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PFDRes47cue

Delayed Requests For EMS / Rehab Units

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Several people have approached me asking why departments wait so long or fail to request EMS to a fire scene with transport buses and a rehab unit. I am not saying this because I am part of an EMS agency that often supplies a transport buses and/or a rehab unit, but rather because I feel that having transport buses and a rehab unit can be very important at a fire scene and can SAVE LIVES! It seems to me and to the people that have approached me about this topic, that departments frequently wait a rather long time into an incident to to call for EMS (transport buses or rehab units). I do not know why more towns do not have these units listed on the initial dispatch for confirmed, reported, or possible structure fires. Doing so would give the Chief's one less thing to focus on. If the Chief finds out it is a false alarm or there really is no need for EMS or rehab, it is very easy to put the units back in service or cancel their response. To me this seems like a very easy thing to do that can have many advantages and can greatly add to the safety of FD members.

Even small fires, should have transport buses and a rehab crew. You never know when someone is going to go down, be involved in a collapse, slip on ice, trip over a hose line, etc. Especially with fire volume being down in comparison to past years (general statement), you just never know what will happen at a scene. People are getting more and more exited when they hear the tones drop for a "FIRE!!!!!" Due to this, you just never know if someone will have a cardiac issue. More commonly, heat or exhaustion issues can happen at any scene. During colder months, cold related issues can happen when firefighters are standing around dripping wet. Having EMS and a rehab unit responding automatically or early on can be a great asset if unfortunately something does go wrong.

As far as rehab units, perhaps Chiefs are calling so late in the fire incident because they do not quite understand the concept of a rehab crew and what has to be done in terms of setting up at the scene. FYI, it is not as easy as stepping out of a truck and does require some set-up time. So if you are going to need a rehab crew, call for one early on so it can be as effective as possible.

If anyone has any insight to this, any input is greatly appreciated.

Happy Holidays!

Edited by PFDRes47cue
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Any time a working fire is confirmed either by the caller or by the first arriving units, a BLS unit should be detailed to the job including but not limited to: structure fires, brush fires, trash fires etc....... THIS IS COMMONPLACE in most areas of our country, yet Westchester county continues to operate in some back closet where I/C's call for stuff long after the need has already been established.

The every department in the county should be running off of box cards and all their apparatus needs should all be preplanned by emergency type and alarm level including EMS at scenes for FF safety.... Again something that is commonplace everywhere else, but in Westchester the vast majority of the departments let their chiefs call for apparatus after the fact like captains choosing dodgeball teams in the school yard.

Edited by mfc2257

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Most departments that I know of around my area, off their 10-75 assignment (1 in particular off the initial dispatch), automatically have an ambulance and a medic in route. One of the problems we have is 90% of our departments run off of a 100% volunteer VAC. We have had working fires where it takes 10-20 sometimes 30 minutes to have a transport bus there. Medics will be on location, and god forbid in those first critical minutes, a firefighter drops, or you pull a lifeless child out of a building, you'll be standing around with a medic doing CPR on the front lawn hoping you can remove your thumb from your rear end before the lawyers arrive on the scene. Unacceptable in my eyes. You're dealing with a guaranteed life or death situation, and all you're going to have is a medic waiting outside for you with no way to transport. If some guy involved in the fireground operation gets hurt seriously enough and theres no bus for him on scene waiting for him (or less then a minute out), he's getting thrown in a chief's car or utility with the medic, and off to WCMC/ Jacobi you'll be going. EMS in this county should be totally paid, and on a county wide system, but thats a separate rant for another thread.

A rehab unit is a different story, and in the northern part of the county, the only one I can think of is the Somers Rehab unit. That would have to be a special call item, unless say on your 2nd alarm assignment, you have them dispatched. Most of the time a 10-75 assignment will get your full department assignment, a FASTeam, maybe an extra engine or ladder, and standby coverage for your town and is primarily is for a "bread and butter" operation, where extended work or "extreme" fire conditions won't be present. You'll be dealing with a single/double room and contents fire, maybe a small bit of extension down a hallway. The moment you start calling in for 2nd alarm assignments, you're dealing with a lot of fire, extended operations and basically completely justifying the use of a rehab unit. I'm not aware of what each chief knows, but sometimes showing up at the local fire departments during their drill nights, and not just posting on this board is the best course of action to get the FD to realize what the Rehab unit could be used for.

