Picture yourself on the front lines of a massive wildfire -- soot smeared into the creases of your face, your clothes stiff and itchy with days-old sweat, your palms blistered from grubbing a fire line through duff and brush with a Pulaski. What dangers might you face? Falling snags? A fire sweeping uphill faster than you can run? Asphyxiation in smoke-thick air? Maybe.

But as the recent deaths of two firefighters in Los Angeles' Station wildfire show, the most likely dangers are often the same ones that haunt our everyday lives -- a car accident in that case, or heart attacks, or illnesses, or just plain lack of access to good medical care.

In Alaska, the trail to a fire line in the Kenai National Wildlife Refuge may pass memorials to folks who died at the claws of grizzly bears. Fire camps in Interior Alaska have shotguns on hand to keep angry moose and hungry bruins away (Bear canisters nothing. We've got guns!). There are also the elements to think of, and rough terrain, and heavy equipment, and aircraft, and sharp tools, and, of course, the fire itself. Dramatic stuff, all of it.

So what was Michael "Kale" Casey  (pictured above) -- a Paonia, Colo.-based wildfire paramedic -- most worried about as he kept tabs on crews battling the 660,000-acre Railbelt fire complex west of Fairbanks this July and August?

Bee stings.

Anaphylactic shock -- the product of a severe allergic reaction in which a person's blood vessels dilate, their blood pressure drops and their airway constricts or even closes -- is a quick killer. And many folks may not know that they're severely allergic to bees -- their last sting may have been mild, or they may never have been stung at all. Now, "imagine a troop of 20 to 40 people kicking through miles and miles of country, chainsawing logs and cutting across river banks," Kale says. Are they going to disturb some bees? You bet.

Add to that inevitability the fact that Interior Alaska is a vast, mostly roadless wilderness, Kale says -- "Gazillions of acres of tundra and swamp with pockets of trees and mountains" -- and any kind of medical problem or injury can become a potentially serious situation. Without easy road access, patients need to get the necessary care in the field or be transported out to the Fairbanks emergency room via riverboat (if it's not an emergency) or by helicopter -- processes that can be lengthy.

Above: An Interior Alaska fire camp, courtesy Michael "Kale" Casey

And crew members often bring unresolved medical issues into the field, he adds -- unevaluated pregnancies or toothaches, for example -- that can quickly escalate into serious situations when definitive medical care is a long way away.

Fortunately, the Railbelt was a fairly safe fire considering there were five or six hundred people fighting the blaze, says Kale, who was the only fire employee authorized to provide field-based advanced life-support. There were only a handful of serious bee stings, and only one of them was critical. Other than that, there were some more minor injuries and illnesses -- Pulaski cuts, stomach troubles, blisters, and the occasional corneal abrasion or infection.

"They want me to be bored," he laughs. "The supervisor is delighted when the medic is reading books and working hard to stay busy."


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