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Lessons learned after the entrapment on Mendocino Complex of Fires

Bill GabbertFebruary 9, 2019October 29, 2020UncategorizedCalifornia, entrapment, Mendocino Complex, report5 Comments

Six firefighters received burns and other injuries when they had to escape from the fire by running through unburned vegetation

fire wildfires crew carrier damaged burned injuries — Crew carrier that was damaged during burnout operations on the Mendocino Complex of Fires August 19, 2018. Photo from the report.

A facilitated learning analysis (FLA) with dozens of valuable lessons learned was just released about an incident where six firefighters were entrapped on a wildfire and had to run to safety through unburned vegetation. The incident within an incident occurred August 19, 2018 on the Mendocino Complex of Fires east of Ukiah, California. Six firefighters received burns and other injuries when the fire crossed a dozer line in multiple locations during burnout operations and cut them off from their planned egress. Some of the firefighters refused treatment, while others were transported to hospitals where they were treated and released.

You can download the entire report here: (large 7MB file).

One thing to keep in mind when you read the lessons learned is that the organizational structure on the fire, which ultimately burned more than 459,000 acres, was very unusual. Two complete Type 1 incident management teams were ordered for the fire due to its enormous size. Normally when there are two teams on a very large fire they divide it into two geographical zones, with each team assuming responsibility for one. Logistically, in this case, there were not enough logistical resources available to support two large incident command posts, so everyone worked out of one base. The two teams were merged into one, which produced duplicates in some overhead positions.

The report was very skillfully designed and written and could be a valuable resource for wildland firefighters.

Below we have a very brief summary from the report of the entrapment, and following that, all of the lessons learned attributed to the personnel who were on the fire, in their own words. We did not include another section from the report that contains analysis from the FLA team.

BRIEF SUMMARY FROM THE REPORT

During burnout operations, a sudden wind shift and explosive fire growth happened and personnel were cut off from their escape routes. Most of the firefighters were able to move back to their vehicles to exit the area. However, six individuals farther down the dozer line were forced to run in front of the advancing flame front, through unburned fuels to a nearby dirt road for approximately one mile before they were picked up and transported for treatment. Five Los Angeles Fire Department firefighters and one CAL FIRE firefighter were injured. Two unoccupied CAL FIRE emergency crew transports parked in the vicinity sustained damage from the fire when it jumped containment lines.

LESSONS LEARNED BY THE PARTICIPANTS

Interviews were conducted with key personnel involved in the entrapment on the Ranch Fire. At the conclusion of each interview, each person was asked what they learned for themselves from this event and what they believe the greater wildland fire community could learn. The following are the subsequent lessons the participants shared with the FLA Team that they believe could benefit others. When possible, these lessons were written in the words of those interviewed, though a few places lesson were edited for clarity. These lessons were broken into four categories: Aviation, Inter- Crew, Fireline, and Overhead.

AVIATION

I’m not sure what lessons I learned could apply to the ground. It is not my job to second guess what folks are doing on the ground. My job is to support them and give them our perspective to help them to succeed. They use our input as another tool.
Let incoming aircraft know what type of response they are being requested. This is what it would sound like, “Declare an IWI and have them report to Mendo IP (initial point – aviation) for an IWI.”
We had an awareness of not taking risks that would incur potential damage or injuries or add more complexity. There is a balance when you are dealing with a life threatening situation that we didn’t make things worse, i.e. compromise ourselves in poor visibility. We ordered additional support to maintain span of control. We immediately ordered up additional support and didn’t try to tackle it ourselves. Didn’t want to be a liability.
Declare an IWI when injuries are discovered and follow IWI protocols so communication is clearer. Not declaring this an IWI created a lot of confusion because others did not understand the extent of the injuries or people involved.
I knew the voice on the ground so I did not provide decision points or trigger points. I just gave him the facts based upon what he was seeing. If it was someone else, I might have said no to the operation (in reference to when Dep. Branch II was asking about location of the fire for the burnout operation).

