Sheep Gap Fire. Facilitated Learning Analysis (FLA) Fuels and Fire Behavior Resulting in a Burnover. September 12, Lolo National Forest, Montana

Transcription

1 Sheep Gap Fire Fuels and Fire Behavior Resulting in a Burnover September 12, 2017 Facilitated Learning Analysis (FLA) Lolo National Forest, Montana

2 Table of Contents Executive Summary Methods Report Structure The Complete Story Lessons Learned, Observations & Recommendations from Participants Fuel Conditions and Fire Behavior Indirect tactics for Implementing Confined and Contained Strategy to protect values as risk Lookouts; Communications; Escape Routes; Safety Zones (LCES) Post Incident Procedures Fire Culture Lessons Learned Analysis A Word about the Fire Culture and the Need to Act A Word about LCES Thoughts on the Heavy Equipment Task Force Post Incident Response Summary and Conclusions Commendations Appendices and Maps Area Map of the Highway 200 Complex Map of the Sheep Gap Fire September Map of the Sheep Gap Fire September Timeline of Events Energy Release Component (ERC) graph ,000 hour Fuel Moisture graph Page

3 Sheep Gap Fire Facilitated Learning Analysis (FLA) Area Map of the Highway 200 Complex 1

4 Sheep Gap Fire Facilitated Learning Analysis (FLA) Map of the Sheep Gap Fire September 11,

5 Executive Summary The morning of September 12 started out as a normal work day for the five-person heavy equipment task force (HEQ task force) working on the Sheep Gap Fire on the Lolo National Forest s Plains Ranger District. They had been brought in the day before to construct a contingency fireline out of the bottom of the west fork of Swamp Creek to the CC Divide. It wasn t easy going, as they cleared a path through tightly-packed trees with a heavy canopy, on steep hills, and on narrow roads with tight switchbacks. The crew was making progress on cleaning up and widening the fireline east of Bemish Ridge. At approximately 0800, firefighters discovered a spot on the east side of the west fork of Swamp Creek that had occurred the night before. The fire had grown to approximately 10 acres. The spot was located nearly a mile from where the HEQ task force was working. Aircraft were called in to make water drops to prevent additional spread of the fire. Around 1600, a second spot was confirmed on the east side of the creek, and by 1615, it was running and spotting uphill towards where the crew was working. Five minutes later, the Division Zulu Supervisor (DIVS) ordered the HEQ task force to stop working and move their equipment out and follow their escape route to their safety zone at drop point 105, nine miles away. Three pieces of equipment (2 feller bunchers and a dozer) proceeded off of FR down the newly-constructed line to FR 7583 below. However, this route was too steep for the skidder, so the operator retreated down FR After instructing the heavy equipment operators to evacuate, the heavy equipment (HEQ) task force foreman and a support driver got in their pick-ups and evacuated down FR17345, where they met the TFLD and HEQBt who arrived on a UTV to begin shuttling the two additional pick-ups from the parking area to drop point 105. Shortly after 1630, the fire crested the ridge. Air attack had been closely monitoring the fire and at 1641, recommended that the DIVS order the HEQ task force to immediately abandon their slow-moving equipment and evacuate, which DIVS did. The HEQ task force began looking for suitable locations along the narrow road to abandon their equipment without blocking the road. The HEQ task force foreman and the support driver began an arduous six-mile journey on rocky roads that were steep, narrow, with encroaching brush that scraped the sides of their trucks as they raced down to locate their co-workers. The fire was closing in on them as they picked up the three operators and headed to the safety zone at drop point 105. Meanwhile, TFLD took another contractor s truck and picked up the skidder operator. He had heard that the lower escape route was compromised, so headed out the top of the ridge. The HEQBt retreated in his UTV out the top to safety. 3

6 By 1715, everyone was accounted for. There were no injuries, however, the equipment wasn t as lucky. By 1000 on September 13, fire personnel confirmed that both feller bunchers, the skidder and a contractor s pick-up were destroyed and the dozer was damaged. An interagency U.S. Forest Service and BLM Facilitated Learning Analysis (FLA) Team arrived on September 20, The team included diverse subject matter experts (SMEs) from four regions within the two agencies. The team was asked to focus on how the events and decision-making that led up to this incident made sense to those involved. Highlights of Lessons Learned Several days of successful suppression operations contributed to an overestimation of future success and an underestimation of potential fire behavior. The underestimation of potential fire behavior led to the belief that the heavy equipment could be evacuated within the estimated timeframes. Scarce resources, combined with the fire culture s can do attitude, may result in implementing strategies and tactics that have a lower probability of success. Guidance is lacking for financially and emotionally assisting contractors after an accident or a near miss. Methods. The FLA Team completed this Facilitated Learning Analysis, which focused on the events and circumstances of September 12, The team interviewed key personnel, gathered and analyzed photos, maps, dispatch logs, and incident documentation. They shared portions of the Narrative and Lessons Learned with key interviewees to clarify details. Report Structure. The FLA Team developed the report structure based on the details of the incident, the needs of the organization, and FLA principles. This report includes these sections: The Story. Describes events surrounding the evacuation of personnel and abandonment of heavy equipment, and what the fuels and fire behavior conditions were leading up to the day of the fire. Lessons Learned, Observations and Recommendations from Participants. Offers forward-looking perspectives from the involved personnel. Their thoughts are offered with minimal processing to provide material for future discussion and action. Lessons Learned Analysis. Takes a deeper look at events and circumstances shaping this event and provides opportunities for group discussion. Summary and Conclusions. Provides insights into the seriousness of this incident, and helps to describe the factors that led to its occurrence. Graphs are included at the end of this document. 4

