1. REHAB POLICY Zone 3

2. Lesson Objectives Upon completion of this lesson, the student will be able to: Describe when rehab is established Identify the terminology used in the rehabilitation process Describe when an individual reports to Rehab Define basic rehabilitation components Describe how rehabilitation fits place within ICS

3. Lesson Overview Establishment of Rehab areas Rehab area location Informal and Formal Rehab Roles and responsibilities Rehab Components Roles of responders Where Rehab fits within ICS

4. Policy References: NFPA 1584 – Standard on the Rehabilitation of Members Operating at Incident Scene Operations and Training Exercises. WAC 296-305-05001 (13) Emergency Fire ground operations — Structural WAC 296-62-095 Heat Related Illness in the Outdoor Environment FEMA. (2008), Emergency Incident Rehabilitation, (USFA publication No. fa-314). Emittsburg, MD.

5. Related Documents: Rehab Area Crew Check In/Out Form Medical Information Report Form Rehab Area Manager check list Zone 3 Rehab Guideline

6. Policy Statement To ensure that the physical and mental condition of personnel 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 that jeopardizes the safety and integrity of the operation, a Rehab 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 30 minutes or when climatic or environmental conditions warrant.

7. BASE That location at which the primary logistics functions are coordinated and administered (Incident name or other designator will be added to the term “Base.”). The Incident Command Post may be co- located with the base. There is only one base per incident.

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

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

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

11. Formal Rehabilitation A Rehab Area is a dedicated area May be located adjacent to the Staging Area, situated in a manner that provides the maximum benefit of rest away from noise, activity and danger. Capable of handling all personnel involved in an incident or event.

12. Forms Rehab Tracking Form - used to record entry and exit of individuals and crew members reporting to an established Rehab Area and to record the medical information collected during examinations of individuals and crews reporting for formal rehabilitation. Rehab Area Manager Check List – A job aid to assist the RAM in managing rehabilitation activities. MIRF – Medical Information Report Form

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

14. When to Report Personnel shall report to Rehab at any time they exhibit or feel symptoms of weakness, dizziness, chest pain, muscle cramps, nausea, altered mental status, or difficulty breathing, signs of heat or cold stress. Through their Company Officer, personnel may request informal rehabilitation Informal self-rehabilitation cycles do not require members report to Rehab for evaluation.

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

16. Decontamination Personnel reporting to the Rehab Area shall undergo appropriate levels of decontamination prior to their arrival. To minimize cross-contamination, turnout clothing, tools and equipment should be removed prior to entry into the Rehab Area, if practical.

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

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

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

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

21. Nourishment Food shall 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 discretion.

22. Rest –The objective evaluation of personnel’s fatigue level will establish the criteria for rehab time. –Rest must not be less than 15 minutes and may exceed an hour as determined by the RAM.

23. Recovery Personnel in Rehab should maintain a high level of hydration. Personnel should not be moved from a hot environment directly into an air-conditioned area. An air-conditioned environment is acceptable after a cool-down period. Removal of turnout gear should be considered in order to allow the body’s temperature to cool.

24. Medical Evaluation Visual assessment of member’s appearance and physical condition. Vitals: –Exceed Heart Rate of 100 bpm –Exceed Temperature of 100.6 F. (orally) –Exceed Blood Pressure of160/90 Rest times are increased, or further medical treatment may be required.

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

26. Documentation A MIRF is filled out for anyone transported to a medical facility. All medical information shall be documented on the Rehab Tracking Form. The RAM ensures the all forms are completed accurately and submitted to the Incident Commander, Planning Section Chief or Documentation Unit Leader. These forms will be available on all apparatus.

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

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

29. Company Officers All officers are responsible for the safety and physical well being of personnel under their command. Company Officers are to monitor their personnel’s air usage and physical condition at all times. They are to notify their supervisor if their crew needs to be evaluated in Rehab.

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

31. Rehab Area Manager Secure all necessary resources required to adequately staff and supply the Rehab Area. As the scope of an incident or event warrants, the Rehab Area Manager may establish Medical Evaluation/Treatment Unit, Transportation Unit, and Reassignment Unit for the sole purpose of evaluation, transport and release of incident personnel from the Rehab Area.

32. Rehab Area Manager Maintain all documentation including Rehab Tracking Form, and MIRFs to be turned in at the end of the incident. The Rehab Area Manager shall maintain personnel accountability using the Passport Accountability system whenever the Rehab Area is established.

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

34. Modular Development of ICS IC Engine Ladder ReHabStaging Staff

35. Modular Development of ICS IC Operations Strike Team Division Resources Medical Unit Rehab Unit Rehab Area Staging Area Staff

36. IC Operations Division Resources Rehab AreaStaging Area PlanningLogistics Service Communications Medical ReHab Food Support Fin/Admin Staff Modular Development of ICS