INTER-CREW

Everybody has a responsibility to run a risk management profile and use Crew Resource Management.
Ask questions when something does not make sense to you.
Ensure you and your resources are briefed thoroughly and information is flowing. People need to understand the assignment and have buy in.
Maintain transparent communication between resources and within your crew.
Speak your mind if something does not feel right. Make sure your voice is heard and understood when doing so. Validate subordinates concerns by passing them up the chain of command. If you are asked a question and don’t have an answer, re-evaluate.
Trust but verify. You will receive intel from other resources, but validate that information for yourself. Gather your situational awareness.
Rely on your experienced personnel within the group, no matter what position they hold.
Do not let urgency influence your actions.

FIRELINE

Remain vigilant and consider the worst-case scenario. Play the “What if?” in your mind.
Take the time to assess the situation and determine if it fits an IWI circumstance. ”I was mad at myself for not following the IWI in the 206.”
Good communications are critical. Validate the information you are given. Take time to scout the line. The best thing to do is ask questions for the things that are unknown and communicate with your people frequently.
Have the courage to turn down an assignment.
Vulnerability and approachability are key traits of a strong leader.
There was a perception that refusing an assignment could get you less desirable jobs or reassigned on the fire.
Rank adds to the confusion and tension around speaking up.
I think the dysfunction and disconnect between commanders intent and what was happening in division and branches was a contributing factor to the very rushed firing operation.
The CAL FIRE/Fed rivalry was evident on this fire and I believe it was a detriment to the operational tempo and production.
Help your supervisors and use humble inquiry to have a discussion about tactics. Do things make sense? What is the end state?
There was no good vantage point for the lookout. Our perception is that a lookout can see the fire but is maybe in a less than desirable location.
If you don’t get a good briefing, ask for it. Make sure to receive a thorough briefing from supervisors.
I think we need to encourage a culture of voicing concerns in a professional manner. Leadership needs to be approachable. I’ve been a metro firefighter for more than 30 years.
I’ve only been in wildland for 6 years, and I’m like born again after doing some structure protection just a few weeks before on another fire (burning out around six homes, we saved five of them). I really believe in that – this highly influenced my decision to accept the assignment. Huge mistake.
PPE. We have it for a reason. Wear it all appropriately, in particular shrouds and gloves.

