karen c. owens - virginia department of health c. owens emergency ... define rehab ... allow for...
TRANSCRIPT
Karen C. Owens Emergency Operations Acting Manager, Virginia
Office of EMS Masters in Public Safety Leadership (B.A. in
Psychology) Virginia EMT-Basic (Instructor) Virginia Firefighter I and II
Upon completion of this program participants will be able to: Define rehab Recognize NFPA standards on rehabilitation and
understand their impacts Understand the relations between incident
rehabilitation and ICS Understand the need for rehabilitation SOGs Recognize effective and ineffective SOGs
How Do You Define Rehab?
The process of providing rest, rehydration, nourishment, and medical evaluation to members who are involved in extended or extreme incident scene operations.
NFPA 1584
Treatment of incident personnel who are suffering from the effects of strenuous work and/or extreme conditions
http://www.nrcc.com/definitions.html
Restoring or bringing “to a condition of health or useful and constructive activity”
Dickinson and Weider
Lessen the risks of injury that may result from extended incident operations
How Do We Do This? Provide downtime Separate responder from incident
1500 – Standard on Fire Department Occupational Safety and Health Programs
1561 – Standard on Emergency Services Incident Management System
1582 – Standard on Comprehensive Occupational Medical Program for Fire Departments
1583 – Standard on Health-Related Fitness Programs for Fire Fighters
1584 – Standard on the Rehabilitation Process for Members During Emergency Operations and Training Exercises
NFPA 1500 Puts emphasis on fire department to identify
safety officer and implement health and safety program Recommends tactical level officers directly
supervise and account for the companies and/or crews operating in their specific area of responsibility Rehab Officer must see those who enter Rehab
NFPA 1561 Requires Incident Command provide for rehab
Also states that those released from rehab: Receive a new incident assignment Return to the Staging Area to await an incident
assignment Or be released from the incident
NFPA 1582 Provides details on pre-service and in-service
medical exams and testing to determine firefighter fitness
NFPA 1583 Provides guidelines on proper fitness
NFPA 1584 Ongoing education on when & how to rehab
Provide supplies, shelter, equipment, and medical
expertise to firefighters where and when needed Create a safety net for members unwilling or
unable to recognize when fatigued
Developing Strong Rehab Operations
What do we prepare for? Physical ASPECTS of the Job Fire Suppression Search and Rescue Roof Operations Extrication
What do we rarely prepare for? Physical IMPACTS of the job Temperature Pulse Blood Pressure
Dehydration increases blood viscosity
Increased viscosity slows blood flow through the veins Harder to get past plaque buildup
If we don’t rehab, what will happen?
Chapter 4.1.1.1 “The fire department shall develop standard
operating guidelines (SOGs) that outline a systematic approach for rehabilitation of members operating at incidents and training exercises”
Sets a minimum standard for Rehab SOGs
Relief from climactic conditions
Rest and recovery
Medical Monitoring
Cooling/warming as needed
Rehydration/electrolyte replacement
Calorie replacement
EMS treatment (if necessary)
Personnel accountability
Release
Provide protection from all weather elements Heat Cold Rain Ice/Snow Wind
Go beyond the shade from a tree Pop-up tents Inflatable shelters
What are your work rest cycles? What is the impact of long work/short rest cycles? NFPA Minimum Standard Assess crews every 45 minutes More in more extreme conditions
Recovery time is based on assessment findings Should be no less then 20 minutes
Consider Wind Chill and Heat Index when determining work rest cycle
If signs and symptoms of heat/cold issues arise, send to rehab IMMEDIATELY
Extreme Caution Heat Stroke likely to occur when working under these conditions. Danger Heat Exhaustion or Heat Cramps likely. Heat Stroke may occur upon
prolonged exertion. Extreme Caution Heat Cramps or Heat Exhaustion likely to occur.
Caution Heat Fatigue may occur
Temperature Most accurate method – Rectal Oral – 1o lower than core Tympanic – up to 2o lower than core
Heart Rate Standard Finding 70 percent of maximum heart rate - ((220-age)x.7)
Should return to <100 after 20 minutes
Respiratory Rate Should be in normal range (12-20) after 20 minutes
of rehab
Blood Pressure Should return to normal/slightly lower than
normal after 20 minutes of rehab Critical Finding – 160 systolic and/or 100 diastolic
after 20 minutes of rehab
Passive Cooling Remove protective gear Thermal layering keeps heat trapped inside
Active Cooling Consider: Cooling Chairs/Vests Misters Direct towel placement
Passive Warming
Consider Provider education Benefits of pre-hydration Known events Known shifts Consider the unknown
What are we taking in on our off time? Appropriate intake Small amounts of fluids more frequently (bladder
comfort/excretion)
Water is appropriate When taken in with a meal
Sports Drinks Fluid, calorie, and electrolyte replacement Most appropriate for moderate to high intensity
activities lasting >1 hour Do NOT dilute mixes!
Nutrition Carbohydrates, Proteins and fat in small portions
Good Options Whole Wheat Snacks High Fiber Popcorn, fresh fruit, raw vegetables, nuts, cereal bars
Complex Carbohydrates Proteins Consider soup, broth, stew (easier to digest)
Remember to choose quick and simple foods for rehab operations
Caffeinated, carbonated, high fructose content, and high sugar drink
Foods with high fat and/or high protein content
Alcohol within 8 hours prior to duty Excessive fluids
Under NFPA standard, responsibility for rehab determination lies with company officer Remain accountable to personnel condition
Check In/Check out should occur for all personnel in rehab
Scene accountability checks should include all personnel in rehab
All personnel should have two sets of vitals prior to release Entry and exit from
Anyone who does not fall within appropriate parameters should NOT be released
Anyone who exhibits sings of heat/cold/cardiac issues should not be released
Work with OMD to develop SOGs and medical parameters
Knowing the medical history of responders can assist in understanding their normal baseline vitals Consider medical monitoring outside of
emergency incidents
What do we do with our knowledge?
Determine rehab area need “Soft” rehab vs. “Hard” rehab Incident size and duration impact this decision
Appropriate size Removal of PPE Area for medical monitoring/treatment Away from incident operations Accessible to transport trucks
Consider need for multiple rehab areas
Real Life/Small Incident Rehab part of Operations
Medium Scale Incident Rehab may become part of EMS activities
Large Scale/Long Term Incident Rehab falls under Logistics
Logistics Section Chief
Service Branch Director
Communications Unit Leader
Medical Unit Leader
Rehab
Food Unit
Leader
Support Branch Director
Supply Unit
Leader
Facilities Unit
Leader
Group Support
Unit Leader
Services under the Service Branch
Response for Treatment and Transport of INCIDENT personnel Note that this is separate from Victim Treatment
and Transport
Establishes and maintains Rehab Operations
Basic level care is minimum support provided Consider policies for IV administration Can they/Should they return to incident ops?
Treat and release policies Can they/Should they return to incident ops?
Mental Health Not always taken care of during operations Critical Incident Stress Management or other
behavioral management programs
Post-Incident Rehydration On-scene hydration is a start, but not enough 12-32 ounces of electrolyte/carbohydrate fluids within
2 hours of operations
Remember that serious medical conditions may occur up to 24-hours post incident
Karen C. Owens [email protected] [email protected] 804-641-8307