EMS Operations at a Structure Fire

[Guest]

i'm looking to change our SOP for "fire stand-by's." im just looking to see how other ems agencies handle fire stand-by's. do you sit in your ambulance and wait to be called or a more proactive approach (such as rehab stations, vital checking stations, etc..). any input is appreciated. thanks in advance.

Edited to add:

if any FD officers have any suggestions as to what they would expect from ems, i'd appreciate that as well. thanks

Edited March 31, 2008 by vacguy

[tdc202 0]

VAc guy From my experience most EMS will be proactive and take vitals set up rehab etc I hope this helps a little

[ny10570 745]

If you're the only crew available forget about rehab. Be there for when crap hits the fan. Get out and stand by near the fast team and check in with the command post. Have your stretcher ready, long board, collars, etc. The two things that kill ff's on scene are sudden cardiac arrest and trauma. Make sure the bus has a clear shot to the road and you have a path to the ambulance.

If you have the equipment and staffing to dedicate a separate crew for rehab and monitoring, thats excellent. But thats best arranged with the depts you will be serving.

[GM911 0]

We bring the multilator, set it up outside the ambulance. If we need to then transport somebody, we'll leave one member with the multilator while we transport to the hospital.

The real pain in the neck is moving the H cylinder into and out of the rig... now there's a reason to get the automated stretchers!!

[NWFDMedic 58]

i'm looking to change our SOP for "fire stand-by's." im just looking to see how other ems agencies handle fire stand-by's. do you sit in your ambulance and wait to be called or a more proactive approach (such as rehab stations, vital checking stations, etc..). any input is appreciated. thanks in advance.

Edited to add:

if any FD officers have any suggestions as to what they would expect from ems, i'd appreciate that as well. thanks

As a fire officer, I would expect my responding EMS agency to do rehab at any fire more than your basic room and contents fire. If your EMS agency is sitting in the rig sipping coffee and you're allowing it to happen at anything more than your basic incident, you are setting yourself up for a world of trouble.

[Guest]

I believe that an EMS crew should be ready at a moments notice at the scene. They should have their ALS/BLS equipment with them to include a stretcher and backboard. They should ask the IC where they want EMS setup and there is nothing wrong with a crew checking vitals and providing rehab. I do not believe rehab and vitals takes away from their ability to function if something major happens.

I have seen EMS crews operate so many different ways at fire scenes that I agree there needs to be a standard so everyone is working to the best of their ability and EMS is not sitting in the rig or being so close to the scene that they are inhibiting fire ground operations.

[Guest]

I have learned alot reading this. Im an EMT and a firefighter. All we have in the town is a rescue squad so we do mutual aid for more EMTs and a Transporting rig. Im right there near the scene ready to go if Im needed for a rescue, but Im also helping to put the fire out. Its is in the SOP I that Im am there as a EMT first, firefighter second. Its hard when you are in a small vol department, we may have many hats to wear. We have ladies auxilliary do rehab.

Edited April 3, 2008 by moosecfd368
grammar, spelling

[NB514 0]

Is this for a commercial ambulance service?

[helicopper 1,050]

Standing by in case of injuries and rehab should be two separate assignments. The resource(s) assigned to rehab should be able to focus on setting up an appropriate environmentally friendly facility (cool in summer/warm in winter) and monitoring fire crews. This should be collocated or at least near whereever the crews are changing SCBA bottles.

Another resource(s) should be, as NY10570 stated, ready with equipment appropriate for the call and probably located near the ICP or near/with the FAST so they know when someone is in trouble/hurt. They should be able to transport without affecting the rehab operation.

On the subject, do FAS teams do any sort of immobilization prior to moving an injured member or do they just drag them out?

[GAW6 66]

At the scene of a working fire, there should be (2) ambulances, (1) for treatment/rehab and (1) for transport.

We set up (1) ambulance and crew with water, misting fans, oxygen, etc. and treat the firefighters as they come out. The other ambulance is there strictly for transport. If our third ambulance and personnel are available, they will cover the Town, otherwise a mutual aid ambulance is put on standby.

[Guest]

At the scene of a working fire, there should be (2) ambulances, (1) for treatment/rehab and (1) for transport.

