NFPA 1584 Rehabilitation Process for Members During Emergency Operations and Training Exercises

NFPA 1403, Standard on Live Fire Training Evolutions, 2018 edition.

NFPA 1500™, Standard on Fire Departmen t Occupational Safety, Health, and Wellness Program, 2021 edition.

NFPA 1561, Standard on Emergency Services Incident Manage­ment System and Command Safety, 2020 edition.

NFPA 1583, Standard on Health-Related Fitness Programs for Fire Department Members, 2022 edition.

NFPA 1851, Standard on Selection, Care, and Maintenance of Protective Ensembles for Structural Fire Fighting and Proximity Fire Fighting, 2020 edition.

NFPA 472, Standard for Competence of Responders to Hazardous Materials/Weapons of Mass Destruction Incidents, 2018 edition.

NFPA 1500™, Standard on Fire Departmen t Occupational Safety, Health, and Wellness Program, 2021 edition.

NFPA 1521, Standard for Fire Department Safety Officer Professio­nal Qualifications, 2020 edition.

NFPA 1561, Standard on Emergency Services Incident Manage­ment System and Command Safety, 2020 edition.

NFPA 1851, Standard on Selection, Care, and Maintenance of Protective Ensembles for Structural Fire Fighting and Proximity Fire Fighting, 2020 edition.

Basic Life Support (BLS).

A specific level of prehospi­tal medical care provided by trained responders, focused on rapidly evaluating a patient’s condition; maintaining a patient’s airway, breathing, and circulation; controlling external bleed­ing; preventing shock; and preventing further injury or disabil­ity by immobilizing potential spinal or other bone fractures.

• A group of members (1) under the direct supervision of an officer; (2) trained and equipped to perform assigned tasks; (3) usually organized and identified as engine companies, ladder companies, rescue companies, squad companies, or multi-functional companies; (4) operating with one piece of fire apparatus (pumper, aerial fire apparatus, elevating platform, quint, rescue, squad, ambulance) except where multiple apparatus are assigned that are dispatched and arrive together, continuously operate together, and are managed by a single company officer; (5) arriving at the inci­dent scene on fire apparatus. [1500, 20211
• Harmful, irritating, or nuisance material foreign to the normal atmosphere. [1500, 20211
• The accumulation of products of combustion and other hazardous materials on or in an ensem­ble element that includes carcinogenic, toxic, corrosive, or allergy-causing chemicals, body fluids, infectious microorgan­isms, or [chemical, biological, radiological, and nuclear defense] CBRN terrorism agents. [1851, 2020]
• Active Cooling. The process of using external meth­ods or devices (e.g., hand and forearm immersion, misting fans, ice vests) to reduce elevated core body temperature.
• Passive Cooling. The process of using natural evapo­rative cooling (e.g., sweating, doffing personal protective equipment, moving to a cool environment) to reduce eleva­ted core body temperature.

Core Body Temperature.

The temperature deep within a living body.

• A team of two or more fire fighters. [1500, 2021 ]
• Emergency Incident. Any situation to which an emer­gency services organization responds to deliver emergency serv­ices, including rescue, fire suppression, emergency medical care, special operations, law enforcement, and other forms of hazard control and mitigation. [1561, 2020]
• Emergency Medical Care. The treatment of patients, using first aid, cardiopulmonary resuscitation, basic life support, advanced life support, and other medical protocols prior to arrival at a hospital or other health care facility.
• Emergency Medical Services. The provision of treat­ment, such as first aid, cardiopulmonary resuscitation, basic life support, advanced life support, and other pre-hospital proce­dures including ambulance transportation, to patients. [1500, 2021]
• Emergency Operations. Activities of the fire depart­ment relating to rescue, fire suppression, emergency medical care, and special operations, including response to the scene of the incident and all functions performed at the scene. [1500, 2021]
• Energy Drink. A type of beverage containing stimulant drugs (caffeine and other ingredients such as taurine, ginseng, and guarana) that is marketed as providing mental or physical stimulation.
• Gross Decontamination. A term used in the hazardous materials response industry to indicate the partial removal of exterior contamination from protective clothing, usually by rinsing with water, sometimes with detergent, to allow for the safe exit of the responder from the protective clothing in the contamination reduction zone of an emergency incident. [1851,20201

Hydration.

