Medical evacuations of firefighters and the Golden Hour

Andrew Palmer
Andrew Palmer
Andrew Palmer

In 2008 firefighter Andrew Palmer was struck by debris during a tree felling operation on the Iron Complex fire in northern California. According to the coroner he died of “blood loss due to blunt force trauma to the left leg”. He bled to death

Andrew was pronounced dead after he arrived via Coast Guard helicopter at the Redding airport. It took three hours and 20 minutes to get him to the airport due to inadequate planning and many screw-ups and poor decisions.

We previously covered the accident and its effects, here and here, including a paper written by Andrew’s brother, Robert, who recommended that injured wildland firefighters be transported to an appropriate medical facility within the first “Golden Hour”.

The federal land management agencies have done little to adopt a “Golden Hour” policy, but the issue, rightfully, refuses to disappear, as evidenced by this excerpt from an October 17, 2011 article in High Country News:

…Rob Palmer’s suggestions are facing resistance from many in the wildfire establishment. Tom Harbour, the U.S. Forest Service’s director of fire and aviation, says, “Implementing a Golden Hour response as Robert Palmer has framed it would require fundamental changes,” and the benefits might not outweigh “the additional risks or the unintended consequences.”

Harbour contends that a Golden Hour mandate would require greater use of aircraft. Because aircraft accidents are responsible for so many wildland firefighter deaths — 50 percent since 2000 — aircraft fatalities would likely increase. And millions of new homes have been built in recent years within wildfire-prone forests; if crews were prohibited from battling some wildfires around homes, that would put more lives at risk.

But Palmer also has allies. Chad Fisher, a National Park Service safety officer at the National Interagency Fire Center in Boise, Idaho, acknowledges that “implementing the Golden Hour proper (a strict policy) is very difficult. Risk management comes into play.” Sometimes fires that threaten valuable resources — such as habitat for rare native trout or historic buildings — must be attacked even where evacuations can’t be done in an hour. Yet Fisher has encouraged the multi-agency National Wildfire Coordinating Group to learn from the Dutch Creek tragedy and make its recommendations for improving the framework for emergency medical care. For instance, all morning briefings for every large fire now include specific evacuation routes and procedures.

Fisher is also pushing what he calls — “for lack of a better term” — the Golden Hour Engagement Strategy. The “comprehensive strategy” recommends providing more appropriate medical gear on firelines, and urges that the distance to medical facilities be taken into account when fire-management decisions are made. The strategy is taking hold, he says, noting that in the last year or so, many crews have bought backboards and litters. He believes that, in the future, fire managers will be more likely to deploy EMTs with fire crews going into especially risky situations.

Fisher created a webinar presentation partly based on Palmer’s talk at the Safety Summit, and he’s showed it to influential agency groups. He’s also working with other Park Service leaders to find a national park where the Golden Hour strategy could best be fully tested.

A list of Wildfire Today articles that mention Andrew Palmer.

Typos, let us know HERE, and specify which article. Please read the commenting rules before you post a comment.

Author: Bill Gabbert

After working full time in wildland fire for 33 years, he continues to learn, and strives to be a Student of Fire.

11 thoughts on “Medical evacuations of firefighters and the Golden Hour”

  1. I have 2 suggestions. First, place more emphasis on the medical unit and the Med Unit Leader. Give them the same say as the Safety Officer. Change the training syllabus to increase qualifications(maybe a paramedic level) and reflect more medical/rescue response planning. My experience has sometimes been that the medical unit is considered an afterthought or even a nuisance. Second, is what several others have said, line qualified paramedics. A paramedic brings you a couple of things, their ALS skills/gear(which is limited in this setting) and most important their decision making. A paramedic as the MUL and paramedics on the line give you that advanced level decision making needed to avoid tragic mistakes like this.

    0
    0
  2. Just because it is difficult to achieve perfection, does not mean we should not try to improve on the current system. The US Coast Guard, using helicopters, routinely extracts personnel from ships at sea, or even people IN the sea. It should be possible to extract an injured person from a wilderness area using the same techniques. That is how Mr. Palmer was extracted, using a Coast Guard helicopter, but it took hours to get it on site.

