Maybe I led a sheltered life as a firefighter, or perhaps I just worked around people who made safety number one, but until today I had never heard of filling a bladder bag (backpack pump) with a mixture of gasoline and diesel fuel and using it to apply the burn mix onto brush or slash piles that were to be burned, or were presently burning. But apparently it is a common practice on some U.S. Forest Service districts, according to a recently released “Lessons Learned” document. Below is an excerpt; the entire document is HERE. After the reported near miss, those practices may change.
I was walking down the hall of the district office with one of the district staff when we stepped into a conversation some of the crew leaders and assistant crew leaders where having about a near miss on some pile burning operations the previously day. There had been a flashback of flame toward one of firefighters while using a Fedco five gallon with fuel mix (piss bag/ bladder bag) to fuel the ignition on one of the piles. Some of the group was thinking it was no was big deal, some were trying to defend the action of using the Fedco as a firing tool, some were not sure and others thought it was not the right tool for the job. One individual said “we used to use them in region “X” and on my old forest all time in pile burning no big deal you have to just be careful with the flashback”.
I decided to bring it forward to the group that this is something we need to talk about, some were a little reluctant but everybody joined in. I had someone inform the rest of the folks waiting to go out pile burning that we all needed to talk about this issue and that “the piles would wait”. Someone pointed out “have you ever seen a dry piss bag on a fire and did you think there was fuel on the outside of the bag”?
The employee who had the near miss said his fire shirt had fuel on it. We talked how the drip torch had a spark arrest in it, and you are creating a fine mist at the nozzle when you pump the bladder bag which is also creating flumes which comes back and creates the flash that becomes a very unsafe operation.
The subject came up how to carry 5 gallon of fuel mix up the hill as the gas cans weight down on the arm. We asked those that did not think this was the right device to use, why did they not say anything. They felt that they were not going to use it and the person who filled it up was the senior leader of the group.
“What if this had not been a near miss but more serious we should have spoken up or at least talked about it.” We discussed, both as a group and one-on-one, the actions, planning and proper tools to use. We all need to have more training and discussions of proper tools, safety, and minimizing risks.
From the FLA. Employee’s left leg after 5 surgeries
I will have to admit that when the National Wildfire Coordinating Group’s Risk Management Committee distributed some information earlier this year about rhabdomyolysis, which is frequently referred to as “rhabdo”, I didn’t pay much attention. But today when the Wildfire Lessons Learned Center announced that a Facilitated Learning Analysis (FLA) for a severe case of rhabdo was available, I read it carefully and am now converted. The injury in the FLA occurred September 21, 2011 while a firefighter was taking the Work Capacity Test, or “pack test”. I have seen the light and realize how serious this condition can be.
Left untreated, or if not treated early enough, rhabdo can lead to irreversible muscle damage, permanent disability, kidney failure possibly requiring lifelong dialysis, and even death. Up to 8% of cases of rhabdomyolysis are fatal according to a NIOSH report. And all of this can be the result of exercising hard or engaging in a strenuous fire assignment if other risk factors are also present.
Rhabdomyolysis is the breakdown of muscle fibers resulting in the release of muscle contents (myoglobin) into the bloodstream which are harmful to the kidneys and may lead to kidney failure.
The link between rhabdo and “compartment syndrome”, the condition that is emphasized in the FLA, is certain, but it is not clear to me, having much more fire training than medical training, if compartment syndrome leads to rhabdo or vice versa, and my research found conflicting information. But that is not really important, in that both conditions are similar in that they are caused by damaged muscle tissue. Compartment syndrome occurs when the damaged muscle is inside an enclosed compartment in a fibrous sheath with other muscles, as is found in the arms and legs. Rhabdo can occur with any muscles, but both can lead to the same outcome, including death.
I was disappointed that the recently released FLA did not state the cause of the injured employee’s compartment syndrome/rhabdo, nor did it provide much useful information about how to prevent a similar occurrence, other than to “prioritize staying physically fit”, and the “incorporation of healthy lifestyle choices and better nutrition”. So I attempted to gather some information here in one place that will hopefully be useful for wildland firefighters, to increase their chances of avoiding rhambdo, or diagnosing it if it occurs. Continue reading “Wildland firefighters: rhabdomyolysis or “rhabdo” can be extremely serious”
Above: Firefighter on the Shep Canyon fire in South Dakota, September 6, 2011. Photo: Bill Gabbert/Wildfire Today.
After reading our excerpt and later the full document from the the Serious Accident Investigation Factual Report for the hyperthermia fatality 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.
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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.)
Following the 2008 crash of the Sikorsky S-61N helicopter operated by Carson on the Iron Complex fire near Weaverville, California in which nine firefighters died, it became clear that the FAA and the U. S. Forest Service had inadequate oversight of the operation of aircraft used for wildland firefighting on federal lands. Here is an excerpt from an article we wrote December 8, 2010 after the NTSB presented their findings from the investigation:
Who regulates wildfire aviation?
The answer is: nobody. The FAA claims they have no authority to regulate the aviation activities of other federal agencies or state and local governments. This authority has to be granted by Congress, which has shown no interest in becoming involved in the aviation safety of firefighters. And the federal agencies, or at least the U.S. Forest Service as proven in this accident, generally do not have the aviation expertise to inspect and regulate their own agency-owned or contracted aircraft. Good luck in trying to not think about this the next time you’re climbing into a helicopter at a fire. (Let’s see – got hard hat, gloves, line gear, tool, life insurance.)
