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Rules of Engagement for Incident Commanders: Always Have Firefighter Rehab Services in Place

Always Have Firefighter Rehab Services in Place at All Working Fires.

Objective: To ensure all firefighters who endured strenuous physical activity at a working fire are rehabilitated and medically evaluated for continued duty and before being released from the scene.

Firefighting is very labor intensive and strenuous, placing a high cardiovascular burden on a firefighter's body. This includes excessively high pulse rates and related high blood pressures.

Even in cooler climates, the core body temperatures of firefighters can rise dramatically during a firefight, causing rapid loss of body fluids. In warmer climates, core temperatures can be even greater and dehydration can quickly lead to heat exhaustion and the potential for heat stroke is ever present.

Many firefighter fatalities related to this physical exertion could have been prevented had the firefighter been medically evaluated while on scene or before returning to the fire station. Therefore, for all working fires where firefighters engaged in strenuous physical activity, the incident commander must ensure that firefighters are cooled and properly re-hydrated with fluids.

Further, they should be medically evaluated by paramedics, or other qualified medical personnel, before returning to the next cycle of firefighting or release from the scene.

For a more-significant or long-term incident, a rehab unit or group with adequate staff should be established and firefighters rotated through the unit for rehydration, cool down and medical evaluation before returning to the next work cycle.

Those firefighters determined not fully recovered or not meeting acceptable medical parameters should be retained in rehab until recovered or transported to a medical facility for further evaluation.

An example of an LODD that may have been prevented with a rehab evaluation occurred on a hot July day. A 43-year-old male paid/call firefighter responded to a residential fire at 1917 hours. The fire occurred on a hot day of 81 degrees and 77% relative humidity.

During fire suppression operations, the firefighter and two other crew members had symptoms consistent with heat strain. About two hours after arriving on scene, fire companies returned to their fire station and the firefighter returned home for the evening.

Crew members called the firefighter at about 2130 hours to check on him, and he stated he was feeling better. About an hour later, a crew member called the firefighter again and he didn't answer the phone. The crew member next called his own wife at home and asked her to drive over to the ill firefighter's home to check on his welfare.

After ringing the doorbell and not getting any response, she entered the house and found the firefighter collapsed on the floor. She called 911 and began cardiopulmonary resuscitation. Paramedics were unable to revive the firefighter and he was pronounced dead at the scene.

In this case, the victims, along with two other firefighters, clearly were affected by heat, enough so that fellow firefighters were concerned about the welfare of this particular firefighter. Yet he was never medically assessed. There are two lessons:

  • The incident commander should ensure firefighters are rehabilitated on scene and evaluated by medically trained staff. 
  • Firefighters who are affected by heat need to step up and be medically evaluated.

Bottom line: Don't let the troops go home after a strenuous working fire without medical evaluation.

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