5

Fire Fighter
Safety
 5
Learning Objectives (1 of 13)
• Identify and analyze the major causes
involved in on-duty fire fighter fatalities
related to health, wellness, fitness, and
vehicle operations.
• Analyze the trend in the number of fire
fighter on-duty deaths over a 30-year
period.
• Define frequency and severity as they
relate to fire fighter injuries.
 5
Learning Objectives (2 of 13)
• Enumerate fire-ground safety issues
addressed in NFPA 1500.
• Compare and contrast fire trends and
fire fighter on duty deaths.
• Describe the relative risk to fire fighters
combating fires in different occupancy
types.
 5
Learning Objectives (3 of 13)
• Analyze the trend in number of fire
fighter injuries.
• Discuss risk management principles
applied to the fire ground.
• Discuss and give an example of an
imminent life-threatening situation.
 5
Learning Objectives (4 of 13)
• Use a probability analysis to assess the
occupied status of a building based on
time and occupancy.
• Estimate the collapse time based on
burn time, fire intensity, content load,
and construction type.
 5
Learning Objectives (5 of 13)
• Examine the difference between a managed
retreat and an evacuation due to an imminent
hazard.
• Evaluate the difference between lightweight
and heavy structural components.
• Discuss and contrast pre-fire and fire
conditions that contribute to structural
collapse.
• Examine hazards presented by suspended
ceilings.
 5
Learning Objectives (6 of 13)
• Compare construction methods in terms
of structural stability, fire extension, and
fuel contribution.
• Review the basics of building
construction and how they relate to pre-
fire planning.
• Estimate the collapse zone for a
building in imminent danger of collapse.
 5
Learning Objectives (7 of 13)
• Describe exclusion zones other than collapse
zones.
• Develop zones and perimeters around a
structure fire.
• Define and explain the five time segments
from ignition to effective action.
• Evaluate the survivability, structural stability,
and flashover from ignition to effective action.
 5
Learning Objectives (8 of 13)
• Evaluate set-up time in regard to staffing on
the first-arriving engine company.
• Compute the staffing necessary to achieve
the tasks enumerated in NFPA 1710.
• Define and compare flashover and backdraft.
• Explain the relationship between NIMS and a
fire fighter accountability system.
 5
Learning Objectives (9 of 13)
• List situations when a personal accountability
report (PAR) should be initiated.
• Explain the importance of alternative egress
for fire fighters conducting an offensive
attack.
• Define rapid intervention crew (RIC).
• Explain the role of the RIC.
• Explain the importance of having a RIC
immediately available from initial attack and
throughout the operation.
 5
Learning Objectives (10 of 13)
• Determine the number of personnel to
be assigned to the RIC based on the
size and complexity of the building and
incident.
• Describe safe interior operations.
• Construct an emergency message for a
disoriented fire fighter needing
assistance.
 5
Learning Objectives (11 of 13)
• Explain measures that can be taken to
improve the chances of survival when fire
fighters are lost and out of air in a large
building.
• Describe methods used to supply air to a
trapped fire fighter who has exhausted his or
her air supply.
• List tools that should be available to a RIC.
 5
Learning Objectives (12 of 13)
• Compare the advantages and disadvantages
of a mobile RIC versus a stationary RIC.
• Recognize hazards in operating opposing fire
lines.
• Evaluate hazards to fire fighters during
overhaul operations.
• Define immediately dangerous to life and
health (IDLH) atmospheres and the
relationship to SCBA usage.
 5
Learning Objectives (13 of 13)
• List factors the IC should consider when
formulating an incident action plan to be used
during overhaul.
• Describe informal rehabilitation at the fire
scene.
• Describe hot weather rehabilitation
• Describe cold weather rehabilitation.
• List the signs of critical incident stress.
 5
Overview
• Fire departments
– Dedicated to saving lives and property
– Saving lives is the highest priority.
• Safety closely related to risk-versus-
benefit analysis.
 5

Fire Fighter Injuries and

Fatalities
• Identifying/analyzing data
– Critically important to reducing fire fighter
injuries and deaths
– The National Fire Protection Association
(NFPA) has compiled fire fighter fatality
statistics for 30 years—downward trend
 5
Fire Investigative Reports
• National Fire Protection Association
(NFPA)
• National Institute for Occupational
Safety and Health (NIOSH)
• U.S. Fire Administration (USFA)
 5
NFPA 1500 (1 of 5)
• Standard on Fire Department
Occupational Safety and Health
Program
• Can substantially reduce injury
frequency and severity
– Minimum safety measures
– ICs and safety officers must be familiar
with this standard.
