NWCG Standards for Rapid Extraction Module Support, PMS 552

Buckle in!

So, if you haven’t figured it out yet, I’m a REMS guy. No, I don’t profess to be an expert, or a SME, but I’ve been in this field for about 30 years. I’ve performed rescues on four continents, war zones, high altitude and a multitude of environments that push the best of us to the limits. I have been involved with REMS on wildfire since 2020, while I was still on Active Duty in the military, and since retiring, have made this a priority. One of the things that I have hoped for was for the standardization of what a REMS team is, and frankly, is not, and for REMS in whatever form it takes to be placed into the VIPR system, to further standardize what you get when you order a team, regardless of vendor. But as they say, “Prepare to be disappointed”!

So, to say I was a little excited when this came out, is an understatement, but based on some of the draft documents that I had seen, I was highly skeptical that this would be a one stop shop for everything REMS and REMS related. I hate being right! As fast as I became excited, I quickly became disappointed in this document and seriously question the subcommittee. Before we move on, here is the complete document for you reading pleasure:

NWCG Standards for Rapid Extraction Module Support, PMS 552

We are going to look at this almost page by page and attempt to dissect what this document is and is not. Further discussing Pro’s and Con’s and shortcomings that I have found within these standards. I say all of this, not as a cheap jab at the sub-committee or the hard work and research that went into this. But I believe that some of their decisions and conclusions are based on incomplete information, or old paradigms of the way XYZ department has done it, because that’s the way we’ve always done it…You get the point.

We start on page 2 with a definition and the core goals of the TEAM. I like this, while I believe they left that explanation vague enough to leave interpretation, and less than a definitive conclusion of the full capabilities of what REMS is and will be on the Fire Ground. Furthermore, one of the inconsistencies I have witnessed on assignments is the lack of understanding of the capabilities of what REMS is, or how they should be employed. Not only by Overhead, but by many MEDLs that are responsible for the proper use and placement of those chess pieces. To make this matter worse, while I like this particular line in the description. Those parties that do not do rescue, and have not performed rescue, will misunderstand this statement:

The REMS team aims to swiftly transport incapacitated firefighters off the fire line, ensuring they receive timely and appropriate medical care.

While the description states that the goal is to provide medical care and transport to definitive care, the phrases rapid transport, swiftly transport, and swift access may mislead the reader to believe that these rescue operations can always be done at warp speed. Unfortunately, that is rarely the case, as rescue, even when efficient and effective, can be a time-consuming enterprise. Some find it hard to believe that just because we can strap someone into the UTV and go 70 down a dozer push, doesn’t mean we should. Depending on the severity of the injuries and our evacuation plan, using the wheel, or doing a complete carry out, may be the best thing for the patient. This takes time, as anything faster, could, (pause for dramatic effect) kill the patient.

Now I know that example is an extreme, but we work and play in an extreme world, so to me at least, it applies.

Page 3 of the document is the Table of Contents or page i. if you’d like, and while it lists everything out, this is where I see the first of what I believe is going to be big issues. Things to note from the beginning. NWCG has adopted the typing model for REMS, which some have expressed a dislike for, but it does make it easier when ordering, and helps those with less understanding, at determining capabilities, maybe… We go to training and qualifications and team considerations, and then to the MEL (Minimum Equipment List). And without getting into the document, this is where the real trouble begins. For each type of REMS team, types I, II, and III, there are both a MEL, and an OEL. OEL standing for Optional Equipment List. While this is a standard practice, it sets a precedence that when you order a specific type of REMS, not all teams will be the same, which detracts from the point of being standardized. BUT, we haven’t seen the lists yet, but we will get there.

The remainder of the Table of Contents looks fairly standard, and the Introduction on the next page is additive to the scope and purpose of what REMS is. Next is the checklist, which looks complete. As we get to page 3 (page 6 of the actual document, in PDF), we get to the breakdown of the typing’s. Essentially, Types I, and II are versions of REMS, and Type III is what was previously known as RATS.

