Firefighter Rehabilitation. by Sandra Stoeckel RN,CEN,AEMT-P, Firefighter

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Firefighter Firefighter

Rehabilitation Rehabilitation

by Sandra Stoeckel RN,CEN,AEMT-P, Firefighter

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We will discuss the need for firefighter We will discuss the need for firefighter

rehab rehab

A review of the necessary components A review of the necessary components

to a rehab area to a rehab area

A discussion of the steps and A discussion of the steps and

parameters needed for safe firefighter parameters needed for safe firefighter

rehab.

Goals

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More firefighters die of stress and More firefighters die of stress and

heat related illnesses than from burns heat related illnesses than from burns

and injuries suffered in structural and injuries suffered in structural

collapses.

Rehab offers mental and physical rest Rehab offers mental and physical rest

from the stress of a fire scene, from the stress of a fire scene,

decreasing injuries from mental and decreasing injuries from mental and

physical fatigue physical fatigue

Why Rehab?

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Convection:

Convection: heat loss as cooler air heat loss as cooler air moves across the body, and the

moves across the body, and the body’s heat is transferred to the body’s heat is transferred to the

moving air moving air

Evaporation:

Evaporation: warmed body warmed body

moisture is lost to the environment moisture is lost to the environment

Mechanisms of Heat Loss

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Heat Cramps

Heat Cramps:: usually develop during usually develop during strenuous or prolonged activity in a hot strenuous or prolonged activity in a hot

environment:

Heat Exhaustion

Heat Exhaustion:: occurs when excessive occurs when excessive sweat loss combined with inadequate fluid sweat loss combined with inadequate fluid

consumption result in depletion of fluid consumption result in depletion of fluid

volume volume

Heat Stroke

Heat Stroke:: caused when the body looses caused when the body looses its ability to regulate temperature in a hot its ability to regulate temperature in a hot

environment environment

Heat Related Emergencies

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Firefighter Firefighter

Rehabilitation is a Rehabilitation is a

method to interrupt and method to interrupt and

prevent medical prevent medical emergencies, and emergencies, and

protect the health and protect the health and

well being of fellow well being of fellow

firefighters

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Components of a

Rehabilitation Sector

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provide a safe area for fire crews to provide a safe area for fire crews to

rest and rehydrate rest and rehydrate

Early identification of workers at risk Early identification of workers at risk

for heat or stress related injuries for heat or stress related injuries

Treatment and disposition of ill or Treatment and disposition of ill or

injured firefighters injured firefighters

Function:

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Staffing:

Most qualified and highly trained EMS Most qualified and highly trained EMS

personnel on the scene should provide personnel on the scene should provide

care and treatment.

Minimum should be EMT’s Minimum should be EMT’s

Large scale incidents: mutual aid EMS Large scale incidents: mutual aid EMS

agencies agencies

Non medical personnel can provide Non medical personnel can provide

hydration and assistance hydration and assistance

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Design and Location:

Should be outside the incident parameters, if possible Should be outside the incident parameters, if possible

out of sight or facing away from the fire scene out of sight or facing away from the fire scene

Should be upwind of the scene Should be upwind of the scene

Should allow prompt re-entry to the scene Should allow prompt re-entry to the scene

Protected from extremes in temperatures and Protected from extremes in temperatures and

environment, free of fumes environment, free of fumes Not accessible to the media Not accessible to the media

Should provide access to SCBA refill Should provide access to SCBA refill

Should have a supply of running and drinkable water Should have a supply of running and drinkable water

Close to ambulance staging in case of a need to Close to ambulance staging in case of a need to

transport transport

Should have one way in/out Should have one way in/out

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Parameters Parameters

SOP’s should be developed to outline SOP’s should be developed to outline all aspects of the Rehab Sectorall aspects of the Rehab Sector

Areas to include:

Areas to include: criteria for entry, criteria for entry,

accountability,entry and triage, medical accountability,entry and triage, medical

evaluation and treatment, and hydration evaluation and treatment, and hydration and and

nourishmentnourishment

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Criteria for entry:

Company SOP’s should designate Company SOP’s should designate

when and why a firefighter should when and why a firefighter should

enter rehab.