Edited by EMSJunkie712

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EMS in this county should be totally paid, and on a county wide system, but thats a separate rant for another thread.

A rehab unit is a different story, and in the northern part of the county, the only one I can think of is the Somers Rehab unit. That would have to be a special call item, unless say on your 2nd alarm assignment, you have them dispatched. Most of the time a 10-75 assignment will get your full department assignment, a FASTeam, maybe an extra engine or ladder, and standby coverage for your town and is primarily is for a "bread and butter" operation, where extended work or "extreme" fire conditions won't be present. You'll be dealing with a single/double room and contents fire, maybe a small bit of extension down a hallway. The moment you start calling in for 2nd alarm assignments, you're dealing with a lot of fire, extended operations and basically completely justifying the use of a rehab unit. I'm not aware of what each chief knows, but sometimes showing up at the local fire departments during their drill nights, and not just posting on this board is the best course of action to get the FD to realize what the Rehab unit could be used for.

From my experience, I would have to disagree with your paid EMS claim. Why should an EMS agency go paid and have enough staff to get one bus out instantly when an agency that is 100% volunteer can get 3 busses and a rehab out at the same time 24/7. I do not feel it is a matter of people receiving pay checks but rather a matter of good leadership, good moral, and most importantly good recruitment. The heart and driving factor behind good EMS operations is not a pay check, it is commitment, membership, and leadership.

Now...there are plenty of agencies that fall under the category of "Going paid would help," however this is not true for some. So to say that all EMD should be paid, is not justifiable.

I have been to many fires where a 100% volunteer EMS agency is arriving at a fire at the same time as the FD. If an EMS agency is toned out as part of the initial assignment for a fire (structure, brush, trash, etc) then there is no reason and no excuse for a response that is longer than the FD (distance travelled put aside.)

Showing up at house duties is a good idea and running drills with the FD's are a great idea and good practice for both EMS and FD agencies. What do you do when both of these have been done on numerous occasions and the same old delay or lack of requesting EMS altogether continues?

It seems that a lot of agencies in Westchester (I can not speak for other places.) are not very proactive. Things do not get added to initial assignments unless something goes wrong first. By-laws and SOP's/SOG's are not rewritten until something goes wrong. Yes being proactive takes more effort and thought up front, but when it could save lives, isn't the effort worth it? I would put more effort in now to avoid possible tragedy later on down the road in a heart beat.

Edited by PFDRes47cue

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You would think with the current rate of deaths to medical issues on the fireground an ambulance would be dispatch to any working fire. Our special ops truck as well as other Rehab units are seldom dispatched in the opening minutes of an alarm.

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You would think with the current rate of deaths to medical issues on the fireground an ambulance would be dispatch to any working fire. Our special ops truck as well as other Rehab units are seldom dispatched in the opening minutes of an alarm.

You would think that...I am beginning to feel that until a department experiences a tragedy, that department will not adjust it's alarm assignments in regards to EMS being dispatched. If this is true, it is a real shame.

God for bid something goes wrong and a FF is injured or worse killed. Will lawyers not see that there is a VAC or paid EMS agency close by? In many cases less than 3 miles away? How can an FD justify ignoring to use such a close and vital resource when a member dies due to EMS not being requested to the scene?

Edited by PFDRes47cue

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A rehab unit is a different story, and in the northern part of the county, the only one I can think of is the Somers Rehab unit.

Pleasantville VAC just placed a rehab unit in service. If no rehab unit is available, detail an extra BLS unit and if there is a ladies or other auxiliary unit available get them mobilized. The extra BLS unit can handle the health/medical aspect of rehab while the auxiliary can provide hydration, nourishment. Rehab or extra BLS unit should be detailed when the second alarm is struck. BLS transport for victims or FF's should be on the road as soon as a fire is confirmed if not before... either as part of the first alarm or as an automatic add-on prior to striking the second.

