Hot Fun in the Summertime

SOPs and Protocol for Warm Weather Firefighter Rehab

By Lou Angeli

Simply stated Firefighter Rehab is designed to ensure that the physical and mental well being of members operating at the scene of an emergency (or a training exercise) don't deteriorate to the point where it affects the safety of any other members. After all, "stressed out" is not a good thing when you're working at America's most dangerous job.

Back in 1993, the US Coast Guard conducted a study dealing with the effects of interior firefighting on the human body. The results of the study are posted in the Coast Guard's Firefighting Initiative, but in short, researchers noted that our body core temperature (even for short exposures), often reaches 104 degrees (F) during the firefight.

(1) Primary Mission

The primary mission for fire command is to identify, examine and evaluate the physical and mental status of fire-rescue personnel who have been working during the emergency incident or a training exercise. Following a proper survey (see below), it should be determined what additional treatment, if any, may be required.

According to FEMA, "Any activity/incident that is large in size, long in duration, and/or labor intensive will rapidly deplete the energy and strength of personnel and thus merits consideration for rehabilitation."

2. Launching The Rehab Operation

A specially designated Rehab Area, (or Group) remote from the fire or emergency incident, should be established at the discretion of the Incident Commander in consult with the senior Safety Officer. If the Incident Commander determines that Rehab is necessary, qualified EMT-Ps or EMT-Bs (assigned to the first alarm response) should be assigned to manage the Rehab Sector under the command of a fire or EMS officer or supervisor.

Note the emphasis of the "first alarm response."

EMS personnel must be on scene and available to provide treatment to fireground personnel at a moment's notice. If EMS does not respond as part of the initial turnout, consideration should be given to the fact that OSHA will certainly ask why they weren't... especially if anyone is injured.

Because they work side by side with the front line troops, company officers play an important role in Rehab. In fact, the federal government suggests that the safety of the fireground rests here, at the supervisor level. If a company member shows signs of fatigue or illness, the company officer will likely be the first to recognize the problem.

Anticipate Rehab needs early in the incident. During large-scale operations, Incident Command should consider augmenting existing resources by requesting additional EMS personnel or even another engine company or squad, to assist in the operation of the Rehab Sector.

(3) Locating the Rehab Sector

It is crucial for Command to establish The Rehab Sector away from any environmental hazards, or by-products of the fire, such as smoke, gases or fumes. During hot months, the ideal location might include a shady, cool area distant from the incident. In winter, a warm, dry area is preferred.

Regardless of the season, the area should be readily accessible to EMS-Rescue personnel and their equipment, so they may restock the sector with supplies, or in the event that emergency transport is required.

Rehab sites can also be established in the lobbies of nearby buildings, parking facilities, or even inside municipal buses. Misting/cooling systems, heating systems, SCBA refilling and canteen service should be stationed in or around this area as well. During large-scale incidents, like multi-alarm fires, Command should consider establishing Multiple Rehab Areas as the situation warrants.

(4) Coordination and Staffing

Command of the Rehab Area should be assigned to a chief or company level officer, who is designated as the Rehab Officer under most Incident Command structures. The incident itself will determine just how many people you'll need to do the job, however a minimum of two trained EMS personnel should initially be assigned to monitor and assist firefighters in the Rehab Sector. Utilize volunteer canteen or auxiliary members to assist EMS personnel in making "working" members as comfortable as possible.

(5) Evaluation of Fire-Rescue Personnel

It is important for command and company level officers to continually monitor personnel for telltale signs of exhaustion, stress, and or physical injury. Individual members are encouraged to report to the Rehab Sector at any time that he or she feels the need to do so. Symptoms may include weakness, dizziness, chest pain, muscle cramps, nausea, altered mental status, difficulty breathing, and others. Regardless of physical well being, all fireground personnel should report to the Rehab Sector immediately following:

- Strenuous Activity

- Forcible Entry, Advancing Hoselines, Ventilation, etc
- The use and depletion of two SCBA bottles
- Thirty (30) minutes of operation within a hazardous/dangerous environment

- Failure of SCBA

(6) Examination of Personnel

Arriving personnel should be examined by qualified EMS personnel, who should check and evaluate vital signs, and make proper disposition, i.e. return to duty, continued rehabilitation, or transport to medical facility for treatment. The workup should include:.

