Transcript A Review of Interagency SOP #503.024

A Review of Interagency SOP #503.024,
Rehab Sector Set-Up and Shop 310
by Kevin Knight, Battalion Chief, CEP, NREMT-P
GILA RIVER FIRE DEPARTMENT
GILA RIVER EMERGENCY MEDICAL SERVICES
INTERAGENCY STANDARD OPERATING PROCEDURE
#503. 024
#250.05
SECTION I.
PURPOSE
To ensure the physical and mental condition of employees operating at the scene of an emergency, training exercise, or
other emergency services activity does not deteriorate or does not jeopardize the safety and integrity of the operation.
SECTION II.
BACKGROUND
This procedure shall apply to all Gila River Indian Community Public Safety activities including but not limited to; fire
ground operations, EMS operations, training exercises/ drills and long term police situations where strenuous mental and
physical activities or exposure to heat or cold exist.
Circumstances surrounding each activity/ incident shall be considered and adequate provisions made early in the incident
for the rest and rehabilitation for all members operating at the activity/ incident. These provisions are to include: medical
evaluation, treatment and monitoring; food and fluid replenishment; physical and mental rest; relief from extreme
environmental factors caused by the activity/ incident.
During any emergency incident or training activity; all members are to immediately report to their respective supervisor
and advise when their ability to perform is approaching a level that could affect themselves, their crew, or the operation in
which they are involved.
Requests for relief and/or reassignment of work crews shall be through the Incident Command System (ICS).
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SECTION III. POLICY
3. Responsibilities
3.1
3.2
3.3
3.4
Incident Commander -The Incident Commander (IC) shall have
the responsibility and authority to implement and monitor all
provisions of this operational procedure. Rehabilitation shall be
conducted at the Advanced Life Support (ALS) level when
available.
Division/Group Supervisors and Company Officers - shall maintain
an awareness of each member operating within his/her span of
control and ensure adequate steps are taken to provide for each
member's health and safety.
Line Personnel -Each member is responsible for his/her
preparedness prior to an incident, including; sufficient rest prior
to reporting for duty, pre-hydration, proper dress and ensuring that
protective clothing and equipment is present and in good working
order.
Members shall remain aware of the health and safety of other
members of their working crew.
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SECTION IV. DEFINITIONS
4.1
4.2
Group or Sector – Within the ICS structure, “Group” is
a NIMS term and “Sector” is a Regional Fire Ground
Command term. The terms “Group” and “Sector” can be
interchangeable. For the purpose of this document,
Rehab Group and Rehab Sector have the same
meaning.
Rehab Group Supervisor – Supervisor is the title that
NIMS uses for the person in charge of a group. Fire
Ground Command uses the term “Officer” for the person
in charge of a sector. For the purpose of this document,
Rehab Group Supervisor and Rehab Sector Officer
have the same meaning.
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SECTION V. PROCEDURES
5.1 Establishment of Rehabilitation
5.1.1
5.1.2
5.1.3
5.1.3.1
5.1.3.2
5.1.3.3
5.1.3.4
5.1.3.5
The Incident Commander shall establish Rehab when conditions indicate that rest and
rehabilitation is needed for personnel working at an incident scene or training exercise.
When possible, the IC shall designate a Certified Paramedic as Rehab Group
Supervisor. The Rehab Supervisor shall then act within the ICS command structure.
Rehabilitation should consider the scope of the incident, including the following:
Time. Extended use of Personal Protective Equipment
Complexity. Crime scenes, standoffs, search operations, mass gathering/public events,
hazardous materials incidents , etc.
Intensity. Mental and/or physical stress on members such as: major extrications, fire
attack or interior search and rescue situations, and any other training or operational
Public safety activity that is physically or mentally demanding.
Climatic conditions such as hot or cold weather.
Geography. The size of an incident or terrain may require consideration for access to
rehab locations.
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5.1.4
The Incident Commander may designate a Rehab Supervisor during any other
Public Safety activities at his/her discretion; climatic, environmental factors and
duration need not be the sole criteria or justification for establishing Rehabilitation.
5.1.4.1
Location
5.1.4.1.1
The Incident Commander will normally designate the location for the Rehabilitation.
If a specific location has not been designated, the Rehab Supervisor shall select
an appropriate location based on the site characteristics listed below.
Multiple Rehab locations may be necessary if the incident is large or divided. In the
event there is more than one Rehab location, they shall be designated Rehab 1
and Rehab 2, etc. Each Rehab will have its own Rehab Supervisor who shall
report to the Medical Unit Leader or Logistics Officer if established. Each Rehab
Supervisor shall be a certified Paramedic when available.
