HomeMy WebLinkAboutSOG 200.04 NEW 1-2014_Worker Rehab200.04 — Worker Rehabilitation
Effective. 1/5/2014
Revised:
Replaces: - f III III III III III III III III III III III III III III III III
I. Guiding PhilosophX
Weather combined with strenuous activity can have a potentially devastating effect on
first responders. We strive to minimize the effects of high heat, humidity, dangerous cold
temperatures and worker fatigue by executing an organized and timely system of worker
rehabilitation.
II. Purpose
The purpose of this policy is to provide advanced planning for routine rehabilitation
during training, daily duties, and actual incidents where members are subjected to heavy physical
labor or prolonged periods of exposure to potentially harmful temperature levels.
III. Goals
The goals of this policy are to:
A. Provide general rehab considerations.
B. List rehab concerns for high heat and humid conditions.
C. List rehab concerns for wet, windy or cold conditions.
D. Outline details for medical evaluation during rehab.
IV. Definitions
A. Dangerous Heat Temperatures -- Occur any time the Heat Index is over 90° F.
The higher the heat index reaches above 90', the more extreme the effects are on
the body and subsequent fatigue levels. Working in direct sunlight or in full PPE
will also increase the effects of the heat index. See Appendix A for chart.
B. High Humidity -- Humidity levels above 60% should be considered elevated.
High levels of humidity amplify the effects of heat on the body. Fluid intake
should be increased in high humidity activities. See Appendix A for chart.
C. Dangerous Cold Temperatures -- Occur any time the wind chill index is below
35° F. Wet clothing and activities around water will increase the effects on the
body. See Appendix B for chart.
V. General REHAB considerations
A. All Department members share responsibility in the implementing rehab.
SOG 200.04 — Worker Rehabilitation Page 1 of 7
1. Fire Administration, the Medical Advisory Group and the Tactical
Advisory Group are responsible for:
a. Keeping the rehabilitation policy updated with current data and
information on rehab safety.
b. Coordinating with Beaumont EMS for their roles in the system.
2. Logistics Section -Support Branch personnel, are responsible for
procuring expendable food and rehydration drink items so that they are
readily available if needed.
3. During a training exercise, the Lead Instructor is responsible for
ensuring effective rehabilitation is maintained as needed throughout the
training exercise.
4. During an incident, the Incident Commander (IC) is responsible for
ensuring effective rehabilitation is maintained as needed throughout the
event.
5. The Incident Safety Officer an/or Training Program Coordinator is
responsible for notifying the Incident Commander or Lead Instructor if
they become aware that adequate rehabilitation is not being maintained.
6. Company Officers are responsible for:
a. Routine rehab needs around the station or in non -emergency
activities.
b. Having their crew report for routine rehab as directed and
cooperating with EMS responsible for checking responder
health.
c. Updating the Incident Commander on the rehab needs of their
crew if they are not adequately being addressed.
7. Each member is responsible for:
a. Staying properly hydrated, particularly when outdoor
temperatures are elevated.
b. Monitoring his/her individual fatigue levels and notifying his/her
chain of command if they have rehab needs that are not being
adequately met.
c. Wearing appropriate clothing in cold weather situations to help
maintain proper body temperature.
d. Being truthful and cooperative during medical evaluations when
required as part of the rehab process.
e. Notifying the Rehab Supervisor of any medication or special
dietary needs at longer duration events.
B. Rehabilitation is a process that should not cause a disruption to emergency
services if it is adequately planned for in advance. Extra personnel should be
called for as needed in anticipation of workers entering rehab.
C. When needed at larger events or structure fires, the IC will designate a Rehab
Supervisor who will be responsible for the Rehab Division.
1. Generally, the Rehab Division should be established near T74 and the
med unit unless they are positioned too close to the hazard zone. Both
units can be utilized in the rehab process. If these units are not available,
a suitable building, area, or vehicle away from the event may be
designated instead.
SOG 200.04 — Worker Rehabilitation Page 2 of 7
2. When possible, the Rehab Division should provide:
a. A place where members can safely remove PPE
b. Some relief from inclement weather
c. Hydration needs
d. Food or snacks at extended events
3. Crews should be rotated into rehab together and should leave together
unless fatigue or injury prevents one or more of them from returning to
duty. In this case, the Incident Safety Officer and/or Rehab Supervisor
will reassign cleared members into new crews as needed when leaving
rehab.
a. The IC should always be made aware of a member that is not
capable of returning to duty.
b. Changes should be noted in the accountability system if crew
personnel get reconfigured after rehab.
c. Crews cleared to leave rehab will report to the Staging Officer
(when implemented at larger incidents) or to the IC (at smaller
incidents) to be re -assigned.
