Emergency Incident Rehabilitation
Download
1 / 53

Amy Gutman MD EMS Medical Director Tobey Emergency Associates [email protected] - PowerPoint PPT Presentation


  • 111 Views
  • Uploaded on

Emergency Incident Rehabilitation. Amy Gutman MD EMS Medical Director Tobey Emergency Associates [email protected] Objectives. Define Emergency Incident R ehabilitation (EIR) Discuss importance of EIR Understand which situations warrant EIR Impact of weather conditions

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' Amy Gutman MD EMS Medical Director Tobey Emergency Associates [email protected]' - aldon


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript

Emergency Incident Rehabilitation

Amy Gutman MD

EMS Medical Director Tobey Emergency Associates

[email protected]


Objectives
Objectives

  • Define Emergency Incident Rehabilitation (EIR)

  • Discuss importance of EIR

  • Understand which situations warrant EIR

  • Impact of weather conditions

  • Criteria for EIR location

  • Criteria for return to duty vs hospital evaluation


Background
Background

  • Job-related danger historically a “badge of courage”

    • Resting is sign of weakness

    • Firefighters often boast of element of danger

  • Firefighter deaths & injuries are not badges of courage but indicators of problems


High risk profession
High Risk Profession

  • If firefighting extended beyond safe operating periods, may result in:

    • Stress or fatigue related illness or injury

    • Though firefighter may be uninjured, they are often fatigued to a point where unable to continue working

    • The mentally & / or physically fatigued firefighter may make poor decisions in a high-risk environment


Process function of eir
Process & Function of EIR

  • The process of providingrest, rehydration & nourishment

  • Medical evaluation & treatment

    • Initial evaluation

    • Continual monitoring of physical condition

  • Transportation for those requiring treatment at a hospital


What is emergency incident rehab ilitation eir
What Is Emergency Incident Rehabilitation (EIR)?

  • Rehab operations not limited to emergency scenes

  • Other activities potentially requiring EIR include:

    • Training exercises

    • Athletic events

    • Parade or event standbys


Why do we need eir
Why Do We Need EIR?

  • Over 50% firefighter deaths directly attributed to stress & overexertion

  • Unknown how many deaths & long-term illness indirectly related to cardiovascular stressors


Breakdown of firefighter deaths 2006 nfpa s fire incident data organization fido
Breakdown of Firefighter Deaths *2006 NFPA's Fire Incident Data Organization (FIDO)

Cause of Injury Percent

Exertion/Stress/Other 42.7%

Struck by Object 31.5%

Entrapment 22.5%

Fall 1.1%

Electrocuted 1.1%

Extreme Weather 1.1%

Nature of Injury Percent

Cardiac Arrest 38.2%

Trauma 29.2%

Asphyxiation 10.1%

Burns 10.1%

Crushing 3.4%

CVA 3.4%

Drowning 2.2%

Electrocution 1.1%

Arrythmia or Seizure 1.1%

Sepsis 1.1%


The functions of a eir operation
The Functions Of A EIR Operation


R1 rest
R1: Rest

  • Adequate time for core temp & vitals to return to “normal”

    • “Normal” yet to be established in firefighters

    • “Normal” currently based upon physiological norms set for healthy, active male athletes & military personnel

  • 10-30 min time frame is based upon time thought necessary to exchange cylinders, obtain refreshment & have vitals return to “normal”

    • Not based in evidence


R2 rehydration
R2: Rehydration

  • Can lose 1-3 lbs of body weight for every 30 minutes in full gear in a working structure fire in “moderate” temperatures

  • Special hydration liquids are generally overpriced & underdeliver

  • Best bet – 8 oz Gatorade with ¼ teaspoon added salt, popsicles, Special K protein water + salt, KoolAid + salt


Rehydration
Rehydration

  • Hydration important to recovery

  • Personnel who perform heavy work under stressful conditions while wearing heavy personal protective clothing are subject to excessive fluid loss

  • While fluid loss obvious in hot weather conditions, do not overlook that dehydration occurs in cold climates

  • Maintaining sufficient levels of water & electrolytes aids in prevention of heat or stress-related illness or injury


R3 restoration of core temp
R3: Restoration of Core Temp

  • How many in this room have had a rectal temp performed prior to gearing up & entering a house fire?

    • Really? No one?

