Nuts and Bolts – Again

Winter 2020 ▲ Vol. 9 Issue 4 ▲ Produced and distributed quarterly by the Wildland Fire Lessons Learned Center

2019 Incident Review Summary Nuts and Bolts – Again By Travis Dotson For more nuts and bolts lessons from real- deal incidents, check out the 2019 Incident his issue of Two More Chains is about things you can do. Actions you can take. Review Summary.

Wait, haven’t we done this issue already? Yes we have. (See our Winter 2018 issue of Looking for Refresher training exercises? T Two More Chains.) But guess what? We’re doing it again. Why? This review summary provides multiple exercises related to recent incidents. It’s a Partly because it’s been a whole year and we have a great source for both formal and informal bunch of new reports with new lessons. And also training. Please use it to stimulate dialogue because it’s a new year with new reports and some of among your peers: the very same lessons from previous years. https://www.wildfirelessons.net/viewdocu Hold on. If the Wildland Fire Lessons Learned Center ment/annual-incident-review-summaries (LLC) is getting reports of the very same types of incidents occurring after we put a bunch of effort into sharing the lessons about how to avoid that incident (for instance, the dangers of loose lug nuts) isn’t that proof that what we are doing isn’t working?

Maybe. But we don’t often get reports from folks who actually use the lesson. Why? Because using the lesson likely prevents the event that triggers a report. Make sense? Unfortunately, our “win column” is therefore sparse and hard to populate.

So here we are again with a handful of hard hits and close calls (see the main menu below). Take a look and cherry-pick the nuggets that pertain to you and the people next to you. Put the lessons to use. Then please send us a note so we can put a mark in our lonely win column.

Ash Pit Burn Injuries – Hey, watch where you’re stepping wildland firefighter! Page 3

Losing Lug Nuts – Ever had one of your rear duals pass you on the highway? Page 4

Chainsaw Cuts – Stop the Bleed – Are you ready to manage a major bleed on the fireline? Page 5

When the Bad Thing Happens . . . – Are you really ready? Page 6

Also in this Issue Ground Truths – Want to move the needle? Read this! Page 2

LLC Staff Picks – Check out what incident reports we think you should know about. Page 7

One of Our Own – We can learn a lot from Brian Kliesen’s ‘Stop the Bleed’ training insights. Page 8

Your Feedback – Readers respond to Kevin Reese’s hit by tree—and the bureaucracy—story. Page 12

Ground By Travis Dotson Fire Management Specialist Wildland Fire Lessons Learned Center Truths [email protected]

Moving the Needle

hen I introduce myself at emails sent, signatures provided, miles meetings or training, I flown, presentations made, blah blah W often say: “I’m just like blah . . . Basic swivel chair scorecard everyone else here. My career path stuff. was Ops, Ops, Ops, Desk.” Eventually we get to the part where one A few folks chuckle, others frown. of us says: “At this level, we have to accept that our role is just to move the Some of us desk pilots don’t really needle.” want to admit that we somehow ended up on the bad side of the More nods. Then we move on to the hike/sit ratio. I try to be a realist. awesomeness of scheduling leave in August. (Let me tell you, it is amazing. There is no doubt that I spend more #LifeFirst.) time reading and thinking about incidents and accidents than I do So how do we move the needle? exposed to the danger under the Here are the steps: trees. So it is. 1. Identify Your Sphere of Influence. One lament I hear a lot from folks like me—those of us who a. Everyone has influence. If you are the have transitioned into management-sized pants or even Squad Leader or Engine Captain, you have national policy sized-pants—is that it’s tough to not see way more influence than you realize. To this discernable proof of progress or impact. The conversation goes day I am living by practices instilled in me something like this: by my first fireground mentors. Accept this Me: “How’s the new job?” gift graciously and use it wisely.

Desky McPaperpush: “It’s good; it’s a challenge. It’s nice to get 2. Identify the Change. paid more. But I struggle with how long it takes to really make a. Find one lesson that applies to your sphere an impact.” of influence. (You might start with the ones in this issue of Two More Chains.) Me: “Yeah, I hear ya. Not quite like the immediate gratification of putting a tree right where you wanted it, huh?” 3. IMPLEMENT. a. This is the action part. Adjust your practice. Desky McPaperpush: “Exactly!” Lug nuts, soft stretchers, tourniquet This is where the recent advancer tilts their head to the side, training, emergency notifications, driving takes a deep breath and pauses for a beat. All to signal the SOPs—ACT on one of them. profound insight they are about to share with me. Then they 4. Repeat. release their wisdom: This moves the needle. “You know, back when I was on the crew, at the end of every shift I could look back and count the chains of line we put in or The process does not vary for different levels of the mopped-up and note the progress toward the stated objectives. organization. I never realized how deeply gratifying that was.” The big needle is made up of all the little needles. Find one and I nod slowly in genuine empathy and social nicety, giving the move it. impression I have never heard anyone say these exact same Swing on, Tool Swingers (and Spreadsheet Ninjas). words before.

