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5 LEVEL Steps to proper Incident Rehab

Emergency Incident Rehabilitation or EIR, is a complex and life saving operation on any emergency scene. Successful EIR means integrating firefighting personnel and emergency medical services. By its nature, EIR is a multidisciplinary activity that is often dismissed by agency leaders and company officers alike. Just getting responders to participate in the rehab process can be difficult.

Starting your EIR and being prepared to function properly is key. In order to keep all the considerations for setting up EIR in mind, I had come up with a way to make the decision-making process more universal (that is, less specific to rehab) so that the same decision-making process for setting up rehab could be used for establishing just about any other days of operation.

Similar to the way we use LOCATE for situational assessment (here for audio, here for text) , try the acronym LEVEL (Location, Estimate number of responders, Vehicles, Environment, and Leadership). You can apply this decision-making model and Rule of Outcomes thinking to nearly any situation. LOCATE is another system to guide responders on assessing the patient, the scene, and as a decision making aid

Location. EIR (or any other base of operations) needs to be established an area that is free from fumes, smoke, or any other hazardous environment. I think the reasons for this are obvious…to put  responders who are in need of incident rehabilitation in an area where they will continually be exposed to carbon monoxide or other products of combustion is counterproductive. Keep in mind that this includes exhaust from running vehicles and generators. Access and egress points are also important when choosing a location for emergency incident rehabilitation and maintaining way in, one way out.

Estimate Number of Responders. Many emergency incidents of  are mass casualty incidents waiting to happen. The successful rehabilitation operation will be able to flex and expand to include traditional as well as nontraditional responders. Remember, anyone on that scene may find themselves in need of rehabilitation and or medical care. That goes for nontraditional responders such as utilities and media personnel as well as fire and emergency services personnel. When you estimating the number of responders you should include the personnel needed for rehab, traditional responders (fire/EMS/police) from your agency and outside agencies, and nontraditional responders. Estimating the Number of Responders is an important factor in proper staffing for your EIR.

Vehicles. Every incident rehab operation will be impacted by vehicle placement. Your need to bring in additional vehicles (transporting ambulances, trailers) is also a consideration. You'll need to maneuver around these vehicles, hose, and various other obstacles to gain access to or move victims on a gurney. Likewise, you must estimate the number of transport vehicles you'll need on scene and those you'll stage away from the situation. You should also consider the need for special call vehicles such as mass casualty trailers and command posts vehicles. 

Environment. This is perhapse the most overlooked component in any operation. The environment (and changes) will largley determine how and where you set up your EIR. The environment will also give you clues on how to best estimate secondary impact (heat or cold stress) on responders. Keep in mind the environment can change...better or worse. The functional EIR will institute its own Action Plan that accounts for changes in weather conditions and prepares accordingly.

Leadership. Leadership in EIR can be a tricky spot. You're expected to manage a multi-discipline group of EMT's and Paramedics, integrate EMS into the ICS and personnel accountability system, act on physical findings that may preclude valuable firefighting personnel from returning to work, manage any other casualties that come along, and do so while operating in the background or the ICS. Leading the EIR requiers appropriate knowledge of ICS and accountability systems. You must also have a basic understanding of fire ground tactics and standard operation practices.

I feel that Emergency Incident Rehabilitation (EIR) is one of the most critical components of any emergency incident operation. Unfortunately, EIR is also one of the most overlooked and under appreciated concepts on the emergency scene. Emergency Incident Rehabilitation is not to be reserved for fire scenes. EIR should be considered at any prolonged event including technical rescue, MVC, or even a routine event.