Norovirus on Elbow Pass fire: lessons learned

The Montana Department of Natural Resources has released a lessons learned report on an outbreak of Norovirus on the Elbow Pass fire in August. It appears that quick, decisive action by the incident management team reduced the spread of the disease before it infected a large number of firefighters.


Lessons Learned

Montana DNRC, Northern Region Safety & Occupational Health

December 2012

Summary of incident:

On the morning of August 4th, 2012, three food handlers who were working for a state kitchen on the Elbow Pass Fire became ill with gastrointestinal symptoms and were transported to a health clinic for treatment. The safety officer and Logistics Section Chief from the Elbow Pass fire camp immediately took precautions, including contacting the Lewis and Clark County Health Department to report a possible outbreak of food-borne illness. Officials from the health department were dispatched on August 5th to investigate the site, and found the kitchen had met cleaning standards and was in good working order. Samples from those sickened were sent to a lab, two of which ultimately tested positive for Norovirus G1. Norovirus is commonly known as stomach flu, and can spread rapidly through person-to-person contact and food contamination, especially in closed communities such as fire camps. The entire kitchen and all kitchen staff were demobilized from the incident on August 6th, and the kitchen was cleaned two more times. By August 7th, an additional four cases were reported for a total of seven individuals. There was no evidence that the virus was ever spread through the kitchen or food, as all cases were directly tied to person-to-person contact. No additional cases were reported after the 7th, and all individuals that were sickened recovered within 24 hours of showing signs of infection.

What was done well:

1. The rapid response of the Incident Command team: this included calling the County Health Department as soon as symptoms were detected and requesting additional medics to be assigned to the incident.

2. Food contact surfaces were disinfected early, and the kitchen overall was held to a high standard of cleanliness.

3. Ill food handlers were kept away from the food production area, transported to a clinic for assessment and treatment, and were not allowed to return to work until well after recovery.

4. The responsiveness of the Incident Management Team and the DNRC-CLO staff to establish timelines for treatment, quarantine of individuals (and separate toilet facilities), and cleaning of the kitchen.

5. Quickly after the outbreak, a back-up plan was established for switching to an alternative food source.

6. The fire camp implemented early on the National Wildfire Coordinating Group, “Infectious Diseases Guidelines for Wildland Fire Management Teams”.

Recommendations/Lessons Learned:

1. Strive to have toilets and “warm water” hand washing stations in place at the incident as soon as possible once crews start to assemble or arrive at the incident.

2. Eliminate or reduce “self-service” food handling. This includes salad and fruit bars, and communal coolers.

3. Encourage everyone in fire camps to practice good hygiene procedures, and educate Incident Management Teams in early detection of food borne illnesses and how to contain them.

4. Specifically train those working as kitchen staff in proper hygiene procedures as well as in early detection of food borne illnesses.

5. Kitchen units, whether state-owned or private contractors, should consider the purchase or lease of portable toilets that can be exclusively used by and travel with the kitchen unit.


Lessons learned from the Redrock-Trailer1 fire norovirus incident

Dozens of people became sick at the Redrock and Trailer 1 fires 25 miles north of Reno, Nevada around July 19. Tests on some of them revealed that they had been infected with the Norovirus. The Medical Unit Leaders, Chris Graves and Diana Ludwig (trainee) prepared a lessons learned document, which is now on our Documents page, titled “Redrock-Trailer fires: Norovirus Lessons Learned”.


Followup: norovirus infected some Red Rock firefighters

The Washoe District Health Department reported that many of the 24 people that became sick on the Red Rock and Trailer 1 fires northwest of Reno, Nevada last week tested positive for the norovirus. The exact numbers were not available, but not everyone with symptoms gave a sample.

Here is a portion of the Wikipedia entry for norovirus:

Norovirus (formerly and still sometimes referred to as the Norwalk virus) is an RNA virus of the Caliciviridae taxonomic family. This virus causes approximately 90% of epidemic non-bacterial outbreaks of gastroenteritis around the world, and may be responsible for 50% of all foodborne outbreaks of gastroenteritis in the US. Norovirus affects people of all ages. The viruses are transmitted by faecally contaminated food or water and by person-to-person contact.

After infection, immunity to norovirus is usually incomplete and temporary. There is an inherited predisposition to infection, and individuals with blood type O are more often infected, while blood types B and AB can confer partial protection against symptomatic infection.

Outbreaks of norovirus infection often occur in closed or semi-closed communities, such as long-term care facilities, overnight camps, hospitals, prisons, dormitories, and cruise ships where once the virus has been introduced, the infection spreads very rapidly by either person-to-person transmission or through contaminated food. Many norovirus outbreaks have been traced to food that was handled by one infected person.

Norovirus is rapidly inactivated by chlorine-based disinfectants, but because the virus particle does not have a lipid envelope, it is less susceptible to alcohols and detergents.