Then we usually joke about different measures we could substitute for chains of line: minutes on conference calls,

Ash Pit Burn Injuries

There were a total of 10 burn injuries in 2019 that occurred when firefighters stepped or fell into ash pits. These instances occurred during mop-up, saw operations, and scouting. The stories and lessons that are available on this page just might help keep you out of the burn center.

When the swamper stepped and reached for a Mulch Fire Ash Pit Burn FLA chunk of birch tree on the black side of the dozer line, his foot sunk into a hot ash pit, approximately 18 inches deep. As the swamper attempted to extricate himself, the sawyer stepped toward and reached for the swamper to help pull him out. They both sustained burn injuries to their lower legs.

Swan Lake Burn Injuries

“When injuries occur, we assess, stabilize, package, LESSONS transport and hand-off patients to a higher level  When setting work priorities, ask yourself if you of care. But, then what? really need to be there – is it worth the risk? What (or who) determines the level of  Be aware that the risks with ash pits are often care and location of not visible and may extend well beyond the treatment(s)? Can we immediate area. influence the process, and perhaps the  Scout areas and use probes to test for extent outcome?” and depth of ash beds. From the Swan Lake A firefighter assigned to the Burn Injuries RLS Alaska Ash Pit Burn Injuries Martinez 3 Fire received 2nd and 3rd degree burn injuries below both knees.

The firefighter, assigned to a Type 3 Engine on the incident, was performing suppression duties in an area of deep vegetation (duff) Where’s material, when he stepped into an the pulaski ash pit, sunk to his waist, and received injuries. handle? Martinez 3 Fire Burn Injury

Firefighter shows the depth of an ash pit that was found on the line of the McKinley Fire.

Handout: Hazards on the Line – Ash Pits Pose a Significant Risk to Firefighter Safety 3

Loose Lug Nuts

In 2019, loose lug nuts resulted in one near miss and one dual wheel set bouncing through traffic on two Ford 550 Type 6 Engines within two days in the Rocky Mountain Region.

The crew members in the Chase Truck were surprised to see the rear wheels start to wobble. They tried both the radio and the cell phone, but were not able to contact the Engine before the dual wheels came off.

Rotor resting on pavement. Notice bent

studs on the left.

The Two Rocky Mountain Region Engine Lug Nut Incidents RLS

Lessons Learned by the Operators  Carry a torque wrench on each Engine and tighten to the specified torque frequently after changing a tire.

 Tightening lug nuts with a lug wrench or breaker bar may give the false impression that they are tight enough.

 Look for wear and stretch in studs.

 Rotate the spare tire into the tire rotation schedule to create even wear on all the tires.

More Lessons from This Lug Nuts RLS: Loose lug nut indicators will be installed on some engines to evaluate their usefulness. For more information, watch the video found here: https://youtu.be/sfgfps4ouGU.

Torque specifications will be posted on vehicle dashboards.

This Has Happened Before! More Lessons on Lug Nuts

Three incidents from 2017 in which the wheel lug nuts came loose or fell off and the operators submitted an RLS or a SAFENET on the incident: o Mile 0 Rx Fire; o Long Valley Fire; o Type 6 Engine Wheel Stud Malfunction RLS.

Two additional incidents from 2016 and 2011 in which the lug nuts came loose and the wheels fell off the trucks: o Type 6 Engine Wheel Torque Malfunction RLS; o Engine 2423 Lessons Learned Review. 4

“The chainsaw contacted the chaps and pulled the chaps away, exposing the firefighter’s calf.”

Kootenai NF Chainsaw Cut

Chainsaw Cuts Stop the Bleed

Chainsaw cuts. They happen. At least 4 times in 2019. In addition to the four flesh cuts, there were 2 SAFENETS about cut chaps: Project Work, Mosquito Lakes.

Some Folks Were Prepared for These Medical Emergencies:

Engine 641 personnel had also undergone a locally developed “Stop the Bleed” training in the spring of 2019 and had been extensively trained in tourniquet use and placement, as well as Israeli Bandage use and placement.

Prescribed Fire Chainsaw Cut [See page 8 for our “One of Our Own” interview with Brian Kliesen, the main instigator behind this locally developed “Stop the Bleed” training.]

