Extracting an injured firefighter – in 2 hours and 15 minutes

Las Conchas Fire extractionThe Wildfire Lessons Learned Center has released a video documenting the extraction of an injured firefighter from the 2011 Las Conchas Fire in northern New Mexico. Kenny Lovell of the Craig Interagency Hotshots is interviewed in the video and tells his story of being seriously injured, treated, and transported after being hit by a rolling rock. He suffered a broken pelvis, a broken fibula, and a large hematoma.

The title of the video, ROCK! Firefighter Extraction Success Story, describes the incident as a success. It was, in the sense that the Hotshot crew had access to equipment which was transported to the accident scene to treat and package the victim, there were several EMTs on the crew, the Hotshots had drilled for similar incidents, a helicopter with short haul capability was available, and 5 months later Mr. Lovell returned to work on the Hotshot crew. All that is great and the Hotshots and the helitack crew deserve praise for accomplishing what they did with the resources that were available..

Having said that, it is still troubling that 2 hours and 15 minutes elapsed before Mr. Lovell departed the accident scene in a helicopter, and 30 minutes later he arrived at a hospital. On the Deer Park fire in 2010 a firefighter with a broken femur was on the ground for 4 hours and 23 minutes before he was transported in a helicopter. And firefighter Andrew Palmer, who bled to death from a broken femur suffered on a fire in 2008, spent 2 hours and 51 minutes at the accident scene before he was extracted via hoist on a Coast Guard helicopter.

Agencies who place firefighters in remote areas should realize they have the ethical responsibility to supply the training, equipment, and aviation resources to at least begin transporting by air a seriously injured firefighter within an hour. I am surprised that OSHA has not cited the federal agencies for this. Of course getting injured firefighters to an appropriate hospital within the Golden Hour would be ideal, but depending on the distance involved that could be difficult. A helicopter with short haul capability can be helpful, but it is not the quickest or most efficient method for extracting an injured person. It involves several steps, especially, like in this case, when the helicopter responds to the scene without being fully configured for short haul.

Several agencies have helicopters with hoists which can quickly extract and then transport injured personnel from remote locations, including CAL FIRE, Los Angeles County Fire Department, and the Coast Guard. If the other federal and state agencies decided to take that step, it would not have to be a trial program with one helicopter like the U.S. Forest Service night flying helicopter effort this year, because other agencies have been using hoists (and night vision goggles) for decades,

“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.”

The above is from the 2010 facilitated learning analysis for the Deer Park Fire extraction, quoting a Senior Firefighter/Paramedic on the Sawtooth Helitack Crew.

 

Thanks go out to Brit

Author: Bill Gabbert

After working full time in wildland fire for 33 years, Bill Gabbert now writes about it from the Black Hills. Google+

12 thoughts on “Extracting an injured firefighter – in 2 hours and 15 minutes”

  1. The NPS has developed a geospatial layer showing ground evacuation times (by litter and vehicle) across the lower 48. It should be live in WFDSS for this fire season, and will help to quantify risk to firefighters from remote assignments. Of course, a spatial layer by itself can’t predict evac time, but can give you a baseline of how long the transport alone would take without a helicopter if everything goes perfectly. More info as available.

  2. Way too long, and more medical research has shown that the “Golden hour” is mostly myth; the actual period is much shorter in trauma situations. In the fire world we are really behind the 8 ball when it comes to EMS in comparison to the military and structural fire. Some crews are fortunate enough to have paramedics, but what use is it if we can’t utilize advanced life support and a decent complement of drugs because we have no options for medical direction? It would be great if the FS and BLM had medical direction so we could have paramedics truly functioning as medics. I am an EMT, but I realize the limitations. We need paramedics, good medevac plans, and people planning how to get injured firefighters out before it happens.

  3. Great article Bill… great points. One of my biggest worries as a long time Hotshot captain was and is our continuing inability to extract one of our own in a timely manner in the event of serious / life threatening injury. As Jake said above .. one hour is way to long.