5.1.4.1.2
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5.1.4.2
Site Characteristics
5.1.4.2.1
It shall be in a location that will provide physical rest by allowing the personnel to
recuperate from the demands of the emergency operation or training evolution.
It shall be far enough away from the scene and with adequate room so that personnel
may safely remove and stow their Personal Protective Equipment, and be afforded
mental rest from the stress and pressure of the emergency operation or event.
It shall provide suitable protection from the prevailing environmental conditions, when
possible. During hot weather, it should be in a cool, shaded area. During cold weather, it
should be in a warm, dry area.
It shall enable personnel to be free of exhaust fumes from apparatus, vehicles, or
equipment (including those used in the Rehab Sector).
It shall be large enough to accommodate several crews, based upon the incident size.
It shall be easily accessible by all vehicles used to transport patients and support the
rehabilitation operation.
It shall allow prompt re-entry to the incident.
It shall be out of the hazard environment.
5.1.4.2.2
5.1.4.2.3
5.1.4.2.4
5.1.4.2.5
5.1.4.2.6
5.1.4.2.7
5.1.4.2.8
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5.1.4.3
Site Designations
5.1.4.3.1
5.1.4.3.2
Tents/Shelters as appropriate
An Ambulance will be assigned to the Rehab Division and availability will
be maintained by responding an additional ambulance when
transportation is needed.
School buses, buses or Metro train cars.
Nearby buildings, stores or other structures.
If in a high-rise, a minimum of 3 floors below the incident. All personnel
working in this environment shall be Certified and cleared to don SCBA’s
and Protective Clothing.
An open area where tarps, fans, heaters, etc can be set up.
5.1.4.3.3
5.1.4.3.4
5.1.4.3.5
5.1.4.3.6
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5.1.4.4
Resources
5.1.4.4.1
Medical Equipment -The Rehab Supervisor shall maintain at least one, nontransport Advanced Life Support Ambulance for people undergoing
rehabilitation in the Rehab location.
Medical Personnel - The Rehab Supervisor shall maintain one Certified
Paramedic for every 10 people undergoing rehabilitation in the Rehab
location.
Fluids/Food - The Rehab Supervisor shall provide, or have provided sufficient
potable water, oral electrolyte solution, ice and food as may be necessary.
Resources such as the OEM should be notified early into an incident to allow
for travel and response time.
Other Equipment -The Rehab Supervisor shall secure from the Medical Unit
Leader or Logistics Section Chief other needed items such as, tarps, lights,
fans, blankets, towels, traffic cones, fire-line tape, etc.
5.1.4.4.2
5.1.4.4.3
5.1.4.4.4
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5.2 General Operational Principles
5.2.1
5.2.1.1
5.2.1.2
General Guideline:
After drinking two 16 ounce
bottles of water, drink one 16
ounce bottle of electrolyte
infused fluids. Then repeat.
Establishment
Climatic or environmental conditions that indicate the need to establish Rehab are a
heat stress index above 90 degrees Fahrenheit or wind-chill index below 10 degrees
Fahrenheit.
On any event or incident lasting more that one (1) hour with long term planning.
5.2.2
5.2.2.1
Hydration
During heat stress, each personnel should replace at least one quart of water per
hour. Plain water should be used for the first hour of the operations and then
supplemented with a commercially prepared beverage such as Gatorade TM .
Carbonated beverages, coffee, energy drinks, tea or alcoholic beverages should be
avoided.
5.2.3
5.2.3.1
Nourishment
If food is required or provided, it shall be soups, broths, fruits (bananas, apples,
oranges) or other easily digested foods. Fast food sandwiches, fatty or salty foods
should be avoided.
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5.2.4
Rest
5.2.4.1
Rest shall be provided when possible after the "one bottle rule" or 45 minutes,
whichever comes first.
For rehab that requires cooling, the members shall completely “dress down”,
removing turnout coats, gloves, helmets, and opening bunker pants.
Personnel should re-hydrate at least 16 ounces during SCBA bottle change.
Rest shall be no less than 10 minutes, preferably 20 minutes and may exceed 30
minutes as determined by the Rehab Supervisor. Personnel requiring rest periods of
greater than 30 minutes should be closely monitored for medical conditions. Those
who exhibit problems with their baseline medical assessment after 30 minutes
should be treated under EMS protocol and transported to a medical facility.
