Emergency Incident Rehabilitation

by Dickinson, Edward V., , Medical Editor; Wieder, Michael A., MS, CFPS

• ISBN13: 9780131142794
• ISBN10: 0131142798
• Edition: 2nd
• Format: Paperback
• Copyright: 2003-09-25
• Publisher: Prentice Hall

Summary

Emergency Incident Rehabilitation, Second Edition is the most comprehensive and up-to-date presentation of rehab operations available. Authored by two members of the task group that developed the newly released NFPA 1584 Recommended Practices on Rehabilitation for Members Operating at Incident Scene Operations and Training Exercises, this edition has been thoroughly updated and expanded to meet these new standards. All of the basic functions that must be performed in a rehab operation are covered in detail and in a logical order, which allows them to be easily implemented by emergency operations of any size. In addition to meeting the NFPA 1500 and 1584 standards, the information contained in this book is also in agreement with the principles of the National Fire Service Incident Management System (IMS). New features to the second edition include: bull; bull;Discussion of the evolution of NFPA 1584 Recommended Practices on Rehabilitation for Members Operating at Incident Scene Operations and Training Exercises. bull;Presentation of concepts beyond the formal rehab sector, including pre- and re-hydration recommendations for the individual firefighter to ensure adequate personal hydration throughout an event. bull;Expanded information on medical assessment, monitoring, and treatment of firefighters during rehab. bull;Updated statistics, the latest information on rehab equipment, and up-to-date recommendations for on-scene food and beverage intake.

Author Biography

Edward T. Dickinson, MD, NREMT P, FACEP, is currently Assistant Professor and Director of EMS Field Operations in the Department of Emergency Medicine of the University of Pennsylvania School of Medicine in Philadelphia. He is currently Medical Director of the Malvern Fire Company, the Berwyn Fire Company, and the Township of Haverford paramedics in Pennsylvania. He is a residency-trained, board-certified emergency medicine physician who is a Fellow of the American College of Emergency Physicians.

He began his career in emergency services in 1979 as a firefighter-EMT in upstate New York. As a volunteer firefighter, he served as a company officer, assistant chief, and training officer. In 1985, he was the first volunteer firefighter in the United States to receive the top award for heroism from the Firehouse Magazine Heroism and Community Awards program in recognition of his rescue of two elderly women trapped in a house fire.

Dr. Dickinson has remained active in fire service and EMS for the past 25 years. He frequently rides with EMS units and has maintained his certification as a National Registry EMT-Paramedic. He has served as medical editor for numerous Brady EMT -B and First Responder texts and is the author of Fire Service Emergency Care, and co-author of Emergency Care-Fire Services Edition, EMT-B textbooks.

Michael A. Wieder, MS, CFPS, MIFireE, is the Assistant Director at Fire Protection Publications, headquarters for the International Fire Service Training Association (IFSTA), at Oklahoma State University in Stillwater, Oklahoma. He has written or edited over two dozen books and 100 periodical articles. Mr. Wieder holds an Associate Degree in Fire Technology from Northampton Community College in Bethlehem, Pennsylvania. He also holds a Bachelor's Degree in Fire Protection and Safety Engineering Technology and a Master's Degree in Occupational and Adult Education from Oklahoma State University. A Certified Fire Protection Specialist and a member of the Institution of Fire Engineers, he is a member of the National Fire Protection Association's Fire Fighter Professional Qualifications (NFPA 1001) and Fire Service Training committees, serves as secretary of the National Fire Service Incident Management System Consortium, and is IFSTA's representative to the National Volunteer Fire Council (NVFC). He is a contributing editor to Firehouse ^® Magazine and The Pennsylvania Fireman. He maintains a very active fire service lecture and legal consultation workload.

Mr. Wieder began his fire service career in 1979 as a volunteer firefighter with the Pennsburg, Pennsylvania, Fire Company. He also served as a volunteer and part-paid firefighter with the Stillwater, Oklahoma, Fire Department.

