One Ash Pit Ate Two Firefighters

This blog post was compiled using several excerpts from two separate documents on the Laguna Fire Burn Injuries.


At approximately 1010 a crew member from the Type 2 crew fell into an ash pit, after ground gave way on a mechanically constructed berm the crewmember was mopping up with a branch line. The crewmember advanced a hose line up the berm and upon reaching the top the employee stepped toward the downhill side facing the Colorado River and berm gave way.

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The berm that gave way.

The employee went down to approximately the knee level in a void space created by burning material being consumed under the crust of the berm. The employee fell forward towards the downhill side adjacent the Colorado River. The employee had forward inertia and momentum which continued him downhill with a section of ash and dirt. The section was approximately 38 inches wide and 18 inches long. The employee extended their hands and arms to provide protection while falling forward. The employee sunk into the hot ash pit up to approximately the armpit and shoulder, additional hot rolling material followed the employee downslope encompassing lower extremities and upper torso.

As the employee was falling an adjacent crewmember heard the employee’s screaming. The witness employee was approximately 6 feet to the south on the same berm. The witness employee observed the employee who fell sinking up to the armpits and shoulders and then rolling forward. The employee also recounted seeing the employee who fell struggling to get out of the ash pit, and then once self-extricated beginning to walk/run around trying to get hot material off the employee’s body and personal protective equipment.

At approximately 1012 a witness employee began yelling for assistance and a radio to notify the crew overhead of an injury/incident. The witness employee generated a radio call as well as a physical call for additional assistance. At approximately 1013 several members of the crew including the crew boss, the foreman, and the squad bosses started toward the scene.

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Overview of fire area and injury location.

At approximately 1024 Fish and Wildlife Engine 2162 with two emergency medical technicians arrived on scene to continue patient care. The emergency medical technicians continued to expose and evaluate the nature of the injuries. At approximately 1027 an update on the employee’s medical condition was given via radio to the incident commander.

The incident commander notified Arizona dispatch, requesting an ambulance to transport the employee and start the notification process to the fire staff. The crewmember was ambulatory and communicating. The decision was made to walk the injured employee to a waiting crew agency vehicle to be driven and rendezvous with the ambulance at the ICP.


It continues…


At approximately 1045 the DFFM Safety Officer called the IC to receive an update on the incident within an incident. The Safety Officer requested the area of the incident within the incident be flagged off to preserve the scene for the investigation process.

At approximately 1100 a crew member from the DFFM Type II crew began flagging off the area of the incident within an incident. The employee was approximately 7’ to the south of the location on the berm, the employee utilized hose line to cool the area and a tool to probe the area as the employee moved forward. The employee stepped through the berm into an ash pit. The employee had forward downhill momentum and “tucked and rolled” down the berm through the ash pit.

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Second employee’s hard hat with burn damage.

The injured employee completed the flagging of the area. At approximately 1120 the injured employee notified the IC of the incident. The injured employee was evaluated by the emergency medical technicians on Fish and Wildlife Engine 2162. The employee suffered first-degree burns to the right ear, right upper arm (triceps area), left arm lower arm, right thigh, right and left shin, and right calf. The injured employee was wearing full PPE at the time of the incident.

The employee opted not to be transported to the hospital at that time because he was the ranking crew member present. The other crew overhead accompanied the previously injured employee to the emergency department. At approximately 1230 a supervisory crew member arrived back to the incident from the hospital. The injured employee was directed to go to the hospital and was driven in a crew vehicle to the hospital. The employee was evaluated, treated, and released by the emergency room with first-degree and possibly a few second-degree burns to travel home with the crew.


 

Do YOU think of mop-up as “dangerous”?

Does it matter if you do or don’t?

(Tell us in the comments)

Read both incident reports here: Laguna Fire Burn Injuries

Sorting the Lumps

As our work on the 2017 Annual Incident Review Summary continues, we’ve got some more analysis to share with you.  Read this.  Do the Exercise and give us some feedback.  The final version of the 2017 Annual Incident Review Summary will be out soon!


