Firefighter rehabilitation

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Firefighter rehabilitation is a vital firefighting service, providing firefighters and other emergency personnel with immediate medical attention including rehydration, treatment for smoke inhalation, and the prevention of life-threatening conditions such as heatstroke and heart attack^[1] after working at the scene of an incident.^[2] Firefighter rehabilitation can include a variety of things from a simple check up to deciding whether or not the firefighter needs to see a doctor. The rehabilitation area is set up in a safe location near the incident so that it can be accessible to any emergency responders who may need it.

Firefighter rehabilitation is designed to ensure that the physical and mental well-being of members operating at the scene of an emergency (or a training exercise) don't deteriorate to the point where it affects the safety of any other members. Firefighting is inherently dangerous in the best of circumstances, and any additional physical or mental stress increases the danger. Studies have shown that core body temperature and heart rate can rise dramatically during firefighting operations.^[3] Without intervention, firefighters may be at risk for serious acute illness from the extreme conditions and high levels of exertion.^[4]

The primary mission for personnel responsible for firefighter rehabilitation is to identify, examine, and evaluate the physical and mental status of fire-rescue personnel who have been working during the emergency incident or a training exercise. Following a proper survey, it should be determined what additional treatment, if any, may be required. The need to implement rehabilitation is based on many factors including, but not limited to, outside temperature, type of work being performed by firefighters, and use of Self-Contained Breathing Apparatus (SCBA).^[5][6]

A specially designated Rehabilitation Area is established at the discretion of the Incident Commander. If the Incident Commander determines that Rehab is necessary, firefighters may be instructed to "self-rehab" in the case of smaller-scale incidents, or qualified Paramedics or EMTs should be designated to manage the Rehab Area under the command of a fire or EMS officer or supervisor.^[5] The site should be located away from any environmental hazards, or by-products of the fire, such as smoke, gases or fumes. During hot months, the ideal location might include a shady, cool area distant from the incident. In winter, a warm, dry area is preferred. Regardless of the season, the area should be readily accessible to EMS-Rescue personnel and their equipment, so they may restock the sector with supplies, or in the event that ambulance transport is required.^[5][7]

Rehab sites can take many forms, including lobbies of nearby buildings, parking lots, or grassy areas such as yards, parks, or fields.^[6] Specially designed rehab vehicles are also used by many fire departments and EMS agencies.^[8]

. During large-scale incidents, like multi-alarm fires, multiple Rehab Areas may be necessary.^[6]

Rehabilitation equipment includes but is not limited to:

• Canopy to provide shade
• Misting fans for cooling
• Cooling Vest for quicker metabolic heat removal
• Chairs to provide temporary rest
• Coolers with water and other rehydrating beverages
• Food

Command of the Rehab Area is assigned to a fire chief or company level officer, who is designated as the Rehab Officer under most Incident Command structures.^[6] A minimum of two trained EMS personnel should initially be assigned to monitor and assist firefighters in the Rehab Sector, but more personnel may be necessary for larger incidents. Volunteer canteen or auxiliary members often assist EMS personnel in making firefighters as comfortable as possible.^[9][10]

It is important for command and company level officers to continually monitor personnel for telltale signs of exhaustion, stress, and or physical trauma.^[6] Individual members are encouraged to report to the Rehab Sector at any time that he or she feels the need to do so. Symptoms may include weakness, dizziness, chest pain, muscle cramps, nausea, altered mental status, difficulty breathing, and others.^[6] The U.S. Fire Administration recommends all fireground personnel (regardless of physical well-being) should report to the Rehab Sector immediately following strenuous activity, the use and depletion of two SCBA bottles (or failure of an SCBA), or forty (40) minutes of intense physical activity.^[6]

When firefighters get to the rehabilitation tent, they are monitored to prevent life-threatening conditions such as heat stroke and heart attack. Medical monitoring includes:^[11]

• Vital signs, such as Respiratory Rate, Blood Pressure, Heart Rate
• Lung Sounds
• Blood Oxygen Levels
• Skin condition and color, Pupils
• Body core temperature
• Administration of a 2-lead EKG, when chest pain or irregular heartbeat is presented
• Scoring on the Glasgow Coma Scale.

Heart rate should be measured as early as possible in the rest period. If the firefighter's heart rate exceeds 110 beats per minute, it is recommended that an oral temperature be taken. If body core temperature exceeds 100.6F, the firefighter should not be permitted to wear protective equipment or re-enter the active work environment, until temperature has been reduced and heart rate decreased.^[12]

Some fire departments run their own fireground rehab, either by in house firefighters trained in the medical field or it may be provided by:

• Private non-profit organizations, such as fire buffs ^[13] (not to be confused with firebugs or arsonists), sparkies ^[14] and other organizations
• Emergency medical services (EMS)
• First Aid and Rescue Squads
• Rehab services run by private individuals

• Dedicated rehab vehicles
• Converted ambulances
• Converted step vans (types of step vans)
• Converted canteen trucks
• Converted buses.
• Pickup trucks

• Firefighting
• Glossary of firefighting terms
• Turnout Gear
• Emergency
• Chest Pain
• Emergency Medical Services
• Fire Buff
• Medical Attention
• Rehydration
• Smoke Inhalation
• Heat Stroke
• Heart Attack

• The Salvation Army Emergency Disaster Services
• Rehab 5
• Box 15 Club
• Box 4 Special Services
• Milwaukee Fire Bell Club

• USFA Emergency Incident Rehab Manual, FA-114
• FireRehab.com
• NFPA 1584 Standard on the Rehabilitation Process for Members During Emergency Operations and Training Exercises
• NIOSH Publication No. 2007-133: Preventing Fire Fighter Fatalities Due to Heart Attacks and Other Sudden Cardiovascular Events