1 00:00:04,180 --> 00:00:05,180 HRI 2013 Closed Caption Final 2 00:00:05,180 --> 00:00:08,700 ìThe excessive heat is our big story at six, firefighters having a hard time battling the 3 00:00:08,700 --> 00:00:13,539 rising temperaturesîÖ ìOn the frontlines of that fire yesterday, when he collapsed, 4 00:00:13,539 --> 00:00:17,450 likely as a result of heat exhaustionîÖ ìCrews say the heat is another factor slowing 5 00:00:17,450 --> 00:00:22,040 them downîÖîFirefighters did go to the hospital with heat exhaustion and smoke inhalationîÖîbut 6 00:00:22,040 --> 00:00:26,920 imagine fighting a fire in triple-digit temperatures and wearing all that gear. 7 00:00:26,920 --> 00:00:32,399 Itís fire proof, heavy, but the material doesnít breathe well, that adds to your bodyís 8 00:00:32,399 --> 00:00:37,430 heatîÖîHe was in tip-top physical condition but he died of heatstroke on the fire lineî.. 9 00:00:37,430 --> 00:00:41,420 ìAll the effects come down on them at the same time, the adrenaline is pumping, theyíre 10 00:00:41,420 --> 00:00:47,890 fighting fire, the heat, a combination of many thingsî. 11 00:00:47,890 --> 00:00:52,850 We went down to Texas the end of July, the beginning of August, it was about midway, 12 00:00:52,850 --> 00:00:54,860 getting into the last 1/3 of fire season. 13 00:00:54,860 --> 00:00:59,230 Weíd been busy up to that point, weíd been down to Southern Arizona, and weíd been in 14 00:00:59,230 --> 00:01:04,189 the high country of Colorado, so a wide range of different fuel types and conditions. 15 00:01:04,189 --> 00:01:10,130 Our first night in Texas, everyone described it as kind of oppressive heat, just that really 16 00:01:10,130 --> 00:01:12,110 high heat with humidity. 17 00:01:12,110 --> 00:01:16,530 The fires in Texas had been going on for, it seemed like, most of the summer, so weíd 18 00:01:16,530 --> 00:01:21,150 been getting a lot of information, we saw some warnings about the high heat, fuel types, 19 00:01:21,150 --> 00:01:25,920 fire activity, things like, and that was after the fatality incident, so there was a lot 20 00:01:25,920 --> 00:01:31,409 going on in that respect, so awareness was high on heat illness, and extreme heat in 21 00:01:31,409 --> 00:01:38,100 Texas at the time, and it was running and gunning from the get a go, it was busy. 22 00:01:38,100 --> 00:01:43,920 Basic human physiology suggests that heat production is a function of metabolic activity. 23 00:01:43,920 --> 00:01:49,070 The more active the skeletal muscle is, the more heat production that individual has to 24 00:01:49,070 --> 00:01:52,070 figure out how to off-load to the environment. 25 00:01:52,070 --> 00:01:57,340 So when the environment is pressing down on you, or pressing back on you because the temperature 26 00:01:57,340 --> 00:02:02,979 of the sun, and the ambient conditions are quite warm, or the temperatures associated 27 00:02:02,979 --> 00:02:08,899 with the fire, that radiant heat from the fire, get to be pretty demanding, those add 28 00:02:08,899 --> 00:02:10,200 to the stress. 29 00:02:10,200 --> 00:02:15,719 It doesnít mean that a person canít develop heat cramps, heat exhaustion, or issues in 30 00:02:15,719 --> 00:02:17,569 cooler environments. 31 00:02:17,569 --> 00:02:23,549 If their work output is so aggressive, or aggressive enough to cause an elevated core 32 00:02:23,549 --> 00:02:29,830 temperature, and even in cooler ambient environments, they canít off-load it quick enough, they 33 00:02:29,830 --> 00:02:32,469 could suffer from a heat-related injury. 34 00:02:32,469 --> 00:02:38,109 I started noticing that line production was decreasing, particularly in the heat of the 35 00:02:38,109 --> 00:02:44,540 day ,in the late afternoon, and when I observed my most fit, hardest working firefighters 36 00:02:44,540 --> 00:02:50,049 going down really quick, in that environment, thatís when I knew it truly was not business 37 00:02:50,049 --> 00:02:51,279 as usual. 