Firefighter Rehabilitation Program

Rehabilitation is the part of an incident where the department gives a member’s body the chance to recover before it fails. Stress and overexertion, nearly all of it cardiac, remains the largest single cause of on-duty firefighter death in the United States data (NFPA, 2026; USFA, 2025), and heat illness and dehydration are the common path to the fireground injuries that do not make the news. When this program is working, rehab is set up at every working fire, every prolonged or strenuous incident and every live-fire or strenuous training evolution, not only the big ones; it is in the right place, with shade or shelter, water, cooling or warming, and someone qualified to take vital signs; members go to it when the trigger says so and nobody self-releases; vital signs are taken on entry and before release; a member who does not meet the release criteria is rested longer or treated and transported; every rehab period is logged so that an event the next day has a record behind it; and members go to rehab without being teased for it.

Required for every department. Program Profile Worksheet Part C item 6: “Any incident or training lasting beyond one SCBA cylinder or 45 minutes of work, or in heat or cold: Required.” Applies to career, volunteer and mutual aid members at the department’s incidents, to all training evolutions with physical exertion or thermal stress, and to planned events (standbys, public demonstrations, physical ability testing). Where the department provides rehab through a partner (EMS agency, canteen association, mutual aid rehab unit), this program sets the standard the partner meets.

Consistent with 06 Glossary and Acronyms.

• Active cooling: cooling by a device or method that removes heat faster than rest alone (forearm immersion, misting fan, ice towels).
• Heat stress: the total heat load on the body from work, environment and clothing; heat strain: the body’s physiological response to it (ACGIH, n.d.).
• Medical monitoring: assessment of a member’s vital signs and symptoms by a qualified person on entry to and before release from rehab (NFPA 1580, 2025).
• Passive cooling: shade, rest, removal of PPE and air movement without a cooling device.
• Rehabilitation (rehab): the function at an incident or training evolution that provides rest, hydration, nourishment, thermal recovery, medical monitoring and accountability before a member returns to work (NFPA 1580, 2025, legacy NFPA 1584).
• Rehab sector (or group): the incident management system assignment that runs rehab, with a named sector officer.
• Release criteria: the vital sign and symptom thresholds a member must meet before leaving rehab for reassignment.
• SpCO: carboxyhemoglobin saturation measured non-invasively by pulse CO-oximetry.
• WBGT: wet-bulb globe temperature, the index the ACGIH heat-stress TLV uses to set work and rest cycles (ACGIH, n.d.).
• Work cycle: a period of work defined by SCBA cylinder use or minutes of strenuous work without SCBA, after which a rehab period is required.
• Psychological safety: the shared belief in a team that it is safe to speak up, ask, admit error and challenge (Edmondson, 1999)DOI; here, that it is safe to say “I need rehab”.

Only the differences from 01 Roles and Responsibilities. Owning team: Health, Wellness and Rehab Program Improvement Team (06 Program Improvement Teams), jointly with the Fire Suppression and Emergency Operations team for the incident management content.

Requirement. The incident commander establishes rehab at every incident or training evolution where members face thermal stress or sustained exertion, and crews are sent to rehab on fixed work-cycle triggers rather than when someone looks tired (NFPA 1580, 2025; NFPA 1550, 2024, ch. 10). (S1)

Minimum method. Rehab is established, and a rehab sector officer assigned, whenever any of the following is true:

Crews are sent to rehab on these work-cycle triggers (NFPA 1580, 2025, legacy NFPA 1584 ch. 6):

These are convenience triggers, not physiological ones; the standard lets the department set tighter rules and this program expects it in heat (NFPA 1580, 2025).

Evidence. Rehab logged on every qualifying incident report; rehab in/out times in the accountability system.

Requirement. The rehab sector is placed and equipped so that recovery actually happens: away from the hazard, exhaust and noise, sheltered from the weather, with seating, water, cooling or warming, lighting at night, toilets at long incidents, and medical monitoring (NFPA 1580, 2025). (S1)

Minimum method. The sector officer picks the site using the checklist in the SWP: upwind and uphill of smoke and apparatus exhaust, outside the collapse zone and the hot and warm zones, a short walk from the work but out of sight of it where possible (members rest better when they are not watching the fire), with a clear path for EMS. Shade or a tent in summer, a heated apparatus cab, bus or building in winter. Seating for every member expected at once. Minimum equipment per section 17.2. The sector is part of the accountability system: a member checks in on entry and out on release and is not available for assignment while in rehab. At large incidents, the sector may be split into entry (gross decon and doffing), rest and monitoring, and re-equipment areas.

