By Bill Tricarico
Senior Risk Management Consultant
Emergency Services Insurance Program

July 2012
Incident Commanders must be concerned with many issues and as the seasons change to summer, heat must be one of the most important. The chances of winning a lottery are 1 in 135,145,920, but according to the National Safety Council, the chance of dying as a result of exposure to excessive natural heat is 1 in 6,174. Throw into that turnout gear, SCBA, hard work, climbing, chopping, advancing heavy hose lines, lifting patients, and all of the other areas of the emergency services field and that number is reduced even further. According to the U.S. Fire Administration, other factors which relate to how an individual reacts to heat are physical condition, age, chronic disease, recent alcohol use, prior heat injuries, genetics, and current medications. For instance, antihistamines impair sweating and diuretics may increase the rate of dehydration.

All of this means personnel on the scene should be more aware of the heat as well as the symptoms of heat exhaustion which include profuse sweating, headache, tingling sensations in the extremities, pallor or ashen color of the face, shortness of breath, nausea, and vomiting. Of more concern is that according to a NIOSH study, heat exhaustion may cause impairment of judgment even before the other symptoms are noted. Imagine how devastating this could be on the fireground.

As a result of all this, establishing Rehab Operations is extremely important. Policies and procedures for the how, when, and where for rehab should be established and followed closely. Rehab cannot be an afterthought, it must be there and ready for use when it is needed. It also must be capable of changing in size accordingly based on the size of the incident. If an incident grows, the rehab operations must be able to accommodate additional needs.

Rehab Operations are not limited to rehydration and cooling in hot weather. There should also be some method of medical evaluation of the members. For instance, recovery from heat exhaustion is usually fairly quick, but immediate return to duty is not advisable since heat exhaustion can develop rapidly into heat stroke and monitoring must be maintained.
For more information on Incident Rehab, the U.S. Fire Administration publication, “Emergency Incident Rehabilitation” may be downloaded at no cost from: https://www.usfa.fema.gov/downloads/pdf/publications/fa_314.pdf. And the NFPA provides Standard 1584, “Standard on the Rehabilitation Process for Members During Emergency Operations and Training,” which actually provides a sample policy for rehab.
The many tasks associated with the fire service provide for hard and stressful work which is difficult even under the best of conditions. Add in the hot and humid summer temperatures and we know we are expecting a great deal from our members. Rehab could very well be a lifesaving necessity.