An “incident” consists of a major structure fire, accident scene, MCI event, or other event which has the potential to create heat or cold stress, dehydration, fatigue, or other physiologic stresses in fire personnel which could negatively affect performance and/or health.
Rehabilitation Officer
a. Initial on-scene fire official i.e. captain, battalion chief
b. Once rehabilitation quarters established, responsibilities of “rehab officer” shall be transferred to lead EMS personnel
c. EMS rehabilitation operations shall be coordinated with lead fire official
Location
a. Ideal rehabilitation location should be a cool place situated away from incident operations and isolated from the public & media
i. Ambulance
ii. Rehab trailer
iii. Adjacent residence
iv. Tent
Indications
a. Obvious fatigue or significant non-operational slowing of work efforts
b. Any sign of acute illness e.g. vomiting, abdominal/chest pain, altered mental status, etc.
c. After use of (2) 30-minute SCBA units or (1) 45 or 60-minute SCBA unit
d. Request of supervisory fire official
e. Any fall or other significant on-scene injury
Assessment (to be done on each patient)
a. Neurologic & orientation status (time, place, person, situation)
b. Vital signs including blood pressure, heart rate, respiratory rate, & temperature
c. Finger stick blood glucose
d. Oxygen saturation
e. Carbon monoxide assessment
Treatment
a. Fire personnel should remove outer clothing layer i.e. PPE
b. Active cooling (in heat-stress environment) or warming (in cold-stress environment) should be instituted
i. Fans, misting, forearm/hand cooling, cool cloths to face (for heat-stress)
ii. Blankets, heated air (for cold-stress)
c. Personnel should consume a minimum of 32 oz (1 liter) of fluid while in rehab
i. Sport drinks are preferred (electrolytes & carbohydrates)
ii. Water is acceptable alternative (initially)
d. A rest period of 10 – 20 minutes is the recommended minimum
e. Any CO level > 12% requires 100% oxygen for a minimum of 30 minutes
i. Use of CPAP should be strongly considered
f. If nausea is present, a firefighter is too fatigued to actively participate in oral rehydration, or has significant hypotension/tachycardia, an IV of Isotonic Solution (NS or LR) 0.9% NORMAL SALINE should be infused at a wide-open rate
i. If nausea not resolved after infusion of 1 liter OR active vomiting occurs, administer ONDANSETRON (Zofran) 4 mg IV/PO
g. Reassessment after time & fluid requirements are met
i. Recheck blood pressure & heart rate
If SBP < 100 OR HR > 120, a 2nd liter of Isotonic Solution (NS or LR) 0.9% NORMAL SALINE (or 2nd course of oral hydration) should be given
If SBP > 100 AND HR < 120, firefighter may be returned to duty provided he/she reports feeling improved
If vital signs not within parameters after 2 liters of fluid OR signs of acute illness occur (except mild nausea), he/she should NOT be returned to duty AND should be transported to local medical facility
Any CO level > 12% requires continued rehab until < 5%
h. Complications including hypoglycemia, decreased oxygen saturation, chest pain, altered mental status, etc. should be treated using the applicable protocol AND the firefighter should not be returned to duty.