Contamination control at rehab. Members doff and bag or stage contaminated PPE and SCBA before entering the rest area, wipe hands, face and neck before drinking or eating, and do not bring contaminated gloves or hoods to the table (NFPA 1580, 2025); see Decontamination and Contamination Control Program.

Evidence. Site and equipment checklist on the rehab log; the incident safety officer’s observation.

Requirement. A qualified person assesses every member on entry to rehab and again before release, recording vital signs and symptoms, and members who do not meet the release criteria are held, treated or transported (NFPA 1580, 2025). Thresholds are set by the department’s medical director or fire department physician. (S1)

Minimum method. Monitoring by EMS where an agreement exists, otherwise by department members trained to the level in section 6 (medical first responder with vital-sign and pulse CO-oximetry competence). The medical monitoring card (section 17.3) records on entry and before release: heart rate, blood pressure, respiratory rate, temperature where a device is available, oxygen saturation, carboxyhemoglobin (SpCO) wherever smoke exposure was possible, and symptoms. NFPA 1580 directs EMS evaluation of members with symptoms rather than indiscriminate vital signs as the clinical gate (NFPA 1580, 2025); this program takes entry and release vital signs on everyone because the log is also the record that protects the member later, and treats symptoms as the override.

Release criteria (defaults; the medical director sets the department’s own). Commonly used criteria from the research, to be confirmed by the medical director:

A member who is transported, or who refuses a recommended assessment or transport, generates an injury or exposure report and the incident commander and the HSO are told before the end of the incident.

Evidence. Monitoring cards and the rehab log; the EMS agreement; transports reconciled to injury reports.

Requirement. Every rehab period includes rest sitting down, fluids, and at long incidents food. (S1)

Minimum method. Water or an electrolyte drink, cool in summer and warm (not hot) in winter, with a target of roughly 250 mL per 20 minutes of work and more in heat; no caffeine or energy drinks in rehab; food (easily digested carbohydrate and some protein) at any incident over three hours and at all-day training; hand and face wipes before eating. Members are encouraged to pre-hydrate on duty days and before training in heat.

Evidence. Supplies on the equipment checklist; consumption noted on the log at long incidents.

Requirement. Rehab removes heat as well as providing rest. (S1 passive; S1 active where the department operates in summer heat)

Minimum method. Passive cooling at every rehab: coat off, hood off, helmet off, bunker pants opened or dropped to the boots, SCBA off, sitting in shade with air movement. Active cooling available within 10 minutes of any station’s first-due area when the WBGT or humidex is at or above the Heat, Cold and Weather program’s threshold: forearm immersion in cool water (the method with the best evidence for lowering core temperature in firefighters), misting fans, ice or cold-water towels to the neck, armpits and groin. A member with a temperature at or above 39 °C or altered mentation is a heat emergency: aggressive cooling and transport.

Evidence. Cooling kit on the equipment checklist; use recorded on the log.

Requirement. In cold, wind and wet, rehab provides warming and dry clothing as deliberately as it provides cooling in summer. (S1)

Minimum method. A heated shelter (apparatus cab, transit bus, heated tent, nearby building); dry gloves, hoods and socks in the rehab cache; warm (not hot) fluids; wind protection; a rule that wet members do not stand in the wind waiting for assignment; monitoring for shivering, numb extremities, slurred speech and confusion, which are transport triggers; rotation of pump operators and exposure-line crews who are standing still in the cold; ice awareness around the rehab area. The cold-stress TLV sets work and warm-up cycles by wind chill (ACGIH, n.d.); the Heat, Cold and Weather program carries the table.

Evidence. Winter shelter plan per district; cold-weather cache on the checklist.

Requirement. A member leaves rehab only when released by the rehab sector officer on the monitor’s recommendation, and is then reassigned by the incident commander through accountability. (S1)

Minimum method. No self-release. The release decision uses 5.3. A member released after a second rehab cycle is assigned lighter work where possible. A member who has been held, treated or transported does not return to duty at that incident and is referred under the medical program’s return-to-work process if transported. Officers do not pull crews from rehab early; if the incident commander needs the crew, the commander asks the rehab sector officer whether they are releasable.

