Lack of medical care on the firelines endangers firefighters

by Neil LaRubbio

When the three young firefighters first appeared at the Dutch Creek trailhead in California's Shasta-Trinity National Forest, veteran crew boss Tim Bailey felt uneasy. Their green protective chaps were a little too clean, and their chainsaws looked practically unused.

But despite their apparent inexperience, the tree-felling crew from Washington's Olympic National Park was gung-ho, recalls Bailey -- eager to help battle the Eagle Fire, a finger of the Iron Complex, which was started by a 24-hour lightning storm that lit more than 1,000 blazes. "If you've ever dumped a tree, you know what the high is," Bailey says. "When someone gives you an opportunity to go dump trees ... you're all hyped up and ready to go."

The tallest crewmember was Andy Palmer, 6 foot 5 and 240 pounds, just 18 years old with a cherubic face. Palmer and his crewmates were assigned to cut down hazardous trees along a bulldozer path. It was his first time on the fireline. He had grown up in Washington and planned to start college in Montana in the fall. He was looking forward to a summer of good money and great adventure. But before the sun set behind the smoky ridges of the Klamath Mountains, all that would end.

A few hours after Bailey saw the crew head down the path, one of Andy Palmer's crewmates felled a large ponderosa pine. It struck a cat-faced sugar pine, and the top of that tree -- 120 feet long and two feet wide -- broke off, hit the ground and shattered. One hurtling chunk struck Palmer, who was standing 35 feet from the ponderosa's stump, breaking his ribs, fracturing three bones in his left leg and severing his femoral artery. Blood poured from his leg like water from a broken spigot.

Palmer's crewmates quickly applied tourniquets, but the radio communications from the scene lacked urgency and clarity, hampering the effort to get emergency medical care out to the rugged location.

It took at least 45 minutes for the first EMT paramedics to reach the site; they had to take an ambulance on a forest road and then hike the rest of the way. Two helicopter crews refused flight requests, saying the heavy smoke obscured visibility. After more delay, a U.S. Coast Guard helicopter crew accepted the mission, but two hours and 40 minutes had passed before they loaded Palmer into the helicopter basket. En route to the trauma center, three hours and 20 minutes after the accident, the young man died of severe blood loss; his life vanished like a puff of smoke.

Controversy still surrounds the July 25, 2008, accident, including allegations that the crew was "sport-felling" -- cutting trees that didn't need to be cut. But the most disheartening aspect for Andy Palmer's older brother, Robert Palmer, is that -- as he puts it -- "I lost faith in the fire world's ability to help one of their own." Now, Rob Palmer is fighting to reform emergency medical care on the firelines. His proposals could even affect decisions on how, and when, to battle wildfires.

Rob Palmer, 30, is a veteran wildland firefighter; he worked 10 seasons in fire operations for Olympic National Park, becoming a crew boss, a skilled tree faller and an EMT. He also managed the ski patrol at Snoqualmie Pass, east of Seattle, rescuing avalanche and trauma victims for five years. After his brother's death, he sank into a period of reflection.

"Andy was in the magic transition between growing up and being a grownup when he died," Rob Palmer says. "It was a huge, huge hole that was left for me and my entire family."

Rob Palmer researched his brother's accident and found that the nearest hospital was only 10 and a half miles away by road; the trauma center in Redding was less than 60 miles away. He talked with fire experts around the West and issued an eight-page report titled The Palmer Perspective in January 2009. He bluntly described how he'd lost faith in the firefighting agencies, and pointed out that crews on many firelines still lacked  evacuation plans and medical gear beyond basic first-aid kits.

His charges echoed through the top levels of every wildfire agency in the nation. Last April, he gave the keynoteaddress to the hundreds of experts  gathered at the Wildland Fire Safety Summit in Missoula, Mont. He recommended better wildfire training for EMTs, and called for more medical staff and equipment on the firelines, including backboards and neck collars. He also urged the adoption of a "Golden Hour Response" policy, which would require that any severely injured firefighter be delivered to a hospital or trauma center within one hour.

