More than 25 years ago, the IAFF produced a manual outlining the effects of thermal stress on fire fighters. Since that document was published, our understanding of thermal stress, its effects on the body, and the prevention and treatment of conditions caused by exposures to hostile physical environments has evolved considerably.

However, the physical and mental demands associated with firefighting and other emergency operations, coupled with the environmental dangers of extreme heat and humidity or extreme cold, create conditions that can have an adverse impact on the safety and health of emergency responders.

Fire fighters who are not provided adequate rest and rehydration during emergency operations or training exercises are at increased risk for illness or injury, and may jeopardize the safety of others on the incident scene. When emergency responders become fatigued, their ability to make critical decisions diminishes.

Rehabilitation remains an essential element on the incident scene to prevent more serious conditions – such as heat exhaustion or heat stroke – from occurring. Accordingly, the IAFF, with the support of the United States Fire Administration (USFA) and the Federal Emergency Management Agency (FEMA), has produced this Emergency Scene Rehabilitation Manual and curriculum materials to better educate all in the fire and emergency medical services.

Anne Arundal County, MD


Cherry Hill, NJ

Chicago, IL




Frisco, TX

LAR601 spec sheets




German Rehab Pod


Lake Havasu, AZ


Misc. Rehab Units – Retired


North Pen Goodwill – Souderton, PA


Ovilla, TX

Washington, DC

ACSM Position Stand. (1996). Exercise and fluid replacement. Journal of Medicine and Science, Sports, and Exercise, 28 (1), January.

Alexander, D. A., & Wells, A. (1991). Reactions of police officers to body handling after a major disaster: A before and after comparison. British Journal of Psychiatry, 159, 547-555.

Armstrong, L. E, et al., (1991). Prediction of the exercise-heat tolerance of soldiers wearing protective overgarments. Aviation & Space Environmental Medicine, July, 62, 673-777.

Augustine, J. (1990). In search of fatigue predictors. Fire Command, August, 12-13.

Avery, A., King, S., Bretherton, R., & Orner, R. (1999). Deconstructing psychological debriefing and the emergence of calls for evidence based practice. Traumatic Stress Points, 12(4), 7-10.

Beaton, R. D., & Murphy, S. A. (1993). Sources of occupational stress among firefighter/EMTs and firefighter/paramedics and correlations with job-related outcomes. Prehospital and Disaster Medicine, 8, 140-150.

Becker, D. (2000) Rehabilitation operations. Journal of Emergency Management Services 25 (11), 37–47.

Bisson, J. I., & Deahl, M. P. (1994). Psychological debriefing and prevention of posttraumatic stress: More research is needed. British Journal of Psychiatry, 165, 717-720.

Bisson, I. J., Jenkins, P. L., Alexander, J., & Bannister, C. (1997). A randomized controlled trial of psychological debriefing for victims of acute harm. British Journal of Psychiatry, 171.

Borg, G. (1998). Borg’s Perceived Exertion and Pain Scales, Human Kinetics Champaign, IL.

Bull, G. (2008). Cold Towels Valuable Rehab Tool. Fire Engineering, April, 2008

Burgess, J.L, Brodkin, C.A., Daniell, W.E., Pappas, G.P., Keifer, M.C., Stover, B.D., Edland, S.D., Barnhart, S. (2006). Longitudinal decline in measured firefighter single-breath diffusing capacity of carbon monoxide values. American Journal of Respiratory and Critical Care Medicine. 1999 Jan;159(1):119-24.

Carlier, I. V. E., Lamberts, R. G., van Uchelen, A. J., & Gersons, B. P. R. (1998). Disaster related post-traumatic stress in police officers: A field study of debriefing on psychological distress. American Journal of Psychiatry, 154, 415-417.

Casa, D.J., Clarkson, P.M., Roberts, W.O. (2005). American college of sports medicine roundtable on hydration and physical activity: consensus statements. Current Sports Medicine Reports, 4, 115-127.

Charlton, P. F. C., & Thompson, J. A. (1996). Ways of coping with psychological distress after trauma. British Journal of Clinical Psychology, 35, 517-530.

