After Action Review Summary Medical Emergency Poisonous Snake Bite Incident within the Incident
Overview On July 29, 2010, NorCal Team 1 was assigned to the McDonald Incident on the BLM Northern California near Termo, California. The fire burned in rugged high desert terrain; fuels consisted of sagebrush, cheat grass and juniper. A Red Flag Warning for high winds and low RH was issued for July 30 and 31, 2010. The fire was contained at 10,677 acres and at it's peak was staffed by 1186 personnel. On July 30, 2010 the safety portion of the Incident Briefings highlighted the Medical Plan (Attachment A) and the Injury or Incident Communications Protocol (Attachment B) in the IAP as well as contingency Medivac procedures if EMS helicopters were unable to complete a mission due to the high winds in the weather forecast (30-40 mph). Team safety personnel also completed training with Incident radio operators. The training included a functional review of managing an Incident within the Incident using the Incident within the Incident Protocol (Attachment C), the Incident Communications Protocol and concluded with multiple scenarios involving fireline and in camp emergencies. The Incident On July 30, 2010 a crew made the decision to sleep in an area of slightly rolling terrain located off of the main access road approximately 1.8 miles East of the Incident Base and approximately.4 miles North on a two track through the sage and juniper (Picture 1). The crew parked their vehicle off of the two track and dispersed in an area approximately 50 feet behind their vehicles (Picture 2). Tents were not used, the crew choosing to sleep on ground cloths in their sleeping bags. At approximately 2300 and about 1 hour after bedding down, a poisonous snake crawled into the sleeping bag of a crew member as they slept. Picture 3). After awaking to the movement, the crew member received multiple bites on the thigh while removing the snake from their sleeping bag.
Picture 1 The crew member crawled approximately 30 feet to the area where their supervisor was sleeping, woke them and notified him that they had been bitten by a snake and that their left side and left leg was going numb. The Crew Superintendent notified McDonald Communications on the fire's command frequency that they had a medical emergency, possible rattlesnake bite with an approximate 5 minute ETA to camp. Picture 2
The Response McDonald communications received the notification at 2307. The Incident within the Incident protocol was initiated, a size up and needs were obtained, a IC was designated and key contacts were made. The crew superintendent and patient arrived at the Incident Base entrance at 2311, this was also the location of the medical unit. The patient received initial care from the med unit staff (an RN with current critical care experience operating under their medical director's protocols) and an EMS helicopter was requested at 2314. The injured firefighter was transfer to the Incident's ALS ambulance at approximately 2318. The Team Operations Section chief assumed Camp IC. A medivac site was illuminated with glow sticks and headlights and the EMS helicopter landed at 2359. Patient care was transferred and the EMS helicopter departed for Renown Medical Center in Reno. The firefighter was admitted to the hospital and is recovering without complications. Lessons learned Picture 3 Planning for an Incident within the Incident is an important and necessary part of any team assignment. Practicing the plan with resources not normally assigned to the team (especially RADO and key unit leaders) is critical for a successful outcome. Having a map (in conjunction with a cell phone list) in the Communications Unit that shows the sleeping locations and tents marked with signs designating IC, OPS, Safety and other key personnel is important for a timely response to an emergency.