OVERHEAD

Who can call for a “Roll Call” to ensure everyone is accounted for? Should it be done at the division or with the Team?
Command channel was never cleared. Weather was read over Command during the incident.
It was a difficult unified command. We typically go unified with an IC and maybe OPS, but not unified with two whole teams.
Trying to meld two Type 1 teams is not advantageous. There are too many voices and it muddies the water. That was happening on this incident. Having Deputy Branches was a side effect of blending two teams together. We had different operational mindsets and they weren’t communicating clearly enough. If we ever have two Type 1 teams again we need to address this more clearly.
Don’t get down into the weeds. This is very difficult when there is a Branch and a Deputy Branch. They need to stay up and out of weeds.
Don’t use deputy branches. I will fight tooth and nail not to have a Deputy Branch again. Next time I can isolate branches, make them smaller or broken apart.
Regardless of how good the plan is, timing is a critical element of the development of the plan. Sometimes we get wrapped up in the plan and fail to reassess the plan. When conditions changed, we needed to reevaluate.
I should have spoken up sooner. When I drove up, I should have voiced more that this was not a viable plan.
Put too much time in trying to salvage a line that was already lost.
I need to ask more questions to get a clearer picture.
Make sure everyone has a clear plan. The basics. LCES. Where are we going? Who is in charge? Leaders Intent, even if briefing has to be hasty.
Drop points are not safety zones. TRAs are not safety zones or deployment zones.
When you have two teams there can be difficulties like one team pushing for one thing and the other team pushing for another. You have to be more vocal. If we make deputy branches, they have to ride in the same vehicle. They cannot divide and conquer tasks because there is confusion about who is in charge.
We created a hybrid of the ICS system. The two ICs got along great. Below OPS is where it got muddled. Both teams had some failures when it came to how we were organized and communicated below us. Once we got feedback from the field, we cleaned up and it went better. There are definitely ways to make it work better.
I should have come up on Command and at least notified the medical unit there was an IWI. I should have forced myself to help Branch check those boxes. I’ve been thinking how I could have helped. “At all costs you have to address what you feel isn’t safe.”
I’m not blaming CAL FIRE or the Forest Service, I’m blaming human nature. We have to let go of what’s on your shoulder [referring to the organization/agency patches].
Talk to each other. We have qualifications for a reason. At the end of the day, we have to work together and realize there are good people out there in all agencies. Talk with people to determine their experience levels and comfort in different fuel types, conditions, etc. If someone is a qualified division, they are qualified. Base actions on the complexity of what the fire is going to do instead of I don’t know this guy or trust him so I’m going to just take this on myself.
It took too long for the FLA team to get here. Quite honestly, we were talking to you seven days later. Guys were barely at the hospital when I requested a team. Bring someone in to look at this objectively. I’m a little frustrated that it took a while to get here.
When we decided to meld the teams, we asked for Agency Administrators and Incident Commanders to get together and have a frank discussion behind closed doors. I believe that should happen more.
Letter of delegation is not real. You need closed-door discussions and talk about it. This settled things down a bit. It might be a best practice.
I believe that CAL FIRE and Forest Service are going to work together in the future. Anytime we are going to do that we need to work out HOW beforehand. Every time we have worked out something it’s been during a fire and that’s not the time to do that. We need to look at how both sides operate and drill down how it works and whose going to do what, before the fire bell rings. On the dirt, we fight fire, and it shouldn’t be that different on the teams.
For me personally, as Operations when I am in the field I try not to be overly involved in tactics so I don’t know all the details of what has already being looked at. If you get too involved you can get things messed up. I should have spoken up sooner. When I drove up I should have voiced more that this was not a viable plan. Looking back, we should have just fired out to protect people. I took for granted that was what was going on.
Branch was calm when the separation happened. He handled it well. It was textbook on how to help folks that are cut off and running. He asked for resources and kept his voice calm. Once the message was passed to all resources that we would shelter in place in the saddle we realized it was not the best place for a safety zone. People stayed calm, folks understood what they needed to do, and it allowed Branch to deal with separated folks.
Peer support is important. Having CISM there was awesome. They had a couple of therapy dogs. We now want to have a permanent CISM and dog on our team.
OPS leadership out there at the time helped people. They had their heads down on the mission and OPS being there may have helped them survive.
We recognized radiant burns can be misdiagnosed or dismissed as minor or superficial. Blisters and swelling can occur many hours later. The burns need to be looked at by a specialist and we had to convince the doctor to get referral to a specialist. We also had firefighters refusing treatment. One firefighter that went in had red ears the night before and the next day they looked like cauliflower. We need a universal protocol.

Breathing wildfire smoke can be similar to smoking up to two packs of cigarettes a day

Bill GabbertFebruary 8, 2019August 10, 2019Uncategorizedresearch, smoke, smoke & health1 Comment

Research shows its worse than we thought

bird dog airplane fire smoke wildfire — A Canadian bird dog airplane disappears into smoke over the Highland Fire in South Dakota, July 1, 2012. Photo by Bill Gabbert.

According to a researcher with the University of Alberta, breathing smoke from a wildfire can be equivalent to smoking up to two packs of cigarettes a day, depending on the density.

Accumulating over time, smoke particles trapped in the lungs can cause “all kinds of problems,” Mike Flannigan of the university’s Department of Renewable Resources told the Associated Press. “The more we learn about smoke and health, the more we are finding out it is bad for us, which isn’t a surprise but it’s worse than we thought.”

The AP reported that Mr. Flannagin was scheduled to make a presentation at the British Columbia Lung Association’s annual workshop on air quality and health on February 6, 2019.

Department of Interior allows waivers of mandatory retirement age for firefighters

Bill GabbertFebruary 8, 2019February 8, 2019Uncategorizedretirement5 Comments

The maximum entry age and mandatory retirement age could be raised on a case by case basis for firefighters and law enforcement officers

Hot shot crew Ferguson Fire firefighters — Bear Divide Hot Shots on the Ferguson Fire. Kari Greer photo taken around July 23, 2018.

