More than 13 years ago, I gave a presentation at the 10th annual EMS Today Conference in Albuquerque, N.M., on the subject of rehab operations, and over the years, I ve given a number of other presentations on the importance of the subject, including a detailed article in November 2000 JEMS [ Rehabs Ops ]. A few years ago, I figured that it was probably a subject beaten to death and no one really needed to hear why or how to conduct rehab operations because everyone would have already implemented procedures on how to establish rehab on emergency scenes.
But consider these facts: The number of annual firefighter deaths from on-scene stress has not decreased in more than 10 years. Further, at least 50% of on-scene fatalities is stress-related. Many EMS agencies don t have procedures in place to conduct rehab operations for their personnel.
So it seems I was wrong, and the need remains for a reminder about the importance of resting and being monitored during extended or intense emergency scene operations.
Originally, the concept of rehab focused on the need for such ops at fire scenes because of the physical nature of firefighting. It soon became obvious within the public safety sector that being involved in the physical aspects of firefighting was not a clear indicator for increased stress levels of emergency workers; workers not wearing turnout gear or performing physical activity also often exhibited medical signs of increased stress. From that finding, the application of rehab to any emergency scene operations became necessary for the health and welfare of anyone responding to or working at an emergency scene.
The nature of EMS is stressful, and often emergency workers can t be checked in the middle of providing care. EMS personnel respond to an emergency scene, treat and care for sick or injured people, and then usually transport the patients to the hospital. So you may wonder how rehab can be integrated into this sequence. But if you understand the concept of rehab, you ll recognize that it doesn t require checking your personnel after every call.
On the other hand, rehab is important for those EMS calls with extreme circumstances or extended duration that could be deemed stressful by the nature of the event. For example, rehab should be considered for a school shooting or other MCI that traps patients in a building, for which rescue attempts will take several hours to complete.
Setting up rehab on an emergency scene requires the resources to continue without interruption of emergency operations. It involves the rotation of crew members into an area for short rest/refreshment period and a check of vital signs. This process allows for crew members to maintain peak functional ability during an emergency operation.
How to set up a rehab sector
The ambulance crew assigned to EMS operations, whether BLS or ALS, should be informed that rehab will be established and told where to set up their equipment. The placement of vehicles should be considered, especially taking into account any inclement weather conditions. Ideally, personnel rotated through rehab should be out of the weather. If the climate is cold, provide an area where personnel can stay warm while resting and having vital signs monitored. All necessary EMS equipment oxygen, cardiac monitor, drug box, telemetry, multiple BP cuffs and stethoscopes should be readily available if rehab is not in the back of the ambulance.
The following list details the four areas within a rehab sector:
- Medical Evaluation: Personnel should be evaluated at least twice, when they arrive in rehab and after 15 20 minutes of rest. A complete set of vital signs should be taken and recorded.
- Rest: Personnel should be able to rest 15 20 minutes; however, the nature of the incident or the amount of resources may dictate shorter or longer rest periods.
- Refreshment: Fluids should be available, and also food if an extended operation is expected. Emergency personnel should be encouraged to drink fluids even if they re not thirsty, because water replacement and adequate hydration are crucial in maintaining ideal body temperature. By the time a person is thirsty, they can be dehydrated by as much as three pints of water. Symptoms of dehydration include headaches, nausea and cramps. Life-threatening symptoms of water loss include hypothermia, heat exhaustion and heatstroke. With a 1 5% liquid loss, the body slows down, skin becomes flushed, and the pulse rate increases. However, 4% or greater loss of liquid is required before thirst occurs. With agreater than 5% loss, heat exhaustion can occur. At a 6 10% liquid loss, sweating stops, dizziness and cyanosis may occur, and speech and walking may become difficult.
- Treatment: Although it s not advisable to have a treatment area set up in the middle of rehab, medical personnel should be immediately available to treat anyone who exhibits signs or symptoms of a life-threatening problem. Minor injuries are best treated away from rehab. In the event that an injured or ill employee requires transport to the hospital, it s advisable to use an additional ambulance, if available, to avoid having to shut down or delay rehab.
EMS agencies without guidelines for conducting rehab on scene at emergency incidents should consider developing a policy and procedure that outlines the operations of rehab. The concept of rehab should be explained to members of the organization before implementation, including what is expected of the providers conducting the medical evaluations and what to expect as a ill or injured provider. Medical standards should be presented to all members to avoid any controversy on an emergency scene. Use a mock rehab sector to provide rest breaks during training sessions so that all personnel are familiar with the operations.
Supervisors and incident commanders must emphasize that when a crew is directed to go to rehab, the crew members must stay together and that all personnel must be evaluated and rest. If the supervisor doesn t demonstrate their commitment to rehab themselves, then other personnel won t support the procedure either. Remember, it s for the benefit of your health and the health of all your personnel, because rehab is aimed at early detection of cardiovascular problems and the prevention of a fatal heart attack or other serious medical events.
For more information or if you would like an example of a rehab form for medical monitoring of personnel, please contact me.