The introduction of water in the form of food or fluids into the body.

Incident Commander (IC).

The individual responsible for all incident activities, including the development of strat­egies and tactics and the ordering and the release of resources. [472, 20181

Incident Management System (IMS).

A system that defines the roles and responsibilities to be assumed by respond­ers and the standard operating procedures to be used in the management and direction of emergency incidents and other functions. [1561, 20201

• An emergency responder who is provided emergency medical care during the rehabilitation process.
• Personnel Accountability System. A system that readily identifies both the location and function of all members oper­ating at an incident scene. [1500, 20211
• Physical and lifestyle preparation strat­egies to increase capability and capacity, reduce the potential for injury, and improve readiness in anticipation of an upcom­ing stressor.

Preliminary Exposure Reduction.

Techniques for reducing soiling and contamination levels on the exterior of protective clothing and equipment following incident opera­tions. This is not the same as cleaning or decontamination.

• An organizational directive issued by the authority having jurisdiction or by the department that estab­lishes a specific policy that must be followed. [1561, 2020]
• The process of returning a member’s physio­logical and psychological states to levels that indicate the person is able to perform additional emergency tasks, be reas­signed, or released without any adverse effects.

Rehabilitation.

An intervention designed to mitigate against the physical, physiological, and emotional stress of fire- fighting in order to sustain a member’s energy, improve performance, and decrease the likelihood of on-scene injury or death.

• Rehabilitation Manager. The person or officer assigned to manage rehabilitation.
• Sports Drink. A fluid replacement beverage that is between 4 percent and 8 percent carbohydrate and contains between 0.5 g and 0.7 g of sodium per liter of solution.
• Standard Operating Guideline. A written organiza­tional directive that establishes or prescribes specific opera­tional or administrative methods to be followed routinely, which can be varied due to operational need in the perform­ance of designated operations or actions. [1521, 20201

4.1.1.1* The fire department shall develop standard operating procedures/guidelines (SOP/Gs) that outline a systematic approach for the prehabilitation, contamination control, reha­bilitation, and recovery of members operating at incidents and training exercises.

4.1.1.2* These SOP/Gs shall, at a minimum, address the following:

• Relief from climatic conditions
• Processes for contamination reduction prior to rehabilita­tion
• Active and/or passive cooling or warming as needed for incident type and climate conditions
• Rehydration (fluid replacement)
• Calorie and electrolyte replacement
• Medical assessment
• Emergency medical services (EMS) treatment in accord­ance with local protocol
• Member accountability
• Member release disposition from rehabilitation (reassign­ment, EMS evaluation, or post-incident recovery)

4.1.1.3* Crews shall be rotated as necessary to allow for reha­bilitation.

• Protocols and procedures guiding fire department and other emergency services personnel who care for ill or injured members during emergency operations shall be developed by the EMS medical director in collaboration with the fire depart­ment physician and fire chief.
• Procedures shall be in place to ensure that contamina­tion control, rehabilitation, and recovery efforts commence whenever emergency operations or training activities pose the risk of members becoming exposed to contaminants and/or exceeding a safe level of physical or mental endurance.

4.1.4* The fire department shall develop SOP/Gs that outline a systematic approach to post-incident recovery in order to return a member to where they can safely perform additional emergency tasks, be reassigned, or be released from duty.

4.1.4.1 These SOP/Gs shall include, but are not limited to, the following:

• On-scene contamination reduction
• Criteria for release to post-incident recovery
• Post-incident requirements to return to service
• Mental and physical rest periods
• Post-incident hydration and nutrition
• Sleep deprivation recognition and prevention
• Recognition and response to potentially traumatic events
• Recognition of Heat/Cold Stress.
• All members shall be provided with information on how the body regulates core temperature, how to recognize the signs and symptoms, and how to utilize controls for heat and cold stress. (See Annex B.)
• Education shall be provided on wild chill and heat index considerations.
• Education shall be provided on the importance of proper hydration, nutrition, and rest.
• Member Prehabilitation.