Most of the time a 10-75 assignment will get your full department assignment, a FASTeam, maybe an extra engine or ladder, and standby coverage for your town

Unless specific alarm instructions, preplans, automatic mutual aid, or box cards have been given to 60 control.... All you're getting in Westchester, for MANY departments is a simple dispatch for a fire that includes the first due department ONLY. The responding department has to ASK 60control to add resources. I hear it all the time... "gimme an engine from Yorktown, and the FAST from Croton and the Truck from Ossining. Start me tankers from Somers, Croton, Millwood, and Yorktown...." Some departments have done some primitive apparatus preplanning but very few have gone to the extent of detailing out for 60 control exactly which units are due on specific incidents and at what alarm level. When I was an officer in Westchester, I knew (for the most part) each of the surrounding departments apparatus and which capabilities they had. I created a box card plan for 4 distinct zones in the district (boxes) and alarm assignments for fire, mva, hazmat, etc through the 4th alarm with specific apparatus requests (ie; on the second alarm I want E146 from Chappaqua b/c its an LDH rig instead of E145 which had the 3in hose reel)...... It was completely disregarded by an old chief who didn't know which end of the hose water came out of and whom the other officers were too afraid to stand up to.

EMS needs to be included into such preplanning so that when an officer rolls up to a job and tells 60 control to strike the second, he/she doesn't need to waste valuable time thinking about who's ego he's going to stroke today with a M/A call.... Probably forgetting to ask for EMS coverage while he's at it.

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From my experience, I would have to disagree with your paid EMS claim. Why should an EMS agency go paid and have enough staff to get one bus out instantly when an agency that is 100% volunteer can get 3 busses and a rehab out at the same time 24/7. I do not feel it is a matter of people receiving pay checks but rather a matter of good leadership, good moral, and most importantly good recruitment. The heart and driving factor behind good EMS operations is not a pay check, it is commitment, membership, and leadership.

That is very rare to have 3 buses and a rehab unit out 24/7 I dont know of many agencies that can do that. Sure some can do it and I have seen it done before but I highly doubt any volunteer angency can do that 100% of the time.

But back to the original question maybe its a matter of the ems agencies going to meet the chiefs of the surrounding departments and explaining the importance and benefits of having the rehab and ems units on the 1st alarm assignment. So that they are automaticly dispatched and it is one less thing for the IC to think about.

Edited by DaRock98

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Pleasantville VAC just placed a rehab unit in service.

I am aware that Pleasantville has a rehab unit, however, being from the northern part of the county, a 20-30 minute response time from them, strictly because of distance, would not be in my department's best interest. I was stating Somers is the only one I am aware of, in the northern part of the county that could provide a timely response. That is like us calling for Vahalla's FAST first due, when you have LMFD or BHFD right there

Unless specific alarm instructions, preplans, automatic mutual aid, or box cards have been given to 60 control.... All you're getting in Westchester, for MANY departments is a simple dispatch for a fire that includes the first due department ONLY. The responding department has to ASK 60control to add resources. I hear it all the time... "gimme an engine from Yorktown, and the FAST from Croton and the Truck from Ossining. Start me tankers from Somers, Croton, Millwood, and Yorktown...." Some departments have done some primitive apparatus preplanning but very few have gone to the extent of detailing out for 60 control exactly which units are due on specific incidents and at what alarm level. When I was an officer in Westchester, I knew (for the most part) each of the surrounding departments apparatus and which capabilities they had. I created a box card plan for 4 distinct zones in the district (boxes) and alarm assignments for fire, mva, hazmat, etc through the 4th alarm with specific apparatus requests (ie; on the second alarm I want E146 from Chappaqua b/c its an LDH rig instead of E145 which had the 3in hose reel)...... It was completely disregarded by an old chief who didn't know which end of the hose water came out of and whom the other officers were too afraid to stand up to.

I want to say that my department has about 10-13 different box alarm set up for our town. Each tailored to their own requirements (FAST, Tankers, etc etc) up to the 4th alarm assignment as well.

Sounds like your old department wants to be able to make the on the fly call, which is perfectly fine, as long as EVERYONE in the department is on the same page prior to arriving on the scene. As a chief / officer you should be well aware of what your departments have around you, but what about that guy who just started driving the trucks and is showing up alone on a supposed residential alarm, and now has fire out the front of the house.

My feeling, in addition to the mutual aid agreements that departments in this county signed, there should be a common SOP agreement as well. That way everyone is on the same page, at the same time, and no matter what you roll up on, I know exactly what I'm getting.

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I am aware that Pleasantville has a rehab unit, however, being from the northern part of the county, a 20-30 minute response time from them, strictly because of distance, would not be in my department's best interest. I was stating Somers is the only one I am aware of, in the northern part of the county that could provide a timely response. That is like us calling for Vahalla's FAST first due, when you have LMFD or BHFD right there

I want to say that my department has about 10-13 different box alarm set up for our town. Each tailored to their own requirements (FAST, Tankers, etc etc) up to the 4th alarm assignment as well.