The Department of the Interior (DOI) has implemented a policy that allows Bureau and Office law enforcement and firefighting chiefs to waive on a case by case basis the maximum entry age and mandatory retirement age for firefighters and law enforcement officers who are covered by the early retirement system. Until the new policy was signed on December 21, 2018 by Secretary of the Interior Ryan Zinke these firefighters were required to retire at age 57 if they had 20 years of covered service and had to begin their service no later than age 37. It is now possible for each of those requirements to be bumped up by three years — to 40 and 60.

The general justification for the change, as stated in Mr. Zinke’s memo, is to “speed up the hiring process”.

Specifically, waivers for the minimum entry age may be granted for those who do not have veterans’ preference if there is a shortage of highly qualified applicants for a specific law enforcement or firefighter position, or if there is a shortage of available candidates in a geographic area.

The mandatory retirement age could be changed to 60 in cases where the continuation of the employee’s services promotes the public interest. One of the examples given was if there is a skill shortage and a qualified replacement is not readily available to replace a highly skilled incumbent who is responsible for a vital program.

In 2001 the maximum entry age and mandatory retirement age were raised by two years, from 35 to 37 and 55 to 57 respectively, for both DOI agencies and the U.S. Forest Service.

“The goal here is to strengthen the ranks of our Forest Service firefighters,” said Forest Service Chief Dale Bosworth on October 21, 2001. “Increasing the maximum entry age for firefighters will allow us to open the occupation to a wider group of candidates thereby increasing our ability to hire the best, the brightest and the most skilled.”

There are four agencies in the DOI that employ wildland firefighters: National Park Service, Bureau of Land Management, Bureau of Indian Affairs, and Fish and Wildlife Service. There is one in the Department of Agriculture, the Forest Service. All five agencies also have law enforcement officers.

“The Forest Service is aware of DOI’s initiative,” Sandra Lopez, a U.S. Forest Service spokesperson told us. “The Forest Service has not made any policy changes at this time and we are reviewing DOI’s initiative.”

Thanks and a tip of the hat go out to Doug. Typos or errors, report them HERE.

Legislation advances that could enhance the safety of wildland firefighters

Bill GabbertFebruary 7, 2019February 27, 2019UncategorizedHoly Grail, legislation11 Comments

Their lives are as important as soldiers

The site in Granite Mountain Hotshots Memorial State Park where 19 firefighters died in the Yarnell Hill Fire June 30, 2013 in Arizona. The crew did not know the exact real-time location of the fire, and others assumed the firefighters were in a different, and safe, location. Photo by Arizona State Parks.

(UPDATED at 5 p.m. MST February 12, 2019)

On February 12 the Senate passed the Natural Resources Management Act described below with a vote of 92 to 8. It directs the Secretary of the Interior and the Secretary of Agriculture to implement systems to enhance the situational awareness capability of wildland firefighters. A last minute attempt by Senator Rand Paul to authorize the sale of some U.S. Forest Service land in Kentucky was shot down.

The bill also includes numerous other actions related to public lands including creating more than 1.3 million acres of wilderness out West, adding three national park units, and expanding eight others.

Now the bill goes to the House of Representatives where it will likely be considered after the mid-February recess.

(Originally published at 2:49 p.m. MST February 7, 2019)

A bill that was introduced a year ago in the 2017-2018 Congress that could enhance the safety of wildland firefighters has been resurrected in the new Congress. Last year S.2290, the Wildfire Management Technology Advancement Act of 2018 looked like it had a chance of being passed after being approved unanimously by the Senate Energy and Natural Resources Committee in December.

Most of the provisions in the bill have now been incorporated into an omnibus bill, a conglomeration of over 100 pieces of legislation combined into one huge lands bill that is hundreds of pages long. It is designated as Senate Bill 47, the Natural Resources Management Act and has 15 bipartisan sponsors — 7 Democrats, 7 Republicans, and one independent.

In a February 5 procedural vote 99 out of 100 senators voted yes. Rand Paul of Kentucky was the lone dissenter. But it still needs full passage from the Senate and the House and of course a signature by the President.

If the bill passes and is actually implemented by the federal land management agencies it would generate progress toward what we have called the Holy Grail of Wildland Firefighter Safety, knowing the real time location of a fire and the resources assigned. Too many firefighters have been killed when one or both of these critical pieces of situational awareness were unknown. Recent examples with a total of 24 line of duty deaths were on the Yarnell Hill and Esperanza Fires.