D. Typically, rehab should meet the following basic targets:
1. At standby calls, non emergency events, or when members are NOT
engaged in strenuous activities but the weather has reached potentially
dangerous levels:
g 0 �� rt'dni i'ell without a
a. Members should not work longer than i
rehab break.
b. Hydration should be provided and a chance to get out of the
extreme weather for at least 1(0 tes'.
c. No formal medical evaluation is mandatory but Officers and the
Incident Commander should monitor members for signs of
distress and take action as appropriate to keep the members safe.
d. Subsequent rehab breaks should occur for
the duration of the event.
e. If needed, call for T74 to assist with worker rehab.
2. For members or crews performing strenuous activities:
a. When working as a crew, the entire crew should be sent to rehab
as a unit. If possible, crews reporting to rehab should be
staggered so that there is not a backup of workers awaiting
evaluation.
b. g i�� iiiii'iii'ii'k (or the
Members should not work longer than �'
consumption of one 45 minute air bottle) without a short break
L' fr�'�d'°w 1(I'„�hfJr;ae,sj for hydration and rest.
C. �m i t s ��� � �� t' ,ic iu d 1, I� t`E (or the
consumption of two 45 minute air bottles), the member or crew
should be sent for at least a 1(0 inns f,�tae rehab break.
i. During training events, station assignments, or non -fire
based emergencies, no formal medical evaluation is
mandatory but it is strongly encouraged. If no medical
evaluation is given, Officers and the Incident Commander
should monitor members for signs of distress and take
action as appropriate to keep the members safe.
SOG 200.04 — Worker Rehabilitation Page 3 of 7
ii. Where EMS is assigned to standby for our workers,
members will be sent for a mandatory formal medical
evaluation during the rehab period. (See Section VIII)
c. Subsequent rehab breaks during the same event should occur
v..lof physical activity for the duration of the
���i t ..�t......,
event. If present, EMS will continue to evaluate workers at each
rehab period.
The Incident Commander may alter these targets as necessary. If
alterations shorten the rehab time, the IC and the Incident Safety Officer
must recognize that this may place our workers at a greater risk of
injury. This increased risk should be weighed against our risk
management policy to determine acceptable limits and when/if
alterations should be implemented.
VI. Rehabilitation Considerations from High Heat and Humidity
A. On hot and humid days before an event or activity:
1. Stay properly hydrated throughout the day by making a conscious effort
to drink more fluids than normal.
2. Avoid caffeinated products that could lead to dehydration.
3. Consider a healthy breakfast with fruit and other nutritious components
at the start of the shift.
4. Keep daily meals small but balanced. Try to avoid large, heavy meals
during the hottest portion of the day.
5. Schedule non -emergency duties away from the hottest hours whenever
possible.
B. On hot and humid days during emergency response or physical activities:
1. Make sure rehab area has air conditioned (A/C) space where members
can spend some time out of the heat and humidity.
a. If nothing else, allow workers in rehab to rest in the cab or interior
of air conditioned vehicles.
b. Make sure exhaust from running vehicles does not pose an
additional hazard for the Rehab Division.
2. Consider large fans or misting fans where possible for cooling down
larger areas where an A/C is not available.
3. Keep hydration fluids cool and readily available to workers.
4. Consider potassium, sodium, and electrolyte replacement needs in mind
at longer duration events. Members on medically restrictive diets should
make the Rehab Supervisor aware if they are on low sodium, restricted
potassium, or have other special dietary needs.
VII. Rehabilitation Considerations from Danaerous Cold Temperatures
A. On cold/wet days before an event or activity:
1. Dress appropriately for the weather with additional or heavier clothing
as needed.
2. Bring extra clothes to the station to have dry clothing available after the
event.
SOG 200.04 — Worker Rehabilitation Page 4 of 7
Remember that plentiful hydration is still an important need even in cold
weather.
4. Avoid unnecessary exposure to extreme wet or cold environments for
non -emergency activities whenever possible.
B. On cold/wet days during emergency response or physical activities:
1. Provide heated areas in rehab where members can warm themselves
while resting.
2. Consider contacting Red Cross for heated refreshments at longer
duration events.
3. Provide dry clothing as soon as practical after the event.
4. Dry wet gear whenever possible between calls.
VIII. Medical Evaluations
A. When available, formal medical evaluations should be used to monitor members
during rehab. To avoid conflicts with treatment and evaluation, a certain level of
authority must be granted to EMS to ensure our personnel are not letting their
own safety reach a critical point. While noble in heart and admirable in attitude,
workers pushing themselves too far past physical limitations will eventually have
a negative effect on overall Operations and incident morale.
