After a fire or other incident occurs that had an unfavorable outcome, Wildland fire organizations typically conduct an investigation or review to cipher out lessons that can be learned. That of course can be extremely helpful and can reduce the number of similar accidents down the road. But looking at multiple incidents can uncover trends or themes that could be even more valuable.
The US Forest Service recently completed a “Metareview” of accidents and incidents, including fatality incidents in the agency over a 10-year period (2007-2016).
Five themes emerged:
- Fatalities and injuries: Why are they continuing to occur?
- Fiscal incentives: How does the current pay structure affect operational strategies and risk management?
- Society: How do social and political pressures play into the wildland fire system?
- Ecological soundness: How do ecological health and land management factors currently play into wildland fire decision making and strategy planning processes?
- Communication/work environment: What do current successes and failures look like in the context of communication and the wildland fire work environment?
The seven-minute video below is an introduction to the effort.
The entire Metareview document can be downloaded as a .pdf, or you can peruse the individual chapters below.
- Chapter 1: Introduction
- Chapter 2: Learning from the Past
- Chapter 3: Conducting this Wildland Fire Metareview
- Chapter 4: Clear, Stable, Long-Term Vision
- Chapter 5: Does Our Communication Lead to Trust?
- Chapter 6: Telling Our Story – Consistently Inconsistent
- Chapter 7: Socio-Political Pressures: Real and Perceived
- Chapter 8: Cost or Investment?
- Chapter 9: Is “Safety First” a Myth?”
- Chapter 10: Mental Health and Suicide – A Call to Action
- Chapter 11: The Quest for 1,000 Hours of Overtime – Money as an Incentive to Risk
- Chapter 12: An Exercise in Envisioning
- Chapter 13: What’s Next? Continuing the Learning
- Chapter 14: Final Learning Challenge
One person who has reviewed much of the document described their impressions to Wildfire Today:
Basically the USFS is actually identifying a lot of their shortfalls and explains the policy issues they are having with conducting prescribed fires; describes that employee pay structures are unethical; describes why the current system by design is causing bad outcomes for employees both mentally and physically, and a lot more. Perhaps the most interesting part about this report is that there aren’t really any solutions offered.
The Forest Service views this metareview as one important step in their learning journey. This tool should be viewed in combination with other interagency wildfire safety products, such as the annual interagency National Wildfire Coordinating Group’s safety gram and the Lessons Learned Center’s annual “Incident Review Summary.”
This fall and winter, the Forest Service’s learning team will host webinars for the fire community to introduce the content and demonstrate how this learning tool can be used to transition from singular incident learning to ongoing, multi-format, iterative, shared learning.
Typos, let us know HERE, and specify which article. Please keep in mind our commenting ground rules before you post a comment.
32 thoughts on “Forest Service examines 10 years of incidents and fatalities to develop Metareview”
Surprise!! Aren’t really any solutions offered..Hmmmm..HRO, eh?
Loooooong learnin journey..” fer shure!”
How much did this cost?
I shall withhold judgement till I read it. I will say this though. Not a single mention of this via official channels. Not a single email from leadership. Nothing. They suck so bad.
It’s the top item in the “Inside the FS” email sent on 11/17 from the Office of the Chief. I guess the chief could have sent the email out directly like he’s done with the OR Rx shitshow. I would have liked to have seen them post it on more channels like IG or FB.
This study falls somewhat in the realm of “historical” insights rather than what current trends and incident Reviews might give us. Definitely a “Researcher’s Dream job” that goes on forever, regardless of the pitch to “make it your own.”
As someone who has studied many past “formal Reviews,” and been a member of some, little consequences tend to follow. Why? Because “upper Management or Leaders” tend not to make the subsequent hard calls for poor actions by individuals. This was my experience and I am not saying they were all this way. Without serious consequences when a very serious disregard of one or more of the 10 Watch Outs occurs and a crew has to deploy their shelters, then you can damn well expect to see this “disregard” to occur again and again! That kind of “leadership” on the line needs to be removed or demoted in their “fire quals.”
