One firefighter died in the line of duty and nine others were injured in Wisconsin when an explosion happened next to a dumpster that had been on fire. This incident highlights the need for rehab at all fire incidents of any size and nature.

Read more about the incident and Editor-in-Chief A.J. Heightman's t... Then tell us, what does your service do to be ready in advance to manage EMS needs at fire scenes?


(Photos A.J. Heightman)

Tags: fire scene safety,, firefighter rehab,, rehab

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My department is a FD/EMS system. Our incident rehab procedures are based upon the NFPA 1584 Standard on the Rehabilitation Process for Members During... .

We dispatch a medic company to every reported structure fire and to every hazmat incident that requires more resources than a single engine company. The medic crew is responsible to collect the personnel accountability tags and take them to the Command Post, then sets up Rehab near the fire but out of any smoke, fumes, or other hazards.


Our Rehab Group has a minimum of one ALS ambulance. For working incidents, we have an Air/Utility with additional rehab supplies and a Rehab bus set up specifically for incident rehab.


Each offers shade, cooling facilities, (we use cool mist fans and cold towels, along with chilled water and sports drinks), rest, and medical monitoring. Medical monitoring includes vital signs, temporal temperatures, and pulse O2 and pulse CO monitoring with a RAD 57. Anyone with signs and symptoms of chest pain, shortness of breath, or severe heat stress also gets a cardiac monitor. Chest pain also gets a 12-Lead ECG.

In hot weather, the Rehab bus doubles as the Dress-Out area for the hazmat technicians. Once the Entry Team departs via the wheelchair lift, the backup team remains in seated in the bus. If they are needed, it takes less than two minutes to get them zipped up and into action.



For prolonged incidents, our local Red Cross assists with rehab, providing meals, additional shelter and cooling, and additional rehab manpower.

We cover a semi-tropical island, with only a few days of really cold weather per year, so we rarely have to worry about cold-weather operations. The Rehab bus handles this quite easily.

The Wisconsin incident occurred in very cold weather with lots of snow cover. The biggest problem with cold-weather operations is that Rehab cannot be adequately conducted in the open. Apparatus cabs and even the ambulance patient compartment can be uses. but larger vehicles are better. If your system doesn't have access to a purpose-built rehab vehicle, even a school bus can be used for cold-weather rehab. Don't forget that firefighters can have heat stress, even in very cold ambient temperatures.
The San Francisco Fire Department dispatches an ambulance to any report of a possible fire. Once a working fire has been confirmed, a Paramedic Captain (to set up the Medical Group) and a single engine company (to fulfill the RIC/RIT function). The Medical Group can be expanded and is routinely expanded if the fire grows. Responsibilities of the Medical Group can include Rehab. The paramedic captains are refreshed annually in the responsibilities of the Medical Group and the other functions at HAZMAT and WMD incidents. Ambulance crews are trained initially upon their hire at their academy and given annual refresher training through the continuing education process.
I'm not sure how having a rehab sector set up would have prevented the explosion from killing one and injuring nine. While it would certainly reduce the response time, I can't see how rehab would prevent this.

D. Phillips, DO
In the Wake County EMS system (county EMS agency plus 5 not-for-profit contract agencies) we dispatch an ambulance to all reported structure fires. When it becomes a "working fire" we add another ambulance, our major incident support unit, and a supervisor (who becomes the Medical Branch Director). One ambulance crew, in full turnouts with stretcher and ALS gear (referred to as the Medical Intervention Team or MIT), deploys close in to the structure, with the fire Rapid Intervention Team (RIT). This crew exists to provide immediate care to an injured firefighter.

The second ambulance crew, along with EMS TRUCK 1 (the major ops unit) and its operator, establish REHAB. They do the full monitoring per our county rehab protocol, which conforms to the current NFPA standard. They have ECG, NIPB, CO monitoring capabilities, fans, cooling chairs, gator aid, water, towels, etc.

In the event of a fire in a high-rise building, our protocol calls for REHAB/MIT to be established on the "resource floor" one or two floors below the fire floor, generally where OPS is located. MEDICAL is located in the lobby with FD lobby control and the CP. TRUCK 1 establishes a medical base one or more blocks away and assures ingress, egress, and a treatment site for those evacuated from the building and requiring care or monitoring. When the Raleigh Fire Department does high-rise training, we do hands-on right beside them.

We will be adding a medical evacuation bus (EVAC-1) to this protocol in the next month or two, when we've completed training all of our drivers and loadmasters. This vehicle is multi-function, can provide warm/cool rehab or rest areas, multi-patient transportation, etc.

We enjoy a great working relationship with the fire departments in our county, both the municipal departments and the private non-profits that serve the unincorporated portions of the county. They provide us with great support while we're doing the "EMS thing", so we provide them whatever resources they might need when they are called upon to do the "fire thing." So far, so good!
It wouldn't, but any LODD incicent will automatically become a long-term incident, due to the investigation. That means a prolonged FD presence at the scene, and a corresponding need for rehab, particularly in very hot weather, or in this case, in very cold weather.

