Suggestions for a medical program on a hand crew

Crew Medical Program — Structure and Guidelines

By Liam DiZio, Pioneer Peak Interagency Hotshot Crew

Lacking from documents outlining wildland fire crew structure are guidelines for a crew medical program. With 20+ crewmembers, crews are often their own best resource for coordinating patient care and extraction. Crew medical programs, then, must be based on this principle of self-sufficiency. This document aims to outline a sample crew medical program structure defining personnel structure, training, equipment, and standard operating procedures (SOPs) to support a strong crew medical program. The goal of this document is to serve as a resource for crew medics and further the goal of standardizing robust crew medical programs in wildland fire. This document applies to any regularly organized wildland fire crew.

Medical Program Personnel Structure

Structuring a crew’s medical personnel ensures a consistent product of patient care and equipment accountability year to year. The suggested structure looks as follows:

Lead Medic
Assistant Medic
Line Medic                    Line Medic

Duties of above personnel are described below.

Lead Medic

The lead medic is the top of the accountability hierarchy for crew medical equipment and care. The lead medic begins the season by coordinating early season medical training and supply logistics. They then then maintain and inventory crew medical equipment and ensure the correct complement of crew medical gear makes it to the fireline daily. The lead is also responsible for patient care and associated medical paperwork. Lastly, the lead medic maintains a relationship with support personnel, taking advantage of training opportunities and organizing seasonal medical supply orders. Success in this position requires daily effort and expertise in a side of fire unknown to most. This role is most appropriate for senior firefighter or below.

Assistant Medic

The assistant medic is responsible for assisting the lead in all duties. The assistant serves as an additional point of contact for crewmembers and assumes lead’s function in their absence or in split squad configuration. Assistant medics should be familiar with all crew medical equipment, medical paperwork, medical supply logistics, and training needs. This role is most appropriate for senior firefighter or below.

Line Medic

Line medics are additional designated medical personnel on the crew. Having two additional line medics ensures that medical knowledge is spread throughout squads and tool/saw teams. Line medics are accountable for crew medical gear on the fireline and patient care in a trauma scenario. Line medics are familiar with contents and function of crew medical equipment. This role is most appropriate for senior firefighter or below.

All four designated medics should hold current EMT-B qualifications or above, ideally supplemented with real world experience. Successful crew medics come from various backgrounds such as civilian EMS, military medicine, and ski patrol. Further qualifications and endorsements allow the crew to carry additional equipment such as IV/IO fluids, various drugs, and advanced airway products.

Training

At the beginning of each season, all crewmembers require some form of medical refresher. This training can occur over one or more days of critical training. Training evolutions should include lecture, hands on skills practice, CPR certification, and medical scenarios.

Lecture

Taught by the lead and assistant, a medical lecture should include information on the crew’s medical equipment, medical mentality, medical incident SOPs, basic trauma care, common fireline medical emergencies, and minor fireline medical issues. Crewmembers should also be briefed on who their lead/assistant/line medics are and the crew SOP for calling out a medical incident on the radio.

Skills Practice

Following the lecture, crewmembers cycle through skills stations learning hemorrhage control and crew extraction platform procedures. These are the skills non medically trained crewmembers are most likely to perform in the field. The hemorrhage control station should include hands on tourniquet and wound packing training. The extraction platform station should include simulated carries and lessons on proper platform set-up and storage.

CPR

Professional CPR training can fit anywhere in the crew’s critical training and can be taught by outside resources or qualified crewmembers.

Scenario

A field medical scenario is an opportunity for crewmembers to learn their role during a medical incident and practice with crew medical equipment in a real setting. Scenarios typically involve two or more patients, a crew-facilitated extraction, and can include other challenges such as mid scenario casualties, improvised litter construction, and complex trauma. This is a good opportunity for line medics to practice patient care and for the lead and assistant to coordinate treatment and provide 8-line information to the incident commander.

Throughout the season, the lead and assistant medics should facilitate additional scenarios to maintain currency and test the crew’s equipment in different environments.

Equipment

A crew must carry enough equipment to be self-sufficient in a trauma and extraction scenario. Equipment must be robust but lightweight enough to encourage daily carry. Establishing a regular daily carry ensures that medical equipment is never far from the bulk of the crew and decreases the likelihood it be forgotten in any situation.

A typical daily carry could include the following:

• 2 trauma kits w/drybag
• 1 SKED w/KTD + drybag

Trauma kits are 7-10 lb. medical kits consisting of hemorrhage control, airway, IV, and splinting equipment. With two on the line, equipment can be spread evenly between squads. Crew medics are encouraged to carry trauma kits and maintain accountability for them. Some crews utilize the Mystery Ranch “Med Lid” attached to medic’s line gear instead of a separate kit. A SKED is an example of a portable extraction platform. Similar devices include the TRS and other foldable stretchers. Having an extraction platform near the bulk of the crew ensures timely extraction in any scenario. A traction device such as a KTD can be included in the SKED drybag to supplement splinting materials in the trauma kit. Storage of trauma kits and SKED in drybags prevents wear and facilitates carry with a hand tool.

Any additional medical gear can be left available at the crew’s camp or in crew vehicles. Additional gear can include the following:

• 2 large trauma bags
• 1 medical supply bag including:
  • Backup medical supplies
  • Minor wound treatment kit
  • Over the counter medications
  • AED
  • Medical paperwork
• Additional stretchers on crew ATV/UTVs

This equipment supplements line medical gear and can be accessed in the event of a major trauma. Trauma bags are large versions of trauma kits consisting of the same items but in larger quantity.

Additional suggested medical gear includes small hemorrhage control kits and extra tourniquets carried by every saw-team. This ensures that time sensitive hemorrhage control equipment is never far from those most likely to require it.

If crew EMTs hold advanced qualifications or endorsements, they may carry additional items such as epinephrine, Benadryl, Zofran, metered dose inhalers, etc.

Procedures

Crews must establish strict SOPs to ensure consistency and efficiency. These include but are not limited to:

• A standard radio callout for initiating a medical incident
  • Example: “break break hold all crew traffic, I have a medical emergency, stand by for size-up” followed by location, MOI/chief complaint, and resources needed
• A standard flagging and radio procedure for placing medical equipment on the line during a shift
• Reiteration of medical plan at every briefing
• Reassessment of medical plan throughout the working shift
• Treatment of medical equipment with respect and protection from damage during inclement weather, firing and aviation operations, and transport.
• Encouraging crewmembers to address medical issues early to avoid aggravation

Conclusion

This document is driven by the mentality that the crew is its own best medical resource on the fireline and should strive for medical self-sufficiency. This can be achieved by establishing a personnel structure, conducting proper training, carrying proper equipment, and establishing medical SOPs. These guidelines provide a framework on which to base an even more robust program should resources allow.

About the author

Liam DiZio has spent six seasons fighting wildfire in Alaska, five of them with Pioneer Peak Hotshots. He is currently a squad leader and certified as an EMT-II in the State of Alaska. His medical experience consists of three seasons as his crew’s lead medic as well as three seasons as a ski patroller in Alaska.