We set up (1) ambulance and crew with water, misting fans, oxygen, etc. and treat the firefighters as they come out. The other ambulance is there strictly for transport. If our third ambulance and personnel are available, they will cover the Town, otherwise a mutual aid ambulance is put on standby.

i agree that is the best idea. is 76B2 still considered the towns "rehab" unit as per mpems?

secondly, i recall pvac always had an officer at the scene of a fire stand-by, is that SOP also or just done by chance?

[Guest]

Another resource(s) should be, as NY10570 stated, ready with equipment appropriate for the call and probably located near the ICP or near/with the FAST so they know when someone is in trouble/hurt. They should be able to transport without affecting the rehab operation.

from first hand knowledge in ems (being a cold zone agency) the IC and FAST may sometimes be too close to the fire. i agree be ready with equipment on the strecher, but as long as their is proper radio communication, ems should remain in the cold zone

[Guest]

Is this for a commercial ambulance service?

i don't think vac or paid would matter in what should be done, but i'm asking for my vac

[Guest alsfirefighter]

VACguy...PM me...I have info for you.

If you're the only crew available forget about rehab. Be there for when crap hits the fan. Get out and stand by near the fast team and check in with the command post. Have your stretcher ready, long board, collars, etc. The two things that kill ff's on scene are sudden cardiac arrest and trauma. Make sure the bus has a clear shot to the road and you have a path to the ambulance.

If you have the equipment and staffing to dedicate a separate crew for rehab and monitoring, thats excellent. But thats best arranged with the depts you will be serving.

Remember this...ALL motorized equipment needs to be re-fueled at some point.

No offense intended towards NY10570 for I often agree with his posts, but I have to disagree with a few points in this one.

Rehab cannot be forgotten or abandoned. Rehab is a required function under certain conditions with NFPA 1584, 1500 and OSHA. The crap very well may "hit the fan" if you don't peform rehab. The 2 things that kill firefighters are sudden cardiace arrest which a ultra high percentage of them are contributed to "overexertion" and yes trauma does kill firefighters...with the highest percentage of those are from MVA's. You need to be in a position to provide rehab and be able to handle treatment/transportation. Why wait for a cardiac arrest if you can prevent it from even happening through medical monitoring, rest and recovery, cooling or warming and re-hydration? This is not a time to be reactive, its a time to be proactive.

I don't know about most of you...but if I'm the FAST leader...my team is being proactive, you won't be able to stand next us and I will even tell you to go and set up rehab. My first responsibility as FAST leader is to find hazards and eliminate them to stop something from happening...if that includes advising to get proper rehab for on scene personnel, I will discuss it with the IC and the EMS commander. Also a good FAST commander knows where EMS is and will ensure they know where they will be coming out and iff they are going to keep going to the ambulance or stop and start work on the patient.

When you check in with command (if you can actually find them and have one dedicated) he needs to make the decision that rehab is needed or not. This is now a requirement under NFPA 1584 Standard on the Rehabilitation Process for Members during Emergency Operations & Training Exercises.

I believe that an EMS crew should be ready at a moments notice at the scene. They should have their ALS/BLS equipment with them to include a stretcher and backboard. They should ask the IC where they want EMS setup and there is nothing wrong with a crew checking vitals and providing rehab. I do not believe rehab and vitals takes away from their ability to function if something major happens.

The IC often has enough going on that he should be able to entrust someone in his command structure to worry about site selection for the rehab and treatment site which very well may be (and pretty much should be) the EMS commander.

Why bring the stretcher? A backboard/reeves will suffice and allow for quicker movement being you don't have to lift the wheels over hoses, etc. Bring the patient to the stretcher...not the other way around. Rehab and vitals are not designed to pull them from something major...its designed to stop something major from happening, or to get them out if something major did occur like a LODD.

I agree there needs to be a standard so everyone is working to the best of their ability and EMS is not sitting in the rig or being so close to the scene that they are inhibiting fire ground operations.

There is a standard...NFPA 1584..which deals with pretty much everything that has been brought up and more.

With NFPA 1584 going from a Recommendation to a full fledge standard I am almost done with a local class for fire service personnel to understand the standard, how to get a good Rehab SOP and how to work within themselves or with the agency who will be providing it to do it correctly in regard to NFPA 1584, 1500 and OSHA. I also do a Rehab course for EMS personnel as well, the info is there you have to find it.