Defense Secretary Robert Gates implemented a Golden Hour policy in the Afghanistan War in 2009, tapping the Defense Department's huge budget to provide three new field hospitals, new helicopters and other equipment that soldiers and medics needed. So far, however, wildfire managers have not followed suit.

Every eight to 16 combat troops have an assigned EMT. For urban firefighters, the EMT/firefighter ratio is one-to-one. But on large wildfires, the national standard is only one EMT for every 499 firefighters. Rob Palmer wants wildland crews to have at least one EMT for every 10 firefighters -- a ratio found mostly in the top crews, such as smokejumpers.

For a wildfire Golden Hour zone to work, Palmer says that firelines would have to be no more than 30 road miles or 50-100 air miles (depending on helicopter type) from a medical facility. He estimates that 50 percent of wildland firefighter fatalities occur outside the zone. If the government or private contractors can't evacuate an injured firefighter within an hour, he says, they should refrain from engaging the wildfire. He believes his reforms could reduce the average annual firefighter casualties from 19 to nine. On top of that, he adds, they could reduce the total federal wildfire suppression budget by somewhere between $500 million and $900 million per year, because fewer wildfire fronts would be attacked.

Rob Palmer's suggestions are facing resistance from many in the wildfire establishment. Tom Harbour, the U.S. Forest Service's director of fire and aviation, says, "Implementing a Golden Hour response as Robert Palmer has framed it would require fundamental changes," and the benefits might not outweigh "the additional risks or the unintended consequences."

Harbour contends that a Golden Hour mandate would require greater use of aircraft. Because aircraft accidents are responsible for so many wildland firefighter deaths -- 50 percent since 2000 -- aircraft fatalities would likely increase. And millions of new homes have been built in recent years within wildfire-prone forests; if crews were prohibited from battling some wildfires around homes, that would put more lives at risk.

But Palmer also has allies. Chad Fisher, a National Park Service safety officer at the National Interagency Fire Center in Boise, Idaho, acknowledges that "implementing the Golden Hour proper (a strict policy) is very difficult. Risk management comes into play." Sometimes fires that threaten valuable resources -- such as habitat for rare native trout or historic buildings -- must be attacked even where evacuations can't be done in an hour. Yet Fisher has encouraged the multi-agency National Wildfire Coordinating Group to learn from the Dutch Creek tragedy and make its recommendations for improving the framework for emergency medical care. For instance, all morning briefings for every large fire now include specific evacuation routes and procedures.

Fisher is also pushing what he calls -- "for lack of a better term" -- the Golden Hour Engagement Strategy. The "comprehensive strategy" recommends providing more appropriate medical gear on firelines, and urges that the distance to medical facilities be taken into account when fire-management decisions are made. The strategy is taking hold, he says, noting that in the last year or so, many crews have bought backboards and litters. He believes that, in the future, fire managers will be more likely to deploy EMTs with fire crews going into especially risky situations.

Fisher created a webinar presentation partly based on Palmer's talk at the Safety Summit, and he's showed it to influential agency groups. He's also working with other Park Service leaders to find a national park where the Golden Hour strategy could best be fully tested.

The Forest Service also uses the "Dutch Creek Incident" in its leadership training courses, and agency firefighters use simulations of medical emergencies to develop better procedures. But even though the agencies have begun to emphasize the importance of fire crews carrying better medical gear such as backboards, so far there is still no formal requirement for anything more than a first-aid kit. Proposals for establishing mobile medical clinics have been shot down, because of the expense. And on some Western fires this summer, it took longer than an hour to transport injured firefighters to medical facilities. "We can always do better," Fisher says, "and the more attention this gets, the better we will do."

Neil LaRubbio earned a master's degree from the University of Montana School of Journalism, where he developed a website for wildfire science news.

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