# Presentation: 484969

## American Flat Incident

- Central Lyon County Fire District
- Engine-34 Burn Over Review

- CLCFD Training Division

## Objectives:

- This presentation will be conducted for training purposes only.
- Talk about the review process.
- Timeline of significant events.
- Why the investigation.
- Incident Management.
- 10 Standard Fire Orders / 18 Watch out Situations.
- Findings
- Conclusions

- CLCFD Training Division

## Preface:

- The American Flat Incident was initially dispatched at approximately 17:48 hrs. July 26, 2003 about 1⁄2 mile up the American Ravine Drainage. The fire burned approximately 30 acres in both Lyon & Storey County. The origin of the fire has been determined to be in Storey Co. NDF, Storey Co. FD, CLCFD & BLM responded to the Incident.

- CLCFD Training Division

## TimeLine of Significant Events: 

- 17:48 Storey Co. Incident initiated at 680 American Flats Rd. Silver City.
- 17:44 SC – Smoke reported below the old mill at American Flats.
- 17:49 LC E-34 out.
- 17:49 SC – Confirmed column of smoke coming from American Ravine.
- 17:57 with a size-up.
- 18:01 E-34 fire has jumped the ravine, advised for air attack being ordered.

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## Timeline Continued

- 18:01 E-34 reports he is in a situation & needs an air drop.
- 18:14 LC – E-34 crew accounted for, E-34 is at a loss.
- 18:34 LC – Medic 36. E-34 crew in staging, Patrol 35 and E-34 crew in staging Hwy 341 and American Ravine Rd.
- 18:30 SC-request CLCFD Central 1 or Central 2 to respond to the incident. Engine burned over but crew is safe.

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## Slide 6

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## Slide 7

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## Conduct the Review

- Interagency Standards for Fire and Aviation Operations 2003.
- Reviews are usually based on improving performance & increasing safety, while investigations are conducted when an accident or incident w/ potential for injury or fatality occurs.
- Depending on the complexity & severity, reviews & investigations may be conducted at the local, state/regional, or national level.

- CLCFD Training Division

## Review: Defined

- Reviews address all or any aspects of wildland fire & aviation management.
- Reviews may focus on programs oversight, safety, leadership, operations, specific incidents, preparedness, training, staffing, business practices, budgets, planning, interagency cooperation, & linkage between fire & other agency programs. Review teams will develop findings & recommendations & establish priorities for action.

- CLCFD Training Division

## Investigations:

- This incident clearly falls within the scope of an Investigation under the accident category of Incident with Potential and/or Non-Serious Injury.
- It became evident early in the investigation there would be two simultaneous investigations; the first one being the accident investigation and the second being the criminal investigation.

- CLCFD Training Division

## The Formal Request

- BLM Chief Officer, Storey County Fire Chief had requested initiation of a review team for the E-34 burn-over incident.
- The team was assembled and dispatched to the BLM Headquarters in Carson City for a meeting at 0900 July 27, 2003.

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## The Investigation Team

- USFS
- BLM
- NDF
- RFD
- CLCFD Liaison

- They were given an in-briefing and delegation of authority at that time.

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## The Team Continued:

- The team met at the site of the incident for additional photos & review of the accident site & surrounding conditions.
- The team reassembled at CLCFD Station 35, for a concurrence of activity & re-interviewed the witnesses. A 24 hr report was issued at approximately 1730 hrs.
- Critical Incident Stress Debriefing was to commence at 1900 hrs for all personnel who wish to attend. Initial debriefing was conducted after the incident.

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## E-34, 1998 Pierce Hawk

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## Slide 15

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## Slide 17

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## Slide 18

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## Slide 22

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## PPE

- The crew of E-34 was witnessed with all proper Personal Protective Equipment after the incident.
- The PPE was inspected by the team & was in compliance & met all standards of the NFPA.
- No fire shelters were deployed or uncased.
- No mechanical failures of equipment were reported or observed.

- CLCFD Training Division

## Fire Behavior

- The Carson/Virginia City area & surrounding mountains/desert has had a severe & protracted drought the last several years.
- Vegetation/fuels have been stressed as a result, with current & previous year’s fire behavior reflecting this drought condition.

- CLCFD Training Division

## Fire Weather, July 26th

- Fire Weather Zone 450 indicated no Red Flag conditions for the evening of the American Flats Incident.
- The forecast called for isolated showers and thunderstorms in the evening.
- A local NDF Battalion Chief on the scene reported down canyon winds at 5-8 MPH.

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## Fire Behavior Calculations

- A fuel model 6 was used to represent fire behavior calculations. This represents, fairly well, surrounding fuels in the canyon bottom and walls.
- The fire was witnessed as running down canyon under the influence of a westerly/northwesterly wind.
- These winds are suspected as having been influenced by thunderstorms in the area creating outflow winds.

