Fire Scene Rehab

You hear the tones go off at noon – the fire division is dispatched to a fully engulfed house fire.  Per protocol, you hop in the truck and head out behind the fire truck to the scene.  Now what?  Fire scene rehab is a crucial responsibility that falls on EMS, and is often times over looked and ignored.  But why do we need rehab?  Take a look at the quick video below.

 So, what is fire scene rehab?  According to fireengineering.com (http://www.fireengineering.com/articles/print/volume-159/issue-4/features/implementing-effective-on-scene-rehabilitation.html), on-scene rehabilitation can be defined as an intervention to mitigate against the physical, physiological and emotional stress of firefighting to improve performance and decrease the likelihood of an on-scene injury or death.  That is a mouthful!  So what does this mean for EMS?  Aside from assisting in any arising medical needs, such as an injured firefighter or a patient that is found, EMS should work to ensure that the firefighters are performing in a safe and healthy manner.  This means providing adequate space to cool off (or warm up in some winter situations), grab something to eat, keep hydrated, and to catch their breath.

Why is this so important?  Fireengineering.com outlined, in the same article, that the leading cause of line-of-duty deaths in the fire service is a heart attack (45% in fact).  This is due to the overwhelming stress involved in fighting the fire. Take a look at firefighternation.com (http://www.firefighternation.com/articles/2015/02/stress-cortisol-complicate-fire-service-work.html).  The body releases a combination of adrenaline and cortisol when we are stressed.  Stress, along with a poor diet, lack of excessive, smoking, and a combination of other factors lead to the increased risk of a heart attack.  This, combined with the physical excursion experienced in fighting a fire, could put the workload over the top for a stressed heart.

Obviously, the firefighter can make certain life style changes to reduce those risks, however on the scene, EMS can provide basic services to help the body fight the stress.

Rehab Location

You pull the ambulance on scene.  Where do you park?  Should it be next to all of the firetrucks?  Maybe back on the road by the pumpers?  Ohh, how about far away from the scene to make sure we are out of the way?  The answer is not a simple one.  You want to be out of the way of the fire operations, but close enough so that the firefighters don’t have far to go between rehab and operations.  Another consideration would be shading.  On a hot, sunny day would you want to go for an intense workout and then sit under the beating sun?  No, you want to sit in the shade.  Finding a large, shaded area or deploying cover is the best way to go about this.  What about when it is cold out, or wet?  Should firefighters be sitting on the cold, wet snow to calm down from the firefighting?  

When on scene, you can always talk to the residents to see if there is somewhere you can set up.  Maybe they have an old barn that is fairly empty that you can set up shop.  Worse case scenario, you can always use the ambulance.

Resources

After picking out your location, then what do you do?  The EMS Division has a cooler specifically for rehab, which is stocked with water bottles and Gatorade.  This should be grabbed before heading to the scene.  If able to, another member should stop and pick up ice to cool down the water and for ice water to soak towels in.  In 1260, there is a fridge that stores more water and Gatorade that you can grab from as well.

Your “Patients”

When performing rehab, you should consider the firefighters, in a way, as a patient.  What I mean is that you need to check their vital signs, make sure that their blood pressure and pulse are reasonable (as determined by WFD policy) before they are allowed to return to operations.  In addition, you are looking out for their best interests.  Take a look at how exhaustion can affect our mind and body in an article on sciencedaily.com (https://www.sciencedaily.com/releases/2015/07/150730162454.htm).  Firefighting is both a mental and physical task, and as research by Dr. Ranjana Mehta found, performing both a mental and physical task concurrently resulting in fatigue quicker than just a physical exercise. 

Another thing to remember is that there are plenty of other firefighters on scene than just the ones that come to visit you.  For country operations, the tender drivers go back and forth between the water source and the fire to bring in additional water for the fire.  Pump operators stay on their apparatuses throughout the entire process, ensuring water gets from the engine to the end of the hose.  Command personnel are moving about directing traffic and ensuring operations are running smoothly.  Police officers are directing traffic.  All of these additional personnel should be offered rehab as well, or at the very least provided water to ensure they don’t become dehydrated.

Fire Related Illnesses or Injuries

So if we look past the leading cause of injury or death, what are some other fire related illnesses or injuries.  According to firerescue1.com (https://www.firerescue1.com/fire-products/fire-rehab/articles/1917068-3-heat-related-threats-to-firefighters-and-how-to-fix-them/), there are a few heat related concerns when dealing with fires, which include heat cramps, heat exhaustion and heat stroke.

According to WebMD (yes, we will use Dr. Google for these definitions), heat cramps are painful, brief muscle cramps where the muscles may spasm or jerk involuntarily.  Heat exhaustion is a heat related illness after exposure to high temperatures, often accompanied by dehydration.  Heat stroke, which is a late progression heat injury, results from prolonged exposure to high temperatures, also usually in combination with dehydration.

Each of these injuries should be considered a high probably on any fire scene, and every EMT should know the signs and symptoms, as well as the treatment for those injuries.