    0
    0
    1. Speaking as a wildland firefighter and a paramedic with backcounty medical experience, the golden hour is a goal for urban hospital trauma settings and is unreasonable in the wilderness environment. Focus must be on patient assessments and rapidly determining the needs for a high risk evacuation. Helicopters may be the right choice, but should not be the first choice.

      0
      0
  3. How do we logically address issues like a 2-person SJ stick in the middle of a western Wilderness: if we had 1 hour response time, we wouldn’t need the SJs; how about when 20-50 lightning strikes occur and they are all staffed with SJs or heli-rapellers: can we get them all picked up and to a medical facility within 60 minutes if 2-3-4-5-6- or more are injured? Do folks on a Type 1 or 2 Incident under an Incident Management Team deserve better treatment than an IA SJ? And leaving the fire world, what about USFS and NPS Wilderness rangers, out by themselves on one-person 10-4 shifts? Is this a can of worms we really want to open? Remember, toothpaste does NOT go back into the tube!

    0
    0
  4. To make a response in the golden hour even in the best of conditions can be hard.

    The safety officer, medical unit leader and air operations need to have a plan early on to deal with this kind of event. Some times it takes new and out of the traditional box thinking and planning but often a good workable plan can be designed for that set of circumstances. It may not meet the golden hour but it will get the injured out as quick as possible.

    Mr. Fisher is headed in the right direction. I wish him well on his quest.

    0
    0
  5. The use of line qualified Paramedics as single resources on the line, would go a long way in getting appropriately qualified personnel to an injured firefighter quickly. This would then put evacuation planning in the hands of someone who does this regularly. The availability of proper evacuation equipment would also need to be provided.

    0
    0
  6. EMS and evacuation/technical rescue is a joke in the wildland fire community. Some crews might have EMTs, but they can do very little compared to paramedics… especially when they carry a small amount of bandages in the 10-person first aid kits. And ALOT of the EMTs just have the class knowledge and no actual experience. Then you have to contend with medical protocals, medical directers and certification between each state the fire is. With how dangerous and remote the area wildland firefighters work and how safety conscious the federal agencies are, you would think they would have had a good plan and resources in place for some time now. But then again, we are talking about federal agencies.

    0
    0
    1. James – lots of criticism, but your post lacks any reasonable suggestions for a positive change on all of the wildfires we have to deal with daily. So, lets hear some ideas to fix what you believe is broken?

      0
      0
      1. No need to dude. Just pointing out the problems. Trying to fix the problems with the fed agencies is impossible when you are just a grunt on the line or even a FMO. Gotta be a suit to do anything, and even then they can not get it right. Even when they have years to fix the problem.

        0
        0
    2. Will the Para’s be that much better for the service, Had a para been on scene for Caleb Hamm maybe, an immediate IV sure would not have hurt, with that in mind consider this assorted IV fluids need be carried, saline, D5W ect, meds for pain and cardic these have to be temp controled, if all the EMT is carrying is a 10 person bandage kit yes he/she has not enough to work with, as for diffrent states thats why your medics should be nationally registered and no i dont like nr but this is diffrent, the forestry service have one med dir and asst, sit down draw up your protocals eval them get them signed off on and use them, fed trumps state ect. I think Emts have there place as well as a para in this situation, as an emt I can start a iv but my med dir has to have confidence I know how and that if there where any other way I wouldnt ask cause I know if I screw up it aint just my lic/cert but his as well,if you have only emts straight out of class then this is a bad sitution for both patient and emt, yes everyone has to learn but this aint it. Why are not the FF taught how to use blood stop or something else along those lines as well as a what I call a turn a quit a piece of cloth/belt and a stick or a commercial brand. Even a good para with these items and an IV will eventually loose a patient to bleeding with more saline in the body than blood/shock,evac either land or air quick will be the issue. Just my thoughts.

      0
      0
  7. Things have changed. Last year on the Cow Creek Fire in Rocky Mountain National Park the type two team that was in charge of the fire saw the need for another method of evacuation. High angle specialists were brought in and for the first time on a large fire a group of short haul climbering rangers were ordered. This trend contiuned this year with short haulers being ordered to respond to large fires mulitple times. I see this as a great trend that hopefully conitues.

    0
    0

Comments are closed.