7 The Complete Story It was supposed to be a quiet fire season. Western Montana had heavy snows the previous winter and a lot of precipitation in the spring through mid-june. Then it dried up. The fine fuels flourished and dried out, which made them easy fodder for fire. The first fires in the region started in early July and were easily managed. However, as the dry spell continued and the number of fires increased, fire resources were becoming scarce. Both the Northern Rockies Coordination Center and the national preparedness level went to PL5 on August 10. Then a lightning strike occurred late in the afternoon on August 29, that sparked the Sheep Gap Fire. The fire was located in the Lolo National Forest, about 10 miles from Plains, Montana. The Eddy Mountain Lookout saw the lightning strike and immediately reported the fire to Dispatch, who quickly ordered up initial response resources that included an engine, three helicopters, air attack and four SEATs. When resources started arriving about an hour later, they noted that the fire was around 20 acres. Initial attack efforts were unsuccessful, and by 2200 hours on August 30, the fire reached 770 acres. Initial attack resources continued to manage the fire until the local Type 3 team took over on August 31. At that time, infrared imagery (IR) indicated the fire was 1,637 acres. The strategy was to protect values at risk at the north, south and east sides of the fire. There When you start seeing 1,000-hour fuels burning completely, that s a good indicator it s a red flag. would be no suppression on the west side of the fire because of limited resources and few values at risk. This strategy continued when the Type 2 team took over on September 2. At that time, the Sheep Gap Fire had been absorbed into the Highway 200 Complex along with seven other fires. The fire had two divisions: Whiskey and Zulu, along with a structure group and a contingency group. The divisions were minimally staffed and were trying to manage both, but with so few resources it was like chasing two ends of a lit fuse. This story focuses primarily on the events that took place on Division Zulu. Despite limited resources, fire personnel successfully moved between the two divisions as priorities changed daily. Containment lines were successfully implemented and held between drop points 106 and 200, preventing losses of values at risk. After successfully protecting the highest priority values at risk, the focus shifted to contingency line Preparedness Level 5 (PL5) is the highest preparedness level. To reach PL5, there are many major incidents throughout the nation, that all fire resources are nearly exhausted. In addition, most or all levels of the fire management organization are operating at maximum capacity, and the resources needed to accomplish incident objectives are unavailable. Many firefighters had worked hundreds of hours and were fatigued. When you engage a team, our mission is to do something. strategies. The purpose of the contingency line was to provide an opportunity to stop fire growth should an uncontained section at the bottom of the west fork of Swamp Creek become active and threaten values at risk around the community of Plains. Over the course of several days, the team worked with the agency administrator and district staff to develop a strategy to build a contingency fireline on Division Zulu. They scouted areas to make contingency lines and came up with three alternatives. The Bemish Ridge contingency line (contingency line) was selected as the best option, with work scheduled to begin on September 11. Although fire suppression efforts were aided from several days of inversions and stable atmosphere, and portions of the fire were held in check by aerial resources, the fire reached 11,346 acres by September 9. 5

