NFPA 1584 - Fireground Rehab protocols

[Guest guest]

Anyone out there have any fire rehab protocols they would care to share?

Don

NFPA 1584: Not Just for Firefighters

* W. Ann Maggiore, JD, NREMT-P

* 2008 Oct 13

Whether you work for a fire department or EMS agency, the new National

Fire Protection Association (NFPA) standard for firefighter rehab

affects you and your service. It outlines the responsibilities for EMS

responders at fires by specifying the standards for rehabilitation of

firefighters. The standard was put into place to affirm the importance

of allowing firefighters adequate rest, hydration and caloric intake

during hot, heavy work.

The new standard recognizes the leading cause of firefighter deaths:

cardiac-related events. Almost half of the on-duty firefighter deaths

are from heart attacks; almost twice the number of police officers who

die on duty from cardiac events. The deaths tend to occur either

during, or immediately after, incidents that require heavy work.

NFPA has looked at each of the three leading factors that contribute

to firefighter deaths: underlying medical conditions, inadequate

physical conditioning and heavy exertion. NFPA 1582 and 1583 look at

the first two, while 1584 aims directly at on-scene heat exhaustion

and inhalation injury.

According to NFPA, rehab should occur whenever on-scene activities

pose the risk of members exceeding a safe level of physical or mental

endurance. The types of incidents will vary from structural and

wildland fires, hazmat incidents, multiple casualty incidents and any

prolonged operation during bad weather. EMS is expected to take the

lead in sharing the rehabilitation concept with law enforcement and

other emergency services personnel who take part in the scene.

The new standard defines eight key objectives for rehab. These include

relief from environmental conditions, rest and recovery, and active or

passive cooling or warming as needed. They also include rehydration,

calorie and electrolyte replacement, medical monitoring, member

accountability and release for return to duty. Hot conditions will

require shelter from the sun, hydration, prevention of burns from

contacting hot asphalt and even sunscreen. Cold weather priorities may

include shelter from wind and snow, increased caloric intake and a

method for thawing gear, and frequent frostbite checks. The area

devoted to rehab may be as simple as a single rescue or ambulance

unit. It also may be as complex as a tent equipped with generators and

communications equipment. Access to fresh water is essential, although

many EMS agencies prefer sports drinks that provide electrolyte

replacement. Think about basic needs, such as portable toilets, early

on when facing incidents that will continue for some time.

Also required by the new standard is a minimum of BLS care and

transport capability on a scene. EMS must keep records of which

firefighters have rotated through rehabilitation, with an evaluation

of vital signs including oxygen-saturation levels, and a thorough

evaluation of injuries or complaints of illness. EMS medical directors

should outline medical protocols that address when firefighters should

be transported to a hospital. Vital signs parameters should be clearly

outlined. Although there is still some discussion, 1584 outlines some

basic vital signs parameters and mandates that EMS should examine

anyone complaining of chest pain, dizziness, shortness of breath,

weakness, nausea or headache, as well as muscle pain, changes in level

of consciousness or mentation, and abnormal vital signs.

If a fire department doesn't have EMS, it's now required to develop

mutual aid agreements with EMS agencies for provision of on-scene

rehab. EMS is required to be trained and equipped to perform

rehabilitation activities, and it must now outline a rehabilitation

program that will be appropriate for the various types of fire

incidents that occur under a constellation of environmental

conditions. For example, although we always think of fire scenes as

involving heat, firefighters can also become extremely cold when they

exit a structural scene to find that the moist inside of their turnout

gear has now frozen.

If your service currently doesn't have an EMS protocol for

rehabilitation, it's time to start asking your service leaders and

medical director to come into compliance. The standard is intended to

help us take care of each other, so that we can continue to take care

of everyone else.