38 00:02:51,279 --> 00:02:55,489 That was kind of think the seed, of trying to figure out what was going on, in that something 39 00:02:55,489 --> 00:03:02,001 beyond whatever those frustrations were, beyond the crew just not producing, it wasnít through 40 00:03:02,001 --> 00:03:07,430 lack of effort, or lack of ethic, the physiological was kicking in, the heat illnesses was kicking 41 00:03:07,430 --> 00:03:14,760 in, that environment was knocking back our production. 42 00:03:14,760 --> 00:03:21,120 Most of the issues that firefighters are going to face is going to be due to an exertional 43 00:03:21,120 --> 00:03:22,120 heat stress. 44 00:03:22,120 --> 00:03:28,599 So, theyíre working hard, in an aggressive environment, the muscle contraction that happens 45 00:03:28,599 --> 00:03:33,579 over and over and over as the person is line digging or hiking aggressively, or whatever, 46 00:03:33,579 --> 00:03:40,939 as that metabolic heat production escalates, the core body temperature starts to run upwards. 47 00:03:40,939 --> 00:03:44,739 And when it gets to a critical level, and thatís going to be different for every individual, 48 00:03:44,739 --> 00:03:49,419 thereís a lot of individual variability, then the person might start to develop those 49 00:03:49,419 --> 00:03:50,510 cramps. 50 00:03:50,510 --> 00:03:56,619 Heat cramps can happen as a result of an electrolyte imbalance, or it could just be a slight drop 51 00:03:56,619 --> 00:04:01,430 in hydration, or it could just be an irregular rise in core temperature. 52 00:04:01,430 --> 00:04:06,019 Itís really hard to pinpoint what the precise mechanism is. 53 00:04:06,019 --> 00:04:13,619 But when those happen, they function as an early warning sign to say, hey, wait a minute, 54 00:04:13,619 --> 00:04:15,469 something is not right here. 55 00:04:15,469 --> 00:04:20,340 ìLetís get you out of this heat, get that fire shirt off youî. ìHe said earlier that 56 00:04:20,340 --> 00:04:21,359 his hands were cramping up tooî. 57 00:04:21,359 --> 00:04:26,110 If they donít address those symptoms, guaranteed heat exhaustionís going to enter into the 58 00:04:26,110 --> 00:04:27,110 picture. 59 00:04:27,110 --> 00:04:32,690 When a person starts to experience heat exhaustion, certain telltale signs are always present. 60 00:04:32,690 --> 00:04:36,419 So, usually itís dizziness, usually itís fatigue. 61 00:04:36,419 --> 00:04:43,389 Itís usually associated with and most often associated with a feeling of being overwhelmed, 62 00:04:43,389 --> 00:04:45,729 the bodyís just overwhelmed with heat. 63 00:04:45,729 --> 00:04:50,169 Everybody on the crew experienced at least mild heat illness once or several times throughout 64 00:04:50,169 --> 00:04:51,789 the course of the assignment. 65 00:04:51,789 --> 00:04:57,699 Those early symptoms of headache, nausea, light headedness, some cramping. 66 00:04:57,699 --> 00:05:00,759 Everybody experienced that while we were down there, across the board. 67 00:05:00,759 --> 00:05:04,729 Some of the most severe effects occurred with our sawyers, certainly with the amount of 68 00:05:04,729 --> 00:05:08,819 work theyíre doing, the extra layers theyíre wearing I think contributed to that. 69 00:05:08,819 --> 00:05:16,199 The common approach to treating heat exhaustion, at least it seems, in the military and the 70 00:05:16,199 --> 00:05:21,060 fire agencies, is to address it with aggressive hydration. 71 00:05:21,060 --> 00:05:25,199 And that is, again, secondary to what really needs to happen. 72 00:05:25,199 --> 00:05:28,759 And so cooling the individual is really the primary course of treatment. 73 00:05:28,759 --> 00:05:32,710 ìWe got to get you out of the heat, dude. 74 00:05:32,710 --> 00:05:33,939 Keeping you in the sunís not helpingî. 75 00:05:33,939 --> 00:05:37,409 Getting them to stop work, which theyíre probably going to voluntarily do, because 76 00:05:37,409 --> 00:05:40,960 theyíre going to collapse, or theyíre just going to complain to the point that theyíre 77 00:05:40,960 --> 00:05:42,139 going to need to stop. 78 00:05:42,139 --> 00:05:46,439 So getting them in the shade, cooling them off with external cooling, and then, down 79 00:05:46,439 --> 00:05:51,680 the line, addressing any hydration issues that may need to be addressed. 