Cheuvront, S.N., Carter, R., Haymes, E.M., Sawka, M.N. (2006). No effect on moderate hypohydration or huperthermia on anaerobic exercise performance. Medicine & Science in Sports and Exercise, 38, 1093-1097.

Conner, D. R., & Hoopes, L. L. (1997). Elements of human diligence: Supporting the nimble organization. Consulting Psychology: Practice and Research, 49, 17-24.

Cook, J. D., & Bickman, L. (1990). Social support and psychological symptomatology following a natural disaster. Journal of Traumatic Stress, 3, 541-556.

Deahl, M. P., & Bisson, J. I. (1995). Dealing with disasters: Does psychological debriefing work? Journal of Accident and Emergency Medicine, 12, 255-258.

Deahl, M. P., Gillham, A. B., Thomas, J., Dearle, M. M., & Strinivasan, M. (1994). Psychological sequelae following the gulf war: Factors associated with subsequent morbidity and the effectiveness of psychological debriefing. British Journal of Psychiatry, 165, 60-65.

Dickinson, E.T. & Wieder, M.A. (2000). Emergency Incident Rehabilitation. Brady-Prentice-Hall Health, Upper Saddle River, NJ.

Dickinson, E. T. (2000). Protecting our own: refuel, recharge, rehab. Journal of Emergency Management Services 25 (11), 25–35.

Echterling, L., & Wylie, M. L. (1981). Crisis centers: A social movement perspective. Journal of Community Psychology, 9, 342-346.

Fahy, R. (2004). Sudden cardiac death. NFPA Journal, July/August, 44-47

Fire Department Safety Officers Association (FDSOA). (1995). Don’t let them crawl away to die: establishing rehabilitation sectors. Safety-Gram, 8 (10), October.

Foa, E. B., & Meadows, E. A. (1997). Psychosocial treatments for posttraumatic stress disorder: A critical review. Annual Review of Psychology, 48, 935-938.

Fullerton, C. S., Wright, K. M., Ursano, R. J., & McCarroll, J. E. (1993). Social support for disaster workers after a mass-casualty disaster: Effects on the support provider. Nordic Journal of Psychiatry, 47, 315-324.

Gist, R., & Lubin, B. (Eds.). (1999). Response to disaster: Psychosocial, community, and ecological approaches. Philadelphia: Brunner/Mazel.

Gist, R., Lubin, B., & Redburn, B. G. (1998). Psychosocial, ecological, and community perspectives on disaster response. Journal of Personal & Interpersonal Loss, 3, 25-51.

Gist, R., & Woodall, S. J. (1995). Occupational stress in contemporary fire service. Occupational Medicine: State of the Art Reviews, 10, 763-787.

Gist, R., & Woodall, S. J. (1998). Social science versus social movements: The origins and natural history of debriefing. Austalasian Journal of Disaster and Trauma Studies, 1998-1. Online serial at

Griggs, T.R. (2006). The role of exertion as a determinant of carboxyhemoglobin accumulation in firefighters. Journal of Occupational Medicine. 2006 Nov;19(11):759-61.

Griffiths, J., & Watts, R. (1992). The Kempsey and Grafton bus crashes: The aftermath. East Linsmore, Australia: Instructional Design Solutions.

Grollmes, E. E. (1992). Postdisaster: Preserving and/or recovering the self. Disaster Management, 4(2), 150-156.

Guidotti, T. L. (1992). Human factors in firefighting: ergonomic-, cardiopulmonary-, and psychogenic stress-related issues. International Archives of Occupational and Environmental Health. 1992;64(1):1-12.

Gump, B. B., & Kulik, J. A. (1997). Stress, affiliation, and emotional contagion. Journal of Personality and Social Psychology, 72, 305-319.

Haigh, C. & Smith, D. (2006). Implementing effective on-scene rehabilitation. Fire Engineering, April.

Heightman, A. J., & O’Keefe, M. (2000) 20 tools to customize your rehab toolbox.  Journal of Emergency Management Services. 25 (11), 49–58.

