Lesson learned: heat-related illness

Lesson learned, heat related illness

A crewperson on an Angeles National Forest hotshot crew had a close call in June with a heat-related illness. While engaged in strenuous physical activity, the firefighter developed severe cramps and had a temperature two degrees lower than normal. During a five-hour period he or she drank all the water from their 100-ounce Camelback once, and again later after refilling it, plus two Gatorades.

The EMTs on the crew who recognized the serious potential of the person’s condition arranged for transportation to a hospital. It turned out to be a mild case of rhabdomyolysis which, if not caught in time and treated can be fatal. The EMT that accompanied the firefighter to the hospital insisted that tests for rhabdo be done, even though the staff at the hospital had not planned on doing the tests.

The hotshot also had hyponatremia, which is a severe imbalance of water to salt. Drinking large quantities of water without enough fluids with electrolytes can cause hyponatremia.

Congratulations to the hotshot crew and the EMTs for making good decisions during this serious incident.

You can read the entire report here, but below are the Lessons Learned:

  • Know yourself and know each other. Each person must monitor their water and sports drink intake. Supervisors must ensure all crewmembers are getting adequate electrolyte replacement.
  • Recognize fatigue and take action early, before it can lead to a heat-­related illness. This may require taking breaks due to environmental conditions.
  • Do not count on observing classic heat-­‐illness symptoms; patient may not present the symptoms you have been trained to look for.
  • The patient is not the one who decides if he or she goes to the hospital. It is the decision of the first responder, EMT, or higher-­‐ranking individual, due to the nature and/or severity of the injury/illness and/or agency protocol.
  • If employees are treated for heat-­‐related illness, the treating facility should be asked to check for rhabdomyolysis. The patient’s representative must insist that CPK, potassium phosphate, and myoglobin tests are done initially and on the follow up appointment.

In 2007 a California radio station held a contest to see who could win a Wii game console by drinking the most water without going to the bathroom. Jennifer Strange, a 28-year-old mother of three, died of hyponatremia after drinking about two gallons of water. A jury found the radio station liable, and awarded her husband $16.5 million.

We have written previously about the “Myth of drinking water”. Some may assume that drinking lots of liquids will prevent heat related illnesses, but that is not always the case. In the article, we quoted Dr. Brent Ruby, who has conducted research in this area. In the quote below he was referring to the 2011 Caleb Hamm fatality on the CR337 Fire in Texas. Mr. Hamm was a member of the Bureau of Land Management’s Bonneville Interagency Hotshot crew.

Dr. Ruby:

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…

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What is the Forest Service doing about tracking firefighters and fires in real time?

Shep Cyn Fire

Firefighter on the Shep Canyon Fire, September 6, 2011. Photo by Bill Gabbert.

Since October of 2013 we have been writing about what we call the Holy Grail of Firefighter Safety – a system that could track firefighters AND the location of the fire in real time. We envision that the data could be monitored by a Safety Officer, Operations Section Chief, or Division Supervisor to ensure that firefighters are safe relative to the location of the fire. It is our position that in the last 9 years the lives of 24 firefighters could have been saved by a system like this. On the 2006 Esperanza Fire and the 2013 Yarnell Hill Fire, the supervisors of the firefighters that were killed thought their personnel were in a different location than where they met their demise. If we go back further, for example to the 2005 Cramer Fire and others over the last couple of decades, we could probably add to the list.

In an effort to find out what, if anything, the federal land management agencies are doing to increase firefighters’ situational awareness by knowing the real time location of firefighters and the fire, we contacted the U.S. Forest Service and gave them a list of questions. Our request bounced around and eventually we received a reply from Mike Ferris of the National Incident Management Organization in Portland.The short answer is — they have started a two-year study to look at the issue. So far the study is funded for one year, but no timeline or target implementation date has been established.

Considering the 12 federal air tanker studies completed over an 18-year period before anything substantial was done to address the aging aircraft issue, we hope this two-year study is not simply the first of many that will be placed on a shelf and ignored before something is done to improve the situational awareness of our firefighters. Analysis Paralysis can be fatal. With no timeline to shoot for yet, it sounds like it could suffer the same fate as the 12 air tanker studies.

We thank Mr. Ferris for responding to our request. His answers are below, along with our questions, in bold.