8 Some components of a heavy equipment task force September 11 and earlier Division Zulu. In the days preceding September 12, Division Zulu had successfully used indirect tactics to reach containment at the bottom of the west fork of Swamp Creek from drop points 106 to 111. Their primary focus on September 11 was to work with the HEQ task force to put in a contingency line that started between drop points 105 and 106 and extended to the CC Divide, with the intent of burning out the contingency at a later date. They continued working with the Sheriff s Department to close roads and manage evacuations. The primary area of concern in Division Zulu was a section of uncontained fireline southwest of drop point 106 along the bottom of the west fork of Swamp Creek. This area was steep, rocky, densely wooded with mixed conifers and cedar trees that frequently fall when impacted by fire. The approximately 10-foot-wide creek had enough water flow to support multiple Mark III pumps. DIVS said, there were too many snags to put people in there, but he did send a senior firefighter (firefighter 1) and a helicopter crew member (firefighter 2) to direct bucket work from safe vantage points to keep the fire in check until the contingency line was built. The HEQ Task Force was contracted to create and enhance the firelines. The HEQ task force was especially useful since handcrews were not readily available and they could accomplish a lot of work in a short amount of time. This HEQ task force and foreman came from the logging industry and was comprised of a feller buncher a bulldozer, a skidder, a skidgine and the foreman overseeing their work and communicating with the fireline supervisors. In addition, a second feller buncher was added to the team through an Emergency Equipment Rental Agreement (EERA). The HEQ task force was assigned to Division Zulu and were supervised by the TFLD and HEQBt, who were Plains RD fire employees. The HEQ task force began building a contingency fireline utilizing road systems and ridgelines to connect the west fork of Swamp Creek to the CC Divide. Feller bunchers are slowmoving motorized vehicles with an attachment that can rapidly cut and gather several trees before felling them. Their top speed is 2-3 MPH. A skidder is used to transport the cut trees to logging trucks or other designated areas. Their top speed is MPH. A dozer is used pushing dirt and trees. Their top speed is about 5 MPH. A skidgine is a log skidder with a firefighting water tank on board. 6

9 They made good progress constructing the line starting on Forest Road 217 and connecting Forest Road 7583 to Forest Road When they went off shift, they left their heavy equipment in the parking area off FR 17345, about nine miles by road from drop point 105 up Bemish Creek. Air Support had been engaged since Sheep Gap Fire started. In addition to dropping water, they also monitored the fire s behavior, reported spot fires and kept an eye on the locations of fire personnel. There were several days throughout the course of the fire where their ability to fly was limited because of heavy smoke. But between September 9-11, there was enough visibility where helicopters were periodically utilized to keep the fire from crossing the west fork of Swamp Creek. By September 11, the fire had grown to 12,386 acres. September 12 Morning Division Zulu and Contingency Group. At 0800, when firefighters 1 & 2 arrived to continue directing bucket work in the bottom of the west fork of Swamp The slopover Creek, they discovered a 10-acre spot fire (spot 1) on the southeast side of (spot 1) was the creek. They informed DIVS of the spot fire, which initiated a creeping and conversation with DIVS and Operations regarding the location of the smoldering in a trigger point (the west fork of Swamp Creek) and whether contingency boulder field. line operations should continue due to the 2-3 hour travel time needed for the equipment to reach drop point 105. They decided to continue operations based on a high probability of success of keeping the spot fire from moving uphill and impacting the HEQ task force. Even if it did move uphill, they felt it would not move towards the location of the HEQ task force. Factors influencing this decision included: the favorable forecasted weather, adequate lookouts and the proximity of the equipment to a road system. They agreed that if activity picked up on the spot fire or another fire got established across the creek, they would shut down the operation and have the equipment and operators move to their established safety zone at drop point 105. The HEQ task force was part of the contingency group assigned to work in Division Zulu. They had been working there the previous day, but this was the contingency group supervisor s first day. At 1030, the contingency group supervisor had a discussion with TFLD and HEQBt about the current operations. The contingency group supervisor expressed concern about the location of the contingency line, the task The connector line the HEQ task force constructed. force working there, and the location of the established fire in the west fork of Swamp Creek. After this discussion, it was decided to keep the HEQ task force working in their current location because the bucket work and broken fuels were successfully keeping the fire in check. Due to his concerns, the contingency group supervisor decided to scout roads and ridges to the east to look for other contingency options. He returned to Arvilla Ridge during the burning period to act as a lookout for contingency group operations. 7

10 After the morning briefing, the HEQ task force left their pick-ups in the parking area where their heavy equipment was stationed and returned to the location they were working the day before. During the next six hours, the feller bunchers widened and improved the connector line by removing trees and brush along FR The dozer operator improved the parking area, then he and the HEQ task force foreman scouted locations for new connector lines further up the road. The skidder operator was initially located in the parking area and was waiting for the feller bunchers to finish the line to his north so he could skid the trees to the Parking area for heavy equipment at the end of parking area. Note: The size of this shift on September 11. parking area was adequate for the pickups and the heavy equipment, but was not large enough to provide an adequate safety zone. Air Support began bucket work on spot 1 around noon and was effective in holding the spot in check and limiting fire spread in the bottom of the west fork of Swamp Creek. By 1400, the smoke lifted enough to allow air attack to provide coverage for the Sheep Gap Fire. Air attack and Division Zulu discussed spot 1, located on the other side of the west fork of Swamp Creek, which was smoldering and creeping in a large boulder field. Air attack told Division Zulu that spot 1 did not appear to be an immediate threat to the HEQ task force due to its location and minimal fire activity. Firefighters 1 & 2 continued working with aerial resources to monitor spot 1 and to direct bucket operations in the drainage. The Fire Blows Up A flurry of activity occurred in a very short period of time. This section focuses on the time the second spot fire was detected to the time all personnel were evacuated and present and accounted for at drop point Fire personnel observed an increase in smoke and fire activity in the bottom of the west fork of Swamp Creek. Firefighters 1 & 2 noticed smoke in a different area of the drainage and moved in to investigate Firefighters 1 & 2 determined that a new spot fire (spot 2) was approximately 200 yards lower in the drainage from the existing 10-acre spot fire (spot 1). They suspected that a tree fell across the creek and created this new spot fire. Firefighter 1 contacted DIVS to report the location of spot 2. DIVS radioed the contingency group supervisor that the fire had breached the trigger point and was across the west fork of Swamp Creek. Bucket operations began focusing on spot 2 to keep the fire in check. I saw that it (the fire) was getting a little angry. Air attack verified with DIVS that spot 2 had crossed the west fork of Swamp Creek. 8

