is NO...there is no going to the IC or the Chief and whining.....decision has been made.....
You can't tell by looking at someone! Stop it wit this nonsense! Please! Buddies should not be making the call because they may or not be trained in EMS or Rehab and are not going to being objective and can be swayed...Let's think here fellas!
Karen...Pulse rate greater than 150 that doesn't recover in 15 minutes.....Temp 101.....everyone takes coat off and at least opens bunkers....push fluids....electrolyte based...gatorade or sports drinks....not coffee, soda and definitely no alcohol!!!!! Cool but not cold (will only make you puke) Rehab located away from scene....fans or cooling mist....sign it....sign out...one way in...one way out....Rehab officer has final say on whether you go back in the fight or not...and their say is law......
I am from a small town, which has four companies, each having two to three company chief officers (Chief, Deputy, and Assistant), and there are also three "paid" fire chief's positions which oversee the town. The three chiefs for the town are three of the stations in town as well. We have no standard operating procedures for rehab, however, our local provider of EMS which is always staffed with at least one ALS qualified ambulance does have such a standard. We as a town have no safety officer, although I am trained at the NFPA 1521 standard for Incident Safety Officer, as well as being certified for the Health and Safety Officer which to those of you who are unaware, the health and safety officer may not be trained to the NFPA 1521 standard for Incident Safety Officer, the health and safety officer is responsible for maintaining fitness programs, and other safety related issues not on the incident. Being trained to the level of 1521, I have offered to become the Safety Officer numerous times, and some of the Chiefs feel I am not fully capable of doing the job as I am 28 years old. I have tried numerous times to establish SOG's without success, however, there is an unwritten rule that upon using two air cylinders they are to go to rehab. Some firefighters go faithfully, and others will state they do not need rehab. We recently had a busy day Monday with three structural fire calls, during the third there were five firefighters who were treated for heat related symptoms.
I have stated before that we not only need to perform rehab on structural incidents but also on every incident we are called to. We do not keep records of our personnel's baseline vital signs, as many are scared to do so, due to the HIPPA laws. I am afraid that we will have an incident where it turns into a civil lawsuit and they begin pulling records of trainings and such and question why there is no dedicated incident safety officer assigned to the department, with myself having the certification, I am afraid that the lawyers may question me in regards to why I am not the assigned safety officer and I become liable at that particular point.
The EMS provider for our local area has the two bottle rule, with stipulations in regards to weather conditions, as well as the services we are providing. Once in the rehab sector, which is close to the scene, however, it is out of the work area, and placed in a quieter area away from apparatus. Upon entering the rehab sector, you are to take off your turn out coat, hood, helmet, gloves, and at least open your turn out pants to allow air movement. Once in rehab, the vital signs of each member are taken as well as a quick, yet thorough past medical history is taken at that point as well. We are given at least ten minutes to sit in the rehab sector and depending on your vital signs as well as other medical signs and symptoms, you may be released. Vital signs are taken initially and depending on whether they come back down to the persons average vital sign area, you may then be released, if the vitals are showing no signs of coming back down, you are required to sit for an additional ten minutes, if they fail to correct themselves during the twenty minutes, you are officially removed from service and may be transported depending on the discretion of the paramedic. Our EMS provider also has a physician who depending on his availibility and the incident, he will respond, upon his arrival on the scene he has the word of "God" In the colder months, the rehab sector which has its own seperate vehicle which acts as a dual rehab vehicle as well as MCI unit, carries a self inflating haz-mat decon tent which you can then force heat into the tent via a propane fired heater, so that is placed in service during the colder months.
While in rehab, all members are provided with fluids, which they try to shy away from Gatorade straight out of the bottle due to the osmorility of the fluids. Osmorility is a factor in the absorbtion of the necessary electrolytes and rehydration factors, the higher the osmorility, the harder it is for the body to absorb the necessary nutrients. We are provided with bottled water which is chilled, however, not completely ice cold as it possibly causes the vital signs to vagal or drop dramatically which then creates more potentially serious medical conditions such as syncope. If gatorade is used, it is mixed in a five gallon water pitcher with the three gallon powdered mixture being used, therefore, watering down the gatorade to decrease the osmorility. Gatorade and other sports drinks contain very high concentrations of sodium and sugar and often create other medical conditions. During the colder months we may be provided with warmer liquids, with the main liquid being chicken broth. The vital signs which are taken are the normal pulse, respirations, and blood pressure. The pulse oximeter which is carried also monitors the carboxyhemoglobin in the blood stream as well, depending on many factors, some members are placed on a four lead monitor and if some concern is shown, the paramedics can then obtain a 12 lead ekg to create a much better assessment of the heart. All names are written on a log, which was supposed to be turned into one of the three "paid" chiefs, however, it is not always given, because the paid chief feels it is unnecessary to review the log.