Things to note that stick out. First, please note that for a Type I REMS, it requires at least 1 EMPF, and 1 EMTF. This makes some sense to me, but every incident I have been on this year, MEDL’s have listed in the special needs of block #12 in the Resource Order (RO) for 1 EMPF and 3 EMTF. So, which one is it? It is either the standard, or it isn’t. I do not care either way, but if you set a standard, use it.

Type II and III REMS can be ALS or BLS. To be honest, I don’t know how I feel about this. To say that I am conflicted is an understatement, but at this time, I haven’t thought through the second and third order effects of this. And of course, I could be caught in the paradigm that it needs to be ALS, because that’s the way we’ve always done it.

Next is the biggest issue so far. The REMS TL is “REQUIRED” to be a Single Resource Boss-Qualified for both Type I and II REMS. While at a quick glance, that makes sense from a leadership training and mentorship approach when viewed through a fire centric lens. However, this is not realistic, nor feasible. As most of the current REMS folks came from the medical side of the house and not the fire side, most lack the training as FFT1’s/ICT5’s that you would need to then become a Single Resource Boss. Most of these folks will also most likely not take two to three seasons off to work on a crew or engine for a chance to complete those task books. Remember, you can’t just join a crew and dictate that you are opening task books. With this, 1 of 2 things is going to happen.

1. REMS guys and gals are going to find a way to circumvent the system and pencil whip the crap out of those task books. This is dangerous and stupid.

2. Fire guys and gals are going to be sent to the 5-day short course for rope technician and then get signed off without any actual experience, which is equally dangerous and stupid.

Without a legitimate pathway for these Rescue Technicians to open task books and complete them as trainee’s without leaving the REMS side of things, this is going to cause more problems than it is going to solve. The realization that the subcommittee either didn’t consider this, or didn’t care enough to address it, shows their lack of understanding, experience and knowledge when it comes to REMS. Yeah, I just said that, and I’ll back it up! However, I come with two possible solutions, well 2 and a half.

1. First, they need to reimplement the task books for EMTF and EMPF, so that all fire line medical providers are standardized under that model. This allows for trainee’s and certain tasks can be implemented starting here. (That’s the half), next allow for REMS team members and current team leaders to open task books (AS CONTRACTORS) and work on them as trainee’s while on assignment. If you want this done right, NWCG needs to make this attainable.

2. Instead of forcing a fire standard on medical folks, use the task books under FEMA for Technical Rescue Team Member, and Technical Rescue Team Leader and modify them for NWCG as Technical Rescue Team Member-Fire (TRTM-F), and Technical Rescue Team Leader-Fire (TRTL-F) with the added in tasks that are fire specific. This can also be tied to ICT-5 for the Team member, and ICT-4 for the TL.

Either way, it is a sustainable and achievable standard that meets the spirit and intent of what it appears the subcommittee is attempting to achieve.

Next, I agree with the vehicle rescue requirements, but it is super vague! If the rest of the requirements are in line with NFPA, should these be also?

Lastly, with these requirements, the physical fitness standard is the Arduous Pack Test. Unpopular opinion here. It is not enough. REMS teams should be held to a standard closer resembling that of Type I crews, Helitak, or Jumpers. Since these personnel are most likely to be our customer base. REMS team members should have a higher level of fitness, period.

Next, we have the “REMS Team Considerations”.

-a. makes sense, but this should be added to the Training and Requirements section. Words mean things…

-b and c. Also makes sense. For this, REMS team members should at a minimum be HELR qualified (Helicopter External Load Rigger). This allows them to rig sling loads and potentially patients under long lines for short hauls and meet NWCG requirements for such.

i. While I like this concept and have done so on incidents. This needs to be a legit conversation between Overhead and the REMS TL. It is not just about staging equipment in the correct location, but what happens when we get it wrong? What’s our PACE plan? And, this equipment is expensive, does the contract cover it, if it is lost, stolen, or damaged?

k. I agree and disagree with this. A team that is built correctly, can be split effectively.

l. Agreed, but what are the requirements for extrication? Both equipment and training/qualification? (As a side note, my agency qualifies our members at the Basic Vehicle Rescue- Operations level; and we do carry Hurst extrication tools and various hand tools).