*****

1. Is the USFS doing anything to develop a system to track the real time location, on a regular basis, of firefighters AND the fire they are assigned to?

At the present time there is no technology in use that enables real-time tracking of ground resources assigned to wildland fires. There is also no standard for such tracking or the technology that would support it that has been accepted on an interagency basis. The U.S. Forest Service continues to review and assess the advances in technology associated with GPS devices. There are GPS devices which show position of the unit as well as devices which transmit that position to a receiver. Wildland fire forces are challenged in the terrain they deal with, the large numbers of federal, state, local, and private cooperators who take action on our fires, and the appropriate use of new technology and data. The Forest Service continues to assess the use of technology used in such places as Department of Defense and weigh the utility and benefit of these technologies. Considering the nearly 10,000 fires per year the Forest Service responds to, over the nearly 200 million acres we protect, in 44 states, our focus is developing decision support which will enable us to take effective, efficient action on those fires and care for the safety of firefighters and civilians.

The Fire and Aviation Management Technology & Development Steering Committee rank the need for a Situational Awareness System for ground forces a priority project. The objectives are:

  • Define business and technical requirements for a situational awareness system for ground forces. This includes the tracking of personnel.
  • Measure current performance as a baseline for evaluation.
  • Evaluate existing technologies against the requirements.
  • Develop an implementation plan for an interagency application.

This project builds on the previous work conducted by the Technology & Development program on assessing the state of the technology and evaluating commercial-off-the shelf products.

2. If so, what exactly?

The Forest Service’s Technology and Development Program (T&D) has been evaluating Satellite Emergency Notification Devices (SEND) since 2008. The Missoula T&D Center led the evaluation of SPOT and DeLorme® InReach® devices with the objective of evaluating the performance of these devices in areas where two way radio and cellular transmission are unavailable. Recently, the Forest Service purchased 6,000 SPOT units for field use, not related to wildland fire activities. The T&D Program and Chief Information Office continue to evaluate the use of SEND devices including functions within wildland fire operations.

Other initiatives have been sponsored by the Department of Homeland Security, Science and Technology Directorate, First Responder Resource Group where tracking systems have been used or tested on fires. The Next-Generation Incident Command System (NICS) was developed through collaboration with Massachusetts Institute of Technology (MIT) Lincoln Labs and CAL FIRE. NICS has been used operationally on wildfires in California. The University of California, San Diego Supercomputer Center currently is hosting NICS (https://nics.ll.mit.edu/sadisplay/login.seam). NICS is open-source, web-based and non-proprietary. Since it is web-based, access to the internet via Wi-Fi or cellular signal is required.

The Jet Propulsion Laboratory and the Forest Service’s T&D Program cooperated on the Personal Alert and Tracking System. This is a two-dimensional tracking system that uses a persistent, self-healing mesh network. This system was tested on two prescribed fires; however, it is not commercially available.

While many of these technologies have potential, more detailed analysis needs to be conducted before any large scale deployment can occur. It is important to describe the other considerations that must be resolved prior to determining a potential solution. Implementing technologies in incident management in the wildland fire environment is very complex and poses a number of operational, integration, distribution and infrastructure issues that need to be resolved before they can be implemented on a national, integrated, interagency scale.

Prior to implementation of any of the solutions, the following must be determined. These issues include:

  • Determining whether firefighters should be tracked all the time or whether simply knowing the location of a fire fighter in distress is what is needed.
  • Determining what types of incidents resources should be tracked on, i.e. initial attack, extended attack, Type 1 or Type 2 incidents, etc.
  • Determining what types of resources to track, i.e. agency personnel, contractors, cooperators, etc. and what level to track them at, i.e. crew, individual firefighter, etc.
  • Determining how to distribute tracking devices to firefighters, i.e. at their home units, on incidents, etc.
  • Determining who will be responsible for tracking resources, i.e. dispatch, incident personnel, etc.
  • Difficulties with receiving satellite or cell phone signals in remote, mountainous areas.
  • Define the frequency of automatic reporting from the device
  • Potential distractions of tracking devices to firefighters (“Christmas tree effect”).