If departments spent 50% of the monies on preventive measures of firefighter safety...ie physicals, rehab, etc. as they do on equipment to react to a firefighter safety issue...ie FAST equipment, survival equipment...we probably wouldn't have the amount of injuries or deaths we have! And most preventive measures are cheaper then the reactive equipment/training we supply/get. Especially rehab..water, gatorade, small food items...vitals by EMS (BLS is the minimum requirement on scene per NFPA 1584).

Its all there gang...Westchester guys stand by...I'm hoping to give it on a county level soon.

[GAW6 66]

If departments spent 50% of the monies on preventive measures of firefighter safety...ie physicals, rehab, etc.

Our Fire District spends a lot of many each year on COMPLETE physicals for all our members, and we have a small gym in the Firehouse.

VACGUY - plans are still active to make 7602 a Rehab unit. Still working on budgeting for needed equipment etc.

It was never (to my knowledge - and that's 20 years worth) our SOP that an officer was at every fire scene, it probably just happens that way.

On another note, one big problem I see is the delay in dispatching an ambulance to a fire scene. I feel we should be simutaneously dispatched.

Edited April 3, 2008 by moosecfd368
edited quote tag

[Guest alsfirefighter]

GAW...contact your local state senator to inquire about grant monies. You can get a basic unit up and running very quickly with district support...for those of you that are 3rd party EMS agencies...communicate with your FD, it for their personnel mostly and they should be assisting with costs. FD's...2% monies help with supplies without killing budgets!

Also remember rehab is not just for the fire operations...its required at training...but remember your law enforcement colleagues...works well for large gatherings...etc.

One quick side note...on equipment...forearm immersion cools better then misters! Their is a study out there (and most of you know I put only a little faith in studies the manufacturer mentions) however as a firefighter who has tried both..the forearm immersion worked better and made me feel cooler and more comfortable faster then the misters.

Any agency interested in rehab training or assistance in equipment info or concepts please feel free to PM me.

[ny10570 745]

Rehab really is an over looked necessity at any emergency scene, but anything worth doing is worth doing right. To do rehab the right way you need a crew that is dedicated to it. If you're going to actively track the condition of the ff's you need to be there the whole time and not getting pulled away in the middle because someone needs help. So you need a second crew there to handle that. Hell, you could even get away without EMT's running your rehab. Get an automated BP cuff, thermometer, CO monitor, clip board, and pen and you have enough to get started. As usual I should have been more clear the first time.

Gingersnaps, not trying to bust chops, but what happens if you're inside on the knob and someone goes down outside?

Vacguy, if the IC and fast (By fast i mean the fast staging area) are that close then they need to re-evaluate what they're doing. As with anything, you and your crews personal safety are paramount. In the end it doesn't matter where anyone on here sets up or stands by. So long the people you are there to help know where you are and you can get to them in a timely manner you are where you need to be. Just don't be wasting time that doesn't need to be wasted.

Chris, every fas team I have seen or worked with operates with a rip and run mentality. For two reasons, the primary concern is removal from the dangerous environment and usually by the time you're found it becomes life over limb. One of the benefits of integrating EMS and the Fire service is more and more firefighters are becoming trained and experienced in EMS. So in the future if you get the trapped ff who is still breathing hopefully we can bring treatment to the ff.

[Guest]

On another note, one big problem I see is the delay in dispatching an ambulance to a fire scene. I feel we should be simutaneously dispatched.

absolutely. a friend was injured in a fire 2 yrs ago and and if we were dispatched the second the pd knew it was confirmed, he wouldn't have had to wait for us.

if pvac is still going to 60 control, that might not be an issue anymore.

in valhalla we only go to structure fires, but in nwp we (are supposed to) go to any working fire, regardless of what is burning

[Guest]

Standing by in case of injuries and rehab should be two separate assignments. The resource(s) assigned to rehab should be able to focus on setting up an appropriate environmentally friendly facility (cool in summer/warm in winter) and monitoring fire crews. This should be collocated or at least near whereever the crews are changing SCBA bottles.

Another resource(s) should be, as NY10570 stated, ready with equipment appropriate for the call and probably located near the ICP or near/with the FAST so they know when someone is in trouble/hurt. They should be able to transport without affecting the rehab operation.

On the subject, do FAS teams do any sort of immobilization prior to moving an injured member or do they just drag them out?

Depending on the incident I will agree about the two separate assignments but at a routine house fire, the incident is handled usually quite quickly and the only rehab in many cases is water or A/C in the ambulance along with a set of vitals. I do not see this interfering with this crew still being able to handle an emergency if needed.