So thats the basics of our rehab assessment and sector, however, we still have no written SOP/SOG's in regards to rehabilitation, we have no safety officer, there is often no accountability or list of members operating on our incidents so if there is no accountability of our personnel, we can not determine who has and has not gone to the rehab sector.
My question to the forum and other professionals here on these forums is this: "If you have a member who is certified to the NFPA 1521 Incident Safety Officer standard do you think that person should be placed into the role of the Incident Safety Officer?" Again as I stated before, I am 28 years old, I have been on initial attack lines and extinguished multiple fires as a nozzle person, I held the position of captain in the fire service as well as batallion chief in the EMS field being an EMT. So as I was told, I would never gain the respect of a safety officer, as many others feel it should be a well seasoned vetren who has been a chief officer, and is well respected on the fire ground. I may not be respected by others, but if I were the safety officer, I would not be looking for respect, I would do the duties as the standards state, if someone doesn't respect me for doing a job to make every attempt to making sure they get home to see their families, then so be it, I will not lose any sleep over their problems with me! So my question has been asked, but I must apologize for carrying on and creating such a long reply, as for the standards, I do have a copy of 1500, 1521, 1584, 1561, 1403, 1021, and possibly a few others, which are on printed on paper and not available as a pdf file, but if anyone needs them please send me a private message and we can discuss the possibilities of getting the standards you need to you!
I'm in an EMS / Rescue Squad. I've been pushing for our Rescue truck to roll on any confirmed fire that we get pulled for. (Our county policy is that an ALS and a BLS/Rescue Squad ambulance rolls for a fire / gas leak standby.) Not only for support in equipment (We carry a few extra tools like pickhead/flat head axes, multi-purpose axes, halligans, rope, etc) but also our Rescue truck is a Command Center. Since the command center walk-through has air conditioning, radio equipment, countertops, etc. I have suggested that it can be used as a Rehab truck. Currently we only have the County EMS services rehab trailer roll on anything higher than 3 alarms. I thought we could load it up with a cooler full of water and a couple cases of snacks, roll it, and let it run as a Rehab unit for the firefighters.
We realized this also, Karen. We saw this and addressed it this way. We are required to do quarterly SCBA drills. At these quarterly drills we take baseline vitals before we begin drill. This information is then logged and used on-scene. This gives us a constant updated system to compare a member to. This way we are also not going off of numbers/info from three years ago.
Our SOP's say keep in Rehab if the Systolic BP is above 130mmHg and Diastolic is above 90 mmHg. We consider hospital evaluation if the systolic is above 200 mmHg after cool down and if the Diastolic is above 130mmHg or below 40 or 50 mmHg. Also it sounds like it is pretty important to decon or clean your BP cuffs after each use I guess they start throwing faulty readings after mutliple uses on multiple patients (as in Rehab).
The best is to have baseline vitals and records of medications. Certain medications like Lasix speed the loss of electrolytes during physial exertion.
When keeping a responder in rehab we have the initial 20 mins rest, then if he is not ready to return to duty we reevaluate every 10 mins.
other things we look at are the CO levels. If carbon monoxide level is higher than 15% we keep in Rehab at 25% we transport to a hospital (these are slightly on the safe side). The average smoker is going to be between 5 and 10 % CO.
Pulse >100 bpm keep in rehab
>150 at anytime or >140 after cool down Transport to hospital
SaO2 < 94% keep in rehab
Body Temp. >100.5 keep in rehab
>101.5 consider transport
Always check your gear too. One of our guys temp was 98.6 on the dot, but he looked really heated. I took mine (I hadn't been through the training yet) it read 75 degrees F. Ha I think he was probably hotter than 98.6 because I didn't even feel chilled!