4.3.1* Members shall maintain proper hydration, nutrition, and rest to maintain normal body function.

4.3.2* Members shall maintain a physical fitness regime in accordance with NFPA 1583 as a prehabilitation strategy for incident response demands.

• Members assigned to incident response duties shall not engage in activities that may diminish their ability to safely perform the essential job tasks.
• Members engaged in nonincident strenuous physical activities shall be allowed recovery time prior to returning to in- service status for incident response.
• When a physically demanding event is scheduled (train­ing/drill), members shall engage in pre-event warm-up activi­ties to help prevent injuries.

4.3.6* The department shall develop and implement SOP/G’s to provide strategies to manage the effects of acute and chronic sleep and circadian rhythm disruption that lead to sleep depri­vation, fatigue, and other adverse health effects.

Preliminary Exposure Reduction

5.1.1* Preliminary exposure reduction activities shall be implemented whenever members are exposed to a contami­nant during incident operations or training exercises that pose a potential safety or health risk to members.

• Incident-related life safety, rescue, fire control, and patient care shall take priority over preliminary exposure reduction.
• Preliminary exposure reduction activities shall be completed prior to rehabilitation or demobilization from the incident but shall not interfere with fireground priorities.
  • Hazard Control Zones.
    • Hazard control zones shall be established in accordance with NFPA 1500 whenever the potential for contamination exists.
    • The perimeters of the hazard control zones shall be designated and communicated by the incident commander and marked when possible.
    • The incident commander shall ensure that the protec­tive clothing and equipment requirements of each control zone are commensurate with the hazards in the zone.

5.2.3.1 All officers and members shall ensure the use of personal protective equipment is appropriate for the risks encountered in each zone.

• The process of utilizing hazard control zones shall continue until the incident hazards have been mitigated or the incident is over.

5.2.5* A no-entry zone is an area at an incident scene that no person (s) shall be permitted to enter due to imminent hazard(s), dangerous conditions, or the need to protect evidence.

5.2.6* The hot zone is the area presenting the greatest risk of contamination to members.

5.2.6.1 All members shall wear appropriate PPE for the risks that might be encountered while in the hot zone.

5.2.7* The warm zone shall serve as a limited access area where contamination reduction activities are implemented if the threat of cross-contamination persists.

5.2.7.1 Preliminary exposure reduction shall be conducted in the warm zone.

5.2.8* A cold zone shall be established outside the area where contamination is being mitigated.

Contamination Reduction.

5.3.1* When protective clothing or equipment has become soiled or contaminated, members shall carry out preliminary exposure reduction followed by advanced or specialized clean­ing in accordance with NFPA 1851.

5.3.1.1* Dry or wet mitigation techniques shall be conducted prior to the removal of any ensemble or ensemble elements.

5.3.2* Members shall remain on supplied air or other appro­priate respiratory protection during preliminary exposure reduction.

5.3.2.1 Members assisting with preliminary exposure reduc­tion shall use appropriate protective clothing, including respi­ratory protection.

• Incidents where known hazardous materials, industrial chemicals, or asbestos are involved shall require a decontami­nation or disposal process for the hazards encountered.
• Preliminary exposure reduction of proximity firefighting ensembles and ensemble elements shall comply with the requirements in NFPA 1851.
• Personnel shall doff contaminated protective clothing prior to entering the cold zone.

5.3.6* Following mitigation, potential contaminated and exposed items (PC&E) shall be isolated and bagged prior to entering the cold zone or being transported away from the scene.

On-Scene Personal Hygiene.

5.4.1* Immediately after doffing contaminated protective equipment, and prior to entering the cold zone, personnel shall wipe all exposed skin areas with soap and water or an appropriate skin wipe if soap and water are not available.