Firefighter B (who is medically trained through the Army National Guard) remembered that he had a personal tourniquet in his line gear and ran to the truck and grabbed it. At 1000, two minutes after the incident happened, the tourniquet was applied, and gauze and triangle bandages were applied to the wound.

South Dakota Fire Chainsaw Cut

The saw came off the cut and into the left outside of Sawyer #4’s saw chaps. The spinning chain rolled the chaps up and then quickly sliced into his left leg above the calf before it finally stopped.

Beeskov Fire Chainsaw Cut

Are you ready to manage a major bleed on the fireline? For more information on this important topic, see Brian Make a Decision Kliesen’s “Stop the Bleed” story Read this blog post to help you decide: Tourniquet Anyone? on page 8.

When the Bad Thing Happens . . .

Are You Ready?

Gimme Shelter Fire resources should not rely upon vehicles as safety zones. Resources should consider using a web belt to carry a fire shelter when performing engine operations and/or have fire shelters readily available on the exterior of the vehicle.

Bald Mountain Incident

Bring Higher Level Care Don’t rely on your transport method for a higher level of care, order line medics at the same time. They may be able to provide an advanced level of care sooner and serve as a backup.

Lime Fire Hit by Tree

Not Back at the Truck All crewmembers discussed the importance of always having life-saving trauma bandages and equipment on their person. It’s one thing to have gear on the truck, but it’s another thing to have the gear on your pack right there at the work site. The Danger is Real Prescribed Fire Chainsaw Cut The individual was admitted to the hospital unconscious with a body temperature of 107.

The fast response and training of the fire crew probably saved this individual’s life and prevented any long-term Not User medical effects. Friendly

Pack Test Heat Stroke/Rhabdo It would be valuable to expand scenario training to include some different types of rescue equipment. The strapping on a stokes litter isn’t what one would consider “user friendly”. Soft Stretcher Milepost 97 The soft stretcher is not the correct tool for every Incident extraction scenario, but in this instance, it proved to be valuable. It is very lightweight, folds down to a compact size, and can be carried in a line pack. East Evans Tree Strike 6

SOMETHING NEW! In this issue of Two More Chains, Lessons Learned Center staff members are recommending incident reports from 2019. We read a lot around here. It’s time we highlighted some specific incidents and their associated lessons for you.

STAFF PICKS I Suggest: Canyon 66 Rollover I Suggest: Canyon 66 Rollover STAFF PICK For this issue of Two More Chains, the Wildland Fire Lessons Learned Center Staff members each selectedGenre:Genre: incid RapidRapidents Lesson Lesson from Sharing Sharing2019 that –– Driving Drivingthey believe deserve your attention and reflection—lessons, lessons, lessons! WhyWhy I I Liked Liked It: It: It’s It’s four four pages pages——II havehave time time for for that.that. ItIt has has great great pictures pictures that that paint paint aa clear picture for me. It has great quotes that really put me in the mindset of those clear picture for me. It has great quotes that really put me in the mindset of those

involved.involved. ItIt has has a a memorable memorable andand actionable actionable lesson: lesson: If If you you can’t can’t seesee the the road road——STOP!STOP!

Recommended By: Travis Dotson, LLC Analyst Recommended By: Travis Dotson, LLC Analyst

I Suggest: East Evans Creek Tree Strike

Genre: Lessons Learned Review – Hit By Tree

Why I Liked It: I like that this report was put together by a diverse group of folks from the BLM, State of Oregon, and the USFS—and the event involved a wide range of firefighters, agency folks, contractors, etc. This LLR tackles the story of the incident, captures some solid lessons, and provides some useful tools for folks out there in the world. Moreover, the LLR Team describes how they, as a team, grappled with the operational realities faced by the folks involved in the incident. We call this sensemaking. It’s hard work and can be tough to do. This LLR Team did it very well. Kudos to them!

Recommended By: Alex Viktora, LLC Assistant Director

I Suggest: Western Oregon Bucking Incident I Suggest: Western Oregon Bucking Incident Genre: Facilitated Learning Analysis – Chainsaw Incident

Genre:Why IFacilit Likedated It: This Learning FLA stood Analysis out –to Chainsaw me because Incident of the complexity, but also the fact that it