11 1610 Firefighters 1 & 2 observed that the fire had spotted 200 to 300 yards ahead of itself. DIVS began discussions about abandoning the contingency line and walking the heavy equipment out DIVS, air attack and the contingency group supervisor decided that the HEQ task force should move their equipment out to drop point 105. At that time, the HEQ task force was working about 100 yards from the parking area. Firefighter 1 said the spot fire had taken off and was spotting yards ahead of itself The HEQ task force foreman notified the HEQ task force operators and support personnel to begin moving equipment and vehicles to drop point 105. Approximate location of spot 2 West Fork of Swamp Creek 9

12 The Escape The feller bunchers started down the connector line, followed by the dozer. The long, steep pitch of the line made it tough going for the slow-moving equipment. The dozer continued to work on the line as he waited for the feller bunchers to reach the bottom. The skidder retreated down FR because the connector line was too steep for that piece of equipment. The HEQ task force foreman walked to the parking area where the four pick-ups were located to retrieve his truck. He told the other support driver that everyone needed to evacuate. They left in two pick-ups to follow the skidder down their escape route to drop point 105. TFLD and HEQBt left their lookout spot on a UTV and headed to the parking area to shuttle out the remaining two contractors pick-ups. They met the HEQ task force foreman and the support pickup driver near the parking area. TFLD took the skidder s pick-up, while the HEQBt drove out on the UTV. Air attack observed the rapidly-changing fire behavior. Since he was unable to see under the smoke column, he requested a Type 1 helicopter to keep eyes on the fire activity and the progress of the HEQ task force. The fire crested the ridge around The helicopter observed September 12, 2017 at 1632 rapidly-developing spot fires between the ridgetop and the escape route. He relayed the severity of the situation to air attack and recommended a rapid evacuation of the HEQ task force personnel. At 1641, Air attack called DIVS to recommend abandoning the heavy equipment and to immediately evacuate using their support vehicles because the fire was progressing from the ridgetop towards FR DIVS contacted the task force foreman and told them to abandon their equipment and escape to drop point 105, utilizing support vehicles. HEQ Task Force. The feller bunchers were on FR 7583, making their way to drop point 105, when they received the order to abandon their equipment. They immediately began looking for suitable locations along the narrow road to leave their equipment without blocking the road. As the dozer operator removed some obstacles on the road, he saw pine needles shooting all around. He said it had gotten really dark and when he looked through the trees, he could see the glow of the fire. The fire was getting angry. He estimated the glowing black in the woods was about 100 yards away. 10

13 September 12, 2017 at 1641 The dozer took off in third gear and drove until he found feller buncher 1. Because of the noise in the cab, he hadn t heard that they were to abandon their equipment. The feller buncher 1 operator waved him down and told him that they were told to abandon the heavy equipment and proceed out via support vehicles. The dozer operator went to the next wide spot and parked his dozer. Both men were picked up by a support vehicle. Feller buncher 2 was farther down the road and was clearing an area to abandon his equipment while waiting for a ride from the support vehicle. When the support vehicle arrived, the dozer operator got out of the vehicle to get the feller buncher s attention. He parked his equipment and left in the support vehicle. When the HEQ task force foreman heard the call to abandon the equipment, he realized the urgency of the situation because he and the other support driver were the operators ride out. Since the feller bunchers and dozer had taken a short-cut down the connector line to reach FR7583, they were now behind the operators, and were driving rapidly to catch up to them. From their current location, their escape route was an arduous six-mile journey on roads that were steep, narrow, rock-filled with encroaching brush that scraped the sides of their trucks as they raced down to find their co-workers. HEQ task force foreman said while they were traveling down their escape route, the fire wasn t at the road, but it was close. He observed heavy winds, trees swirling and was concerned his escape route would be cut off from falling trees or approaching fire. After It was weird stuff happening the way the wind was sucking stuff off the ground and throwing it in every direction. the harrowing experience to reach the operators, he was informed of a spot potentially cutting off his escape route to drop point 105. It was recommended that they turn around and escape to the south, but he knew that was not a viable option. We can t go back through what I just drove through, and decided to proceed to drop point 105. As they were leaving, he looked across the canyon and saw a big spot fire that was mid-slope on the other side of the drainage. The fire was throwing stuff a long ways. This year was one of the top two years of the most extreme fire behavior that I ve seen. The skidder operator was driving down FR towards drop point 105 when the order came to abandon their equipment. He parked his skidder on FR 7583 and was picked up by the TFLD. Since the original escape route to drop point 105 was potentially being compromised, they headed to the top of the ridge and escaped over the CC Divide. 11

