Firefighter Rehab Gets an Upgrade
Annex B of NFPA 1584 includes a table for estimating the physical workload of activities such as donning SCBAs and SCBA search and rescue.
- By Jerry Laws
- Jul 17, 2007
THE National Fire Protection Association’s
Technical Committee on Fire
Service Occupational Safety and
Health is significantly revising NFPA 1584
according to a timetable that would produce
a new standard for firefighters’ rehabilitation
in 2008.
The standard would
specify how fire departments carry out
rehab for members operating at incidents
and training exercises, including rest, relief
from heat and cold, fluid replacement,
medical monitoring, and release.
NFPA 1584 currently exists as a recommended
practice that covers much of
the same ground, but it has been
rewritten by the committee to be a standard.
The current 2003 edition was the
first edition. The draft standard strongly
encourages fitness and healthy nutrition
and hydration, and thus it echoes and
supports what fire service leaders are
saying and doing.
James B. Harmes, president
of the International Association of
Fire Chiefs, explained why when he mentioned
an Indiana fire department’s
$55,000 FIRE Act grant for gym equipment
as he testified before the U.S.
House Appropriations
homeland security subcommittee
March 9.
Critics of that grant
missed the point, he said.
REST AND WORK ROTATION
Some environments are too hot to allow continuous exposure. Heat stress can be diminished
and effective work performance can be maintained through rehabilitation during rest periods.
This is often linked to SCBA air cylinder time (approximately 20 minutes). Rest periods will
limit accumulation of metabolic heat and when combined with rehydration and active cooling
will also allow the release of body heat and the lowering of core body temperature before the
fire fighter returns to the task.
Crews can be assigned from other stations to avoid committing first responding crews to a
long duration incident. Activate extra alarms if it is likely that you will need to rotate crews more
frequently due to the heat. This allows for staging and crew rotation. It should be noted that
studies have shown that during intense workloads, core temperatures continue to increase even
when the work has discontinued.
Fire fighters might feel that adequate cooling has taken place;
however, their core temperature can continue to rise.
Active Cooling
Fire fighters should “dress down,” removing their bunker coats, helmets, gloves, and so forth,
and open their bunker pants to release trapped heat. The use of active cooling through forearm
immersion, misting fans, and/or air conditioning can significantly lower core body temperature
during normal rehabilitation periods between cylinder changes.
Where active cooling is not provided,
a smoke ejector placed where fire fighters can remove protective clothing, drink fluids, and
rest will still increase evaporation of perspiration and enhance cooling and recovery. Note: When
the air temperature is greater than 104º F (40º C), increasing air motion might actually increase
heat stress; therefore, a smoke ejector fan will not be effective.
If smoke ejector fans are used, fire
fighters should use safety goggles or glasses to avoid debris from blowing into their eyes.
SOURCE: Toronto Fire Services sample advisory on heat stress |
“In 2005, 55 firefighters died of heart
attack in the line of duty. That is almost
half of the 115 firefighters that died that
year,” Harmes said. “Because of these statistics,
America’s fire service has put a new
priority on ensuring that firefighters are in
top medical condition to perform a physically
demanding job. I am currently
leading a campaign for fire service personnel
to take 10,000 steps a day to get
some aerobic exercise.”
How 2003 and 2007 Editions Differ
Some fire service/EMS commentators (at www.firerehab.com, for example) have
welcomed the draft standard’s downplaying
of the importance of Rate of Perceived
Exertion (RPE), which is an element
of medical monitoring. Both
editions acknowledge the subjective
aspects of RPE, but the 2003 recommendation
suggests that emergency medical
care evaluate RPE along with heart rate,
blood pressure, and temperature of each
department member entering rehab.
The
2007 draft standard, on the other hand,
says emergency medical care “shall be
alert for . . . general complaints such as
cramps, aches and pains, rate of perceived
exertion (RPE) scale.”
There are differences, too, in how the two editions define rehabilitation. The
2007 draft defines it this way: “An intervention
designed to mitigate against the
physical, physiological, and emotional
stress of fire fighting in order to sustain a
member’s energy, improve performance,
and decrease the likelihood of on-scene
injury or death.” The 2003 edition defines
rehabilitation as: “The process of providing
rest, rehydration, nourishment,
and medical evaluation to members who
are involved in extended or extreme incident
scene operations.”
And while the 2007 draft says rehab
operations “shall commence whenever
emergency operations or training exercises
post a safety or health risk to members,”
the 2003 recommendation says they
should commence “whenever emergency
operations pose the risk of members
exceeding a safe level of physical and
mental endurance.”
The 2007 draft specifies steps to be
taken to actively cool department members
suffering heat-related stress, includes
nutrition guidelines and beverages to
avoid, and states company officers should
assess their crew at least every 45 minutes,
and more frequently when working in
extreme conditions, to determine whether
they need rehabilitation. If one or more
members of the crew is seriously injured or
dies during the incident, all members shall
be removed from service and undergo critical
incident stress management procedures
as department policy dictates, it says.
Sample SOP, Heat and Cold
Stress Management Annex
Figure A.4.1.1.2 in the 2007 draft is a
three-page sample operating procedure
for rehab. It explains how the rehab manager
should select a site for rehab, should
ensure members remove bunker coats,
helmets, and hoods and open their bunker
pants to promote cooling, and should time
personnel who are in rehab to ensure they
receive at least 10 to 20 minutes of rest.
Both company officers and crew members
should be familiar with the signs and
symptoms of heat stress, it says, and
everyone involved in rehab—from the
officer to EMS—should work in close
coordination. It also says members should
drink at least 32 ounces of water during
rehab and should consume a sports drink
containing electrolytes after the first hour.
Members also should consume at least 16
ounces of water during the final rehab
period, this SOP states.
Annex B, Managing Heat and Cold
Stress, includes a sample heat stress advisory
document provided by Toronto Fire
Services and a table for estimating the
physical workload of light (driving, pump
operations), medium (carrying, pushing or
pulling, donning SCBA), and heavy (using
an ax, SCBA search and rescue, auto extrication,
ground ladder raises, forcible
entry) activities.
Timetable for the Standard’s Completion
The 2003 document can be reviewed via the “preview this document” link at www.nfpa.org/; the 2007 draft is available
via a link on the same page.
Carl E. Peterson, assistant director of
NFPA’s Public Fire Protection Division,
said 44 comments arrived about the 2007
draft by the March 2 deadline. The committee
was scheduled to meet March 23-
24 to act on those comments, with the
Report on Comments scheduled to be
published and posted by Aug. 24.
If there are no challenges to the committee’s
actions, the new document
should be issued by the Standards
Council in early December and available
in February 2008. If there are challenges,
they would be voted on by the
NFPA membership at the Annual
Meeting in June 2008, and the resulting
document would be issued in July and
available in September 2008, Peterson
said.
This article originally appeared in the July 2007 issue of Occupational Health & Safety.