 5
NFPA 1500 (2 of 5)
• Important fire-ground safety issues:
– Risk management principles
– IC responsible for overall safety
– Incident management system must be
used at all scenes
– IC maintains command and control.
• Common strategy
• Based on situation analysis
 5
NFPA 1500 (3 of 5)
• Important fire-ground safety issues
(continued):
– Situation analysis must be ongoing
• Changes in strategy consistent with the
changing situation
– Pre-established SOPs must be
implemented.
 5
NFPA 1500 (4 of 5)
• Important fire-ground safety issues
(continued):
– Accountability system
– Rapid Intervention Crews (RIC)
– Inexperienced members must be directly
supervised.
 5
NFPA 1500 (5 of 5)
• Important fire-ground safety issues
(continued):
– Medical treatment and rehab must be available as
needed.
– PPE must be worn.
– SCBA
– PASS devices
– CISD
– Post-incident analysis
 5
Fire-Ground Safety
• Improvements
– Attention to safety
– Safe operation attitude
• Still experiencing a large number of
on-duty deaths
– Responding to fewer fires
– Dying at nearly same rate
 5
Fire-Ground Fatalities
 5
Increased Hazards (1 of 2)
• Lightweight construction
– Truss roofs
 5
Increased Hazards (2 of 2)
• Heavy fuel loads
– Large amounts of plastics
• Very large buildings
 5
Occupancy
• Plays a role in fire fighter safety
• No routine fires
• Most fatalities occur in residential fires.
• Risk increases twofold in a
manufacturing setting.
 5
Single-Family Mindset
• Must be avoided
• Escape routes are closer and easier to
find.
• SCBA depletion or failure
 5
On-Duty Deaths
• Leading causes:
– Sudden cardiac death
• Preventable
– Asphyxiation
– Crushing injuries and burns
 5
Responsibility
• Administration
• Procedures
– Training
– Equipment
• ICs have overall safety responsibility.
– Must monitor, organize, coordinate, and
provide adequate safety measures
 5
Personal Responsibility
• Fire fighters must take personal
responsibility through:
– Following procedures
– Maintaining firefighting skills
– Proper use of equipment
 5
Risk Management
• Most important element
• NFPA 1500
– Risk management principles
– Must be applied to every situation
• IC weighs risk against possible benefits.
 5
Two-in, Two-out Rule
• Exception:
– Imminent life-threatening situation
– Definition is not completely understood
• IC expected to exercise judgment
 5
Probability
• Important concept to risk management
and size-up processes
– People being in the building considered as
a degree of probability
– Determining factors: time of day, day of
week, time of year
• Primary search is the only sure way of
knowing.
 5
Fire Intensity
• Important in determining what there is to
save.
• Hazards increase as fire progresses
towards flashover.
– Building is getting weaker
– Flashover is unpredictable.
 5
Flashover (1 of 2)
• Time to flashover depends on:
– Compartment size
– Ventilation
– Ignition source
– Fuel supply
– Fuel geometry
 5
Flashover (2 of 2)
• Time to flashover depends on
(continued):
– Distance between fuel cells
– Location of the fuel
– Heat capacity of the fuel
– Geometry of the enclosure
 5
Building Design Loads
• Loads imposed on buildings:
– Live loads
– Dead loads
– Seismic, wind, snow, and ice loads
• Affect structural stability
– High loads can result in premature
collapse.
– Loads placed on lightweight roof structures
 5
Fuel Load
• Consists of fuels provided by:
– Contents
• Primary fuel load in structure fires
– Combustible building materials
• Wood frame construction
 5
Structural Stability (1 of 4)
• IC/safety officer must watch for signs of
structural failure
• Should be considered in size up
– Failure can occur at any time.
• Must understand collapse dynamics
 5
Structural Stability (2 of 4)
• IC must take into account when:
– Deciding on strategy
– Placing companies
• Cannot be reliably predicted
– No building is immune.
– Some withstand a large fire without
collapse.
– Others experience early collapse.
