The National Wildfire Coordination Group (NWCG) has done a good job of prioritizing safety in wildland fire operations and promoting human life over property. For example, fireline checklists inspired by aviation safety prove their worth every day. Nevertheless, the work remains — and will always be — inherently dangerous. There are simply too many variables in nature to realistically overcome all risk. Consider a smoldering snag: Although an experienced firefighter can read a snag well, the infinite variables that keep the snag standing — soil, wind, slope, etc. — can conspire to bring the snag down suddenly and with deceptively little warning. With tens of millions of snags and tens of thousands of wildland firefighters operating about them, it is statistically certain that a snag will fatefully fall at the wrong time in the wrong direction. In an effort to improve response to the inevitable injuries, we propose a universal Basic Fireline Life Support system that addresses the medical emergencies specific to wildland fire and does not require any prior medical experience. Earlier this year we ran a pilot of this course with several crews in USFS Region 1. We propose that it can be scaled to all at-risk personnel regardless of their medical background The fire agencies have relied on the National Registry of Emergency Medical Technicians (NREMT) to provide the foundation of their emergency medical response. The NREMT provides excellent standardized training and is integral to the national EMS response. However, the EMT curriculum reflects America’s health burden — elderly with chronic medical diseases. The wilderness self-selects and it is unlikely a wildland firefighter EMT will encounter end-stage chronic obstructive lung disease, uncontrolled diabetes, or congestive heart failure on the fireline. Only a small portion (less than five to ten percent) of a standard 100-hour basic EMT class discusses traumatic injuries. Additionally, there is nothing in the curriculum on decision making for types of evacuation (e.g. ground vs. air). It is a given in the class that the EMT will be part of an ambulance team, obviating this decision point. Major trauma in the young and healthy is a major cause of morbidity in wildland fire. A wildland firefighter who encounters a major trauma in the wilderness faces the challenge of an improvised evacuation with little help from their EMT training in managing the patient.

Similarly, wilderness first responder and wilderness EMT classes provide great exposure to medicine specifically in the wilderness. It certainly helps urban based EMTs and rescuers start to think about how the practice environment often dictates patient management. However, these classes, while shorter than NREMT certifications, will often take a full week or more and are still prohibitively long from the perspective of training all wildland firefighters. And like urban EMT classes, the material is diluted by topics that are less relevant to wildland fire like toxicology (i.e. drugs and medications), pediatrics, obstetrics, geriatrics, diving injuries, and altitude illnesses.