The second thing is that we have to work with what we have. In the dwindling manpower scenarios across the country and the lack of available ambulances you may only receive one medical unit per incident. At this point what do you do? Only rehab or only handle an emergency if it ARISES and not do any rehab which is needed at EVERY fire? It would be great to have two EMS units on scene for every structure fire but I don't see that as happening in most areas. With the ambulance service in our town we are lucky to get one in town ambulance to a call let alone multiple units. Many times we are waiting for a mutual aid ambulance for medical calls, so receiving more than one for a structure fire is a stretch.

The towns EMS does have a special truck that they use for larger scale incidents but I have never seen them set up anything resembling rehab at a structure fire unfortunately. They have some sort of system to page volunteers from EMS to come in and man this unit. It is an odd EMS system that we have an I wont get too far into that. It is supposed to be a volunteer service but when no one wants to sign up to volunteer than they get paid. ($25per hr medics and $20per hr EMTs) I don't get it.

As far as the FAST team, I would also say that depends on the incident. I can say that if you have a firefighter down with no impending danger than proper immobilization should be performed, but of course if the member were in immediate danger than it would be rapid extrication.

The IC often has enough going on that he should be able to entrust someone in his command structure to worry about site selection for the rehab and treatment site which very well may be (and pretty much should be) the EMS commander.

Why bring the stretcher? A backboard/reeves will suffice and allow for quicker movement being you don't have to lift the wheels over hoses, etc. Bring the patient to the stretcher...not the other way around. Rehab and vitals are not designed to pull them from something major...its designed to stop something major from happening, or to get them out if something major did occur like a LODD.

This is great that your departments have all these available resources to have an EMS commander and such but we do not. We have a 98 member career department with a volunteer/paid EMS system. We run 22 members per shift and do not have the resources to dedicate someone as EMS commander at a structure fire. Now if we had a larger scale incident than they do hire back extra people and bring in another assistant chief to assist the IC but at a typical structure fire this is not the case and the IC can easily handle the 2 second decision as to where he wants EMS set up.

As far as the stretcher is concerned I am referring to "bringing their stretcher" as in taking it out of the ambulance. In this case I am referring to the EMS crews that I directly work with. Many times they dont even take the stretcher out of the rig. And I am not only talking about at fires but at medicals as well. I did not mean bringing the stretcher to the patient as much as getting it out of the ambulance and placed in a reasonable spot.

Edited April 2, 2008 by bhansensfd

[Guest]

At the scene of a working fire, there should be (2) ambulances, (1) for treatment/rehab and (1) for transport.

We set up (1) ambulance and crew with water, misting fans, oxygen, etc. and treat the firefighters as they come out. The other ambulance is there strictly for transport. If our third ambulance and personnel are available, they will cover the Town, otherwise a mutual aid ambulance is put on standby.

I disagree..You dont need 2 ambualnces. Rehab as in fans and water and rest, lies within the fire dept. The ambulance on scene she be standing by for any unexpected incidents. The rescue (depending if your dept has one) should be utilized for rehab. Also rehab is supposed to be away from the scene, so the ff's dont get so excited watching the fire and want to go running back. Our policy in our dept is rehab to be away from the sight of the fire. The ambulance crew should be at the IC ready to go if needed. Of course all SOPS are different, my dept is a combo dept and we have our own ambulances. Our ambulance doesnt get called unless we go to a second alarm.

[DaRock98 76]

I disagree..You dont need 2 ambualnces. Rehab as in fans and water and rest, lies within the fire dept. The ambulance on scene she be standing by for any unexpected incidents. The rescue (depending if your dept has one) should be utilized for rehab. Also rehab is supposed to be away from the scene, so the ff's dont get so excited watching the fire and want to go running back. Our policy in our dept is rehab to be away from the sight of the fire. The ambulance crew should be at the IC ready to go if needed. Of course all SOPS are different, my dept is a combo dept and we have our own ambulances. Our ambulance doesnt get called unless we go to a second alarm.

You may not NEED 2 ambulances at a working fire but if you have the manpower and the coverage I say why not, it can't hurt. Personally I would like to have 2 of them at the scene but thats just my opinion. I agree that rehab should be away from the scene but not to far away just in case the stuff really hits the fan you don't want your ff's running back to the scene if they need to get back quickly. The one thing I have witnessed at a fire is the EMS being a block and a half away and not right up next to the IC, if they are not carring a radio how do they know if they are needed? I know a lot of ff's who never go to rehab I guess they feel they don't need it but if EMS is right there as you walk out I would like to see them approach members and make them sit down for a set of vitals and a quick drink of water. I know its not a perfect world but that would be some of the things I would like to see being done by EMS.

