When we were writing the July 13 article about Frank Anaya, the latest California inmate firefighter that died on a fire, we discovered details about a previous inmate fatality that were shocking. It involved the death of Jimmy Randolph in August of 2012 whose passing was associated with heat stroke. The shocking part was that Mr. Randolph was found unresponsive one morning in the sleeping area on a fire and died in a hospital seven hours later. He had complained of a headache the previous evening and was checked out by the medical unit, but apparently no one was aware of the seriousness of his condition.
Firefighter Jimmy Randolph was assigned to the Buck Fire as a part of a strike team. At approximately 1800 hours on August 18, 2012, Firefighter Randolph advised a correctional officer that he had a headache. He was escorted to a medical team, evaluated, and given a three-day no-work note. At approximately 0530 hours the next morning, Fire fighter Randolph could not be awakened. He was treated and transported to the Desert Regional Hospital in Palm Springs. With his family by his side., he was pronounced dead at 1230 hours on August 19, 2012. The cause of death was listed as anoxic encephalopathy combined with complications of heat stroke.
Anoxic encephalopathy is a condition where brain tissue is deprived of oxygen and there is global loss of brain function. The longer brain cells lack oxygen, the more damage occurs.
I checked the weather for August 18, 2012 for San Jacinto, California which is in the general vicinity of the Buck Fire, and the high temperature that day was 92 degrees — a temperature commonly found on a large wildfire in the summer.
The wildland firefighter community has experienced an alarming increase in heat related and other physiological injuries in the last few days. Heat related injuries and Rhabdomyolysis are not the same, but can occur at the same time. Extreme weather conditions are predicted to continue across western states for the next week. The National Weather Service is issuing Heat Warnings for the SWCC, GBCC, RMCC, OSCC, and ONCC.
It is a very well-written document about how to prevent, mitigate, and recognize heat related injuries.
The brain uses a quarter of the body’s entire energy supply, yet only accounts for about two percent of the body’s mass. So how does this unique organ receive and, perhaps more importantly, rid itself of waste? New research suggests it has to do with sleep.
In the TedMed video above, neuroscientist Jeff Iliff explains the connection between sleep and brain function.
A study of almost 7,000 firefighters from municipal fire departments found that 37 percent screened positive for common sleep disorders, including obstructive sleep apnea, insomnia, restless leg syndrome, and shift work disorder.
The researchers found that compared with sound sleepers, those with a sleep disorder were about twice as likely to have a motor vehicle crash, to nod off while driving, and to have cardiovascular disease or diabetes. They were more than three times as likely to suffer from depression and anxiety.
Wildland firefighters usually work 8-hour shifts — except when they don’t. While on fires their shift schedules and sleep routines are often disrupted. The 8-hour shift can be extended to 12 to 16 hours, and their usual sleeping and waking times may be changed and sometimes shortened; not unlike the jet lag of traveling to a different time zone. The first shift on a fire may be longer than 16 hours and a crew used to working during the day can be placed on a night shift.
A firefighter sleep study conducted by the Missoula Technology Development Center between 2006 and 2008 found that sleep deprivation contributed to fatigue, stress, and impaired performance of Incident Management Team members.
I talked with pilots and other personnel that traveled with an air tanker to a new assignment. Depending on their original location, they flew across two to four time zones and after arrival, they started work about two hours earlier than usual. So the net change was four to six hours worth of jet lag when taking the new work schedule into account. After a couple of days at the new site two crewmembers told me that they were really tired, even though they were not physically working much harder than normal. Their supervisor eventually recognized this and made sure they got a day off.
That kind of disruption in a work/sleep/wake schedule is common among wildland firefighters, especially those that travel long distances to an assignment. It is possible that wildland fire managers do not recognize this and the negative effect it can have, or if they do, may feel there is little they can do to mitigate the problem.
Crew supervisors and incident management teams should at least strive to give firefighters an opportunity to get an adequate amount of quality sleep.
On June 17 the Incident Management Team (IMT) running the Frye Fire near Safford, Arizona wrote on Inciweb that “21 additional personnel with unknown illness were demobilized.” On June 18 the Tucson News reported that 45 people at the fire had been treated for strep throat, also known as streptococcal pharyngitis.