Sounds like your old department wants to be able to make the on the fly call, which is perfectly fine, as long as EVERYONE in the department is on the same page prior to arriving on the scene. As a chief / officer you should be well aware of what your departments have around you, but what about that guy who just started driving the trucks and is showing up alone on a supposed residential alarm, and now has fire out the front of the house.

My feeling, in addition to the mutual aid agreements that departments in this county signed, there should be a common SOP agreement as well. That way everyone is on the same page, at the same time, and no matter what you roll up on, I know exactly what I'm getting.

I wasn't talking about Yorktown per se otherwise I would have referenced them specifically. Yes P-Ville to the Heights is a haul.

Your department may have done preplanning or box assignments with regard to resource management, but most hadn't when I moved out-of-county 6 years ago, and to this day many continue to operate on the fly... Not just my old department.

I'm referencing a county-wide issue (worse north of WP for sure) not any specific department or member posting on this board.

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Every FF I ever spoke with never passes a chance to quote from the bible, that is, NFPA Standards. NFPA 1584 took effect in Jan 2008. It became, so to speak, the law of the land within the fire service. It requires/recommends a minimum BLS level (ALS prefered if available) care & transport capability not only at fire scenes but also at all training activities. In 25 more days, Jan. 2011, it will be 3 years. My ques would be... what's the hold up.

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Every FF I ever spoke with never passes a chance to quote from the bible, that is, NFPA Standards. NFPA 1584 took effect in Jan 2008. It became, so to speak, the law of the land within the fire service. It requires/recommends a minimum BLS level (ALS prefered if available) care & transport capability not only at fire scenes but also at all training activities. In 25 more days, Jan. 2011, it will be 3 years. My ques would be... what's the hold up.

People pick and choose which NFPA standards they will abide by and which ones are not. Sounds like a scene from "A Few Good Men"

I hate when people specfically ask for apparatus by town name. Wouldn't using NIMS typing but much easier? I guess the dispatch would send what you need and not who you want.

Compare this to a report of a motor vehicle accident with people trapped and waiting for the ambulance to get there and asking for the rescue by town name.

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That is very rare to have 3 buses and a rehab unit out 24/7 I dont know of many agencies that can do that. Sure some can do it and I have seen it done before but I highly doubt any volunteer angency can do that 100% of the time.

But back to the original question maybe its a matter of the ems agencies going to meet the chiefs of the surrounding departments and explaining the importance and benefits of having the rehab and ems units on the 1st alarm assignment. So that they are automaticly dispatched and it is one less thing for the IC to think about.

Agreed, it is very rare for an agency to be able to get buses out consistently and several at a time. I also know there are paid EMS agencies (either full staffing or just en EMT or Driver, etc) that can not get a bus out with paid help. Agencies that can not get rigs out, do not have rehab units, or special-ops units, or several buses...or at least they shouldn't.

Just a little side discussion...

As for the thread topic. I think it is very important for agencies with Rehab units to meet with surround officials. This often does not lead to change...not sure why, but it's the truth. I really believe it just comes down to the fact that a lot of Westchester agencies are not proactive for what ever reason. This is a big issue in the emergency service community. 99% of the time nothing changes until an incident occurs. Why is this? Why risk life when you can be proactive and change stuff in advance and as a precaution?

People pick and choose which NFPA standards they will abide by and which ones are not. Sounds like a scene from "A Few Good Men"

I hate when people specfically ask for apparatus by town name. Wouldn't using NIMS typing but much easier? I guess the dispatch would send what you need and not who you want.

Compare this to a report of a motor vehicle accident with people trapped and waiting for the ambulance to get there and asking for the rescue by town name.

This two is a topic for another thread but since it was brought up, I will express my opinion...

I think calling for towns that you want when there is no real benefit, is ridiculous.

Another thing that gets me is when you are coming back from the hospital and here a neighboring department get toned out for an MVA that is right near your location. You then contact 60-control and ask them to ask the IC if they would like you to respond until further information is known. Then the IC says no thank you we have ambulances...but then they wait 20 or so minutes for their own bus to get to the scene. This is simply a EGO problem. We will do it ourselves because we are the best, but in the end it makes you look dumb when you ask 4 times for an eta on a bus while the potential M/A bus drives by and waves.

