Whether you work for a fire department or EMS agency, the new National Fire Protection Association (NFPA) standard for firefighter rehab affects you and your service. It outlines the responsibilities for EMS responders at fires by specifying the standards for rehabilitation of firefighters. The standard was put into place to affirm the importance of allowing firefighters adequate rest, hydration and caloric intake during hot, heavy work.
The new standard recognizes the leading cause of firefighter deaths: cardiac-related events. Almost half of the on-duty firefighter deaths are from heart attacks; almost twice the number of police officers who die on duty from cardiac events. The deaths tend to occur either during, or immediately after, incidents that require heavy work.
NFPA has looked at each of the three leading factors that contribute to firefighter deaths: underlying medical conditions, inadequate physical conditioning and heavy exertion. NFPA 1582 and 1583 look at the first two, while 1584 aims directly at on-scene heat exhaustion and inhalation injury.
According to NFPA, rehab should occur whenever on-scene activities pose the risk of members exceeding a safe level of physical or mental endurance. The types of incidents will vary from structural and wildland fires, hazmat incidents, multiple casualty incidents and any prolonged operation during bad weather. EMS is expected to take the lead in sharing the rehabilitation concept with law enforcement and other emergency services personnel who take part in the scene.
The new standard defines eight key objectives for rehab. These include relief from environmental conditions, rest and recovery, and active or passive cooling or warming as needed. They also include rehydration, calorie and electrolyte replacement, medical monitoring, member accountability and release for return to duty. Hot conditions will require shelter from the sun, hydration, prevention of burns from contacting hot asphalt and even sunscreen. Cold weather priorities may include shelter from wind and snow, increased caloric intake and a method for thawing gear, and frequent frostbite checks. The area devoted to rehab may be as simple as a single rescue or ambulance unit. It also may be as complex as a tent equipped with generators and communications equipment. Access to fresh water is essential, although many EMS agencies prefer sports drinks that provide electrolyte replacement. Think about basic needs, such as portable toilets, early on when facing incidents that will continue for some time.
Also required by the new standard is a minimum of BLS care and transport capability on a scene. EMS must keep records of which firefighters have rotated through rehabilitation, with an evaluation of vital signs including oxygen-saturation levels, and a thorough evaluation of injuries or complaints of illness. EMS medical directors should outline medical protocols that address when firefighters should be transported to a hospital. Vital signs parameters should be clearly outlined. Although there is still some discussion, 1584 outlines some basic vital signs parameters and mandates that EMS should examine anyone complaining of chest pain, dizziness, shortness of breath, weakness, nausea or headache, as well as muscle pain, changes in level of consciousness or mentation, and abnormal vital signs.
If a fire department doesn't have EMS, it's now required to develop mutual aid agreements with EMS agencies for provision of on-scene rehab. EMS is required to be trained and equipped to perform rehabilitation activities, and it must now outline a rehabilitation program that will be appropriate for the various types of fire incidents that occur under a constellation of environmental conditions. For example, although we always think of fire scenes as involving heat, firefighters can also become extremely cold when they exit a structural scene to find that the moist inside of their turnout gear has now frozen.
If your service currently doesn't have an EMS protocol for rehabilitation, it's time to start asking your service leaders and medical director to come into compliance. The standard is intended to help us take care of each other, so that we can continue to take care of everyone else.