By Travis Dotson

Graph showing 2017 wildland fire incidents

There it is – the 2017 season boiled down to a few lines and numbers. These are all of the “outcomes” from reports submitted to the Wildland Fire Lessons Learned Center. (You can see incidents sorted by “Activity” in last week’s post: “Smokeless Danger“) I made up the categories and sorted them all. For this particular boring graph I tried to simplify everything as much as I could, lumping categories so I had fewer categories (like combining Hit by Tree, Hit by Straw, and Hit by Vehicle).

I’m a lumper…you may be a splitter. I’m ok and your ok (so I’ve heard), but I’ll go into a bit of detail for all you splitters out there. Let’s just go right down the list starting from the “top.”

Exertion – This was almost exclusively made up of Rhabdo and Heat Illness reports (28 out of 31) mostly because there is a specific reporting mechanism (Rhabdo/HRI) for those types of reports. This does not change the fact that the incidents did indeed occur, I just think it’s fair to acknowledge the reporting does seem to follow what we focus on. Nonetheless, HRI and Rhabdo will put you or your crewmembers in the hospital. Plan for it.

Fuel Geyser – Another specific reporting form (Fuel Geyser) helped us get more data on the danger of fuel in your face. So while it’s still happening, it’s fantastic to note that we are seeing significantly fewer injuries associated with the geysers. Is this the result of awareness and education actually working? We would like to think so. Either way, keep pointing that cap away from your vitals when you go to open the tank. Better yet – cover it with a rag, because the geyser remains a distinct possibility.

Entrapment – Big year for entrapments. Heavy equipment got caught the most. They get stumped and they move slow. Fire does not get stumped and it can go from slow to fast very fast. Firing Ops is the other time we often get entrapped – playing with fire is just that. One interesting note, in 2018, of the 20 reports that met the NWCG definition for “Entrapment”, only four chose to describe the event as an entrapment. Why do we avoid that term? (Get busy in the comments y’all.)

Vehicle Accident – Pretty standard. Driving is double-digit danger. We had a few rollovers and a chase truck vs power pole. But what stood out this year was the wheels coming off, or almost coming off. Three different instances of loose lug nuts. Go check your wheels right now (and get serious with those morning PM checks!)

Hit by Stuff – Mostly trees and branches from trees, but also straw from a helicopter. Most of the hit by tree instances involved chainsaw ops, but not always. Those trees will fall on you or throw their big branches at you randomly sometimes. Don’t hang out under them if you don’t need to.

Equipment Damage – Now there’s a broad category. This is usually vehicles being burned. This year there were three of those fire-damaged vehicles plus a couple big rigs (dozer transport and a skidgine) that rolled into trees – super close calls in both instances. Also, one engine’s light bar fell off on the way back to the barn. Check your brakes and the screws on your light bar.

Burn Injury – This bucket always shows up, but this year it wasn’t as full as in previous years. We had multiple instances of folks falling into hot ash, as we do every year. A fire-whirl rolled over an engine on a prescribed fire, someone grabbed a pump exhaust pipe in the dark, and one of those many fuel geyser’s did end up with a fuel ignition/burn injury. There was also one instance of a blown hose spewing hot water resulting in serious burns. In terms of burn injury lessons, this is the one you should read: Temple Fire Burn Injury

Medical Emergency – Super broad category, but it loses its umph when you take out the “exertion” events. What’s left is exactly what you would suspect – cardiac events, seizures, and other unpredictable, high stakes scariness. It might even happen while you are in travel status. Get ready.

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Uno Peak Boulder Near Miss

Close Call – I didn’t have enough room to call this the “No s#!t there I was” category – but that’s what it is. When you end up cartwheeling over a dozer blade. When you’re driving down the road and your brakes fail. When a boulder rolls between two trucks. That kind of stuff.  Random exists whether we want it to or not.

Chainsaw Cut – This is a super sneaky category. There were only three chainsaw cuts this year, but the significance cannot be overstated. Someone died from a chainsaw cut.

All the cuts were to swampers. And it’s going to happen again. Go slow. Be careful. Respect the spinning chain.

Other – There is always “Other.” This year it was a fall off a ladder during structure prep, hazmat exposure during mop up, and a PT session turned search and rescue. Don’t hate…you could be next.

