SOP 511.27: Occupational Safety and Health/Rehabilitation

|GEORGIA DEPARTMENT OF CORRECTIONS
Standard Operating Procedures|Col2|Col3|
|---|---|---|
|Policy Name:Occupational Safety and Health/Rehabilitation|Policy Name:Occupational Safety and Health/Rehabilitation|Policy Name:Occupational Safety and Health/Rehabilitation|
|Policy Number: 511.27|Effective Date: 9/20/2023|Page Number: 1 of 10|
|Authority:
Commissioner|Originating Division:
Facilities Division
(Fire Services)|Access Listing:
Level I: All Access|

I. Introduction and Summary:

This standard applies to all emergency operations and training exercises where
strenuous physical activity, exposure to heat or cold creates the need for the
rehabilitation of personnel. It was promulgated to:

A. Prevent injuries, illnesses, and deaths that may result from excessive fatigue; and

B. Establish procedures for medical evaluation and treatment, food and fluid

replenishment, and relief from extreme climatic conditions during emergency
operations and prolonged training exercises.

II. Authority:

A. National Fire Protection Association (NFPA) 1500; and

B. ACA Standard: 2-CO-3B-01.

III. Definitions:

A. Level I Rehabilitation - Situations of short duration. The incident commander

may elect to use the rehabilitation supplies from an apparatus on the scene or may
special-call the rehab unit to the scene. Typically, in Level I Rehabilitation, the
crews are not rotated, and the incident or training exercise has a limited duration.

B. Level II Rehabilitation - Situations that require a major time and personnel

commitment. Examples include a major fire or a lengthy training exercise in which
the firefighter’s health and safety must be addressed.

IV. Statement of Policy and Applicable Procedures:

A. General:

1. The Station Chief shall evaluate the circumstances at each incident and shall

make early, adequate provisions for the rest and rehabilitation of all firefighters

|GEORGIA DEPARTMENT OF CORRECTIONS
Standard Operating Procedures|Col2|Col3|
|---|---|---|
|Policy Name:Occupational Safety and Health/Rehabilitation|Policy Name:Occupational Safety and Health/Rehabilitation|Policy Name:Occupational Safety and Health/Rehabilitation|
|Policy Number: 511.27|Effective Date: 9/20/2023|Page Number: 2 of 10|
|Authority:
Commissioner|Originating Division:
Facilities Division
(Fire Services)|Access Listing:
Level I: All Access|

working at the scene. These provisions include:

a. Medical evaluation.

b. Treatment and monitoring.

c. Food and fluid replenishment.

d. Mental rest; and

e. Relief from extreme climatic conditions and other environmental factors

present at the incident.

2. During prolonged incidents, strenuous training sessions, and periods of

extreme heat or cold, the Station Chief shall request a Rehabilitation Unit be
dispatched to the scene.

B. Rehabilitation Sector:

1. The Station Chief shall establish a rehabilitation sector when conditions

indicate that firefighters working at an incident or training exercise require rest
and rehabilitation.

2. The Station Chief shall appoint a Rehabilitation Officer who will assume

command of the rehabilitation sector. At most incidents, the location of the
rehabilitation sector will be designated by the Station Chief. However, if the
incident commander has not designated a rehabilitation site prior to the
appointment of a Rehabilitation Officer, the Rehabilitation Officer shall
promptly select an appropriate location based on the most desirable site
available.

|GEORGIA DEPARTMENT OF CORRECTIONS
Standard Operating Procedures|Col2|Col3|
|---|---|---|
|Policy Name:Occupational Safety and Health/Rehabilitation|Policy Name:Occupational Safety and Health/Rehabilitation|Policy Name:Occupational Safety and Health/Rehabilitation|
|Policy Number: 511.27|Effective Date: 9/20/2023|Page Number: 3 of 10|
|Authority:
Commissioner|Originating Division:
Facilities Division
(Fire Services)|Access Listing:
Level I: All Access|

3. The rehabilitation sector should be placed in a location that allows firefighters

to physically and mentally rest, recuperate from the stress, pressure, and
demands of the emergency operation or training evolution.

