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 accountability...one 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.

Podcast #209: Public Service Lay-Offs and Local Preparedness

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Lay-offs. Not a term we're used to talking about when it comes to emergency services and first responders. Not until recently, that is. The growing concern over state, city, and local government budgets as well as a Nation-wide fiscal crisis, have made the potential of public service lay-offs a reality.

Citizen groups and government officials are stammering about pay and benefits awarded to those who protect our lives and property and serve our communities.

"Why should firefighters get that retirement?"  
"Why should police officers get that type of health care?"

Those are just a few of the battle cries we hear from citizens who are struggling under an increasing tax burden and who may have been downsized (and lost everything) from the corporations they served.


While these questions should be (easily) answered; I think I bigger problem(s) exist.

1. Local traditional responders will be the ones who will be there (or not) to save lives when a crisis or disaster hits. Not just for terrorism folks. For the natural disasters we've read so much about and for the routine, incipient events that are controlled and managed...that are kept from becoming the "big one".
2. The willingness to cut public service responders...to "make them suffer, too" as one media outlet put it, is concerning. Look around. Chances are you'll see someone with a sticker on their car that says something like: "9-11-01 Never Forget". On 9-12-01 the first responders of this Nation were held up as a national treasure. Today, just shy of 10 years later...we're wiling to cut away that treasure to balance a budget. 
3. Lastly...you wont know what you've got (had) until its gone.

Join Mitigation Journal co-host Matt Comer, special guest Alan Bubel, and me as we tackle the ramifications of public service lay-offs and the impact to local preparedness. This is a two part topic: in part one, Alan and Matt look at the ramifications from the fire and EMS perspective (MJ Podcast #209 release date 5/30/11). In part two, I'll examine the larger picture of local preparedness and we'll pull it all together under the All-Hazards approach in MJ Podcast #210 (release date 6/13/11).

NY Tornado Exercise Gets Little Attention

A recent health-care preparedness exercise has gone virtually unnoticed. FLurriccane 2011, a Finger Lakes Regional Exercise was designed to test preparedness for healthcare facilities in the face of an impending natural disaster. This exercise ran between May 16 in May 20, 2011 and was sponsored by the New York State Department of Health office of health emergency preparedness, finger Lakes regional resource Center and the New York State office of emergency management. Despite the commitment of hospitals, health departments, emergency management officials in a nine county area, this well-planned and well executed exercise remained unnoticed. It's hard to believe that that's the case knowing that this is one of the largest exercises in recent years.

At the heart of this exercise was a category five hurricane bearing down on Western New York. And while most people still believe that it can't happen here… this exercise showed us what might happen if in fact it did happen here. By all preliminary accounts of this exercise participants were well-prepared to carry out their emergency plans. While we wait for the after action reports, I can safely say this was one of the best exercises I've seen in some time. That is to say, I think it made a difference. I think it will save lives. I think lessons were learned.

I was tasked with running a tabletop exercise as a follow-up to the FLurricane exercise at a local community hospital. The focus of this particular tabletop was on evacuation of a hospital in senior living facility. Again, I think you made a difference. I think lives may be saved because of this training. I think lessons were learned.

The point is that we can no longer continue down the path of ignoring natural events.  Our preparedness pendulum has swung so far towards the side of terrorism that we have continued to ignore the devastation of natural events… unless of course they occur in another country. I wonder  if the outcomes of Hurricane Katrina would have been different if emergency managers and responders learned the lessons from Hurricane Pam?

 Within the first six months of 2011 the United States has been victim to snowstorms crippling major cities, devastating floods, and most recently ferocious tornado activity.  To illustrate the potentials  take a look at the New York Times website… they have a fantastic aerial photograph series from Joplin, Missouri, that illustrates the impact to communities and infrastructure from natural events.
See (http://www.nytimes.com/interactive/2011/05/25/us/joplin-aerial.html?hp)


Yet much of the preparedness efforts and planning, training, and readiness go unnoticed and under reported. The value of this material appearing in the media is not to promote any hospital or health department. The true value of media coverage of these planning events and exercises is to illustrate to the public that there is a side of preparedness focused on community infrastructure rather than solely focused on terrorism. I believe that message is critical to maintaining confidence in our local governments during times of crisis.
Joplin Before and After the Tornado

School Security Goes in Wrong Direction part two

Follow up video from Mitigation Journal podcast #208: When School Security Goes in Wrong Direction part two.

MJ208: School Security Goes in Wrong Direction

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This week on Mitigation Journal we're discussing school security and how a recent "live" training exercise may have done more harm than good. Joining me this week is Dan McGuire from CISM Perspectives.

Its important to note that our view of this situation is based on prior experiences, information available in mainstream media sources, and posted comments on those mainstream media sites. 

The background story can be found here. Several years ago there was a movement to remove decrease the amount of security in public schools. In December, 2006, Mitigation Journal told you about research that indicated school security may actually be doing more harm than good. See School Security Should Go Over the Top (Mitigation Journal 12/06).

We continue to support our position that schools, hospitals, shopping malls and similar locations are soft targets. These soft target locations can also be locations of critical infrastructure and need to be protected. The problem in this situation seems to be that the planning and delivery of the training scenario.


The video (segment 1 of 3) is from our recording of Mitigation Journal #208. We'll be posting remaining segments here.