Rehab Decision at a Two-Alarm Apartment Fire
At 02:10 on a 28°F night, you arrive as the second-arriving engine at a two-alarm fire in a three-story garden-style apartment building. Fire has burned through the roof of the B wing. Your crew of four has completed two 20-minute interior work cycles on the stairwell. One firefighter, 14 years on the job, is sitting on the bumper, pale and sweating despite the cold, answering questions slowly. His heart rate is 148, respiratory rate 30, and he says he feels "a little off." The incident commander asks you to keep the crew available because the primary search of C wing is incomplete. Your engine still has 400 gallons and a 1,000 gpm pump.
1. What is your immediate rehab and medical decision for this firefighter, and what findings drive it?
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He comes out of service now. The combination of a heart rate of 148 after two work cycles, slow answers, pallor, and sweating in 28°F weather points to exertional heat stress with possible cardiac or other medical involvement; the cold does not rule out heat illness because turnout gear traps heat.
Decision: remove him from the IDLH, begin rehab (rest, fluids, cooling, vitals), and do not return him to firefighting until he is asymptomatic and his heart rate falls below the department's return-to-work threshold (commonly under 100 bpm within about 20 minutes of rest). If he does not meet that threshold or remains confused, he goes for medical evaluation and transport. He does not drive himself, and he is not left alone.
2. How do you answer the IC's request to keep the crew available for the C-wing search?
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I tell the IC the crew is not available as a unit: one member is in rehab and the crew is out of service until he is cleared or replaced. I do not split a four-person crew to leave one member behind and send three into a search; that breaks crew integrity and leaves an unaccounted member.
Reasoning: the need to search C wing is real, but the IC must solve it with resources that are actually intact. I request a mutual-aid engine or ask the IC to reassign an available crew already in rehab or staging. If the IC insists, I state plainly what I can and cannot provide and let the IC make an informed resource decision. I also confirm that the firefighter is logged out of the accountability system so no one is searching for him inside.
3. What benchmarks and documentation do you require before he returns, and what is your response if he refuses care?
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Rehab is not a break; it is a monitored process. I reassess pulse, respirations, skin, mental status, and temperature after rest and fluids, and I check for medications or medical history that make the presentation more concerning. Return to work requires normal mental status, no chest pain or shortness of breath, and a heart rate at or below the department's rehab standard after the rest period; if not, medical evaluation is the next step.
If he refuses, I document the refusal, the vitals, and the advice given, notify the IC, and keep him out of the IDLH. A refusal is not a clearance. I also make sure the company officer and safety officer know the outcome so the decision is not quietly reversed on the fireground.