4. The rehabilitation sector should also be located far enough away from the

incident scene to allow firefighters to safely remove their protective clothing
and Self-Contained Breathing Apparatus (SCBA).

5. The rehabilitation sector should be located in an area that provides suitable

protection from the prevailing environmental conditions. If possible, the sector
should be in a cool, shaded area during hot weather and in a warm, dry area
during cold weather.

6. If the rehabilitation sector is located outdoors, the area should be free of ants

and other stinging or biting insects.

7. Firefighters in the rehabilitation sector should not be exposed to exhaust fumes

from apparatus, vehicles, and motorized equipment, including those involved
in the rehabilitation sector operations.

8. The rehabilitation sector should be large enough to accommodate multiple

crews and should allow for expansion or contraction as the size of the incident
varies.

9. The rehabilitation sector should be easily accessible by EMS units and other

support vehicles.

10. The rehabilitation sector should be located close enough to the incident to

allow firefighters to promptly re-enter the emergency operation site after
recuperation.

11. The following areas should be considered when selecting a site for the

rehabilitation sector:

|GEORGIA DEPARTMENT OF CORRECTIONS
Standard Operating Procedures|Col2|Col3|
|---|---|---|
|Policy Name:Occupational Safety and Health/Rehabilitation|Policy Name:Occupational Safety and Health/Rehabilitation|Policy Name:Occupational Safety and Health/Rehabilitation|
|Policy Number: 511.27|Effective Date: 9/20/2023|Page Number: 4 of 10|
|Authority:
Commissioner|Originating Division:
Facilities Division
(Fire Services)|Access Listing:
Level I: All Access|

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

b. At least two floors below a fire in a high-rise building.

c. A large climate-controlled vehicle such as a school or transit bus.

d. Fire apparatus, ambulances, or other emergency vehicles at the scene or

called to the scene.

e. The fire department Rehabilitation Unit.

f. An open area in which a rehabilitation site can be created by using tarps,

fans, etc.; and

g. At an industrial site, the rehabilitation sector shall be placed outside the

fenced compound area.

12. The Rehabilitation Officer shall secure all the resources required to

adequately staff and supply the rehab sector. The supplies may include the
items listed below:

a. Fluids such as water, Gatorade, and ice.

b. Food such as soup, broth, or stew in hot/cold cups.

c. Medical equipment such as blood pressure cuffs, stethoscopes, oxygen

administration devices, cardiac monitors, intravenous solutions, and
thermometers. (Medical Supplies may be furnished by the ambulance
assigned to the rehabilitation sector.); and

d. Other items such as awnings, fans, tarps, smoke ejectors, heaters, dry

clothing, extra equipment, floodlights, towels, traffic cones, and fire line
tape (to identify the entrance and exit of the rehabilitation area).

|GEORGIA DEPARTMENT OF CORRECTIONS
Standard Operating Procedures|Col2|Col3|
|---|---|---|
|Policy Name:Occupational Safety and Health/Rehabilitation|Policy Name:Occupational Safety and Health/Rehabilitation|Policy Name:Occupational Safety and Health/Rehabilitation|
|Policy Number: 511.27|Effective Date: 9/20/2023|Page Number: 5 of 10|
|Authority:
Commissioner|Originating Division:
Facilities Division
(Fire Services)|Access Listing:
Level I: All Access|

C. Guidelines:

1. The establishment of a rehabilitation sector shall be considered during the

initial planning stages of an emergency response. The climatic or
environmental conditions of the emergency scene should not be the sole
justification for establishing a rehabilitation sector. Any activity or incident,
whether emergency or nonemergency, that is large in size, long in duration,
and labor intensive will rapidly deplete the energy and strength of personnel.

2. Climatic or environmental conditions that indicate the need to establish a

rehabilitation sector include a heat index above 95 degrees.

3. A critical factor in the prevention of heat stress injury is the intake of water

and electrolytes during periods of intense physical activity.

a. During these periods, an individual should drink at least one quart of water

or Gatorade per hour.

b. Adequate fluid intake is important even during cold weather operations.