Incident Scene and Training Rehabilitation

6.1 Criteria for Implementation. Rehabilitation shall be provi­ded in accordance with fire department standard SOP/Gs, NFPA 1500, and NFPA 1561.

• Rehabilitation shall commence whenever the physical or mental demands of an incident operation or training exercise poses a potential safety or health risk to members.

6.1.1.1* Rehabilitation at small-scale and routine incidents shall be crew-based, also known as self-rehab.

6.1.1.2* Rehabilitation shall be formalized into a rehabilita­tion group based on the incident size, scope, duration, or complexity

• Members shall be assigned to rehabilitation as prescri­bed by departmental SOP/Gs.

6.1.3* Emergency medical services (EMS) practitioners in rehabilitation shall have the authority, as delegated by the inci­dent commander, to use their professional judgment to keep members in rehabilitation or to transport them for further medical evaluation or treatment.

6.1.4* Members shall undergo rehabilitation following the use of a self-contained breathing apparatus (SCBA) cylinder, or after 40 minutes of intense work without SCBA.

6.1.4.1 A supervisor shall be permitted to adjust the require­ments in 6.1.4 in order to address incident-related life safety, rescue, and patient care.

6.1.4.2* Crews shall be rotated as necessary to allow for reha­bilitation.

6.1.4.3 For incidents, training, and exercises involving train­ing fires, crew rotation shall be in accordance with NFPA 1403.

• Responsibilities of the Incident Commander.
• The incident commander (IC) shall ensure that a reha­bilitation group is established when indicated.
• The IC shall assume the rehabilitation responsibility if it is not delegated.
• The IC shall consider the circumstances of each incident and make adequate provisions early in the incident for the rest and rehabilitation of all members operating at the scene.
• Responsibilities of the Supervisor.

6.3.1 Supervisors shall maintain an awareness of the physical and mental conditions of each member operating within their span of control and ensure adequate steps are taken to provide for each member’s safety and health.

6.3.2* Supervisors shall ensure that members remain hydrated and that potable fluids are available.

• Supervisors shall continuously assess their crew members to determine their need for rehabilitation.
• Company officers shall assess incident demobilization and post-incident recovery processes and ensure their members are ready to return to service.
• Responsibilities of the Rehabilitation Manager.
• When formal rehabilitation is established, the rehabilita­tion manager shall be responsible for all rehabilitation activi­ties.
• The rehabilitation manager shall designate responder rehabilitation location (s) and have the location(s) communica­ted to incident personnel.

6.4.2.1 The rehabilitation manager shall ensure that the loca­tion (s) include a gateway and process for contamination reduc­tion prior to rehab entry.

6.4.3* The IC or rehabilitation manager shall identify those resources that might be needed at the rehabilitation location.

• The rehabilitation manager shall request necessary medical personnel to evaluate symptomatic members being rehabilitated.
• EMS personnel shall be alerted for members with any of the following:
  • * Chest pain, dizziness, shortness of breath, weakness, nausea, or headache
  • Ceneral complaints, such as cramps, aches, and pains
  • Symptoms of heat- or cold-related stress (see Annex B)
  • Changes in gait, balance, coordination, speech, or behav­ior
  • Alertness and orientation to person, place, and time of members
• Minimum list of symptoms and shall not replace good judgment, experience, and training.
• The rehabilitation manager shall request necessary resources for rehabilitation of personnel.
• The rehabilitation manager shall release personnel for reassignment or for demobilization and post-incident recovery following rest and recovery.
• The rehabilitation manager shall release those individu­als needing additional medical care to EMS.
• The rehabilitation manager shall maintain the accounta­bility of all personnel in the rehabilitation location.
• The rehabilitation manager shall maintain appropriate records and documentation.
• Responsibilities of the Member.
• Members shall participate in rehabilitation activities when assigned.
• Members shall maintain their hydration.
• Members shall advise their company officers when they believe their level of fatigue or exposure to heat or cold is approaching a level that could negatively affect them, their crew, or the operation in which they are involved.
• Members shall remain aware of the health and safety of other members of their crew.
• Formal Rehabilitation Location Characteristics.