Whywas I Likednot an It: uncommon This FLA stood situation. out to Competing me because objectives of the complexity, following abut major also winter the fact storm that it wascreated not an a uncommon complicated situation. work assignment. Competing I could objectives envision following this scenario a major every winter step storm of the created way a complicatedand spent time work contemplating assignment. Iwhat could decisions envision I thiswould scenario make everyas I read step on. of So, the what way and spent timehappened? contemplating Read it what and finddecisions out! I would make as I read on. So, what happened? Read it and

findRecommended out! By: Bre Orcasitas, LLC Field Operations Specialist

Recommended By: Bre Orcasitas, LLC Field Operations Specialist

I Suggest: Valley Fever

Genre: Rapid Lesson Sharing – Health

Why I LikedI Suggest: It: It’s importantValley Fever for wildland firefighters to be aware of Valley Fever and know where and how

this diseaseGenre: occurs. Rapid You Lesson—and Sharing your doctor – Medical/Health—might think you have the flu, but you actually have Valley Fever—which can be deadly. The dangerous fungus that causes Valley Fever can be transported into your Why I Liked It: It’s important for wildland firefighters to be aware of Valley Fever and know lungs on a simple speck of dust. Two wildland firefighters came down with Valley Fever last year. That’s where and how this disease occurs. You—and your doctor—might think you have the flu, but why I believe it’s worth everyone’s time to check out this informational RLS. you actually have Valley Fever—which can be deadly. The dangerous fungus that causes Valley RecommendedFever can By: be Paul transported Keller, LLC into Writer your-Editor lungs on a simple speck of dust. Two wildland firefighters came down with Valley Fever last year. That’s why I believe it’s worth everyone’s time to check out this informational RLS.

Recommended By: Paul Keller, LLC Writer-Editor

One of Our Own

Brian Kliesen

Spreading the Word on ‘Stop the Bleed’

By Alex Viktora

ou don’t want to confuse Brian Kliesen with Dracula, but this guy knows a whole lot about blood—how to keep it in you, not take it out. Y As the Supervisor of Santa Fe Helitack, Brian oversees the ten- person helicopter module based in Los Alamos, New Mexico on the Santa Fe National Forest. He also serves as the Forest’s EMS Coordinator.

Brian has worked on helitack crews in Wyoming, Idaho and California after starting out on trail and engine crews in Colorado. The Santa Fe Helitack Crew in the spring of 2016. From left to right: As a National Registry Emergency Medical Technician and former Crewmembers Dan Sebern, Dijon Clay, Lucas Vega, Margot Jennings, Gehrig U.S. Army Reserve Combat Field Medic, Brian brings a diverse Browning, Supervisor Brian Kliesen, Pilot Ben Frisius, NPS Lead Crewmember background to medical training. Finishing as a Staff Sergeant in the Bonnie Bolser, and Espanola Ranger District FMO Jon Boe. Photo by Evan Welsh. Army Reserve in 2018, he worked at Army clinics and hospitals at Fort Riley and Fort Hood, as well as in the field supporting training, weapons ranges, and exercises.

He also served overseas briefly with the United Nations High Commission for Refugees. For seven seasons, he worked for Raytheon Polar Services in Antarctica as a Helo-Tech, as well as for several medical-based Non-Government Organizations in Africa, South America, and Asia.

Alex: What motivated you to start the “Stop the Bleed” program?

Brian: The Santa Fe and the Carson National Forest train together in the early season as we are a combined fire organization. We spend three days with all the firefighters from both Forests. And we also invite our cooperators, the BIA, BLM, local volunteer, city, county, and state fire departments. We do a lot of the basic early-season training, policy and safety briefings, weather, fire outlook, chainsaw, updates, leader’s intent, aviation and equipment.

This last year, we hosted an hour-long “Stop the Bleed” class. There are several national Stop the Bleed programs that are out there and ours is very similar. We simplified the course based on the Combat Lifesaver Course that I taught in the Army.

It’s a very basic skillset for all firefighters and field personnel: How to recognize severe bleeding and how to stop it using a tourniquet. This provides time for an individual to see the injury site clearly and see if it can be converted to a pressure dressing—and if the pressure dressing isn’t working, you put the tourniquet back on.

I was lucky to have four of my U.S. Army Reserve medics from the 491st Medical Company in Santa Fe participate last year. And because we also invite folks from the municipal, city, and county fire departments, we had quite a few paramedics and medics who were able to help us with this training. This program is very basic. While there are other training programs out there that are probably a lot more involved than what we’ve developed, ours provides the basic skillset that we’re looking for in our line of work. And it’s not just for firefighters.

North American Rescue Squad Kit This is the larger kit that Brian refers to. He had them remove the chest decompression needles because “they are beyond our level of training.” He explains that this also reduced the cost of the pack when ordering it direct from the manufacturer. This is what Brian is trying to get on the engines on the Carson, Santa Fe and Gila Forests. He reports that, to date, these kits are on 75 percent of these Forests’ engines.

