EMERGENCY INCIDENT REHABILITATION

1. EMERGENCY INCIDENT REHABILITATION Mason County Emergency Medical Services Douglas Richardson, EMT-P Emergency Incident Rehabilitation

2. Objectives • Define rehabilitation in context to emergency workers. • Discuss the importance of rehabilitation to the fire and emergency services. • Understand situations warranting, and criteria for initiating rehabilitation. Emergency Incident Rehabilitation

3. Objectives • Discuss the impact of Heat Stress on emergency workers. • Discuss the impact of Wind Chill on emergency workers. • List criteria for the appropriate placement of a rehabilitation area. Emergency Incident Rehabilitation

4. Objectives • List five (5) reasons to send emergency workers for medical evaluation. • List four (4) criteria that should be meet before emergency workers are allowed to return to duty. Emergency Incident Rehabilitation

5. Objectives • List two (2) reasons for not allowing injured emergency workers to return to active duty. • List ten (10) reasons to transport emergency workers to an appropriate hospital for further evaluation. Emergency Incident Rehabilitation

6. Objectives • Discuss the physiological consequences of fluid loss. • Define osmolarity and discuss the importance of osmolarity in the rehydration of fire / rescue personnel. Emergency Incident Rehabilitation

7. What is Rehab and Why Do We Need It? Emergency Incident Rehabilitation

8. Background To Rehab For many years the fire service has treated the element of job-related danger as a badge of courage, worn with pride. Firefighters would boast of this element of danger when discussing the merits of various occupations. Emergency Incident Rehabilitation

9. Background To Rehab In the last 20 years or so, however, the attitude of the fire service toward safety has changed dramatically. Firefighters and department officials began to realize that needless deaths and injuries of firefighters were not badges of courage but indicators of problems. Emergency Incident Rehabilitation

10. Background To Rehab • If firefighters are extended beyond their safe operating periods, the results may be: • Stress- or fatigue-related illness or injury • The Firefighter, although uninjured, will be fatigued to a point at which he/she is unable to continue in the operation • The mentally and/or physically fatigued firefighter may make poor decisions in a high-risk environment Emergency Incident Rehabilitation

11. What Is Rehab? In the Emergency Services, rehabilitation, or rehab, describes the process of providing rest, rehydration, nourishment, and medical evaluation to responders who are involved in extended and/or extreme incident scene operations. Emergency Incident Rehabilitation

12. What Is Rehab? • Note that Rehab operations are not limited to emergency scenes. Other type of activities that might necessitate Rehab include: • Training exercises • Athletic events • Parade or event standbys Emergency Incident Rehabilitation

13. Why Do We Need Rehab • Over 50% of all firefighter deaths are to some extent, directly attributed to stress and overexertion. Emergency Incident Rehabilitation

14. The Functions Of A Rehab Operation • Physical assessment • Revitalization (rest, rehydration, and nutritional support) • Medical evaluation and treatment • Continual monitoring of physical condition • Transportation for those requiring treatment at a hospital Emergency Incident Rehabilitation

15. The Functions Of A Rehab Operation • Initial critical incident stress assessment and support. • Reassignment Emergency Incident Rehabilitation

16. The Functions Of A Rehab Operation Emergency Incident Rehabilitation

17. Physical Assessment • General physical assessment • Basic vital signs • Medical evaluation • Revitalization • Reassignment Emergency Incident Rehabilitation

18. Revitalization • Rest • An adequate amount of time for core temp and vital signs to return to normal. • Fluid replenishment • Provided with appropriate fluid to replace those lost • Nutrition • Should receive nutritionally sound food Emergency Incident Rehabilitation

19. Medical Evaluation and Treatment • Firefighters who appear ill or injured should be assigned to personnel in the medical evaluation/treatment area for rehab • This should not be delayed by providing with drinks/food unless the medical evaluation shows this to be a priority. Emergency Incident Rehabilitation

20. Continual Monitoring of Physical Condition • Firefighters in the rehab area should have their condition continual monitored. • Firefighters who meet the criteria for release from rehab should be reassigned or released from care • Firefighters who do not respond to rest or medical attention may require more intensive interventions. Emergency Incident Rehabilitation

21. Continual Monitoring of Physical Condition • No one should be released from rehab until he/she is medically sound or, • Is transported to a medical facility for further treatment. Emergency Incident Rehabilitation

22. Knowing When To Establish Rehab Emergency Incident Rehabilitation

23. Knowing When To Establish Rehab The goal of emergency incident rehab operations is to lessen the risks of injury that may result from extended operations, which are sometimes carried out in adverse conditions, involving weather and other factors. Emergency Incident Rehabilitation

