Editor’s note: This is the last part of the three part series on the Incident Scene and Training Rehab part of the guidelines for NFPA 1584. The second installment explains how to train firefighters about medical monitoring and handling symptomatic firefighters. This article continues to examine training on guidelines, and will focus on accountability, release and documentation.
Accountability
Personnel on scene need to be accounted for whether they are at rehab or working the incident. There are a few schools of thought on how accountability should take place when personnel come to rehab. Some agencies have the accountability officer for the incident continue to account for personnel in rehab while others have an accountability officer at rehab. The latter actually has some great benefits. When personnel are sent to rehab they should be sent as a company or crew. Crews should stay together — they go into rehab together and they come out of rehab together. Once the crews are sent to rehab, the rehab accountability officer then accounts for them during their time in rehab. This also helps to ensure that the crews do stay together and do not leave rehab until all members have been successfully rehabbed.
Release
Once all members have been released from rehab, they return to the incident accountability officer to be placed back into action at the incident or training event. If for some reason one of the crew members is not able to be released, the incident commander should be notified immediately. The crew members that are able to return to duty can report to the incident accountability officer and stand by to have additional personnel assigned to them or be assigned a duty according to the number of personnel available in their crew.
Regardless of whether the incident accountability officer or the rehab accountability officer is maintaining the crew’s accountability tags, the accountability officer in the rehab sector is still responsible for maintaining accountability for personnel in the rehab sector.
Documentation
Here is that dirty word that everyone seems to dislike — documentation. Documentation is a very critical element of the rehab sector. There are a few areas that should be maintained as part of the documentation while personnel are in rehab. They are:
• Time in/out
• Medical monitoring
• Emergency care
The time in and out of rehab is important to document. The length of time that personnel spend in rehab is essential to their recovery. In most instances rehab should not be less than 15 minutes. However, if you find personnel in rehab for longer than 30 to 45 minutes there should be question as to why they were in rehab so long. There can be many reasons for this. Typically the most logical reason is that the individual had some type of medical reason to wait in rehab. However, it could be as a result of not enough personnel assigned to rehab to take care of the personnel coming through rehab. This can be remedied in the future by training and assigning more personnel to the rehab section. One scenario that is not typical, but can occur, takes place when personnel do not want to go back to the incident scene or the training evolution and decide to hang out at rehab longer to avoid returning.
Medical monitoring should be well documented. Any findings should be listed on the form and referred to later if the individual experiences any further signs or symptoms.
Emergency care should be documented on a regular patient care report. Once you begin emergency care, the information is treated like any other medical record for the agency. The information accordingly becomes confidential.
There are forms developed that can be used for your documentation at the rehab sector. When conducting your training on rehab you should review the forms and explain how the forms should be completed. Give the participants a couple of scenarios and allow them to complete the forms for practice. Remember — how you train is how you perform in the real environment.
So what do you do with the rehab records after the incident? With the exception of the patient care report — if any was completed — all the rehab forms should be filed with the incident report or training report. The patient care report — if any are completed — should be filed the same way as your other patient care reports are filed as this has now become a medical incident. The rehab reports are important elements because in the event a firefighter develops any illness or complains of any symptoms after the incident, there are records on file that will show the baselines of that individual on the incident or training scene.
Summary
Accountability and documentation are two critical components of the rehab sector. When conducting your training, emphasis needs to be placed on these two topics. Personnel need to be accounted for when on the scene of an incident or at a training event. There needs to be complete and accurate recordkeeping of personnel when they are in the rehab sector. While neither seems to be that critical on the surface, they can actually save a life.
References
Lindsey, J. (2007) Fire Service Instructor Prentice Hall, Upper Saddle River, N.J.
NFPA 1584 Standard on the Rehabilitation Process for Members During Emergency Operations and Training Exercises (2008) National Fire Protection Association Batterymarch, Ma.