Ok, there’s all the dirty details you pesky splitters. Please do something with all of this information, at least do this exercise:


Do the exercise.

Exercise!

  • Get with two other firefighters and write down which category above means the most to you.
  • Talk with each other about why the category matters to you.
  • Take turns describing what kind of incident you are most likely to experience based on the numbers and your brand of exposure.
  • Write down three ways to prepare for your bad day.

 


 

“I Noticed My Skin Falling Off”

By Travis Dotson

This quote: “I had been hit by IED in Afghanistan. I’d rather go through that than be burned again.”

Damn – for real? That says a lot. That scares me.

This quote: “When the hose burst it got me in the groin. I spun around. I ran to the shade. I was not sure if that was the water pressure stinging me or what. Then I ripped my shirt off and I was all red. I ran to the engine and ripped off boots and pants. That’s when I noticed my skin falling off.”

Damn! That scares me even more. I do not want that to happen to me or anyone I know. I don’t want that to happen to anyone period.

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Image from the report cover

Where are these quotes from? You guessed it – an accident report. It’s called the Crescent Fire Scald Injury. It’s 19 pages long. You should read it – if you want to be scared out of your wits. Or if you want to learn something that could keep your skin from falling off.

Do you run a pump? Do you know someone who does? If you are reading this, chances are the answer to one of those questions is yes. You now have a decision to make.

There are some real hose head nuggets in this report. Real technical nuts and bolts stuff that you can take action on. Check this out:

Finding: An obstruction in the pump bypass line on the Region 5 Type 3 Model 62 fire engine did not allow for adequate water flow through the line during the pumping operations. This condition led to the excessive heating of water sufficient to sustain burns.

Required Action: 1. Check the #17 pump bypass valve for obstruction. Inspect water flow through the pump bypass line by engaging the pump, opening the tank to pump valve (#1), closing the pump to tank valve (#2), opening the pump bypass valve (#17), and closing all other valves. Run the pump up to 400 psi and visually check the water flow at the line’s return point at the top of the tank. The return point should be located near the tank tower on top of the engine. Water flow at the return point should be a fairly strong stream of approximately 6 gpm.

There is more.

You should go see what else you need to do.

You can get the full report here: Crescent Fire Scald Injury

Please help keep you and your fellow firefighter’s skin on.

Physical Training and Death

By Travis Dotson

This is a nightmare.

Your Engine Crew heads out on a normal PT hike which turns into a medical incident. That medical incident has all the common elements of an emergency situation, including communication struggles and delays. That medical incident ends with the death of your fellow crewmember.

This is a nightmare, but it’s not – it’s real.

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The team who put this report together opens the report with these words:


Dear Reader,

While Bill Jaros always had a smile on his face, Bill’s coworkers and friends believed that it was important to inform the FLA Team that this crewmember was also going through significant personal challenges in his life. Due to these taxing circumstances in his personal life, Bill was experiencing a considerable amount of family and personal stress.

Once the FLA Team had interviewed Bill’s coworkers and learned about the difficulties that Bill was experiencing in his personal life, after much discussion, the FLA Team realized that this FLA needed to share and address—in a thoughtful and respectful manner—Bill’s psychological health. (Whether or not this contributed to his eventual medical incident during the PT hike that day is unknown.)

Bill’s family was briefed on this decision and they provided their support, as did Bill’s coworkers, for this FLA’s mental health focus.

That is why this FLA’s “Key Discussion Points” section concentrates on “Stress and Stress Management.” As is pointed out in this part of the FLA, it is critical for all wildland firefighters to be aware of the need to manage stress, both personal and professional. A series of discussion questions are provided here to help encourage discussion on this essential front. They include: “How are you managing your stress level?” and “Are you checking in with crewmembers who appear stressed?”

In addition, at this FLA’s conclusion we present a special section “Resources to Help Firefighters” that provides contact information on a variety of resources that are available to help provide mental health support to firefighters.

This FLA is respectfully dedicated to the memory of William “Bill” Jaros.