The rest of the considerations are in line with what I would call industry standard and are all reasonable. Next let’s dive into the Minimum Equipment Lists, and Optional Equipment Lists. But before we begin, hey subcommittee, the copy and paste from a structure department light rescue truck is a nice touch. Too bad the list is a disgrace to modern rescue.

Let’s get started:

We start with an explanation of the MEL, and how that standard should be applied. Nothing new here, although is specifically states, that all REMS team members shall (meaning mandatory) have an approved Fire Radio. I am not opposed to this, but Comms needs to set aside a channel for REMS use’ in an IWI. Putting everything over Command or bogarting a TAC channel is not appropriate. Instead of going line by line, I am just going to cover the things I do not like:

-1500’ Rope (9.5mm through 12.5 mm). First and foremost, even if we split this rope into 200 foot, or 250 foot sections, do you know how much weight that is? Too much. Part of being a Rope Rescue Technician, or a Specialist is knowing how to do more with less. Further, there is currently 8mm rope on the market that meets or exceeds the specification for not only T rated rope, but G rated rope. This is an excessive amount of rope that is going to sit in the trailer and collect dust.

- Descent Control Devices. Why 5? That’s an odd number, literally! Four is sufficient, unless they want one specifically for the rescuer to self-belay on a separate line while the riggers prepare the system. And why not, that is a thing. But if so, why not clarify that, there is more than one way to do this than what RESCUE 3 teaches. Further, all of these devices are analog, there are better and more efficient items on the market.

- 2x High Efficiency Multi-Purpose Rope Rescue Devices. As far as I can tell, this is a direct reference to the CMC MPD, which in my opinion is a piece of shit! Something like the harken Clutch by CMC, or the Skylotec Sirius or SPARK for your smaller diameter ropes are much better options. And in my opinion, there is nothing wrong with the PETZL Gri-Gri. Your lack of ability doesn’t make the device bad.

- 22 Carabiners. At first, I was like WTF, but then I realized that this was in totality. Looking at my current set up (which we are scaling down), we have a total of 36 carabiners, between 2 sets per team.

- Base Plate or O ring. There should be two! In the event of any type of horizontal system, you will need that second plate or O ring.

- Prusiks, 16 is excessive 8 is a more realistic number. Maybe 10 for redundancy.

- 12 20’ Long webbing/sling/cord. Thanks for the options, I guess… but 12, seriously, you guys need to read or take a refresher class.

- 12 Various sizes of webbing/sling/cord. So, combined with the above, that is 24 pieces of something, with a mandatory 240 feet of 20 ft lengths. Does the subcommittee realize that we have to carry this stuff? Further, there is much better equipment on the market, Power Cord, Texora Slings, Black Mamba Slings, just to name a few. None of which are cost prohibitive when you compare it to the amount of webbing/slings, or cords they want.

- Next are the generic terms for a SKED and a stokes basket. While my agency does carry both, is it really necessary? (That’s a legit question).

- Sleeping Bag. I kind of like this but wish they would have just left it at patient padding. Carry a sleeping bag big enough to provide adequate padding for a patient is not heavy, but bulky.

- 5 pickets. WHY!? You do know that most vendors sell pickets in sets of 3, right? So, 6 pickets is the more appropriate number. While you can purchase single pickets from some vendors, it is cost prohibitive. As an example, if you were to go to www.rocknrescue.com, you will see that a set of picket’s costs about $199.99, and an individual picket is $99.00. You do the math. Now, I know the smart people are going to be like, you only need 5, or there isn’t enough webbing in the kit. Maybe! My advice, train more.