Henderson, T. (2008). How to improve wildland firefighter health, welfare and performance. Fire Management Today. March 11, 2008

Hobbs, M., Mayou, R., Harrison, B., & Worlock, P. (1996). A randomised controlled trial of psychological debriefing for victims of road traffic accidents. British Medical Journal, 313, 1438-1439.

House, J.R., Holmes, C., Allsopp, A.J., (1997). Prevention of Heat Strain by Immersing the Hands and Forearms in Water. Royal Naval Medical Service.

Hytten, K., & Hasle, A. (1989). Firefighters: A study of stress and coping. Acta Psychiatrica Scandinavia, 355(supp.), 50-55.

International Association of Fire Fighters, Thermal Heat Stress Protocol For Fire Fighters And Hazmat Responders, Washington, DC

International Association of Fire Fighters, Thermal Stress and the Fire Fighter, Washington, DC

International Fire Service Training Association (IFSTA). (2001) Fire Department Safety Officer, 1st Edition, Fire Protection Publications, Stillwater, OK

Jankovic, J., Jones, W., Burkhart, J., Noonan, G. (1991). Environmental study of firefighters. Annals of Occupational Hygiene, 35, 581-602

Kenardy, J. A., & Carr, V. (1996). Imbalance in the debriefing debate: What we don’t know far outweighs what we do. Bulletin of the Australian Psychological Society, 18(2), 4-6.

Kenardy, J. A., Webster, R. A., Lewin, T. J., Carr, V. J., Hazell, P. L., & Carter, G. L. (1996). Stress debriefing and patterns of recovery following a natural disaster. Journal of Traumatic Stress, 9, 37-49.

Kenney, W. L. (1997). Fluid intake during cold weather. Penn State University Sports Medicine Newsletter.

Lee, C., Slade, P., & Lygo, V. (1996). The influence of psychological debriefing onemotional adaptation in women following early miscarriage: A preliminary study. British Journal of Medical Psychology, 69, 47-58.

McCrae, R. R. (1984). Situational determinants of coping responses: Loss, threat, and challege, Journal of Personality and Social Psychology, 46, 919-928.

McEvoy, M. (2005). Biomedically speaking: measuring exhaled CO. Fire Engineering’s FireEMS Magazine, May, 6-7.

McEvoy, M. (2005). Averting oxygen hazards with oximetry. Fire Engineering’s FireEMS Magazine, June, 8-11.

McEvoy, M. (2006). Biomedically speaking: interpreting carboxyhemoglobin SpCO findings. Fire Engineering’s FireEMS Magazine,April,10-14.

McFarlane, A. C. (1988). The longitudinal course of posttraumatic morbidity: The range of outcomes and their predictors. Journal of Nervous and Mental Disease, 176, 30-39.

McFarlane, A. C. (1989). The aetiology of post-traumatic morbidity: Predisposing, precipitating, and perpetuating factors. British Journal of Psychiatry, 154, 221-228.

McLellan, T.M., Selkirk, G.A., (2005). The Management of Heat Stress for the Firefighter, Defence Research and Development Canada.

Meichenbaum, D. (1994). A Clinical Handbook/Practical Therapist Manual for Assessing and Treating Adults with Posttraumatic Stress Disorder. Waterloo, Ontario (Canada): Institute Press.

Mitchell, J. T., & Everly, G. S. (2nd Edition). Critical Incident Stress Management: A New Era & Standard of Care in Crisis Intervention. Ellicott City, MD: Chevron Publishing.

Mitchell, J. T., & Bray, G.P. (1990). Emergency Services Stress: Guidelines for Preserving the Health and Careers of Emergency Services Personnel. Englewood Cliffs, NJ: Prentice-Hall.

Mitchell, J. T., and Everly, G. S. & (1995). Critical Incident Stress Debriefing: An Operations Manual for the Prevention of Traumatic Stress among Emergency Services and Disaster Workers. Ellicott City, MD: Chevron Publishing.