Evidence. Release times and decisions on the log.

Requirement. A rehab log is completed for every rehab period and attached to the incident or training record (Form - Rehabilitation Log). (S1)

Minimum method. The log records the incident, the sector officer and monitor, site conditions (temperature, humidity or WBGT, wind), each member’s entry and release times, cylinders used, vital signs on entry and release, SpCO, treatment, disposition (released, held, treated, transported, refused), and fluids and food at long incidents. The log goes with the incident report; the HSO retains it with the exposure records. A transport, a refusal or a heat or cold illness becomes an injury or exposure report the same day.

Evidence. Logs on file; sample reconciled to incident reports.

Requirement. Rehab at every live-fire evolution and every strenuous or thermally stressful training activity is established before the evolution starts, to the same standard as at incidents (NFPA 1400, 2026). (S1)

Minimum method. The training safety officer or lead instructor establishes rehab as part of the pre-evolution briefing; the training ground has a fixed rehab area with shade, shelter, water, cooling and warming equipment; students are cycled through rehab on the same work-cycle triggers; summer schedules move strenuous evolutions to cooler hours when the WBGT forecast is high; physical ability testing has EMS or a trained monitor present; the log is kept. Recruit classes are at higher risk because members are unacclimatized, keen, and reluctant to speak up.

Evidence. Training records show rehab; the training safety officer’s checklist.

Requirement. Where EMS provides monitoring, a canteen association provides supplies, or a mutual aid partner provides a rehab unit, a written agreement sets what they provide, when they respond, and what the department does when they are delayed. (S1)

Minimum method. An agreement with the EMS agency for on-scene monitoring at working fires and training on request, including who holds the release decision (the incident commander on the monitor’s recommendation) and how transports are recorded; a canteen or support association agreement for supplies and shelter; mutual aid rehab in the automatic aid agreements. The department never lets the absence of a partner mean the absence of rehab: the apparatus kit and trained members are the fallback.

Evidence. Agreements on file; reviewed annually.

(a) Work-as-done. Before the rehab SOG is written or changed, the learning team describes how rehab really happens: where crews actually sit (on the tailboard beside the exhaust), what the first crew out does when nobody has set rehab up yet, how often the cycle is respected on a second-alarm fire, what the pump operator does for three hours in January, whether anyone takes release vitals when the EMS crew has left for a transport, how a volunteer who came from work at 1700 feels about a 20-minute hold at 0100, and what gets written down afterward. The volunteer stations’ version is collected at a station night.

(b) Capacity and margins. Rehab works most days because officers know their crews, crews rotate themselves, EMS is on scene, and the weather is moderate. The margin disappears when the incident is understaffed so there is no crew to rotate to, when it is 30 °C and humid, when the EMS unit has transported, when the incident is at the end of a long shift, or when the culture rewards staying on the line. The program protects the margin by making rehab an accountability function (a crew in rehab is not available, so the commander has to call more resources rather than skip rehab), by putting a cooling kit on the first-due apparatus so rehab does not wait for a unit, and by training two monitors per platoon and station.

(c) Just culture. A crew that skipped rehab to finish a search, or a sector officer who released early because command was pressing, acted under pressure the system created. The learning team asks what the pressure was and the program removes it (more resources earlier, a stronger line in the SOG, a word to the commander). The learning firewall applies to rehab logs, AARs and learning teams. Falsifying a log or deliberately bypassing accountability after the fix is a conduct matter for a separate process run by different people.

(d) Psychological safety. Rehab only works if “I need rehab” costs nothing socially. Any member can say “I’m done, I need rehab” to their officer, or the officer can say it for a crew member, and the only acceptable reply is “Go.” The incident safety officer and the rehab sector officer have authority to pull any member or crew into rehab, and to hold anyone, including chief officers. Leaders show it is safe by going through rehab themselves at working fires, by never joking about it, and by naming in the AAR the crew that went to rehab on time as the example. Officers are told in training that teasing about rehab is a safety hazard, not banter.