On June 22 the IMT posted much more information about the “incident within an incident”. A doctor went to the remote Columbine Spike Camp on Mt. Graham where firefighters were staying so they did not have to endure the long round trip each day to the Incident Base. He swabbed the throats of 80 firefighters, with 63 (or 78 percent) testing positive for Streptococcus.
(As of June 24 the Frye Fire has burned over 29,000 acres at Mt. Graham near Safford, Arizona east of Tucson.)
Before and after those shocking test results, the IMT took many actions in order to mitigate the situation.
The IMT created an Incident Health Group led by a Medical Unit Leader with the sole function of dealing with the Strep outbreak. (Functional Groups can be quickly created within the Incident Command System to handle specific tasks. An example of one that is often used is a Structure Protection Group. They may or may not be tied to a specific geographic location.)
The Team disinfected pretty much everything in sight.
They stopped using the hand-wash station.
The caterer was ordered to stop meal production and to dispose of all currently prepared meals. Personnel then were given bottled water and MREs.
Symptomatic personnel were isolated, and incoming resources were kept separate from existing personnel.
Contracts were issued for a doctor, an RN, and two paramedics to administer testing and provide medication.
Treatment with an oral antibiotic for those affected began.
The IMT recommended follow-up for the personnel that demobed prior to June 16.
When additional personnel presented with symptoms, they were kept isolated from the Incident Command Post population in an isolation/decontamination room where they could get a shower and a change of clothes. They also had access to another isolated room nearby where they could rest and recuperate so as not to expose others while under treatment during contagion.
Although the doctor suggested most patients would not be contagious 24 hours after the antibiotic treatment, the IMT decided to extend the period to 48 hours.
Graham County Public Health developed an epidemiological investigative process to include interviews and questionnaires with all available parties.
Strep throat affects about 3 million people in the U.S. each year. With treatment by a medical professional, which often requires lab tests or imaging, it is usually resolved within days or weeks. Common symptoms include sore throat, fever, and swollen lymph nodes in the neck. Rarely, complications can involve the heart or kidneys. Treatment is important to reduce complications.
Thanks and a tip of the hat go out to Tom. Typos or errors, report them HERE.
The lessons learned from this research clearly indicate that the best protection against a heat injury is reducing work rate.
Aggressive hydration strategies are over-preached and may provide a false sense of protection. It should be emphasized that the autopsy report as described in the fatality report indicated no signs of dehydration or electrolyte imbalance.
With that in mind, below is the article we wrote in 2016 after reports were released on two very serious injuries that occurred during the first two days of training for new firefighters.
When therapy is delayed, the mortality rate may be as high as 80%; however, with early diagnosis and immediate cooling, the mortality rate can be reduced to 10%.
These two very serious incidents in a two week period that occurred at the beginning of the fire season should be a wakeup call for agencies employing wildland firefighters.
I am not a medical or exercise specialist, but neither were any of the four members of the South Dakota Rhabdo FLA team. It was comprised of a District Fire Management Officer, a Natural Resources Specialist, an Assistant Superintendent on a Hotshot crew, and an Assistant Fire Engine Operator.
A person might expect that for an exercise-induced injury that is fatal in eight percent of the cases, a medical expert and an exercise physiologist would be members of the team. The FLA concentrated on recognizing symptoms of Rhabdo, which is good. Firefighters need to be be informed, again, about what to look for. But the necessity of treating the symptoms could be avoided if the condition was prevented in the first place.
Prevention was not addressed in the document, except to mention availability of water. Dehydration isn’t the leading cause of Rhabdo, which is caused by exertion, but it can be a contributing factor.
With two life-threatening medical conditions on firefighting crews in a two-week period that occurred during mandatory exercise on day one and two of training, medical and exercise professionals perhaps could have evaluated what caused the injuries, and suggested how to design and implement a physical fitness program that would lessen the chances of killing firefighters on their first or second day on the job. But the LEARNING opportunity of the FLA was squandered.
The wildland fire agencies are not alone in hiring people off the streets and throwing them into a very physically demanding job. The military does this every day, as do high school athletic programs. There is probably a large body of research that has determined how to turn a person into an athlete without putting their lives in danger.
While the three firefighters and the natural resources specialist I’m sure meant well and did the best they could to write the FLA within the limits of their training and experience, the firefighting agencies need to get serious about a professional level exercise training program. After all, they are employing TACTICAL ATHLETES.
