Training for medical situations is imperative for wildland firefighters. What are your plans to handle bleeding control, remote crash-rescue situations and air-medical support?
I am excited to announce that "Pulse Check" will be an occasionally slotted column offering current medical information to help wildland firefighters from all parts of the world and from within all resource types. Its goal is to give you, the wildfire professionals on the line and managing firefighters, something to talk about, seek more information about and gather more training so that you are prepared for that potential medical situation.
So, what's on the horizon currently regarding wildland fire medicine? For starters, let's begin with the incidents and tragedies that should cause us to re-think how we do our jobs: Firefighters shot and killed in an ambush setting in New York on Christmas; Australian firefighters burned, with one dying from the injuries; multitude of wildland fire motor vehicle accidents during the 2012 fire season in the United States; firefighters relying solely on national guard aviation resources to get them out of trouble on a medical incident.
One of the several messages I continually preach is simple yet, for some reason, not followed. If you do not train for medical situations, then you will fail to have a successful outcome.
Having spent a number of years in the military, we were always training, even when we hated it. Another one: If you are solely reliant on an air-resource to get you out of trouble during a medical incident, you are in the wrong. Unfortunately, there are people still doing and not doing some of those things mentioned above.
All the tools in the world to make our jobs safer can be given and taught and refreshed. But, if people are not listening, doing, teaching and preparing themselves or others, then all those tools are…useless.
In an effort to help make us safer, more prepared and provide continuing education hours to the medical providers within our group of wildland fire professionals, let's discuss some equipment that people should think about having, and training that people should be doing.
Israeli Dressings, Quik-Clot Combat Gauze and Combat Application Tourniquet (CAT): Have you ever heard of them? If so, do you have them on you, in your line gear, or are they back on the truck in the first-aid kit? If you said on the truck — wrong answer! Soldiers, sailors, Marines and Air Force crews are required to carry them at all times.
We no longer should be and will not be any different. Some say, "We are not in the combat zone or military." Again, wrong. Austere environment, long distance from urban-setting Emergency Medical Services (EMS) and often without the technical experts of Special Operations Paramedics (although we could and should change that with all the men and women coming home from combat that have combat medicine experience, i.e., hire them for the firelines). And guess what? People shoot firefighters, so don't think you're exempt from bad bleeding or that you're not in a combat zone anymore. Otherwise, I would not have fire departments now asking me to teach them basic Self-Aid/Buddy-Aid tactical care. See my point here?
If you have never seen those items mentioned above and want those potentially life-saving devices, then start doing your research and get them on your person. They do no good in the truck on the medical emergency kit. Train on them; teach others how to use them; and make sure everyone has them in the same place on their personal gear and in the medical bag. Also, make sure everyone knows where they are on the truck.
What? Why? Because we drive in rural areas, on mountain roads, and if we get in a wreck, how close is the closest rescue truck? Are you prepared to get your unconscious co-workers out of their truck when they roll it? What about that remote heli-base that does not have crash-rescue support except a crash axe and the air-ship that is a freaking giant with lots of injured in it? Do you want to be swinging a crash axe trying to gnaw through a door and window, or put a fast-blade into it and be done?
I carry one all summer in my truck with extra rechargeable batteries and blades and still cannot figure out why hotshot crews, engines and helitack crews don't have them. A majority of vehicles we drive in fire operations are pick-ups, SUVs and crew-carriers, yet most people would have to wait for a rescue truck to show up if there were a serious accident where men and women were trapped.
They cost less than $200 USD. If you cannot afford to buy new, there's Craigslist, eBay or a pawn shop. Again, train on it. Ask a local fire department to meet you at a junk yard and show you the tricks of the trade. I can cut the roof off a car or truck in less than five minutes. It beats waiting for an hour if you are bleeding to death and the rescue truck is an hour away.
I am not going to say this again: Well, maybe until people get it. Do not rely solely on air-medical or national guard aviation to get you out of trouble. If that is your only plan…you are wrong! Period. End of discussion.
As I read a report from an incident management team that chose to do this, I was absolutely appalled. There was not even a thought to put a paramedic up there with that fire crew or stage the medical equipment on the mountain. They had to fly it in when a person actually got hurt. And what were people thinking putting lives at risk for a piece of ground that offered nothing but terrain features that resembled Mann Gulch, Cramer and South Canyon — and the only way to extract the injured or ill was by military helicopter?
In the military, a combat medic or paramedic (they are very different skill sets in the military, but both offer life-sustainment) always goes with a patrol. They can maintain a solider/patient until more help arrives.
Getting an injured firefighter off the mountain in three hours without anything going wrong is not a successful operation…it is a lucky operation. Plain and simple…luck. We can and should be doing better. You all deserve it.
You need a back-up plan. You must have a better plan. What would have happened if that were a late-night rescue or a sudden snow storm came in and delayed flying? Were you prepared to care for your co-worker all night?
Managing the risk we put ourselves into sometimes should not be the thoughts or worries of someone else above us. It starts with us, individually, at a personal level. Do you want to go home at the end of your shift or fire? Then you need to be doing everything you can to foster an environment of self-preservation.
Every piece of equipment that relates to extrication, medical care for trauma and medical extraction, and rescue I have on my truck is for each of you during a summer of fire.
Equip, train, teach and continually prepare to take care of ourselves because we are our own cavalry when bad things happen. And that is how we should manage risk! If you don't believe me, ask members of the Special Operations world who were successful in getting U.S. public enemy #1.
Bill Arsenault is a 23-year veteran of emergency services including EMS, structural and wildland fire, law enforcement and the U.S. military. He has performed in a number of different wildland fire positions, including line-paramedic for the last 13 years. He can be reached at firstname.lastname@example.org.