Despite outside temperatures, heat stress injuries may occur during
firefighting or other strenuous activity anytime that protective clothing and
equipment are worn.

c. Individuals should avoid caffeinated and carbonated beverages because

both interfere with the body’s water conservation mechanisms; and

d. Certain drugs also impair the body’s ability to sweat. Use caution if a

firefighter has taken antihistamines, diuretics, or stimulants.

4. If the duration of an incident extends through regular mealtimes, the Georgia

Department of Corrections shall provide food to the firefighters at the scene
whenever it is possible to do so.

|GEORGIA DEPARTMENT OF CORRECTIONS
Standard Operating Procedures|Col2|Col3|
|---|---|---|
|Policy Name:Occupational Safety and Health/Rehabilitation|Policy Name:Occupational Safety and Health/Rehabilitation|Policy Name:Occupational Safety and Health/Rehabilitation|
|Policy Number: 511.27|Effective Date: 9/20/2023|Page Number: 6 of 10|
|Authority:
Commissioner|Originating Division:
Facilities Division
(Fire Services)|Access Listing:
Level I: All Access|

5. Forty-five minutes of work time is generally recommended as an acceptable

level of work prior to mandatory rehabilitation.

a. Members having worked through two (2) full 30-minute-rated SCBA

cylinders, or for 45 minutes, shall be rotated to the rehabilitation sector for
rest and evaluation.

b. In all cases, an objective evaluation of a member’s fatigue level is the

appropriate criterion for determining if rest is required. Rest periods for
firefighters in the rehabilitation sector shall be at least 10 minutes or
greater; and

c. Crews sent to rehab should be replaced by fresh crews from the staging

sector. Crews released from the rehabilitation sector should be rotated to
the staging sector prior to returning to work. This procedure ensures that
fatigued individuals do not return to work before they are rehabilitated.

6. Firefighters should not be removed from a hot environment and placed directly

into an air-conditioned environment because the body’s cooling system may
shut down in response to the external cooling. An air-conditioned environment
is acceptable only after a cool down period at ambient temperature with
sufficient air movement.

7. EMS at the advanced life support level will be provided at each incident. EMS

personnel (paramedics) will evaluate the vital signs and the physical condition
of firefighters as they are rotated through the rehab sector.

a. EMS personnel will determine whether a firefighter will be allowed to

return to work, remain in rehabilitation, or receive further medical
treatment and be transported to a medical facility for further evaluation.

b. Continued rehabilitation consists of the ongoing monitoring of vital signs,

rest, and fluid intake. Medical treatment for a firefighter whose signs and

|GEORGIA DEPARTMENT OF CORRECTIONS
Standard Operating Procedures|Col2|Col3|
|---|---|---|
|Policy Name:Occupational Safety and Health/Rehabilitation|Policy Name:Occupational Safety and Health/Rehabilitation|Policy Name:Occupational Safety and Health/Rehabilitation|
|Policy Number: 511.27|Effective Date: 9/20/2023|Page Number: 7 of 10|
|Authority:
Commissioner|Originating Division:
Facilities Division
(Fire Services)|Access Listing:
Level I: All Access|

symptoms indicates potential problems will be provided in accordance with
local medical control procedures. EMS personnel will be aggressive in
determining that potential medical problems exist.

8. When working crews arrive at the rehabilitation sector, each firefighter’s vital

signs shall be taken and recorded. The following criteria are used in the
evaluation of fire ground personnel during a fire or emergency incident.

a. Transportation to the hospital is required when the diastolic blood pressure

is greater than or equal to 130.

b. Transportation to the hospital is also required when the diastolic blood

pressure is greater than or equal to 110 and the individual is symptomatic.

c. An individual may be transported to the hospital for further evaluation

when the diastolic blood pressure is less than or equal to 110 and the
individual is symptomatic.

d. The individual may be transported when the systolic blood pressure is

greater than or equal to 200 and after further evaluation and rest the systolic
blood pressure is still greater than or equal to 200.

e. When a pulse rate of greater than or equal to 140 is found, administer

oxygen and fluids, rest for a minimum of 10 minutes, and reassess the
individual. If the heart rate is less than 140, the individual may return to
work.

f. If after 10 minutes the heart rate remains above 140, the individual must

rest for an additional 30 minutes. Administer fluids and oxygen and record
the heart rate and rhythm on a cardiac monitor and obtain an EKG printout.

