Who Uses Lessons?

By Travis Dotson

If you haven’t seen it yet, please look at the 2018 Incident Review Summary.

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We compile this 10-page report every year. It’s kind of a big deal to us here at the Lessons Learned Center because, well, it’s the lessons (pretty much what we do). It for damn sure is not ALL the lessons from the past year. But it’s the topics we chose to highlight based on reviewing incident reports all year (year after year).

We get it wrong sometimes. That happens when you try to simplify complex things.

But, so what, imperfect tools are still useful (ever used a McLeod?).

Please answer the four questions below:


Thank You!

Please use the lessons.  We care about all of you.

Drawing the Line of Duty

This is from the 2018 Incident Review Summary.


By Travis Dotson

We recorded the work-related death of 19 wildland firefighters in 2018.

lineDuty

But not everyone is on the same page about which ones should be considered a “Line of Duty Death.” Everyone agrees that if you are overrun by fire or get hit by a tree on the fireline—that is death in the line of duty. But what if a fire crew member doing project work begins convulsing, goes unconscious, and is pronounced dead at the hospital? What if a fire crew member gets home from a fire assignment and dies the next day due to complications from pneumonia? Tough questions. But for us here at the Lessons Learned Center we list them all because we are concerned with LESSONS—not numbers. Each of these tragic instances provides an opportunity for collective and individual solemn introspection.

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Exercise

In small groups discuss these topics:

  • What does the term “Line of Duty Death” mean to you?
  • What are the lessons from a non-typical firefighter death?
  • Should we honor people differently based on how they died?

Random?

Here is more from our forthcoming 2018 Incident Review Summary.

By Travis Dotson


Strange things do happen out there on fire assignments. Some of them are certainly outlier occurrences, some of them are not. Either way, these instances often provide an opportunity to re-frame and think about hazards we may not have recognized.

randomrandomrandom

Check these events out – then do the exercise at the end.


Shooting

“The incident personnel watched with binoculars as one of the two individuals put a scoped rifle on a bi-pod and looked up the mountain toward them.”

Miriam Fire Shooting Incident


 

SepticTank

North Spring Fire Septic Tank Incident


 

BlastCaps

Blasting Caps Discovered During Mop-Up


CansExplode3

Owyhee Fire Can Explosion

Davis Fire Can Explosion


Exercise (30 minutes)

Study these incidents.

Individually think about a time you were surprised on a fire.

Tell each other your “surprise stories.”

Discuss this question:

If we blame all surprises on “poor SA” –

what lessons are we missing out on?

How We Roll

Here is more from our forthcoming 2018 Incident Review Summary.

By Travis Dotson


In 2018 we collected 17 reported Rollover Incidents. Mostly Water Tenders and Dozers (5 each). The others were chase vehicles, an Engine, a UTV and an ATV.

Almost all of the rollovers involved slipping off the road shoulder.

We move big heavy things around on dirt roads under difficult conditions while stressed and tired.

We sometimes slip off the road.

Rolls

Got a Dozer or a Water Tender in your Task Force?

Heads up.

5n5


Here are a few clips from reports:

“…he began to feel the back of the Tender pulling him sideways as the Tender began to slide off the road.” Cougar Creek Fire Water Tender Accident

“…dozer slipped off the edge of a logging road and tumbled down end-over-end…” Sugar Pine Fire Dozer Rollover

“…passenger side front wheel traveled off the edge of the road, and the engine departed the roadway, and rolled.” Fawn Fire Engine Rollover

“There were three slip locations, spread over several hundred feet, where Dozer 1 left the trail prior to the rollover.” Ferguson Dozer Fatality

“…it left the road on the downhill side and rolled over.” Miles Fire Water Tender Rollover

“…he became distracted and the truck drove straight off the road.” Ferguson Fire Water Tender Rollover


This is from the 2016 Incident Review Summary:

2016_Rolls


 

Exercise (30 minutes)

Study the quotes above.

Individually write down your answer to this question:

What are all the reasons you can think of why we might “slip off the road”?

Compare your list with others.

Discuss ways to prepare for and prevent rollovers.