Generally speaking: when physical and Generally speaking: when physical and

psychological limits have been psychological limits have been

reached reached

““Whole crew “ conceptWhole crew “ concept

““two bottle” ruletwo bottle” rule Time limit

Time limit

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Accountability:

Method used to track individuals Method used to track individuals

Entering rehab as an entire crew Entering rehab as an entire crew

Log crews in and out of rehab Log crews in and out of rehab

All entry and exit thru a single All entry and exit thru a single

point

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Entry and Triage:

All entry thru a single All entry thru a single

point point

Upon entry, or prior to Upon entry, or prior to

entry all firefighters entry all firefighters

should remove all gear should remove all gear Evaluation for injury or Evaluation for injury or

heat or stress related heat or stress related

illness illness

Baseline vitals Baseline vitals

Brief information Brief information

collection collection

Heart rate > 120 bpm Heart rate > 120 bpm

Blood Pressure Blood Pressure

>200 systolic>200 systolic

< 90 systolic< 90 systolic

> 110 dyastolic> 110 dyastolic Injuries

Injuries AnyAny

Anyone meeting these Anyone meeting these

criteria need medical criteria need medical evaluation as well as evaluation as well as

rest and rehydration rest and rehydration

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Medical Evaluation/Treatment:

AllAll personnel should rest for a minimum of personnel should rest for a minimum of 20 minutes

20 minutes

Hydration should be given Hydration should be given

Repeat vital signs should be completed at Repeat vital signs should be completed at

the end of 20 minutes.

If a crew member has abnormal vital signs, If a crew member has abnormal vital signs,

then the whole crew should remain in rehab then the whole crew should remain in rehab

and receive additional monitoring.

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Revaluation findings mandating continued Revaluation findings mandating continued

Rehab Rehab

Policies regarding Policies regarding

return to work return to work

must be detailed must be detailed in company SOGs in company SOGs

Helpful to have Helpful to have

baseline vital baseline vital records on all records on all

members, as well members, as well

as documented as documented

medical history medical history Heart Rate >

Heart Rate >

100100

Blood Pressure Blood Pressure

>160 systolic>160 systolic

< 100 systolic

>90 diastolic

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Hospital Evaluation:

Consider Hospital Consider Hospital

evaluation for any of the evaluation for any of the

following:

Chest pain Chest pain

Shortness of breath Shortness of breath

Altered mental status Altered mental status

(confusion, seizures,dizzy,ect.) (confusion, seizures,dizzy,ect.)

Skin that is hot and dry or Skin that is hot and dry or

moist moist

Irregular pulse Irregular pulse

Oral temerature > 101 F Oral temerature > 101 F Pulse > 150 at any time Pulse > 150 at any time

Pulse > 140 after cool down Pulse > 140 after cool down

Systolic BP > 200 after cool down Diastolic BP > 130 at any time

If any of these conditions

present or occur, start oxygen therapy and transport to the hospital for further evaluation.

All transport policies should be outlined in company SOGs

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Hydration& Nourishment in Rehab Hydration& Nourishment in Rehab

Fluid replacement is crucial during rehab, Fluid replacement is crucial during rehab, both water and electrolytes

both water and electrolytes

Varied recommendations on the use of Varied recommendations on the use of

commercially prepared sports beverages commercially prepared sports beverages

Good rule of thumb is to dilute drinks such as Good rule of thumb is to dilute drinks such as

Gatorade

Gatorade by 50% by 50%

Fluids should be cool or ambient Fluids should be cool or ambient

temperature.

Avoid beverages containing carbonation and Avoid beverages containing carbonation and

caffeine caffeine

Incidents > 2-3 hours should consider solid Incidents > 2-3 hours should consider solid

foods foods

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What This Means What This Means

Firefighter Rehab is a positive mechanism to Firefighter Rehab is a positive mechanism to

prevent injury, illness and even unexpected prevent injury, illness and even unexpected

death death

Firefighter Rehab should be taken seriously Firefighter Rehab should be taken seriously by by ALL firefightersALL firefighters

Firefighter Rehab is

Firefighter Rehab is NOTNOT punishment punishment Does

Does YOUR YOUR company have Rehab SOGs?company have Rehab SOGs?

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Next Steps Next Steps

Develop Rehab Sector protocols Develop Rehab Sector protocols

Stock your Rehab supplies with bottled water, sports Stock your Rehab supplies with bottled water, sports

drinks, broths, crackers ect.

Use small scale rehab for heavy trainings Use small scale rehab for heavy trainings

Investigate rehab equipment available Investigate rehab equipment available

Attempt to collect baseline vitals of all your members Attempt to collect baseline vitals of all your members

and keep them in a convenient spot on a truck and keep them in a convenient spot on a truck

Develop a basic form for triage evaluation Develop a basic form for triage evaluation

Using a rehab sector at heavy trainings helps to work out Using a rehab sector at heavy trainings helps to work out

logistical problems that may be encountered logistical problems that may be encountered