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.

Screen Shot 2018-02-13 at 10.01.26 AM

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.

 


 

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?