14 Air Support. Air attack had been in constant communications with Division Zulu throughout the afternoon. He first recommended that the heavy equipment operators vacate the area. As conditions worsened, air attack sensed the urgency and recommended that the heavy equipment operators abandon their slow-moving equipment and evacuate. He made multiple calls on air-to-ground. The helicopters had been dropping buckets most of the day and were generally successful in keeping the fire in check. Helicopter 1 couldn t keep up with the spread of spot 2. At this time, the fire came up the hill like an express train. Embers were the size of tea cups and dinner plates. Air attack asked Helicopter 1 to find the HEQ task force. He found the heavy equipment as they were slowly making their way down the dozer line and stayed in the area. As he followed their progress, he was concerned when one of the feller bunchers turned left down the road towards drop point Embers were the size of tea cups and dinner plates. Photo of fire taken on September 12, 2017 at , because they were going closer to the fire. He felt they should have turned right and headed towards the CC Divide. He said he stayed in the area as a second set of eyes for air attack since the smoke column had limited air attack s visibility. Helicopter 2 played a small but significant role in the escape of the heavy equipment operators. He had been working on the Cub Fire most of the day, but air attack asked him to come to the Sheep Gap Fire when the equipment was threatened. Air attack had relayed the routes of the HEQ operators to helicopter 2 and he dropped water on a couple of spot fires, including one drop on a spot below the road that likely would have compromised their escape route. 12

15 Parked Feller buncher 1 September 12, 2017 at 1655 Feller buncher 2 not yet parked 13

16 Sheep Gap Fire Facilitated Learning Analysis (FLA) 14

17 Postscript After everyone met at drop point 105, the continued fire activity resulted in resources progressively moving and ultimately ended up at drop point 102. You could hear it roaring; it was cranking. By 1830, all heavy equipment personnel met with OPS and Contingency Group at drop point 102, were debriefed and released for the night. On September 13, the HEQ task force met at the spike camp to get an update on their equipment. A helicopter flew over the area to help firefighters locate the equipment. It wasn t easy, as they encountered many fallen trees. We had to cut our way in. They located both feller bunchers and the contractor s pick-up, which were destroyed. The dozer suffered damage. They found the skidder the following day, and it too had been destroyed. On September 22, the fire was 24,816 acres. On September 24, the fire was transitioned back to the local unit. By October 15, the fire is expected to be contained. Both feller bunchers were destroyed. 15

18 The Skidder (top left; top right) and a contractor s pickup (middle) were destroyed in the fire. The dozer (bottom right) was heavily damaged. 16

19 Lessons Learned, Observations and Recommendations from Participants Fuel Conditions and Fire Behavior Western Montana received above-average moisture during the winter and spring and was expected to have a below-average fire season. We were laughing this spring about not having a fire season. Everyone thought it wasn t going to be much of a fire season. Portions of the Northern Rockies had not received any measurable precipitation since mid-june. Thousand-hour fuel moistures were recorded in the single digits. Twenty-inch diameter logs were completely consumed to ash in one burning period. The fire behavior we have experienced this season was definitely in the top few years of the worst fire seasons we have experienced. Fuel density on the Sheep Gap Fire Extreme fire behavior exceeded the expectations of personnel on the incident. We had a lot of bad days and this wasn t one of them. (referring to conditions prior to the incident). In my 30 plus years of firefighting, this was one of the fastest moving fires I have encountered. Indirect tactics for Implementing Confined and Contained Strategy to protect values as risk Using the heavy equipment task force had been successful on the Highway 200 Complex to build indirect fireline at the bottom of the slope, which was later burned off to protect values at risk. The success of using heavy equipment to construct indirect fireline in steep and rugged terrain and dense timber stands, far away from main roads is a questionable tactic in the minds of some personnel associated with this incident. The fire either never gets there or the line is black on both sides. If used, it takes time to construct, and may require a larger footprint that may result in giving up ground that the fire may never reach. Multiple contingency line options were considered and evaluated by the agency administrator, resource advisors, heavy equipment operators, operations and division/ group supervisors. However, the concerns of many people regarding the probability of success of these options were not known and understood by decision makers. Planning Level 5 made getting resources very difficult. If we were not in Level 5, this fire would have 600 people on it we had 80. We were hanging on by the skin of our teeth until we got resources. 17