The Six Rivers PT Hike Fatality FLA Team


 

Please read this short report:

Six Rivers Physical Training Fatality

Please do one thing to better prepare for the nightmare, because it’s real.

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Minor Rhabdo Fatal Burns

By Travis Dotson

Look at this word cloud:

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I collect very simple notes about the types of injuries listed in the reports submitted to the Wildland Fire Lessons Learned Center. I took all of the notes from 2017 and used a word cloud generator to make this one. The size of the word is relative to how often it shows up compared to others.

What does it mean?

It means whatever you want it to mean. Just like every one of the reports these words came from, to most of us they end up meaning nothing. Yes, they might evoke some sort of emotion when we first see them. Most of us will quickly move away from that emotion into some sort of analytical sense-making  basically making up reasons for the presence and size of the words.

We don’t know why Rhabdo is so common.

We don’t know why firefighter fatality numbers refuse to change.

We don’t know when one of those words will apply to us.

That is unsettling. But it is.

And off we go to Division Delta.

Please leave a one-word comment regarding the utility of this word cloud thingy. You get a choice between these two words: Useless or Useful.

Your call if you want to say why.

Like a Phoenix — The Evolving Nomad

More on the recent Two More Chains – please follow the link below to read this piece by Bre Orcasitas.

Dear Evolving Nomad Readers, Recently I was asked to be a guest author for the Wildland Fire Lessons Learned Center’s Two More Chains article, Fall Issue. For those who are not Wildland Firefighters, the Two More Chains articles issued by the LLC offer a strong voice for the fire community. They consistently touch on subject matter […]

via Like a Phoenix — The Evolving Nomad

We Made it Out, But it Was Very, Very Close – Reflections From The Nuttall Fire.

Everyone was moving in slow motion. On our intercrew I could hear our Lookout giving us updates calmly but forcefully: It was time to be gone.

 

By Matt Holmstrom

Current – Superintendent Lewis & Clark IHC

Nuttall Fire – Squad Leader Lassen IHC

There are so many impressions and recollections that I have from that day, July 2, 2004. Some of them are lessons I tried to learn and pass on to my guys, some that, even now, I’m not sure that I have fully processed. I do know it was very, very close.

And I do know that this is in contrast to the official record.

I was a young Squad Leader that day. One Foreman was detailed away and the other was in a large-scale lookout. So it was the Superintendent, another Squad Leader, and myself running the crew.

I remember that during the previous shifts we had been burning across these ridges and for at least one night shift. The slop-over on the Division that day wasn’t too large and certainly wasn’t very active. I thought it would be a good transition day from nights to days.

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We were cutting direct line and making good progress with the other crews. On our initial scout that morning we had identified the same “safety zone” that everyone else did. This would become the safety zone that the Flagstaff IHC ended up deploying in.

The fact that 80+ people all thought that a SZ that 20 people later deployed in looked good should give a good indication of our mindset. The Augusta IHC ended up in a nearby aspen grove with our Superintendent. Lassen and Plumas IHCs ran uphill back to the road system.

One of the Most Terrifying Moments in My Life

On that run, at the start, I was impatient to get going. I was trail, making sure that everyone had been accounted for and was together moving up the line.

Plumas was ahead of us and it seemed to take forever for the hike to start. Everyone was moving in slow motion. On our intercrew I could hear our Lookout giving us updates calmly but forcefully: It was time to be gone.

As we started up slope, the gaps started almost immediately. The Squad Leader leading our crew out was very tall and was striding it out, gapping the slower guys at the back. I was annoyed and was trying to close up those gaps. That’s when I had one of the most terrifying moments in my life.

I looked back below us to gauge the distance between us and the fire—fire that we could now hear. What I saw made me almost physically ill: one lone blue hardhat at the bottom of our line, looking around, obviously confused.

At first, I thought that I had miscounted. That I had missed one of my guys. I immediately started another head count. I was turning around to go back and shouting down at them to hurry when the two overhead from Plumas thundered past me downhill on the run.

Because both crews wore the same color hats, I couldn’t tell that this person was a Plumas firefighter, and not one of mine.