This issue is serious enough that the NWCG (since there is no National Wildland Firefighting Agency) should hire an exercise physiologist who can design, implement, and monitor a program for turning people off the street into tactical firefighting athletes.
“Aggressive hydration strategies are over-preached and may provide a false sense of protection”, Dr. Brent Ruby said.
Above: Firefighter on the Shep Canyon fire in South Dakota, September 6, 2011. Photo: Bill Gabbert/Wildfire Today.
As we officially enter Summer this week in the northern hemisphere, it’s a good time to revisit an article we wrote in 2011 about heat-related injuries.
After reading our excerpt and later the full document from the the Serious Accident Investigation Factual Report for the hyperthermia fatality of Caleb Hamm on the CR 337 fire in Texas, we heard from Dr. Brent Ruby, who has completed studies on this exact issue, even having studied wildland firefighters while they were working on fires. In one of his studies he was monitoring a wildland firefighter outfitted with a core temperature monitor, an ambient temperature sensor, and a special Camelback hydration system that monitored his water intake. This firefighter experienced a heat-related illness, heat exhaustion, and had to be evacuated off the fireline by a helicopter. That was a terrible thing to happen to a firefighter, and I’m sure the researchers thought the same thing, but it was probably a once in a lifetime cornucopia of incredibly useful data. Dr. Ruby sent us this message, reprinted here with his permission:
I was bothered by the findings of the CR337 fatality report from the investigation team. There are issues within this case that are very similar to a published heat exhaustion case study we published recently (Wilderness and Environmental Medicine 22, 122-125, 2011, http://www.ncbi.nlm.nih.gov/pubmed/21664560). In this report, we document drinking behavior, activity patterns, skin and core temperatures in a subject that suffered heat exhaustion and required evacuation. The lessons learned from this research clearly indicate that the best protection against a heat injury is reducing work rate. [*the abstract from the study is below]
Aggressive hydration strategies are over-preached and may provide a false sense of protection. It should be emphasized that the autopsy report as described in the fatality report indicated no signs of dehydration or electrolyte imbalance. I have tried to push these concepts to crews and safety officers when I get a chance to speak to them at meetings. I was bothered by this fatality knowing that it is seemingly directly linked to some of our research findings. I have tried to emphasize this to anyone that will listen in the world of wildfire.
You can certainly review our website to gain a better understanding of the publications we have done from research with the WLFF http://www.umt.edu/wpem. We have a great deal of physiological data, hydration, energy demands of the job, importance of supplemental feedings, etc. from all our work over the years. This peer reviewed research provides objective, scientific evidence that can be used to to change or influence policy to enhance safety on the line.
Let me know if you have any questions.
Regards, Brent Ruby
Brent C. Ruby, Ph.D., FACSM
Director, Montana Center for Work Physiology and Exercise Metabolism, The University of Montana
High work output combined with high ambient temperatures caused heat exhaustion in a wildland firefighter despite high fluid intake.
Cuddy JS, Ruby BC.
Montana Center for Work Physiology and Exercise Metabolism, The University of Montana, Missoula, MT 59812-1825, USA.
The purpose of this case study is to examine the physiological/behavioral factors leading up to heat exhaustion in a male wildland firefighter during wildland fire suppression. The participant (24 years old, 173 cm, 70 kg, and 3 years firefighting experience) experienced heat exhaustion following 7 hours of high ambient temperatures and arduous work on the fire line during the month of August. At the time of the heat-related incident (HRI), core temperature was 40.1 °C (104.2 °F) and skin temperature was 34.4 °C (93.9 °F). His work output averaged 1067 counts·min(-1) (arbitrary units for measuring activity) for the 7 hours prior to the HRI, a very high rate of work over an extended time period during wildfire suppression.
In the 2.5 hours leading up to the heat incident, he was exposed to a mean ambient temperature of 44.6 °C (112.3 °F), with a maximum temperature of 59.7 °C (139.5 °F). He consumed an average of 840 mL·h(-1) in the 7 hours leading up to the incident and took an average of 24 ± 11 drinks·h(-1) (total of 170 drinks). The combined effects of a high work rate and high ambient temperatures resulted in an elevated core temperature and a higher volume and frequency of drinking than typically seen in this population, ultimately ending in heat exhaustion and removal from the fire line.
The data demonstrate that heat-related incidents can occur even with aggressive fluid intake during wildland fire suppression.