Donald Phillips said:
I'm not sure how having a rehab sector set up would have prevented the explosion from killing one and injuring nine.

D. Phillips, DO
Skip, that sounds like a very well-thought out and practiced system.

We looked at an EVAC bus as well. We'd love to have one, but we have to get it funded first.
I was pretty impressed by the capabilities. It wouldn't help us much for rehab compared to our current system, but if we ever have to evacuate a lot of smoke inhalation patients from a high rise/mid rise from a fire or evacuate a nursing home to somewhere else prior to a hurricane, the EVAC bus would be just the ticket.
As many who have posted on this already know, I agree that rehabilitation plays a key role in the health and safety of members operating at working fires. We've discussed this in the Incident Ops group. I don't necessarily see how this fatal fire in Wisconsin "highlighte the need for rehab at all fire incidents of any size and nature."

In the past five years, I have managed EMS operations at two LOD FDNY fatal fires. The first was a third alarm fire in the Bronx during a blizzard in 2005 and the second was a second alarm in Brooklyn last January. Three members of the service: two lieutenants and one firefighter, succumbed to their injuries. What those incidents taught me had nothing to do with incident rehabilitation. We need to be ready to manage incidents with adequate resources from go. One ambulance is not enough. One ambulance and one officer is not enough. The EMS response needs to better complement the fire response based upon the number of members operating on the scene, the type and occupancy of the structure(s) involved, access to the incident, escalation potential and presenting or suspected hazards.

Kathy
Donald Phillips said:
I'm not sure how having a rehab sector set up would have prevented the explosion from killing one and injuring nine. While it would certainly reduce the response time, I can't see how rehab would prevent this.
I'm glad I'm not the only one who thinks this is an odd segue into a rehab discussion. I understand the explosion probably prolonged the incident, leading to the need for rehab, but it's still a little awkward. Not enough of a transition from a writing standpoint.
Well, the Red Cross brings out a trailer for sandwhiches and coffee/drinks.

EMS?....well maybe an ALS unit, unless they're too tired, then the BLS transport truck in our town comes out. Sometimes they even stay awake through the whole fire!

Our dept. makes you rest after using two (45 min) bottles). And we have water to drink.

There is no cooling area, vital signs, or anything like that. It's been talked about, but then again, alot of things get talked about.
The state of NC funded ours for us. Their paradigm is evacuation of coastal health care facilities in the face of an impending hurricane. The "big counties" will send their busses as components of heavy EMS task forces, supported by ambulances, logistics vehicles, and command elements (Medical Incident Support Teams, like an IMT).

Meanwhile - we get the busses. Our paradigm is a nursing home evacuation, of which we seem to do one every 8 months or so. If we combine the capabilities of our Major Incident Support Truck (1/2 rehab and 1/2 MCI for 50 patients), the bus, and our Mobile Communications/Command unit, we can get a bunch of patients moved in a timely manner. Good partnerships with our county Fire - Rescue - Emergency Management Department. They arranged the funding, we all play in the design/build process, and we (because we have 'em on duty 24x7) provide the operators with the Class B non-commercial licenses.

Ben Waller said:
Skip, that sounds like a very well-thought out and practiced system.

We looked at an EVAC bus as well. We'd love to have one, but we have to get it funded first.
I was pretty impressed by the capabilities. It wouldn't help us much for rehab compared to our current system, but if we ever have to evacuate a lot of smoke inhalation patients from a high rise/mid rise from a fire or evacuate a nursing home to somewhere else prior to a hurricane, the EVAC bus would be just the ticket.
Sure....there's no connection between the Wisconsin incident and the rehab issue. The lady asked about EMS support to fire operations, so rather than pointing out the disconnect, let's talk about EMS support to fire operations.

Sounds like there are some communities where non-fire EMS supports fire, some where fire-EMS supports fire, and some communities where nobody provides medical support to firefighting operations.

THAT is unfortunate. Explosions notwithstanding, too many firefighters get sick or hurt at fires not to have EMS standing by. And standing by should NOT mean asleep in a BLS truck! It should mean out, up front, suited up and ready to go. Do the FFs sleep in the truck when they assist at EMS calls? Probably not. So why shouldn't there be, as Kathy describes, a calibrated EMS response proportional to the size of the firefighting incident?

To do otherwise is to ignore high risk - like not having an EMS unit at a 100,000 person event on a 99 degree day. That is NOT providing good EMS to the community.
Skip, our emphasis on acquring a MAAB (the model we looked at) is to have the evacuation capabilty locally available. If a hurricane evacuation requires Interstate Highway lane reversals, getting an evac bus from the Midlands/Piedmont to the coast is going to be a big problem. If the bus is on the coast, it can get at least one load of patients out without fighting the lane reversal problem.

However, having the evac bus in the middle of the state is far better than not having one at all.

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