HRI 2013 Closed Caption Final
ìThe excessive heat is our big story at six, firefighters having a hard time battling the
rising temperaturesîÖ ìOn the frontlines of that fire yesterday, when he collapsed,
likely as a result of heat exhaustionîÖ ìCrews say the heat is another factor slowing
them downîÖîFirefighters did go to the hospital with heat exhaustion and smoke inhalationîÖîbut
imagine fighting a fire in triple-digit temperatures and wearing all that gear.
Itís fire proof, heavy, but the material doesnít breathe well, that adds to your bodyís
heatîÖîHe was in tip-top physical condition but he died of heatstroke on the fire lineî..
ìAll the effects come down on them at the same time, the adrenaline is pumping, theyíre
fighting fire, the heat, a combination of many thingsî.
We went down to Texas the end of July, the beginning of August, it was about midway,
getting into the last 1/3 of fire season.
Weíd been busy up to that point, weíd been down to Southern Arizona, and weíd been in
the high country of Colorado, so a wide range of different fuel types and conditions.
Our first night in Texas, everyone described it as kind of oppressive heat, just that really
high heat with humidity.
The fires in Texas had been going on for, it seemed like, most of the summer, so weíd
been getting a lot of information, we saw some warnings about the high heat, fuel types,
fire activity, things like, and that was after the fatality incident, so there was a lot
going on in that respect, so awareness was high on heat illness, and extreme heat in
Texas at the time, and it was running and gunning from the get a go, it was busy.
Basic human physiology suggests that heat production is a function of metabolic activity.
The more active the skeletal muscle is, the more heat production that individual has to
figure out how to off-load to the environment.
So when the environment is pressing down on you, or pressing back on you because the temperature
of the sun, and the ambient conditions are quite warm, or the temperatures associated
with the fire, that radiant heat from the fire, get to be pretty demanding, those add
to the stress.
It doesnít mean that a person canít develop heat cramps, heat exhaustion, or issues in
cooler environments.
If their work output is so aggressive, or aggressive enough to cause an elevated core
temperature, and even in cooler ambient environments, they canít off-load it quick enough, they
could suffer from a heat-related injury.
I started noticing that line production was decreasing, particularly in the heat of the
day ,in the late afternoon, and when I observed my most fit, hardest working firefighters
going down really quick, in that environment, thatís when I knew it truly was not business
as usual.
That was kind of think the seed, of trying to figure out what was going on, in that something
beyond whatever those frustrations were, beyond the crew just not producing, it wasnít through
lack of effort, or lack of ethic, the physiological was kicking in, the heat illnesses was kicking
in, that environment was knocking back our production.
Most of the issues that firefighters are going to face is going to be due to an exertional
heat stress.
So, theyíre working hard, in an aggressive environment, the muscle contraction that happens
over and over and over as the person is line digging or hiking aggressively, or whatever,
as that metabolic heat production escalates, the core body temperature starts to run upwards.
And when it gets to a critical level, and thatís going to be different for every individual,
thereís a lot of individual variability, then the person might start to develop those
cramps.
Heat cramps can happen as a result of an electrolyte imbalance, or it could just be a slight drop
in hydration, or it could just be an irregular rise in core temperature.
Itís really hard to pinpoint what the precise mechanism is.
But when those happen, they function as an early warning sign to say, hey, wait a minute,
something is not right here.
ìLetís get you out of this heat, get that fire shirt off youî. ìHe said earlier that
his hands were cramping up tooî.
If they donít address those symptoms, guaranteed heat exhaustionís going to enter into the
picture.
When a person starts to experience heat exhaustion, certain telltale signs are always present.
So, usually itís dizziness, usually itís fatigue.
Itís usually associated with and most often associated with a feeling of being overwhelmed,
the bodyís just overwhelmed with heat.
Everybody on the crew experienced at least mild heat illness once or several times throughout
the course of the assignment.
Those early symptoms of headache, nausea, light headedness, some cramping.
Everybody experienced that while we were down there, across the board.
Some of the most severe effects occurred with our sawyers, certainly with the amount of
work theyíre doing, the extra layers theyíre wearing I think contributed to that.
The common approach to treating heat exhaustion, at least it seems, in the military and the
fire agencies, is to address it with aggressive hydration.
And that is, again, secondary to what really needs to happen.
And so cooling the individual is really the primary course of treatment.
ìWe got to get you out of the heat, dude.
Keeping you in the sunís not helpingî.
Getting them to stop work, which theyíre probably going to voluntarily do, because
theyíre going to collapse, or theyíre just going to complain to the point that theyíre
going to need to stop.
So getting them in the shade, cooling them off with external cooling, and then, down
the line, addressing any hydration issues that may need to be addressed.
If they continue to ignore those symptoms, then it can progress almost instantly from
heat exhaustion to heat stroke.
And at that point then, helicopterís got to get involved, medivacís going to be the
case, and then a whole lot of other individuals are put at risk.
So you need to get that person off of the site immediately, cool them down rapidly.
But the only way youíre really going to know, is this heat exhaustion?
Is this heat stroke?
Thatís not really the argument that you need to have on the mountain.
Thatís an argument thatís reserved for the clinical environment.
And the only way youíre going to know is if you have a good solid measure of core body
temperature.
The only way to really get a solid measure of core temperature is to go straight to the
gold standard approach, and thatís rectal temperature.
So, if the fire community is serious about being able to monitor temperature in a field
setting, if somebodyís gone down from a suspected heat-related illness, by far the best measurement
that you could obtain is a rectal temperature.