 5
Structural Stability (3 of 4)
• Stability affected by:
– Fire intensity
– Burn time
– Content loads
– Construction methods and materials
 5
Structural Stability (4 of 4)
• 20-minute rule
– Ordinary construction
– Structural collapse anticipated:
• Heavy volume of fire
• Two or more floors
• 20 minutes or longer
 5
Time and Intensity
• Is it safe to enter?
– IC should “start the clock.”
– If fire is still not under control:
• IAP should be reviewed.
• Operation possibly changed to defensive
 5
Managed Retreat
• When changing from offensive to defensive
– Engine companies provide protection.
• If collapse is imminent, the offensive
operation should be abandoned immediately.
• All units notified by:
– Radio announcement
– Pre-planned signal
 5
Construction Materials (1 of 2)
• Wide variety in use
– Behavior of buildings will vary significantly.
– Lighter weight structural members
• Provide same load-bearing capabilities
• Truss construction takes the place of large
wood beams or steel I-beams
• Structurally sound under normal conditions
 5
Construction Materials (2 of 2)
• Lightweight members are affected by
fire sooner.
– Trusses lose load-bearing capacity once
they lose their triangular configuration.
– Failure with little warning
 5
Structural Connections (1 of 2)
• Play a critical role in a building fire
– Gusset plates used in place of nails
• Nails form a stronger connection.
– Penetrate only a fraction of an inch
– Form a large surface area to collect heat
 5
Structural Connections (2 of 2)
• Wood truss loses its stability as:
– Gusset plate teeth lose strength
– Fire burns through the wood connecting
surfaces
 5
Gusset Plate Failure
 5
Fire Spread
• Can occur through variety of openings
– Horizontal: joist/truss spaces
– Vertical: utility shafts
• Renovations affect fire spread:
openings in floors not always properly
sealed
 5
Roof Operations
• Conscious decision regarding roof
safety
– Lightweight truss roofs are dangerous.
• Risk-versus-benefit decision
– Must be made before placing fire fighters
on or under roof
 5
Pre-Fire Conditions (1 of 5)
• Factors for evaluating collapse potential
of a building:
– Weight – Renovations
– Fuel loads – Deterioration
– Damage – Support systems
– Truss construction
 5
Pre-Fire Conditions (2 of 5)
• Weight, live and dead loads including:
– Air conditioning units
– Tanks containing liquids
– Large signs and marquees
– False fronts (façades)
– Cantilever appendages
– Heavy machinery
 5
Pre-Fire Conditions (3 of 5)
• Fuel loads
– Type, location, and arrangement fuel loads
• Damage structural support system
– Previous fires, weather or collapse
 5
Pre-Fire Conditions (4 of 5)
• Renovations
– Older buildings
• Deterioration
– Buildings or areas in poor repair
– Vacant buildings
 5
Pre-Fire Conditions (5 of 5)
• Support systems
– Long spans (churches, warehouses)
• Truss construction
– Identified through pre-planning
 5
Fire Conditions
• Sometimes difficult to read
• Failures occur without warning.
• Must recognize signs of imminent
collapse
– Maintain span of control
• Time and fire intensity are major factors.
 5
Signs of Structural Collapse (1 of 2)
• Bulging, cracked, or unsupported walls
• Walls leaking water or smoke
• Falling bricks
• Floors holding large volumes of water or
stock soaked with water
 5
Signs of Structural Collapse (2 of 2)
• Movement in floors or roof
• Other signs of structural movement,
including unusual noises
• Vertical structural members that are out
of plumb (columns, walls, etc.)
 5
Fire Extension
• Some buildings limit fire spread better
than others.
• Concealed spaces
– Fire can extend to remote locations
• Results in a sudden increase in heat intensity
• Can break out at multiple locations
 5
Concealed Spaces (1 of 2)
• Fire fighters without a hose line are at
high risk.
• Fire extension can cut off primary
means of egress.
• Proper venting will direct fire.
• Improper venting pulls fire.
 5
Concealed Spaces (2 of 2)
• Fires in concealed ceiling areas can get
behind fire fighters.
– Hose streams can accelerate movement of
fire.