MEDICAL PLAN 1. Incident Name 2. Date Prepared 3. Time Prepared McDonald Fire 07/29/10 2100 5. Incident Medical Aid Station 4. Operational Period 07/30/10 0600-2100 Medical Aid Stations Frontline Medical Location McDonald ICP, 855 Grasshopper Rd., Termo, CA N 40 50.338 / W 120 30.794 Paramedics Yes No 6. Transportation AIR Resources Name Address Phone Mountain Life Flight 710 Ash St. Susanville, CA 96130 911 or 530-251-2844 RN Care Flight (Day/Night) 450 Edison, Reno, NV 89502 911 or 800-648-4888 RN Enloe FlightCare (Day/Night) 1531 Esplanade, Chico, CA 95926 911 or 530-332-6774 RN CHP (hoist with 165 line) Benton Airfield, Redding, CA 911 or 530-225-2040 Cal Fire-Bieber 202(Short haul) 510 Bridge St., Beiber, CA 96009 911 or 530-294-5251 BLM 553 (BLS medivac) Helibase, Ravendale, CA 911 or 530-257-5575 Name Location Ground Ambulance Services Mt. Shasta Medic 73 McDonald ICP. (Incident Ambulance) Semsa Ambulance Susanville, CA Modoc Med Center Ambulance Alturas, CA 7. Hospitals Paramedics Yes No Paramedics Yes No Name Address Travel Time Air Ground Phone Helipad Yes No Burn Center Yes No Banner Lassen Medical Center 1800 Spring Ridge Dr., Susanville N 40 26.16 / W 120 37.40 20 50 530-252-2096 (good for med. control) Modoc Medical Center 228 McDowell, Alturas CA N 41 28.48/ W 120 32.42 20 45 530-233-5131
Renown Medical Center. Level II UC Davis Level I Trauma/Burn Cntr. 1155 Mill St.,Reno, NV N39 31.34 / W119 47.45 2315 Stockton Blvd. Sacramento N38 33.17 / W 121 27.05 1 hr. 1:45 1:30 6 hrs. 8. Medical Emergency Procedures 775-982-2005 916-734-3636 916-734-3790 Contact McDonald Communications and declare a medical emergency on Command, advising your location and situation The closest Division Supervisor will respond to the location to take control and direct necessary actions The closest Safety Officer and EMTs will respond to the location to assist with patient care Use the attached Injury/Incident Communications Worksheet to coordinate appropriate care and transportation Secure the scene area and identify witnesses for later investigation Keep a log Prepared by (Medical Unit Leader) 10. Reviewed by (Safety Officer) Attachment A
Injury or Incident Communications Protocol Location Situation Any special equipment required Number of injured Type of injuries Immediate transport required: Yes No Best method: Ambulance Helicopter Vehicle Closest pick up point (DP, Helispot) LOC Resp. Pulse BP Weight Injury Medical History/Allergies Air Transportation Triage Mechanism Contact EMS Helicopters on CALCORD Air Ambulance Transport to Med Unit Struck by tree Fall of 10' or more Snake bite with pain and swelling Insect bite with shortness of breath Signs of heat stroke (hot, dry, disoriented) Burn Injury greater that 1% body surface Area Injured Significant blunt of penetrating trauma to head, neck, chest, abdomen or pelvis Any arm or leg fracture Symptoms Disoriented Chest pain or shortness of breath Weak or absent radial pulse Pale, col and sweating Minor dehydration Cut or laceration with bleeding controlled minor bites and stings Minor burns Minor blunt trauma Minor penetrating trauma Extremity sprains and strains Alert and oriented No shortness of breath Good pulses Medivac Sites Identify potential medivac sites. Obtain Lat./Long. and give information to the medical unit If air or ground ambulance is DELAYED: Package and transport patient to rendezvous with Incident Ambulance. Re-route EMS helicopter to rendezvous point or medivac site as appropriate. If Declaring an Incident within the Incident The closest DIVS will respond to manage the incident. They are responsible for giving an accurate size up, ensuring scene safety, setting priorities and initiating an appropriate response. The closest Safety Officer and Line EMS will respond to the scene to assist the DIVS. Secure site and begin initial investigation when situation is stabilized. Attachment B
Incident with the Incident ICP Support Radio procedures for Communications Unit at ICP 1. Clear the Command channel for Emergency traffic 2. Obtain an Incident size-up and needs using the Communications Protocol 3. Designate an IC (i.e. Firerfighter Smith is now Medivac IC) 4. Notify and request the in-camp OSC, SOF, MEDL and IC to respond to the Comm. 5. If incident is expected to extend beyond 15 minutes. Move the new Incident to the Contingency Frequency; List Frequency HERE 6. Notify Air OPS if air transport is being requested Oversight Responsibilities: OSC SOF MEDL IC Provide assistance to the OSC and MEDL Provide oversight to ensure: 1. an accurate sizeup was obtained 2. Scene safety 3. Priorities are appropriate 4. Appropriate resources are requested Provide direction and support to Branch Director or DIVS as requested or necessary Advise the IC on requesting an accident investigation team/cisd/hazmat, etc. Ensures that Accident Site is secured. Delegates to and directs SOFR(s) Coordinates EMS response as appropriate Ensure the Protocol is being followed Request PSC, LOGS and PIO as needed. Notifies Agency Administrator and coordinates information flow with designated Agency Rep. Through Agency Administrator, contacts the Sheriff or Medical Examiner, in the event of a fatality. The IC or his representative will also contact other appropriate agencies/representatives Requests a Critical Incident Stress Debriefing Team (CISD) through the Agency Administrator. Attachment C