The technology to monitor in real time a fire and firefighting resources has existed for years. Various systems are being used already by a few state and local agencies. The military does it for their war fighters, monitoring the enemy and their own forces. If implemented on fires, it will save lives.

Firefighters lives are as important as soldiers.

We were told by a staffer in Washington that articles on Wildfire Today in which we wrote about the Holy Grail of Wildland Firefighter Safety were distributed on Capital Hill to inform legislators about the issue.

The key points, below, in the legislation as currently written, have requirements for the Secretaries of Interior and Agriculture. The completion dates will be established from the time the legislation is signed.

- Establish a research, development, and testing program, or expand an applicable existing program, to assess unmanned aircraft system technologies, including optionally piloted aircraft, across the full range of wildland fire management operations. (within 180 days)
- Develop consistent protocols and plans for the use on wildland fires of unmanned aircraft system technologies, including for the development of real-time maps of the location of wildland fires. (within 180 days)
- Develop and operate a tracking system to remotely locate the positions of fire resources, including, at a minimum, any fire resources assigned to Federal Type 1 wildland fire incident management teams. (within 2 years)
- Establish a system to track and monitor decisions made by state and federal wildland firefighting agencies to flag unusual costs, and those that endanger firefighters or deviate from an applicable fire management plan. (no time requirement)
- Assign air quality resource advisors to Type 1 incidents managing a fire on federal land. (no time requirement)
- Establish a system to collect data on firefighter injuries that were treated by a doctor, and all deaths during the Work Capacity Test, vehicle crashes, and aircraft accidents. (no time requirement)
- The two Secretaries will work with NASA to establish a “Rapid Response Erosion Database” and maps that would make it possible to evaluate changes in land cover and soil properties caused by wildland fires. (no time requirement)
- The two Secretaries, NASA, the Secretary of Energy, and the National Laboratories shall establish and maintain a system to predict the locations of future wildfires for fire-prone areas of the United States. (no time requirement)

This version of the bill removes the previous requirement to conduct a study to determine the feasibility of operating aircraft at night when managing wildland fires.

The bill does not appropriate any additional funding to implement the real-time tracking provision. A study by the Congressional Budget Office concluded that the estimated $8 million cost is “insignificant” in the overall billions of dollars spent on wildland fire. Discussions behind the scenes in Washington are centered around small tracking devices being included in kits available from the wildland fire warehouse system which can be ordered by incident management teams the same way they order radio kits. The devices could then be distributed to personnel and other resources on fires. The newer Bendix-King radios used by firefighters already have GPS receivers which could be used to provide location data in a tracking system.

There is no routine annual funding for the land management agencies in this bill. That is addressed in H.R.266 which has not been passed. If the agencies are not funded they will be subject another government shutdown on February 15.

In the video below published on February 4, Senate Majority Leader Mitch McConnell appears to favor passage of the bill — beginning at 1:30.

Chilean President declares state of catastrophe due to numerous wildfires

Bill GabbertFebruary 6, 2019February 7, 2019UncategorizedChile, DC-102 Comments

A DC-10 Very Large Air Tanker is en route from San Bernardino, California

(This article first appeared at FireAviation.com)

DC-10 air tanker — Tanker 910, a DC-10, at McClellan October 10, 2017. Photo by Sergio Maraschin

One of 10 Tanker Air Carrier’s DC-10 very large air tankers is en route to Chile. Tanker 910, N612AX, departed from San Bernardino, California Wednesday. It made a stop at La Aurora International Airport in Guatemala later in the day, and information on Flight Aware appears to indicate that it will also stop at Pisco, Peru.

John Gould, President of 10 Tanker said the aircraft is expected to arrive at Santiago, Chile early Thursday morning. He said it will be working for the National Forest Corporation, or CONAF (Corporación Nacional Forestal), which is a Chilean private, non-profit organization, through which the Chilean state contributes to the development and sustainable management of the country’s forest resources. CONAF is overseen and funded by Chile’s Ministry of Agriculture. There is no one governmental agency that has the authority, responsibility, and resources to manage wildfires in the Country.

