On my desk is an original copy of the pamphlet published in 1978 titled “Some Common Denominators of Fire Behavior on Tragedy and Near-Miss Forest Fires” by Carl C. Wilson and James C. Sorenson (USDA 1978).
Although the Incident Response Pocket Guide (IRPG) (NWCG 2010) discusses the four major common denominators in a single page, the original pamphlet used 31 pages to address the topic.
Like many of our historic documents, much of the thinking included in the Wilson and Sorenson work is just as applicable today as it was when it was published. For example, 32 years ago, these authors wrote: “The potential for loss of life in forest fires, due to burns or other fire-induced causes, is higher now than ever before. Many people live in or play in the wildlands. As a result, “protection of life and property” has begun to dominate fire suppression action plans. The relative safety of “perimeter fire strategy” must often be sacrificed in favor of people and their possessions. This puts forest fire agencies at a disadvantage, because most training in the past has concentrated on perimeter strategy.”
Those words might as easily have been written yesterday
On one page is a drawing of a firefighter with a big question mark where facial features should be, and the accompanying text reads: “The external signs and warnings are important, but the internal state of the firefighter is also important in tragedy and near-miss fires. Even well-trained firefighters are often unaware of a dangerous situation until it is too late.”
Again, we hear truth from the experts of another era in our profession.
While it’s extremely useful to identify common denominators of fire behavior, what about human behavior? Are there any common denominators of human behavior that can be identified, at least when a tragedy was related to fire behavior?In most fire-related accidents—at least in ground fire operations— human behavior plays a crucial role. An accident investigator can’t point to a mechanical part and say: “There, you see: that’s what caused this accident!” No, our accidents are much more complex than that, and attempts to list causal and contributing behavioral factors for such accidents have largely failed for a number of reasons.
For one thing, unlike a mechanical part, humans do not always “fail” in the same way under the same set of conditions. Applying the scientific method requires three basic steps: observation, hypothesis, and testing; the testing phase requires repeatability—in other words, the same set of conditions should generate the same results every time the experiment is conducted.
This repeatability simply doesn’t exist with human behavior and is the prime reason that mechanistic analyses of human behavior are misguided. Furthermore, because behavioral “failure” is a subjective judgment based on hindsight, we might as well eliminate that term from usage in reference to human behavior.
Variability in human behavior and situational creativity are responsible for both our greatest successes and our tragedies. The operational context in which behavioral variability is expressed also changes constantly: the same basic set of decisions and actions might lead to a successful outcome in the morning and tragedy in the afternoon.
A wide range of human behavior has been observed on many different fires, in different locations, and under various conditions. Might there be some benefit to wildland firefighters if we could identify and understand some of the “common denominators of human behavior on tragedy fires?” Could recognition of these factors during an operation increase the chances of a safe outcome?
The authors of the original “common denominators” were wise in recognizing that no list or group of concepts can be considered definitive and all-inclusive in an environment as dynamic as wildland fire. At one point in the 1978 pamphlet, they admonish readers to “remember that all fires differ and that the change of one small factor can result in an entirely different picture.” They also give a nod to the significant role played by human behavior in determining whether an outcome was a tragedy or a near miss: “Whatever the reasons, individual behavior and circumstances make the difference between life and death.” While that’s certainly true, simply knowing that may not make us any safer on a fire.
The following list can’t be considered to cover every situation on every fire. But these things come up often enough in accident reports and analyses of near misses to indicate they are worthy of being considered common denominators of human behavior on many of the wildland fires in which we’ve lost firefighters. And just maybe, they could apply to fires that haven’t happened yet, where we also might lose firefighters, which is why they’re worth thinking about.
Many assumptions regarding roles and responsibilities are made during any communication. Page ix of the IRPG addresses firefighter responsibilities for effective, ongoing communications.
There are also some finer points to be made here: are the objectives provided only tactical, or are there some strategic objectives that should be communicated as well? For example, is “Keep the fire north of this road” a sufficiently complete objective? Sure, it’s measurable; but what happens if it can’t be achieved? Unless the manager or incident commander is present at the point of friction, firefighters will have to devise new objectives on the fly. These new objectives may or may not be aligned with the leader’s intent unless the overall objective has been clearly stated beforehand, with enough leeway to allow for changing conditions.