(e) Learning link. Any member transported from rehab, any heat or cold illness, any cardiac symptom, and any incident where rehab was required and not established is a Tier 2 Post-Incident Analysis; a death or critical injury is Tier 3 (The Human Factor, 2026a). Every working fire and live-fire evolution gets a Tier 1 After-Action Review with these questions: “When did rehab get set up, and when should it have?” “Who was due for rehab and did not get there, and what was in the way?” “Did anyone leave rehab before they were released, and why did that seem necessary?” Method: Incident Investigation and Learning Program; tiers: Manual 02 - The Three Tiers and Event Triage.

• SWP - Rehabilitation at Incidents and Training
• Related: the live-fire and heat SWPs in Training Safety and Live Fire Program and Heat, Cold and Weather Program

• Form - Rehabilitation Log
• Rehab unit and apparatus kit equipment checklist (toolkit 17.2)
• Medical monitoring card (toolkit 17.3)
• EMS, canteen and mutual aid rehab agreements
• Training and competency sign-off (toolkit 17.4)
• Retention: rehab logs with the incident record and the exposure records, duration of service plus 30 years (OSHA, n.d.-a, as the benchmark); see 05 Document Control and Records

Loop test. A volunteer firefighter tells her captain on Monday that at Saturday’s barn fire nobody set up rehab, the crew drank from a garden hose, and one member went home dizzy. By Tuesday the HSO has the incident flagged for a Tier 2 review, the dizzy member has been contacted and an exposure report started, and the captain has heard back. Within the week the district’s apparatus kits have been checked and the incident commander has been through a learning conversation, not a disciplinary one. Within the quarter, the review’s finding (no trained monitor in that district on weekends) has become a training action with a date, and every station has been told what changed.

Checklist: Checklist - Rehabilitation. Accreditation crosswalk: this program supports CPSE (2019) criteria 11B.1 (rehabilitative evaluation) and 11B.5 (cardiac assessment) by providing the on-scene monitoring record that the medical program and the cardiac risk work rely on. The five questions an auditor asks first:

1. Show me the rehab logs for the last 10 working fires and the last three live-fire evolutions; are entry and release vitals on every one?
2. Who approved the release thresholds, and when?
3. Open the nearest front-line apparatus: show me the rehab kit, the cooling capability and the pulse CO-oximeter.
4. Name the trained rehab monitors on this platoon or at this station.
5. In the last 12 months, who was transported from rehab, and where is the injury report?

• Rehab only at “big” fires. Cardiac events happen at the room-and-contents fire with two cylinders burned, not only at the third alarm. The triggers in 5.1 answer it.
• Rehab beside the exhaust, downwind of the smoke. The crew breathes diesel while recovering from smoke. Siting rules answer it.
• Vitals on entry, never on release. The log says the member was fine when they arrived and says nothing about when they left to go back in. Release vitals answer it.
• Self-release. The member who feels guilty sitting down goes back in at a heart rate of 140. The no-self-release rule and the accountability link answer it.
• No SpCO. Carbon monoxide poisoning looks like fatigue. Pulse CO-oximetry answers it.
• No cooling in July, no shelter in January. The nine components include thermal recovery for a reason (NFPA 1580, 2025). Active cooling and warming kits answer it.
• No rehab at training burns. Recruits are unacclimatized and will not speak up. The training-ground rule answers it (NFPA 1400, 2026).
• No log, so a cardiac event the next morning has no record. Most jurisdictions’ heart presumptions run for 24 hours after a response because the risk persists after the incident (J32 Workers' Compensation and Firefighter Presumptions); the log is the member’s evidence. Documentation answers it.
• Volunteers skip rehab to go home or back to work. The accountability link and the officer’s duty answer it, and the culture work makes it possible.

Stage 1 minimum (first 12 months).

• Rehab SOG with the triggers in 5.1 and the release criteria in 5.3 approved by the medical director or fire department physician.
• Apparatus rehab kit (part A of 17.2) on every front-line apparatus; one cooling and one warming kit per district.
• Pulse CO-oximeter and blood pressure cuff on every first-due apparatus or with every trained monitor.
• Two trained monitors and one trained sector officer per platoon and per volunteer district.
• EMS agreement, or a written fallback.
• Rehab log in use at every working fire and live-fire evolution.
• Rehab at every training evolution with exertion or thermal stress.