[Guest]

I know a lot of ff's who never go to rehab I guess they feel they don't need it but if EMS is right there as you walk out I would like to see them approach members and make them sit down for a set of vitals and a quick drink of water. I know its not a perfect world but that would be some of the things I would like to see being done by EMS.

all FF's should have vitals checked after being 'put to work,' regardless how they feel about it. they shouldn't have a say in this. but half of them come out looking like they're gonna croak, but they sit on the front of an engine a smoke a cigg! lol i've

[jcoppola 52]

In the real world, and in my city, there are never enough ambulances to park a whole bunch of them at the fire and wait for something to happen. In Norwalk, it is protocol for the dispatchers to send a stand by ambulance to all confirmed fires and they stand by until released by IC. Their primary purpose is for FD assistance, not civilian. If they spring into action for a civilian, another will be assigned. I think our medics do a really good job of helping us at fires. They are not following guys around with stethoscopes and BP cuffs, but they ARE INDEED monitoring the members, just how they generally look. If someone needs to be evaluated, they simply do it. I have seen them take a member aside and have a look at them if they look somehow out of sorts, but they don't do formal rehab, with the exception being a HAZMAT.

As an officer, I expect the standby medics to be close to the command post and the RIT team, so they could provide ALS if needed and they aren't roving around looking for something to do. They are, in effect, an extension of the RIT team and should take that posture.

JVC

[helicopper 1,050]

Who says that EMS has to run the rehab operation? Ideally, it should be run by people with medical training but that could be other FD resources. If you don't have enough resources, call more - call mutual aid if need be but as ALS points out, rehab is not a luxury, it is a necessity. j, I hear ya - there are never enough especially to have them sitting around.

As for not calling EMS to the scene of a fire until a second alarm, can't/don't FF get hurt at the first alarm? I hear lots of agencies operate that way and it always baffled me. FF with SCBA going into hazardous environments or simply operating with full PPE and exerting themselves (think cardiac issues) but no EMS on scene.

What ever happened to being proactive?

[ny10570 745]

I don't get why people make excuses for their dept not having enough resources. Its your butt that on the line. Make them either increase staffing or call in mutual aid. If there are not enough resources then put pressure on your leadership to get those resources there. Make it their problem and let them deal with it. Now if you don't believe that rehab has anything to offer you or you think having EMS standing by just in case something happens to you is a waste, then so be it. But don't excuse management 's responsibility to protect you because there aren't enough resources.

This is not directed at anyone individual. Just a reference to a general attitude.

[MoFire390 118]

where I belong any time a structure fire gets conformed we roll our rehab unit and an ambulance. we also place a crew in quarters to cover the area until the scene is clear.

[firemoose827 324]

Everyone makes excellent points here, especially ny10570, alsfirefighter, and Chris192 as usual I always enjoy reading your posts!

I know a lot of ff's who never go to rehab I guess they feel they don't need it but if EMS is right there as you walk out I would like to see them approach members and make them sit down for a set of vitals and a quick drink of water. I know its not a perfect world but that would be some of the things I would like to see being done by EMS.

I am so happy you brought that up Darock98. You have no idea how much of a sore point rehab is in our dept and its starting to get worse.

At first, our Ambulance responded initially with the first due engine with a full crew, they grabbed two coolers one filled with water and the other with Gatorade or the equivalent and went to the scene. They would assess firefighters as they came out, took vitals, offered them cool drinks , basically the Proactive attitude. EMS Approached Firefighters and didn't wait for them to decide if they wanted rehab or not. When you exited the IDLH atmosphere, there was an EMT waiting to give you a drink, check your BP and pulse, and make sure you weren't about to keel over with a massive MI. If you refused to have your vitals checked they left you alone. But at least they gave the firefighters a cool drink and had the chance to assess their behaviors and appearance to check for signs of any impairment.

