2023

Author(s): Woodbury B, Merrill SA

Historically, firefighting has been a hazardous profession and in response, many departments and national organizations have adopted rehabilitation protocols to minimize excess risk. Fire rehab is a coordinated plan to ensure firefighters, who encounter extremes of temperature, exposure, and exertion, do not develop significant illnesses related to exertion or exposure. Fire rehab can vary from simple temperature management and oral rehydration to aggressive medical treatments and transport to a higher level of care.  Fire rehab is continually evolving as our understanding of physiologic responses to exertion and exposure change, technologies evolve, and risk tolerance adjusts. Fire rehab services have a varying structure, depending on the service and the region. Small, rural fire services may have few responders with medical training and coordinate with local EMS agencies to assist or oversee rehab.  Some fire services have a sufficient number of trained EMS providers and coordinate their own rehab, including transport to health care facilities. Large services may have highly scalable rehab plans that include multiple rehabilitation units operating under a coordinating officer.  Over the years, a group of central resources has been created that provides education and guidance on fire rehab. In 1987, the National Fire Protection Association (NFPA) released its Standard on Fire Department Occupational Safety and Health Program, which comprehensively addressed common dangers and protective measures for firefighters. In 1992, the U.S. Fire Administration (USFA) published the short report FA-114, Emergency Incident Rehabilitation, which included a sample standard operating procedure (SOP) for fire rehab. A textbook bearing the same title was released in 1997, providing further details of the science and reasoning for the fire rehab protocols. USFA published an updated SOP, and much more comprehensive, report on Emergency Incident Rehabilitation in 2008.  NFPA 1584, Recommended Practice on the Rehabilitation of Members Operating at Incident Scene Operations and Training Exercises was issued in 2003, establishing guidelines for fire services. These recommendations were upgraded to standards in a 2008 update and again updated in 2015, with carbon monoxide monitoring added to recommended practices.  It is important to delineate that fire rehabilitation, when discussed in the context of wildfires, relates to the ecological recovery of an affected area, not the physiological recovery of humans working to contain fires. The subject of the ecological recovery after a wildfire is addressed in other literature and will not be covered in this article.