Caring For Firefighters Rehab OperationsRehab Operations

Caring for FirefightersRehab Operations Explain the need for firefighter rehabilitation.Describe CERT’s role.Describe the “formal rehab” process.Explain hydration strategies and dehydrationconcerns associatedi t d withith rehab.h bSelect appropriate fluids and foods for rehaboperations.

Why Firefighters Need Rehab Firefighter rehab ensures that the physical andmental well-being of responders does notdeteriorate negatively affecting their safety.deteriorate,safety Firefighting is inherently dangerous and anyadditional physical or mental stress increases thedanger significantly. Research indicates a firefighter's body coretemperature often reaches 104 degrees Fahrenheitduring a fire even for short periods.

What will CERT do? Ashland CERT has illustrated it is a reliable manpowerresource. Rehab is manpower intensive and distracts firefighters toconduct making it a good fit for CERT.conduct,CERT CERT conducted rehab during the Oak Knoll fire verywell with little training and illustrated the need for a rehabpre-planl tot includei l d CERT’sCERT’ involvement.ilt CERT will be partially mobilized on an emergencyincident pprojectedjto last over two hours, or whenenvironmental conditions require formal rehab. CERT will establish the “Rest and Refreshment Unit” thatprovides “formalformal rehabrehab” for firefighters described later.

NFPA* 1584 Guideline #2Formal Rehab Must enter a formal rehab area, drinkappropriate fluids, be medically evaluated, andrest for a minimum of 20 minutes after any of thefollowing:– Depletionpof two 30-minute SCBA cylindersy– Depletion of one 45- or 60-minute SCBA cylinder– Following 40 minutes of intense work without an SCBA Formal Rehab is conducted by the Rest /Refreshment Unit, which is CERTCERT’ss responsibility.*National Fire Protection Association - Advocates for fire safety

Number of Personnel Needed to Runthe Rehab Area Depend On The number of personnelrequiring rehab services The duration of theincident The environmentalconditions at the time ofthe incident Responder’s conditionwhen they arrive at therehabh b area.

Entry Point/Initial Assessment Area Everyone must go throughthishi entry pointi andd bebsigned in (CERT ICS Form211). Remove SCBA and PPE, ifappropriate (outside only) Check vital signs (EMT)and be observed for otherproblemsbl((everyone)) Mayy be sent to additionaltreatment or rest.

Send to Treatment if Pulse is in excess of 120 bpm Body temperature is elevated ShowingSi signsioff chest pains,i shortness offbreath, altered level of consciousness,extreme fatigue,f ipoor skinki color,l andd similari ilsymptoms.

Rest/Refreshment Unit Responsibilities Provide restAssist EMTsProvide shelterProvide fluidsProvide nutritionReport statusMaintain sign in / out((ICS Form 211))

CERT Resources for Rehab PeopleElectric generationPop up shade structuresBlankets, tables, chairsBeverage containers,containers ice chestsTrash receptaclesComm nications withCommunicationsith Incident Command

Time Needed in Rehab The responderresponder’ss level of physical conditioning The atmospheric conditions The nature of the activities the responder wasperforming before entering rehab The time needed for adequate rehydration and/oreating NNFPA 158458 ssaysys 100 minutesu es aftere thee initialassessment and 20 minutes if two SCBAs havebeen used or 40 minutes of heavy work performed

The Three Dispositions for RespondersSent to The Treatment Area The responderprespondspappropriately to rest andrehydration and is able toreturn to action or return toquarters. Standard, basic EMStreatment procedures areinitiated and the firefighteris monitored. Advanced medicaltreatment, followed bytransportpto a medicalfacility.

Traumatic Injuries These include cuts, sprains,strains, debris in eyes, etc. Person should not return tothe incident if their injurycould be made worse

Stress-Related Illnesses May be psychological andphysiological Decreased ability tomobilize the fight-or-flightggresponse IncreasesIor ddecreases iinthe firefighter’s appetite

Signs of Overstressed Firefighters Inappropriatepp plevels ofanger or aggressivebehavior Obvious emotionalsymptoms such as crying,yelling,llior a sense off panici Signs of being withdrawn,i a stateint t off shock,h k or bbeingidepressed

Two Common Types ofPhysiological Injuries Heart Attacks Strokes

Classic Cardiac Symptoms Shortness of breath,breath beyond that of someonewho simply has been working hard and istiredtired. Tightness in the chest or chest pain, oftenradiating to the back,back abdomen,abdomen or downone or both arms. UnusuallyUll rapid,id slow,lor otherwisehiirregular pulse and/or the sensation of heartpalpitations.l i i

Common Signs of Stroke Severe headacheDifficult, slurred, or lost speech abilityFaciali droopWeakness or paralysis on one side of thebody, typically on the opposite side of thebody from any present facial droop

Lung Toxin Symptoms May include a cough,breathlessness, wheezing, andexcessive bronchial secretions. Symptoms may start relativelysoon after exposure to thesmoke and continue to developfor up to 36 hours. Adult respiratory distresssyndrome or delayedpulmonary edema may occurin severe cases.

