Kent County Chiefs Association

Standard Operating Guidelines &

Standard Operating Procedures

Subject: Emergency Incident Rehabilitation

SOG # 1-1-6

Approved

January 2000

Approved by: President James L. Price, Jr.

Revised

April 2026

I.             Purpose

This policy provides guidance for the implementation of rehabilitation (Rehab) procedures, as outlined in NFPA 1584 (2002) Standard for the Rehabilitation Process for Firefighters and Emergency Responders during emergency operations and Training Exercises.  The purpose of this policy is to ensure that the physical and emotional condition of firefighters and emergency responders operating at the scene of an emergency or a training exercise, or while operating in extreme weather conditions.  This is accomplished through medical screening, monitoring, rest and relief, hydration, and active/passive cooling, thus decreasing the probability of injury/illness and contributing to the safety and success of the operation.

II.            Scope

This procedure shall apply to all emergency operations and training exercises where strenuous physical activity or exposure to heat or cold exists.

III.          Responsibilities

A. Incident Commander.

The Incident Commander (IC) shall consider the circumstances of each incident and make adequate provisions early in the incident for the rest and rehabilitation for all members operating at the scene.  These provisions shall include: medical evaluation, treatment and monitoring; food and fluid replenishment; mental rest; and relief from extreme climatic conditions and the other environmental parameters of the incident.  The rehabilitation shall include the provision of Emergency Medical Services (EMS) at the Basic Life Support (BLS) level or higher.

B.    Supervisors

All crew leaders/supervisors shall maintain an awareness of the condition of each member operating within their span of control and ensure that adequate steps are taken to provide for each member’s safety and health.  The command structure shall be utilized to request relief and the reassignment of fatigued crews.

C.   Personnel

During periods of hot weather, members shall be encouraged to drink water and activity beverages throughout the workday.  During any emergency incident or training evolution, all members shall advise their supervisor, when they believe that their level of fatigue or exposure to heat or cold is approaching a level that could affect themselves, their crew, or the operation in which they are involved.  Members shall also remain aware of the health and safety of other members of their crew.

IV.          Establishment of a Rehabilitation Sector

A. Responsibility

The Incident Commander will establish a Rehabilitation Sector or Medical Group when conditions indicate that rest and rehabilitation is needed for personnel operating at an incident scene or training evolution.  A Qualified EMS Officer, or highest-ranking clinician, will assume the role of Medical sector/Rehab group and shall be known as the Rehab Officer.  The Rehab Officer will typically report to the Logistics Officer or the Incident Commander if the Logistics Officer position is not staffed.

B.   Location

The Rehab Officer or Medical Sector will normally designate the location for the Rehabilitation Area.  If a specific location has not been designated, the Rehab Officer shall select an appropriate location based on the site characteristics and designations below.

1.    Site Characteristics

a. It should be in a location that will provide physical rest by

  allowing the body to recuperate from the demands and

  hazards of the emergency operation or training evolution.

                         b. The site should be located far enough away from the active

                             operations that members may safely remove their personal

                             protective equipment (PPE) and be afforded mental rest from the

                             stress and pressure of the emergency operation or training

                             evolution.  It should be large enough to accommodate multiple crew

                             and rehab personnel, based on the size of incident.

c.    It should provide suitable protection from the prevailing environmental conditions.  During hot weather, it should be in a cool, shaded area.  During cold weather, it should be in a warm, dry area.

d. It should enable members to be free of exhaust fumes from

apparatus, vehicles, or equipment (including those involved

  in the Rehabilitation Sector/Group operations).

e.    It should be easily accessible by EMS units.  It should allow prompt reentry back into the emergency operation upon complete recuperation.  (Within Walking distance of the Emergency Scene)

f.     Personnel should doff as much contaminated PPE as practical prior to entering the rehab site.  After doffing PPE and prior to entering the rehab area, personnel should decontaminate affected skin by washing with soap and water or by using a commercially available skin wipe manufactured for fire service skin decontamination as available.

2.    Site Designations

          a. A nearby garage, building lobby, or other structure.

b.    A school bus, municipal bus or similar type vehicle.

c.    Fire apparatus, ambulance, or other emergency vehicles at the scene or called to the scene.  (Consider Special

                                Operations Trailer 8)

d.    An open area in which a Rehab Area can be created using tarps, fans, etc.