3. Who is involved in the development?

The National Technology & Development Center will be the lead for this project. Since the objective is to provide an interagency solution, an interagency complement of subject matter experts will be assembled. After defining the business need and technical requirements, a request for information (RFI) will be published in the Commerce Business Daily (CBD) to solicit information from the commercial sector.

4. Is the development adequately funded? What is the amount of the funding?

Funding is part of the regular appropriations for the technical program of work identified for that year. The estimated duration for the project is two years. The estimated budget is $290K. This budget has been requested, however, since funds are appropriated for a one year period, the request for funding has to be done every year. Within the estimated two-year period, a recommendation will be given to senior fire leadership.

5. What is the stage of development?

Preliminary development, testing, and evaluation have been completed to give an initial assessment on the state of the technology. Since the technology associated with this project changes rapidly, a RFI will be published.

6. When will it be implemented?

No current timeline has been established. Once the advantages and disadvantages have been completely assessed, then recommendations will be forwarded to senior fire leadership for their deliberation and decision.

7. What will be the cost?

Funding needs will be determined once a comprehensive review has been completed and a complete understanding of the operational, integration, distribution and infrastructure issues are identified and understood.

8. Specifically, how will firefighters be tracked? Using a currently available consumer-grade personal locator device that is available now off the shelf? Or will the hardware be incorporated into radios carried by firefighters?

It is still too early to determine just what product or products will give firefighters and fire managers the best options for firefighter safety.

9. Specifically, how will the real time location of the fire be determined? How will it be made available to firefighters?

This is part of the project. The project takes a longer view and takes a look at what type of tracking is needed.

10. Are the federal land management agencies interested in what is being used now in southern California called the “Next Generation Incident Command System”, which will do much of the above? If not, why not?

The Next Generation Incident Command System was developed by MIT Lincoln Labs with CAL FIRE as the primary wildland fire agency associated with the development. The Forest Service, in conjunction with the NWCG Equipment Technology Committee, is currently collaborating with CAL FIRE and NICS to assess the emerging technology and keeping abreast of developments.

11. Are the federal land management agencies interested in a system developed by DARPA that does all of the above and much more, called “Fireline Advanced Situational Awareness Handheld (FLASH)”. If not, why not?

The Forest Service attended the demonstration in Prescott, Ariz. of the FLASH system. All viable technologies will be considered. Technology providers are encouraged to respond to the RFI after the business needs and technical requirements are defined.

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Revised guidance for safety zones is released

Safety Zone Calculation

Safety Zone Calculation, released July, 2014. Bret Butler.

In his continuing efforts to improve the recommended standards for wildland firefighters’ safety zones, researcher Bret Butler has released a revised version based on additional research. Dr. Butler developed the guidelines that had been used for years which were based on the height of the flames, but in May, 2014 released a new recommendation that was based on height of the vegetation, wind speed, slope, fire intensity, and a constant number. This new July, 2014 version replaces the one that was released in May.

A safety zone is an area where wildland firefighters may be forced to take refuge from an approaching wildfire. There, a firefighter should be able to survive without being injured from exposure to the radiant and convective heat from the fire, and would not have to deploy and enter a fire shelter.

The latest version of the guidelines released a few days ago is based on height of the vegetation, wind speed, slope, and the same constant number (8). It removes a factor that could be a little subjective or difficult to quantify accurately in the field, fire intensity.

The new system, like the one unveiled in May, calculates the Safe Separation Distance (SSD) between the fire and the firefighters. To determine the SSD, using the table above multiply the constant number (8) times the number from the table (Slope-Wind Factor) times the height of the vegetation.

Example for 15 mph wind, 24% slope, 6-foot vegetation:

The Safe Separation Distance is   8 x 3 x 6 = 144 feet

Dr. Butlers’ Additional Considerations:

  1. For a 20-person crew, add 10 feet of radius and for a vehicle add another 5 feet of radius.
  2. The area in red requires large natural openings or construction by mechanized equipment.
  3. The proposed rule is to be used for flat ground rather than the existing flame height rule.
  4. Also consider additional lookouts on the ground and in the air to monitor fire activity with early egress to escape routes and safety zones.
  5. At 30% or greater slopes, hot gases tend to stay close to the ground.