Personnel requiring more than one hour of rest should be released from duty and
transported to a medical facility.
Personnel released by the Rehab Supervisor are to report to the Staging Area,
and/or Operations as determined by Command.
5.2.4.2
5.2.4.3
5.2.4.4
5.2.4.5
5.2.4.6
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5.2.5
Medical Evaluation
5.2.5.1
Rehab shall be staffed with a Personnel ratio of no less than 10:1, which is to be a
Paramedic whenever possible.
Rehab medical evaluation shall consist of a minimum of a) mentation, b) visual
exam, c) blood pressure, d ) pulse, e ) temperature.
Medical Evaluation will be initiated at the beginning of the rest period and repeated
every 10 minutes. If the assessment results in findings that are not within normal
limits, reassessment is to be done every 5 minutes.
Any member who exhibits a body temperature of > 100.6F, a consistent pulse rate of
> 110bpm shall not be permitted to wear full protective clothing, including SCBA and
shall require additional rehabilitation including cardiac monitoring.
Any member(s) who receives any treatment(s) other than oral fluids, food, and/or
rest shall be treated and documented as an injury to personnel. As an example, ice
for sprains or strains shall be considered injuries rather than rehabilitation.
All Rehab evaluations shall be documented on a rehabilitation roster and shall
become a permanent record attached to the incident report. Any member that
requires more than oral fluids/food/and or rest shall require a patient care report,
which shall be attached to the incident report.
All injury reports shall remain part of the employee's protected medical file and
treated as other confidential medical records.
Any/all Rehab reports involving Mutual or Auto Aid personnel shall be made available
to their respective departments.
5.2.5.2
5.2.5.3
5.2.5.4
5.2.5.5
5.2.5.6
5.2.5.7
5.2.5.8
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5.3
5.3.1
5.3.2
5.3.3
5.3.4
5.4
5.4.1
5.4.2
5.4.3
5.4.4
Accountability
Personnel assigned to Rehab shall enter and exit the Rehabilitation Area as a crew.
The crew designation, number of crew personnel, and the times of entry/exit shall
be documented by the Rehab Supervisor, or his/her designee on the Individual
Rehabilitation Report.
Crews shall not leave the Rehabilitation Area unless authorized to do so by the
Rehab Supervisor.
Crews released from Rehabilitation Area must clear with Command and have an
assignment or destination prior to reassignment.
Crews placed out of service due to a member being placed out of service will report
to Incident Command for further direction and assignment.
Release of Medical Patients
In the event that a crew member is sent to the treatment unit, that crew member
should be transported to a medical facility.
If the crew member sustains a minor injury or illness and refuses
transportation, the treating EMS Paramedic shall complete a PCR documenting the
refusal. The refusal must be witnessed by the Rehab Supervisor and that crew
members Company Officer.
The discussion to allow a crew member that was treated and signed a refusal to
return to duty or go out of rehab shall be a consensus decision of the crew member,
Rehab Supervisor and Company Officer.
The crew members’ Company Officer is responsible for following their Departments
Industrial Injury and HR policies regarding an event.
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SECTION VI. EXCEPTIONS
Any exceptions will be approved with the IC, with careful consideration
given to the safety of the personnel involved in the operation.
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Rehab Sector Set-up:
Tarps w/Shade Canopies (as needed due to size of
incident and environmental conditions)
Cones
Medic/Rescue
(seating for 4)
(min 15 yds)
EXIT
Donning Area
Treatment
Area
Re-Assessment Area
(dirty towel container)
(water/ice)
Exhaust
(towel water)
(seating for 4)
(garbage)
(Be aware of wind conditions and adjust exhaust
directions away from rehab area)
(table)
(seating for 4)
(towel water)
(clean towel container)
(water/ice)
Doffing Area
ENTRY
Evaluation Area
Rehab 423
(seating for 4)
(par board)
(min 15 yds)
Exhaust
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Vehicle Cab
Command/Sector Clipboard
Rehab Sector SOP
30- Rehab Forms
30- HAZMAT Forms
5- Treat/Transportation Forms
5- IC Forms
6- PCR’s
200-400- Electrolyte Packets
 2- Exterior Telescoping Scene Lights
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Compartment #1
 Stokes Basket, Frame and Wheel
2- Flashlights
Tarps
5-6- Red Tarps
1- Green Tarp
1- Yellow Trap
2- Ice Chests
Prefilled w/water bottles
Ice to be filled at time of incident
Ensure the lid is propped open when
OOS for drying. Also, ensure it is
placed in the compartment so it can
be filled with ice w/out removing it.