Of course, we all made it out that day, but that was a powerful reflection in leadership that I have always carried with me.  Those two guys ran down at fire coming uphill at them to help a slower teammate who somehow just got separated in the retreat. I got to see leadership and bravery exemplified, and tempered with humility.

Mike Sherman and Pete Duncan, my hat is off to you both for your courage and leadership. Again, none of this is in any official records, mostly because those guys are humble. They’ll probably be mad at me for mentioning them here.

I was in Disbelief—I Felt Tricked or Somehow Betrayed

Our Lookout, my Captain, later asked me why we didn’t leave when he first told us about the activity below us. He had eyes on the entire Division, gave us plenty of advance warning, and we could’ve left far earlier.

I couldn’t answer then and I would struggle to answer now.

I reflect back to the confidence that I felt that morning. The idea that this would be a good shift to transition over from the night burns we’d been doing and into the day shift. I remember being extremely convinced that The Plan was solid. After all, it was developed by guys who had been fighting fire longer than I’d been alive. If they weren’t concerned, why should I be?

I remember even once we were pulling out, I was in disbelief. I felt tricked or somehow betrayed. The fire had not done what it was supposed to, what we had planned for it.

I had completely forgotten that there is a home team, and we were not it. Looking back, I would say that we got head-faked by our earlier work. We were victims of our own making – through several successful shifts and the corresponding over confidence.

So, what did I take away from the Nuttall Fire?

  • Every day is a new day. Don’t be overconfident.
  • All transitions are tough and may be dangerous.
  • Listen to your Lookouts, you put them there for a reason.

Always remember that the fire gets a vote on your plan—Mother Nature always bats last.

 

 

Burn Injuries – Wrong Hurts

By Alex Viktora

Wildland Firefighters receive burn injuries every season. Often times some sort of flammable liquid ignites resulting in a burn, like the rather common drip torch leg burn scenario mentioned in this NWCG memo. Other times we fall in stump holes and ash pits—sometimes up to our waist!

And then there is the plain old flame front scorching our elbows through Nomex or the super bad deal entrapment situations. Bottom line, it happens. So we need to know how best to follow through on medical treatment for these instances—because you can do it wrong, and wrong hurts!

Read these reports using the links below:

Rim Fire Burn Injury    Farm Fire Burn Injury    Mystery Fire Burn Injury

Information Collected from Multiple Burn Injury Incidents—Here are Some of the Most Important Reminders, Lessons and Tips

 First of all, if you or someone with you, gets burned, report the injury! Even if you think it’s a minor burn, even if you think you screwed-up somehow—let someone know about the burn. Chances are it’s worse than it seems and time untreated can be a bad deal all around—from paperwork to infections. It’s just better to let someone know and get the ball rolling toward proper treatment.

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Go to the place that can help – It’s called Definitive Medical Care (Emergency Room, Clinic, etc.)

  • Burn injuries are often difficult to evaluate and may take 72 hours to fully manifest.
  • Burns are different. Not all doctors have experience with the types of burns that firefighters suffer. Burns require specialized experience to treat appropriately. This often means that the injured party will need to seek care at a Burn Center.
  • Burns must be kept clean. Therefore, the fireline isn’t a good place to try to manage a burn injury. If you’re treated and released, don’t go back to the line. Don’t go up on a lookout. Focus on taking care of your burn injury.

Nobody wants to hang out at the hospital, but make sure to run through this list before you are discharged:

  • Make sure your Agency Administrator is notified, especially if you’ll require follow-up treatment and referral to a Burn Center.
  • Agency Administrators should be involved if there is hesitation to refer to a Burn Center.
  • Referrals to Burn Centers are critical and must be in the patient’s hands before leaving the Emergency Room, clinic, or doctor’s office.
  • When there is any doubt as to the severity of the burn injury, the recommended action should be to facilitate the immediate referral and transport of the firefighter to the nearest Burn Center.
  • Physicians Assistants (PA) CANNOT write referrals for Burn Centers (or any other increased level of care). If a PA prescribes any follow-up, including Burn Center visits, it must be countersigned by a Doctor (MD).

Copy? Here’s the deal: Get your higher-ups involved. Have a discussion with your higher-ups about a Burn Center referral.