6.6.1* Formal rehabilitation shall be located in the cold (clean) zone.

6.6.1.1 The location shall include a gateway and a process for contamination reduction prior to PPE doffing.

• The location shall provide protection from the prevail­ing environmental conditions.
• For hot environments, the location shall include shade and/or air-conditioning and a place to sit.
• For cold or wet environments, the location shall provide dry, protected areas out of the wind, heated areas, and a place to sit.
• The location shall be free of exhaust fumes from appara­tus, vehicles, or equipment.
• The location shall be large enough to accommodate multiple crews and rehabilitation personnel, based on the size of the incident.
• The location shall allow access for EMS to transport members to a medical treatment facility when necessary.
• When the size of the operation or geographic barriers limit members’ access to the rehabilitation area, the incident commander shall establish more than one rehabilitation area.

6.6.7* Each rehabilitation area shall be given a geographic name consistent with its location at the incident site.

• Rehabilitation Efforts. Rehabilitation efforts shall include providing the following:
  • Relief from climatic conditions
  • Rest and recovery
  • Active and/or passive cooling or warming as needed for incident type and climate conditions
  • Rehydration (fluid replacement)
  • Calorie and electrolyte replacement, as appropriate, for longer duration incidents (see 6.8.4)
  • Medical treatment when indicated
  • Member accountability
  • Member release disposition from rehab (reassignment, EMS evaluation, or post-incident recovery)
    • Rest and Recovery Criteria.

Members shall rest for a minimum of 20 minutes following the use of an SCBA cylinder or after 40 minutes of intense work without SCBA.

The member shall not return to operations in the following situations:

• If the member does not feel adequately recovered
• If EMS or supervisory staff present see evidence of medi­cal, psychological, or emotional distress
• If the member appeal’s otherwise unable to safely perform his or her duties

Cooling and Warming.

6.8.1* Members who feel warm or hot shall remove protective clothing, drink fluids, and apply active and/or passive cooling as needed for the incident type and climate conditions.

• Members with cold-related stress shall be moved to a warm environment, remove any wet or damp clothing, and add additional warming layers, blankets, or use other methods to regain normal body temperature.

6.8.3* Members entering rehabilitation shall consume fluids, regardless of thirst, during rehabilitation and be encouraged to continue hydrating after the incident.

6.8.3.1* Members shall avoid overhydration, which can lead to hyponatremia.

6.8.4* Departments shall ensure that appropriate calorie and electrolyte replacements are available.

Emergency Medical Care.

6.9.1* During incident scene operations, transport-capable basic life support (BLS) EMS shall be on-site as part of the inci­dent scene rehabilitation for the evaluation and treatment of symptomatic members.

• During training exercises, basic life support (BLS) personnel and equipment shall be on-site.
• For live fire training in acquired structures, emergency medical services with transport capabilities shall be available in accordance with NFPA 1403.
• For all other training activities, the instructor-in-charge shall evaluate the need for on-site transport capabilities based on a risk assessment of the training activity.
• EMS personnel shall evaluate members with symptoms suggestive of a health and/or safety concern.
• Members with abnormal signs or symptoms shall be removed from active duty until cleared by the appropriate medical personnel.

6.9.4.1 Symptomatic members shall be treated and transpor­ted in accordance with local EMS protocol.

6.9.4.2* Symptomatic members exposed to fire smoke shall be assessed for carbon monoxide poisoning.

• EMS personnel shall be alert for the following:
  • * Personnel complaining of chest pain, dizziness, shortness of breath, weakness, nausea, or headache
  • General complaints, such as cramps, aches, and pains
  • Symptoms of heat- or cold-related stress (see Annex B)
  • Changes in gait, speech, or behavior
  • * Alertness and orientation to person, place, and time of members
• Rehabilitation Disposition.
• The rehab manager or their designee shall determine when a member or company can be as follows:
  • Cleared for further incident assignment or demobiliza­tion
  • Maintained in rehabilitation for further rest and recovery
  • Transported for more definitive medical evaluation/treat­ment
• Members being released from rehabilitation shall confirm their accountability with the rehabilitation manager.