Moran, C. C. (1998). Individual differences and debriefing effectiveness. Austalasian

Journal of Disaster and Trauma Studies, 1998-1. Online serial located at

Motowidlo, S. J., Packard, J. S., & Manning, M. R. (1986). Occupational stress: Its causes and consequences for job performance. Journal of Applied Psychology, 71, 618-629.

National Institute for Occupational Safety and Health (CDC). (1992) Working in Hot Environments. Washington, DC

Ostrow, L. S. (1996). Critical incident stress management: Is it worth it? Journal of Emergency Medical Services, 21(8), 28-36.

Pearson, D. (1999). Avoiding dehydration: what to drink,” Strength and Conditioning Journal. June.

Raphael, B., Meldrum, L., & McFarlane, A. C. (1995). Does debriefing after psychological trauma work? Time for randomized controlled trials. British Journal of Psychiatry, 310, 14791480.

Ross, D., McBride, P., & Tracy, G. (2004). Rehabilitation: Standards, Traps, and Tools. Fire Engineering May 2004

Rubonis, A. V., & Bickman, L. (1991). Psychological impairment in the wake of disaster: The disaster-psychopathology relationship. Psychological Bulletin, 109, 384-399.

Sachs, G. M. (2000). The Fire and EMS Department Safety Officer. Brady/Prentice-Hall Health, Upper Saddle River, NJ.

Sawka, M. N., Pandolf, K.B. (1990). Effects of body water loss on physiological function and exercise performance. Perspectives in Exercise Science and Sports Medicine, Vol. 3: Fluid Homeostasis During Exercise. Carmel, IN.

Sawka, M.N. (1992). Physiological consequences of hypohydration: exercise performance and thermoregulation. Medicine & Science in Sports and Exercise, 24(6), 657-669

Skinner, J. S. (1985). Fighting the fire within. Firehouse, August, 46-48,66.

Shireffs, S. M. & Maugham, R. J. (2000). Rehydration and recovery of fluid balance after exercise. Exercise and Sports Reviews (ACSM), 28 (1), January.

Smith, D. L. (2002). Acute effects of fire fighting activity on coagulation. Medicine and Science in Sports Exercise. 34 (5), S194

Smith, D. L., Petruzzello, S.J. (1998). Selected physiological and psychological responses to live-fire drills in different configurations of fire fighting gear. Ergonomics, 41(8), 1141-1154.

Smith, D. L., Petruzzello, S.J., Chludzinski, M.A., Reed, J.J., Woods, J.A., (2001) Effects of strenuous live-fire fire fighting drills on hematological, blood chemistry, and psychological measures, Journal of Thermal Biology, 26(4-5), 375-380.

Smith, D. L., Petruzzello, S.J., Manning, T.S. (2001) The effect of strenuous live-fire drills on cardiovascular and psychological responses of recruit firefighters. Ergonomics, 44(3), 244-254.

Stephens, C. (1997). Debriefing, social support, and PTSD in the New Zealand police: Testing a multidimensional model of organizational traumatic stress. Australasian Journal of Disaster and Trauma Studies, 1. Electronic journal accessible at

Taylor, S. E. (1983). Adjusting to threatening events: A theory of cognitive adaptation. American Psychologist, 38, 1161-1173.

Taylor, S. E. (1991). Asymmetrical effects of positive and negative events: The mobilization-minimization hypothesis. Psychological Bulletin, 110, 67-85.

Taylor, S. E., & Brown, J. D. (1998). Illusion and well-being: A social psychological perspective on mental health. Psychological Bulletin, 103, 193-211.

Taylor, S. E., & Lobel, M. (1989). Social comparison activity under threat: Downward evaluation and upward contacts. Psychological Review, 96, 569-575.

Thompson, J., & Solomon, M. (1991). Body recovery teams at disasters: Trauma or challenge. Anxiety Research, 4, 235-244.

U.S. Department of the Army. (2003). Heat Stress Control and Heat Casualty Management (TB Med 507). Washington, DC.

U.S. Department of the Army. (2005). Prevention and Management of Cold Weather Injuries (TB Med 508). Washington, DC.

