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.

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.

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