Yaroslav Katkov, 28, collapsed during his second attempt at a 1.45-mile training hike near the De Luz Fire Station while wearing full gear and carrying 20 to 30 pounds of weights, according to an autopsy.
He was flown in an air ambulance to Temecula Hospital but suffered a two-minute seizure while en route. When he was admitted, his body temperature was 107.4 degrees. Fifteen hours later he was pronounced dead.
CAL FIRE’s preliminary report on the incident, the “Green Sheet”, said the three-person crew began a physical training hike at 8:40 a.m. with the expectation that they would finish within the 30-minute time limit. Mr. Katkov struggled, stopping multiple times, completing the hike in 40 minutes. After a 20-minute break to rehydrate, the Captain had the crew repeat the hike at 9:40 a.m.
NBC San Diego described what occurred on the second hike:
Katkov took more than 20 breaks along the trail which were documented by the captain, the report said. About halfway through the trail, the second firefighter noticed Katkov stumbling and losing his balance. He was told to hike directly behind Katkov and hold onto him so that he didn’t fall off the trail.
As they approached a ridge, the firefighter had to push Katkov’s back to help him get over. Once Katkov did, he fell forward and sat down. Katkov was then told to remove some of his gear so that he could cool down but was unable to, the report said.
More gear was taken off, and water was poured over Katkov’s head. At around 10:38 a.m. when the fire captain noticed Katkov’s mental status declining, he called for an air ambulance rescue.
Cal Fire’s helicopter arrived over Katkov and the crew at approximately 11:19 a.m. and Katkov was hoisted from below, according to the report. About 15 minutes later, the Cal Fire [helicopter] dropped Katkov off at a site where a Mercy air ambulance was waiting to transport Katkov to the hospital.
The second helicopter took off with Katkov inside at around 12:04 p.m., about an hour-and-a-half after the fire captain called for emergency assistance. On the way to the hospital Katkov was unresponsive but breathing, according to the report.
KNTV reported that Mr. Katkov was flown to Temecula Valley Hospital. Google Maps shows it would take an estimated 31 minutes to drive from De Luz Station to Temecula Valley Hospital, part of the time on curvy county roads. Based on that, we can assume it would take no more than 10 minutes for the Mercy air ambulance to arrive at the hospital — at about 12:14 p.m. This was approximately one hour and 36 minutes after the request for extraction by helicopter. Presumably the incident occurred in a remote area inaccessible by ground ambulance. It is likely that the medical crew on the Mercy helicopter began treatment of the patient as soon as he arrived at their location during the 30 minutes before the helicopter took off.
Estimated time line:
10:38 a.m. — Air ambulance rescue requested
11:19 a.m. — CAL FIRE/San Diego Sheriff Dept. helicopter arrives at scene
11:34 a.m. — (Approximate time) The CAL Fire helicopter delivered Mr. Katov to Mercy Air ambulance
12:04 p.m. — Mercy air ambulance departs for Temecula Valley Hospital
12:14 p.m. — (Approximate time) Mercy air ambulance arrives at hospital.
If left untreated, severe rhabdo may be fatal or result in permanent disability.
Too many wildland firefighters have suffered from rhabdomyolysis (often referred to as rhabdo) in recent years. In some cases they could have been treated much earlier if the victims and those around them had recognized the symptoms.
Firefighting, both structural and wildland, involves tasks in environments that place fire fighters at increased risk for this condition. Rhabdo is a breakdown of muscle tissue that releases proteins and electrolytes into the blood stream and can cause heart and kidney damage. If left untreated, severe rhabdo may be fatal or result in permanent disability. Heat exposure and intense physical effort are just two of many known risk factors for rhabdo.
NIOSH has developed two sets of factsheets and wallet cards—one for structural firefighters and their healthcare providers and another for wildland firefighters and their healthcare providers—to increase awareness about the signs and symptoms of rhabdomyolysis and help fire fighters get early treatment to prevent more serious medical problems.
Factsheets for wildland firefighters and their healthcare providers:
When we were writing the July 13 article about Frank Anaya, the latest California inmate firefighter that died on a fire, we discovered details about a previous inmate fatality that were shocking. It involved the death of Jimmy Randolph in August of 2012 whose passing was associated with heat stroke. The shocking part was that Mr. Randolph was found unresponsive one morning in the sleeping area on a fire and died in a hospital seven hours later. He had complained of a headache the previous evening and was checked out by the medical unit, but apparently no one was aware of the seriousness of his condition.