  • Theoretically, this means “normalization” of core temp to 98.6F, with cessation of either shivering or sweating due to adequate revitalization


R4 rx treatment
R4: Rx (Treatment)

  • Injuries

    • Obvious & “non-obvious”

  • Dehydration

  • Heat Exhaustion

  • Hypothermia

  • Seemingly minor complaints may lead to immediate or delayed cardiovascular abnormalities


R5 climate relief
R5: Climate Relief

  • Personal climate

  • Environmental climate

  • Case climate

A little something for the ladies


R6 calorie refueling
R6: Calorie Refueling

  • Aside from liquid hydration & calories

  • Healthy, nutritious & easily digestible

  • “FireBar” is one such product

    • Don’t waste your money…Snickers are a better bet for less money (yes…Snickers)


Physical assessment
Physical Assessment

  • General Assessment

  • Vitals

  • Medical evaluation

  • Revitalization

  • Reassignment


Revitalization
Revitalization

  • Rest

    • Adequate time for core temp & vitals to return to normal

  • Fluid replenishment

    • Provide appropriate fluids to replace losses

  • Nutrition

    • Nourishing & nutritionally sound food


Medical evaluation treatment
Medical Evaluation &Treatment

  • Firefighters appearing ill or injured are assigned to personnel in medical evaluation area

  • Injured personnel have priority over those simply requiring simply drinks/food, unless that is a medical priority

    • i.e. hypoglycemia or dehydration


Continual monitoring
Continual Monitoring

  • Continual monitoring throughout EIR

  • Firefighters meeting criteria for release may go back to original assignment (“Medically Sound”) or reassigned to less strenuous activities

  • Firefighters who do not respond to rest or medical attention may require more intensive interventions

    • Transported to a medical facility for further treatment


E stablishing eir
Establishing EIR


Goal of eir operations
Goal of EIR Operations

  • Lessen risks of injury resulting from extended or intense operations

    • i.e. adverse conditions - specifically foul weather

  • Rehab necessary when emergency operations pose a risk of pushing personnel beyond a safe level of physical & mental capabilities


When to establish eir
When To Establish EIR

  • Extended fire incidents

    • Multiple alarm fires, wildfires

  • Hazardous Material Incidents

  • Prolonged rescue/recoveries

  • Adverse weather conditions

  • Crime scene/standoffs

  • Search & Rescue


Weather conditions
Weather Conditions

  • Hot Weather

    • Ambient temperature

    • Relative Humidity

    • Direct Sunlight

  • Cold Weather

    • Ambient temperature

    • Wind chill factor


Hot weather
Hot Weather

  • Personnel perform heavy physical labor in hot atmospheres while wearing bulky protective clothing

  • Often cannot break from assignment to go to rehab, remove gear & cool down

  • USFA recommends EIR initiated when heat stress index exceeds 90 ºF (32 ºC)


Heat index
Heat Index

  • Ambient air temperature & relative humidity factored together to create a “Heat Index”

  • Working in direct sunlight adds 10ºF to heat index

  • Working in full turn-out gear adds additional 10ºF to heat index



Cold weather conditions
Cold Weather Conditions

  • Often overlooked when determining the need for rehab operations

  • Effects of cold weather on responders who operate in low temp conditions for long periods of time are significant


Cold weather rehab challenges
Cold Weather Rehab Challenges

  • Hypothermia

    • Insufficient clothing protection against the cold

    • Allows decrease in body temperature

  • Frostbite

    • Isolated body part freezing


Wind chill
Wind Chill

  • Just as heat & humidity combine to increase the impact of heat, cold & wind combine to impact the effects of cold

  • Combined effect of cold + wind = Wind Chill Factor

  • USFA recommends initiating rehab operations when wind chill drops below 10ºF (-12º C)


Other situations where eir necessary
Other Situations Where EIR Necessary

  • Crime scene/standoffs

  • Search activities

  • Public events

  • Training events


Crime scene standoffs
Crime Scene / Standoffs

  • Bomb squad & tactical / SWAT team members

    • Operate for long periods of time in heavy protective clothing

    • Heat & Cold effects

    • High stress situations


Usar activities
USAR Activities

  • Large area searches for missing person(s)

  • USAR activities follow natural or manmade disasters such as structural collapses

  • Searches for climbers, hikers or others involved in sports or recreation activities


Public events
Public Events

  • Fairs, carnivals, festivals

  • Auto Races

  • Parades

  • Concerts

  • Sporting events

  • Political rallies

  • Large-scale religious ceremonies


The first five minutes of an incident can dictate the outcome of the next five hours

The first five minutes of an incident can dictate the outcome of the next five hours

Establishing & Managing EIR


Establishing managing a rehab area
Establishing & Managing A Rehab Area outcome of the next five hours

  • Location is one of the most important decisions

  • Relocation of rehab late in incident often confusion

  • The safety of Rehab site is paramount


Rehab location
Rehab Location outcome of the next five hours

  • Close to Incident Command...