C.   Resources

1. The Rehab Officer shall secure all necessary resources required to

adequately staff and supply the Rehabilitation Area.  The supplies

  should include the items listed below:

            a. Fluids- water, activity beverage, oral electrolyte solutions

                 and ice.

b.    Food- soup, broth, or stew in hot/cold cup

c.    Medical- blood pressure cuffs, stethoscopes, oxygen administration devices, cardiac monitors, IV solutions, thermometers, ice and heat packs, etc.

d.    Other- awnings, fans, tarps, smoke ejectors, heaters, dry clothing, extra equipment, floodlights, blankets and towels, traffic cones and fire line tape (to identify the entrance and exit of the Rehabilitation Area)

D.   Hydration

1.    A critical factor in the prevention of heat injury is the maintenance of water and electrolytes.  Water must be replaced during exercise periods and at emergency incidents.  During heat stress, the members should consume at least one quart of water per hour.

2.    Care should be taken with fluid replenishment.  Drinking too much, or too fast, can cause gastric distension or discomfort, which may result in in vomiting.  During high-intensity, lone-duration activity (longer than 1 hour), the following precautions are recommended.

a.    Personnel should drink 8-oz of fluids after 20–30-minute work cycle.  It is recommended that fluids contain approximately 7g of carbohydrates (CHO) (i.e. Sports Drinks)

3.    Care should be taken with fluid replacement containing Caffeine, high-fructose content, and high sugar, such as Energy Drinks

4.    The rehydration solution should be 50/50 mixture of water and a commercially prepared activity beverage and administered at about 40°F.  Dehydration is important even during cold-weather operations where, despite the outside temperature, heat stress may occur during firefighting or other strenuous activity, when protective equipment is worn.

E.   Nourishment

1.    The home department shall provide food at the scene of an extended incident when units are engaged for three or more hours.  A cup of soup, broth, and stew is highly recommended because it is digested much faster than sandwiches and fast-food products.  In addition, foods such as apples, oranges, and bananas provide supplemental forms of energy replacement.  Fatty and/or salty foods should be avoided.

F.    Rest

1.    The “two air-cylinder” rule or 45 minutes of work time, is recommended as an acceptable level prior to mandatory rehabilitation.

2.    Members actively operating on the fireground shall re-hydrate (at least eight ounces) while SCBA cylinders are being changed.

3.    Firefighters having worked two full 45-mintue rated SCBA bottles, or 45 total minutes, shall be immediately placed in the Rehabilitation Area for rest and evaluation.  In all cases, the objective evaluation of a member’s fatigue level shall be criteria for rehab.

4.    Rest shall not be less than 15 minutes and may exceed an hour as determined by the Medical Sector/Rehab Branch

G.   Recovery

1.    Members in the Rehabilitation Area should maintain a high level of hydration.  Members should not be moved from a hot environment directly into an air-conditioned area because the body’s cooling system can shut down in response to the external cooling.  An air-conditioned environment is acceptable after cool-down period at ambient temperature with sufficient air movement.

2.    Certain drugs impair the body’s ability to sweat and extreme caution must be exercised if the member has taken, antihistamines, such as Actifed or Benadryl, or has taken a diuretic or stimulants.

V.           Rehab for Incident Scene Operations Guidelines

A.   The Incident Commander (IC) maintains the ultimate responsibility for the health and safety of members operating on the emergency scene or training exercise.

B.   The Incident Commander (IC) should ensure the establishment of incident rehab and either designate a Qualified Medical Officer or all for the establishment of the “Rehabilitation Sector/Medical Group”

C.   Rehabilitation Sector/Medical Group Establishment

1. All officers should consider rehabilitation during the initial planning stages of an emergency response.  However, the climatic or environmental conditions of the emergency scene should not be the sole justification for establishing a Rehabilitation Area.  Any activity/incident that is large scale, long in duration, and/or labor-intensive will rapidly deplete the energy and strength of personnel and therefore merits consideration for rehabilitation.

2. Climatic or environmental conditions that indicate the need to establish a Rehabilitation Area are a heat stress index about 90°F or temperature below 20°F.

D.   Medical Evaluation & Monitoring

1. EMS shall be available as part of incident scene rehab for the evaluation and treatment of personnel

2. Emergency Medical Services – EMS shall be overseen by the Medical Sector/Rehab Branch

3. All EMS care should be performed by trained individuals at the BLS level or higher

4. The following vital signs should be obtained for all personnel entering rehab:

a.    Temperature

b.    Heart Rate

c.    Respiratory Rate

d.    Blood Pressure

e.    Pulse Oximetry

5. EMS personnel will complete diagnostic workups as indicated and appropriate (within the trained clinician’s scope of practice) Diagnostic Workups include, but are not limited to:

a.    3-Lead Electrocardiogram

b.    12-Lead Electrocardiogram

c.    End-Tidal Capnography

d.    Carbon Monoxide Evaluation and Monitoring for personnel exposed to fire smoke shall be assessed for carbon monoxide poisoning.

