“The organization is ethically and morally obligated to put an EMS program in place that is supported by the organization, and given the standardized training and equipment to make the program succeed.”
Senior Firefighter/Paramedic, Sawtooth Helitack Crew
That quote is on the cover of the Facilitated Learning Analysis (FLA) that the U. S. Forest Service recently released about an incident on the Deer Park fire in central Idaho involving a helicopter and a firefighter with a broken femur.
Briefly, on August 6, 2010 a firefighter serving as a lookout for a burnout operation on the Deer Park fire in central Idaho suffered a broken femur, the large bone in the thigh, after being stuck by a 200-pound rock. The life flight helicopter coming to evacuate him landed on a very small helispot without being able to communicate with ground personnel. After the crew and the pilot shut it down and exited the aircraft, the ship rocked backward and settled on the housing around the enclosed tail rotor, damaging that system. The helicopter was in danger of sliding down a steep slope. This not only put the helicopter out of service, but also blocked the use of the helispot.
A broken femur can be a very serious injury. If the nearby large femoral artery is severed, a patient can quickly bleed to death.
A second helispot was then constructed and an agency-contracted helicopter landed and flew the patient to the fire’s helibase, where he was transferred to a larger and faster National Guard helicopter, then transported to Boise for treatment. He is now recovering from his injuries at his home.
The injury was first reported at 1027. At some time after 1450, at least four hours and 23 minutes after the injury was reported, the patient departed the helibase enroute to the hospital, about 55 air miles away. For comparison, it took 2 hours and 51 minutes for Andrew Palmer to be flown away from his injury site in a Coast Guard helicopter. Unfortunately Mr. Palmer, who was struck by a falling tree on a fire in northern California in 2008, was dead by the time he arrived at the airport in Redding, three hours and 20 minutes after his injury.
A person could argue that if the lifeflight helicopter had landed safely at the small helispot on the Deer Park fire and remained in service, the patient could have been transported off the fireline approximately 1 hour and 15 minutes after the first report of the injury, but he would have still been about 55 air miles from the hospital in Boise. Obviously this is not within the preferred goal of getting a seriously injured patient to an appropriate medical facility within the “golden hour”, as touted by Jim Milestone, superintendent of the Whiskeytown National Recreation Area, who was on the investigation team for the Palmer fatality.
And, to borrow a few words from the firefighter/paramedic quoted above:
The federal agencies still have an ethical and moral obligation to develop procedures that deal with the time frames for providing appropriate medical treatment for their employees at their work place, where ever it may be.
Wildland firefighting is one of the most dangerous occupations in the world. Injuries are going to happen in inconvenient locations. For the employers of firefighters to put their heads in the sand on this issue, hoping it will go away, is ethically and morally reprehensible. I am surprised that OSHA is not regularly citing them for repeated violations on this issue. The desk-bound ‘ologists, political appointees, and yes, some former firefighters that manage the fire programs in the federal agencies need to wake up and smell the coffee.
But despite the helicopter incident, a lot of things went right. The firefighters on the ground displayed a great deal of leadership and ingenuity in managing and organizing the tasks of treating and moving the patient, managing the two helispots, and constructing the second helispot. They are to be commended for dealing with the unusual obsticals that were thrown at them, which made me think of a training exercise in S-420 or S-520.
In addition, the U.S. Forest Service and the Sawtooth National Forest deserve praise for creating an excellent FLA in a short amount of time. We first heard about the completed FLA yesterday, only 15 days after the accident. This is a opportunity for the wildland fire community to benefit from the lessons learned.
As a person who has been instructing Incident Command System courses for a long time, I noticed one thing in the report:
1224 – Personnel on scene meet and clarify incident organization. Separate individuals are established as Incident Commanders of Helicopter Issue, Medivac Spot #2 construction, patient care, and fire suppression activities in Division C.
It’s great that they established an organization for each of the four tasks above. And maybe the people who wrote the report got confused about the titles assigned to the firefighters responsible for each task, but with the benefit of hind sight, it appears that having four Incident Commanders, plus THE IC for the fire, could lead to confusion. Another option would have been to establish Functional Groups with a Group Supervisor in charge of each.
To see a larger version of the FLA below, click on the “+” or “full screen”.
Deerpark Facilitated Learning Analysis
These are the links referred to in the FLA:
- Video: Deer Park Accident Description
- Video: Flathead IHC “conveyor belt” method of patient transport
- Map: Deer Park fire map
Official report on the Andrew Palmer fatality
A summary of the findings from the Andrew Palmer fatality
Reflections on the Andrew Palmer fatality
Medevac on wildfires: can we do it in one hour?