Firefighter Rehabilitation - CE0016 Houston Fire Department Continuing Education Firefighter Rehabilitation CE0016 Firefighter Rehabilitation Purpose Of Lesson Plan: The purpose of this lesson plan is to identify the Rehabilitation Guidelines, Exercise, and Proper Nutrition. Exercise and proper Nutrition are essential in providing firefighters with the necessary strength and energy for all types of fire fighter incidents. When firefighters are in good, physical condition, their recovery time in the Rehab Sector will be brief. NOTE: This lesson plan is a supplement to the Procedure in regard to Rehabilitation Sector (volume II -- 17). Definitions: Rehabilitation Sector - In the fire service, the terms "Rehabilitation" or "Rehab" are used to describe the process of providing rest, re-hydration, nourishment and medical evaluation to firefighters who are involved in extended and/or extreme incident scene operations with the goal of getting them back in the action or back to the fire station safely. Rehab Sector Officer - An EMS Supervisor in charge of the overall functioning of the Rehab Sector. The responding EMS supervisor shall assume the duty of the Rehab Sector Officer unless assigned other duties by the Incident Commander. Tactical Sector Officer - Assigned by I.C. to manage specific geographical areas of the incident scene or fireground functions. Rehab Ambulance - Medic unit assigned to the Rehab Sector to provide initial medical care to emergency personnel. Rehab Vehicle - Designated apparatus outfitted with canteen equipment (e.g., liquid refreshments, and snacks), portable fan and supplies necessary for tracking crew status. Identifiable on scene, when available, by a Blue Strobe light and/or a Blue Flag. Radio designation will be (Incident name) "Rehab 1,2..." Canteen/Rehab Volunteers - Department members and community Volunteers trained in Rehabilitation Sector procedures who respond and assist with certain functions in the Rehab Sector. (Identifiable by Royal Blue helmets and vest with prominent "Rehab" labels. Canteen Operations - Duties required to provide liquid refreshments and snacks to emergency personnel involved in the incident. May include more extensive provisions during a prolonged operation. Peer Support Team - This service is provided by the Department's Critical Incident Stress Management Team. The Peer Support Team will be dispatched to the incident upon request of the Rehab Sector Officer or Incident Commander. Rehabilitation Guidelines Dispatch An EMS supervisor and Medic unit shall be dispatched anytime the Incident Commander requests a Rehab truck. Establishing Rehab At 1st alarm incidents, the Incident Commander is responsible for requesting the setup of Rehab Sector. Anytime there is a working fire with 4-inch hose on the ground; the Incident Commander will immediately call for a Rehab truck to respond to the fire. At non-fire incidents, a Rehab truck will be requested at the discretion of the Incident Commander. The Incident Commander should announce a pre-determined location to setup Rehab Sector. Tactical Officers or Incident Commander should direct those companies that need medical evaluation, fluid, and rest to the pre-determined location. Fire companies must remain intact and await the setup of Rehab Sector, if not established. When the Paramedic/EMT of the Medic unit or the operator of the Rehab truck gets on location, one of them will request a setup location for Rehab. If the Incident Commander or the Rehab Sector Officer has not established a Rehab setup area, the Incident Commander or the Rehab Sector Officer will establish one. Rehab Sector Officer (EMS Supervisor) The Rehab Sector Officer reports to the Incident Commander and his primary responsibility is the health and welfare of committed members. The Rehab Sector Officer supervises the setup of equipment for Rehab and should assign a member to maintain the Rehab worksheet (HFD form 322). All fire companies entering and exiting the Rehab Sector must be recorded and monitored. The status of fire companies in rehab must be conveyed to the Incident Commander regularly. If fire companies will remain in Rehab longer than normal (more than 20 minutes), Rehab Sector Officers should inform the Incident Commander. Additional Alarm(s) may be necessary due to fatigued fire companies in Rehab. If the Rehab Sector Officer anticipates the need for extra personnel to assist in the Rehab Sector, he must request help in the early stages of the incident. Tactical Sector Officer Tactical Sector Officers assign firefighters to the Rehab Sector. These Officers and also Company Officers should be observant for signs of fatigue and heat exhaustion to firefighters, especially during hot weather. Firefighters should be assigned to the Rehab Sector every 20 - 30 minutes of exhaustive work or when they have used 2 air bottles each. Entrance to Rehab When reporting to the Rehab Sector, the firefighters must remain together and remove bunker gear to begin the cooling down process. Upon entry into the Rehab Sector, the company officer should report to the Rehab Sector Officer by giving his apparatus number, number of firefighters, names of firefighters and Rehab entry time. The officer or member assigned to log firefighters in and out of the Rehab Sector should be located in one corner of the Sector to facilitate the flow of personnel rotating in and out of Rehab. After completing check-in, all members will report to the Rehab Ambulance (Medic unit) for a brief medical evaluation (visual assessment and/or vital signs) and treatment if appropriate. Rehab Ambulance (Medic Unit) Rehab Ambulance personnel shall report to the Rehab Sector Officer and remain in