Firefighter Jimmy Randolph was assigned to the Buck Fire as a part of a strike team. At approximately 1800 hours on August 18, 2012, Firefighter Randolph advised a correctional officer that he had a headache. He was escorted to a medical team, evaluated, and given a three-day no-work note. At approximately 0530 hours the next morning, Fire fighter Randolph could not be awakened. He was treated and transported to the Desert Regional Hospital in Palm Springs. With his family by his side., he was pronounced dead at 1230 hours on August 19, 2012. The cause of death was listed as anoxic encephalopathy combined with complications of heat stroke.
Anoxic encephalopathy is a condition where brain tissue is deprived of oxygen and there is global loss of brain function. The longer brain cells lack oxygen, the more damage occurs.
I checked the weather for August 18, 2012 for San Jacinto, California which is in the general vicinity of the Buck Fire, and the high temperature that day was 92 degrees — a temperature commonly found on a large wildfire in the summer.
The wildland firefighter community has experienced an alarming increase in heat related and other physiological injuries in the last few days. Heat related injuries and Rhabdomyolysis are not the same, but can occur at the same time. Extreme weather conditions are predicted to continue across western states for the next week. The National Weather Service is issuing Heat Warnings for the SWCC, GBCC, RMCC, OSCC, and ONCC.
It is a very well-written document about how to prevent, mitigate, and recognize heat related injuries.
The lessons learned from this research clearly indicate that the best protection against a heat injury is reducing work rate.
Aggressive hydration strategies are over-preached and may provide a false sense of protection. It should be emphasized that the autopsy report as described in the fatality report indicated no signs of dehydration or electrolyte imbalance.
With that in mind, below is the article we wrote in 2016 after reports were released on two very serious injuries that occurred during the first two days of training for new firefighters.
****
Safely training the tactical athlete
After reading the Facilitated Learning Analysis (FLA) about the Rhabdomyolysis (Rhabdo) injury that occurred May 2, 2016 in South Dakota on the first day of the fire season after running for more than nine miles before doing uphill sprints, I started thinking about, not so much WHAT happened, but how to prevent similar serious injuries.
Both of these exercise-induced conditions can be life-threatening; 33 percent percent of patients diagnosed with Rhabdo develop a quick onset of kidney failure, and 8% of all cases are fatal.
When therapy is delayed, the mortality rate may be as high as 80%; however, with early diagnosis and immediate cooling, the mortality rate can be reduced to 10%.
These two very serious incidents in a two week period that occurred at the beginning of the fire season should be a wakeup call for agencies employing wildland firefighters.
I am not a medical or exercise specialist, but neither were any of the four members of the South Dakota Rhabdo FLA team. It was comprised of a District Fire Management Officer, a Natural Resources Specialist, an Assistant Superintendent on a Hotshot crew, and an Assistant Fire Engine Operator.
A person might expect that for an exercise-induced injury that is fatal in eight percent of the cases, a medical expert and an exercise physiologist would be members of the team. The FLA concentrated on recognizing symptoms of Rhabdo, which is good. Firefighters need to be be informed, again, about what to look for. But the necessity of treating the symptoms could be avoided if the condition was prevented in the first place.
Prevention was not addressed in the document, except to mention availability of water. Dehydration isn’t the leading cause of Rhabdo, which is caused by exertion, but it can be a contributing factor.
With two life-threatening medical conditions on firefighting crews in a two-week period that occurred during mandatory exercise on day one and two of training, medical and exercise professionals perhaps could have evaluated what caused the injuries, and suggested how to design and implement a physical fitness program that would lessen the chances of killing firefighters on their first or second day on the job. But the LEARNING opportunity of the FLA was squandered.
The wildland fire agencies are not alone in hiring people off the streets and throwing them into a very physically demanding job. The military does this every day, as do high school athletic programs. There is probably a large body of research that has determined how to turn a person into an athlete without putting their lives in danger.
While the three firefighters and the natural resources specialist I’m sure meant well and did the best they could to write the FLA within the limits of their training and experience, the firefighting agencies need to get serious about a professional level exercise training program. After all, they are employing TACTICAL ATHLETES.
This issue is serious enough that the NWCG (since there is no National Wildland Firefighting Agency) should hire an exercise physiologist who can design, implement, and monitor a program for turning people off the street into tactical firefighting athletes.
“Aggressive hydration strategies are over-preached and may provide a false sense of protection”, Dr. Brent Ruby said.
Above: Firefighter on the Shep Canyon fire in South Dakota, September 6, 2011. Photo: Bill Gabbert/Wildfire Today.