Today the NTSB announced that they will hold a public forum on the oversight of “public aircraft operations”, which includes aircraft used by the federal government on wildland fires. Maybe something good will come out of this, but all they can do is make recommendations, and the FAA sometimes ignores recommendations made by the NTSB. And good luck getting Congress to do anything about anything.
Here is the full text of the NTSB announcement:
====================================
“FOR IMMEDIATE RELEASE: September 30, 2011
NTSB ANNOUNCES PUBLIC AIRCRAFT FORUM
The National Transportation Safety Board will hold a two-day forum on safety issues related to the oversight of public aircraft operations on November 30 and December 1, 2011, in Washington, D.C.
The event, entitled “Public Aircraft Oversight Forum: Ensuring Safety for Critical Missions,” will be chaired by NTSB Chairman Deborah A.P. Hersman and all five Board members will participate.
Public aircraft are operated by a federal, state, or local government for the purpose of fulfilling governmental functions such as national defense, intelligence missions, firefighting, search and rescue, law enforcement, aeronautical research, or biological or resource management. Government organizations conducting public aircraft operations supervise their own flight and maintenance operations without oversight from the Federal Aviation Administration (FAA).
“Our accident investigations have demonstrated the risks of inadequate safety oversight and identified persistent confusion as to the role of the FAA when it comes to public use aircraft,” said Chairman Deborah A.P. Hersman. “During the forum, we will gather information on the roles and responsibilities of the entities engaged in public aircraft operations and hear about methods for ensuring effective safety oversight.”
Recent NTSB investigations of accidents involving public aircraft include:
the August 5, 2008, accident near Weaverville, California, involving a helicopter operated by the U.S. Forest Service on a firefighter transport mission
the September 27, 2008, accident in District Heights, Maryland, involving a helicopter operated by the Maryland State Police as a medical evacuation flight
Panelists participating in the forum will represent federal, state, and local government entities, aviation industry trade associations, and civil operators contracting with government entities. A detailed agenda and list of participants will be released closer to the date of the event.
The forum will be held in the NTSB Board Room and Conference Center, located at 429 L’Enfant Plaza, S.W., Washington, D.C. The public can view the forum in person or by webcast at www.ntsb.gov.”
The fatality on the Coal Canyon fire in South Dakota and two police officers being killed in Rapid City, all within the last few weeks, gave Kevin Woster, a columnist for the Rapid City Journal pause. He wrote an excellent piece about the dangers that firefighters and police officers face, and how it affects him. The Governor of South Dakota, Dennis Daugaaard, who spoke at firefighter Trampus Haskvitz’s funeral, released a column on August 19 that addresses the issue of the recent fatalities.
I have to admit that the death of Trampus Haskvitz on the fire about 15 miles from my house while I was riding my motorcycle in northern California affected me as well. I made it back home a few hours before the funeral service began, which occurred within walking distance from my house. The procession of over 130 fire department vehicles, mostly brush engines, passed within two blocks.
Mr. Woster’s column mentioned the phrase that was repeated in many episodes of Hill Street Blues by Sgt. Phil Esterhaus, played by Michael Conrad, at the end of his shift briefings as his cops left the meeting to begin their shift. We first posted this 11-second video August 6, 2009, but it bears repeating.
If you don’t remember Hill Street Blues, it was a television series, an excellent police drama, that ran for 146 episodes in prime time between 1981 and 1987. The show received a total of 98 Emmy nominations during its run and won four Emmy awards for Outstanding Drama Series.
The high-ranking U.S. Forest Service official who used his Blackberry five times during Trampus’ funeral may not have felt the impact of the fatality that some of us did, but at least he gets points for showing up.
The short-haul extraction of a firefighter that was hit by a rolling rock “the size of a Volkswagen Beetle” on the Las Conchas fire in New Mexico, July 2, 2011.
The extraction of a firefighter who was injured by a falling tree on the Hastings Fire near Fairbanks, Alaska, June 16, 2011.
The 24-hour report on the crew carrier that overturned in southern California on July 4, 2011, injuring nine firefighters. (Wildfire Today originally covered this on July 5.)
An Interagency Aviation Accident Prevention Bulletin. An excerpt: “There have been multiple airspace related events with conditions that could lead to a mid-air collision. Analysis of past and recent near mid-air collisions revealed that communications, deviation from standard operating procedures, and situational awareness were common contributing factors.”
Firefighters on the Las Conchas fire short-haul an accident victim, July 2, 2011.
Maybe I led a sheltered life as a firefighter, or perhaps I just worked around people who made safety number one, but until today I had never heard of filling a bladder bag (backpack pump) with a mixture of gasoline and diesel fuel and using it to apply the burn mix onto brush or slash piles that were to be burned, or were presently burning. But apparently it is a common practice on some U.S. Forest Service districts, according to a recently released “Lessons Learned” document. Below is an excerpt; the entire document is HERE. After the reported near miss, those practices may change.
The employee who had the near miss said his fire shirt had fuel on it. We talked how the drip torch had a spark arrest in it, and you are creating a fine mist at the nozzle when you pump the bladder bag which is also creating flumes which comes back and creates the flash that becomes a very unsafe operation.