6. All Firefighters shall report to the designated rehabilitation area, after emptying their second SCBA cylinder, completing 45-minutes of working time, or experiencing a medical compliant; Syncopal Episode, Chest Pain, Respiratory Destress, or obvious physical/mental stress.  Personnel are to remove their turnout gear and have vitals assessed.  Emergency medical services personnel shall fill out the KCCA-approved rehab form.

7. Any firefighter suffering from any of the below charted conditions should immediately undergo treatment and transport to the closest appropriate facility.

Syncopal Episode (Fainting/Blacking Out)

Chest Pain

HOT, Dry Skin

Altered Mental Status

Systolic BP Greater than 200

Diastolic BP Greater than 130

Heart Rate Above 140 After Cool Down

8. Any firefighter whose initial vital signs are outside the range charted below must be re-evaluated after 15-minutes of rest, by emergency medical services personnel before they are permitted to the rehabilitation area and return to active duty

Heart rate Greater than 140bpm or less than 60bpm

Systolic Blood Pressure Above 160 or less than 90

Diastolic Blood Pressure above 100

Body Temperature Greater than or equal to 101°F

SPO2 Less than 93

* If initial vitals are noted to be within range, it is still recommended that all personnel rest for 15 minutes and consume 8-16 ounces of water during their rest period.  Caffeinated beverages should be avoided.  Once the rest period is completed, those firefighters may return to active duty, or their units assigned task*

9. Any firefighter whose initial vitals were outside the acceptable limits shall be re-evaluated after 15-minute rest period.  If their vitals remain outside the acceptable limits, they should rest an additional 15 minutes.  The second chart below should be followed for those who have rested and did not meet the initial criteria for release back to active duty.

Heart Rate Greater than 120bpm or less than 60bpm

Systolic Blood Pressure Above 150 or less than 80

Diastolic Blood Pressure Above 90

Body Temperature greater than or equal to 100.6°F

SPO2 Less than 93

10. At the completion of a half hour of resting, and the vitals still outside of the acceptable limits, transport to an appropriate medical facility should be encouraged.  Should the Firefighter accept transport, an EMED’s Report shall be completed by the transporting agency’s crew

11. If the Firefighter refuses transport but agrees to sit out of Active Duty, a Refusal of transport shall be obtained, and the Firefighter will be discharged as “Not Cleared for Active Duty”.  Command should be notified via radio, as well as a Face-to-Face meeting.

12. If at any time the Firefighter contests further evaluation, A Refusal form shall be initiated, and the Rehab Officer/Medical Sector designee is notified.  If a Refusal form is obtained, or the Firefighter refuses to complete the form, it is the recommendation of the Medical Sector/Rehab Officer that the firefighter does not return to active duty.  Command shall be notified via radio, as well as a face-to-face meeting.  Refusals shall be completed as a separate chart from the KCCA Rehab completed EMED’s Chart.

E. Rehab Discharge

1. Firefighters who are leaving the Rehab area shall be noted as “Discharged” with one of the following options:

a.    Return to Active Duty

b.    Return to Active Duty with restrictions

c.    Not Cleared to return to Active Duty – (Transport to appropriate facility, or Sit Out and Obtain Refusal or Transport)

d.    Contest Medical Evacuation – Refusal of all EMS Rehab Services (Reference Section D, Part 12 for procedures)

F. Call Completion

1.  All the completion of the incident, the KCCA Rehab Form shall be uploaded to the highest level of cards EMED’s Chart, or Medical Sector/Rehab Officers EMED’s Report.

VI.          Resources

A.   Maryland Medical Protocols: Heat-Related Emergencies (PG145)

B.   FEMA: US Fire Administration: Emergency Incident Rehabilitation Guidebook (2008)

Betterton Volunteer Fire Company, Inc.

Chief Renny Grapes

YES      NO      NOT PRESENT

Chestertown Volunteer Fire Company, Inc.

Chief John Darling

YES      NO      NOT PRESENT

Community Volunteer Fire Company of Millington, Inc.

Chief Vince Baxter

YES      NO      NOT PRESENT

Galena Volunteer Fire Company, Inc.

Chief Jeffrey R. Haley

YES      NO      NOT PRESENT

Kennedyville Volunteer Fire Department, Inc.

Chief James L. Price, Jr.

YES      NO      NOT PRESENT

Kent & Queen Anne’s Rescue Squad, Inc.

Chief Jason Lobley

YES      NO      NOT PRESENT

Rock Hall Volunteer Fire Company, Inc.

Chief Mike Pinder

YES      NO      NOT PRESENT

Kent County Emergency Service Board

Chair Lynn Sutton

Submitted for Emergency Service Board Approval on ______May 4th, 2026______________

Compliance Date ______June 3rd, 2026____________________________________________

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