FIREFIGHTER FIRST AID
PILOT PROGRAM TEACHES TECHNIQUES SPECIFICALLY FOR THE FIRELINE
BY TODD MINER
Wildland firefighting is tough and dangerous. Given the physical nature of the work, the environment, the seasonality and uncertainties of employment, the pay scales, the time away from home and family, and especially the dangers faced, firefighting agencies need to do better for those all-too-often ignored critical workers. One of the most pressing and most easily addressed needs is to reduce the impact of injuries through rigorous and specific first aid training for not just medics, but all frontline wildland firefighters.
You don’t need to read this article to know that wildland firefighting is a hazardous occupation. You know the risks. You have likely experienced an injury or illness while fighting wildfires yourself. You’ve seen your crew members get injured or become ill.
But let’s go beyond personal experience and look at some of the evidence regarding wildland firefighter injuries. That evidence, limited as it may be, is sobering and it supports our gut ideas and all those anecdotal reports of the hazards.
Some examples from the sparse literature:
• According to a 2021 report by the Thomson-Reuters Foundation, one in four United States Forest Service firefighters has a work-related injury or illness every year.
• Sixty per cent of Spanish helitack crews were found to suffer from chronic pain.
• Researchers studying a 2002 Florida fire found that firefighters on average were seen by the medical tent two times each in just a 19-day span.
Other researchers, more generally, have documented a disturbing number of injuries. As Montana researcher Taylor Purchio put it in 2017, “[T]oday’s wildland firefighters, regardless of crew type or physical fitness, are suffering injuries at an alarming rate.” From the other side of the world, Australian researcher Annamarie De Vos and colleagues called wildland fire fighting “one of the most difficult and hazardous of occupational activities associated with a range of uncertain and unpredictable work-related risks.”
While the few studies that have been done paint the picture of a dangerous occupation, many experts think the real injury rate is much higher than published reports or is at best poorly understood. In addition to describing how hazardous firefighting is, De Vos pointed out that the hazardous are usually underestimated. Despite the obvious risks and hazards, as fire health expert Kat Navarro commented in 2019 in the journal Environmental Research, “very little is known about the exposures and health outcomes associated with wildland fire fighting.” Researcher Taylor Purchio probably summed it up best in his 2017 master thesis: “Unfortunately, the amount of data on [wildland firefighter] injuries is underwhelming, and research shows that injuries . . . are often underreported.”
Although the hazards are obvious to those in the field, and injury rates have been found to be very high, there has been no broadly delivered or accepted specific first aid training for wildland firefighters. Specific first aid training has been developed, and is sometimes required for, many other occupations – most far less dangerous than wildland fire fighting – but none for those working the fireline. Wilderness First Aid (WFA) and Wilderness First Responder (WFR) have been developed, and one or the other is often required for wilderness guides. Lifeguards have their own first aid training. The military has developed, and it delivers first aid training for its soldiers. Specific first aid training has been designed and required for some structural firefighters. Even babysitters have had specific first aid training developed for their needs.
Given the hazardous nature of fighting fires, there is a very clear and significant need to develop first aid training specifically designed for the unique needs and environments of wildland firefighters. And once designed, the training needs to be made easily available to frontline wildland firefighters.
In response to the needs of wildland firefighters, the University of Colorado School of Medicine began developing a unique course, Wildland Firefighter First Aid (WFFA), in 2019. The school’s Wilderness & Environmental Medicine Section (www.ColoradoWM. org), a unit of the Department of Emergency Medicine, noting the lack of first aid training for wildland firefighters, researched the epidemiology of wildland firefighter safety, the settings in which they work, and the resources available to them. The researchers then took an existing curriculum, Wilderness First Aid, the most germane curriculum to the wildland firefighter situation, and adapted it for the fire line. Since being first rolled out and tested, the curriculum has been continually tweaked to better fit the needs of wildland firefighters and to respond to the latest research.
The Colorado School of Medicine prides itself on teaching evidence-based medicine. In developing and updating the course, every effort has been made to follow the limited evidence, and when that is not possible, to distinguish between teachings supported by research and those supported by expert consensus or tradition.
Wildland Firefighter First Aid is a 16-to-24-hour introduction to emergency medical response program for front line wildland firefighters. As a U.S.-based curriculum, the course is designed to train firefighters to follow the National Wildfire Coordinating Group’s Treatment Principles and to competently follow the Patient Assessment protocols of the Incident Response Pocket Guide (IRPG). The course teaches the specific treatments – and much more – from the IRPG. More about the IRPG, which is also available in Spanish, can be found at https://www.nwcg.gov/publications/461.
The class is focused equally on knowledge and skills. Knowledge is gained through PowerPoint lectures, case studies, and group exercises. Skills are demonstrated by faculty and then practiced by students. Knowledge and skills are brought together and enhanced through scenarios, in which a common injury is simulated, and participating firefighters have to realistically respond. For skills and scenarios, only supplies and equipment normally available are used to keep things as realistic and transferable as possible.
Wildland Firefighter First Aid emphasizes prevention, assessment, and evacuation. Can the firefighter stay on scene and just rest? Does the firefighter need to get out of the field and back to definitive care, but on a non-emergency basis, or is this a full-on, life and death emergency? However, the class also goes beyond just assessment as it teaches treatment for the following medical issues, all of which have been shown to be common and or life-threatening injuries:
• fractures and musculoskeletal injuries
• head injuries
• heat injuries
• mental health.
