KING COUNTY FIRE MODEL PROCEDURE Section 21 King County Rehab Guidelines

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1 KING COUNTY FIRE MODEL PROCEDURE Section 21 King County Rehab Guidelines Adopted 9/16/15 Revised Aug 18, 2018 REHABILITATION AND MONITORING ON THE FIRE GROUND 1.0 PURPOSE: Provide rehabilitation & medical monitoring to be utilized for establishing the mental and physical condition of incident personnel participating in tactical operations and training. By establishing a rehab area, appropriate personnel will be utilized to perform appropriate level of care during and subsequent to an incident. To remind all personnel that they play a key role in ensuring that firefighting personnel are properly monitored during emergency operations so that members do not succumb to debilitating exhaustion or over-exertion that could cause injury. 2.0 GUIDELINE REFERENCES: 2.1 A Guide for Best Practices IFCA, NFPA FEMA Emergency Incident Rehab (2008) 2.3 WAC (Heat Related Illness in the Outdoor Environment) 2.4 WAC ORGANIZATIONS AFFECTED: 3.1 King County Fire Zones 3.2 KCM Rehab providers 4.0 RELATED DOCUMENTS: 4.1 Rehab Accountability Log 4.2 Electronic Patient Care Record 4.3 Rehab Unit Leader Checklist 4.4 Firefighter Rehab and Accountability Tag 5.0 DEFINITIONS: 5.1 Crew Integrity: Should one or more members of a crew be required to remain in rehab for medic evaluation, the remaining crew member(s) can be released from Rehab in order to perform other functions at the scene. Passport accountability remains in force. Members leaving Rehab take their passports to their reassignment position; this may include make-up companies as assigned by the Section 21 KC Rehab Guidelines Page 1 of 5 Revised 8/15/18

2 staging area manager. 5.2 Formal Rehabilitation: The process of mental and physical assessment and revitalization of members while engaged in emergency operations. This occurs at an established rehab area. 5.3 Recycle / Bottle Exchange: A part of the informal rehabilitation where members exit the hazardous area in order to receive gross decontamination, change their first SCBA bottle, hydrate and return to work activities. 5.4 Rehab Area: An area for the purpose of quickly evaluating the mental and physical condition of firefighters. This area should be out of the hazard zone, adjacent to staging and air re-filling including a shelter from the elements and an area for rest and hydration. Firefighters requiring medical intervention are normally transferred to an appropriate specified EMS unit. 5.5 Gross Decon: A quick rinse to remove hazardous / toxic debris from personnel prior to entering the rehab area. 5.6 Hygiene: Hands should be washed before drinking or ingesting anything on the fire ground. Provisions should be made to provide hand washing or cleaning facilities at the Rehab Area. Waterless hand sanitizers, waterless hand wipes or similar sanitation products may be used in place of portable wash stations. 5.7 Nourishment: Nutritious and healthy food should be provided within the Rehab Area, at the scene of an extended incident or event, when units are engaged for three or more hours or at the incident Commander s (IC s) discretion. 5.8 Staging Area: The location where incident personnel and equipment are assigned on immediately available status. 5.9 Rehab Area Manager (RAM): Officer or member in charge of the management of the rehab function. An MSO, Paramedic or EMT will normally fill the Rehab Area Manager position reporting to the Medical Group Sup (MGS) or IC Rehab Accountability Log: Utilized during Formal Rehab to track and document Rehab status by Companies, 5.11 Firefighter Rehab and Accountability Tag: A tag given to firefighters while in the Rehab Area containing the following elements: Check in Receipt to be placed on Accountability Log upon check in Baseline Medical assessment results Rest and recovery checklist Pre-release assessment checklist Release receipt - to be placed on Accountability Log upon check out Section 21 KC Rehab Guidelines Page 2 of 5 Revised 8/15/18