20 Lookouts; Communications; Escape Routes; Safety Zones (LCES) When establishing trigger points, considerations have to be made for the slow operational speed of heavy equipment (2-3 mph); the slow process for loading and transporting heavy equipment, and the length of the escape route especially under potentially extreme fire conditions. Trust your instincts regarding placement of indirect line, personnel in relation to uncontrolled fireline and trigger points. I expressed concerns with the location of the fireline and the close proximity of the fireline in relation to the established fire in the west of Swamp Creek. Trust your gut. Not all resources on the fire were knowledgeable of all available escape routes and safety zones for themselves and for others. I don t want to be the one to make the call for us to operate, but we should have had a safety zone. (HEQ task force member) Effective communications and lookouts ensured that personnel escaped prior to being overrun by the fire. However, there was little margin for error. The dispersed location of the heavy equipment and their different movement speeds may result in span of control issues, communication challenges and lack of situational awareness of the fire. I was out of the loop. I wish I would have had a heavy equipment boss. Post Incident Procedures We do not have good guidance on how to deal with contractors after they have been involved in an accident or a near miss while on an incident. It seems like we were more concerned about the process than taking care of the people. I feel like we failed these people. Decisions affecting contracted resources who are exposed to highly-traumatic events are being made solely on policy, processes and procedures with little consideration and compassion for them as fellow firefighters. Contract resources who have been involved in traumatic events deserve the same opportunity for Critical Incident Stress Management (CISM) assistance. We can t go back through what I just drove through. Holy shit that was close! The helicopter said they need to leave the equipment and get out now. It would be beneficial to develop a brief white paper to provide guidance to assist fire managers and agency administrators in navigating post-incident processes and procedures involving contractor accidents, injuries and loss of equipment. This guidance may also be considered for inclusion in the Red Book. 18

21 Fire Culture The strong sense of purpose to do something and to fully utilize available resources may influence strategic and tactical decisions. We get ordered to do something. It s not anything great, but it s something (referring to the contingency line) A line on a map looks better than nothing. You get into a piece of ground where there are no good options, what do you do nothing? Trying to do too much with too little. Two divisions minimally staffed chasing both ends of a lit fuse. We ve been pushing our luck on this fire from the onset. Too few resources for what we were trying to do. Input from adjacent private land owners or stakeholders to suppress the fire, may contribute to the pressure to do something even if resources are scarce and options are limited. However, this does not appear to be a significant factor in this incident. Implementation of tactics requiring significant resources when resources are scarce and the likelihood of receiving sufficient resources is doubtful, greatly diminishes the probably of success. You put a line in but don t have the people to burn it out, is that a good tactic? A line on a map is better than nothing. Lessons Learned Analysis This section highlights conditions that were key to the accident and that may be setting the organization up for a subsequent accident. A Word about the Fire Culture and the Need to Act.. The 2017 fire season had already proven to be one of the most severe fire seasons in recent history. Thousand-hour fuels were recorded in the single digits. By the time lightning started the Sheep Gap Fire of the Highway 200 Fire Complex on August 29, 2107, the National Fire Preparedness Level had reached Level 5. Existing fires were experiencing difficulty filling resource orders and it was unlikely this situation would change in the immediate future due to unfavorable fire weather forecasts. Even with all of these challenges, the Sheep Gap Fire, which was staffed with around 80 firefighters, had successfully managed to protect numerous values at risk around the small town of Plains, Montana. However, this success may have come at a physical and emotional cost. Most of the firefighters had been working many 16 hour days on numerous fires. Some of the firefighters on the Sheep Gap Fire lived in or near Plains, so they were protecting their homes and the homes of their neighbors and friends. This indirect pressure, combined with previous success could exacerbate the current dilemma facing our agency. Agency personnel are continually stretched to do more during each of these extreme fire seasons with everdiminishing resources. 19