- Scoring for Glasgow trauma scale.
- Checking Pupils
- Checking Vital Signs, such as blood pressure, pulse, breathing rate
- Checking lung sounds
- Administration of a 2-lead EKG, when chest pain or irregular heartbeat is presented
- Skin condition and color Body core temperature

- Heart rate should be measured as early as possible in the rest period.

If the firefighter's heart rate exceeds 110 beats per minute, it is recommended that an oral temperature be taken. If body core temperature exceeds 100.6F, the firefighter should not be permitted to wear protective equipment or re-enter the active work environment, until temperature has been reduced and heart rate decreased.

It is recommended that re-examination occur at ten minute intervals. Using standing orders or existing protocol, Rehab Team Members should record examination results on medical evaluation forms as indicated by the local jurisdiction.

(7) Treatment During Rehab

Upon completing the physical examination, the following steps should be taken to minimize further risk to fire-rescue personnel: Turnout gear, helmets, masks and hoods should be removed immediately. Prior to ingesting anything orally, fluid or solid, it is recommended that the firefighter clean his/her hands and face with water and a cleaning agent, as provided by Rehab Sector personnel.

- The firefighter should rehydrate
- Oral rehydration and nutrition is recommended in the form of 1-2 quarts of fluids
- Body core temperature should be reduced by cooling the body
- Cool body temperatures gradually using misting systems, fans, etc
- Individuals should be offered Oxygen therapy via nasal canulla or O2 mask.

- Standing rest before reporting for further assignment

The firefighter will only report to manpower staging when presentation is deemed normal by the attending EMS personnel. Note: According to FEMA and the NFPA, Water is the best rehydration agent, however some agencies suggest a rehydration solution of 50 / 50 mixture of water and a commercially prepared activity beverage administered at about 40F. Avoid cooling the body using ice packs or hose streams. Cooling should be gradual, limiting further shock to the body.

In the event that presentation appears abnormal, the Firefighter should immediately receive additional treatment, especially if conditions persist following fifteen minutes of rest. As is appropriate in most locales, those complaining of chest pain, difficulty breathing and altered mental status must receive immediate ALS treatment and transport to definitive health care. Follow your local jurisdiction's ALS protocols in this event.

(8) Accountability

Members reporting to the Rehab Sector / Group should enter and exit the Area as a team. Their company designation, number of personnel, and the times of entry to and exit from the Rehab Area should be documented. This can be done either by the Rehab Officer or his / her designee on a Company Check-In / Out Sheet. Keep crews together, and don't allow overanxious members to freelance the event.

(9) The Vital Importance Of Firefighter Rehab

Very few firefighters who wear the badge are athletes. But, from the moment the alarm is sounded, and that first surge of adrenaline reaches the heart, we're asking our bodies to work triple overtime. Couple that with 55 pounds of business suit, 1200 degree temperatures and another 50 pounds of hand tools and equipment, and the importance of effective rehabilitation at the fire scene becomes crystal clear.

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Originally published in Fire Chief Magazine -- written by Lou Angeli

for printed copies contact @Lou HDfirefighting@gmail.com

Kokomo Fire Chief, Deputy, Resign Over Layoffs

Bitter Battle Ends With 12 Firefighter Layoffs

contributed by
KEN de la BASTIDE

KOKOMO, IN (May 28, 2009) The two highest ranking administrative officers of the Kokomo Fire Department have resigned their positions as a result of Mayor Greg Goodnight's decision to lay off 12 firefighters.

Chief Scott Kern, a 20-year veteran of the department, and Assistant Chief Randy Wilson submitted their letters of resignation Friday to Goodnight, according to city spokesman David Gavin. The resignations took effect on Sunday.