On Tuesday Chilean President Sebastián Piñera declared a state of catastrophe in some regions of the country due to unusually hot weather and numerous wildfires. Below is an excerpt from Prensa Latina:

[Undersecretary of the Interior, Rodrigo] Ubilla said that this extreme measure seeks to strengthen the network of logistical support to deal with these disasters, and that these commanders will be responsible for ‘controlling public order, operationally support the tasks of prevention, fire fighting and adopt all necessary measures to avoid risks to the population.

More than 8,000 hectares [19,000 acres] of forests and pastures have already been burned by flames, dozens of homes have been destroyed and hundreds of people evacuated, according to reports from the National Forestry Corporation (CONAF) and the National Emergency Office of the Ministry of the Interior (ONEMI).

Two years ago Global Supertanker’s 747 very large air tanker spent a month or so fighting fires in Chile working out of Santiago. Andrea Avolio, a vice president of the company, said their aircraft is presently down for several weeks undergoing heavy maintenance. She said the company has not received any inquiries from officials in Chile about it being deployed.

Dan Snyder, CEO and President of Neptune, said he has recently had some informal discussions with folks in Chile but no orders have been placed. Neptune sent one of their BAe-146s, Tanker 03, to Concepción, Chile two years ago at the same time the 747 was farther north in Santiago.

A spokesperson for Aero-Flite said as far as she knew the company has no plans to send one of their RJ85 large air tankers to South America. Currently three of them are working in Australia.

Last month an IL-76 airplane hauled a Kamov Ka-32A11BC helicopter to Chile to fight fires. And on Christmas Eve Billings Flying Service unloaded one of their CH-47D Chinooks off a ship in Chile.

Billings Flying Service CH-47D helicopter — Billings Flying Service’s Helicopter 03, a CH-47D Chinook, being unloaded from the ship in Chile. Billings Flying Service photo.

Climate change brings less rain with more dry lightning and wildfires to Tasmania

Bill GabbertFebruary 6, 2019September 21, 2020UncategorizedAustralia, climate change, lightning, Tasmania

wildfires in Tasmania satellite photo — Satellite photo of smoke from wildfires in Tasmania, January 21, 2019. The red dots represent heat detected by the satellite. NASA & Wildfire Today.

Climate change has already brought alarming change to Tasmania, the huge island south of the Australian mainland. Until recently it was assumed that the climate differences would not be massive since it was thought by some that the ocean surrounding the island would not be heating as quickly as it was in other areas.

Now the southwest area of the state, the heart of its world heritage area, is being described as dying — the rainforest and heathlands are beginning to disappear. The nearby seas, it turns out, are warming at two to three times the global rate.

Richard Flanagan writes about this issue in an opinion article at The Guardian. Below is an excerpt:

…Then there was the startlingly new phenomenon of widespread dry lightning storms. Almost unknown in Tasmania until this century they had increased exponentially since 2000, leading to a greatly increased rate of fire in a rapidly drying south-west. Compounding all this, winds were also growing in duration, further drying the environment and fuelling the fires’ spread and ferocity.

Such a future would see these fires destroy Tasmania’s globally unique rainforests and mesmerizing alpine heathlands. Unlike mainland eucalyptus forest these ecosystems do not regenerate after fire: they would vanish forever. Tasmania’s world heritage area was our Great Barrier Reef, and, like the Great Barrier Reef, it seemed doomed by climate change.

Later [Prof Peter] Davies [an eminent water scientist] took me on a research trip into a remote part of the south-west to show me the deeply upsetting sight of an area that was once peatland and forest and was now, after repeated burning, wet gravel. The news was hard to comprehend – the enemies of Tasmania’s wild lands had always had local addresses: the Hydro Electricity Commission, Gunns, various tourism ventures. They could be named and they could be fought, and, in some cases, beaten.

Six weeks ago, the future that Davies and others had been predicting arrived in Tasmania. Lightning strikes ignited what would become known as the Gell River fire in the island’s south-west. In later weeks more lightning strikes led to more fires, every major one of which is still burning.

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