We have gone over these violations resulting in accidents or deaths, time and time again. What we need to be more careful about is training fire line leaders who WILL NOT VIOLATE RULES THAT HAVE BEEN LEARNED OVER MANY DECADES!
I couldn’t get past the Disclaimer: Trigger Warning as it triggered so many bad experiences working for such a Sh** Show.
I read the entire document. It’s pretty good, but what it comes down to is that the USFS is incapable of carrying out their mission. A Land Management agency that has a Fire Suppression priority means that you no longer have a land management agency. What’s the solution: a national fire service.
The current system fails at both management and suppression. And it’s also systemically abusing their employees, findings in the Metareview even suggested that suicides are line of duty deaths. They go through the system we use to pay employees that incentivizes risk and mental health struggles.
Knowing that the system is built to cause mental and physical health problems, what is the agency doing to treat the problems that are caused by the job? Not enough.
So many problems they cite are systemic, and managerial, and I just don’t see a solution other than breaking up the land management agencies. At this point they are too big to care.
I’ve been opposed to a national fire service for awhile but given how long it took them to figure out how to roll out the “retention allowance” and then given how poorly it was implemented, I think I’m in the national fire service camp now. The national chief of our organization should be someone who has made wildland fire their career. Not sure which department it should fall under yet. But our leadership from the Chief himself down to even the forest and district level has continually and routinely failed us as employees. Not sure how you can fix that other than burning it all down and starting from scratch again.
I think that fire suppression is part of land management as are managed fires and prescribed burns. Separating fire out as its own agency is going to create a political pain in the ass in the future because you’re going to have to work with the other “land management” agencies..I don’t think creating a national fire service is really going to fix much..in fact I believe it will add pointless bureaucracy to an already sluggish system.
I would like to see more info or stories of close calls or near misses. A lot of resources and keep the stories in house but I guarantee there’s a lot of close calls in many ways every year…we can learn from those experiences, but sharing those stories are embarrassing and mistakes or failures aren’t always seen as a learning experience.
I absolutely agree with Joe Shmoe and Oldguy’s comments. Rather than a huge document highlighting the failures, they should have investigated the AAR’s of the actions of those individuals that came so close, yet avoided an accident. There would be so much more to be gained by the success stories, and perhaps the answers to the very issues this report highlights. The people that made the unconventional decisions to save a life should be celebrated and their thought processes should be examined to see how they or their actions avoided becoming a statistic in this report.
“I would like to see more info or stories of close calls or near misses. A lot of resources and keep the stories in house but I guarantee there’s a lot of close calls in many ways every year…we can learn from those experiences, but sharing those stories are embarrassing and mistakes or failures aren’t always seen as a learning experience”. No truer words ever spoken…
As a total greenhorn (out of timber management), I was sent on a mop-up mission with a five gallon backpack sprayer. I came close to falling into a deep hellhole of glowing dead-root wood big enough to hold three or more guys; it would have been fatal, not just a third degree burn, and no one would have been able to fish me out, even if there had been an ambulance standing by. It wasn’t reported.
Because I would say that 99% of the “mistakes and near misses” don’t get reported or discussed. Lots of injuries and accidents go unreported as well.
Why 2007-2016? Why not 2000 -2020? A 20 year study. Who are they after?
This meta review came out of the Twisp Fire FLA which happened in 2015. Talking with some folks involved in creating this metareview it has been a long time in the making and they ran into a lot of hurdles getting it published. One of their takeaways in this metareview is to do more metareviews going forward. “Who are they after?” No one? Personally I would have liked to see this metareview go harder and call out agency leadership for their continual lack of actual leadership.
Fatalities and injuries: Why are they continuing to occur? Because there is never any minority report included, as Admiral Hyman Rickover always required? Because there is a habit of persistence on the same course whilst expecting a different result?
Does anyone know why CalFire has removed the detailed final report on the Esperanza Fire from its website?
curious, w, just what you’re referring to there on the Esperanza. Links please?