Both Kern and Wilson remain with the department. Gavin said Goodnight has named Deputy Chief Brad Myers as acting chief. Earlier this month, Goodnight ended the department's EMS service. Those duties were shifted to Howard Regional Health System and St. Joseph Hospital.

The layoff of the 12 firefighters was not unexpected. Jeremy Shaw, president of Local 396 of the International Association of Firefighters Union, said last week that since Goodnight took office on Jan. 1, 2008, the number of firefighters has declined from 121 to 100.

Kern said last week that Goodnight’s decision jeopardizes safety at fire scenes for members of the department.

Goodnight said Kern has mentioned resigning three or four times in the past few weeks.Kern could not be reached for comment.“What we have done is revamp the fire department,”

Goodnight said Tuesday. “We have eliminated two administrative offices, reducing that number from eight to six and eliminated ambulance transport, which had 15 jobs associated with the service but only eliminated 12 positions.

“We have the same number of people at each station and truck and the same number of stations,” he continued.

Goodnight said he met three times with officials of Local 396 to provide them an opportunity to help find a solution. He said the union recommended closing Kokomo Beach and the Senior Citizens Center. Goodnight said that would not provide enough savings.

“This is an attempt by firefighters to hold onto their benefits,” Goodnight said. “The union president also suggested a trash fee, which the citizens of Kokomo can’t afford.”

A pamphlet being distributed by the firefighters union is urging residents to speak out against the cuts in the fire department.

“Hardest hit will be the southeastern and southwestern parts of the city,” the pamphlet reads, “which is troubling since high-occupancy buildings such as the Walnut Creek Apartments, Westbrook Apartments and new library are located in this areas.”

The pamphlet further states with the planned annexation of 14 square miles over the next two years the fire department’s resources will be stretched thinner, which could mean longer response times.

Goodnight said the pamphlet is not accurate in that the Kokomo Fire Department already provides service to 7 square miles of the annexation area that are in Center Township.

“When I eliminated the two management positions, the union said it created a safety issue,” Goodnight said. “When we eliminated ambulance transport, the union said it created a safety issue.

“They say it every single time,” he said. “We have less people in the front office and no people providing ambulance transport. Everything has stayed exactly the same."

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Rescource: Kokomo Tribune

Why America Still Burns!

A History Lesson
by: Lou Angeli

Organized chaos. That's how the fire scene is often described. The adrenaline charged atmosphere feels like a battleground. But in this war zone there's no time to develop a battle plan. For the firefight to be successful action must be immediate. Firefighters have only a few precious minutes to defeat their opponent.

Back in the day, Firefighting was all about racing to the scene, donning a tin helmet and aiming the nozzle at the flames and smoke. And that's pretty much how the general public still perceives the job. But times have changed, and today there’s an art, not to mention a science, to fighting fires.

In terms of extinguishing blazes, today’s firefighters are trained to go face-to-face with the beast, inside the burning building for an "offensive" attack. Some fire training experts say that the trick is to tame the fire, before extinguishing it, and there are dozens of tactics for doing so. But these strategies often come with extreme risk. Bottom line -- firefighters must make crucial life and death decisions quickly.

During the past 30 years, annual civilian fire deaths have been reduced by 50%. But firefighters deaths continue to rise, with 112 being lost in the line of duty last year alone. Even more disturbing are OSHA and the National Fire Protection Association’s predictions that fully one-third of the current firefighting force of 1,100,000 will be injured on the job during they year 2009. Of those who will be injured, it is estimated that over half do not have adequate insurance coverage to attend their needs. Is this any way to treat the Bravest?

Change Comes Slowly to America's Firehouses

Our firefighting counterparts of just 50 years ago were leather-lunged old salts who were overworked, under trained and poorly equipped. Without adequate personal protection, or proper equipment, a "career" in the fire service back then was a sure fire invitation to an early grave.

Thankfully, our job as firefighters has evolved into a high-tech profession. During the last generation alone, the fire-rescue service has seen more change than it did in its first 250 years. In the years immediately following World War II, some of the technology that had been made available to the armed services was brought home to fire stations by the soldiers and sailors who actually used it.