|GEORGIA DEPARTMENT OF CORRECTIONS
Standard Operating Procedures|Col2|Col3|
|---|---|---|
|Policy Name:Occupational Safety and Health/Rehabilitation|Policy Name:Occupational Safety and Health/Rehabilitation|Policy Name:Occupational Safety and Health/Rehabilitation|
|Policy Number: 511.27|Effective Date: 9/20/2023|Page Number: 8 of 10|
|Authority:
Commissioner|Originating Division:
Facilities Division
(Fire Services)|Access Listing:
Level I: All Access|

g. If after 30 minutes the pulse rate remains above 140, transport the

firefighter to a medical facility for further evaluation; and

h. In the above cases, Medical Control will be contacted in every situation

and treatment, or transport will be determined in conjunction with Medical
Control.

9. All medical evaluations shall be properly recorded by the paramedic, along

with the individual’s name and chief complaints. The form must list the date,
time, and incident number and be signed by the rehab officer.

11. Firefighters sent to rehabilitation shall enter and exit the rehabilitation sector

as a crew. The crew designation, number of crew members, and times of entry
to and exit from the rehabilitation sector shall be documented by the
Rehabilitation Officer. Crews shall not leave the rehab sector until released by
the rehab officer.

D. Responsibilities:

1. All Station Chiefs shall monitor the condition of each firefighter working under

their command and shall ensure that adequate steps are taken to provide for
each firefighter’s safety and health. The incident command system is to be used
to request that a crew be relieved and for the reassignment of fatigued crews.

2. During periods of hot weather, firefighters are encouraged to use their

individual water bottles and drink water or Gatorade throughout the workday.
During any emergency incident or training evolution, all firefighters shall
advise their supervisor when they believe their level of fatigue or exposure to
heat or cold is approaching a point that could affect them, their crew, or the
operation in which they are involved. Each firefighter shall also monitor the
health and safety of the other firefighters of his/her crew.

|GEORGIA DEPARTMENT OF CORRECTIONS
Standard Operating Procedures|Col2|Col3|
|---|---|---|
|Policy Name:Occupational Safety and Health/Rehabilitation|Policy Name:Occupational Safety and Health/Rehabilitation|Policy Name:Occupational Safety and Health/Rehabilitation|
|Policy Number: 511.27|Effective Date: 9/20/2023|Page Number: 9 of 10|
|Authority:
Commissioner|Originating Division:
Facilities Division
(Fire Services)|Access Listing:
Level I: All Access|

E. Heat Stress Index:

TEMPERATURE DANGER INJURY/THREAT CATEGORY

Below 80 degrees F None Little or no danger under
normal circumstances.

80 to 90 degrees F Caution Fatigue possible if exposure is
prolonged and there is
physical activity.

90 to 105 degrees F High Heat cramps and heat exhaustion
possible if exposure is prolonged and
there is physical activity.

105 to 130 degrees F Extreme Heat cramps or exhaustion likely
heat stroke possible if exposure is
prolonged and there is physical activity.

Above 130 degrees F Mortal Heat stroke imminent.

Add 10 degrees F when protective clothing is worn and add 10 degrees F when in
direct sunlight.

F. Wind-chill Index:

Wind-chill Temperature (degrees F) Danger

Above 25 degrees F Little danger for properly
clothed person.

25 to 75 degrees F Increasing danger, flesh may
freeze.

Below 75 degrees F Great danger, flesh may freeze
in 30 seconds.

|GEORGIA DEPARTMENT OF CORRECTIONS
Standard Operating Procedures|Col2|Col3|
|---|---|---|
|Policy Name:Occupational Safety and Health/Rehabilitation|Policy Name:Occupational Safety and Health/Rehabilitation|Policy Name:Occupational Safety and Health/Rehabilitation|
|Policy Number: 511.27|Effective Date: 9/20/2023|Page Number: 10 of 10|
|Authority:
Commissioner|Originating Division:
Facilities Division
(Fire Services)|Access Listing:
Level I: All Access|

V. Attachments: None.

VI. Record Retention of Forms Relevant to this Policy: None.