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“Command from Division 2. Supervision of Division 2 transferred to Engine 6 officer. Engine 3’s crew is available.”
“Engine 3’s officer from command. Confirm you’ve transferred supervision of Division 2 to Engine 6 officer. Engine 3’s crew is assigned to rehab.”
“Command from Engine 3’s officer. Confirm Engine 3 is assigned to rehab.”
Time for Engine 3’s crew to head over to rehab and get something to drink, maybe something to eat, and share stories. After 10 minutes or so, they may be rotated out of rehab for another tactical assignment or released from the scene to return to quarters.
It’s a typical scenario on most emergency scenes. But with the growing body of knowledge on the connection between fireground exposures and firefighter cancer, as well as the physiological effects that thermal stress has on firefighters, we need to ensure that on-site firefighter rehab is an integrated component of your fire department’s health and wellness program. In this article, we’ll discuss integration of a “decon alley” between the hazard area (the hot zone) and rehab (the cold zone).
Today’s firefighter rehab
Fire department EMS personnel or third-party EMS providers must become knowledgeable and skilled in complying with the on-site firefighter rehab defined in NFPA 1584: Standard on the Rehabilitation Process for Members During Emergency Operations and Training Exercises requirements. Fire departments should develop training materials and SOGs to provide those personnel with the pertinent information from:
- Chapter 4: Preparedness.
- Chapter 5: Rehabilitation Area Responsibilities and Characteristics.
- Chapter 6: Incident Scene and Training Rehabilitation.
NFPA 1584 as the standard specifies medical monitoring for all personnel upon their entry into the rehab area. Every member must have an initial medical assessment that includes:
- Body temperature.
- Heart rate.
- Respiratory rate.
- Blood pressure.
- Pulse oximetry.
Any personnel who’ve been exposed to smoke without the protection of SCBA must be assessed for possible carbon monoxide (CO) poisoning. Any individual who is complaining of flu-like symptoms, such as headaches, fatigue, nausea, dizzy spells, confusion and irritability, must also be assessed for possible CO poisoning.
Decon as the gateway to firefighter rehab
It’s imperative that fire departments establish an appropriate “decon alley” as the gateway from the hazard area to rehab. Here are five steps to decontaminating and doffing PPE between the hot zone and the cold zone:
1. Hose down: The firefighter enters the decon alley through the gross wash (Level I decon). At a minimum, the firefighter should be hosed down from head to toe with a low velocity water stream. The intent is to flush surface contaminants from the exterior surfaces of the PPE and SCBA, not drive them into the fabric or harness components.
2. Drop equipment: Next, firefighters progress to the tool drop, where they'll leave any hand tools and portable radios. Another firefighter takes the equipment from the tool drop for gross decontamination before the equipment goes to the equipment retrieval area adjacent to rehab.
3. Doff turnout gear: Next, firefighters doff their PPE while they continue to breathe air from their SCBA cylinder. The doffing sequence is:
- Remove helmet.
- Remove turnout coat and gloves.
- Drop turnout pants.
- Step out of boots.
4. Remove SCBA: After doffing turnout gear, firefighters can remove their SCBA face piece, shut off the cylinder valve and disarm PASS.
5. Wash up: The last step is personal hygiene, using soap and water or disposable towels to clean the head, face and neck areas before moving to the rehab area.
Firefighters performing the hosing down and collecting tools need to be at a level of PPE at or beyond the structural firefighting ensemble to protect them from contaminated water splashes and the inhalation of aerosolized contaminants as the PPE off-gasses – a potential concern when the PPE is still hot after exiting the hot zone.
Personnel should have change of clothing (appropriate for seasonal weather) with them as part of their PPE while on duty so that they have something to change into if necessary in rehab.
Rehab area layout and documentation
Upon exiting decon alley, firefighters then proceed to medical monitoring, the entry point for rehab (if necessary, a firefighter may first change or add clothing before proceeding to medical monitoring). In addition to the medical assessment, each firefighter gets logged into rehab:
- Unit number.
- Time into rehab.
Depending upon weather conditions, an area for passive or active cooling/heating should be set up and firefighters should proceed there if necessary. Otherwise, firefighters should be in either the rest and recovery area or the rehydration/calorie replacement/electrolyte replacement area.
When the rehab manager notifies a firefighter that it’s time to leave rehab, the firefighter proceeds to the exit point medical monitoring for a check out medical exam and documentation:
- Unit number.
- Time out of rehab.
- Disposition (e.g., reassigned to operations, returning to quarters or transported to hospital).
If returning to operations or returning to quarters, the firefighter would retrieve their PPE and any equipment they dropped off in decon alley from the equipment retrieval area.
Adding a decon alley to fire department operations at structure fires can be an important part of reducing firefighter exposures to carcinogens and other toxic materials on scene, as well as reducing the amount of contamination that gets transported back the fire station.