Edited by PFDRes47cue

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Agrees, it is very rare for an agency to be able to get buses out consistently and several at a time. I also know there are paid EMS agencies (either full staffing or just en EMT or Driver, etc) that can not get a bus out with paid help. Agencies that can not get rigs out, do not have rehab units, or special-ops units, or several buses...or at least they shouldn't.

Agreed!

As for the thread topic. I think it is very important for agencies with Rehab units to meet with surround officials. This often does not lead to change...not sure why, but it's the truth. I really believe it just comes down to the fact that a lot of Westchester agencies are not proactive for what ever reason. This is a big issue in the emergency service community. 99% of the time nothing changes until an incident occurs. Why is this? Why risk life when you can be proactive and change stuff in advance and as a precaution?

Yes it is sad, we are not proactive but instead reactive and thats what hurts us as a whole.

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People pick and choose which NFPA standards they will abide by and which ones are not. Sounds like a scene from "A Few Good Men"

I hate when people specfically ask for apparatus by town name. Wouldn't using NIMS typing but much easier? I guess the dispatch would send what you need and not who you want.

Compare this to a report of a motor vehicle accident with people trapped and waiting for the ambulance to get there and asking for the rescue by town name.

Hahaha good analogy. People have to get with the program. Its 2010 and we still call for stuff by name instead of by kind and type. Its just plain stupid to be working that way.

Funny how NFPA gets used when people want a bigger better truck but they ignore the stuff that may make them better or keep them safe.

Agreed, it is very rare for an agency to be able to get buses out consistently and several at a time. I also know there are paid EMS agencies (either full staffing or just en EMT or Driver, etc) that can not get a bus out with paid help. Agencies that can not get rigs out, do not have rehab units, or special-ops units, or several buses...or at least they shouldn't.

Another thing that gets me is when you are coming back from the hospital and here a neighboring department get toned out for an MVA that is right near your location. You then contact 60-control and ask them to ask the IC if they would like you to respond until further information is known. Then the IC says no thank you we have ambulances...but then they wait 20 or so minutes for their own bus to get to the scene. This is simply a EGO problem. We will do it ourselves because we are the best, but in the end it makes you look dumb when you ask 4 times for an eta on a bus while the potential M/A bus drives by and waves.

Most volunteer agencies cant staff 3 buses and a rehab unit at the same time.

What is "full staffing"? Two EMTs or an EMT and a medic is full staffing. You don't have to be like a circus clown car to be fully staffed. If its a paid agency the buses are staffed already so I don't know what you mean by saying they cant get rigs out. Maybe they dont have any more left to send you but I believe most have more than 3 out so your comparison is flawed.

If you are driving by an incident just hold it down until the resident agency gets there and then leave. If you ask for permission and are turned down so be it. Go home and watch TV, it isn't your problem. If somebody is too stupid or has to big an ego to take help thats there problem.

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Hahaha good analogy. People have to get with the program. Its 2010 and we still call for stuff by name instead of by kind and type. Its just plain stupid to be working that way.

Funny how NFPA gets used when people want a bigger better truck but they ignore the stuff that may make them better or keep them safe.

Most volunteer agencies cant staff 3 buses and a rehab unit at the same time.

What is "full staffing"? Two EMTs or an EMT and a medic is full staffing. You don't have to be like a circus clown car to be fully staffed. If its a paid agency the buses are staffed already so I don't know what you mean by saying they cant get rigs out. Maybe they dont have any more left to send you but I believe most have more than 3 out so your comparison is flawed.

If you are driving by an incident just hold it down until the resident agency gets there and then leave. If you ask for permission and are turned down so be it. Go home and watch TV, it isn't your problem. If somebody is too stupid or has to big an ego to take help thats there problem.

My comparison is not flawed. By "full staffing" I was referring to a paid agency such as Transcare, Empress, etc The agencies that I am referring to are those that just have a paid EMT. They do not roll the bus when they fail to get a driver. This does not have to do with having buses out already. This is an example of a agency with paid personnel that can not get a rig out...this happens quite often.

As far as coming across another agencies call, yes if this happened I would hold it down until the resident agency arrived. This was not what I meant...i might have been unclear. I was referring to instances when you are not at the scene but near the scene.

As far as staffing several buses and extra equipment. Yes, it is true most agencies can not manage this. However, there are some that can so for a previous post to say that all EMS should be paid due to response time and getting rigs out is not accurate.

Edited by PFDRes47cue

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Most of the views seem to be that Rehab is only needed for 2nd alarms or higher?