6.11.1* A rehabilitation documentation report shall be created and include the following information:

• Unit number
• Member name
• Time-in/time-out for members/crews entering or leaving the rehabilitation area
• If the member is referred for medical evaluation
• Rehab disposition

6.11.2 When emergency medical care is provided, the inci­dent commander and the health and safety officer shall be notified.

• Wildland Incidents. (Reserved)
• USAR Incidents. (Reserved)
• Special Operations Incidents. (Reserved)

Post-Incident Recovery

• Personnel and crews released from the incident shall follow a demobilization process that includes the following:
  • Communication of post-incident status
  • Time for post-incident personal hygiene
  • A plan for station, apparatus, protective clothing, and equipment decontamination
  • Identification of potentially traumatic events
  • Completion of exposure reporting
• Post-Incident Status.

7.2.1 Crews released from an incident scene for post-incident recovery shall be deemed one of the following:

• In service
• Limited availability
• Out of service

7.2.2* Post-incident recovery shall include, as needed, the following:

• Personal hygiene
• Rest
• Hydration
• Nourishment
• Securing clean personal protective clothing
• Changing into clean clothing
• Addressing behavioral health needs, as appropriate
• Returning the apparatus to service

7.2.3 Company officers shall determine when post-incident recovery has been completed prior to returning the company to service.

Post-Incident Personal Hygiene.

• Members exposed to fireground contamination shall take a warm (not hot) shower using a mild soap as soon as possible upon return to quarters.
• Members shall dress in clean clothing after a shower.
• Soiled or contaminated clothing shall be handled with nitrile examination gloves before laundering.

7.3.3.1* Cleaning of clothing worn during incidents where members were exposed to contaminants shall be laundered separately from non-exposed clothing.

• Station, Apparatus, Protective Clothing, and Equipment Decontamination.
• Personal protective equipment exposed to fireground contamination shall be decontaminated in accordance with NFPA standards and manufacturer recommendations.
• Soiled or contaminated equipment shall be stored and cleaned or disinfected away from living, sleeping, or eating areas.

7.4.3* Cleaning and decontamination of apparatus and equip­ment shall be done wealing nitrile examination gloves.

• Potentially Traumatic Events.
• Supervisors and members shall monitor members for signs of post-incident stress.

7.5.1.1 Following occupational exposure to potentially trau­matic events or signs of post-incident stress, assistance or inter­vention shall be offered in accordance with department policies and Chapter 13 of NFPA 1500.

• If one or more of the crew members is seriously injured or killed during the incident, all members of the crew shall be removed from emergency responsibilities at the incident as soon as possible.

7.5.2.1 Behavioral health services shall be made available to all members of the department.

• Exposure Reporting. Following a possible exposure to toxic substances or harmful biological, chemical, or physical agents, the appropriate exposure report(s) shall be completed.

7.6.1 Members that experience symptoms associated with occupational exposure to toxic substances or harmful biologi­cal, chemical, or physical agents shall request medical evalua­tion and report the exposure to their supervisor for appropriate exposure report documentation.

7.6.2* An incident exposure report shall be utilized to docu­ment the possible exposure to toxic substances or harmful biological, chemical, or physical agents during an incident or response.

7.6.2.1 The incident exposure report shall be completed as part of an electronic incident reporting system where respond­ing members are linked with the incident response record.

7.6.3 A personal exposure report shall be utilized by the member to document an exposure or an injury related to expo­sure to toxic substances or harmful biological, chemical, or physical agents.

7.6.3.1* A personal exposure report shall be completed by the member following an exposure to toxic substances or harmful biological, chemical, or physical agents during a training exer­cise or an incident or response.

7.6.3.2 Following a training event or other nonincident- related exposure where toxic substances or harmful biological, chemical, or physical agents are present, a personal exposure report shall be completed by the member.

7.7 Exposure Report Retention and Access.

7.7.1* Exposure reports shall be retained by the fire depart­ment for 30 years.