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Compartment #2
100- Towels
For active cooling
To be wetted via the water cooler
To be placed over head/around neck
2- Water Coolers
Water/ice for wetting towels. This
water is NOT for consumption!
Water & ice to be filled at time of
incident.
Ensure the lid is left off the
cooler and cooler is upside
down when OOS for drying
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Compartment #3
1- Table
For water coolers
For misting fan
8- Chairs
3- Benches
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Left Compartment #4
Fire Extinguisher
1- 50’ Extension Cord
3- Garbage Cans
1- Cleans Towels
1- Dirty Towels
1- Garbage
2- Buckets
To catch excess water when wetting towels
1- Grey Water Container
2- Clamps
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Right Compartment #4
Fire Extinguisher
Tool Box
Portable Lights
Reflector Set
1- Roll Caution Tape
20- Large Garbage Bags
10- Large Red Bags
6- Flats Water
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Rear Compartment #5
Ensure the lid is left off the cooler when OOS
for drying
4- Canopies
1- Water Cooler w/Misting Fan
Water/ice to be filled at time of
incident
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When using the power
inverter ensure the unit
is running on high idle
and that the inverter
switch is “on” in the cab.
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Shop 310 should be;
1. Started every morning or trickle
charge the batteries
2. Washed and detailed
(including equipment) as
needed
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An incident occurs where Incident Command (IC)
requests a formal Rehab Sector be set-up or an
agency/department is requesting rehab for a training
session.
1. S423 will be notified via dispatch.
2. The CSO/second on S423 will place Rehab 423 in
service, place ice and water in all coolers and
respond to the incident.
3. The assigned Medic Unit, S423/S426 and Rehab 423
will set up and run the Rehab Sector.
Note: Should S423 not be available for placing Rehab
423 in service, an EMS Battalion Chief or designee may
coordinate a Medic Unit (not the Medic Unit already
assigned to the incident) to assist in this process. If
resources are not available then Rehab 423 may be
delayed or not available for the incident.
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After the incident is completed, Shop 310 will be taken
back to B100 and placed OOS with the following
process completed;
1.
2.
3.
4.
Rehab 423 will advise dispatch OOS
Wash /dry and replace dirty towels on unit
Restock all equipment used
Ensure all equipment is cleaned and re-organized in
its designated spots
5. Shop 310 will be parked in its designated space
**Note: Ice and water left over from the incident can
remain in the coolers for the remainder of shift in the
case Rehab 310 is requested again. Ice and water will be
removed upon shift change with cooler lids being left
open so that they can dry out, decreasing the chance of
mold growth.
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1. What is the purpose of the Interagency Rehab SOP?
A. To make lots of extra busy work
B. To help us all stay in shape
C. To ensure the physical and mental condition of employees does not
deteriorate
D. To make sure we miss the Cardinals game on Sunday afternoon
2. Who has the responsibility to request Rehab 423 and a formal rehab?
A. The incident RP
B. The incident 425
C. The incident IQ
D. The incident IC
3. Who is responsible for his/her preparedness prior to an incident, including;
sufficient rest prior to reporting for duty?
A. Only EMT’s
B. Only Firefighters
C. Only Rehabbers
D. All Responders
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4. The establishment of rehab is not appropriate during cool, comfortable weather?
A. True
B. False
5. Fluids such as water, sports drinks and teas are acceptable fluid replacement
beverages during rehab.
A. True
B. False
6.
Personnel should re-hydrate at least 24 ounces during each SCBA bottle change.
A. True
B. False
7. Any member who exhibits a body temperature of > 100.6F, a consistent pulse rate
of > 110bpm shall not be permitted to wear full protective clothing, including
SCBA and shall require additional rehabilitation including cardiac monitoring.
A. True
B. False
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8. Per the Rehab Algorithm should your initial medical assessment be outside
normal limits, which of the following is most correct?
A. Sent automatically to the Treatment area
B. Depending on assessment given an additional 20 min rest
C. Orally hydrate
D. Both B & C
9. When staging vehicles near the rehab sector ensure the exhaust is pointed away
from the sector (taking into account wind conditions) and stage a minimum of?
A. 15 feet
B. 10 yards
C. 15 yards
D. 10 feet
10. The water coolers used for wetting towels is found in which compartment?
A. # 1
B. # 2
C. Left # 4
D. Rear #5
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