22 After successfully protecting the highest priority values at risk, the focus shifted to contingency line strategies to protect the values of risk in the Plains area in the event the fire were to hook around and make a run to the east. Around September 9, a team comprised of the agency administrator, operations, divisions and READS, began discussing multiple contingency line alternatives. Each alternative had pros and cons. The eastern-most option was ultimately dismissed because it was felt that the fire may never get there and that it gave up too much ground. The alternative located in the bottom of Bemish Creek, was dismissed due to resource concerns in the riparian area. Interestingly enough, this was the alternative that the heavy equipment operators preferred because it was the easiest to operate within. The alternative that was ultimately chosen was the western-most line which was the closest to the fire. On September 11 and 12, the contingency group was tasked with creating the contingency line using the HEQ task force. Several fire personnel from the contingency group and Division Zulu expressed serious concerns to each other about the probability of success of this effort. Their concerns were many, including: The close proximity of slow moving equipment to uncontrolled fireline. Being able to successfully create the indirect line before fire overtook it. The unlikelihood of receiving adequate resources to burn off of the line even if they were successful in completing it. Whether the resources would accept the assignment to burn and hold the line, and If they accepted the assignment, could they successful burn and hold the entire contingency line? There was little doubt in their minds that the fire would eventually cross the west fork of Swamp Creek. It was only a question of time. Even with all of these concerns whether due to selfimposed or direct pressure the decision was made to continue on with the operation. Basing today s expected fire activity off of recent observed fire activity, can be beneficial, but can also lull you into a false sense of security. The weather forecast on September 12 was not exceptional and was similar to previous days weather forecasts. The Haines Index was predicted to be a value of 3 to 4 (depending on variable sources) on September 12, and firefighters were not expecting significant fire behavior. An inversion and smoke had persisted over the area for several days. Visibility improved on September 11 and even more so on September 12, allowing for more consistent air operations. The spot fire (spot 2) occurring at 1530, was likely caused by a tree falling across the west fork of Swamp Creek. No significant weather event caused a dramatic increase in wind speeds or a shift in wind direction. However, what was exceptional, was the very steep slope at the location of the spot fire and the low fuel moistures in the area. These were the main factors contributing to the extreme fire behavior and prolific spotting. Many personnel present commented they had never seen fire move downslope that fast. However, upon closer inspection, it was the rapid develop of multiple spot fires on the lee side of the slope that gave the impression the fire was rapidly running downhill. 20

23 A Word about LCES.. This was the first time on this fire that the HEQ task force was working a considerable distance from major roads. Prior to September 11, the heavy equipment task force was working relatively close major roads and locating escape routes and safety zones was easy. The safety zone for the heavy equipment working for the contingency group, was located at drop point 105. The distance from drop point 105 and the parking area where the heavy equipment bedded each night was approximately nine miles via winding switchback roads. The estimated time to safely extract all the equipment to the drop point 105 safety zone was a good two to three hours. This timeframe had been discussed between fire personnel and the HEQ task force foreman a number of times prior to spot 2 taking off. The distance from the area on the contingency line where the heavy equipment was operating on September 12 to the uncontrolled fire s edge was.8 miles. It took less than one hour for the fire to reach their escape route. Based on the length of the escape route, proximity of the uncontrolled fire edge, and the established trigger points, there was a high probability of the fire reaching the escape route before personnel and heavy equipment could reach the safety zone at drop point 105. The reason this was not perceived by some as a serious issue, is likely due to the minimal fire behavior observed over the previous two to three days, and the fact that aviation resources had been successful in minimizing fire spread in the bottom of the west fork of Swamp Creek. There was a high confidence that aerial resources would continue to be available for the next several days and if aerial resources were grounded due to smoke, it made sense that fire behavior would be minimal. There were also at least three lookouts monitoring the fire from multiple locations and maintaining communications with the HEQ task force. When the second spot (spot 2) occurred in the west fork of Swamp Creek, lookouts and fireline supervisors were quick to identify the severity of the situation and immediately begin moving the HEQ task force towards safety. Even though there were a number of layers and many personnel involved, communication was effective in moving the them to safety. The difference in life and death in this situation, may have been as little as five minutes. If something as simple as a tree or a rock blocking the escape route, the outcome would have been catastrophic. Although this incident did not result in the loss of life, a significant amount of equipment was lost. This loss will likely have a major impact on the owners and operators for weeks and months to come. Drop point 105 was understood by all contingency group personnel to be the established safety zone. The contingency line was located in an area far from major roads and required lengthy travel on slow-speed switchback roads. Given this, it may be prudent to have considered an alternate escape route where the location was known by all personnel on the fire. During the time of the incident, when it became apparent that all personnel could not safely reach drop point 105, local resources knew of another escape route to the south over CC Divide, which they used. It would have been beneficial had all personnel known about the alternate escape route prior to the incident. Thoughts on the Heavy Equipment Task Force.. The HEQ task force has proven to be an effective organization model for the contracting and efficient use of heavy equipment. Within this model, the placement of a contractor-provided heavy equipment foreman with the equipment task force, is highly beneficial and maximizes the efficient use of the heavy equipment task force. 21