80 00:05:51,680 --> 00:05:57,939 If they continue to ignore those symptoms, then it can progress almost instantly from 81 00:05:57,939 --> 00:06:00,199 heat exhaustion to heat stroke. 82 00:06:00,199 --> 00:06:04,720 And at that point then, helicopterís got to get involved, medivacís going to be the 83 00:06:04,720 --> 00:06:10,360 case, and then a whole lot of other individuals are put at risk. 84 00:06:10,360 --> 00:06:16,120 So you need to get that person off of the site immediately, cool them down rapidly. 85 00:06:16,120 --> 00:06:18,840 But the only way youíre really going to know, is this heat exhaustion? 86 00:06:18,840 --> 00:06:19,850 Is this heat stroke? 87 00:06:19,850 --> 00:06:23,050 Thatís not really the argument that you need to have on the mountain. 88 00:06:23,050 --> 00:06:27,050 Thatís an argument thatís reserved for the clinical environment. 89 00:06:27,050 --> 00:06:30,509 And the only way youíre going to know is if you have a good solid measure of core body 90 00:06:30,509 --> 00:06:31,509 temperature. 91 00:06:31,509 --> 00:06:32,509 The only way to really get a solid measure of core temperature is to go straight to the 92 00:06:32,509 --> 00:06:33,509 gold standard approach, and thatís rectal temperature. 93 00:06:33,509 --> 00:06:34,509 So, if the fire community is serious about being able to monitor temperature in a field 94 00:06:34,509 --> 00:06:35,509 setting, if somebodyís gone down from a suspected heat-related illness, by far the best measurement 95 00:06:35,509 --> 00:06:36,509 that you could obtain is a rectal temperature. 96 00:06:36,509 --> 00:06:37,509 Roll them over, and get over yourselves, and get the measurement, move on within the course 97 00:06:37,509 --> 00:06:38,509 of treatment, because none of the other devices are going to provide a reliable, or even remotely 98 00:06:38,509 --> 00:06:39,509 accurate approach, especially in an unconscious individual. 99 00:06:39,509 --> 00:06:40,509 We really relied on our EMT to make judgments for us, to trigger an EMS response. 100 00:06:40,509 --> 00:06:41,509 We did rely on personal assessment of those early signs, though. 101 00:06:41,509 --> 00:06:42,509 We wanted folks to be honest with themselves, and if they werenít feeling so good to speak 102 00:06:42,509 --> 00:06:46,870 up about it, to either tell their buddy, tell their leader, tell me. 103 00:06:46,870 --> 00:06:51,159 And I said it over and over and over again, because it is somewhat against our natural 104 00:06:51,159 --> 00:06:52,159 culture. 105 00:06:52,159 --> 00:06:57,279 And I think the reason why is it can be perceived, or sometimes perceived, as a weakness. 106 00:06:57,279 --> 00:07:01,400 And in that situation the thought had nothing to do with fitness, strength, motivation, 107 00:07:01,400 --> 00:07:05,139 work ethic, it was a physiological issue. 108 00:07:05,139 --> 00:07:11,300 Our mission is to suppress fires, given whatever objectives are given to us, employ the best 109 00:07:11,300 --> 00:07:13,349 tactics to achieve those objectives. 110 00:07:13,349 --> 00:07:19,050 Weíre a production oriented culture, and weíre given a mission, we want to do it as 111 00:07:19,050 --> 00:07:23,319 best we can, as fast as we can, as good as we can. 112 00:07:23,319 --> 00:07:29,320 And taking breaks will naturally detract from your line production, from the speed at which 113 00:07:29,320 --> 00:07:31,510 you accomplish your tactical objectives. 114 00:07:31,510 --> 00:07:33,900 So, those are counter-intuitive. 115 00:07:33,900 --> 00:07:39,210 But the bottom line that we saw, was that we could produce more line if we gave the 116 00:07:39,210 --> 00:07:42,249 crew members more frequent breaks as it got hotter. 117 00:07:42,249 --> 00:07:44,060 You have some conflicts. 118 00:07:44,060 --> 00:07:48,659 Number one, you want to take care of the folks working for you, but you have objectives that 119 00:07:48,659 --> 00:07:51,389 you want to achieve as well, and so you have to find a balance. 