The Wildland Fire Lessons Learned Center produced this excellent video that every firefighter in a supervisory position should see before the next fire season. It was uploaded to YouTube on November 4, 2011.
The tragic and possibly unnecessary death of Andrew Palmer on the Iron Complex fire in northern California may lead to a slightly safer work environment for wildland firefighters. Andrew was injured by a falling tree and bled to death before he was transported to the Redding, California airport three hours and 20 minutes after the accident. An investigation discovered many mistakes, indecisiveness, and a lack of planning that all contributed to the disastrous outcome.
In an effort to reduce the chances of similar tragedies, we now have:
- Dutch Creek Protocol, guidelines for emergency medical response and extractions.
- Guidelines on communication during a medical emergency, and
- The following three questions that every firefighter should answer before committing to a fire:
More articles at Wildfire Today that mention Andrew Palmer.
A check of the current issue military IFAK (individual first aid kit) revela that the Amry, Air Force and Marine Corps individual kits all include Quickclot, the Army kit includes a nasal airway and the Marine Corps kit includes a 4 x16 Water Gel burn dressing. All kits includes additional dressings including crinkle gauze and the Israeli Bandage. Medics and Corpsmen carry much more extensive inventories of medical equipment and supplies.
1998 the Medical Services and First Aid regulation, 29 CFR 1910.151, was revised. The revision states, “in the absence of an infirmary, clinic, or hospital in near proximity to the workplace which is used for the treatment of all injured employees, a person or persons shall be adequately trained to render first aid. Adequate first aid supplies shall be readily available.”
Equipping a 20 person Type I hand crew with two ten person unit type first aid kits isnt adequate. The OSHA standards are the MINIMUM requirement.
“Managers” should get real familiar with the General Duty Clause…
Yes I agree it comes down to dollars and I believe that managers have to look at where they can save. On the surface this looks like a savings if the hours spent on medical training are cutout of the budget, but when you take into account the time lost from a preventable injury along with the hours and production lost for the injured & his coworkers taking care of him & extricating him. Additionally what’s the crew’s production rate after that type of incident until they are sure their coworker / brother or sister firefighter is doing fine? Then you need to factor in all the money spent on creating a report on the incident as well as the actual billed cost for the employee’s medical treatment, rehabilitation, and of course god forbid that an employee cannot ever return to work so now you need to add in the training cost of his or her replacement and how do you account for the loss of that experience they brought to the worksite. This type of training does not only affect us during fire season but should be a concern in our other duties as well. WOW; that was a great job cutting costs.
Of course this like all things comes down to dollars. That’s why there are no mandates or new requirements to come out of this. Just a really simplistic document(Dutch Creek Protocol, apologies to those involved but it’s not up to par against the backdrop of modern EMS).
Contractors can help this problem. I was a MUL in CA and you could usually order and receive in a timely manner any amount and level of provider you wanted. I’m sure that’s not the same across the country. Contractors already exist that can provide anything from a guy with a first aid kit to full Med Units with ALS care and flight and fireline qualified people. I’ve worked with contractors as well and would always choose that option first due to the simplicity of everything in one package and the fact that I have almost always been impressed with the professionalism and the level of care.
Some dipstick thought that the Medical First Responder class took too many hours out of the USFS apprentice academies… and another dipstick allowed the curriculum (probably the MOST IMPORTANT for firefighter safety) to be cut.
Gary,
No “Monday morning quarter-backing” was was received or inferred from your post. It was spot on.
It was a great post to continue discussion on where we are; where we could be; where we SHOULD be; and the barriers that still exist.
I work on a NF that has AEDs and EpiPens on all modules (engines, helitack, and crews) and lots of trained and EQUIPPED EMTs and Medical First Responders.
We began integrating and communicating with our local EMSA over 20 years ago… after a similar fatality that SHOULD have been prevented.
Ken – sounds like your forest is setting the standard that others should be following. This pre-existing relationship with the local EMS provider, their medical control, etc., empowers you to do things (legally) that many could not – and I would guess could be fairly seamlessly incorporated in case of a major incident as well due to your proactive approach. I applaud your efforts and hope others will follow the example, along with all the other work that is being done at various levels, albeit slowly at times, to improve care on the line.
Ken Thank You for your response to my post.
In no way was I attempting to Monday night quarterback the job done by anyone trying to help Andy. The subject of emergency medical care on the fire line has been placed on a back burner for far too long. As I said in my first post the protocol is a step in the right direction as well as the addition of more line EMTs and line Medics. But how are they trained or are they just a local or regional EMS provider with no wilderness EMS training. How much EMS / First Aid training is in our yearly fire line refresher classes? Everyone always tries to highlight safety in the RT-130 which is what it is meant to do as well as give new information. But with the exception of the career firefighters / volunteer firefighters that are mainly structural based in most cases around the country. How much first aid training do we provide our personnel? Looking at this closer how many of our seasonal firefighters and single resources that in their daily jobs work alone or in small units, in a lot of these cases out of radio or cellular range. Do they get any first aid training annually? If we would spend even an hour or two a year actually training on first aid and the extrication of the injured how many of our coworkers that have a medical emergency could we change the outcome for? I’m sure this lack of training is not the norm in a lot of places throughout the country but until a certain level of EMS training is mandated as part of the fire line curriculum we will have unprotected fire personnel in the field.