24 When the FLA team began gathering information regarding the incident, there was considerable confusion within the team regarding the terminology used to identify the leadership position within the heavy equipment task force. Heavy equipment task force foreman (non-fire qualified contractor) was being referred to as TFLD (Task Force Leader), and can lead to confusion regarding fire training, qualifications and experience. Although many fire personnel within the Northern Rockies Region understand that this position may come with no required fireline qualifications, personnel from other geographic locations may falsely assume that the heavy equipment TFLD meets NWCG standards identified for the task force leader position. As part of discussions with fire personnel associated with the Sheep Gap Fire, it was recognized by participants that this could lead to assumptions regarding the level of fire experience, which may impact the safety of personnel within the HEQ task force or other personnel on a division. While the heavy equipment task force is an efficient and effective model, this incident brought to light a potential pitfall regarding the number of fireline personnel (HEQB, TFLD) required to provide adequate supervision and safety of the task force. The contract requiring of a minimum of one HEQB working directly with the task force is likely adequate in most situations. However, in situations such as the events of September 12 when multiple pieces of equipment become separated and utilized different escape routes, fireline supervision may become inadequate. This issue may also occur in other situations, simply due to the nature of the different pieces of equipment, which operate at different speeds, have different limitations and capabilities. Post Incident Response.. When resources are limited, contract personnel are heavily relied on to assist with firefighting efforts. This is especially true in Region 1. On this incident, the HEQ task force provided a valuable service, and contributed to the successful protection of many values at risk. However, when something goes wrong as in this case we fall back to the black-and-white contractual language, because there is no guidance to address the human and emotional impacts to contractors. In the course of narrowly escaping the fire, the contractors were exposed to a potentially life-threatening event. Many personnel were unaware of the significance of the impacts to those involved in the day s events, and in retrospect would have offered CISM support. It was unclear in the minds of many, whether CISM could or should have been offered to contract personnel. Through the course of conversations with personnel involved in the incident, it became apparent that there are a lot of unknowns regarding working with contractors, and issues dealing with comp claims and equipment recovery. Contracting officers, who may be their sole point of contact, are not always available to provide guidance to those affected after an incident. When this happens, someone needs to provide some guidance or service. In the case of this incident, the equipment time recorder provided valuable support in a timely and compassionate fashion. This may not always be the case, which is why additional guidance clarifying the role of the team and the local unit is necessary. Summary and Conclusions This was a close call! Human lives could have easily been lost. Although human lives weren t lost, four very expensive pieces of equipment were destroyed and one piece of equipment was severely damaged. Personnel on the fire were confident that there would be sufficient time for contingency group resources to vacate the contingency line and reach the safety zone at drop point 105 if the fire spotted across the west fork of Swamp Creek. 22

25 Predictions of significant fire behavior had been forecast for more than a month. However, many days prior to this incident, the fire behavior was not exceptional. In fact, it was somewhat mild because of excessive smoke and an inversion layer over the Sheep Gap Fire. Personnel were able to successfully contain the fire in the west fork of Swamp Creek for many days using aerial resources and sprinkler systems. Barring any significant change in weather, they were relatively confident that they could hold the fire on the northwest side of the west fork of Swamp Creek. The potential for extreme fire behavior was realized when slight atmospheric conditions changed, smoke levels diminished, and the sun s rays reached the slope above spot fire 2 during peak burning period. These factors, combined with the steep slope and continuous fuels where spot fire 2 occurred, accounted for the rapid spread and extreme intensity of the fire. They were fortunate that any number of things that could have happened did not happen and did not keep them from utilizing their escape route to reach the safety zone. Commendations. The Facilitated Learning Analysis Team would like to commend the following people for their exceptional work on the Sheep Gap Fire: Aerial Resources for their vigilance in keeping close eyes on the HEQ task force and other personnel who working on the fire on September 12. Because of their fast response and urgent communications to evacuate personnel as they saw fire conditions rapidly change, they most likely prevented the loss of lives. As they followed the evacuation of the HEQ task force, they ensured their safety by dropping water on a spot burning near the escape route. The Equipment Time Recorder on the Highway 200 Complex, and showed compassion and concern about the people rather than the process. She provided exceptional assistance to the contractors affected by the burnover. The many Fire Personnel, who worked long hours, for many days, on multiple fires to protect lives and property within several communities along the Clark Fork River valley. The FLA team was impressed with the high level of professionalism and esprit de corps of these firefighters. We are proud to work alongside these dedicated men and women. 23

26 Timeline of Events This is a brief overview of the timeline of the significant events on the Sheep Gap Fire. All times are approximate unless otherwise noted. August 29, Eddy Mountain Lookout saw lightning strike and reported the fire to Dispatch Initial attack ordered: Engine 51, air attack Type 1 helicopter, light and medium helicopters, and 4 SEATs Resources begin arriving. The fire was reported to be around 20 acres. August Fire transitions to a Type 3 team. September 2 September 7 September 9-10 September 11 September 12 Type 2 Incident Management Team assumes command of fire. IMT 2 begins discussion with the agency administrator and the district about a proposed contingency line. IC Team develops a contingency line plan with operators, resource advisors and DIVS. Contingency group (HEQ task force) begins working the contingency line in Division Zulu Contingency group supervisor assumes operational control of the contingency equipment group Firefighters find the 10-acre spot fire (spot 1) southeast the west fork of Swamp Creek and notify DIVS The contingency group (HEQ task force) works along FR Helicopters begin bucket drops to check fire in the west fork Swamp Creek In-briefing held between the incoming and outgoing Type 2 Teams. 24