120 00:07:51,389 --> 00:07:56,050 How can I take care of my folks while still achieving the objectives and perform excellent 121 00:07:56,050 --> 00:07:57,050 work? 122 00:07:57,050 --> 00:08:04,400 And so, going through some of those experiences we started changing our tactics. 123 00:08:04,400 --> 00:08:10,349 We came up with some ideas of how to take the breaks, and kind of a more formalized 124 00:08:10,349 --> 00:08:16,539 approach to it, utilizing temperature charts and some ideas that weíd seen from the military, 125 00:08:16,539 --> 00:08:21,749 and coming up with a work ratio based on escalating temperature, where it broke it down into a 126 00:08:21,749 --> 00:08:23,469 few categories. 127 00:08:23,469 --> 00:08:28,840 And when weíd hit those temperature trigger points, it resulted in us taking set breaks, 128 00:08:28,840 --> 00:08:29,870 work/rest ratios. 129 00:08:29,870 --> 00:08:37,219 Thereís no scale that you can calibrate thatís going to be more effective than a really experienced 130 00:08:37,219 --> 00:08:38,650 crew supervisor. 131 00:08:38,650 --> 00:08:44,699 That they know what that crew can tolerate and what they should tolerate, and to be conservative 132 00:08:44,699 --> 00:08:49,250 in the work/rest thatís necessary. 133 00:08:49,250 --> 00:08:56,240 A bi-modal shift, as I saw it, as it related to that incident, would be just focusing work 134 00:08:56,240 --> 00:09:03,470 production, focusing line suppression efforts in the mornings, say 0600 to 1400, and then 135 00:09:03,470 --> 00:09:10,730 through 1400 to 1800, or pull back to patrol, monitoring, like we were doing in the work/rest 136 00:09:10,730 --> 00:09:17,490 ratio, where it involved refurb, active patrol of the line we put in, as well as scouting 137 00:09:17,490 --> 00:09:23,010 line that weíre going to put in later, responding to any kind of flare-ups, spot fires, any 138 00:09:23,010 --> 00:09:24,139 kind of needs around the fire. 139 00:09:24,139 --> 00:09:29,760 And then in the evenings pick it back up as temperatures started to drop back down. 140 00:09:29,760 --> 00:09:32,610 Get back on the line and continue with line construction. 141 00:09:32,610 --> 00:09:34,769 It may not work in all situations. 142 00:09:34,769 --> 00:09:37,660 Itís likely not to work in every situation. 143 00:09:37,660 --> 00:09:42,710 So some things that can be barriers are travel times, as well as any logistical needs, if 144 00:09:42,710 --> 00:09:45,240 youíre needing to pick up food or water, things like that. 145 00:09:45,240 --> 00:09:49,500 Thereís so many different variables, but the shorter that we can make the briefings, 146 00:09:49,500 --> 00:09:55,060 the quicker we can get to the line, and the better weíre able to utilize the more mild 147 00:09:55,060 --> 00:09:56,060 conditions. 148 00:09:56,060 --> 00:09:57,060 You know, the animals have figured it out. 149 00:09:57,060 --> 00:10:00,440 Desert animals are active in the mornings and evenings, and shade up during the heat 150 00:10:00,440 --> 00:10:01,440 of the day. 151 00:10:01,440 --> 00:10:07,890 Itís about being more efficient with your energy. 152 00:10:07,890 --> 00:10:12,139 That would be awesome if weíd be able to predict who was going to go down before they 153 00:10:12,139 --> 00:10:15,390 went down, so we could address it ahead of time. 154 00:10:15,390 --> 00:10:19,899 What happens though, if somebody goes down from a heat-related illness, the likelihood 155 00:10:19,899 --> 00:10:23,000 of a subsequent one is higher. 156 00:10:23,000 --> 00:10:30,160 Right now, we have data from other projects that strongly suggests that the biggest protection 157 00:10:30,160 --> 00:10:35,480 against the potential development of a heat illness, especially in a group of 20 people 158 00:10:35,480 --> 00:10:40,690 on a crew, the individuals that have the highest aerobic fitness level, theyíre going to have 159 00:10:40,690 --> 00:10:43,100 the best possible protection. 160 00:10:43,100 --> 00:10:49,290 So, of the different categories that puts a person at risk for heat-related injury, 161 00:10:49,290 --> 00:10:51,620 certainly aerobic fitness is the highest. 