2. On-Duty U.S. Firefighter Fatalities for 2007/2008 2008  17 or 37.7% of Firefighter deaths were from overexertion/stress 2007  55 or 47.8% of Firefighter deaths were from overexertion/stress (https://www.usfa.dhs.gov/downloads/pdf/08-fatality-summary.pdf).

3. Heat Stress Awareness www.cityofmesa.org/fire/wellness/safetyan dwellness.aspx www.cityofmesa.org/fire/wellness/safetyan dwellness.aspx

4. When Do We Rehab? Best case:  Every IDLH event  High levels of exertion  Weather extremes Typical applications  45-60 minutes in PPE  2 SCBA bottles During training events  Locally  All Div. 10 sponsored events

5. Group Rehab Group Primary responsibility is to ensure that firefighters are able to safely return to incident and to return home after their shift.

6. Safety Section Rehab function falls under the Safety Section in MABAS Division 10 The REHAB Group will operate on IFERN, however, they will also need to monitor the primary fire ground channel.  Consideration to Nextel or other local channel once SSO / PLANS have arrived SSO ISO RITO REHAB ACCOUNTABILITY

7. Staffing of Rehab Group At least one ALS ambulance and crew will be assigned to the rehab group  The officer or senior paramedic will serve as the initial Rehab Officer for the incident  This crew will remain in the rehab group unless an emergency condition requires immediate transport of personnel An additional Transport Ambulance will be assigned to transport anyone from the scene who needs emergency care  This includes fire victims etc. as long as transport ambulance is replaced by Staging or Command

8. Site Location and Characteristics Rehab should be stationed out of the weather, uphill and upwind The location should be located safely away from the incident where crews can remove their protective clothing and have their vital signs checked while receiving fluids and rest. The location should be large enough to handle the needs of the incident.

9. Site Location and Characteristics The location should be easily accessible by ambulance. The location should be sufficiently remote and located in a safe haven. The Site location should allow for prompt personnel re-entry to the emergency operations after being evaluated and thoroughly rehabbed. Use of tobacco products in the REHAB area (s) is strictly prohibited.

10. Rehab Flow Chart Receive or Request Assignment to REHAB SECTOR Rehab Companies are to remain on primary fire ground channel. 1.Log-in to Group 2.Check Mental Status 3.Physical Appearance 4.Check Baseline Vital Signs 5.General Condition 6.Removal of Turnout Gear and SCBA 7.Medical Control Form After 20 minutes Transport Ambulance Used Notify Dept by SSO 1 2 3 4 Add 15 minutes if vitals exceed baseline

11. Typical REHAB Flow

12. Rehab Operations All fire service personnel involved in emergency operations should be routinely evaluated in the rehab area as deemed necessary. Crews shall report to Rehab utilizing the Passport system. Assignment to the Rehab Group is to be considered an order as is any assignment given by a superior officer on the fireground.

14. Rehab Operations First and foremost, any person with complaints should be fully assessed. Additionally, persons with abnormal vital signs, or other emergent condition (s), shall be removed from active duty for further evaluation  Remember to Treat the Symptoms  In these cases, treatment should be initiated; ensuring Emergency Medical Personnel follow and treat per their system protocol.  The Rehab Group Officer shall direct all medically unstable personnel be transported to a hospital.

15. Rehab Operations Those found to be medical unstable and refuse transport to a medical facility shall be referred to the SSO. At the discretion of the SSO, that individual and the crew to which he/she is assigned will be relieved of duty and directed to return to their department. Consequently, the affected members’ department Chief or Duty Officer will be notified by the SSO or his designee of the reason for the company’s return.

16. Rehab Operations The Rehab Officer, SSO or Incident Commander should ensure that at least one ALS ambulance is always dedicated to Rehab for transportation of firefighting personnel.  1 ambulance for triage  1 dedicated for transport.

17. Documentation The names of all personnel passing through Rehab shall be recorded on the Medical Rehab Check Sheet, as well as all patient data. This document shall be given to the stricken department and become part of the incident’s permanent record. For all situations where medical treatment was initiated, the appropriate Patient Care Report (s) (PCR) shall be utilized following EMS System protocols.

19. General Rehab Considerations Firefighting crews should be recycled through Rehab on a regular basis, ensuring assigned crews stay together. Most Firefighters are under hydrated prior to response. Crews in Rehab shall receive 32 oz of water, medical evaluation and rest. Additionally, cooling and or warming as appropriate All Groups/Officers shall maintain an ongoing awareness of the condition of their personnel and use Rehab to combat excessive fatigue and exhaustion. Core body temperature can continue to rise while in Rehab

20. General Rehab Considerations Fluid Intake is imperative to proper rehab of personnel, it insures that fluids that are lost are replaced and that proper cardiovascular function is maintained.  It is important that cooler fluids be used to enhance the cooling capacity of the fluids to help regulate temperature in the body in hot weather.  During long-term operations, fluids with electrolytes and carbohydrates should be available to enhance the fluid replacement process in the body.

21. General Rehab Considerations Personnel not Involved in Actual Firefighting:  Incident Commander  Group Officers  Pump Operators  Rehab Personnel NEED TO BE EVALUATED AS CONDITIONS WARRANT!