• Must be checked
– Thermal imaging cameras
– Opened up with tools
 5
Truss Assemblies
• Floor assemblies
– Used to reduce construction costs
– Creates concealed space
– Less fire-resistive than heavier, solid beam
construction
• Have played a major role in fire fighter
fatalities
 5
Truss Floor Assembly
 5
Non-Combustible Buildings
• Mistaken for fire-resistive
– Modern, big-box retail stores
– May be masonry or metal on the exterior
– Lightweight metal truss roof structure
• Large open areas with long spans
– Expect imminent roof collapse if fire enters
spaces.
 5
Automatic Sprinkler Systems
• Usually control fires
– Consider code variances or “trade-ups”
– If system is not controlling fire, consider
hazards in entering large-span truss space
with heavy fire load.
 5
Fire Zones and Perimeters
• Establish collapse zone
• Collapse indicated by:
– Construction features
– Fire factors
• Cannot accurately predict:
– Type of collapse
– Collapse zone
 5
Exclusion Zones
• Collapse zones = exclusion zones
– No one permitted to enter
– Can exist in buildings (suspect roof
structures)
– Other areas:
• Falling glass
• Flammable/combustible atmospheres
 5
Cold Zone
• PPE is not required.
• Location of command post
– Staff and command functions
• Includes rehab and medical areas
 5
Hot Zone
• Safe only when wearing appropriate
PPE
• Established and enforced by IC and
safety officer; everyone must abide by
their decision.
 5
Warm Zone
• Not always necessary during a structure
fire
• Established as an intermediate zone
– Between hot and cold zones
– When different levels of PPE are needed
for various areas
 5
Accountability System
• Must be established on the fire-ground:
– Ensures everyone entering the area has a
specific assignment
• Eliminates freelancing
– Tracks all personnel
• Identifies the location of any missing personnel
 5
Time, Fire Intensity, and
Structural Stability
 5

Time: Ignition to Effective

Actions
• Goal: To arrive prior to flashover and
intervene
– Interrupts fire’s progression
– Progression in small enclosures can be
fast.
• May occur prior to the arrival
• Objective is to contain the fire
 5
Analyzing Time
• It is necessary to consider the following
five components:
– Pre-burn time
– Dispatch time
– Turnout time
– Response time
– Set-up time
 5
Detection/Transmission Time
• Pre-burn time
– Time from ignition until fire is reported
• Will vary greatly
• Is unknown until the alarm occurs
– Dependent upon discovery and reporting
• Unless equipped with a detection/alarm system
– Can be estimated based on experience
 5
Dispatch Time
• NFPA 1221: Installation, Maintenance,
and Use of Emergency Services
Communications Systems sets time
goals for dispatch centers.
• Includes time for the dispatcher to:
– Take the call
– Select units for the assignment
– Dispatch companies
 5
Turnout Time
• Time from alarm receipt until apparatus
leaves station
• Can differ greatly between fully staffed
stations and on-call stations
 5
NFPA 1710
• Standard for the Organization and
Deployment of Fire Suppression
Operations, Emergency Medical
Operations, and Special Operations to
the Public by Career Fire Departments
defines turnout time
• Time beginning when units
acknowledge notification to beginning
point of response time
• Time objective = one minute
 5
NFPA 1720
• Standard for the Organization and
Deployment of Fire Suppression
Operations, Emergency Medical
Operations, and Special Operations to
the Public by Volunteer Fire
Departments does not address turnout
time.
 5
Response Time
• Dependant on road conditions, terrain,
distance, traffic, and other factors
• Averages can be established using
computer models.
 5
NFPA 1710
• NFPA 1710 establishes two response
time goals:
– Four minutes (240 seconds) or less for
arrival of the first engine company
– Eight minutes (480 seconds) or less for the
deployment of a full first alarm assignment
– No less than 90 percent within time goal
 5
Response Safety
• Many fire fighters are killed or injured
while responding to incidents.
– Response/travel time improvements
• Realized by reducing distance from fire station
to response area
• Not by increasing speed of apparatus or
ignoring negative right-of-way situations
 5
Set-Up Time
• Time necessary to position apparatus,
advance hose line and apply water
• Affected by staffing levels and training
– Two-in/two-out rule changes setup time
• Four people must be on the scene.
• Two must be positioned outside the hazard
area.
 5
NFPA 1410
• Standard on Training for Initial
Emergency Scene Operations sets
training goals.
– 3 to 6 minutes to establish water supply
and discharge water
– Improvement through training
 5
Initial Response Only
• Times are valid for initial response only
– Less dispatch time when units are on-
scene, calling for help.