162 00:10:51,620 --> 00:10:56,410 And then whether or not the individual has had a previous illness is another predictive 163 00:10:56,410 --> 00:10:57,730 factor. 164 00:10:57,730 --> 00:11:03,019 Hydration status of the individual I suppose is somewhat linked, but itís really difficult 165 00:11:03,019 --> 00:11:06,580 to evaluate accurately an individualís hydration status. 166 00:11:06,580 --> 00:11:13,980 The worst practice that you can do is to drink exclusively an overabundance of plain water. 167 00:11:13,980 --> 00:11:19,240 Thatís going to do you a disservice, and thatís more dangerous than not drinking an 168 00:11:19,240 --> 00:11:21,370 adequate amount of fluids. 169 00:11:21,370 --> 00:11:26,459 Nowadays we think of that as hyponatremia, when the blood sodium, drops below critical 170 00:11:26,459 --> 00:11:33,339 values, so have some sport drinks always on hand, have electrolytes in the foods that 171 00:11:33,339 --> 00:11:38,610 you have, and use those during the especially aggressive periods of work, when the sweat 172 00:11:38,610 --> 00:11:41,380 rate is at its highest. 173 00:11:41,380 --> 00:11:51,040 The idea of cumulative exposure may work in their favor, in terms of assisting them to 174 00:11:51,040 --> 00:11:55,899 develop some of the physiological characteristics that are associated with heat acclimatization. 175 00:11:55,899 --> 00:12:01,790 It really had more to do with the amount of exertion that they were expelling. 176 00:12:01,790 --> 00:12:04,209 Acclimation really didnítÖit helped. 177 00:12:04,209 --> 00:12:09,410 I think it provided us more resilience to the heat illness, but if folks were working 178 00:12:09,410 --> 00:12:12,790 hard, and it was hot, symptoms arose. 179 00:12:12,790 --> 00:12:19,690 In a given 14 day cycle, if theyíre not given an adequate work/rest ratio here and there, 180 00:12:19,690 --> 00:12:23,500 and their dietís not very great and their sleepís not very great, which certainly sounds 181 00:12:23,500 --> 00:12:30,540 like most 14 day assignments, then that could increase their risk during that window of 182 00:12:30,540 --> 00:12:37,220 time, but donít use segments of the fire season to train for the future fire season. 183 00:12:37,220 --> 00:12:39,779 You want to show up fit for duty. 184 00:12:39,779 --> 00:12:46,100 That includes being aerobically fit to tolerate the work, and also to tolerate some of the 185 00:12:46,100 --> 00:12:49,949 environmental concerns. 186 00:12:49,949 --> 00:12:56,279 As a Hot Shot crew, assigned to west Texas IA at that time, after a fatality occurred, 187 00:12:56,279 --> 00:13:01,509 it was not lost on us that we were a Hot Shot crew doing the same exact thing, in the same 188 00:13:01,509 --> 00:13:05,970 exact place, at the same time, that resulted in a fatality. 189 00:13:05,970 --> 00:13:12,150 So it drove home the point that we were in a serious condition, a serious environment, 190 00:13:12,150 --> 00:13:16,139 with extremely serious consequences. 191 00:13:16,139 --> 00:13:21,980 And so that facilitated us really taking a look at how we were doing business, and how 192 00:13:21,980 --> 00:13:31,009 we might change it to make sure that we did everything possible to keep the crew safe. 193 00:13:31,009 --> 00:13:36,589 I think, overall, itís really more about just being willing and able to recognize that 194 00:13:36,589 --> 00:13:39,060 youíre in a situation that requires some different tactics. 195 00:13:39,060 --> 00:13:43,790 So you need to recognize that youíre in a potentially dangerous situation, learn about 196 00:13:43,790 --> 00:13:45,790 it, and adapt to it. 197 00:13:45,790 --> 00:13:48,050 And that will be different in every kind of situation. 198 00:13:48,050 --> 00:13:51,070 It may not be heat, it may be something else. 199 00:13:51,070 --> 00:13:56,529 So I think itís imperative on everyone thatís on the line to be able to, and be willing 200 00:13:56,529 --> 00:14:03,019 to, and strive to assess the situation, recognize it, and figure out a way to deal with it.