Carbon Monoxide (CO) CO is an asphyxiant.asphyxiant Preexisting medical conditions increasesusceptibility to CO poisoning, includinghyperthyroidism, obesity, bronchitis, asthma,heart disease, and alcoholism. Minor exposure symptoms include headache,nausea, vomiting, drowsiness, red/flushed skinappearance and poor coordination.appearance,coordination Moderate or severe CO poisoning causespain, shortnessconfusion, unconsciousness, chest pof breath, and coma.

Hydration is the Key! 60% of the human body is water The human body loses water in urine,in stool, during exhalation, andthroughg sweating.g During extreme work or exposure tohigh atmospheric temperaturestemperatures, themajority of water lost from the body isffromsweating.ti

Individual Sweat Factors The individual’smetabolism and physicalfitness The level of exertion The atmospherictemperature The amount of clothingand PPE being worn

Electrolytes Include sodium,sodium potassium,potassium calciumcalcium, andmagnesium Lost in the same way as water Replace with sports drinks.

Redydration Should drink 2-4 ozminimum during selfrehab May drink 12 to 32 oz informal rehab Do not drink too much Severely dehydratedpersonnel may require anIVV Must continue torehydrate even afterleaving the scene

Fluids for Rehab Dispensed from individual orbulk storage containers. Individual servingg containersare best suited for smallincidents; bulk containers forlarge incidents. Drinking cups will be neededif using bulk containers. Have trash receptaclesavailable.il bl

Considerations for Choosing aRehab Fluid Must be tasty Must be easily tolerableto the digestive system. Should be nutritionallysound and replaceelectrolyteselectrolytes,carbohydrates and water.

Suitable Drinks for Rehab Operations Water is always good; does not replaceelectrolytes and carbohydrates. Coffee,Coffee tea,tea soda,soda hot chocolate,chocolate dairyproducts, fruit juices, and high energydrinks (like Red Bull) are not good Sport beverages replace water, electrolytes,and simple carbohydrates and arepreferred. Some agencies mix these 50/50 with water

Food Service in Rehab Usuallyy onlyy needed atincidents that exceed 2-3hours. May be needed sooner atlate night/early morningincidents. Short- to medium-durationincidents typically onlyrequire prepackaged foods. Long-duration incidentsmay requirei meal-likel liksupport operations.

Food Providers Independently operatedcanteen units (Red Crass,Salvation Army, etc.) Brought to the scene bydepartment / CERTmembers, church groups,or civic organizations Commercial caterers,restaurants that deliver.

Simple and Complex Carbohydrates Simplep carbohydrates:ySugarsgsuch as gglucose,,sucrose, dextrose, lactose, and fructose Found in fruits, milk, processed sugar, and honey. Complex carbohydrates: Molecules made up ofthree or more sugars. FoundFd iin starchyt h ffoods,d suchh as bbread,d pasta,t anddpotatoes. The body has a limited ability to storecarbohydrates.q Medium to longg duration incident will requirecarbo replacements.

Food for Rehab Fast food that is better thannothing.thi Seek a balance of carbohydrates,fats,ats, aanddpproteinsote s Fruits, doughnuts, candy bars,and energy bars are useful atshort incident with no canteen.canteen Commercial suppliers may servehot dogs, hamburgers, eggsandwiches, cold cut sandwiches,soups, and stews. Long term caterers typicallyprovide three full meal servicesper day at major incidents.

Food Serving Principles Wash yyour hands before eating.g All food serving equipment must be sanitary andfully compliant with local health departmentregulations. All foods should be fresh and storedappropriatelyappropriately. Have pre-established agreements with localgrocerygoce y oro foodood pproviders.ov de s Provisions must be made for collecting anddisposing of trash. For medium and long term operations rotate outpersonnel and volunteers who are serving food.

Caring for Firefighters Rehab OperationsRehab Operations Explain the need for firefighter rehabilitation. Describe CERT’s role. Describe the “formal rehab” process. Explain hydration strategies and dehydration concerns associtd ith hbiated with rehab. Select appropriate fluids and foods for rehab operations.