22. Vital Signs Guidelines When crews arrive at Rehab, they should be given fluids as soon as possible and a complete set of vital signs shall be taken. Mental status shall be determined using typical EMS protocols for orientation to person, place, and time. If any emergent conditions exist, the triage crew will immediately coordinate transportation of the injured firefighter using a transport ambulance from the scene. The supervisor of the injured/exposed firefighter will be notified by the SSO.

23. Vital Signs Guidelines Vital signs will be taken by IDPH Licensed Triage personnel upon entry into the group. Accordingly, information will be documented on the Medical Log After 20 minutes in rehab, vital signs will be re- evaluated by Triage Personnel, in view of that, if vital signs are within acceptable ranges, personnel will be made available through the Rehab Group to Staging for a reassignment. As a result, the Company does not have to physically report to Staging, but the assignment or available status can take place from Rehab the area.

24. Guidelines for RELEASING Personnel from Rehab for Incident Assignment Prior to Release: Gear should be removed Rehydration with at least 32 oz of water Minimum of 20 minutes in Rehab VITAL SIGNS Systolic B/P less that 160 Diastolic B/P less than 100 Heart rate less than 110 Oral temperature less than 100.6 Any personnel who exceed these limits must stay in Rehab an additional 15 minutes. Release to scene through Staging (Directly from REHAB) Return PASSPORT to company officer General Considerations Mentally prepared to return Oriented No C.I.S. symptoms Turnout gear in good condition SCBA refilled/checked Entire crew prepared and ready

25. Guidelines for TRANSPORTATION of personnel to hospital (After 30 minutes in Rehab) ANY emergency condition shall be treated and transported as soon as possible VITAL SIGNS Diastolic B/P greater than 130 Systolic B/P greater than 200 Diastolic B/P greater than 110 and symptomatic Diastolic B/P less than 110 and symptomatic Heart rate above 140 or less than 60 with hypotension Oral temperature greater than 100.6 Symptoms of CO exposure Any other emergent condition not described above Procedure Crew is considered to be out of service until manpower is evaluated by SSO Notification of the patients immediate supervisor by SSO Treat/transport per system SOG

26. Rehab Officer Qualifications The Rehab Officer will be assigned by the Incident Commander or the Safety Section Officer. Persons assigned as a Rehab Officers’ should be a MABAS Division 10 Company Officer or higher. Company or Line Officers may also serve in this function as long as all duties and responsibilities of the position are known and completed. Additional qualified personnel may be designated by the MABAS Division 10 Safety Committee.

27. Documentation All care and treatment in Rehab is protected under the HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY (HIPAA). Patient care information should not be released outside of the confines of the chain of command and patient care standards. WWW.HIPAA.org

28. Face-to-face discussions between providers Despite the new focus on privacy, the law does not prohibit health care providers from having discussions involving patient information when necessary for the treatment of the patient. However, when it comes to discussing patient information with others who are not involved in the treatment of the patient, the rules become more stringent. Providers are not allowed to discuss individually identifiable patient information with friends, coworkers, or family members.

29. Face-to-face discussions between providers Although HIPAA has ushered in a new era of privacy, health care providers still have wide latitude to discuss or broadcast patient information with others when necessary for the treatment of the patient. In other circumstances, more restrictions apply. Ambulance providers need to take reasonable steps to ensure that they are disclosing health information only when appropriate because, in today’s environment, the penalties for privacy violations can be serious.

30. RAD-57 Non-invasive medical device used to monitor blood levels of substances such as methemoglobin and carboxyhemoglobin. Firefighter Rehab video

32. Triage and Transportation Group Duties

33. Ambulances Assigned to REHAB 2 per box alarm  TRIAGE  TRANSPORT Report to REHAB Group Leader or SSO if REHAB not on-scene Position TRIAGE Amb. near incident scene and 1528 for access to equipment Position TRANSPORT Amb. in a manner to be used to quick exit from incident scene  If unable to locate directly at REHAB Group, stretcher and equipment should be relocated to Group area in event a member must be transported

34. Medics and REHAB Unit 1528 and 1888 have identical REHAB Kits available for your use  Thermometers  Pulse/CO Monitor  Report forms  TRIAGE Vest  Blue REHAB Area Barricade Tape  Spare vital signs equipment

35. Triage Group Process May initially function as the REHAB Group Leader  Senior medic Perform “triage” of firefighters reporting into area  Visual appearance  General impression on physical / mental status  Begin log-in procedure using MABAS 10 Medical REHAB Control form

36. Triage Group Process (cont.) Instruct crews to remove appropriate levels of PPE based on environmental conditions and shelter availability Assess baseline vital signs for entire crew  Record initial signs  20 minutes thereafter unless initial signs warrant earlier reassessment Begin REHAB Process  Rest  Rehydrate 32 oz of fluid if possible  Water then electrolyte replacement  Re-nourish as needed  Refill and recharge SCBA and equipment

37. General REHAB Area Principles TRIAGE crew is responsible for assessing the functional capacity of the members in REHAB area  Protect their well being by proper and thorough assessment of condition It is more important to treat/evaluate SYMPTOMS over SIGNS  An overexerted / exhausted firefighter may have acceptable vital sign values Side with SAFETY  The firefighters family is counting on you

38. Troubleshooting REHAB Concerns  Bypassing of vital sign assessment  Early release request by crew  1 member not within acceptable limits