– Reduce for subsequent calls by:
• Placing units on alert status
• Moving into vacated stations
• Placing units in staging areas
– Set-up time will change depending on task
assignment
 5

Adequate Number of
Personnel
• Set-up time is related to staffing.
– Initial attack should be delayed if:
• Company staffing is less than four
• Imminent life-threatening situation does not
exist
 5
NFPA 1500
• Stipulates a minimum of four fire
fighters as an initial crew at a working
structure fire
– Unless imminent life-threatening situation
exists
– Three is acceptable in situations of
imminent danger
 5
Fire-Ground Tasks (1 of 3)
• Required to save lives and protect
property
• Additional attack lines
• Attack line above the fire
• Attack line to concealed spaces
• Backup for the initial attack line
 5
Fire-Ground Tasks (2 of 3)
• Exposure protection
• Forcing entry
• Laddering the building
• Opening up concealed spaces
• Salvage or property conservation
 5
Fire-Ground Tasks (3 of 3)
• Search and rescue of area around the
fire
• Search and rescue of area above the
fire
• Search and rescue of other areas
• Utility control
• Ventilation
 5
NFPA 1710
• Establishes minimum staffing levels
– Tasks to be accomplished
– Personnel needed
– Minimum of 14 personnel
• 15 if an aerial device is used
 5
Tactical Reserve
• Planning is crucial.
• Tactical efficiency can reduce number
of people necessary.
• Size of tactical reserve force depends
on:
– Stage and type of incident
– Number of units working
 5
Elapsed Time and Flashover
• Time is a critical factor.
• Longer the fire burns:
– Less chance for rescue
– Greater chance of structural collapse
– Post-flashover chance for survival = near
zero
– Risk to fire fighters increases
 5
Communications
• Lifeblood of any command organization
• Situation could be chaotic without
communications.
– Each crew should have a radio.
 5
Radio Discipline
• Significant challenge
• Imperative when everyone is assigned a
radio
– Proper use of the radio
• Clear
• Calm
• Concise
 5
Progress Reports
• Essential to the IC
• Interior crews = eyes and ears of the IC
• Provide information to everyone on fire-
ground
 5
Emergency Operations
• Mayday is used to indicate that a fire
fighter is in trouble.
• SOPs should define response to a
Mayday
– Critical functions will not be accomplished
if all personnel begin focusing on the
rescue operation.
 5
Mayday
• IC must remain in total control.
• Officers must remain within the ICS.
• Specific assignments should be made
for the rescue operation.
 5
Evacuation Signal
• Should be established through SOPs
– 10 three-second blasts of air horns
– Emergency evacuation radio message
 5
Evacuation
• “Drop everything and run”
– Seldom warranted
– Used during defensive operations
• Offensive operations
– Organized retreat is better alternative
 5
Command and Control
• Common goal
– Organized fashion
– Safe and effective operation
• Freelancing leads to injuries and
fatalities.
 5
Accountability
• A good organizational structure:
– Accounts for all personnel at scene
– Maintains reasonable span of control
• Crew unity is essential.
• Crew members should not be separated
within the structure.
 5

Personnel Accountability
Report (1 of 2)
• Often referred to as a PAR.
• SOPs call for PARs in the following
situations when:
– IC thinks it is necessary
– Safety officer requests one
– IC changes from an offensive to a
defensive attack
 5

Personnel Accountability
Report (2 of 2)
• Sudden changes occur.
• Entire building has been searched.
• Fire is extinguished.
• Called for at prescribed times
– NFPA 1500: Every 10 minutes
 5
Accountability Procedures
• More important as incident increases in
size and complexity
– Mutual aid resources
– A regional approach is logical
 5
Accountability Officer
• Should not be the safety officer
– Safety officer is mobile.
– Accountability officer is stationary.
• The accountability officer is an
informational resource for the safety
officer, RIC, and IC.
 5
Safety Officer
• Safety is everyone’s responsibility.
– Whether or not a safety officer has been
assigned
• Safety officer monitors all areas.