Burn Center Tips

  • Burn Centers have both in and outpatient services. If you think you might need to go to a Burn Center, ask to be referred—even if you won’t need inpatient treatment (hospital stay).
  • Burn Centers may prefer to consult via telemedicine (such as e-mailing photos or videos of the injury, video-calls, etc.), rather than transporting a patient to their facility.
  • Ask about the option to have a Nurse Case Manager assigned to the case.

OWCP Claimant tips

  • Your OWCP claim number is critical. Once you get this claim number, put it in a place you’ll be able to access when you’re on the phone with doctors, visiting the hospital, filling prescriptions, etc.
  • YOU—the patient and claimant—are ultimately responsible for your OWCP case. Get involved. Pay attention. Ask questions. If you’re not getting the answers you need, keep asking.

Call the Wildland Firefighter Foundation (208) 336-2996. They have experience dealing with folks who have received burn injuries in the line of duty.

Watch this video:

Socks Matter

By Alex Viktora

I used to work for the National Park Service. One of the sweetest things about working for the NPS was the official socks.

That’s right. Socks.

As a member of a wildland fire crew, I rarely had much need to be in official NPS uniform, so my annual uniform allowance was spent on socks. Brown wool socks. If you wear them with shorts, you look like…well…German?

I bought so many of these things, I still have a cache of unopened wool socks in my closet.

As most firefighters can attest, keeping your feet in good shape is super important. The NPS uniform socks—most of which are a milk chocolate-colored wool blend—were awesome socks on the fire line.

I’ve always known this.

But what I just now learned is this: These sock could save me from a serious burn. Come to think of it, they probably already have.

My Leg Had Fire Swirling Around It

In maybe my third season, I was on a prescribed fire somewhere in Utah. I’d been running a torch for days and days during our typical spring burning. I usually carry the torch in my right hand, and so my right pant-leg was, uh, pretty dirty. It wasn’t drenched or dripping, but it was certainly flammable—as I was about to find out.

On this particular shift, I was the guy way up the hill, with torches strung out down the hill below me.

We came to a place where we had to hold-up firing for a bit. For some reason, someone rang me up on the radio. I answered the call. As I did so, I moved maybe 10 feet downhill from the line of fire that I just laid in ponderosa litter. (If you’ve never burned in ponderosa needle litter, you’re missing out. Mmmm….Pondo litter!)

This line of fire backed slowly towards me. And as I yammered away on the radio, the fire inched closer and closer to my right leg.

Suddenly, I looked down. My leg had fire swirling around it.

I thought: “Wait—I’m on fire?” What a bizarre realization!

I put the fire out and I can’t say for sure how it all happened. One thing’s for sure: Putting that fire out took longer than I woulda guessed.

My Nomex turned that telltale yellow/brown. And I had some ‘splanin to do to the boss. My damaged ego was the worst of my injuries. My leg was barely as red as a sunburn.

Did my socks help prevent a serious burn injury? Turns out, they may have.

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Tips on What To Do If Your Pant Leg Catches on Fire

The folks at the National Technology Development Program in Missoula have done some recently released great work to describe what happens when Nomex catches on fire. And it turns out, wool socks could be a key part of avoiding a burn injury.

Check out this new video for some cool tests:

 

Here’s a few specific tips on what to do if you find yourself with your pant leg on fire:


Testing Results and Accident Observations

  • Swatting at burning fuel can increase the fire intensity.
  • Stop, drop and roll does not readily extinguish fuel fires on clothing.
  • Fuel-soaked clothing burns hotter and for a longer duration than clean clothing.
  • Wool-blend socks provide significant protection to the wearer from thermal burn injuries caused by burning drip torch fuel.
  • Pouring water from a readily available water bottle onto the clothing is an effective way to extinguish the fire.
  • Dropping the pants to the ankles removes heat from next to the skin.

Next time you’re shopping for socks, consider some woolies that come up above your boots. Turns out, even the lovely brown ones might save your skin.

Do you have a story like this? Do you own any green Nomex pants that aren’t as green as they used to be?

 

 

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?