The Care and Feeding of Firefighters

     You respond to a working fire. It's 0600 and near-freezing outside; the building is a three-story apartment with occupants trapped. Several residents have inhaled some smoke, but there are no burns or major inhalation illnesses. The fire extends from the first floor into an open attic area. Firefighters began their work early, and about an hour in, a firefighter went down.

     What are EMS' responsibilities at a scene like this? The answer changed with the January introduction of NFPA 1584: Standard on the Rehabilitation Process for Members During Emergency Operations and Training Exercises. This National Fire Protection Agency standard culminates an effort begun in 2005 to update the Emergency Incident Rehabilitation manual published by the U.S. Fire Administration in 1992.

     The standard recognizes the benefit of on-scene recovery of fire personnel. Just 32 pages long, it's comprehensive and readable, with appendices and diagrams to facilitate implementation of rehabilitation programs. EMS agencies that work with fire services will want to obtain copies so that, working with fire leaders, they can develop compliant programs.

SAFER OPERATIONS
     Firefighting has tremendous physiologic demands with high levels of short-term physical stress. The workload includes moving quickly, wearing heavy equipment, climbing, lifting and breathing from a tank. An incident may require the energy equivalent of running a marathon. Scenes are hazardous, and deaths are common.

     The most frequent cause of on-duty firefighter death is not burns or injuries, but heart disease. Forty-five percent of firefighters who die at work do so from cardiac events, compared to 22% of police officers, 11% of emergency medical providers and 15% of all workers. Firefighters are most likely to die during and immediately after heavy exertion.

     There are three contributors to firefighter injuries and deaths: underlying medical conditions, inadequate physical fitness and incident-related exertion. NFPA has addressed these risks sequentially. NFPA 1582 sets standards for an occupational medical program for firefighters. NFPA 1583 describes member fitness program requirements. NFPA 1584 has been created to reduce scene risks related to exhaustion, overheating and inhalation of combustion products. The association between fatigue and injuries is not proven to date, but studies of other professions suggest fatigue can lead to poor judgment, injuries and even death.

     The implementation of NFPA 1584 is a commitment to developing a safer incident environment. Fire agencies that don't provide EMS will need to develop operating relationships with their regional EMS organizations to provide rehabilitation service. This will benefit EMS in building the dual-response framework for all incidents, and the standardized principles of rehabilitation will help it develop safer work environments for its members.

IMPLEMENTING 1584
     The standard mandates that all departments, regardless of geography or incident type, prepare a rehabilitation program that maximizes safety practices. The fire service almost always has its greatest activity at the extremes of weather, particularly unusual weather, so essentially, all departments must develop a program that functions across time, temperature, moisture, humidity, wind direction and availability of natural shelter.

     For smaller EMS and fire agencies, the rehab program will need to be developed using mutual aid agreements with neighbors. Departments that don't have internal EMS resources must establish an interagency agreement with the local provider. In planning across the involved agencies, the process, protocol and paperwork should be standardized, and the necessary equipment purchased and placed for timely deployment. Grant sources may assist in funding.