Roll them over, and get over yourselves, and get the measurement, move on within the course
of treatment, because none of the other devices are going to provide a reliable, or even remotely
accurate approach, especially in an unconscious individual.
We really relied on our EMT to make judgments for us, to trigger an EMS response.
We did rely on personal assessment of those early signs, though.
We wanted folks to be honest with themselves, and if they werenít feeling so good to speak
up about it, to either tell their buddy, tell their leader, tell me.
And I said it over and over and over again, because it is somewhat against our natural
culture.
And I think the reason why is it can be perceived, or sometimes perceived, as a weakness.
And in that situation the thought had nothing to do with fitness, strength, motivation,
work ethic, it was a physiological issue.
Our mission is to suppress fires, given whatever objectives are given to us, employ the best
tactics to achieve those objectives.
Weíre a production oriented culture, and weíre given a mission, we want to do it as
best we can, as fast as we can, as good as we can.
And taking breaks will naturally detract from your line production, from the speed at which
you accomplish your tactical objectives.
So, those are counter-intuitive.
But the bottom line that we saw, was that we could produce more line if we gave the
crew members more frequent breaks as it got hotter.
You have some conflicts.
Number one, you want to take care of the folks working for you, but you have objectives that
you want to achieve as well, and so you have to find a balance.
How can I take care of my folks while still achieving the objectives and perform excellent
work?
And so, going through some of those experiences we started changing our tactics.
We came up with some ideas of how to take the breaks, and kind of a more formalized
approach to it, utilizing temperature charts and some ideas that weíd seen from the military,
and coming up with a work ratio based on escalating temperature, where it broke it down into a
few categories.
And when weíd hit those temperature trigger points, it resulted in us taking set breaks,
work/rest ratios.
Thereís no scale that you can calibrate thatís going to be more effective than a really experienced
crew supervisor.
That they know what that crew can tolerate and what they should tolerate, and to be conservative
in the work/rest thatís necessary.
A bi-modal shift, as I saw it, as it related to that incident, would be just focusing work
production, focusing line suppression efforts in the mornings, say 0600 to 1400, and then
through 1400 to 1800, or pull back to patrol, monitoring, like we were doing in the work/rest
ratio, where it involved refurb, active patrol of the line we put in, as well as scouting
line that weíre going to put in later, responding to any kind of flare-ups, spot fires, any
kind of needs around the fire.
And then in the evenings pick it back up as temperatures started to drop back down.
Get back on the line and continue with line construction.
It may not work in all situations.
Itís likely not to work in every situation.
So some things that can be barriers are travel times, as well as any logistical needs, if
youíre needing to pick up food or water, things like that.
Thereís so many different variables, but the shorter that we can make the briefings,
the quicker we can get to the line, and the better weíre able to utilize the more mild
conditions.
You know, the animals have figured it out.
Desert animals are active in the mornings and evenings, and shade up during the heat
of the day.
Itís about being more efficient with your energy.
That would be awesome if weíd be able to predict who was going to go down before they
went down, so we could address it ahead of time.
What happens though, if somebody goes down from a heat-related illness, the likelihood
of a subsequent one is higher.
Right now, we have data from other projects that strongly suggests that the biggest protection
against the potential development of a heat illness, especially in a group of 20 people
on a crew, the individuals that have the highest aerobic fitness level, theyíre going to have
the best possible protection.
So, of the different categories that puts a person at risk for heat-related injury,
certainly aerobic fitness is the highest.
And then whether or not the individual has had a previous illness is another predictive
factor.
Hydration status of the individual I suppose is somewhat linked, but itís really difficult
to evaluate accurately an individualís hydration status.
The worst practice that you can do is to drink exclusively an overabundance of plain water.
Thatís going to do you a disservice, and thatís more dangerous than not drinking an
adequate amount of fluids.
Nowadays we think of that as hyponatremia, when the blood sodium, drops below critical
values, so have some sport drinks always on hand, have electrolytes in the foods that
you have, and use those during the especially aggressive periods of work, when the sweat
rate is at its highest.
The idea of cumulative exposure may work in their favor, in terms of assisting them to
develop some of the physiological characteristics that are associated with heat acclimatization.
It really had more to do with the amount of exertion that they were expelling.
Acclimation really didnítÖit helped.
I think it provided us more resilience to the heat illness, but if folks were working
hard, and it was hot, symptoms arose.
In a given 14 day cycle, if theyíre not given an adequate work/rest ratio here and there,
and their dietís not very great and their sleepís not very great, which certainly sounds
like most 14 day assignments, then that could increase their risk during that window of
time, but donít use segments of the fire season to train for the future fire season.
You want to show up fit for duty.
That includes being aerobically fit to tolerate the work, and also to tolerate some of the
environmental concerns.
As a Hot Shot crew, assigned to west Texas IA at that time, after a fatality occurred,
it was not lost on us that we were a Hot Shot crew doing the same exact thing, in the same
exact place, at the same time, that resulted in a fatality.
So it drove home the point that we were in a serious condition, a serious environment,
with extremely serious consequences.
And so that facilitated us really taking a look at how we were doing business, and how
we might change it to make sure that we did everything possible to keep the crew safe.
I think, overall, itís really more about just being willing and able to recognize that
youíre in a situation that requires some different tactics.
So you need to recognize that youíre in a potentially dangerous situation, learn about
it, and adapt to it.
And that will be different in every kind of situation.
It may not be heat, it may be something else.
So I think itís imperative on everyone thatís on the line to be able to, and be willing
to, and strive to assess the situation, recognize it, and figure out a way to deal with it.