The National Fire Protection Association establishes the standards that unify fire service procedures and processes. The standards periodically are updated for new and innovative approaches to make the job safer and more efficient.

NFPA 1584 is the standard that sets the parameters for rehabbing members during emergency operations and training exercises. Its most recent revision included updates in five key areas: medical monitoring, NIMS terminology, definition standardization, standard operating procedures and firefighter lifestyle.

Medical monitoring
The revised standard acknowledges that vital signs alone cannot determine if a firefighter entering or in rehabilitation should receive further medical treatment. Instead, “any firefighter exposed to carbon monoxide or presenting with headache, nausea, shortness of breath, or gastrointestinal symptoms,” should be measured for CO poisoning by pulse CO-oximetry or other approved method. A non-invasive monitor uses an LED-based sensor to detect carbon-monoxide poisoning. Prompt diagnosis and treatment can limit the likelihood of long-term cardiac and neurological damage.

NIMS terminology
There has been great emphasis on the standardization of terminology for incident management. In an effort to maintain this consistency, the standard is compliant with NIMS terminology.

Definition standardization
Revised definitions ensure conformity among the seven health and safety standards for which the committee is responsible.

SOPs
The committee added a sample standard operating procedure for a rehabilitation process and information on the classification, signs, symptoms and treatment of heat stress and cold stress to the standard's annex. This enables chief officers to take the SOP and edit it to meet their departments' needs.

Firefighter lifestyle
The standard places a greater emphasis on firefighter nutrition, hydration and healthy lifestyle before emergency operations or training exercises.

Non-compliance

Rehabilitation is a key component in keeping firefighters healthy and safe, and fire chiefs ultimately are responsible for making it happen. Two incidents illustrate the importance of rehabilitation. The first resulted in two injured firefighters and the second in a firefighter death and subsequent National Institute of Occupational Safety and Health investigation.

On March 1, 1997, a municipal fire department in New Jersey responded to a house fire call. As the firefighters were en route, they heard police radio reports that people were jumping out of windows. When they arrived, firefighters found injured people lying on the pavement and a man hanging out of an attic window screaming, engulfed by smoke, his clothes burned, ready to jump 30 feet to the pavement. Eighteen residents were sent to area hospitals. Residents reported the possibility of more people trapped in the building that was engulfed by smoke and flames.

Firefighters aggressively fought the fire and searched for missing persons for approximately an hour before being given a rest period. At about 8:30 a.m., the next shift relieved them. After being relieved, the firefighters received medical evaluations from EMS personnel at the scene. Two firefighters had symptoms associated with smoke inhalation, which occurred during their search. They were taken to an emergency room for evaluation and treatment.

After investigating the incident, the New Jersey Occupational Health Surveillance Program recommended that firefighters be given supervised rest periods with appropriate frequency. The agency based this finding on NFPA 1500, Fire Department Occupational Safety and Health Program — which recommends that firefighters be given supervised rest periods, referred to as rehabilitation — and the U.S. Fire Administration's rehabilitation manual.

According to the New Jersey recommendations: “The provisions for a rehabilitation period should include: fluid and food replenishment; medical evaluation, treatment and monitoring; mental rest; and relief from extreme conditions. Supervisors should maintain an awareness of the condition of their subordinates and ensure that adequate steps are taken to provide for each member's safety and health. Firefighters also should advise their supervisors when they become fatigued to a point that could affect their performance. USFA recommends that the firefighters be given rehabilitation after two 30-minute-rated SCBA air tanks have been used, or after 45 minutes, whichever comes first.”

The second incident that emphasizes the need for rehabilitation occurred on Dec. 7, 1997. A 52-year-old male volunteer fought fire for four hours in a 200-year-old, 2-story log cabin. The cabin's heavy timber construction made overhaul difficult. Afterward, the volunteer returned to his quarters and later assisted with fund-raising activities. He left the fire station early because he was not feeling well.

The firefighter's wife found him in cardiac arrest when she arrived at home late that evening. He was pronounced dead 19 hours after fighting the fire. The death certificate lists coronary artery disease as a consequence of fatigue/exhaustion as the cause of death.

Legal obligations

Rehabilitation techniques and research have evolved in the 11 years since these incidents, but many fire departments still lack rehab sectors. Some claim that it costs too much to purchase the equipment necessary to fully implement NFPA 1584 standards. Others argue that non-compliance will bring no repercussions, particularly for training incidents.

But the liability of non-compliance has increased over time. Fire chiefs are responsible for supplying personnel with the resources necessary to perform safely at the scene of incidents. It also is essential that chiefs enforce the same performance standards during training. The same should be true for rehabilitation standards at a training evolution.

There are two factors to consider when determining compliance with the revised NFPA 1584. The first factor is a department's legal obligation and second — and even more compelling — is chiefs' responsibility to provide safeguards for personnel.

In recent years, the fire service has been the subject of more and more lawsuits. A lawsuit relating to rehab mostly likely would allege deprivation of rights under Section 42 U.S.C. 1983 of the Civil Rights Act, claiming that the fire department failed to implement improvements identified in prior incidents.

In the 2005 case of Estate of Phillips v. District of Columbia, the families of two deceased firefighters alleged a violation of "constitutional rights" and "intentional torts," claiming senior fire officials had a "policy and custom" of not improving fireground operations and had ignored operations shortcomings identified after an earlier unrelated firefighter fatality.

The rehabilitation standard has been out for a number of years, and fire chiefs have a legal obligation to improve fireground operations. The revised NFPA 1584 provides chiefs the guidance to develop a rehabilitation program to help protect firefighting personnel.

This revision is really a lifestyle habit that personnel need to commit to adopting. Senior fire department officials must lead by example and adopt the same lifestyle changes that they are requesting of their personnel. In addition, officers should provide the necessary education to personnel so they understand how to adopt a healthy lifestyle. Departments should provide appropriate hydration and food at the scene of incidents and training exercises. This means at the next training session, instead of serving donuts and coffee, departments should consider fruit and healthy-carbohydrate food.

Regardless of the legal implications as a result of non-compliance, chief officers have vowed to provide a safety net for personnel. The most important asset of any organization is its personnel. Chiefs should provide their personnel with the tools to ensure their safety.

Jeffrey T. Lindsey, Ph.D., EMT-P, CHS IV, is the director of graduate studies at George Washington University in Washington, D.C. He also is the education coordinator for 24-7 EMS. Lindsey has more than 29 years of experience in the emergency services and retired as fire chief from Estero (Fla.) Fire Rescue.

Related Stories

• USFA and IAFF to Study Firefighter Rehab
• A silent killer strikes the fireground

For More Info

• International Association of Fire Fighters Emergency Rehabilitation Program
• National Volunteer Fire Council Health and Wellness Guide
• Fire Service Joint Labor Management Wellness-Fitness Initiative
• NFPA 1584, Rehabilitation Process for Members During Emergency Operations and Training Exercises
• New Jersey Occupational Health Surveillance Program Firefighter Injury Project Investigation Report
• NIOSH Firefighter Fatality Investigation: Volunteer Fire Fighter Dies of a Heart Attack after Conducting Firefighting Activities at a Single Family Log Cabin Dwelling-Virginia
• USFA "Emergency Incident Rehabilitation" Manual