I tried to find the detailed final report on the Esperanza on the CalFire website. All I could find was a useless “summary.” What kind of links would you like?
I can never tell if I am being trolled or the agency really doesn’t have a clue. This isn’t the first time there has been some “journey” but a journey would normally have a destination in mind. It seems like each FS “journey” is comprised of getting on a bus and taking a lot of laps around the obvious station and then never getting off there.
These “cathartic” learning sessions just seem kind of redundant and patronizing. It’s like if I were to read some report that poor neighborhoods have higher crime rates because people there are poor and then found some poor people and told them not to worry because I was busy learning about it and then shared some obvious things I learned with them. Just either bump grade levels/pay and cap hours until I make the same as a 1000 hour season with less hours worked or go away.
Also, the whole bit about claiming 16s? Maybe include some of the language in the report about what constitutes “official time”. There is a fair argument to made that we are not getting compensated for what could be considered work hours, or paid standby, talking about closed camps and the sheer amount of off hours phone calls I have to field as a supervisor, even when laid off or on days off that there is no charge code to cover it. If we want to talk about falsifying time, lets also talk about not paying people for their work and give it the same weight. What about districts that try to abuse credit to avoid paying o/t for training? What about the actual CFR definition of hazardous duty that somehow got pigeonholed into what we are allowed to claim H for? No thanks.
“there is no charge code to cover it.”
Every Region and Unit has a support code. You charge “it” to that. If I take a phone call on my day off, BOOM, 1hr OT to the support code. Somebody “needed” information and didn’t tell me till the end of the day making me stay and extra couple hrs?? BOOM…support code OT. I have to cover duty on my normal day off but am unable to go in due to having my kids?? BOOM…8hrs OT to support.
The Support Code is there for a reason, use it.
I think it’s also easier for those at the higher grade levels in management to just “boom” charge hours to this support code. What about the FEO that fields work-related calls from seasonals during off hours, or you had a delay that didn’t get you back to the station in time to be off by 1800? Small things like that here and there that really add up to hours and hours over time? I can’t tell you how many times I’ve been told to “just flex” my hours or “make it up on the back end” or whatever. Sometimes that works out, but often times we are just too busy or it’s the middle of fire season and there’s no way I’ll be able to leave a couple hours early to make up for that time, due to fire danger.
Personally, I think the outdated 40-hours a week schedule we work is exhausting for this line of work. We have to try and cram a fairly significant workload into 8-hour days, especially during critical training, then we can’t go home and just check-out for the rest of the day. Our phone has to be on in case an employee calls, or dispatch, or the duty officer. A fire starts on your district at 1830 and you are half way home? You better be ready to turn your ass around and get back to the station. And we will, every time, because most of us have a sense of duty and want to be the ones fighting fires on our districts. But I would much rather just work a standard fire service schedule doing 24’s and be fully engaged for the few days I’m at work, then be able to essentially turn my phone off during my days off and fully disengage because I know someone else is at my station working 24’s and covering calls and whatever project work. Our schedule now puts too much pressure on the employee to always be ready to do work related things or go back to work, whether they are on the clock or not.
And don’t forget you friendly neighborhood dispatcher who has to be on-call a couple of nights a week-can’t go anywhere and has to babysit their phone- and isn’t compensated for it.
Absolutely. Dispatch gets completely screwed over left and right. We boots on the ground appreciate them so much, but they definitely get the short end of the stick all of the time. I’m sure dispatch would love to do a normal fire dispatcher schedule as well.
“What about the FEO that fields work-related calls from seasonals during off hours, or you had a delay that didn’t get you back to the station in time to be off by 1800?”
Yes they can. Any supervisor who tells you otherwise is flat lying through their teeth. I an a CH1 on a large forest. I have told all the DFMO’s to tell everyone under them that ANYONE can charge to support. The reasons you cited are ample justification. Have a discussion with your leadership, if they’re making you work extra hrs for free or credit hrs, they’re remiss and ill informed.
Good to know and thanks for the reply. Unfortunately, I doubt I am the only one who runs into this issue. I never understood the motivation some supervisors have to shaft their employees out of overtime in order to save the gov a couple bucks.
