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near the body.

B.Comply with established guidelines for pre-entry screening of HAZMAT responders.  Any personnel with pulse above 100, blood pressure outside a range from 90/60--150/90 or temperature above 99°F should not be allowed to enter the site.  They may enter if these vital signs are normal after a minimum rest period of five minutes.  Records must be kept of these measurements on each individual.

C.Allow fire fighters or HAZMAT responders to work one work period, for example 30 minutes of a 30-work/30-rest cycle.

D. Measure heart rate on each emergency responder (may be measured by worker himself) at the end of the work period, or when he/she voluntarily removes  himself/herself early from the work area.

E.If the pulse exceeds 75% of the AAMHR, the responder worked too long and his next work cycle should be decreased by one third (from 30 minutes to twenty minutes in our example).  If the AAMHR is impractical to use, a value of 110 beats-per-minute may be substituted (Skinner).  This value is low, but should ensure that all responders who are at risk of dehydration are adequately followed.  Under the AAMHR, a young responder would be "allowed" a much higher pulse, but will suffer no penalty in adhering to this 110 action level, other than being observed during his rest cycle.

1.  Remember, the responder must complete his 30 minute rest cycle, during which time he/she should relax and rehydrate under observation by paramedics.  His pulse should be monitored again after 5 minutes, and if still elevated, he/she should begin aggressive oral rehydration (see G below).  Intravenous fluid therapy or other intervention may be instituted during this period if clinically indicated.

2.  Before beginning the next cycle, the worker should be evaluated by a paramedic, who will assess his condition and measure vital signs.  If the worker is orthostatic, if his vital signs are outside the parameters listed above in part A, or if his present blood pressure is below his initial blood pressure (taken on HAZMAT responders), then he/she should not return to work until this situation has stabilized.  This is evidence of significant dehydration or undue stress imposed by the work environment.

3.  Paramedics must be alert for heat injuries ranging from heat cramps to heat stroke, and must record all of the information on each patient for potential hospitalization of these individuals.

F,If the pulse does not exceed 75% AAMHR (or 110 as above), the worker can continue to follow prescribed work/rest schedules.

G.Drink cool (40°F), dilute fluids at a minimum rate of at least 8 ounces every 15 minutes or 1 liter(quart)/hour (Skinner).  Those who are dehydrated must drink at a rate of 8 ounces every 10 minutes or 1.5 liters/hour.  The stomach can absorb fluids no faster than this.  Electrolyte replacement solutions, such as Gatorade®, should be diluted first by an equal volume of water.  Responders cannot wait until they are

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