Non-fire personnel can also benefit from this training who use tools, equipment and chainsaws. That’s one of the things that we’re trying to address by making small, individual trauma kits available to other field-going personnel in trails, range, recreation, archaeology, or any field staff (see photos on next page). We realize that it could be one of our employees, a member of the public, or one of our cooperators who gets injured.

Alex: Can you talk about the specifics of this training?

Brian: First, we discussed how to use the equipment—to make sure that everybody was on the same page. Then we divided into smaller groups to give everyone an opportunity to utilize the two different types of tourniquets that we use, the C-A-T (Combat Application Tourniquet) and the SOF-T, as well as the Emergency or Israeli Bandage, with a medic to offer instruction and answer questions.

We went over recognizing a severe bleed, and when and how to use tourniquets on arms and legs. It’s really an opportunity to give everyone a chance to get some hands-on training, utilize the equipment, and see how it’s done. After about an hour, we finished with a 10-minute question and answer period and closed by going over the procedure one more time.

It seems every year or so there’s a serious injury or fatality where you wonder if people had this advanced training, if maybe that would have made a difference.

This year as part of the three-day Northern New Mexico Fire Summit coming up in April in Santa Fe, we’re going to present the same program. We’ll take the EMTs and those with the more extensive medical backgrounds and talk about going beyond tourniquets—including wound packing and using different methods for where a tourniquet is not appropriate. During this time, the other participants will learn about the tourniquets and emergency dressings.

Alex: How did you get your supervisors and leadership to support this kind of training?

Brian: The leadership here on the Carson and Santa Fe has been real proactive when it comes to training.

We all remember the Andy Palmer incident in which Andy was struck by a tree and basically bled out before they were able to get to advanced medical care. In 2018, I was on the Ferguson Fire in California at Yosemite where Brian Hughes, the Arrowhead Hotshot Captain, was struck by a tree and killed.

It seems every year or so there’s a serious injury or fatality where you wonder if people had this advanced training, if maybe that would have made a difference. Of course, a lot of times it wouldn’t.

With my military training and background, it’s a basic skillset. Every soldier, every person in the military, receives that same training: How to recognize a severe bleed, how to do self-aid or buddy-aid where they can do it on themselves or to their buddy.

We have EMTs in the Forest Service and the Region developing an EMS program where we’re going to have recognized medical direction and control and some standard operating procedures.

So basically, my crew and I were talking about it one day, and I just went up to our leadership at the fire staff level and said, “Hey, I want to put on a class.” And they said Okay. So we pulled this together pretty quickly last spring and presented at the Fire Summit we held here in Santa Fe.

Alex: Can you describe these individual first aid kits that you’ve put together and explain how they are different from the typical basic first aid kits that most wildland firefighters carry out on the line?

Brian: The basic first aid kit that’s available from the USFS cache, the red belt pack ten-person first aid kit is essentially useless. It contains some Band-Aids and a few basic things. It’s more of an OSHA requirement. The majority of the first aid kits that the Forest Service has, those large and medium-size metal kits that you hang on the wall or are in a vehicle, those also fulfill an OSHA requirement. But they aren’t necessarily very useful.

After our training, many of the Districts came up and asked: “Hey, can you suggest or recommend where we can get these items?’’ So I created a list of items that were available on GSA Advantage and pointed out this is where these items can be found.

We also identified a squad level or a crew kit that’s specifically for trauma that is available on GSA Advantage and we also built a smaller kit you could carry in the field with you, something lightweight that you can put on your chainsaw chaps or strap onto the side of your line gear of a backpack. Neither kit has Band-Aids, aspirin, or moleskin. It’s designed for trauma, when somebody has a significant cut, a crush injury, a burn injury, something like that.

Many on the Carson and the Santa Fe are now carrying both these kits—and we’re building more. The larger kit is still easy to carry, can be attached to line gear or used as a waist pack and would probably be carried on the engine or perhaps taken with the crew if they have to hike into a project site or fire. The smaller kits are lighter and have two emergency (or Israeli) dressings, a roll of kerlix gauze, a C-A-T tourniquet, exam gloves, a set of trauma shears, an emergency blanket, and a roll of tape.

And we’re now working on building the Medical Incident Report and a patient contact report into one sheet. So one side’s the MIR and the other side’s the patient information sheet. This will be included in those kits, along with and a sharpie, a black magic marker. Nothing in the kit has an expiration date.

Alex: What was your reaction when you first heard about the Pagosa Ranger District chainsaw cut incident last August in which a swamper’s left forearm received a deep chainsaw cut and a tourniquet was used?