- Combination Extrication Tool. I agree with this, as my agency has these. However, there is nothing above, as previously stated in terms of training standards. They should list the NFPA standard for vehicle rescue. You shouldn’t just hand a dude a cutter/spreader, and be like, have fun bro! Second, it says battery powered recommended. Why subcommittee, why? This leaves it open for something other than a battery powered tool. I can see it now, REMS XYZ rolls up the dozer push with their hand me down Hurst or Holmatro tools with the hydraulic hoses dragging behind and the porta-power hanging on for dear life…. Tell me I’m wrong!

- Cribbing. Not a bad idea, but where is all this stuff going? I would move the optional chainsaw up from Optional equipment to the MEL and add that one of the team members be a FAL 3, at a minimum. This way, you can just cut what you need.

- Reciprocating saw. I would make this 2. This gives you more options and redundancy, especially if you have to make access to a vehicle, where everything must be carried in a on foot.

Next is the Type I Non-Vehicle Rescue Cache (Hike In). This is confusing, as there is no explanation as to whether this is in addition to the MEL, or how the subcommittee proposes to break down the MEL.

I have two concerns with this list.

• It dictates 9.5 mm (3/8’s) rope to 12.5 mm (1/2) rope. To me, this is a failure on the part of the subcommittee to have the correct knowledge and experience in this field to realize that there is 8mm rope on the market that meets and exceeds G rated requirements per NFPA standard. I mention this, as weight is an increasingly important factor, as we continue to add gear to this list. I would recommend that the language be changed to state that the rope regardless of diameter meet the MBS of technical rescue rope, as per NFPA standard xyz.

• Next is the technical descent control device. This may be a little nitpicky, but all of the examples are analog devices. The subcommittee needs to acknowledge that there are other options out there, that are just as safe and effective as those old school devices. The real concern here, is that there are MEDLs, and MEDL trainee’s out there that have zero awareness. Meaning these folks meet the minimum standards to be in the position and lack the knowledge, understanding, or experience to use discretion. Bluntly, the MEDL who got their EMT, has never actually worked as an EMT, let alone a rope rescue tech, will read this list and take it verbatim, as gospel, without exception. You think I am joking, but alas, I am not, they are out there. But I will not name names.

The rest of the list is fine, and any of the items that I do not agree with, we have already discussed.

Moving on the TYPE I OEL (Optional Equipment List):

- Mechanical Winch. What a neat device, but for those of you that have used them, especially in industry, know that most of these devices are expensive, heavy, and SLOW. It is not a bad option, but I was hoping for clarification on the subcommittee’s thought process here?

- Artificial High Directional. This is a great add, but it needs to be on the MEL, and not on the OEL. There are those that will argue that the use of a monopod, bipod, or tripod on a wildfire is slim to none, and they may be correct. However, is you are going to be a technical rescue team, comprised of rescue technicians, you need to have the equipment capable of doing all the things that a rope rescue technician can do, that includes high directions and horizontal systems.

- As stated previously, I think the chainsaw should be on the MEL.

- Patient cover tarp, or bivy shelter. This is a huge problem. This shouldn’t be optional, this should be mandatory, as well as the rest of the equipment needed for patient packaging. As a matter of fact, I would argue that it needs to be its own kit. But they already mentioned the patient harness, but there is no mention of a helmet, or eye protection. This needs to be a rescue helmet, if you think that placing the patient in the stokes or SKED with their fire helmet on is OK, then we have other problems, specifically if it is a full brimmed helmet. I am going to guess that a space blanket and a ready heat blanket are part of the medical equipment list. We had the sleeping bag for padding, although I would prefer wool blankets. And of course, webbing to secure the patient. This isn’t necessary for a SKED, but for the stokes, you cannot count on or trust the commercial seat belts that come with those devices. While I think that was well covered in the MEL. The lengths of webbing for this should be separate for this specific task. But that’s my opinion.

Next, we have the MEL and OEL for a Type II REMS. It essentially mirrors the lists for a Type I, with the biggest exception being that a type II can either be ALS or BLS equipped. As discussed at the beginning of the article, I am torn on this, but it does allow greater options for Overhead and the MEDL’s when resources become scarce, so there is that.

