Mark Hnat: When we have a medical emergency on a fire incident, three easy steps to help
you solve it would be: evaluate your patient, evaluate where they need to go, and evaluate
how you’re going to get them there.
Michelle Moore: Our goal here is to stabilize and transport our patient to definitive care
[music playing]
Mark Hnat: I think when we're talking about medical emergencies happening on a wildland
fire there's a lot of things we need to consider, we don't normally have fires close to the
hospital, we don't have incidents that are right on the street, we're not like your urban
EMS fire system. Since we're out in more remote areas we need to be able to manage our patients
for a longer period of time. It may not be, you know, just an hour or two, it might be
a couple hours or it might be overnight.
Michelle Moore: The numbers that I looked at said more than 97% of all the injuries
that we had with these smokejumpers for 10 years, were first aid, first responder, all
stable patients. So absolutely the majority, high majority, of all of our medical issues
or incidents on fire are stable patients.
Bill Arsenault: Sounds like someone isn't feeling to well. You want me to bump out and
take a look? Ok, I'm up along the top where the division break is, I can bump out and
probably be there in about a minute or two.
[radio traffic]
Bill Arsenault: Affirm. Break. Zulu and Operations - Arsenault.
Mark Hnat: The medical emergency that occurs on a wildland fire incident is a rare event
and when it does it happens to one of our own and that puts us in a really bad situation.
Nobody wants to deal with that and everybody is pretty much dealing with a worse-case scenario.
There are some things we can do to combat that; we can train ahead of time, we can have
a pre-plan of what we're going to do before the incident occurs, and we can size up stuff
as we're doing a size up of the fire. And then just take that simple process of: evaluate
the patient, evaluate your destination, and evaluate how you'll get them there.
[radio traffic and ill firefighter having conversation with paramedic]
Mark Hnat: So once you have your patient evaluation, whether they're stable or unstable, that's
going to help drive what your destination is going to be, what your definitive care
for that patient is. Whether that means that person needs to go to a burn unit or that
person needs to go to the trauma center or the community hospital or maybe that person
needs to be hiked out and be evaluated at a local clinic. Or just hiked back out of
the elements maybe it's got too hot for them or the fatigue is setting in and need to get
them out and be done for the day.
Michelle Moore: Whether it's a non-emergency medical transport or a medevac, a medical
situation on the fire can really be looked at pretty simply. Our goal here is to stabilize
and transport our patient to definitive care. So the first part of that is to be able to
have somebody on your incident that can, you know, look at a situation and say this is
a stable patient or this is a not stable patient.
[radio traffic, paramedic talking to IC]
Mark Hnat: So I think another thing we need to consider is not every patient needs to
come out in a litter and not every patient needs to come out immobile, completely immobilized.
There's a lot of injuries and illness people might have but they're still mobile. Whatever
time it took you to get to where you're going to be, probably double that to get out. You
don't move nearly as fast. You don't move merely as agile when you start talking about
moving with a patient and so forth.
[radio traffic, paramedic updating IC, patient health is decreasing]
When we're looking at rescue situations and we're looking at taking someone from the medical
emergency to where they need to go, you need to remain flexible with it, there's so many
times where little things will go wrong that if we can remain flexible and either trouble-shoot
it really quick or change our plan B, we're going to move a lot faster. A lot of times
people get bogged down into, "my plan going to go this way" and then as soon as it falls
apart and the whole process stops.
Michelle Moore: Transport is complicated and I think that we need to have realistic expectations
about how long that transport is going to take, even under good situations and be prepared
for extended transport.
Mark Hnat: Is there road access in there somehow? Is there a way we can get a pickup truck into
them? Is there a way we can use maybe an all-terrain vehicle, or is by foot the option? Or maybe
helicopter is the option. I think the one thing I see a lot of times is folks get, have
a medical emergency, and it puts them into a panic mode. They assume the first choice
is always going to be, "we'll get the medevac helicopter in here." And I think there's a
lot of times we can manage these situations with a lot simpler, safer solution. There
are certainly times we need that medevac helicopter and we need to be prepared for it but we got
to realize that there's more than one option and we need to be exploring all those options.
[radio traffic] [paramedic and firefighters talking]
Mark Hnat: When we started tackling the problem, we had one person identified as the Incident
Commander, we had one person assigned to the patient care on scene, and then one person
assigned as the radio link, and then another person was assigned to evacuation problems
so they're the one solving how we're going to get the person out of there. So almost
an incident-within-an-incident command system and we have, you know, logistics person, we've
got an operations person, we've got a communications person and they're just working together to
solve a problem.
Michelle Moore: Previously I think, you know, from my experience, you know, the EMTs, the
guy who wears the 20-person kit and they went to the class and everybody thinks that if
something goes wrong, Joe is going to take care of it because Joe is our line EMT. Everybody
has to be involved and whether those are your WFRs or your licensed EMTs or your expired
EMTs or your ski patrol guy or the guy who has nothing to do with anything about medicine
or stabilizing a patient but can haul a litter but it's a crew issue, there's parts of it
for everybody. We need to engage all those other people who have the training so that
they have a role in these medical emergencies.
Mark Hnat: We will practice in the environment we're going to play in and we're going to
work in, you know, that's the way to do it. Try to get it realistic but don't make it
overcomplicated.
Michelle Moore: We work in an environment that's continually changing and it is complex
and if you don't practice on the side of the hill, you're not going to be able to do your,
you know, your stabilization and your transport as well as you could if you practiced where
you work and where you are.
Mark Hnat: It's important in your preseason what your resources are in the area, what
the local ambulance services are, what your local rescue services are, what your local
medical facilities are, and then even say you're prepositioned somewhere else for severity
or you're covering another unit in a nearby area, just get a heads up of what the resources
are in the area so when you do have a medical emergency you'll have a better idea of what
the solutions might be. Having that stuff pre-identified is going to make the process
when you have the emergency go so much smoother. You won't have to think about it, you'll already
know what those things are.
Michelle Moore: You know, it's July and it's rained for 2 days and everybody is sitting
around, go pull out that trauma kit off the truck and let's do some scenarios and continue
that so it's not just the beginning of the year when everybody is focused on training.
Michelle Moore: You know I think with every plan we make it's important to have a plan,
it's important to have a Plan B but like anything else with fire, there's still this whole concept
of being flexible and plans change and situations change, fires change and terrain changes
Mark Hnat: You know I think when you're making your plan, when you're doing your initial
assessment and size-up of the fire, you're looking for your escape routes and safety
zones and while you're doing that, consider how you would evacuate a patient if you needed
to. Whatever time it took you to get to where you're going to be, probably double that to
get out.
Michelle Moore: Be wary thought if your plan is contingent on an aircraft, I mean, not
only in initial attack setting but also a large fire setting, if your plan is contingent
on a helicopter it is a flawed plan. You got to have a Plan B; you have to have a plan
C.
Mark Hnat: A lot of times we'll trigger both at the same time if we do decide we're going
to use a helicopter we'll get that launched at the same time we are launching the helicopter
we're getting ground forces mobilized as well. You really, any plan you have, you can't put
all your faith in that one plan because plans do go wrong or things do get caught up or
maybe part of that plan isn't available anymore and now it's not an option anymore.
[radio traffic] [firefighters talking in background]
Mark Hnat: Nobody wants to end up in a situation with a medical emergency within their crew
or an adjoining crew but if we have preseason training, if we look at the risk factors while
we’re sizing up our fire and then manage appropriately during the incident, I think
we can, we can make these problems a whole lot easier than they are.