Brian: When I read that RLS I was really happy that the guys responded so well. This was one of our engine crews that had participated in our Stop the Bleed training. Initially, somebody else tried to put a belt on as a tourniquet and the guys there identified that as inadequate. Using a belt is a Hollywood thing. So, they removed the belt right away and put a tourniquet on. This is the Small Trauma Kit Brian refers to The whole point of a tourniquet—having folks in the field put them in their fire packs, a that he’s designed to carry on a pack or saw tourniquet or an Israeli emergency bandage—is to apply it right there at the point of injury. And chaps. This kit contains: Exam Gloves x 4 each, the sooner you put on a tourniquet, the sooner you’re going to stop the blood flow, the loss of Lg and XL; Trauma Shears; Survival Blanket; 1 blood. And then you’ve got time to evaluate the injury and decide if you can convert it to a roll 4-inch Kerlix; 2 6-inch Israeli/Emergency Dressings; 1 C-A-T Tourniquet; 1 Sharpie and pressure dressing, or if the tourniquet needs to stay on. the Medical Incident Report. “We didn’t We like to teach: “Air goes in and out, blood goes round and round, life is good.” So I was really include the Combat Gauze due to cost and happy that they recognized and remembered the training because it had been several months expiration,” Brian informs, “although that is an option.” before. And it was only a one-hour-long class.

On that RLS incident, everybody paid attention and they knew what to do and responded really well. Ultimately, the individual didn’t suffer a severe injury. They did the proper first aid and got him to the appropriate medical treatment. I think he received 18 staples or something. Today that swamper is fine and his injury seems to be healing well. He’s not going to have any loss of motion, though he might have some scar tissue develop over time. It’s nice when the individual is able to return to work without any loss of range of motion. He’s going to have a very sexy scar and be able to tell that story as a teaching moment. And he’ll never forget how to treat a major bleed if it ever comes up again.

When I read that RLS I was really happy that the guys responded so well. This was one of our engine crews that had participated in our Stop the Bleed training.

Alex: How do you respond when you hear “liability” and “tourniquet” in the same sentence? What advice do you have for that kind of concern?

Brian: Here’s what we’re up against. For many years, people were taught—and those people are now in the higher positions—that if you put a tourniquet on someone, the expectation is that they’re going to lose the limb or they’re going to lose function of the limb. There is always a chance that something will be used inappropriately or incorrectly, but that comes back to training. If you are away from your basic 911, in a rural or wilderness context, using a tourniquet or pressure dressing can save someone’s life.

We now know through research and through evidence from the military by the soldiers in Afghanistan and Iraq and Africa and the Far East that the whole goal is to keep the blood on the inside instead of the outside.

This last year, we successfully lobbied the national aviation program to require emergency dressings and trauma shears in the first aid kits for all the Exclusive Use and “Call When Needed” Type 2 and Type 3 helicopters. This was a very simple, easy and inexpensive upgrade.

Tourniquets and emergency dressings are becoming more available and the training is out there now where people know that they can put a tourniquet in place, convert it to a pressure dressing, and then remove “Air goes in and out, blood goes round and round, the tourniquet. If it doesn’t stop the bleeding, they put the tourniquet back on, write down the time so that the surgeons and the doctors life is good.”

know approximately how long that the tourniquet had been in place. Then the medical team can do the appropriate interventions to properly restore circulation.

We know from the military that people have had tourniquets on for 8, 10, 12 hours and they’ve been able to get full or a majority of their function returned to that particular limb. It’s a very effective, very safe way to stop a severe external hemorrhage. However, the thing is that it only works for arms and legs. So a severe cut or injury to the neck or the torso requires other techniques.

That’s another training area that we’re hoping to expand on in this next class at the Northern New Mexico Fire Summit. A lot of the city, county, state, municipal EMTs and paramedics will be there. They can help those individuals or EMTs who would like to learn some more advanced techniques. Like teaching how to respond if the injury is in the chest, or in the abdomen, or the pelvis, or shoulders, or where ever.

Of course, our main focus is on the arms and legs because those are the areas that get hit by pulaskis, chainsaws, rocks, and whatever.

Alex: What kind of advice do you have for folks who might want to replicate—to the extent that they can—the training program that you’ve implemented?

Brian: Nationwide, there’s a very strong push right now for Stop the Bleed programs. You can Google “Stop the Bleed” and you’ll see there are classes that are available where you can learn the basics. The Stop the Bleed programs seem to be popping up all over the place. You can also talk to your local ambulance service, hospitals, or fire department. With so many people with previous military experience who have been exposed to this process, the information is out there.