the Rehab Sector until released. The Rehab Ambulance should be located in close proximity to the main entrance of the Rehab Sector. This will facilitate the triaging of members entering the Rehab Sector. EMS personnel's main responsibilities are to evaluate the medical condition of fire companies in Rehab and triage them upon entrance and exit. Several key functions that EMS Personnel must perform are: Assure that the Rehab Sector provides a safe area in which fire and rescue companies can rest and receive re-hydration or replacement of water and electrolytes lost in perspiring. Identifying firefighters and rescue personnel entering the sector whom are at risk for heat and stress related illness or injury. Medically monitor fire companies and determine whether they: 1. Are fit to return to active duty. 2. Require additional hydration and rest. 3. Require transport to an emergency facility for further evaluation and treatment. When needed, EMS personnel will contact the Rehab Sector Officer to obtain additional medical assistance and transportation as needed. Upon completion of the medical evaluation, all firefighters, not in need of medical attention, should proceed to the Rehab vehicle for fluid supplement, snacks, and rest. Rehab Vehicle The Rehab vehicle should be located in the opposite corner of the Rehab Sector with the serving window preferably facing the internal perimeter. Upon spotting the vehicle, the E/O should: Set up for Canteen operations. Provide liquid refreshments and snacks. Maintain records of Canteen activity. Maintain apparatus in a safe and sanitary condition. Provide the Rehab Sector Officer with the podium, additional clipboards, and sufficient Rehab sector worksheets (HFD form 322). Set out the Blue Strobe/Flag to assist in identification of the Sector. Set out and start the portable fans if needed. Canteen/Rehab Volunteers Volunteers will assist with activities in the Rehab Sector as designated by the Rehab Sector Officer. Some of their duties will be the following: Assist in maintaining Rehab Sector worksheet (HFD form 322) Assist in dispensing liquid refreshments and snacks, utilizing sanitary practices. Assist firefighters in removing and donning gear. Assist in maintaining the Rehab Sector as a safe environment. Rest Periods Rest periods should be of sufficient time to rehabilitate firefighters. Ideally, rest periods should be approximately 15-20 minutes. It is vital that rest periods be used for resting, not for reminiscing with other firefighters. Proper rest is necessary for rejuvenating fatigued and exhausted firefighters. Fire companies must remain together during rest periods. Reassignment to Incident Firefighters/fire companies shall not leave the Rehab Sector without clearance from the Rehab Sector Officer. Recording apparatus number, number of personnel, and time of departure from Rehab Sector is imperative. It is paramount that fire companies do not leave the Rehab Sector without clearance; otherwise, their status and location, after they have left, will be unknown. Prior to returning to the Incident (Hot Zone), firefighters shall change out their air bottles as needed. Once the Rehab Sector Officer has cleared a fire company for reassignment, the officer of the company will contact the Incident Commander for reassignment. Benefits of Exercise Firefighting is one of the most physically demanding and dangerous jobs of all professions. It requires above average strength to rescue victims, place ladders, handle hoselines, and force entry with heavy tools. It requires above average aerobic fitness to conduct fireground operations. It requires endurance to rapidly move down hallways, climb ladders or fight fires on steep hillsides. It requires above average flexibility to reach for equipment, tilt a ladder, and move a victim into a snorkel bucket. These activities must often be performed with little or no athletic warm-up and while wearing 60 or more pounds of protective equipment. Even greater than this is that these arduous activities must often be done in adverse conditions--hot, humid or freezing weather-- and in buildings filled with smoke and deadly chemical fumes. Proper exercise will physically strengthen firefighters in order for them to perform well. Exercise also has other benefits. The following are some examples: Increased Athleticism - Fitness results in better coordination of muscles, increase in strength, flexibility and stamina. While improvements in these areas certainly help athletic performance, they also help reduce the risk of injury, while producing stronger, limber muscles that are susceptible to strain and sprain. Better Posture - Poor posture is a major cause of injury and often leads to greater problems later in life. Exercising in proper form promotes better posture, as well as strengthening and stretching of muscles that help one to stand up straight. Fat Loss - Aerobic and strengthening exercises can cause weight loss when combined with a calorie-reducing diet. Without exercise, dieting can cause the loss of muscle as well as fat. An aerobic exercise regimen burns fat while building muscle. This may mean less dramatic weight loss, but since muscle tissue burns more calories than fat tissue, the result will last longer. Improved Heart Health - Though the symptoms of heart disease may not surface until middle age, the onset of disease can begin taking place as early as the teens. Exercising for 20 to 30 minutes, three times a week, can reverse years of cardio-neglect. In fact, consistent, regular exercise actually strengthens the heart, resulting in more blood and oxygen flow throughout the body. At the same time, aerobic exercise lowers blood pressure and