By Randall Talifarro
Published Monday, June 11, 2012
| From the August 2012 Issue of FireRescue
Rehab is more important now than ever. Structure fires are burning with greater intensity, with synthetics and chemicals contributing to most fire loads. At the same time, PPE has dramatically improved our ability to avoid thermal injuries but limited our ability to dissipate heat, resulting in an increased likelihood of heat-stress events.
A Safety & Rehab Culture
Historically, firefighters have taken great pride in demonstrating bravery, skill and prowess by pushing themselves to the limit. I’ve heard firefighters brag about how much heat they took, how many bottles they went through, and even about not wearing SCBA at all. And more often than not, the individuals were congratulated for their effort. Additionally, some incident commanders (ICs) still operate from the perspective of years past when bunker pants, Nomex materials and proper-fitting gear were seemingly optional. We must put a stop to these attitudes and create a culture in our organizations that values both heroism and a safety mindset because, as we all know, too many fatalities and injuries have resulted needlessly.
A strong safety mindset supports aggressive interior operations only when warranted, and requires that firefighters base these decisions on a risk-benefit assessment. Equally as important, we must ensure continuous personnel monitoring and rehab whenever our crews are in high-heat or high-stress conditions. We need to support officers who request additional resources quickly and err on the side of frequent and appropriate rehab. Additionally, we must educate our officers about the correlation between PPE enhancements and heat-stress events.
By the Numbers
Heat-stress and heat-related cardiac events aren’t occurring because firefighters are less fit or less tough. I see more attention being given to firefighter fitness than at any point in my career. A report by the Illinois Fire Service Institute (IFSI, 1998) references Smith et al. (1997), which documents a firefighters’ average heart rate when exerting themselves during overhaul in ordinary (ambient) room temperatures as 139 bpm vs. 175 bpm when exerting themselves during overhaul in live fire conditions. Additionally, Smith et al. (1995) documented an increase of 50 bpm in firefighters walking on a treadmill wearing PPE vs. street clothes. Further, the 1998 IFSI report suggests that firefighters lose nearly two quarts of sweat per hour when firefighting in newer PPE.
Firefighters are covered head to toe in PPE designed to keep heat away from the body. But it’s difficult keeping heat away from the body while simultaneously allowing heat to escape. This is the dilemma of new gear. In 2007, NFPA 1971 raised the THL (total heat loss) requirements for manufacturers—a change that will improve new gear. But most firefighters work in gear designed before those changes took effect. Further, this design change will lessen—not eliminate—the problem.
The U.S. Fire Administration produced a manual on Emergency Incident Rehabilitation (February 2008), and NFPA 1584 addresses rehab for members during operations and training exercises. These documents are good resources for those seeking to implement rehab into their department SOPs. Neither identifies hard and fast rules, per se, relative to when and where rehab must be established. Instead, they state that the decisions should be based on scene conditions, environmental factors and the experience of the IC. But NFPA 1584 does establish guidelines to help an IC with this effort:
- The company or crew must self-rehab (rest with hydration) for at least 10 minutes follow-ing the depletion of one 30-minute SCBA cylinder or after 20 minutes of intense work without wearing an SCBA. The company officer (CO) or crew leader must ensure that all assigned members are fit to return to duty before resuming operations.
- The company or crew must enter a formal rehab area, drink appropriate fluids, be medically evaluated and rest for a minimum of 20 minutes after any of the following: depletion of two 30-minute SCBA cylinders; depletion of one 45- or 60-minute SCBA cylinder; whenever encapsulating chemical protective clothing is worn; and following 40 minutes of intense work without an SCBA.
It’s imperative that chief officers review these documents and build effective policies based upon their full recommendations.
Firefighter rehab, along with a healthy lifestyle and diet, could go a long way toward reducing fatalities and injuries. As such, these concepts must be given a higher priority and must be embedded in firefighter culture and SOPs. Further, following the above NFPA guidelines can dramatically affect cardiovascular- and heat-related injuries or fatalities.
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