As we officially enter Summer this week in the northern hemisphere, it’s a good time to revisit an article we wrote in 2011 about heat-related injuries.
****
After reading our excerpt and later the full document from the the Serious Accident Investigation Factual Report for the hyperthermia fatality of Caleb Hamm on the CR 337 fire in Texas, we heard from Dr. Brent Ruby, who has completed studies on this exact issue, even having studied wildland firefighters while they were working on fires. In one of his studies he was monitoring a wildland firefighter outfitted with a core temperature monitor, an ambient temperature sensor, and a special Camelback hydration system that monitored his water intake. This firefighter experienced a heat-related illness, heat exhaustion, and had to be evacuated off the fireline by a helicopter. That was a terrible thing to happen to a firefighter, and I’m sure the researchers thought the same thing, but it was probably a once in a lifetime cornucopia of incredibly useful data. Dr. Ruby sent us this message, reprinted here with his permission:
I was bothered by the findings of the CR337 fatality report from the investigation team. There are issues within this case that are very similar to a published heat exhaustion case study we published recently (Wilderness and Environmental Medicine 22, 122-125, 2011, http://www.ncbi.nlm.nih.gov/pubmed/21664560). In this report, we document drinking behavior, activity patterns, skin and core temperatures in a subject that suffered heat exhaustion and required evacuation. The lessons learned from this research clearly indicate that the best protection against a heat injury is reducing work rate. [*the abstract from the study is below]
Aggressive hydration strategies are over-preached and may provide a false sense of protection. It should be emphasized that the autopsy report as described in the fatality report indicated no signs of dehydration or electrolyte imbalance. I have tried to push these concepts to crews and safety officers when I get a chance to speak to them at meetings. I was bothered by this fatality knowing that it is seemingly directly linked to some of our research findings. I have tried to emphasize this to anyone that will listen in the world of wildfire.
You can certainly review our website to gain a better understanding of the publications we have done from research with the WLFF http://www.umt.edu/wpem. We have a great deal of physiological data, hydration, energy demands of the job, importance of supplemental feedings, etc. from all our work over the years. This peer reviewed research provides objective, scientific evidence that can be used to to change or influence policy to enhance safety on the line.
Let me know if you have any questions.
Regards, Brent Ruby
Brent C. Ruby, Ph.D., FACSM
Director, Montana Center for Work Physiology and Exercise Metabolism, The University of Montana
High work output combined with high ambient temperatures caused heat exhaustion in a wildland firefighter despite high fluid intake.
Cuddy JS, Ruby BC.
Montana Center for Work Physiology and Exercise Metabolism, The University of Montana, Missoula, MT 59812-1825, USA.
The purpose of this case study is to examine the physiological/behavioral factors leading up to heat exhaustion in a male wildland firefighter during wildland fire suppression. The participant (24 years old, 173 cm, 70 kg, and 3 years firefighting experience) experienced heat exhaustion following 7 hours of high ambient temperatures and arduous work on the fire line during the month of August. At the time of the heat-related incident (HRI), core temperature was 40.1 °C (104.2 °F) and skin temperature was 34.4 °C (93.9 °F). His work output averaged 1067 counts·min(-1) (arbitrary units for measuring activity) for the 7 hours prior to the HRI, a very high rate of work over an extended time period during wildfire suppression.
In the 2.5 hours leading up to the heat incident, he was exposed to a mean ambient temperature of 44.6 °C (112.3 °F), with a maximum temperature of 59.7 °C (139.5 °F). He consumed an average of 840 mL·h(-1) in the 7 hours leading up to the incident and took an average of 24 ± 11 drinks·h(-1) (total of 170 drinks). The combined effects of a high work rate and high ambient temperatures resulted in an elevated core temperature and a higher volume and frequency of drinking than typically seen in this population, ultimately ending in heat exhaustion and removal from the fire line.
The data demonstrate that heat-related incidents can occur even with aggressive fluid intake during wildland fire suppression.
Unfortunately, even though Dr. Ruby’s research is funded by taxpayers through the National Institutes of Health, the National Science Foundation, and the Department of Defense, taxpayers are blocked from seeing the full results unless they pay a fee to the privately owned company that published the paper. We have written before about the results of taxpayer-funded wildfire-related research being held hostage by private companies. Dr. Ruby told Wildfire Today that he will send a copy of his paper to individuals that write to him at brent dot ruby at mso dot umt dot edu
The combined information about the fatality of Caleb Hamm on the CR 337 fire and Dr. Ruby’s study on wildland firefighters, is shocking. From the abstract, again:
The data demonstrate that heat-related incidents can occur even with aggressive fluid intake during wildland fire suppression.
