Hold & improve: balancing risk to fight fire during a pandemic

A firefighter walks a ridge as smoke billows from nearby flames. This year the wildland fire community has faced the challenge of mitigating the risks of fighting fire during a pandemic. (Photo by Kyle Miller)

BY NEAL HERBERT

Fighting wildfires during a pandemic seems a little like the paradox of an unstoppable force meeting an immovable object. Wildfires and a virus as two forces of nature putting first responders in an impossible situation. But focusing on this stark choice of dueling threats tends to obscure one of humankinds’ greatest gifts: flexibility. Our ability to react and adapt, making small changes to our routines so we bend instead of breaking.

Dr. Kaili McCray (PhD, MPH, MHE) has been deeply involved in planning efforts to mitigate the risk of COVID-19 to wildland firefighters. He manages the Medical Standards Program for the Department of the Interior. He chairs the Emergency Medical Standards Committee on behalf of the National Wildfire Coordinating Group. And he’s part of the special advisory team the Fire Management Board established to address medical and health-related issues related to firefighters and COVID-19.

Neal Herbert sat down with Dr. McCray to discuss how the wildland fire community is working to keep firefighters safe during these unprecedented times.

How is COVID-19 affecting wildland firefighting?

The biggest impact has been the adjustments made to support social distancing. In many states it was too risky for firefighters to go into a clinic for a regular fitness exam. Some health facilities were also prioritized for COVID-19 response and couldn’t do routine procedures. Agencies provided medical clearance waivers for returning firefighters by having firefighters self-certify that there had been no significant changes in their health. We also created an online, provisional clearance process for new hires in some areas of the country to help ensure continuity of operations.

Wildland fire is a risky business and we’re used to managing and mitigating risks. In many ways COVID-19 is just a new risk we’ve had to add to our matrix. Everyone in the wildland fire community has chipped in to help where they can. The Fire Management Board has also been fully engaged since the onset of the pandemic. They established three Area Command Teams to develop Geographic Area Response Plans, and they set up an advisory team of fire, medical, and public health professionals to develop mitigations and best practices specific to COVID-19.

We implemented those recommendations very rapidly. Now we’re taking a step back to ensure that we don't just implement these mitigations blindly. To borrow a term from wildfire, we're “holding and improving” our line: looking at how our recommendations work in real life and making adjustments as needed. We still have to fight fire. We still have to consider the risks that come along with fighting fire. And we need to see how all these mitigations work together. We also have to ensure that the intent of the COVID-19 mitigations is understood and being carried out efficiently.

We also need feedback from the field. We're looking for more opportunities to do that. We've already started to make some adjustments based on some after action reviews.

What kind of feedback have you received so far?

Initially there was a bit of confusion about things like the “module as one” concept. In wildland fire a module is typically a 7-to-10-person team of people. But in this case, we really mean “family.” It’s the group of people you work with most closely no matter the size. If it’s a 3-person engine crew, that’s the module/family. If it’s a 5-person finance section, that’s the module/family. If you stick together and everyone in your module is healthy, then you’re fine. You don’t have to wear a face mask in the car when you’re with your module. But as soon as somebody goes outside of that module, they need to protect themselves. That’s where they need to wear gloves, wear a cloth face mask, and wash their hands appropriately. Maybe you only send one person from your crew to go to the store, so only one person has to be diligent about taking these precautions.

Have you worked as a firefighter?

I came to the Medical Standards Program in 2010. Before that I worked at the Centers for Disease Control and Prevention and a state health department in the field of chronic disease prevention. I had never fought fire before and right away the folks that I work with said, "you need to get on a fire." One summer I worked on an engine crew for the Bureau of Land Management in Boise. Another summer I did a detail with the Craig Hotshots. That was one of the best experiences ever, especially in terms of me really learning what arduous duty really means. After that I started working on incident management teams as a Resource Unit Leader and a Medical Unit Leader. Now I’ve been rostered on Great Basin Team 1 Medical Unit Leader since 2014.

You mentioned that firefighters need medical clearance. Can you talk more about the program that manages that process?

We want to help people fight fires safely. We have high expectations for our wildland firefighters. They work long hours – like 15 or 16 hours a day – in remote, steep, hot, and often smoky conditions. The work is arduous. They’re not hiking on trails: they’re often making their own trail as they go. They’re hiking with heavy packs and equipment, digging with hand tools and clearing brush with chain saws. In the worst-case scenario, a wildland firefighter must be medically and physically able to run and find a safe spot to deploy a fire shelter at a moment's notice.

The Medical Standards Program administers a process to make sure arduous wildland firefighters meet the minimum medical requirements needed to perform this work without endangering themselves or each other. We also help facilitate the risk mitigation and waiver process for people who don't meet one or more medical standards but can demonstrate their ability to still perform the work safely. And this is an important point: we’re not about keeping people out of fire. If someone has a condition that prevents them from meeting a medical standard, we work with them to ensure the condition won’t incapacitate them on the fire line. What we've seen as a benefit of the program is people with chronic conditions actively managing those conditions when they otherwise might not have. That's a big benefit to the agencies and to the individual in terms of their well-being and long-term health as a firefighter.

How is the Medical Standards Program structured?

It’s an interagency effort across the Department of the Interior fire bureaus. We have staff from the Bureau of Land Management, the National Park Service, the Bureau of Indian Affairs, and the U.S. Fish and Wildlife Service. More than 20,000 people have participated in this program since it started in 2014, including full-time firefighters as well as DOI employees qualified to respond to fires when needed. We have a national contractor that provides annual medical services for firefighters. Those services include exams, scheduling, record keeping, and a national management system for firefighters and managers to track exam and clearance progress milestones.

COVID-19 has taken a lot of attention this year. What’s the long-range view for this program?

Our response to COVID-19 has shown that we can uphold the integrity of the core medical standards program while focusing on larger issues. I think this capacity can carry-over to help us address other critical safety and health issues that affect firefighters. Currently we’re in the process of standing up a new contract for medical services – something we do every five years. Once that’s done, we’ll turn our attention to how we can assist with priority issues like mental health and the impacts of smoke.

Neal Herbert is a Public Affairs Specialist with the Office of Wildland Fire.