Are Some IMTs Making Emergencies Harder to Manage?

By Jayson Coil, Battalion Chief Special Operations and Wildland Fire, Sedona Fire District, Arizona

I have a rule about not setting things on the top of my toolbox when loading-up for an assignment. This rule was developed after a new coffee cup and a BK radio slid off the toolbox and into traffic as I was leaving. So, I conducted my own little AAR as I filled out the damaged equipment report and realized that even though I intended to put them both in the front seat, there were distractions that prevented me from doing so.

On incidents, standardizing helps avoid bad outcomes by creating a shared understanding and expectations. When I think about how we make decisions and apply our training and experience to avoid costly errors, this standardization makes sense.


Do you remember what direction Wagner Dodge gave the rest of the jumpers when he realized the fire was below them?


When faced with a high stress, serious consequence situation, we do not engage in a strict comparison of options. In fact, we typically have incomplete information that requires us to continually reassess and validate the decision as the situation becomes clearer. So, we fall back onto our training and utilize recognition primed decision making (RPDM). And if the slide in our head—even if it’s a slide we developed in training—lines up with the reality we are facing, we make higher-quality decisions.

Do you remember what direction Wagner Dodge gave the rest of the jumpers when he realized the fire was below them? He told them to drop everything heavy. This was not anything they had practiced. Different crew members interpreted the order to mean different things. Because of this and other tragic events, we now incorporate “dropping your tools” into shelter training and conduct exercises on static and dynamic deployment. So at least in that example, we have demonstrated that we recognized developing a standardized approach to a critical task and practicing to proficiency makes sense.

Developing Good Checklists

There’s another reason why I think we should ensure that all IMTs follow a standardized approach. It has a lot to do with airplanes. When United Airlines Flight 173 ran out of fuel over Portland, Oregon and ten people were killed, the National Transportation Safety Board (NTSB) listed the probable cause as: “The failure of the captain to monitor properly the aircraft’s fuel state and to properly respond to the low fuel state and the crewmember’s advisories regarding fuel state. This resulted in fuel exhaustion to all engines. His inattention resulted from preoccupation with a landing gear malfunction and preparations for a possible landing emergency.”

From this event and the subsequent work to reduce human error, crew resource management (CRM) was developed. In fact, CRM was one of the first books included in the wildland fire leadership development program. In CRM they recognize that checklists, such at the medical incident report, are effective ways to develop reliability and consistency. A good checklist establishes common ground, provides for standardization, serves as a cognitive aid, and reduces error.


We did our AARs and serious accident investigations and we took steps to standardize and improve. But, not every IMT has adopted the new standards. I don’t understand why.


So, I have explained why I believe we should train the way we perform in the real world and how the lessons learned in CRM can be applied to real life. If you think about my poor coffee cup and radio, a checklist that ensures nothing is on my truck before I pull out is a good thing. It would be even better to establish a standardized practice of never putting anything onto my toolbox. Also, I bet most of you know someone who has been hunting and leaned a gun against their vehicle only to drive off. That is a little off topic, but another practice to avoid. Trust me.

I Don’t Understand Why

A more serious example is the process improvements we have made for managing medical emergencies on fires. After Dutch Creek, we developed new protocol and the 9 Line. In 2014 we got a new med plan, the ICS-206WF, which included the medical incident report (MIR). We even added the MIR to the IRPG so everyone would have the same script to follow when reporting an emergency.

We did our AARs and serious accident investigations and we took steps to standardize and improve. But, not every IMT has adopted the new standards. I don’t understand why. Some IMTs still use the old ICS206 and some change the reporting requirements so they do not align with the MIR and the IRPG. Is their behavior aligning with the teaching of good CRM or what we should have learned from Dutch Creek? I don’t think so.

When there is high stress, new priorities, incomplete information and difficult environmental conditions, we are not going to take the time and consciously align our behavior with the model that a particular IMT has chosen to adopt. Sorry, but that is not how people behave.

Those people in the field who are managing the emergency will use their intuition, experience and training. If an effective and coordinated response that provides the greatest possibility for a positive outcome is the goal, we all need to align. To put it another way, if one of our top priorities is to increase the likelihood that an emergent event that threatens the life of a firefighter is handled as effectively as possible, then we need to follow the standard on every incident.


If an effective and coordinated response that provides the greatest possibility for a positive outcome is the goal, we all need to align.


The people we place in high-risk environments should know the training they have engaged in to effectively manage an emergency will apply. Sure, it’s more difficult for the MEDL to get all the information and it also takes up a few more pages in the IAP, but I fail to realize how either one of those issues trumps consistency and clear expectations for the crews in the field.