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## Incident Management

- Objectives:
- 	Keep the fire on the south side of the canyon & prevent it from traveling downhill toward residences at the mouth of the canyon.

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## Strategy

- The strategy (significant contribution) was to control the fire utilizing a direct attack when the road & fuels allowed & indirect in the steeper areas of the canyon.

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## Tactics

- Initially E-34 went to make a direct attack on the fire & establish an anchor point on the road.
- When the engine captain determined he could not be effective using this tactic, he began to retreat by backing out the way he came in.
- Civilians played a role in E-34 making the decision to retreat.

- CLCFD Training Division

## Tactics Continued

- There were areas to turnaround in, but approximately 535 ft of backing was required to reach the turnaround. The upslope shoulder of the road had heavy brush laden with large rocks.
- Some areas in the canyon had limited communication on the assigned frequency prompting the engine to communicate on local agency frequency. The limited communications lead to a short period of concern by the operations & Incident commander for the safety of the engine crew.

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## 10 Standard Fire Orders

**Keep informed on fire weather conditions & forecasts.**
- 	- Being a VFD Engine crew, they did not receive the daily forecast but did observe the thunder cell development & factored this into the decision making.

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## 10 Standard Fire Orders

**Know what your fire is doing at all times.**
- 	- The engine captain momentarily left the engine to walk ahead to see what the main fire was doing & in turn made a decision to relocate the engine to an area of lighter fuels after his observation.

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## 10 Standard Fire Orders

**Base all actions on current and expected behavior of the fire.**
- 	- Observed and retreated.

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## 10 Standard Fire Orders

**Identify escape routes and make them known.**
**	**- The only escape route was the way in. When the spot fire started behind him, he realized his escape route was being compromised.

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## 10 Standard Fire Orders

**Post lookouts when there is possible danger.**
**	**- None posted, first on scene.

**Be alert. Keep calm. Think clearly. Act decisively.**
**	**- Observed through interviews & taped radio transmissions.

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## 10 Standard Fire Orders

**Maintain prompt communications with your forces, your supervisor and adjoining forces.**
- 	- When communications were marginal on assigned frequency he used a local frequency to communicate on.

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## 10 Standard Fire Orders

**Give clear instructions and insure they are understood.**
- 	- Completed

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## 10 Standard Fire Orders

**Fight fire aggressively, but provide for safety first.**
**	**- The engine crew intended to direct attack the fire but decided too many of the watch out situations were present and retreated.

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## 18 Watch Out Situations

**The fire has not been scouted and sized up.**
- 	- When no information was available the engine captain scouted the fire.
- 	- There was a delay in air attack reaching the fire due to thunderstorms over the Minden Airport.

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## 18 Watch Out Situations

**The crew is in terrain they have not seen in daylight.**
- 	- Daylight incident however crew very familiar with terrain.
**Safety zones and escape routes are not identified.**
**	**- Identified as the route in to the incident.

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## 18 Watch Out Situations

**Unfamiliar with weather & local factors influencing fire behavior.**
**	**- Very familiar as he is a long time resident of the area.
- 	- The E-34 crew had 16 years of firefighting experience in area.

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## 18 Watch Out Situations

**Uninformed about strategy, tactics, and hazards.**
**	**- There was sound communications from E-34 captain to command on strategy and tactics.
**Instructions and assignments are not clear.**
**	**- This was a initial attack fire. The fire situation was a rapidly changing environment.

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## 18 Watch Out Situations

**No communication link between crewmembers or supervisor.**
**	**- Not a factor.
**Constructing line without a safe anchor point.**
- 	- Not a factor.
**Building line downhill with the fire below.**
**	**- Not a factor.

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## 18 Watch Out Situations

**Attempting a frontal assault on the fire.**
- 	- Had the fire taken the typical upslope run, the engine would have been able to attack the heel of the fire. However the dynamics of the canyon and thunderstorm’s effect rapidly turned this into a potential frontal assault situation. This was a strong factor in decision to retreat.

- CLCFD Training Division

## 18 Watch Out Situations

**Unburned fuel between you and the fire.**
**	**- Strong factor in decision to retreat.
**Cannot see the main fire and not in contact w/anyone who can.**
**	**- The engine captain left the engine to observe the fire & used this in his decision to retreat.

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## 18 Watch Out Situations

**On a hillside where rolling material can ignite fuel below.**
- 	- Not a factor.
**The weather is getting hotter and drier.**
**	**- Not a factor.