3 6.0 POLICY All firefighters and officers should monitor the condition of each member operating within their crew and ensure that adequate steps are taken to provide for each member s safety and health. A Formal Rehab Area should be considered by the Incident Commander anytime the environment, workload, and/or atmospheric conditions indicate the probability of injury or temperature related illness to personnel (i.e. Working fires w/ supply, larger brush fires, Hazmat incidents when encapsulating suits are worn, etc.). Recycle / Bottle Exchange is recommended after 1st SCBA bottle use or 20 minutes of hard work without an SCBA. Formal Rehab must be initiated for incidents where a 2nd alarm or greater has occurred where those units are assigned work activities and should be considered for large scale drills or exercises anticipated to last an hour or longer, or when the incident commander (IC) feels it is necessary. The need for additional dedicated resources for rehab should be considered. The Incident Commander may establish multiple rehab areas during haz-mat or large-scale incidents when it is deemed conducive to efficient operations. Once Formal Rehab has been initiated, all personnel must come through rehab following the use of a 2nd, 30 or 45-minute (or 1st 60 minute) SCBA bottles or 40 minutes of hard work without an SCBA. A Rehab Tracking form will be utilized for each company / crew. All personnel shall report to the established Rehab Area prior to demobilization and release from incident scene to assure medical readiness and rest period prior to available status. 7.0 FORMAL REHAB PROCEDURES The Incident Commander shall designate a Rehab Manager. Generally, this will be an MSO but may be a Paramedic or EMT. The Rehab Area Manager will request resources for rehab through the Incident Commander as needed. Such as; Rehab Units, Air Units, Buses, Aid Units or additional companies to staff Rehab Area. Rehab should be located in a secure area with a check-in and check-out funnel point where passports are collected, and time tracked in an area that allows enough space and protection from adverse environmental conditions including fire, smoke, exhaust, extreme heat and cold. An ideal location would be adjacent to the Staging Area, with air refilling out of direct sight of the working incident, with room for separate areas to remove PPE, a rest & evaluation area, a treatment area and access to a restroom when possible. 7.1 Baseline Evaluation: Documentation will occur immediately each time a firefighter enters Formal Rehab: Time, Name, Unit, Mental Status and any symptoms (CP, SOB, poor gait, confusion, dizziness, nausea/vomiting, cramps, aches & pains). These items will be recorded as initial triage information. All symptoms will be thoroughly evaluated by the appropriate EMS level of care per King County protocols and standards of care. Section 21 KC Rehab Guidelines Page 3 of 5 Revised 8/15/18

4 7.2 Primary Evaluation: Documentation will occur after 10 minutes of rest after a firefighter enters Rehab. Firefighters must be seated with feet on ground and either begins cooling (remove turnouts) and hydration or warming during this 10 minutes. The Primary evaluation will consist of recording: Time, Mental Status, Heart Rate, BP, O2 saturation, CO (if available) and any symptoms (CP, SOB, poor gait, confusion, dizziness, nausea/vomiting, cramps, aches & pains). The following are the normal range vital signs required to be released back to duty: Mental Status: Glascow Coma Scale 15 Heart Rate: /min Blood Pressure: Systolic <160 and/or Diastolic <100 Carbon Monoxide: <5% O2 Saturation >92% Temperature: 98.6 to Symptoms: Symptom free 7.3 Secondary Evaluation: Firefighters not meeting the normal range vital signs at the primary evaluation will remain in rehab at rest for an additional 10 minutes and then be evaluated again. Care will be taken to closely monitor these individuals for need of immediate treatment. Firefighter s not meeting the standards at the secondary evaluation will not return to the fire ground and will be required to meet the following treatment plan: A paramedic evaluation is mandatory. A standard Medical Incident Report shall be used to record patient data. In addition to a paramedic evaluation, online medical control may be utilized in order to dictate care and disposition. Care will be taken to closely monitor these individuals for need for immediate treatment. If a firefighter is deemed not fit for duty by the Paramedic, the IC and firefighters immediate supervisor will be notified immediately. The firefighter s immediate supervisor will determine the disposition of the firefighter for the remainder of the shift. 8.0 ADDITIONAL NOTES At any point in rehab, a paramedic evaluation can be requested if rehab personnel deem it necessary. Personnel not in the IDLH but within the hazard zone (pump operators, IC, etc.) should be observed and periodically monitored for potential exposure to toxic gasses and / or heat and cold stress. Section 21 KC Rehab Guidelines Page 4 of 5 Revised 8/15/18

5 In warm weather, removal of turnout gear is necessary in order to allow the body s temperature regulating mechanism to function properly. The duration of the ventilation process will depend on the workload and atmospheric air temperatures. The use of tarps for shade, cooling chairs and electric fans to provide airflow may be necessary during hot weather. Buses and / or nearby structures should also be considered for sheltering personnel during rehab. Fluid replacement is necessary in order to maintain the high metabolic demand placed on firefighters during emergency operations. It is recommended that members drink one liter of water per hour in order to replace fluids lost due to dehydration. After one hour, electrolyte additives should be added to the water source. The Rehab Manager should facilitate the acquisition of fluids as needed. Caffeinated beverages will be avoided during the emergency incident due to their diuretic effect. Upon arrival at Rehab, the company officer or team leader shall report the unit designator and staffing level to the recorder, notify the Rehab Area Manager of any possible heat illness, burns and / or injuries and assure that the unit members participate in the rehabilitation process. The Rehab Area Manager (RAM) shall see that all personnel reporting to Rehab from tactical operations are evaluated and documented on the Rehab Tracking Form. Release of personnel from Rehab by the Rehab Area Manager (RAM) will be to Staging, and then utilization of units will be as requested by the Incident Commander through the Staging Area Manager At the end of the incident, the Rehab Manager shall review the Rehab Accountability Log with the Incident Commander or MGS to assure all personnel have been accounted for, and the Host agency will retain as part of the incident record. Section 21 KC Rehab Guidelines Page 5 of 5 Revised 8/15/18