In addition, many school districts are now providing the training for a mass casualty or a shooting incident. So it’s becoming more common. With the price of tourniquets going down and their availability increasing and with widespread training, I predict you’re going to be seeing this quite often.

It is a very basic skill set. It’s nothing too difficult or invasive. It’s just like with any other skill, you learn the basics and then you practice it so that it becomes second nature. Then, when you do see an incident or accident where a tourniquet or a pressure dressing is appropriate, you’ll know what to do.

Alex: What advice do you have for somebody who’s freaked out by the It is a very basic skill set. It’s nothing too difficult or sight or the thought of blood?

invasive. It’s just like with any other skill, learning Brian: That’s a personal thing. There are quite a few people out there who cannot handle the sight of blood. They need to recognize that they the basics and then practicing it so that it becomes have those limitations, but also remember that what’s happening to second nature. them is nothing compared to what’s happening to that individual who has the severe injury.

Once again, it all comes back to training—to doing it often enough. They used to call it “muscle memory.” Now I think the term is “familiar task transfer.” There are studies that say you have to do something so many times in order for it to be ingrained in your memory. So, training that you have to do every year helps.

Most people have CPR certification for two years. But, they should really review or go over that stuff every single year, or even more often if they’re in an environment where the possibility exists that they may have to do CPR.

The same applies to a severe bleed. You have to be able to recognize it and respond. If you train often and thoroughly enough—so that training is ingrained in you and you respond quickly—there won't be as much blood and maybe you can get past that.

But again, it’s all about the training. It’s all about the exposure and sort of getting used to stuff. Some people don't like to fly, yet they learn over time that it’s safe and they take longer hops and they fly in smaller planes, or whatever.

They get used to it.

Your

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“First the Tree Tries to Kill Him – Then the Bureaucratic Aftermath Does the Same”

Kevin Reese’s amazing—and upsetting and heart-rending—true story featured in our Fall Issue’s “One of Our Own” motivated several folks to respond. Some shared how they, too, have similar disturbing experiences.

Besides appearing in Two More Chains, we also posted Kevin’s “One of Our Own” on the LLC’s Blog and received the following comments there:

Absolutely Shameful I am in a similar position currently, with the OWCP denying from the actual event, thru to treatment and recovery. Like my case entirely and everyone just parroting the party-line: the old wound, it sort of follows you around. In the end, you “Just set up a payment plan.” have to decide to make yourself whole again, regardless of what happens, and everything else will fall into place. My representatives have yet to step in, but I remain hopeful that it gets resolved. It is absolutely shameful how they treat 4. Be “multi-modal” in your PT. I had acupuncture, yoga, and people. Thank you for sharing your experience. lots of body work, along with the standard therapy. I got all this prescribed—I could have never paid for them myself. Eric Leavitt From a WC standpoint, it would have been cheaper to What I Learned – and Now Tell Others prescribe pills. After a few years, they would have offered a I keep coming back to this article. I wasn’t going to comment, settlement which in the end would have been more costly to but there’s a few things I can’t just turn off. I’m a vollie fire the system than my recovery. But, by then, they would have chief in what used to be coal country. I’ve seen this happen just been trying to close the case and the numbers probably lots of times before, just not from the fed side of things. In wouldn’t reflect on the actual injury accident. In their books, 2007, after working fires non-stop for about a week, and after it would have moved to a different category. a few hours’ sleep, we got to work on a 6×6 we broke late the I didn’t lose my “job” as chief. I was back at work within a few night before so we could get back to the fire. I slipped and fell weeks, arm immobilized, but semi-functional. I only had pain off it, broke my humerus bone badly. It took three years to meds immediately after the surgeries, and even that was hard recover, and was in pretty much constant pain for two of to get off of. them. But I had support, and found doctors and other My original surgeon didn’t want to move me thru recovery, caregivers who moved me toward a successful outcome. and sounds like what Kevin went thru. He finally gave up and What I learned, and what I tell others: moved me to pain management, where I found someone who 1. The WC (Worker’s Comp) system docs are likely the worst. I cared. Right before I completed recovery, WC offered me a got kicked up the ladder to specialists by an astute pain pretty large settlement to close the case. I took it to a lawyer, management doctor. If you have one of those who pushes and before I finished the appointment with him, the pills, find another. The WC system doesn’t care if you recover, caseworker called me and withdrew the offer. She didn’t it only monitors cost and how much effort it’s taking. If it can know I was at an attorney. Apparently, it had been a mistake. keep you quiet by narcing you out, it will. In order to move They have their own level of incompetence. thru doctors, you may need an advocate. Find one in your I actually tell my own people who get hurt to get an attorney. organization if you can, but in other countries, “advocates” Thank god it’s only been two years. But it’s not between me are what we call lawyers. and them anymore. It’s between them and Worker’s Comp. 2. Get a lawyer who specializes in WC. Right away. I didn’t, As soon as you understand the process and that the system but I got thru lucky. I’m not taking into account that most of doesn’t really care about you, the faster you can take care of you who are reading this are Fed employees. You folks may yourself and your family. need to find someone who specializes in Fed cases. And Kevin, yeah, the PPE is 1980s state-of-the-art. I think it’s 3. Be prepared that this may end your employment. There’s a more cultural than about the money. lot of stigma surrounding everything involved in an injury, Doug Fritz

