REHAB POLICY

REHAB POLICYREHAB POLICY

Zone 3Zone 3

Lesson ObjectivesLesson Objectives

Upon completion of this lesson, the student Upon completion of this lesson, the student will be able to:will be able to:Describe when rehab is established Describe when rehab is established

Identify the terminology used in the rehabilitation Identify the terminology used in the rehabilitation processprocessDescribe when an individual reports to RehabDescribe when an individual reports to Rehab

Define basic rehabilitation componentsDefine basic rehabilitation components

Describe how rehabilitation fits place within ICS Describe how rehabilitation fits place within ICS

Lesson OverviewLesson Overview

Establishment of Rehab areasEstablishment of Rehab areas

Rehab area locationRehab area location

Informal and Formal RehabInformal and Formal Rehab

Roles and responsibilitiesRoles and responsibilities

Rehab ComponentsRehab Components

Roles of respondersRoles of responders

Where Rehab fits within ICSWhere Rehab fits within ICS

Policy References:Policy References:

NFPA 1584 – NFPA 1584 – Standard on the Rehabilitation of Standard on the Rehabilitation of Members Operating at Incident Scene Operations and Members Operating at Incident Scene Operations and

Training ExercisesTraining Exercises..

WAC 296-305-05001 (13) WAC 296-305-05001 (13) Emergency Fire Emergency Fire

ground operations — Structuralground operations — Structural

WAC 296-62-095 WAC 296-62-095 Heat Related Illness in the Heat Related Illness in the Outdoor EnvironmentOutdoor Environment

FEMA. (2008), FEMA. (2008), Emergency Incident RehabilitationEmergency Incident Rehabilitation, ,

(USFA publication No. fa-314). Emittsburg, MD(USFA publication No. fa-314). Emittsburg, MD..

Related Documents:Related Documents:

Rehab Area Crew Check In/Out FormRehab Area Crew Check In/Out Form

Medical Information Report FormMedical Information Report Form

Rehab Area Manager check listRehab Area Manager check list

Zone 3 Rehab GuidelineZone 3 Rehab Guideline

Policy StatementPolicy Statement

To ensure that the physical and mental condition of personnel To ensure that the physical and mental condition of personnel operating at the scene of an emergency or a training exercise does operating at the scene of an emergency or a training exercise does not deteriorate to a point that affects the safety of each member or not deteriorate to a point that affects the safety of each member or that jeopardizes the safety and integrity of the operation, a Rehab that jeopardizes the safety and integrity of the operation, a Rehab Area will be established at all emergencies of a significant nature in Area will be established at all emergencies of a significant nature in which it may be expected that the work interval will last longer than which it may be expected that the work interval will last longer than

30 minutes or when climatic or environmental conditions warrant.30 minutes or when climatic or environmental conditions warrant.

BASEBASE

That location at which the primary logistics That location at which the primary logistics functions are coordinated and functions are coordinated and administered (Incident name or other administered (Incident name or other designator will be added to the term designator will be added to the term “Base.”). “Base.”).

The Incident Command Post may be co-The Incident Command Post may be co-located with the base. located with the base.

There is only one base per incident. There is only one base per incident.

A rehab area is established…A rehab area is established…

At all emergencies of a significant nature in At all emergencies of a significant nature in which it may be expected that the work interval which it may be expected that the work interval will last longer than 30 minuteswill last longer than 30 minutesWhen climatic or environmental conditions When climatic or environmental conditions warrant. warrant. At extended training exercises At extended training exercises When physical exertion can reasonably be When physical exertion can reasonably be expected to adversely impact personnel.expected to adversely impact personnel.Considered during the initial stages of an every Considered during the initial stages of an every emergency response.emergency response.

Rehab AreaRehab Area

That designated support That designated support function established near to an function established near to an emergency or training event at emergency or training event at the direction of the IC during the direction of the IC during evolutions that pose increased evolutions that pose increased physical, and emotional stress physical, and emotional stress to event participants. to event participants. established with ease of established with ease of access, preferably within access, preferably within walking distance of a defined walking distance of a defined event. event. Personnel assigned to a Personnel assigned to a Rehab area are out-of-service Rehab area are out-of-service until re-assigned.until re-assigned.

Informal RehabilitationInformal Rehabilitation

Informal rehabilitation is a Informal rehabilitation is a routine and shorter duration routine and shorter duration rest period that occurs at the rest period that occurs at the end of a work cycle. end of a work cycle. It may be self-directed, or It may be self-directed, or directed by a supervisor, and directed by a supervisor, and does not require members does not require members report to Formal Rehab for report to Formal Rehab for evaluation. evaluation. Personnel may be designated Personnel may be designated out-of-service during Informal out-of-service during Informal Rehab, depending upon event Rehab, depending upon event circumstances.circumstances.