As we get to the Type III requirements, it gets weird. They half some of the gear, but not other stuff. I cannot see any rhyme or reason for this, so I will not comment any further on it. I just kind of wonder what a Type III team is going to do with 1200 foot of rope?

We move onto the OEL for a Type III, and I notice that the UTV is optional equipment. This does not compute, period! There are fires where you cannot be rapid anything without a UTV.

Let’s get into the medical side of the house. We are going to do this in chunks:

• 4 TQ’s is too many to me, 2 or 3 would be sufficient. The reason for this, is that while these are the primary implement for life threatening bleeding, these should be stocked in every first aid kit on the line. The TQ’s in your kit are redundancy, not primary. I would even argue that every crew member carries one on him/her as part of their mandatory equipment.

• Trauma Dressing (8x10), nothing wrong here, except that is a combine dressing. So, this item is doubled and redundant.

• Rolled gauze, 2 EA, 4 and 6 in. To me, that means 4 rolls, 2 of 4 in, and 2 of 6 in. Once again 2-3 rolls of gauze is appropriate.

• Pelvic Binder. This is a great piece of equipment, but it is bulky. This should be on the list for carry in the UTV, or vehicle.

• Trauma Dressing is mentioned a second time, so what is it? Was the same item added twice by mistake, or was this to represent a separate item?

• PEEP valve, I don’t think this is necessary, but if we are going to carry it, my suggestion is that it should be added to the BLS list, as it is in the BLS national scope of practice.

• 4 chest seals, too many. Two is sufficient. With that, and depending on brand, you can stretch that to 2 commercial seals, and 6 improvised seals.

• 4 Angiocaths. I would double this to 8, and specify sizes, 2 EA of 14, 16, 18 and 20, or some variation there-of. If you are the type of provider that always reaches for the 20’s, or has never attempted the 14, you are in the wrong profession.

• Instead of calling it an IV tourniquet, can we call it what it is, a restricting band.

• 8 4x4’s. Nope. 4 2x2’s is more appropriate.

• IV tape does not need to be 2 in., but rolls of 1 in, 2 in and 3 in should be carried somewhere in the bag.

• Regarding the IV fluids and IV tubing. They should list a total volume, and allow providers to carry what they normally carry, ie. IV fluids, 0.9% Normal Saline, Lactated Ringers, Isolyte A, D5W in Saline, etc, for a total volume of 1000 ml. That way, they can carry 1, 1000ml bag, or 2, 500 ml bags, or even 4, 250 ml bags. The IV tubing should match the number of bags carried. As far as the 60 gtt set, that is only needed for drips. And while it can be done in a 1000 ml bag, or 500 ml bag. A 250 ml bag, or preferably a 100 ml bag is ideal.

• I have no problems with the two semi-rigid splints (SAM splints) or the compact traction splint, but I think providers and specifically MEDL’s need to be educated on the effectiveness of these items, or the lack of effectiveness of these items in the back country. If you need further explanation, remember, Google is your friend.

  

- 4 masks, 4 eye pro, 4 ear pro? Is that one set per team member?

• AED for both ALS and BLS. This is perplexing. While the Life pack 1000 AED does have three lead capability, as do others, this is not an ALS device. We will get the the full cardiac monitor listed under the UTV and vehicle list. To me, this is a redundant piece of equipment, added weight and a lack of understanding as to what backcountry medicine is by the subcommittee. While standards of care should not change between the front and back country, continuity of care and more importantly the chain of continuum of care do differ. But that is for another article.

• O2 cylinder, to be deployed. Does this mean they want you to carry one of those ML or M4/6/9 cylinders, or do they mean a D cylinder in a bag?

• O2 therapy, Simple Mask? So, the 1980’s called, they want their O2 supplies back! What would be more appropriate is a disposable CPAP device.

The last thing in the book is the UTV risk assessment. It is standard risk matrix stuff and actually a good tool. In closing, this is a good start but lacks some serious understanding at the technical rescue and back country medicine level.