Unfortunately, even though Dr. Ruby’s research is funded by taxpayers through the National Institutes of Health, the National Science Foundation, and the Department of Defense, taxpayers are blocked from seeing the full results unless they pay a fee to the privately owned company that published the paper. We have written before about the results of taxpayer-funded wildfire-related research being held hostage by private companies. Dr. Ruby told Wildfire Today that he will send a copy of his paper to individuals that write to him at brent dot ruby at mso dot umt dot edu
The combined information about the fatality of Caleb Hamm on the CR 337 fire and Dr. Ruby’s study on wildland firefighters, is shocking. From the abstract, again:
The data demonstrate that heat-related incidents can occur even with aggressive fluid intake during wildland fire suppression.
Working on a wildfire on a hot day can lead to heat exhaustion and hyperthermia, and can be fatal EVEN IF a person drinks plenty of water and is not dehydrated.
Symptoms and prevention
We asked Dr. Ruby for more information:
Exertional hyperthermia occurs when the metabolic heat production from hard work overwhelms the bodies ability to off load it to the environment. This unloading can be blocked by clothing and/or slowed due to high radiant heat from the sun or an adjacent fire.
The basic symptoms of heat exhaustion are commonplace and can include profuse sweating, weakness, nausea, sometimes vomiting, lightheadedness, headache and sometimes mild muscle cramps.
The best approach [to prevent heat exhaustion and hyperthermia] is to know thyself and thy physical limits. Establishing a pace schedule that allows temperature to come back down in between periods of work that result in a rise in temperature. The factors of importance are pace, fitness level for the task at hand, hydration behaviors and simultaneously electrolyte concentrations in the blood.
It is important for wildland firefighters to drink plenty of water, but this will not, by itself, totally eliminate all chances of heat-related illness.
Be careful out there.
UPDATE October 27, 2011:
Dr. Ruby sent us the following list of other publications on similar topics that are in peer reviewed journals. I assume that most of them are not available to the public (don’t get me started on that again!) unless you pay the ransom fees at the private companies, or send a message to Dr. Ruby: brent dot ruby at mso dot umt dot edu
UPDATE October 28, 2011:
The U.S. National Library of Medicine has an excellent article about heatstroke, which can follow heat cramps and heat exhaustion and is life-threatening. The article includes causes, symptoms, first aid, what not to do, when to call 911, and prevention (including “avoid exercise or strenuous physical activity outside during hot or humid weather”. Good luck with that one, firefighters.)
As we reported earlier Sunday, on Saturday June 17 the Inciweb page for the Frye Fire in southwestern Arizona included this statement:
21 additional personnel with unknown illness were demobilized.
It turns out that the illness was strep throat. According to the Tucson News 45 people at the fire have been treated for the disease, also known as streptococcal pharyngitis.
This is being handled as an “incident within an incident”, with a separate Incident Commander and staff managing the situation, which allows the primary firefighting personnel to continue to perform their usual duties.
Below is an excerpt from the Tucson News, dated June 18:
…A medical group was created with doctors and nurses being brought to the Safford area to help with the strep throat outbreak.
[Information Officer Evan] Burks said antibiotics were administered and the affected fire personnel were quarantined, but will not be sent home.
“We have not released those resources. They’re still here. But we have separated them from the healthy firefighters,” Burks explained. “The antibiotics start working within 24 hours, and it looks like the firefighters are getting healthy pretty quickly here. Once they’re healthy, and good to go, they’ll be back to work [on the Frye Fire].”
Medical personnel have identified those with strep throat and they are taking “extra precautions to wash hands, and stay healthy,” Burks explained. “That’s always the number one priority, to keep our firefighters healthy. But there is always that risk out there.”
If the statement in the June 17 Inciweb report is true, that 21 personnel were released with an unknown illness, possibly strep throat, they could be unknowingly infecting their families or coworkers.
Strep throat affects about 3 million people in the U.S. each year. It is treatable by a medical professional and often requires lab tests or imaging. With treatment it is usually resolved within days or weeks. Common symptoms include sore throat, fever, and swollen lymph nodes in the neck. Rarely, complications can involve the heart or kidneys. Treatment is important to reduce complications.
As of Saturday night the Frye Fire had burned about 9,000 acres 8 miles southwest of Safford.