Formal RehabilitationFormal Rehabilitation

A Rehab Area is a dedicated area A Rehab Area is a dedicated area

May be located adjacent to the Staging May be located adjacent to the Staging Area, Area,

situated in a manner that provides the situated in a manner that provides the maximum benefit of rest away from noise, maximum benefit of rest away from noise, activity and danger. activity and danger.

Capable of handling all personnel involved Capable of handling all personnel involved in an incident or event.in an incident or event.

FormsForms

Rehab Tracking FormRehab Tracking Form - - used to record entry and exit used to record entry and exit of individuals and crew members reporting to an of individuals and crew members reporting to an established Rehab Area and to record the medical established Rehab Area and to record the medical information collected during examinations of individuals information collected during examinations of individuals and crews reporting for formal rehabilitation.and crews reporting for formal rehabilitation.

Rehab Area Manager Check ListRehab Area Manager Check List – – A job aid to A job aid to assist the RAM in managing rehabilitation activities.assist the RAM in managing rehabilitation activities.

MIRFMIRF – Medical Information Report Form – Medical Information Report Form

Rehab Area Manager (RAM)Rehab Area Manager (RAM)

Is responsible for overseeing the organization of Is responsible for overseeing the organization of the Rehab area; the Rehab area; Directs the acquisition of facilities, equipment Directs the acquisition of facilities, equipment and supplies to support the Rehab function and and supplies to support the Rehab function and for discharge of rehabilitation activities, for discharge of rehabilitation activities, Reports to the Medical Unit Leader if Reports to the Medical Unit Leader if established. established. If the Medical Unit is not established at an If the Medical Unit is not established at an incident, the Rehab Area Manager shall report to incident, the Rehab Area Manager shall report to the Incident Commander or Operations Section the Incident Commander or Operations Section Chief.Chief.

When to ReportWhen to Report

Personnel shall report to Rehab at any time they Personnel shall report to Rehab at any time they exhibit or feel symptoms of weakness, exhibit or feel symptoms of weakness, dizziness, chest pain, muscle cramps, nausea, dizziness, chest pain, muscle cramps, nausea, altered mental status, or difficulty breathing, altered mental status, or difficulty breathing, signs of heat or cold stress.signs of heat or cold stress.

Through their Company Officer, personnel may Through their Company Officer, personnel may request informal rehabilitation request informal rehabilitation

Informal self-rehabilitation cycles do not require Informal self-rehabilitation cycles do not require members report to Rehab for evaluation.members report to Rehab for evaluation.

When to ReportWhen to Report

An IC may be permitted to adjust the following time An IC may be permitted to adjust the following time frames based upon the needs of the incident or event.frames based upon the needs of the incident or event.Having worked for 2 full 30 minute air bottles, 1 full 45 or Having worked for 2 full 30 minute air bottles, 1 full 45 or 60 minute air bottle.60 minute air bottle.Having worked through 1 full air bottle after already Having worked through 1 full air bottle after already being in Rehab.being in Rehab.40 minutes of intense work time in full PPE without 40 minutes of intense work time in full PPE without SCBA.SCBA.Whenever personnel are working in fully-encapsulating Whenever personnel are working in fully-encapsulating chemical protective clothingchemical protective clothingWhenever directed by the IC or Company Officer.Whenever directed by the IC or Company Officer.

DecontaminationDecontamination

Personnel reporting to the Rehab Area Personnel reporting to the Rehab Area shall undergo appropriate levels of shall undergo appropriate levels of decontamination prior to their arrival. decontamination prior to their arrival.

To minimize cross-contamination, turnout To minimize cross-contamination, turnout clothing, tools and equipment should be clothing, tools and equipment should be removed prior to entry into the Rehab removed prior to entry into the Rehab Area, if practical.Area, if practical.

MedicalMedical

The Rehab area shall be assigned a Medical The Rehab area shall be assigned a Medical Service Officer, when available, and shall be Service Officer, when available, and shall be designated as the Rehab Area Manager (RAM). designated as the Rehab Area Manager (RAM). In the absence of a MSO, a Company Officer In the absence of a MSO, a Company Officer may be assigned as the RAM.may be assigned as the RAM.Shall be staffed by qualified EMS (minimum BLS Shall be staffed by qualified EMS (minimum BLS level caregiver) personnel level caregiver) personnel The Rehab Area Manager shall be responsible The Rehab Area Manager shall be responsible to ensure that adequate resources are available to ensure that adequate resources are available for hospital transport.for hospital transport.