    As an ATGS, I regularly process orders for ground crews for lunches, batteries, etc.. for air tankers, helicopters, etc… but when it comes to medical aide, the reality is that it is not done (thank goodness?) on a regular basis. That being said, training on what to pre load the order with is not at the tip of most firefighter tongues nor in the “second nature” of our ordering process… How many times has the “cookie cutter Medical Plan in the IAP been tested?

    In this day and age of technology and information, there is NO reason we should not have the ability to quickly respond to medical trauma for our firefighters.. whether it be ground (EMT’s on the crews) and air (dedicated Medi-Vac) on EVERY incident from IA to project. If the land management agencies cannot pony up and do this then it is time for them to get out of the emergency services business.

    As a good friend of mine says “The Agencies are only as safe as they can afford”.

    1. Thanks Tony. Anyone that has ever carried an injured firefighter for any distance knows that it’s one of the hardest things they will ever do. On the first very large fire I was on, with the El Cariso Hot Shots, we had to carry, using a Stokes litter, one of our fellow hotshots a very long distance up a steep slope. We traded off frequently, but the entire crew was wasted by the time we finally got him to a helispot at the top of the ridge. It’s not the best way to manage a serious injury, or the best way to treat one of our fellow firefighters. They deserve better.

  4. Safety for our firefighters is essential, and part of our concern for their safety must be care after injury. But, that said, there also must be a dose of reality introduced to the discussion before we start writing “policy” that requires the impossible when it comes to issues like Medivac and “the Golden Hour.” There are hundreds of millions of acres of Public Lands across the US, much of it a long way from places where there are Medivac airships and Trauma Centers. Couple that with the number of wildfires that we experience, often with multiple ignitions at the same time during lightning busts (with potential for simultaneous injuries) and the 2-person IA fires that are attacked with SJs and Rappelers because of the inaccesibility of fire site. We’re talking about making aggressive IA to keep fires small, but then also suggesting that Medivac procedures and equipment be in place before we IA a fire? It’s easy to have appropriate Medical response available on a Type 1 incident, and usually on Type 2s as well, but what about the rest? Are 2 smokejumpers on the side of a mountain less worthy of timely medical treatment than members of an IHC on a Type 1 Incident. And then, what about our Wilderness Rangers, River Rangers and Trail maintenance crews that are out every day long distances from reliable medival evacuatiion?
    I don’t have the answers for many of the scenarios I’ve offered above, but am fearful that we might buy into something that we cannot implement, and that we’ll have lawyers banging at our doors when the next tragic event occurs because we did not follow our own rules about the Golden Hour.

    1. Mr. Emmett, don’t let the perfect be the enemy of the good. Just because it is not feasible to get every firefighter to an appropriate hospital within an hour of an injury does not mean we should throw up our hands and give up without making any attempt to enhance the safety environment of our firefighters. There are some steps that could be taken, such as outfitting some of our firefighting helicopters with hoists and providing the needed medical equipment and training. Cal Fire is installing hoists on about a dozen firefighting helicopters. What are the USFS, NPS, BIA, BLM, and the FWS doing? Like Mr. Gabbert said, one firefighter bled to death a few years ago while waiting almost 3 hours to begin transport. How many more must die to initiate change?

      To do nothing is not acceptable.

  5. So this has been a topic in countless AARs, FLAs, Annual Refreshers and such for a number of years. Has anyone written an Issue Paper or White Paper on the issue of fireline EMS and medical evacuation?

  6. Frank, you are so right!! To do nothing, when we can learn from incidents, such as my son, Caleb Hamm, LODD 7.7.11 in Mineral Wells, TX.. Procedures were not followed, which is a story unto itself. But not to learn from that?? Not to WANT to learn from that?? That is what is unacceptable!! That is what hurts the most, is not to WANT to learn from that. My heart hurts, because another parent will go thru this, just a matter of time.

    Thanks for listening.

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