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.

BurnGraph.png

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:

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?