“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
More information:
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?
After reading Bill’s comment on # 1 C, I have to ask: has the Forest Service explored the possibility of incorporating short-haul operations into its helicopter program?
Using this tool, helicopters stationed at Sequoia-Kings, Yosemite, Grand Canyon and other national parks have been extracting seriously injured people from remote, LZ-free areas for years. Short-haul requires minimal, relatively lightweight equipment. It diminishes or eliminates the need to move a critically injured patient, cut a sizeable helispot or rely on non-agency aircraft to respond from distant hospitals or airbases. The NPS already has rigorous safety protocols and a proactive, well-established working group in place.
At Sequoia-Kings I have seen the timeliness of a short-haul response mean the difference between life and death for a Park visitor. It would be wonderful if the same level of care could be reliably offered to the folks on the fireline.
The lookout from Flathead IHC is truly fortunate. He had great support from his crew and other resources around him. Incident managers response was spot on. Good thing all aviation wasn’t grounded due to smoke.
Seems like some measure of luck was at play. I didn’t see it in the FLA but I would guess his femoral artery wasn’t severed. If if was 4 hours 23 minutes plus flight time could have been too long.
Better make sure any ship/pilot combination with extraction capabilities can fly when all other aviation is grounded due to smoke.
We have a daily Med Plan at our unit. We have drilled on it and will continue to get partners into the fold including local life flight.
A good report/review of the incident. The people on the fire and then medical incident sound like they were well trained and made good decisions and took the right actions, even when things did not work out as expected.
During incidents the medical unit, operations, air ops and helibase manager need to meet and come up with plans on differnt situations, one of them being a serious medical emergency in remote areas.
Nothing complicated but just who will do what and where resources are aviliable.
In daily work the district, park or forest needs to have standing, current plans on how to respond to remote or unusual medical events. It’s a critical safety task of the agency. Responsibilities need to be assigned, resources identified, plans done, coordination established with others, training and pratice done along with constant updating. A job for the safety officer in my book. I am sure some agencies have these working and in place and others do not. They can save someones life and prevent a nasty legal action.
The Golden Hour is a goal that’s nice to be able to meet, and the quicker a serious injury patient gets to good hospital the better for them. But in reality there are a lot of places where it can’t be met. Even with fully crewed professional rescue aircraft ready to go. It may be a one hour one way trip just to the accident site. Then there is the unexpected as the Deer Park incident showed. But trained and experienced people will often find good solutions even after plan A and B both fail.
If an employer plans to put a person in a remote or dangerous situation they need to have a means of getting them back out in event of a emergency.
Many years ago as a backcountry Ranger I had a very serious broken ankle in the Grand Canyon. Badly deformed, no pulse in the toes and major pain. Late on a weekend afternoon, with a bad snow storm moving in. Stright line distance about 20 miles to the helibase. An hour and a half later the 206 flew in and got me out. The park had a plan and even with some ruts along the way, like finding a pilot after hours, but it worked. And I was very,very grateful.
good to see a “review” of such an incident in such a short time after it occurred. I wonder perhaps, if while the goal of firefighter safety is certainly admirable, knowing that it is unreachable as well given the conditions we face, which change by the incident, perhaps more we should ascertain a level of “acceptable risk” for all concerned, while trying to be as safe as possible
Bill offers several excellent thoughts about the dangers of fighting fires in the wildlands, and about the need for Agencies to support their employees with the best medical care possible in a timely manner when the inevitable accident does occur.
But to maybe stimulate discussion from other readers, I wonder how we deal with the accidents that occur when the Smokejumpers drop a “2-manner” in a remote western Wilderness, or a small fire is staffed by rappelers because there is no place to land the helicopter. Is the “Golden Hour” objective really achieveable?
And in the broader world of natural resource management, how do we address the medical care of folks like solitary Wilderness Rangers, the Wild & Scenic River Rangers, and the the packers that run the USFS pack strings in to the remote backcountry on a weekly basis for trail crews?
I wish I knew the “right” answers to these questions, and look to other readers who in their collective wisdom may have some ideas.
No one ever said that fighting fire in the wild was safe and easy, and even after 100 years new challenges continue to arise; let’s hope that reasonable alternatives for firefighter safety and medical care are within our reach.
Good points Dick, and there is no easy answer. Like B. Morgan says below, due to the remote locations where our firefighters work, there will be times when it will be impossible to get an injured firefighter to an appropriate medical facility within an hour. When this is the case, an incident-specific plan needs to be developed that can help mitigate this problem.
There are no doubt some actions the agencies CAN take to improve medical treatment and evacuation of firefighters. The FLA has quite a few suggestions. I am no aviation expert, but I was intrigued by their suggestion #1 C:
The U. S. Coast Guard and Los Angeles County Fire Department do this on a regular basis. Here are some links showing them in action:
LA County
Coast Guard