ShelterShelter

The Rehab Area Manager shall address the The Rehab Area Manager shall address the needs for sheltering personnel against needs for sheltering personnel against environmental effects. environmental effects. Consideration may include using adjacent Consideration may include using adjacent buildings, lower floors, aid vehicles, fire buildings, lower floors, aid vehicles, fire apparatus, busses, Explorer Rehab Units, tents, apparatus, busses, Explorer Rehab Units, tents, awnings/tarps, trees and other means to reduce awnings/tarps, trees and other means to reduce the impact of weather and temperature. the impact of weather and temperature. The Rehab Area Manager may request such The Rehab Area Manager may request such equipment and devices necessary to facilitate equipment and devices necessary to facilitate rest, cooling, heating and recovery.rest, cooling, heating and recovery.

HydrationHydration

During air bottle exchange or while in Rehab, During air bottle exchange or while in Rehab, personnel shall re-hydrate by drinking at least 8 personnel shall re-hydrate by drinking at least 8 oz of fluids and will be encouraged to drink 1 liter oz of fluids and will be encouraged to drink 1 liter (32 oz) of water before leaving.(32 oz) of water before leaving.It is recommended that all first response It is recommended that all first response apparatus carry a minimum compliment of 12 apparatus carry a minimum compliment of 12 (12 oz) bottles of water for each 3 person crew (12 oz) bottles of water for each 3 person crew and 16 (12 oz) bottles of water for each 4 person and 16 (12 oz) bottles of water for each 4 person crew. crew. All Zone response units shall carry adequate All Zone response units shall carry adequate water for their assigned crew.water for their assigned crew.

HygieneHygiene

Hands shall be washed before drinking or Hands shall be washed before drinking or ingesting anything on the fire ground. ingesting anything on the fire ground.

Provisions shall be made to provide hand Provisions shall be made to provide hand washing or cleaning facilities at the Rehab washing or cleaning facilities at the Rehab Area. Area.

Waterless hand sanitizers, waterless hand Waterless hand sanitizers, waterless hand wipes or similar sanitation products may wipes or similar sanitation products may be used in place of portable wash stations.be used in place of portable wash stations.

NourishmentNourishment

Food shall be provided Food shall be provided within the Rehab area, within the Rehab area, at the scene of an at the scene of an extended incident or extended incident or event, event,

When units are When units are engaged for three or engaged for three or more hours or more hours or

At the Incident At the Incident Commander’s Commander’s discretion. discretion.

RestRest

– The objective The objective evaluation of evaluation of personnel’s fatigue personnel’s fatigue level will establish the level will establish the criteria for rehab time. criteria for rehab time.

– Rest must not Rest must not be less than 15 be less than 15 minutes and may minutes and may exceed an hour as exceed an hour as determined by the determined by the RAM. RAM.

RecoveryRecovery

Personnel in Rehab should maintain a high level Personnel in Rehab should maintain a high level of hydration. of hydration.

Personnel should not be moved from a hot Personnel should not be moved from a hot environment directly into an air-conditioned area. environment directly into an air-conditioned area. An air-conditioned environment is acceptable An air-conditioned environment is acceptable after a cool-down period. after a cool-down period.

Removal of turnout gear should be considered in Removal of turnout gear should be considered in order to allow the body’s temperature to cool. order to allow the body’s temperature to cool.

Medical EvaluationMedical Evaluation

Visual assessment of member’s Visual assessment of member’s appearance and physical appearance and physical condition.condition.

Vitals:Vitals:– Exceed Heart Rate of 100 bpmExceed Heart Rate of 100 bpm

– Exceed Temperature of 100.6 F. Exceed Temperature of 100.6 F. (orally)(orally)

– Exceed Blood Pressure of160/90 Exceed Blood Pressure of160/90

Rest times are increased, or further Rest times are increased, or further medical treatment may be medical treatment may be required.required.

ReassignmentReassignment

At the discretion of the MSO, personnel may be At the discretion of the MSO, personnel may be relieved from duty reassigned pending further relieved from duty reassigned pending further rest and/or medical evaluation. rest and/or medical evaluation. In the event that personnel are relieved, In the event that personnel are relieved, reassigned or placed out of service, the MSO reassigned or placed out of service, the MSO shall notify the Medical Unit Leader, Operations shall notify the Medical Unit Leader, Operations Section Chief, or Incident Commander. Section Chief, or Incident Commander. Personnel will report to Staging only when Personnel will report to Staging only when evaluation presents normal and the Rehab Area evaluation presents normal and the Rehab Area Manager has released them. Manager has released them.

DocumentationDocumentation

A MIRF is filled out for anyone transported to a A MIRF is filled out for anyone transported to a medical facility. medical facility.

All medical information shall be documented on All medical information shall be documented on the Rehab Tracking Form. the Rehab Tracking Form.

The RAM ensures the all forms are completed The RAM ensures the all forms are completed accurately and submitted to the Incident accurately and submitted to the Incident Commander, Planning Section Chief or Commander, Planning Section Chief or Documentation Unit Leader. Documentation Unit Leader.