Tools and equipment like Chem-Ox masks, fog nozzles, even 1.5 inch hose were all born from military uses during the War. Imagine the culture shock that existed among veteran 1950's firefighters, when these "wet behind the ears" probies introduced their new toys. Hell, the old-timers we're just growing accustomed to motorized apparatus.

But the post War techno-revolution was short-lived, and our counterparts of the late 50's and early 60's found themselves falling way behind the rest of society. The World was changing, and so were our first-alarm districts. In homes and businesses, wooden furniture and cotton products were replaced by plastics and hydrocarbons, which changed the way we did business at fires. The DuPont slogan, "Better Living Through Chemistry," brought new meaning to America's Bravest.

Without proper equipment and training, fighting these "new wave" fires was a tough game. By 1965, we'd lost possession of the ball and our forward momentum had stalled. Our coaching staff was perplexed and the spectators were beginning to lose their interest.

The Fire Act of 1972

President Richard M. Nixon (a Republican) made a bold move by appointing a special commission to study the fire problem here in the United States. His directive was simple -- determine the fire problems, and make suggestions on how to fix them. Nixon was determined to make the Commission succeed, and he did so by enlisting and recruiting the nation's movers and shakers of the fire-rescue services.

Once together, theirs was no small task. The commission took on some very controversial issues including rising civilian deaths, firefighter safety, the high-rise dilemma, and fire prevention. Their report "America Burning" was a harsh, and very critical review of the fire situation here in America.

"It is appalling,' the report began, 'that the most technologically advanced nation in the World, reports the highest per-capita fire deaths and monetary fire loss." They pulled no punches in their treatment of the issues, and those of us who serve today, owe a great deal to the men and women who recommended the changes most of us take for granted.

35 Years Later

Now 35 years later, the fire problem here in the United States has once again raised its fiery head. And according to fire administrators, the situation seems to be getting worse, instead of better.

“To a great extent, the fire problem in America remains as severe as it was 30 years ago.” That’s the very first sentence in the updated report, “America Burning Recommissioned.”

Even with the introduction of the smoke detector, the incidence of fire in this nation has increased to an alarming rate. Why? Some say it’s public apathy.

“Americans have always been neglectful of safety and loss prevention,” says investigative journalist Herb Denenberg, He adds, “Perhaps we are more focused on producing wealth than preserving it.” The most recent commission agrees. “The indifference with which Americans confront the subject, which the 1973 Commission found so striking, continues today.”

Fire is the most common of all home disasters and the third leading cause of accidental injury and death in the home. Fires spread very quickly, but it isn’t the fire itself that kills! Deadly smoke and poisonous gases snuff the life out of victims long before the flames reach them. There's no time to stop and think and wonder what's the best thing to do. The situation can change in seconds. Half a minute after the smoke alarm goes off, an entire floor of your house could be filled with dense smoke.

More than 4,500 Americans die each year in fires and over 150,000 are injured. An overwhelming number of these life-threatening fires occur in the home. However, there are time-tested ways to prevent and survive a fire. It's not a question of luck - it's a matter of planning ahead. Too many fires are caused by carelessness and ignorance of fire safety principles that have been, until now, thought to be obvious. Education about the fire hazard should not only reach children, but to the adult community as well – the caretakers.

But one of the problems for fire departments is finding necessary funding to conduct adult oriented public education programs. Fact is, there are few fire safety informational programs designed for secondary education and adults.

Do you know what you should do if there's a fire? Are you sure? Does everyone who lives in your home know? If you're not able to answer these questions, ask your kid.

In a recent early morning row home fire in Baltimore, a news helicopter arrived before the fire department. Hovering above the scene, the camera reveals a fire that's moving rocket fast through the center of the block, spreading quickly to homes on either side through common cocklofts.

What struck me most about the chopper coverage was the evacuation of the two attached homes -- both led by children. In one scene, a youngster is shown taking his parents and siblings by the hand and moving them to a safer spot further up the block.

Now, that kid deserves a medal.

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