Rehab Units Prevent Near Misses

The topic of on-scene rehabilitation (rehab) has gained increasing attention over the last several years. This movement has certainly not been embraced by everyone in the fire service, nor is it progressing fast enough. But fortunately, more and more fire departments are requiring crews to rotate through rehab on an organized schedule. The results: firefighters who are able to fight longer and identify the signs of exhaustion and medical emergencies.

NFPA 1584: Standard on the Rehabilitation Process for Members During Emergency Operations and Training Exercises (2008 edition) addresses rehab for both emergency operations and training. Per the standard, a rehab station is a location designated near the action areas that provides relief from climactic conditions, rest and recovery time, cooling or warming, rehydration and calorie replacement. All of these functions seek to recharge firefighters for another round of work. Rehab also offers medical surveillance, providing an opportunity for early detection of physiological deficits that a firefighter may not recognize or want to reveal.

Near-Miss Report #10-652  
“Approximately three minutes in to their (second) evolution, one of the firefighters walked out of the hot zone and stated that he did not have a good facemask seal. We started assisting with removing his gear and getting him to sit down in our rehab area. After a couple of minutes, the safety officer asked him how he was feeling. He stated that he was OK and that, ‘I just need to catch my breath.’ While taking the firefighter’s pulse a second time, the officer noticed an irregular heartbeat … [and] initiated ALS procedures … which showed that the firefighter had a heart rate of 120 with over 20 premature ventricular contractions (PVCs) a minute scattered throughout his EKG. After this was noted, we started to call for a transport unit to take the firefighter to the local hospital for further evaluation.”

The denial factor is often a huge hurdle. As the report shows, rehab is meant to prevent denial and also back up observation with medical evaluation.

Near-Miss Report #08-297
“We were working the end of a night shift at a mutual-aid structure fire. The temperature was in the high 90s and humidity was over 90%. I was relieved probably 2 hours and 45 minutes into the call. I was wearing full PPE all the time. Upon coming out of the scene and going to rehab … my vital signs were taken several times, and each time they deteriorated from the previous time, and it was decided to put me in the ambulance to cool me down. While waiting for the gurney, it became increasingly difficult to drink as I went into convulsions. I was expedited down the hill to the awaiting ambulance.”

These reports are all too common. Fortunately, there are steps you can take to prepare your department.

  • Consult NFPA 1584 for a comprehensive approach to rehab.
  • Contact other departments for copies of their rehab policies.
  • Consider partnering with neighboring departments to share costs for a regional rehab unit.
  • Ensure that personnel understand the value of rehab and that officers enforce rehab policies.
  • If you don’t provide EMS, contact your EMS provider and develop a cooperative partnership so you have proper medical monitoring at your rehab sector.

In Closing
A firefighter’s body gives out before a firefighter’s will, making rehab an important issue in our field. Further, the leading cause of firefighter line-of-duty deaths (LODDs) is cardiovascular events. As the two excerpts illustrate, an established rehab sector can make a huge difference in firefighter survival. Without the trip to rehab, the firefighters’ health issues may not have been identified. And instead of reading about their experiences in near-miss reports, we may have been reading about them in a NIOSH LODD report.
It’s June, which means we’re in the dog days of summer. Stay hydrated, shorten work cycles, and call for help early. You’ll live to fight fire another day.

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