The way I see it, we have lots of things we can change, including: briefing times, the order of briefing, how far the toilets are from the sleeping area, if we are going to let crews spike out, collar brass, no collar brass. The list goes on and on. With all that ability to change stuff, let us all agree to leave the ICS206 WF and MIR standardized. Deal?

15 thoughts on “Are Some IMTs Making Emergencies Harder to Manage?

  1. Thanks Jayson! I love with standards as long as we box ourselves in by them. I think the 206WF is vastly superior to what we were using 15 years ago, but in the words of Frank Zappa, “without deviation from the norm, progress is not possible.” The evolution of the ICS215a is a case in point. keep up the good fight.

    Like

    • Tony, I agree that we should strive for continuous improvement and I also agree that the 206WF is much better. We should always look for the areas to make the system better and move towards improvement while being deliberate enough about our actions that this intent is realized.

      Liked by 1 person

  2. The ICS 206 has a different purpose than the MIR. The 206 is used to demonstrate what medical resources are available, how to contact that resource and the availablity of diffinitive care facilities. The MIR is designed for the complete and succinct communication from the field to the communications unit/MEDL on the medical status of an injured party (s).
    The documents complement each other.
    Dan from Parker. AH COML, NWCG COMT, NWCG MEDL/t and a member of a Colorado Type III IMT.

    Like

    • Daniel, I agree that the balance of the ICS-206WF serves a different purpose then the Medical Incident Report, which is a component of the ICS-206WF. I view the former as a pre-plan and a resource to aid in increasing the quality of decisions in a medical emergency and the later as a way to communicate essential information in a consistent manner. Thanks for pointing out how they compliment each other, I think that is an important point! Respectfully, Jayson Coil

      Liked by 1 person

  3. Great thoughts Jayson, it also indicates the importance of developing sound habits of implementing the “checklists” so that it becomes second nature and not reactionary to short sighted fight or flight nature.

    Like

  4. During the 2015 Fire siege in Nor Cal, our Forest ran into so many problems with each IMT having their own versions of the Med Plans/MIR forms, that after the season ended, we put into our Forest Emergency Response and Evacuation Plan (EMREG) that NO team on an Incident on our Forest would use anything but the approved NWCG MIR form. (formerly the 9-line). No team versions, no “Improved” types…Our main issue during fires that will burn all summer long is that every 14 days when an IMT timed out and a new team came to take over our fires, the Med Plan changed. The IMT’s did a poor job of transitioning the people on the fires to the new versions. What about spiked out Crews? Did they get the word it has changed? Remote Spike camps? Incoming resources ‘Loaned’ to the fire from another fire or Forest for the day? ..Sometimes, a Team left, another replaced them, then the first Team came back for another rotation. In those cases the plan went form one, to another, then back to the first one. It was impossible for the ground troops to follow. Helpfully, that winter, in Jan of 2016, the Teams here in R5 all decided to standardize to the MIR form version anyway, and hopefully they have by now Nationally. The idea is to get someone injured to fast medical care, not to make paperwork easier…

    Liked by 1 person

    • Michael, thank you very much for sharing your experiences. There certainly highlight another very valid perspective on how we can make things harder on the crews. If you wouldn’t mind sharing I would be very interested in the EMREG. My email is jcoil(at)sedonafire.org. Thank you!

      Like

  5. Thank you for this discussion! I’m always finding needs for this debate to continue. Each “good idea” that deviates from standardization needs thorough review. This issue has been the cornerstone of my 20+ year effort to facilitate implementation of ICS in law enforcement and other disciplines. I’m all for constant improvement, etc., but for all the great reasons stated above, there are times and occasions for no-compromise consistency (aka “predictability”). By the way, NEVER set the Portable Breath Test instrument on the roof of the patrol vehicle while helping the client sit in the back seat. Never.

    Like

    • Thanks Steve, I appreciate your statement “each good idea that deviates from standardization needs thorough review”. I also really appreciated your advice regarding the Portable Breath Test. I did get an email from another IMT Member backing up my the importance of not leaning a rifle against your truck when coming back from hunting. Makes me feel better knowing I am not alone!

      Like

  6. I think your right but I do have a problem with the 206-WF being fixed. It works if you only have 2 divisions. The way its set up you can’t add more or delete extra lines not needed ie remote camps. Wile all the info is good and needed it is not good to put extra sections that just add to confusion. An unlocked 206 WF would get more use.

    Like

  7. I too have been bullied in my nursing career. I recently was terminated during probation after an initial satisfactory evaluation because I didn't chart to the satisfaction of the assistant head nurse (one of the two bullies). Just before the termmintion my son sent me a book I highly recommend everyone read which talks about preventing and dealing with bullying in the workplace. I haven't finished it yet but have started using it in my new position with the Constant Critic. &#;2128–

    Like

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s