Table of Contents

Preface	p. ix
Acknowledgments	p. xiii
About the Authors	p. xv
What Is Rehab and Why Do We Need It?	p. 1
Background to Rehab	p. 2
What Is Rehab?	p. 4
Why Do We Need Rehab?	p. 5
The Functions of a Rehab Operation	p. 11
Knowing When to Establish Rehab	p. 15
When to Establish Rehab	p. 16
Rehab Within the Incident Management System	p. 38
Rehab's Role in the Personnel Accountability System	p. 49
Establishing and Managing a Rehab Area	p. 53
Choosing a Rehab Area	p. 54
Rehab Apparatuses and Equipment	p. 59
Operating a Rehab Area	p. 77
Medical Aspects of Rehab Operations	p. 89
Principles Guiding Rehab Operations	p. 90
Injuries and Illnesses at Emergency Incident Scenes	p. 92
Medical Staffing of the Rehab Sector	p. 104
Medical Equipment in the Rehab Sector	p. 105
Entry and Triage	p. 107
Medical Evaluation/Treatment Unit	p. 109
Fluids and Nutrition in Rehab	p. 114
Basic Concepts	p. 115
Fluids and Electrolytes	p. 116
Provision of Solid Foods in Rehab	p. 123
Conclusion	p. 127
Index	p. 129
Table of Contents provided by Ingram. All Rights Reserved.

Excerpts

Most firefighters, very early in their training, learn this adage: Take care of yourself first, worry about your partner or the other firefighters second, and make any victims of the incident your third priority. This has been a constant for as long as the fire service has been organized. Even though the widely held public perception is that firefighters will selflessly throw themselves in harm's way to protect a victim, most firefighters realize that this is not necessarily the case. Firefighters cannot help victims if they become victims themselves. When firefighters do become victims, the emergency incident grows in scope and complexity, with firefighters who should be providing care needing help themselves.Despite being taught this care priority adage, as the rates of fire incidence rose in the 1960s and 1970s, so did the number of firefighter injuries and deaths. Many of these injuries and deaths could be attributed to highly stressed, poorly conditioned firefighters who collapsed after overextending themselves. They and other emergency personnel would get caught up in the action of a major incident and work strenuously for hours on end, never taking a break for rest or nourishment. Too often in such cases, firefighters pushed themselves beyond the point at which their bodies or minds could respond appropriately, which resulted in injuries or serious medical emergencies.As injury and death rates continued to rise, progressive leaders in the fire service realized that changes had to be made. Many fire departments began to take new steps to increase the safety of their firefighters in the early 1980s. Many of the earliest safety improvements could be traced directly back to incidents in which specific problems had occurred. Departments that had bad experiences with hazardous materials incidents formed hazmat teams. Departments that had suffered firefighter injuries or deaths when the firefighters became lost on the fireground developed accountability programs. Fire departments that had recurring problems with fatigue- and stress-related injuries and deaths on the fireground developed better plans for rotating personnel and getting them the rest, fluids, and nourishment needed to restore them to sound physical condition. Somewhere along the line, this last process became known asEmergency Incident Rehabilitationor, simply,rehab.Today, to the majority of the fire community the termrehabmeans a specially designated area on the emergency scene where personnel can rest, receive fluids and nourishment, and be evaluated for medical problems. Many jurisdictions routinely operate rehab areas as a part of their overall emergency scene. Correspondingly, the rate of firefighter injuries and deaths due to stress and fatigue has decreased dramatically in recent years. As is discussed later in the book, the term rehab in the wildland fire community more commonly refers to the restoration of land following a fire. However, moves are in progress to encourage the wildland fire community to change its terminology.The inclusion of rehab in emergency operations increased dramatically throughout the nation in the late 1980s in response to the requirements set out in the National Fire Protection Association's (NFPA's) Standard 1500,Standard on Fire Department Occupational Safety and Health Program.The first edition of this standard was released in 1987. Although controversial at first, the standard has had a profound, positive effect on the safety of firefighters. Departments that had not yet started their own programs used the standard as a template for creating programs that increased the safety of their firefighters. While the standard covered many subjects, both on and off the emergency scene, it was particularly in the area of emergency scene operations that the greatest move forward in safety occurred. Accountability systems, Incident Management Systems, and rehab operations became