Dr. Butler’s disclaimer: This proposed safety zone rule should be considered preliminary because it is based on limited data and analysis and subject to increase or decrease based on additional data. It is presented for release this fire season with the intent of increasing firefighter safety and reducing risk of injury. It is likely that an updated rule will be released in the next year.

For more information see the article in the International Journal of Wildland Fire titled: Wildland Firefighter Safety Zones: A Review of Past Science and Summary of Future Needs

We will let you know if another revised version of the guidelines is released in two months.

(NOTE: if you want a copy of the table above, click on it to open it in a window of its own, then click on Print in your internet browser.

Thanks and a hat tip go out to Ryan.

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Firefighter receives award for saving life

Kaili McCray

John Segar, FWS Chief Branch of Fire Management, presents Kaili McCray with Citation for Exemplary Action.

The U.S. Fish and Wildlife Service (FWS) at the National Interagency Fire Center (NIFC) in Boise, Idaho presented a Citation for Exemplary Action to Larry (Kaili) McCray, Wildland Fire Medical Standards Program Manager with the U.S. Department of the Interior (DOI). McCray, a FWS employee serving at NIFC in the position co-funded by other DOI bureaus, was awarded the Departmental honor for heroic acts at the 2013 Beaver Creek Fire on the Sawtooth National Forest northwest of Hailey, Idaho.

The Exemplary Act Award recognizes McCray’s prompt action and decisions that contributed to saving a life on August 13, 2013. McCray administered chest compressions, applied an automated external defibrillator (AED), and ordered oxygen in response to a fire camp crew member who suffered a cardiac arrest. He coordinated his efforts with two other trained employees assigned to the fire from the U.S. Forest Service and the State of Maryland. The emergency room physician who later cared for the victim credited the responders’ actions and use of the AED on site with saving the patient’s life.

McCray was assigned to the Beaver Creek fire as a Medical Unit Leader trainee when the incident occurred, and has also been qualified as a wildland firefighter since 2010.

The Citation, signed by FWS Director Dan Ashe, was presented to McCray by his supervisor, FWS Chief, Branch of Fire Management, John Segar.

“The victim’s heart had stopped. Kaili’s quick thinking, decisive action, and leadership were directly responsible for preventing a death,” said Segar. “He joins a small and select group within the fire community ever to receive this award.”

In 2013, there were nine cardiac cases reported on wildland fires, with six of them fatal. The three saves resulted from AED and other life support equipment being available and properly used by trained personnel responding immediately. Since 1990, cardiac arrest has been the third-leading cause of wildland firefighter deaths. Aircraft and vehicle accidents are the first and second leading causes respectively of wildland firefighter fatalities.

The Wildland Fire Lessons Learned Center posted a standard incident review, which is available online.

More information, including many excellent photos, of the Beaver Creek Fire.

Beaver Creek Fire

Incident Command Post on the Beaver Creek Fire, August, 2013

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Shawna Legarza on the CBS Evening News

Shawna Legarza, a former Hotshot who is now the Director of Fire and Aviation for the U.S. Forest Service’s California Region was interviewed for the CBS evening News.

The subject came up of tracking the location of firefighters. We have written often about what we call the Holy Grail of Wildland Firefighter Safety, a system that could track in real time the location of firefighters on the ground AND the location of the fire, all displayed on one screen — anything from a cell phone or seven-inch tablet to a laptop computer at the Incident Command post. This data should be available in real time to ground and aviation personnel on fires, as well as key supervisors and decision makers in the Operations and Planning Sections. Knowing the positions of personnel relative to the fire would be a massive step in improved situational awareness and could reduce the number of firefighters killed on fires. This information could have saved 24 lives in recent years — 19 on the Yarnell Hill Fire and 5 on the Esperanza Fire. In both cases the firefighters and their supervisors did not know where the firefighters were relative to the location of the fire.

The technology is available right now. The military has been using it for years. Our leaders in wildfire suppression need to make the decision to get it done.

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What have we learned from Yarnell Hill?

Granite Mountain

Granite Mountain Hotshots hiking to their assignment, June 30, 2013. Photo by Joy Collura.

