Large Incident Rehab Training Meeting - May 3, 2012

Post date: May 4, 2012 5:21:33 PM

13 C.E.R.T. members attended our Large Incident Rehab training session presented by Tim Phelan, the Medical Coordination Center Coordinator for University Hospital Emergency Medical Services in Newark, NJ. The training started with an overview of the equipment, resources, and capabilities of the NJ EMS Task Force and the history of the group including deployments and training exercises they have lead and participated in.

The second half of the training focused on the purpose and execution of a Large Incident Rehab group at a medium or long duration emergency incident. The notes from the second half of the talk are posted below.

1. Medical Unit
   1. Would operate under the Logistical Area, Services Branch
   2. Specifically for responders, victims would be handled in the Operations Area
   3. Ensure the physical and mental condition of members operating at the scene.
   4. Time for rest and recovery, hydration, medical monitoring, and receive nutritional support in the form of solid food
2. Why is Medical Unit Necessary
   1. Emergency Service Providers are often required to work in a hostile environment
   2. With little to no notice, no time for warm up
3. Physiology
   1. Hydration Requirements
      1. 60-70% of the body is water
      2. Excessive fluid loss must be replaced by oral intake
      3. Loss of 2% of body weight can cause confusion and inhibit coordination
         1. 2% of 200lb is 4lbs
      4. 4% mental reasoning and physical ability
         1. 4% is 8lbs
   2. Electrolytes
      1. Sodium, potassium, calcium, and magnesium
      2. Lost along with water
      3. Excessive loss can cause the lost of proper muscle functioning
         1. Commonly seen in heat cramps
   3. Carbohydrates are the bodies main source of energy
      1. Simple carbohydrates include sugars
         1. Found in fruits and honey
      2. Complex carbs are molecules made up of three or more sugars
         1. Bread, Pasta, Potatoes, PB
         2. Once ingested convert to simple sugars
         3. Must be replaced as they are consumed via exertion
4. The Rehab Group
   1. Who is responsible for establishing rehab
      1. Incident commander establishes
      2. All members must notify IC if it is needed
   2. What
      1. Responders are sent for period of rest
      2. Fluids
      3. Monitor vitals
      4. Food during extended operations
   3. When
      1. Any time incident is of extended duration, physically, mentally or emotionally taxing, or at times of extreme environmental conditions
      2. The two air bottle rule
         1. Rotate through rehab after using 2 30 minute air bottles or 45 minutes of work time
      3. During extreme conditions more frequent breaks may be necessary
      4. Should remain in rehab for a minimum of 20 minutes
   4. Where
      1. Close enough to the scene to allow immediate access
      2. Safe area far enough away to remove protective clothing
      3. Shielded from sights and sounds of the incident to allow emotional and physical rest
      4. Protection from the elements and environmentally controlled
   5. How
      1. EMS function under control of Logistics Area, Medical Group
      2. Staffed by a min of 2 EMT-B level providers
      3. Dedicated to this purpose not assigned to other areas of the incident
      4. Nearby building, garage or other structure
      5. Specialized vehicles or portable temporary structures
   6. Medical Monitoring
      1. Pulse, BP
      2. Core body temp should be assessed for all patients with hr > 110
      3. Reassessment
         1. 15-20 minutes of rest and hydration later
            1. Can return to duty
            2. Remain for additional 20 minutes
            3. If 40 minutes in and still elevated transport to the hospital
      4. Immediate transport
         1. Chest pain
         2. Shortness of breath
         3. Altered mental
         4. Skin hot, mor or dry and flushed in color
         5. Newly onset irregular pulse
   7. Hydration and Nutrition
      1. Hydration
         1. Begin as soon as vitals taken
         2. 1-2 quarts
         3. Minimum 12-32 oz in 20 minutes
         4. Water is very good
            1. Best after short workouts
            2. But plain water does not replace electrolytes
               1. But sports drinks have sugar
               2. Sports drinks quench your thirst before adequate hydration
               3. So dilute 50/50 with plain water
         5. Not ice cold and not piping hot
      2. Nutrition
         1. Short < 3 hours: generally no food
         2. Moderate 3-4 hours: fruit - apples, oranges, and bananas
         3. Long > 4 hours: solid food, complex carbs
         4. Food Handling issues
            1. Keep hot and cold seperate and keep them hot and cold
            2. Designate a food service area and an area to wash face and hands
            3. Outside agencies may be better setup to handle