Reading the NWCG Memo reminds me of the CAUSE acronym that I learned decades ago in the Wilderness First Aid course taught by the Mountaineers outdoor club in Seattle-
Take Charge
Make a safe Approach
Give Urgent first aid
Treat for Shock
Evacuate
Or even more basic (what I teach 5th graders in my Outdoor Ed ‘Wilderness Survival’ class:
Know the hazards (of your activity and your location)
Prepare for the hazards (with knowledge, equipment and a plan)
Deal with the hazards as you encounter them (or cancel if it becomes unsafe)
It’s directly applicable to tree felling operations.
In this case, a tourniquet could not be applied due to the location of the injury (femoral artery proximal to the pelvis/groin), but the use of quick clotting technology might have been useful (if it was an approved pre-hospital BLS/ALS treatment).
There are a lot of pre-hospital interventions (ie – “quik clot”, Cyanokit, etc…) that make great common sense, but haven’t yet been approved by the local EMSA regulators for use in the field (BLS or ALS)…. yet.
Reminds me a lot about the Wedworth-Townsend Act of 1970, and how much opposition it garnered (internally and externally) throughout the state of California before it slowly expanded through 1975-1985.
It is great to see both FIRESCOPE (probably the best fireline EMS model) and NWCG working on fireline EMS issues and making some headway towards changes.
The protocol is a step in the right direction, but educating all levels of our firefighters on how to properly prevent and treat these injuries should be the goal. Here is some basic equipment that we could carry that adds ounces not pounds to a line pack. Let’s face it injury is our biggest enemy and bleeding is going to be the leading cause of injury preventable death. Rapid control of blood loss is what we need to do! But how can we do this? I have come to believe in 2 products that rapidly control extremity bleeding, the first is a tourniquet. There are several really good ones on the market today. My personal favorite is the Combat Application Tourniquet C.A.T. for short. This is a video that demonstrates how it works and if necessary you can apply it yourself. http://www.combattourniquet.com/tourniquet-videos.php The second item is Quick Clot a commercial blood clotting agent for extremity use. This virtually stops all the bleeding. http://www.youtube.com/watch?v=bQYhsU3jDb4 (This video is graphic) As a paramedic with 20 years field experience and Wildland firefighter I have used both of these products and they work! Now if every firefighter adds 8 ounces or less to their pack, they can carry 1 C.A.T. and 2 twenty five gram packets of Quick Clot. If you watched the videos and saw what 1 of each of these items can do imagine the capabilities that 1 squad or 1 crew would have in managing the bleeding of one of our own involved in an accident.
Additionally here are some other items I also carry in my pack other than just the regular band-aid boo-boo stuff, 10ft of duct tape (endless uses), 1 triangular bandage, 10ft of 4 inch wide rolled muslin, 10 packs of sugar for the diabetic problem, and a folded SAM splint to stabilize a fracture. And all this equipment weights maybe an additional half a pound. Remember before adding any new equipment of this nature, check with your agency for its regulations on its use and you must get training on its use.
“Standard Emergency Procedures” in 2012? WOW! Shoulda, Woulda. Coulda been done for the last 50+ yrs!
3 hr and 20 minutes to Redding? With all that aviation support afforded to all those land management agencies EVERY contract season…there ought be NO EXCUSE to get to an open area, helispot or whatever.
Granted, I was not there. BUT after ALLLLLL these years of wildland firefighting…this is all of a sudden a “protocol” issue. AND I thought after 20+ in the military, things were sometimes screwed up…
But not this screwed up. Maybe reading the Secret of Special Op Leadership ought to be an enlightening read for these decision makers. Especially when “leadership” couldn’t see this one coming. Tree falling issues ought to have 50+ year old “protocols.” But now 2012?
Yep back to the drawing board. Those 3 questions OUGHT to be in the IRPG and Fireline Handbook in BOLD letters and ingrained into every DIVS and other leadership. Maybe if one is carrying a GS9 through 12/13 series and an occrence of this magnitude happens again, it’s an Automatic bust to a GS7 with NO safe pay. THAT MIGHTTEACH folks if ther TRUE ACCOUNTABILITY and not just lessons learned!!
We all listened to this mishap over the radio from one of the helibases. Several of us were jumping out of our skin at the length of the response. It remains my belief that a proper response could have been produced faster and it was my guess that the organization attempted to save money by not launching multiple aircraft to coordinate this evacuation. It seemed to me, listening to this, that the medical unit dragged their feet ordering a suitable medical aircraft and I believe the only reason they would have done so is that they were attempting to save money, or they encountered some sort of resistance from someone at the sending agency for the medical aircraft who was trying to save money. I quit a 14 year career over this and the subsequent Iron-44 incident. It was my belief, throughout that summer, that the agencies struck contracts with suitable aircraft under political pressure to allow vendors to divert aircraft to lucrative offshore oil work as that work became abundant. This led to a shortage of aircraft suitable for the tasks at hand, and rather than allocating multiple type 3 aircraft, the agencies chose to allocate S-61, an aircraft and set of pilots poorly suited to landing at remote helispots…leading to the deaths of 9 guys.
2 things I thought to be sacrosanct in wildland firefighting: allocation of proper equipment and that if somebody gets hurt on an incident we all drop everything and spend whatever it takes, in terms of attention, energy, resources, and dollars, to get them to the appropriate level of care right now. Broken femur on the hill, medivac right now. Lifeflight doesn’t want to launch a ship? Bully them, coax them, bribe them, whatever make it happen right now. Those 2 things were violated within a few weeks in 2008. That was it for me, I worked for awhile longer, but my heart wasn’t in it.