It has been almost a year since 19 firefighters were killed on the Yarnell Hill Fire, June 30, 2013. The dust has settled near Yarnell, Arizona and many claims have been filed against various government agencies. One of those was converted into a lawsuit Monday when it was filed in Maricopa County Superior Court in Phoenix. It lists 162 property owners who name the state and the Arizona State Forestry Division as defendants. From the suit:

If the Arizona State Forestry Division had competently managed, contained and suppressed the Yarnell Hill Fire, no member of the Granite Mountain Interagency Hotshot Crew would have died. And Yarnell and its people would have escaped devastation.

That was the first of several lawsuits that will probably be filed. The second was issued Wednesday by 12 of the families of the firefighters killed in the fire.

While the sudden deaths of 19 people is horrific, it would ease our pain somewhat if we thought that something, anything, could come out of this that resembled lessons learned. If a few tidbits could be found in the ashes of the fire that could help others avoid a similar fate, maybe we could move forward with a glimmer of hope.

Reason swiss cheeze modelAn experienced firefighter can analyze the two official reports about the fatalities, and combined with reading between the lines and drawing conclusions based on their knowledge, they can nit pic using 20-20 hindsight like a Monday morning quarterback. We succumbed to what we saw as inevitable and after the second report came out in December wrote a piece listing 19 issues, or holes in the slices of Swiss cheese, that when combined, the holes align, permitting (in James T. Reason’s words) “a trajectory of accident opportunity”, so that a hazard passes through holes in all of the slices, leading to a failure.

We put the 19 issues into four categories: supervision of aerial resources, supervision of ground personnel, planning, and communication. This was not the first time these issues, or deficiencies have been seen on wildland fires. Communication, for example, is listed in almost every investigation report for a fatality on a fire. And it was not the first time that firefighters took on an assignment without an adequate briefing, without a current map of the fire, had incorrectly programmed radios, no safety officer, no written incident action plan, or that an incident management team arrived on the third day of a fire without any Division Supervisors.

When you combine all of the slices of the Swiss cheese and their 19 holes, failure is not inevitable, but it becomes more difficult to avoid. When a sleepy fire awakens and becomes complex all within the space of a few hours, it taxes the infrastructure that has been put in place. A robust organization can be resilient in the face of adversity, recovering quickly from difficult conditions, possibly even compensating for 19 holes. But if the organization and decision making, affected in some cases by little sleep over the previous 48 hours, is stressed and tested beyond its limits, undesirable results are more likely to occur.

It is conceivable that if one or more of the issues, or holes, had not occurred, we would not be mourning the 19 members of the Granite Mountain Hotshots.

One thing we don’t know about the fatalities on the Yarnell Hill Fire is why, exactly, the 19 firefighters walked into what became a lethal firetrap in a canyon. Nothing in the reports shed much light on how that decision was made, or by whom. It seems counter-intuitive that experienced firefighters would leave the safety of a previously burned area and expose themselves to the fire as they walked through unburned, very flammable vegetation, especially after a warning had been issued over the radio about an approaching thunderstorm cell with strong winds.

As the lawsuits work their way through the court system, the discovery process may yield information the government agencies that commissioned the reports preferred to be kept out of the public eye. Questions may be answered.

We can label them mistakes or unfortunate decisions, but what was done on the fire has been done before. Most of the time firefighters are lucky and get away with it, returning to their families when the fire is out. Other times they become documented in fatality reports.

While there may be few cultural changes coming out of this fire, other than perhaps being more aggressive and attacking new fires with overwhelming force, many firefighters and managers will move some basic safety principles closer to the surface of their ongoing evaluation of conditions on a fire. Supervisors may double and triple-check the location of their fire resources, and confirm through active listening techniques that orders and assignments are absolutely clear and understood. And that works both ways, up and down the chain of command. Fire managers could evaluate the supervision of aerial resources more often to ensure that the workload and span of control are within reasonable limits. Agency administrators could be certain that the management structure on a fire is appropriate for the complexity, and that “short” incident management teams are rarely if ever used. Transitions from one incident management organization to another may be watched more carefully.

Based on what we know about the fire, there is no earth-shaking revelation that can become a lesson learned. They have already been taught. Firefighters have been making the same mistakes for decades. They end up in reports that sit on shelves or hard drives. Unfortunately, another firefighter will repeat them. And they might be lucky, or resilient, and go home to their family when the fire is out.

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