U.S. Fire Administration (1992). FA-114, Emergency Incident Rehabilitation. Emmitsburg, MD.

U.S. Fire Administration. (2002) FA-220, Firefighter Fatality Retrospective Study. Emmitsburg, MD

VFIS. Rehabilitation. (Date Unknown), On-line article at . York, PA

Wenger, B.C. (2001) Textbook of Military Medicine: Medical Aspects of Harsh Environments.

Wessely, S., Rose, S., & Bisson, J. I. (1999) Brief psychological interventions (“debriefing”) for treating immediate trauma-related symptoms and preventing post-traumatic stress disorder (Cochrane Review). The Cochrane Library, 1. Oxford, UK: Update Software.

Wieder, M.A. (1999). Operating a rehab area, part I. Firehouse, May.

Wieder, M.A. (2000). The evolution of rehab operations and rehab training materials.  Speaking of Fire, January.

Wieder, M.A. (2000). Operating a rehab area, part II. Firehouse. February.

Wieder, M.A. (2000). Operating a rehab area, part III,” Firehouse. June.

Wilcox, I.M., Cronin, J.B., Hing, W.A. (2006). Physiologic response to water immersion – a method for sports recovery? Sports Medicine, 36, 747-765

Woodall, S. J. (1994). Personal, organizational, and agency development: The psychological dimension. A closer examination of critical incident stress management. National Fire Academy Executive Fire Officer program, available through Learning Resource Center, National Emergency Training Center, Emmitsburg, MD [(800) 638-1821].

Woodall, S. J. (1997). Hearts on fire: An exploration of the emotional world of firefighters. Clinical Sociology Review, 15, 153-162.

Wright, R. M. (1993, May). Any fool can face a crisis: A look at the daily issues that make an incident critical. In R. Gist (Moderator), New information, new approaches, new ideas. Center for Continuing Professional Education, Johnson County Community College, Overland Park, KS.

Applicable NFPA Standards

NFPA 472, Standard for Professional Competence of Responders to Hazardous Materials Incidents

NFPA 1001, Standard for Fire Fighter Professional Qualifications

NFPA 1500, Standard on Fire Department Occupational Safety and Health Program

NFPA 1521, Standard for Fire Department Safety Officer

NFPA 1561, Standard on Emergency Services Incident Management System

NFPA 1581, Standard on Fire Department Infection Control Program

NFPA 1582, Standard on Comprehensive Occupational Medicine Programs for Fire Departments

NFPA 1583, Standard on Health-Related Fitness Programs for Fire Fighters

NFPA 1584, Standard on the Rehabilitation Process for Members During Emergency Operations and Training Exercises

Websites – Bayonne, NJ fire canteen club website. – Boston. MA Sparks Association website. – Dayton, OH area rehab organization website. – Teaneck, NJ Box 54 Club rehab website. – Baltimore area rehab organization website. – Chicago, IL buff/rehab organization website. – Cambridge, ON, Canada rehab organization website. – Chester, Township, PA Fire Company/canteen website. – Passaic County, NJ Rehab and Canteen unit website. – Information on the relationship of smoke inhalation and cyanide poisoning. – Cherry Hill, New Jersey fire department rehab website. – PowerPoint presentation on rehab. – Information on all aspects of emergency incident rehabilitation operations. – Providence, RI Rehab and Canteen website – Article on setting up rehab areas. – United Kingdom fire service website on firefighter hydration. – Washington, DC rehab organization website. – Grapevine, Texas Citizens Fire Academy Alumni rehab organization website. – Greater Toronto, ON rehab organization website. – Lodi, NJ rehab site. – Moline, IL rehab organization website – North Area Volunteer Ambulance Company (NY) rehab team website. – Phoenix, Arizona Fire Department rehab SOP – Pikes Peak, Colorado area rehab team website. – Racine, Wisconsin rehab organization website. – Central Texas (Austin area)  rehab organization website. – Sacramento, CA rehab organization website. – Philadelphia rehab organization website. – Rehab presentation by Sandra Stoeckel.