• SOPs outline when position is
established
– When IC can no longer effectively monitor
safety at the scene
 5
Alternative Egress (1 of 2)
• Interior stairs
– Preferred means of access and egress
• Fire escapes
– Additional means
– Provide access to upper floors
 5
Alternative Egress (2 of 2)
• Proper laddering
– Should be accomplished early in operation
• Provides alternative means of egress
• Addressed in SOPs
• Location of ladders must be
communicated to crews.
 5
Rapid Intervention Crews
• Staffing is not sufficient until:
– Safety and tactical positions are covered
– Tactical reserve is available.
• Critical need to provide rescuers for fire
crews
– RIC: no substitute for safe and effective
operations
 5
Fire Fighter Rescue
• IAP will reduce the need for emergency
rescues.
– Risk-versus-benefit analysis
– Good tactics
– Company-level attention to safety
 5
Safe Interior Operations (1 of 2)
• Maintain crew integrity
• Provide hose line protection
• Provide means of communications
• Maintain contact with the hose line
 5
Safe Interior Operations (2 of 2)
• Maintain contact with a wall or rope
• Indicate door leading to where fire
fighters are working
• Learn self-survival techniques
 5
RIC Officer
• Determines need for special tools
– Based on:
• Construction type
• Occupancy
• Fire location
• Other factors
– Could be identified through pre-planning
 5
Common RIC Tools (1 of 2)
• Rescue ropes, search ropes, guideline
ropes
• Thermal imaging camera
• Patient carrier, webbing, or harness
• Portable ladders for above- and below-
grade rescues
 5
Common RIC Tools (2 of 2)
• Forcible entry tools
• Wire cutters and other hand tools
• Lighting equipment
 5
RIC Operations
• RIC should have access to pre-plans.
• Critically important to train and practice
– Preferably under live fire conditions
 5
Hose Lines
• Avoid opposing hose lines.
• Interior hose lines should attack from
same point.
– Communications between units is
essential.
 5
Master Streams
• Improperly operated on the exterior will
push fire into the building, endangering
anyone inside
 5

Personal Protective
Equipment (PPE)
• Appropriate level established by IC and
safety officer
• Overhaul phase
– Removing SCBA is questionable
• Removing PPE inside fire building is
unsafe
 5
Overhaul Safety (1 of 2)
• Safety considerations:
– Structural damage/stability
– Smoke and airborne contaminants
– Cutting hazards
– Holes in floors
 5
Overhaul Safety (2 of 2)
• Safety considerations (continued):
– Damaged stairways
– Utility hazards
– Overhead hazards
– Visibility
 5
Rehabilitation
• NFPA 1584: Recommended Practice on
the Rehabilitation of Members
Operating at Incident Scene Operations
and Training Exercises
– Provides guidelines for hot and cold
weather rehabilitation
 5
Three Phases
• Pre-incident hydration and preparation
• Incident rehabilitation
• Post-incident recovery
• Dependant on:
– Weather conditions
– Length of time on the scene
– Activity level
 5
Informal Rehab
• Takes place at the company apparatus
– Should be in cold zone
– Members can “dress down” while resting
and rehydrating
– Should not be placed near exhaust fumes
 5
Formal Rehab
• Established area for rehab
– Should provide shade and mechanical
cooling or heating
• Dependant on weather conditions
– Water or sports drinks and healthy food
should be available.
 5
Two-Cylinder Rule
• Requires Rehab after a second,
30-minute SCBA cylinder
• Rest period should be at least 20
minutes
 5
Critical Incident Stress
• Stress management is related to rehab.
– Best to take action at incident scene
– Critical incidents
• Fire in which fire fighters are seriously injured
or killed
• Fire in which children are seriously injured
• Fire that results in one or more fatalities
 5
Signs of Critical Incident
Stress
• Shaking or trembling
• Loss of muscular control
• Blurred vision
• Respiratory difficulties
• Confusion and disorientation
• Chills
• Signs and symptoms of shock
 5
Proactive Measures
• Schedule breaks
– Designated rehab area
• Rotate frontline personnel
• Check personnel for signs and
symptoms.
 5
Summary (1 of 2)
• The primary rescue technique is
extinguishing fire.
– Heat, smoke, and toxic gases must be
vented.
• Structure becomes safer once fire is
extinguished.
 5
Summary (2 of 2)
• Measures to reduce fire fighter injuries
and deaths:
– Improved PPE
– PASS devices
– Rapid intervention crews
– Accountability systems
– NIMS
– Rehab