7.7.2 The fire department shall provide member access to their exposure records.

Process Implementation (Reserved)

 Explanatory Material

Annex A is not a part of the requirements of this NFPA documen t but is included for informational purposes only. This annex contains explan­atory material, numbered to correspond with the applicable text para­graphs.

A.3.2.1 Approved. The National Fire Protection Association does not approve, inspect, or certify any installations, proce­dures, equipment, or materials; nor does it approve or evaluate testing laboratories. In determining the acceptability of installa­tions, procedures, equipment, or materials, the authority having jurisdiction may base acceptance on compliance with NFPA or other appropriate standards. In the absence of such standards, said authority may require evidence of proper instal­lation, procedure, or use. The authority having jurisdiction may also refer to the listings or labeling practices of an organi­zation that is concerned with product evaluations and is thus in a position to determine compliance with appropriate standards for the current production of listed items.

A.3.2.2 Authority Having Jurisdiction (AHJ). The phrase “authority having jurisdiction,” or its acronym AHJ, is used in NFPA documents in a broad manner, since jurisdictions and approval agencies vary, as do their responsibilities. Where public safety is primary, the authority having jurisdiction may be a federal, state, local, or other regional department or indi­vidual such as a fire chief; fire marshal; chief of a fire preven­tion bureau, labor department, or health department; building official; electrical inspector; or others having statutory author­ity. For insurance purposes, an insurance inspection depart­ment, rating bureau, or other insurance company representative may be the authority having jurisdiction. In many circumstances, the property owner or his or her designa­ted agent assumes the role of the authority having jurisdiction; at government installations, the commanding officer or depart­mental official may be the authority having jurisdiction.

A.3.3.3 Basic Life Support (BLS). Basic life support could also include expediting the safe and timely transport of the patient to a hospital emergency department for definitive medical care. Basic life support generally does not include the use of drugs or invasive skills.

A.3.3.8 Core Body Temperature. There is no single core temperature, as temperature varies from one site to another, but valid measures of core body temperature approximate the temperature of the central blood. Clinically measured sites to approximate core body temperature include the rectum, gastrointestinal tract, and bladder. Accurate measurement of core body temperature is not possible on the fireground. Commonly used sites for determining body temperature include the oral cavity and tympanic membrane. However, the temperatures taken from these sites may differ considerably from actual core temperature. See Sawka and Pandolf, “Physi­cal Exercise in Hot Climates: Physiology, Performance, and Biomedical Issues.”

A.3.3.16 Hydration. Dehydration is the loss of body fluid, or a negative fluid balance. The magnitude of dehydration can vary tremendously following strenuous activity in the heat. Dehydra­tion can cause impairment of thermoregulation, decreased physical performance, increased cardiovascular strain, and a disruption of blood chemistry.

A.3.3.18 Incident Management System (IMS). The system is also referred to as an incident command system (ICS).

A.3.3.19 Member. A fire department member can be a full- time or part-time employee, can be a paid or unpaid volunteer, can occupy any position or rank within the fire department, and can engage in emergency and non-emergency operations. [1500,20211 “

A.3.3.24 Preliminary Exposure Reduction. This term describes the exposure reduction process that is utilized for regular exposure in day-to-day operations and training. This is not designed for the increased exposure at a hazardous materi­als incident.

A.3.3.27 Rehabilitation. Rehabilitation efforts should include providing relief from extreme climate and/or incident condi­tions, rest and recovery, rehydration, replacement of calories and electrolytes (as needed for scheduled activities of moder­ate to high intensity and lasting 1 hour or longer), active and/or passive cooling as needed for incident type and climatic conditions, and member accountability and medical treatment, if indicated.

A.3.3.31 Standard Operating Procedure. The intent of stand­ard operating procedures is to establish directives that must be followed. Standard operating guidelines allow flexibility in application. [1521, 2020]

A.4.1.1.1 This procedure should include the following elements of the rehabilitation process:

• Initiate rehabilitation
• Responsibilities
• Accountability
• Safety
• Release