These forms will be available on all apparatus.These forms will be available on all apparatus.

AccountabilityAccountability

Personnel assigned to Rehab shall enter and exit as a Personnel assigned to Rehab shall enter and exit as a crew. crew. The Rehab Area Manager or designee shall document The Rehab Area Manager or designee shall document the arrival of members reporting to the Rehab area using the arrival of members reporting to the Rehab area using the Rehab Tracking Form. the Rehab Tracking Form. The Rehab Area Manager shall obtain and passports The Rehab Area Manager shall obtain and passports until members are released from the Rehab Area. until members are released from the Rehab Area. Crews shall not leave the Rehab area until authorized by Crews shall not leave the Rehab area until authorized by the RAM. the RAM. Crews leaving the Rehab area shall return to Staging Crews leaving the Rehab area shall return to Staging report for assignment unless directed otherwise by the report for assignment unless directed otherwise by the RAM.RAM.

Firefighter Firefighter

Must monitor the condition of each member operating Must monitor the condition of each member operating within their crew provide for each member’s safety and within their crew provide for each member’s safety and health. health. When fatigued and rehab is necessary, they must report When fatigued and rehab is necessary, they must report to the rehab area. to the rehab area. Encouraged to drink water and activity beverages Encouraged to drink water and activity beverages throughout the workday. throughout the workday. Shall advise their Company Officer when they believe Shall advise their Company Officer when they believe that their level of fatigue or exposure to heat or cold is that their level of fatigue or exposure to heat or cold is approaching a level that could affect themselves, their approaching a level that could affect themselves, their crew, or the operation in which they are involved.crew, or the operation in which they are involved.Ensure apparatus are stocked with Rehab Tracking Ensure apparatus are stocked with Rehab Tracking Forms, MIRFs, and water at the start of each shift.Forms, MIRFs, and water at the start of each shift.

Company OfficersCompany Officers

All officers are responsible for the safety All officers are responsible for the safety and physical well being of personnel under and physical well being of personnel under their command. their command.

Company Officers are to monitor their Company Officers are to monitor their personnel’s air usage and physical personnel’s air usage and physical condition at all times. condition at all times.

They are to notify their supervisor if their They are to notify their supervisor if their crew needs to be evaluated in Rehab. crew needs to be evaluated in Rehab.

Incident CommanderIncident Commander

Consider rehab during the initial planning Consider rehab during the initial planning stages of an emergency response.stages of an emergency response.The I.C. shall appoint a RAM to The I.C. shall appoint a RAM to coordinate Rehab. coordinate Rehab. Shall acquire adequate provisions to Shall acquire adequate provisions to support Rehab activities based upon support Rehab activities based upon climatic and environmental conditions. climatic and environmental conditions. Consider requesting additional alarms or Consider requesting additional alarms or resources to support Rehab activities.resources to support Rehab activities.

Rehab Area ManagerRehab Area Manager

Secure all necessary resources required to Secure all necessary resources required to adequately staff and supply the Rehab Area. adequately staff and supply the Rehab Area.

As the scope of an incident or event warrants, As the scope of an incident or event warrants, the Rehab Area Manager may establish Medical the Rehab Area Manager may establish Medical Evaluation/Treatment Unit, Transportation Unit, Evaluation/Treatment Unit, Transportation Unit, and Reassignment Unit for the sole purpose of and Reassignment Unit for the sole purpose of evaluation, transport and release of incident evaluation, transport and release of incident personnel from the Rehab Area.personnel from the Rehab Area.


Maintain all documentation including Maintain all documentation including Rehab Tracking Form, and MIRFs to be Rehab Tracking Form, and MIRFs to be turned in at the end of the incident. turned in at the end of the incident.

The Rehab Area Manager shall maintain The Rehab Area Manager shall maintain personnel accountability using the personnel accountability using the Passport Accountability system whenever Passport Accountability system whenever the Rehab Area is established.the Rehab Area is established.


The Rehab Area Manager retains The Rehab Area Manager retains discretion to determine individual status, discretion to determine individual status, and shall inform the Incident Commander and shall inform the Incident Commander of instances where an individual must be of instances where an individual must be reassigned or place out-of-service due to reassigned or place out-of-service due to their medical and physical condition within their medical and physical condition within the conditions set forth in this policy.the conditions set forth in this policy.

Modular Development of ICSModular Development of ICS

IC

Ladder

ReHab Staging

Engine Engine Engine

Staff


IC

Operations

Staff

Rehab Area Staging Area

Strike Team Division

Resources

Medical Unit

Rehab Unit

IC

Operations Planning Logistics Fin/Admin

Service Support

Communications

Medical

Food

ReHab

Staff

Rehab Area Staging Area

Division Division

Resources