Working on a wildfire on a hot day can lead to heat exhaustion and hyperthermia, and can be fatal EVEN IF a person drinks plenty of water and is not dehydrated.
Symptoms and prevention
We asked Dr. Ruby for more information:
Exertional hyperthermia occurs when the metabolic heat production from hard work overwhelms the bodies ability to off load it to the environment. This unloading can be blocked by clothing and/or slowed due to high radiant heat from the sun or an adjacent fire.
The basic symptoms of heat exhaustion are commonplace and can include profuse sweating, weakness, nausea, sometimes vomiting, lightheadedness, headache and sometimes mild muscle cramps.
The best approach [to prevent heat exhaustion and hyperthermia] is to know thyself and thy physical limits. Establishing a pace schedule that allows temperature to come back down in between periods of work that result in a rise in temperature. The factors of importance are pace, fitness level for the task at hand, hydration behaviors and simultaneously electrolyte concentrations in the blood.
It is important for wildland firefighters to drink plenty of water, but this will not, by itself, totally eliminate all chances of heat-related illness.
Be careful out there.
===============
UPDATE October 27, 2011:
Dr. Ruby sent us the following list of other publications on similar topics that are in peer reviewed journals. I assume that most of them are not available to the public (don’t get me started on that again!) unless you pay the ransom fees at the private companies, or send a message to Dr. Ruby: brent dot ruby at mso dot umt dot edu
====================
UPDATE October 28, 2011:
The U.S. National Library of Medicine has an excellent article about heatstroke, which can follow heat cramps and heat exhaustion and is life-threatening. The article includes causes, symptoms, first aid, what not to do, when to call 911, and prevention (including “avoid exercise or strenuous physical activity outside during hot or humid weather”. Good luck with that one, firefighters.)
After reading the Facilitated Learning Analysis (FLA) about the Rhabdomyolysis (Rhabdo) injury that occurred May 2 in South Dakota on the first day of the fire season after running for more than nine miles before doing uphill sprints, I started thinking about, not so much WHAT happened, but how to prevent similar serious injuries.
Both of these exercise-induced conditions can be life-threatening; 33 percent percent of patients diagnosed with Rhabdo develop a quick onset of kidney failure, and 8% of all cases are fatal.
When therapy is delayed, the mortality rate may be as high as 80%; however, with early diagnosis and immediate cooling, the mortality rate can be reduced to 10%.
These two very serious incidents in a two week period that occurred at the beginning of the fire season should be a wakeup call for agencies employing wildland firefighters.
I am not a medical or exercise specialist, but neither were any of the four members of the South Dakota Rhabdo FLA team. It was comprised of a District Fire Management Officer, a Natural Resources Specialist, an Assistant Superintendent on a Hotshot crew, and an Assistant Fire Engine Operator.
A person might expect that for an exercise-induced injury that is fatal in eight percent of the cases, a medical expert and an exercise physiologist would be members of the team. The FLA concentrated on recognizing symptoms of Rhabdo, which is good. Firefighters need to be be informed, again, about what to look for. But the necessity of treating the symptoms could be avoided if the condition was prevented in the first place.
Prevention was not addressed in the document, except to mention availability of water. Dehydration isn’t the leading cause of Rhabdo, which is caused by exertion, but it can be a contributing factor.
With two life-threatening medical conditions on firefighting crews in a two-week period that occurred during mandatory exercise on day one and two of training, medical and exercise professionals perhaps could have evaluated what caused the injuries, and suggested how to design and implement a physical fitness program that would lessen the chances of killing firefighters on their first or second day on the job. But the LEARNING opportunity of the FLA was squandered.
The wildland fire agencies are not alone in hiring people off the streets and throwing them into a very physically demanding job. The military does this every day, as do high school athletic programs. There is probably a large body of research that has determined how to turn a person into an athlete without putting their lives in danger.
While the three firefighters and the natural resources specialist I’m sure meant well and did the best they could to write the FLA within the limits of their training and experience, the firefighting agencies need to get serious about a professional level exercise training program. After all, they are employing TACTICAL ATHLETES.
This issue is serious enough that the NWCG (since there is no National Wildland Firefighting Agency) should hire an exercise physiologist who can design, implement, and monitor a program for turning people off the street into tactical firefighting athletes.
