Coronado National Forest
U.S. Forest Service
300 W. Congress St.
Tucson, AZ 85701
INCIDENT NAME: Frye Fire AZ-CNF-000467
The Frye Fire began with a lightning strike on June 7, 2017 on Mount Graham. The Las Cruces Type 3 Team assumed command of the assignment on June 10th from the Coronado National Forest. On June 16, 2017 at approximately 0630 – Several crewmembers reported an illness to the Las Cruces Type 3 Team. Crewmembers complained of unidentified illness with sore throat, aches, chills and fever. Med Unit Staff took vitals on all patients and confirmed fever of 100 degrees Fahrenheit or higher. They inspected each individual’s throat and saw redness and pustules in the back of their mouths. Med Unit Staff administered acetaminophen, cough drops, and recommended they seek medical attention at the local hospital. Crew begins to travel to Safford, AZ. at recommendation of Med Unit staff, Crew seeks care at Mt. Graham Regional Medical Center (MGRC).
Initial conversations revolved around source of transmission and how to take action to prevent further spread of illness. Agreement occurred between the outgoing type 3 IC and the incoming type 2 IC that transmission was likely through a common source and further precautions and investigations is warranted.
The following actions were taken by the Las Cruces Type 3 Team, :
Disinfect all commonly used surfaces such as tables, door handles, serving areas, ice chests, Medical unit facility.
Discontinue use of local water system (spigots at Columbine and potable water tender) and containers that were filled with water from the local system.
Discontinue use of hand-wash station.
Requested most recent water test results from both.
Caterer was contacted and directed to stop meal production and distribution and to dispose of all currently prepared meals.
All Columbine resources were directed to consume bottled water and MREs.
Isolate crews and crewmembers presenting symptoms from interaction with other individuals at Columbine.
Isolate incoming resources from interacting with all on-site resources.
An increase in numbers of individuals affected at Columbine was reported. Advise both crew leaders to take all members to seek treatment at care facilities and to isolate all affected individuals from those not presenting symptoms and general public. Requested that any diagnoses be relayed back.
Testing is requested to diagnose using wide-spectrum pathogen testing.
Ordering contracted a physician to administer diagnosis and treatment of affected patients at Columbine spike.
2 confirmed positive to Step throat tests came back initially.
Contracting was set up for a MD to provide services at Columbine spike.
Confirmation is made that a Dr., a RN and 2 paramedics are contracted to treat patients (administer testing and provide medication) and Dr. had gone to Columbine Spike and voluntarily swabbed 80 personnel with an additional 63 positive results for Streptococcus. Immediate Azithromycin antibiotic oral treatment began for each member.
The Dr. reported he had also seen six firefighters in his private practice on Friday, the day before; five resulted as positive. Dr. Batty began delivering Azithromycin doses to positive result patients and returned to Columbine Saturday morning for additional testing and a second dosing.
At the recommendation of the Med Unit Staff and Dr., all resources that tested positive were directed to remain at Columbine spike for at least 24 hours after receiving antibiotics to further reduce spread during the contagious period.
The Dr., the RN and the Paramedics were incorporated and coordinated with the medical unit to enforce control measures to reduce spread of infection and additional measures were undertaken at direction of Med Unit Staff. Diagnosis and treatment of assigned personnel until transfer of command continued at the direction of the IC and Med unit leader.
Additional follow-up remains necessary with all exposed resources, which demobilized prior to the Southwest Area Incident Management Team 3 arrival on Friday, June 16, 2017 in order for breadth and spread to be accurate.
Upon Team 3 accepting the assignment, on approximately Friday, June 16, 2017 1230 hours, the Agency Administrator’s also notified the IC of the emerging illness that was rapidly spreading through the spike camp.
Upon arrival, the Southwest Area type 2 Team created an Incident Health Group, led by a local MEDL home based in Safford. The MEDL was in-briefed and assigned solely to focus on the Strep outbreak response and planning along with the Team 3 PSC, with direct report to IC.
Attempts were made to avoid direct exposure to Type 3 team members and other personnel.
Decision was made that Team 3 would assume command of the fire Sunday June 18th at 0600, and the ICP would be moved to Thatcher Middle School beginning this afternoon.
The Incident Health Group along with the regular medical unit stayed proactive in ordering additional Doctors. The Group will continue to monitor the situation and assess any future needs.
The Dr. ordered additional antibiotics and delivered them to the ICP. The Southwest buying team is working on a package to reimburse Dr. for his services and the costs of medications and testing equipment.
Incident Health Group Supervisor consistently briefed all members present at IMT meetings and briefings in order to deliver a consistent message and denigrate potential rumors.
Incident Health Group Supervisor contacted Graham County Public Health who agreed to contact Graham and Greenlee County Epidemiologist and they agreed to contact the State Public Health Department in addition.
Team 3 developed a procedural flowchart and advised all personnel of the appropriate handling procedures once a new patient presented with Strep symptoms. This included potentially keeping them isolated from the ICP populace in an isolation/decontamination room, a shower, change of clothes plus another isolated room nearby where they could receive rest and recuperation and so as not to expose more personnel while under treatment during contagion.
Although Dr. suggested most patients would not be contagious after 24 hours post-antibiotic treatment, the decision was made by Team 3 to extend this period to 48-hours as a measure of additional surety that any contagious spread does not propagate.
Graham County Public Health developed an epidemiological investigative process to include personal interviews and questionnaires with all available parties.
Continued research and testing of necessary patients is ongoing.
Additional positive strep-result patients from previously demobilized crews are now being reported and tracked at the ICP.
The Incident Command System is designed in a way that allows expansion and contraction. With that flexibility the team was able to create a Group designated to come up with a plan to treat and care for those infected and ensure spread was minimal. Creating this separate dedicated Incident Health Group allows the Type 2 IMT to also concentrate on the planning and implementation of the strategies for regular fire operations.