Cost (order of magnitude; confirm locally).

• Apparatus kits: a modest one-time purchase per apparatus plus consumables.
• Pulse CO-oximeters: a per-device purchase for each first-due apparatus or monitor kit; this is the single most valuable device in the program.
• Cooling and warming kits: tubs, misting fans, a canopy, a CO-safe heater, dry clothing cache; a one-time purchase per district.
• Rehab unit or trailer at Stage 2 for a large department, or an agreement with a canteen association.
• Training: four hours per sector officer, a skills session per monitor, time credited for volunteers.
• Program manager time: about two hours a month plus the seasonal notices and the appraisal.

Record the figures in the team’s budget worksheet (06 Program Improvement Teams section 11).

This chapter relies on the following legal requirements, which differ by province and territory. Check your jurisdiction’s section on each topic page before adopting it.

Full form: Form - Rehabilitation Log. Header: incident or training number; date; location type; rehab sector officer (role); monitor (role, agency); time established; site conditions (air temperature, humidity or WBGT, wind, precipitation); shelter and cooling or warming in use; partner on scene. Per member rows: member ID; unit; time in; cylinders used; entry heart rate, blood pressure, respiratory rate, temperature, oxygen saturation, SpCO, symptoms; fluids and food; cooling or warming applied; release heart rate, blood pressure, respiratory rate, temperature, oxygen saturation, SpCO, symptoms; time out; disposition (released, held and released, treated, transported, refused assessment or transport); monitor initials. Footer: total members through rehab; transports (injury report numbers); sector officer signature (role); attached to incident report (date); HSO review (date).

Part A: every front-line apparatus (Stage 1).

Part B: rehab unit, trailer or district cache (Stage 1 per district; Stage 2 unit).

Incident/training no.: ______   Date: ______   Member ID: ______   Unit: ______
Monitor (role/agency): ______   Smoke exposure possible?  Y / N

                    ENTRY (time ____)     RELEASE (time ____)    Threshold (medical director)
Heart rate          ______ bpm            ______ bpm             <= ___
Blood pressure      ___/___               ___/___                < 160/100
Respiratory rate    ______                ______                 Normal for member
Temperature         ______ C              ______ C               < 38 C; >= 39 C = emergency
SpO2                ______ %              ______ %               Normal for member
SpCO                ______ %              ______ %               < 5 % non-smoker
Symptoms (circle)   chest pain / SOB / dizzy / nausea / confusion / cramps / headache / none
Fluids taken        Y / N   Food (if > 3 h)  Y / N   Cooling / warming applied: ______
Cylinders used this cycle: ____   Rest period required: 10 / 20 min   Rest completed: Y / N

Disposition:  Released ___  Held (reassess at ____) ___  Treated ___  Transported ___  Refused ___
If transported or refused: injury/exposure report no. ______   IC and HSO notified (time) ______
Monitor initials: ____   Sector officer initials: ____

1. Get the assignment from command; put on the vest; get a radio designation.
2. Pick the site: upwind, uphill, out of the hazard and collapse zones, away from exhaust, shade or shelter, EMS access, out of sight of the fire where possible.
3. Set up: seating, water, cooling or warming, monitoring station, PPE doffing and bagging area at the entry, accountability board.
4. Tell command and accountability that rehab is established and where.
5. Receive crews: tag in, doff and bag PPE, wipes, seat, fluids, entry vitals.
6. Hold the clock: 10 or 20 minutes by the cycle; longer if vitals or symptoms say so.
7. Release only on the monitor’s recommendation and the criteria; tag out; tell accountability.
8. Anyone symptomatic: EMS now; tell command; start the injury or exposure report.
9. Long incident: food at three hours, toilets, lighting, relief for the monitors, re-supply.
10. Demobilize: log complete and signed, transports reconciled, kit restocked, log to the officer in charge.

American Conference of Governmental Industrial Hygienists [ACGIH]. (n.d.). Threshold limit values for chemical substances and physical agents and biological exposure indices (current edition).

Occupational Safety and Health Administration [OSHA]. (n.d.-a). Access to employee exposure and medical records (29 C.F.R. § 1910.1020). U.S. Department of Labor. https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.1020