24. Knowing When To Establish Rehab Ideally, rehab operations should commence whenever emergency operations pose a risk of pushing personnel beyond a safe level of physical and mental endurance. Emergency Incident Rehabilitation

25. Knowing When To Establish Rehab • Extended fire incidents • Hazardous Material Incidents • Prolonged rescue/recoveries • Adverse weather conditions • Crime scene/standoff’s • Search activities Emergency Incident Rehabilitation

26. Extended Fire Incidents • Structure Fires • High-rise structural fires • Wildland fires Emergency Incident Rehabilitation

27. Weather Conditions • Hot-Weather • Ambient temperature • Relative Humidity • Direct Sunlight • Cold-Weather • Ambient temperature • Wind chill factor Emergency Incident Rehabilitation

28. Hot-Weather Even under the “ideal” climatic conditions, fires, hazmat incidents, and rescue operations place a variety of thermal stresses on the responders operating at them. Emergency Incident Rehabilitation

29. Hot-Weather Emergency responders must frequently perform heavy physical labor in heated atmospheres, while wearing bulky protective clothing. In those “ideal” conditions when the responders have completed their assignments they go to a safe area such as rehab to remove their clothing and cool down. Emergency Incident Rehabilitation

30. Hot-Weather Emergency Incident Rehabilitation

31. Hot-Weather • Ambient air temperature and relative humidity can be factored together to create what is often referred to as a “Heat Index” • Working in direct sunlight can add 10ºF to the heat index. • Working in full turn-out gear can add an additional 10ºF to the heat index. Emergency Incident Rehabilitation

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33. Injuries Associated with Heat Stress Index Conditions Emergency Incident Rehabilitation

34. Heat Stress Index • The USFA (United States Fire Administration) recommends that rehab operations be initiated whenever the heat stress index exceeds 90 ºF (32 ºC). Emergency Incident Rehabilitation

35. 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-temperature conditions for long periods of time. Emergency Incident Rehabilitation

36. Cold-Weather Conditions Cold weather poses different rehab challenges to emergency responders then the warm-weather scenarios talked about earlier. The potential threat to the well-being of the emergency workers from them, however is just as great. Emergency Incident Rehabilitation

37. Cold-Weather Conditions An emergency worker insufficiently protected against the cold may have his/her body’s core temperature lowered to dangerous levels under extreme circumstances. This condition is referred to as hypothermia. Emergency Incident Rehabilitation

38. Cold-Weather Conditions The most common cold-weather related injuries among emergency responders are localized cold injuries, commonly called frostnip or frostbite. These injuries occur when particular parts of the body are exposed to extreme cold for extended periods of time. Emergency Incident Rehabilitation

39. Wind Chill Just as heat and humidity combine to increase the impact of heat, cold and wind combine to impact the effects of cold upon the human body. The combined effect of cold and wind is referred to as the Wind Chill Factor. Emergency Incident Rehabilitation

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41. Wind Chill Factor The USFA (United States Fire Administration) recommends initiating rehab operations whenever the wind chill factor drops to 10ºF (-12º C) or lower. Emergency Incident Rehabilitation

42. Other Situations Where Rehab May Be Necessary • Crime scene/standoffs • Search activities • Public events • Training events Emergency Incident Rehabilitation

43. Crime Scene / Standoffs • Bomb squad members who have been operating for long periods of time in heavy protective clothing. • Police tactical unit teams who have been operation in forward positions for a long period of time. Emergency Incident Rehabilitation

44. Search Activities • Large area searches for person(s) who have wandered away from their home. • Urban search and rescue (USAR) incidents following a natural or manmade disaster, such as a structural collapse. • Searches for climbers, hikers, or others involved in sports or recreation activities. Emergency Incident Rehabilitation

45. Public Events • Fairs, carnivals or other festivals • Auto Races • Parades • Concerts • Major sporting events • Political rallies • Large-scale religious ceremonies Emergency Incident Rehabilitation

46. Establishing and Managing A Rehab Area The first five minutes of an incident can dictate the outcome of the next five hours. Emergency Incident Rehabilitation

47. Establishing and Managing A Rehab Area • Once the need for a rehab has been established the most important decision and one that must be made almost immediately is where to locate the rehab operations. • 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. Emergency Incident Rehabilitation

48. Locating the Rehab • Close to Incident Command • More easily keep track of who is in rehab • Easier to anticipate when people will be ready • More efficient use of equipment • Away from Incident Command • Easier for the personal to relax • Fewer distractions Emergency Incident Rehabilitation

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50. Site Characteristics • The site for the Rehab must be selected on several criteria: • The estimated number of people that will need to be rehabbed • The weather at the time of the incident • The duration of the incident Emergency Incident Rehabilitation