In recent years, it has become fashionable to refer to firefighters’ “loss of situational awareness” as an explanation for why they missed some important environmental cue. But such assessments tell us nothing of actual events and can lead to few useful conclusions. For one thing, awareness can only deal with immediate surroundings, and as to awareness beyond what is observed or communicated, it’s impossible to lose something you never had in the first place. Furthermore, some human factors experts believe that the only way to literally lose situational awareness is to become unconscious: while awake, people are always aware of something.
The more pertinent questions are: What is the focus of your awareness at any given time and why? Saying a firefighter lost “situational awareness” is the same as saying the firefighter made a mistake. We don’t learn anything from this type of afterthe- fact judgment that would prevent a similarly trained and experienced firefighter in the same situation from making exactly the same mistake!
The concept of “plan continuation,” that firefighters doggedly stick with a plan even in the face of growing proof that it’s going to fail, is also cited as a factor in some accidents. And yet, that same stubbornness in sticking to a plan and executing it, even against intimidating conditions, is a highly valued characteristic of firefighters in most situations. There are likely cultural aspects to this factor as well: firefighters—and especially leaders of firefighters—don’t like to admit that their initial plan has failed or all their hard work was ultimately for nothing. Perhaps firefighters at all organizational levels need to get better at analyzing and revising objectives in the face of changing conditions. Perhaps we need to understand that we have more options than simply ordering more resources and hoping that they show up in time to do some good.
We don’t seem to know why this happens. Were firefighters actively engaged in convincing themselves that the impossible was possible? That they could accomplish their plan when most neutral observers would say “No way”? Or were they just intent on doing something because, well, that’s what they’re there for—to do something?
What role does fatigue play in this absence of reassessment and response? If you’re tired, is it easier to miss small environmental cues or overlook the fact that your escape route is longer now than it was 2 hours ago? Actually, there is no “if you’re tired” on a fire. Fatigue is a constant even if you are fit and meet the 2:1 work/rest requirements.
The critical fact in all operations is that, in real time, we are only capable of acting with foresight, never with hindsight. We only get to make decisions with the information we have at the time. Perhaps we can avoid many hazardous situations if the potential “worst case scenario” is constantly kept at the forefront of our thinking. This is exactly what many of our most seasoned practitioners do on a routine basis and why the “High Reliability Organizing” principle of “preoccupation with failure” makes intuitive sense to most firefighters.
It’s possible to have all of the necessary conditions in place on a fire for a tragic outcome and not have it occur—for example, when a crew is not communicating effectively with other units but no harm results. This probably happens far too often. Such an outcome can only be called “good luck,” but most firefighters would rather be good than lucky.
While many individuals are involved in wildland firefighting operations, we don’t really know much about how the human mind works when on the fireline. Which actions are intentional or conscious, and which actions are automatic or unconscious? How much of what we do is analysis, and how much is intuition? The disciplines of social science and psychology may have much to offer us in terms of insight into how the firefighter’s mind functions under stress. Yet, we have been slow to integrate these disciplines into our profession, perhaps because we have focused our scientific efforts for so long on understanding the physics of how fires burn.
The 1978 “common denominators of fire behavior” booklet states that “each set of circumstances has the potential for creating a tragedy or near-miss fire. Often, human behavior is the determining factor.” Thirty-two years later, that statement still rings true.
While the importance of human behavior in wildland firefighting has long been recognized, for some reason we have been slow to deepen our understanding of it. We must continue to strive for an understanding of why firefighters’ actions made sense to them at the time. What factors do they focus on, and why do those factors seem important? It could be that such an understanding might lead to a more definitive recognition of the common denominators of human behavior on tragedy fires.
Ultimately, our goal is to have fewer and fewer of those to study.
Larry Sutton is the fire operations risk
for the Forest Service at the National Interagency Fire
Center in Boise, ID.
Last updated 4 November 2014