BUT...A few months ago, the fire chief approached the EMS captain and advised him to no longer respond in that fashion. Too many firefighters thought of the EMS' actions as "Annoying" and wanted it to stop. So, the Chief advised the Captain to no longer respond immediately to the scene, instead, he wanted them to hang out for 5-10 minutes and see if there was any additional manpower that needed a ride to the scene, than when they got there to just sit in the rig and the fire dept would call them if needed. No more active rehab, just an ambulance should something happen. At least, that's what I have been told by the EMS Captain and other members. I have been involved with personal and family issues since summer and have not been around too often.

But, Firefighters like myself who are also EMT's, actually WANT EMS to carry on the way they used to, and continue to offer any of us who AREN'T the macho type the rehab we all need. I have extensive cardiac history in my family and do not want to end up another LODD statistic.

A few more thoughts about using fire dept resources for rehab is another agency that often gets overlooked, and would be an ideal resource to use for rehab, and thats Explorers, or Junior Firefighters, even your exterior firefighters who are not allowed to pack up. They could be trained in rehab, and set up the rehab sector and run it with the aid of an EMT from EMS. Just another thought.

Also, like in our dept, we have the Ladies Auxilliary that brings additional water, juice, coffee and food to the scene that could also aid in rehab along with Explorers. Any other thoughts on these ideas?

Great Topic Vacguy!

[Guest]

I don't get why people make excuses for their dept not having enough resources. Its your butt that on the line. Make them either increase staffing or call in mutual aid. If there are not enough resources then put pressure on your leadership to get those resources there. Make it their problem and let them deal with it. Now if you don't believe that rehab has anything to offer you or you think having EMS standing by just in case something happens to you is a waste, then so be it. But don't excuse management 's responsibility to protect you because there aren't enough resources.

This is not directed at anyone individual. Just a reference to a general attitude.

Easier said than done. You dont just go tell the chief you need to increase staffing. It is WAY more complicated than that. If it was that easy every career department would be up to adequate staffing levels as proposed by NFPA. Taxpayers just dont see it like we do and they have the ultimate say.

As far as mutual aid our region does not have enough EMS units available. They are all commercial ambulance services so they are all about the dollars and could care less what we think we need or if we call mutual aid. The ambulance services both commercial and volunteer(not bashing volunteers) have the municipalities dupped into thinking they provide ample coverage.

You know Joe taxpayer gets all upset when there is no ambulance but they dont call or write the Mayor. After their initial anger it all subsides and nothing changes. Then we are left hanging in the wind trying to tell admin and the government we need more resources and they ask "if it is so bad why havent I heard any complaints."

All these situations are why they have created such programs as Fire Ops 101, so these politicinas can unserstand what we do and the difficulties of our job.

These arent excuses brother, this is reality! If you guys have the resources of multiple ambulances and ability to get mutual aid ambulances at a moments notice god bless ya but it isnt that way here.

[Guest alsfirefighter]

NFPA 1584 outlines the minimum levels of what is needed in regard to rehab and the medical section. According to the standard Emergency Medical Care shall be available as part of the incident scene rehabiliation. The very next line states that BLS is the minimal level. So as Chris discusses you can use other personnel as needed to assist in the rehab process.

Also part of NFPA 1584's requirement is annual training of fire service personnel in the recognition and understanding of heat and cold illnesses.

I also don't completely understand the concept of not sending a bus to a 1st alarm structure fire assignment. Then again I never understood why ambulances are often only sent to structural fires but not chimney fires and other calls where there are significant risks.

Rehab may be annoying to some...but they need to get over it. This isn't a democracy...write a policy, be a leader and do it and enforce it. IF they don't like the rules...there is always the Elk's club.

Fact is it works and does for a lot of fire departments...Phoenix has been for years for obvious reasons, but of course the drain slows as you go north and east.

[Guest]

NFPA 1584 outlines the minimum levels of what is needed in regard to rehab and the medical section. According to the standard Emergency Medical Care shall be available as part of the incident scene rehabiliation. The very next line states that BLS is the minimal level. So as Chris discusses you can use other personnel as needed to assist in the rehab process.

Also part of NFPA 1584's requirement is annual training of fire service personnel in the recognition and understanding of heat and cold illnesses.

I agree that NFPA conveniently outlines these guidelines for us but unfortunately CT isnt an NFPA state so trying to get anyone to listen to NFPA in this state is next to impossible.

I do think this is a great topic and discussion though and I am glad to see so many members participating. I agree with the fact that rehab is a necessity and should not be overlooked. It is nice to see how the other departments handle these situations and how others feel on this topic.