cholesterol levels, both major health risks for many Americans. Intellectual Gains - The reasons aren't entirely understood, but theories promote the effects of discipline and self confidence gained through exercising. Fitness also helps the immune system, creating better work performance and fewer absents from work and school. Exercise increases blood and oxygen flow throughout the body, including the brain. This may explain why studies have shown that people who exercise react more quickly to stimulus than their less fit counterparts, pointing to a possible link between motor and intellectual skills. Maintaining a regular physical fitness program has a two-fold advantage: It reduces injuries and Rehab recovery time. Firefighters that are not on a regular exercise program put a heavy burden on physically fit firefighters. It is essential that firefighters receive proper Rehabilitation, but it is also essential that Rehab is not abused. Firefighters who are in poor physical condition will definitely require Rehabilitation more frequently and possibly remain in the Rehab Sector longer than the allotted time (20 minutes). This situation may necessitate additional alarm(s) to control the incident. The Importance of Nutrition The importance of good nutrition is nothing new. Back in 400 B.C. Hippocrates said, "Let food be your medicine and medicine be your food." Today, good nutrition is more important than ever. At least four of the 10 leading causes of death in the U.S.--heart disease, cancer, stroke and diabetes-- are directly related to the way we eat; diet is also implicated in scores of other conditions. While the wrong diet can be deadly, eating the right food is among the key cornerstones of good health. Of course, food alone isn't the key to a longer and healthier life. Good nutrition should be part of an overall healthy lifestyle that also includes regular exercise, not smoking or drinking alcohol excessively, stress management, limiting exposure to environment hazards and other factors. And no matter how well you eat; your genes play a big part in your risk for certain health problems. But don't underestimate the influence of how and what you eat. For example arteriosclerosis (hardening of the arteries) can begin in early childhood, but the process can be halted--even reversed--if you make healthy changes in your diet and lifestyle. The gradual bone thinning that results in osteoporosis may be prevented if you consume enough calcium from dairy products and other sources throughout your life and participate in weight bearing exercise. You may be genetically predisposed to diabetes but if you keep your weight within a healthy range through diet and exercise, the disease may never strike you. The keys to good nutrition are balance, variety and moderation. High-fat foods are balanced with low-fat foods and calorie intake is offset by enough activity to maintain normal weight. To stay healthy, your body needs the right balance of Carbohydrates, fats and protein -- the three main components of nutrition. Each day you should consume: 15 to 20 percent of total calories from protein foods. 15 to 30 percent of calories from fat. 50 to 65 percent from carbohydrates. You also need vitamins, minerals and other substances from different foods, and while some foods are better than others, no single food or food group has all the nutrients the body needs--so eating a variety of foods is essential. Moderation means eating neither too much nor too little of any food or nutrient. Too much food can result in excess weight and even too much of certain nutrients, while eating too little, can lead to numerous nutrient deficiencies and low body mass. Summary Anytime there is a working fire with 4-inch hose on the ground; the Incident Commander will immediately call for a Rehab Truck to respond to the fire. At non-fire incidents, a Rehab truck will be requested at the discretion of the Incident Commander. Fire companies that have been sent to Rehab Sector must remain intact and await its setup, if it hasn't been establish. The Rehab Sector Officer should assign a member to maintain the Rehab worksheet (HFD form 322). All fire companies entering and exiting the Rehab Sector must be recorded and monitored. If fire companies will remain in Rehab longer than normal (more than 20 minutes), the Rehab Sector Officer should inform Incident Commander. Tactical Officers should assign firefighters to the Rehab Sector every 20-30 minutes of exhaustive work or when they have used 2 air bottles each. When reporting to the Rehab Sector, the firefighters must remain together and remove bunker gear to begin the cooling down process. Upon entry into the Rehab Sector, the company officer reports to the Rehab Sector Officer his apparatus number, number of firefighters, names of firefighters and Rehab entry time. After completing check-in, all members will report to the Rehab Ambulance (Medic unit) for a brief medical evaluation (visual assessment and/or vital signs) and treatment if necessary. Upon completion of the medical evaluation, all firefighters, not in need of medical attention, should then proceed to the Rehab vehicle for fluid supplement, snacks, and rest. Ideally, rest periods should be approximately 15-20 minutes. Fire companies must remain together during rest periods. It is paramount that fire companies not leave Rehab Sector without clearance. Prior to returning to the incident (Hot Zone), firefighters shall replace their air bottles as needed. Once the Rehab Sector Officer has cleared a fire company for reassignment, the Officer of the company will contact the Incident Commander for reassignment. 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