“I have told all the DFMO’s to tell everyone under them that ANYONE can charge to support.”
Sadly you are more unique than you might realize. Many forests I’ve worked on it’s like pulling teeth trying to get FFMOs/DFMOs/module leaders to let us charge hours to the support code. They’d rather give their folks base 8s all summer than charge any OT to the support code. Oddly enough turnover on those forests, districts, and modules is quite high yet the various leaders can’t seem to figure out why. Like SMN said below, “some supervisors have to shaft their employees out of overtime in order to save the gov a couple bucks”. They fail to see that “investing” some money in their folks via OT on the support code would likely save them a lot of hiring/onboarding headaches and training costs in the long run. Gotta step over a dollar to pick up a dime. Meanwhile we’ll paint a hillside with VLATs from sun up to sun down and accomplish nothing but that’s fine.
I have run into many inept leaders as well. The truth is, the Forest and Regional support codes have millions upon millions in them and that is what they are there for, to take care of the troops and bring in help. I guarantee your FFMO’s, FMO’s and DFMO’s are charging to that when they’re Duty Officers.
I have a Forest Aviation Officer that tried to find the bottom of that code with aircraft one year. (LATS, VLAT’s, T1 Helos etc) and couldn’t. I feel for you, perhaps you all should confront them about this, I would. It’s ridiculous that your leadership withholds those funds when it has positively no affect on their budgets. They’re on the same FAM board calls I’m on and they KNOW they could easily let people that are putting in extra time charge to support. Sorry folks, but that is mismanagement.
The issue I have on my Forest is management’s assumption that everyone’s life is work and being paid doesn’t matter. For some- it is. Especially those you don’t have children and are above a 9 or so. It is assumed everyone checks their emails off the clock. It’s assumed everyone can change work schedules without notice. It’s assumed everyone is on call without being on call. It’s assumed no one makes plans for non work related activities. It’s assumed employees will just work for free when needed. I have never been asked to do something while off the clock and been paid for it. I have never heard of a pcode folks can use for this stuff although I do believe there is one. That would involve an official OT authorization that would turn into the ever common. “Just take credit” at which point I would have to refer my mang. To the master agreement that they seem to know nothing about. Thanks for not doing this to your folks. I’m glad you respect your employees.
Hazard pay has to go away. Not only does it increase exposure to risk, it contributes to increased acres burned and total fire costs. Increase the pay of firefighters and get rid of hazard pay. On a side note the federal government should have to limit their total fire costs like most state fire agencies have to. This is of course related to firefighter pay.
@mike I’ve always thought you could increase firefighter pay and decrease costs. Less LA County cooperators doing menial tasks for $100/hour and more well-trained federal firefighters at increased, but reasonable, pay. And it’s not just california, why are boulder county firefighters showing up to southeastern oregon for $80/hour to be a hecm trainee on the federal dime? It’s wild.
Hazard pay definitely needs to go away. Incentivizes risk. Doesn’t make sense when tree felling isn’t included. Also disincentivizes Rx work and other project work.
1000% agree to all of this! I’ve thought that since my first season and even brought it up before, but it seems like kind of one of those things for a lot of people where that’s the way it’s always been. So now instead of trying to get rid of it, they are fighting to get hazard pay definitions expanded and include RX. I agree it should just be a matter of paying us better and getting rid of hazard pay.
There are competing interests. Hotshots might like Hazard Pay because they get a lot of it, but IA resources probably want to get rid of it, because they are doing a lot of hazardous work without the hazard pay.
We are such a diverse, decentralized workforce so it’s hard to come together and find consensus. The agency has been taking advantage of that dynamic for a long time, and we have been shooting ourselves in the foot for decades.
That’s why I’m thrilled to have Grassroots Wildland Firefighters stepping up and a newly motivated NFFE union starting to get things moving.
Yea! Cut the fuelish “management” and pay firefighters. Or tell management to take its shoes off the next time it calculates cost/benefit.