- CLCFD Training Division

## 18 Watch Out Situations

**The winds are increasing and/or changing direction.**
**	**- Major factor in decision making process. Strong down slope winds.
**Getting frequent spot fires across the line.**
**	**- Major factor in decision making.
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- CLCFD Training Division

## 18 Watch Out Situations

**Terrain or fuels will make escape to safety zones difficult.**
**	**- Major factor in decision making.
**Feel like taking a nap near the fire line.**
**	**- Not a factor in decision making.

- CLCFD Training Division

## Training and Experience

- The CLCFD utilizes the Standards & Qualifications located in the NWCG (National Wildfire Coordination Group) 310-1 publication. Both individuals involved in this incident were qualified for the positions filled and posses fire qualifications cards (red cards). The engine captain had 11 years of experience as a volunteer firefighter and the firefighter had 5 years experience.

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## Findings

**Backing:**  The arrival of a concerned citizen on scene added to the complexity of the developing situation. The concerned citizen was insistent that E-34 crew take immediate suppression action on the fire. E-34 crew recognized the changing fire environment & opted to retreat to their pre-determined safety zone. The civilian was on foot & to the rear of the engine. The captain of E-34 was unable to ascertain whether the civilian was attempting to assist their backing retreat or was continuing to insist they suppress the fire. At some point during this confusion, the right front tire slipped over the edge of the embankment, high centering E-34. No spotter or backer was used during the retreat.

- CLCFD Training Division

## Findings Continued

**Fire Weather for Volunteers**: The Review Team is uncertain as to whether the E-34 crew had access to the Zone 450 Fire Weather Forecast prior to their dispatch to the incident. The debriefing interviews showed that both crew-members were aware of the thunder cells in the area.

- CLCFD Training Division

## Findings Continued

**Qualifications & Certifications: **Both crew-members of E-34 are trained & red carded for their positions in accordance with the NWCG 310-1 publication. The crew’s training records reflect they have both received over 30 hours of refresher training of 2003.

- CLCFD Training Division

## Findings Continued

**Equipment Capability and Maintenance:  **E-34 was a fairly new type III engine, 1998 Pierce/Fire Hawk all wheel drive, and was capable of handling the terrain and road conditions that were present on the American Flats access road. Review of the maintenance records indicate the vehicle met all standards and no defects were identified.

- CLCFD Training Division

## Findings Continued

**Air Operations:  **E-34 was the first on-scene resource to arrive at the American Flats Incident. Upon seeing the smoke column, the approaching BLM Chief Officer requested air resources, including an air attack platform through Minden Dispatch. Thunder cell activity over the airport prohibited launching any air resources to the fire. There were no fire resources that could see the overall fire scene.

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## Findings Continued

**Civilians Present:  **Two civilians arrived on-scene, arriving between E-34 (in the lead) and Brush 35. One of these individuals was quite insistent that action be taken on the growing fire. The arrival of & the combative nature of the civilians exasperated & confused a developing & potentially dangerous situation. As the E-34 captain attempted to retreat from the worsening fire situation the civilian _**may**_ have hindered this retreat.

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## Conclusions

- The Fire District has an array of backcountry roads within its protection boundary. Off road vehicle training in adjunct w/ standard operational procedures for these vehicles would increase skills & efficiency & may reduce future accidents.

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## Conclusions

- The review team feels strongly that if a backer was used during this incident, this incident may have been less likely to occur.
- The team recommends the zone fire weather forecast be transmitted / faxed or posted at each fire station.
- The review team recommends that aerial resources be utilized as much as possible due to the complex terrain & limited access/egress during initial attack.

- CLCFD Training Division

## Conclusions

- The review team recommends that Law Enforcement be utilized as much as possible on Initial Attack fires to aid in lessening the involvement of civilians on the fire ground. Law Enforcement could be utilized to manage the local concern & further ensure safety for fire personnel in the area.

- CLCFD Training Division

## Conclusions

- Staffing considerations & procedures should be implemented when utilizing an engine of this type & capability. Reference NWCG Handbook 3, PMS 410-1, Appendix A. The review team recommends that three firefighters be utilized to staff apparatus of this type and capability.

- CLCFD Training Division

## Conclusions

- The prioritization of public safety became paramount in the protection of the civilians on this incident. The crew remained calm & acted decisively even with the impending fire situation & the compounded effect of the engine becoming immoble.

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## Conclusions

- The Fire District has accepted the NWCG Fire Qualifications and Certification System as a standard.
- The review team feels that the initial training and yearly refresher contributed to the appropriate and timely decisions reached and implemented by E-34 crew.

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## New Engine 34, Pierce Saber Hawk

- CLCFD Training Division

## Thank You,From the staff of Central Lyon CountyFire District. 

- CLCFD Training Division