1. Members sent for rehab are considered to be under direct order from
their IC to report to the division. Failure to follow this order would fall
into the same classification as failing to comply with a lawful order from
a superior.
2. Members will not be allowed to return to emergency work until they
have been cleared by the EMS providers in rehab.
a. A member who refuses the EMS evaluation or recommended
treatment options would be considered to be going against medical
advice (AMA) and will not be allowed to return to duty at that
time.
b. The IC will be notified if members refuse medical evaluation or
treatment during rehab.
3. Beaumont EMS medics performing the evaluation will have sole
authority on whether or not a member is physically fit to return to work
at the incident.
4. If there is disagreement about the needed treatment of a responder, the
on scene action should always favor responder safety.
a. After the event, the situation can be reviewed by Fire
Administration and EMS Administration to determine if any
adjustment needs to be made to the policy from either agency.
b. The IC can call and consult with the EMS Supervisor if needed for
clarity on scene.
B. When workers enter rehab, they will be initially screened for:
1. Abnormal Vital Signs
a. Body Temperature
b. Heart Rate (Pulse)
c. Respiratory Rate
d. Blood Pressure
e. Pulse Oximetry
SOG 200.04 — Worker Rehabilitation Page 5 of 7
f Carboxyhemoglobin Monitoring (CO), if available
2. Chest pain, dizziness, shortness of breath, weakness, nausea, headache
3. General complaints of cramps, aches, or pains
4. Symptoms of heat or cold related stress
5. Changes in speech, behavior, or signs of emotional distress
6. Alert and oriented x3
C. Any signs or symptoms of life threatening conditions will require a need for
immediate treatment and transport to a medical facility.
1. To replace the EMS medics during care for one of our members or a
civilian on scene, the IC will assign BFR members to temporarily take
over medical evaluations until another BEMS med unit can arrive to
continue these duties.
D. Unless members appear to have life threatening symptoms from their initial
evaluation, they will be allowed to rest and hydrate and then retake vitals before
determining clearance from rehab. After this second assessment, members will be
either:
Cleared to return to emergency response duties.
a. All vital signs are within acceptable ranges.
i. Body temperature within a generally acceptable range
ii. Heart rate lower than 100 beats per minute
iii. Respirations in the normal 12-20 breaths per min range
iv. Systolic rates lower than 160; Diastolic rates lower than
100
V. Pulse oximetry in normal acceptable range
vi. CO levels within acceptable range
b. There should be no signs of unusual physical or emotional distress.
2. Held for further evaluation.
a. Workers may be held for another 15 to 30 minute rehab period if
their condition has not returned to a normally acceptable level, but
they do not appear life threatening.
b. Members ti 1
�%,,,119j''rehab should be
transported to a medical facility for further evaluation.
3 1111111111� „ � to a medical facility for treatment or more advanced
evaluation.
E. Medical evaluations should continue as needed for the duration of the event.
SOG 200.04 — Worker Rehabilitation Page 6 of 7
Appendix A: Heat Stress Index
Heat Index - ategory Dangers
80-90 Caution Fatigue possible with prolonged exposure and/or physical
activity.
91-10,5 Extreme caution .sunstroke, heat cramps and heat exhaustion possible with
orolonaed exr)osure and/or ohvsical activity.
Appendix B: Wind Chill Index
(Mph)
Temperature ("F)
Calm
40
36
30
25
20
16
10
5
0
-6
-10
-16
-20 -25 -30 -36 -40 -45
36
31
25
19
13
7
1
-5
-11
-16
-22
-28
-34 -40 -46 ,52 -5 63
10
34
27
21
15
9
3
-4
-10
-16
-22
-28
-35
-41 -47 -53, -459 -66 -'7P
1s
32
25
19
13
6
0
-7
-13
-19
-26
-321
-39
-46 -61 -68
20
30
24
17
11
4
-2
-9
-15
2S
29
23
16
9
3
-4
.11
.17
-24
-31
-311
-44
-451
30
28
22
15
8
1-5
-12
-19
-26
-33
-39
-46
-63
35
28
21
14
7
0
-7
-14
-21
-27
44
41
40
�27
20
13
6
1
-8
-15
-22
-29
-436
43
-60
(Wind speeds
Wgrier than
Frostbito
Times
30
was
10 min Smin
40rnph
have I ittle
addificniar
effect)
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