    • Easy tracking of personnel

    • Easy to track progress of those in rehab

    • Efficient use of equipment

  • But…Far enough away

    • Easier for the personnel to relax

    • Fewer distractions


Site characteristics
Site Characteristics outcome of the next five hours

  • Estimated number of people needed to run EIR?

  • Weather conditions?

    • Need for shelters or buses?

  • Length of time rehab required?

  • Is site large enough?

  • Is site free of vehicle exhaust?


Site characteristics1
Site Characteristics outcome of the next five hours

  • Restricted media access

  • Adjacent to SCBA refill

  • Easy ambulance entrance & exit

  • Ideally has both running & drinking water

  • Restroom facilities

  • If involves fatalities, site should be out of view of work area


Additional resources
Additional outcome of the next five hoursResources

  • Metro Bus

  • Salvation Army &/ or Red Cross

  • BLS or ALS Engines

  • Additional Ambulance or Rescue Units

  • Medical Director (s)


Eir staffing
EIR Staffing outcome of the next five hours

  • The most highly trained & qualified EMS personnel on scene should provide medical evaluation & treatment in Rehab

  • Highest ranking medical officer should command EIR if possible


Roles of the eir staff
Roles of the outcome of the next five hoursEIR Staff

  • EIR personnel must assure the sector provides a safe area in which rescue crews can rest & receive treatment & rehydration

  • EIR personnel must identify personnel entering rehab at risk for heat & stress-related illness or injury

  • Rehab Sector commander must give regular updates to the Safety Officer or Incident Commander


Roles of the eir staff1
Roles of the outcome of the next five hoursEIR Staff

  • Rehab area should be equipped to handle a myriad of medical situations

  • Required Equipment:

    • Cardiac monitor/ defibrillator

    • Airway bag

    • Drug box & IV supplies

    • Suction

    • Trauma supplies

  • Rehab personnel must assure accountability for fire & rescue personnel who enter & exit rehab


Roles of the eir staff2
Roles of the outcome of the next five hoursEIR Staff

  • Rehab personnel must medically monitor crews to determine whether they:

    • Are fit to return to active fire/rescue duty

    • Require additional hydration & rest

    • Require transport to an ED for further evaluation and medical treatment


Eir time frame
EIR Time Frame outcome of the next five hours

  • The amount of time a responder requires in EIR varies depending on a variety of conditions:

    • Responders level of physical conditioning

    • Atmospheric conditions

    • Nature of the activities the responder was performing

    • The time needed for adequate rehydration

  • A good rule of thumb is 20 minutes per visit

    • Equates to change-out time for oxygen cylinders


Medical evaluation
Medical Evaluation outcome of the next five hours

  • Immediately on entry assess for injury

    • If no injury, then onto full assessment

  • Vitals

    • BP, RR, HR, SaO2, Temp – obtain and document

  • Personnel with abnormal VS should be sent for treatment

    • HR > 120 BPM

    • SBP > 160 mm/Hg or < 90 mm/Hg

    • DBP > 110 mm/Hg


Medical evaluation1
Medical Evaluation outcome of the next five hours

  • No personal should return to active duty if after 20 minutes of rest if:

    • HR > 100 BPM

    • SBP > 160 mm/Hg or < 100 mm/Hg

    • DBP > 90 mm/Hg

    • Injury that may worsen or impairs performance

    • Inability to hold down water

  • My personal marker – tell personnel that they cannot leave until they pee…if not adequately hydrated, they will not be able to urinate


Hospital transport
Hospital Transport outcome of the next five hours

  • Serious symptoms:

    • Chest pain, SOB, AMS

    • Heat exaustion

  • Irregular, persistent HR > 150 bpm

  • Oral temp > 105ºF

  • SBP > 200 mm/Hg post cool down

  • DBP > 130mm/Hg at any time


Summary
Summary outcome of the next five hours

  • Deciding when & if to initiate EIR

  • Planning a EIR location

  • Understanding importance of early decision-making

  • Rehydration & constant monitoring is of the utmost importance

  • Following guidelines for returning emergency workers to duty aids in both returning fit workers to duty & preventing further harm to ill or injured personnel


Questions prehospitalmd@gmail com
Questions outcome of the next five [email protected]


ad