I would contend that Rehab is an esential part of any initial call of structure fire. I would also tell you that by the numbers Rehab is MORE important than a FAST team. Can anyone tell me how many firfighters are killed from being trapped in a fire every year? and how many die of stress (heart/stroke ect)?

If you looked at the numbers and I have. you would see that all this FAST trainning while important, maybe less important on a fire scene than a good rehab sector.

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I would contend that Rehab is an esential part of any initial call of structure fire.

The issue here is your definition of a structure fire.

A special rehab unit is rarely needed for a room & content fire, even when its called a working fire (10-75). its over in 10-15 minutes.

A room & content fire is not a structure fire its a fire in a structure. A structure fire is when the structural components of a building are now under attack. Will it is a technical language issue it is important that we compare apples to apples.

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The issue here is your definition of a structure fire.

A special rehab unit is rarely needed for a room & content fire, even when its called a working fire (10-75). its over in 10-15 minutes.

A room & content fire is not a structure fire its a fire in a structure. A structure fire is when the structural components of a building are now under attack. Will it is a technical language issue it is important that we compare apples to apples.

Good point!

Should a transport bus either ALS or BLS be invited to attend a "fire in a structure" despite the short duration? I would think one should...

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Good point!

Should a transport bus either ALS or BLS be invited to attend a "fire in a structure" despite the short duration? I would think one should...

In NR on a 10-75, 60 control automatically sends FAST & 1 ALS ambulance.

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Good point!

Should a transport bus either ALS or BLS be invited to attend a "fire in a structure" despite the short duration? I would think one should...

A BLS (preferably ALS) unit should be at every fire regardless of how large it is. Plenty of room and contents fires have flashed before, plenty of guys have had MI's at bread & butter jobs, plenty of guys have been burned and seemingly benign calls.

A rehab unit or a second BLS unit to assist with rehabbing should be added above the second and WHENEVER the IC feels like he needs it... If it's 100+ degrees out and you've got a room and contents at the back of a SFD with Colliers conditions, it may be over quickly, but you'll have a hell of a time overhauling and the IC may think that a rehab unit for his guys is appropriate even if the second was never struck.

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If you are calling a FAST team you should be calling a Rehab team as well. I know the thought proccess of rehab is new to many but it truly is an esential part of firefighting to keep your members safe and ALIVE just like the FAST team.

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Boy PFD, you're on a roll today! :lol: Glad to see some topics worth getting involved in.

Once our IC calls a "10-75" we get a FAST, two ambulances & a Medic. One Ambulance is for us and is to stay on scene, the other is to transport as needed. If an incident is in inclement weather or will be prolonged, the EMS OIC (working with our IC) will make the call for a Rehab unit.

Additionally, when operating at any Haz-Mat incident, EMS is sent on the initial run with our FD units. As needed, additional will be called upon.

Some EMS Rehab units I know of are Cortlandt VAC, Somers FD, Pleasantville VAC and rumor has it Peekskill VAC will soon.

Not sure who to call? Have your IC contact 60 Control for a rehab unit, and we will gladly find you one!

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If you are calling a FAST team you should be calling a Rehab team as well. I know the thought proccess of rehab is new to many but it truly is an esential part of firefighting to keep your members safe and ALIVE just like the FAST team.

Yes, both should be called. But we still find the majority of depts. that do not call enough interior firefighters to put out the fire in the 1st place. Once thats done, there is less need for FAST & Rehab.

We also need to address who has FAST and who has rehab. These are basic skills.

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If you are calling a FAST team you should be calling a Rehab team as well. I know the thought proccess of rehab is new to many but it truly is an esential part of firefighting to keep your members safe and ALIVE just like the FAST team.

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Funny how NFPA gets used when people want a bigger better truck but they ignore the stuff that may make them better or keep them safe.

You hit the nail on the head. NFPA 1500 CLEARLY states that Rehab MUST be set up at working fires and special ops incidents.

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i think in this respect we could learn something from new york city. However, because of the fractured nature of Westchester's EMS system...its going to ultimately be up to the local agencies (fire and EMS) to figure it out for themselves.

now, the FDNY*EMS guys can clarify this, but from my 6 months in NYC they would declare these jobs MCIs and send a BLS bus, ALS bus and a conditions boss. If i'm not mistaken, as additional alarms were called for, additional ambulances were called in - i don't really recall how they determine the ratio of alarms to ambulances, but i do remember it being done pretty well.

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