Scenarios, which students generally find to be the most valuable parts of the class, are designed for small groups of three to five firefighters, and in which one of the participants is the “patient.” The patient has a simulated and moulaged-injury, which the other participants must treat. The scenarios, which last about 30 minutes, are then debriefed with an experienced facilitator. In scenarios firefighters must apply their didactic and hands-on learning in as realistic a situation as is possible. Several rounds of scenarios are run with the goal of improving with each round.
The course has been offered to the USFS Advanced Academy for the past two years to very positive feedback by both firefighters in training and USFS training managers.
Wildland Firefighter First Aid was first offered in early 2020. Due to the COVID pandemic, the class was delivered entirely online. As one would guess with a course that is half skills and scenarios, and is teambased, delivery was difficult. Scenarios were not done and there is no doubt that skills, practiced without live, real-time feedback, suffered.
However, despite the many COVID challenges, in the four classes that were offered in 2020 participants gave the classes an overall rating of nine out of 10. Stellar ratings continued in 2021 when the class was half online and half in-person. Below are some comments from class evaluations:
• The best part was thinking outside the box, doing most with what limited tools and resources you have. A ton of great, straight forward information.
• I have little medical experience, so this helps me feel more confident out in the field.
• Lots of good information that usually isn’t covered in our fire medical refreshers.
• It was interesting to see a wilderness take on medical. Normally we just get a lot of street medicine that isn’t practical in our job.
• I really enjoyed reviewing how to handle these situations with what we have on hand. Case studies were especially helpful, especially when we needed to use our MIR and develop a plan for evacuation.
• As an EMT, the course was a good review of my initial EMT class. The benefit is teaching practical skills such as spinal immobilization or wound cleaning but utilizing items that are immediately available to crew on a wildland fire. All wildland firefighters should take this class.
Crew bosses and managers also thought highly of the class. Some of their comments:
• This was great – my crew learned a ton.
• I feel a lot better after this class, knowing the crew has taken the class.
• I appreciated how the material was accurately focused on the specific needs of firefighters.
A key to the classes’ success has been the involvement of the crew bosses; they became vital players sharing concrete examples, leading discussions, acting as dispatch in scenarios, helping to debrief scenarios. The crew bosses’ years of experience and their credibility added immensely to the participants’ learning.
More information about Wildland Firefighter First Aid, including a sample syllabus and registration links, can be found at www.ColoradoWM.org. The course can be done in a minimum of 16 hours, though more time (up to 24 hours of training) allows for more skills and scenarios practice and is recommended. The course can be delivered anywhere, either in person or as a hybrid offering.
Wildland firefighters, beyond the USFS Advanced Academy, need and deserve specific training in wildland firefighter first aid. In the United States and other countries, wildland firefighters are expected to be able to take care of initial medical emergencies in case of an accident. Pull out a copy of the NWCG Incident Response Pocket Guide and carefully read the expectations of wildland firefighters when it comes to a medical emergency. The Guide assumes firefighters have the knowledge and skills necessary to perform comprehensive emergency medical care as described in the Medical Incident Report. For instance, the Guide assumes a firefighter knows how to stop bleeding; it assumes everyone knows how to keep an airway clear and the sometimes-necessary techniques such as the recovery position. The Guide assumes firefighters know what is normal for circulation and how to take a pulse and likewise for respirations. The Guide states “Stabilize patient” – assuming a firefighter knows what that means.
At the end of the Patient Assessment page in the Guide, complete with dozens of bulleted tasks, is the statement, centered and in bold “Make a transport decision.” That’s a big call. Of course, one expects the decision would be done in conjunction with a dispatcher; still the Guide assumes there is competency by the firefighter who may well be the on-scene IC, at least until outside medical help arrives.
Wildland firefighting first aid training is needed by all wildland firefighters; it should not be reserved just for medics or those attending the USFS Advanced Academy. If firefighters are expected to use and follow the IRPG they must get focused, comprehensive, evidence-based first aid training.
In addition, as research on wildland firefighter mortality and morbidity is limited, more study is needed to better understand wildland firefighter injuries and illnesses so that evidence-based medical responses and training can be developed.
If we are to continue to improve wildland firefighter first-aid training, it will be very helpful to know the epidemiology of injuries and illnesses so that the proper attention and prioritization can be made for different issues. What are the injuries? What causes the injuries? Who is at risk? Better and co-ordinated tracking systems of accidents and events, whether during training, transport, or fire fighting itself are needed.
More study on the effectiveness of Wildland Firefighting First Aid, or other firefighter first aid training, is also needed. External evaluation would provide unbiased measures and perspectives in examining value, along with objective feedback from new perspectives.
The Wildand Firefighter First Aid pilot offerings have been successful from firefighters’ and managers’ perspectives. Wildland firefighters deserve more opportunities to train with a course like this or something similar. Let’s take one of the most dangerous occupations and make it safer.
ABOUT THE AUTHOR
Todd Miner, Ed.D., FAWM, is the education director and a senior instructor, University of Colorado School of Medicine, Department of Emergency Medicine, Wilderness & Environmental Medicine Section.