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Nothing has Changed [Editor’s Note: We also received the responses below via our I went through it in 2002 as a Missoula jumper. 2002-2006 Two More Chains reader input opportunity. when my court case was thrown out due to a technicality. (See input link in box at bottom of this page.)]

F*****s almost drowned me in medical bills while they kicked Risking Their Lives me to the curb. Without help from a few senators, they I believe the [Kevin Reese’s] article about OWCP should go would have broke me. national. We need to spread the word that folks are risking their

I’ll never be the same (back injury). I’m blacklisted from the lives and getting injured and there is no help for them.

FS, but I went back to school for a master’s degree. I miss fires I know. I'm one of them.

and the whole team. Thomas Grubbs, Fuels AFMO

Sorry to hear your story. Bums me out that nothing has changed. Grand Valley Ranger District

Chad Newman Grand Mesa-Uncompahgre and Gunnison National Forest

For another OWCP billing nightmare story, see Adam Crichton’s first-person account featured in the LLC Blog site. This Engine Operator, a Rhabdo patient, spent seven days in the hospital—and then one year and five months in a

frustrating swirl with the bureaucracy. He has some significant lessons for you.

Response to Travis Dotson’s “Ground Truths” Column in the 2019 Fall Issue of Two More Chains

In this column, Travis acknowledged that even though rocking your chinstrap “isn’t cool” he challenged sawyers to wear their helmet chinstraps.

Leading the Charge for Change I think the most telling thing is that the firefighters see that the As an agency we are now exploring PPE options (helmets, Nomex, cost of better PPE gets in the way of keeping people safe. chaps). If there is something that improves safety and helps Followed close behind is the “cool” factor. individuals be more efficient, why not do it? The only hurdle is the

There are still people who do not wash Nomex, wear eye pro, “cool” factor. Many of our firefighters have come over to the dark side from the FS/BLM and are on board with positive change. roll sleeves down, wear gloves or any number of safety-related things. Then the newer firefighters want to emulate them and I think the current generation of supervisors are the ones who will do the same thing and it becomes a systemic problem. lead the charge for positive change. Safety is real and makes a

As a manager now, I have seen how my actions affect what my difference (even if it is not “cool”). Thanks for pointing out some of the systemic issues with the fire service. Hopefully it will change. subordinates do. I go out of my way to wear gloves, role my sleeves down, wash my Nomex after every roll and be the example. Jacob Ware, Fire Chief Elk Creek Fire Protection District, Colorado

Response to the 2019 Summer Issue of Two More Chains on Standardization

The Importance of Institutional Memory In 2009 the level of standardization in the rappel program was away from the chest to keep things aligned and prevent cross minimal. In 1997 an effort was made over a three-day period to loading. For experienced rappellers this was not an issue, but less standardize procedures in each make and model of helicopter that experienced people thought this was awkward. Hence, the Kong Clip was in use at the time. This occurred at the annual Base Manager's and O-Ring. meeting in Tucson. Agreements were reached, procedures were Standardization can be a great thing as long as it takes into account written down, but they faded quickly due to a lack of commitment institutional memory. Change must be thought out. The history of how and oversight. standards or procedures were developed and evolved needs to be During that timeframe the harness changed from one made by local passed down. Serious oversight of high risk activities is a must. Growth smokejumper bases to a commercial harness. I remember efforts must be managed so that only fully-qualified people are carded. An going into deciding if the harness could work, what to do without easy fix may not be the correct fix. the “Capewell” release to release the hook, and defending the Russ Truman, Regional Fire Operations Manager, Pacific Cascade original harness. Region, Washington Department of Natural Resources I don't recall any effort going into exploring potential unintended (USDA-FS Retired – Former Check Spotter) consequences. I remember needing to hold the genie and hook

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