Waterfall Incident Board of Review report
Excerpts from the report filed by the Waterfall Incident Board of Review. A link to the full report can be found at www.nevadaappeal.com.
• No staging area manager was assigned resulting in no single point of contact for
communications and unmanaged congestion.
• Radio frequencies were overloaded prior to and during the burnover.
• Personnel at Staging Area 2 were not advised of the approaching fire front which left them vulnerable to the burnover.
• Retreating firefighters from the blowup on the southeast end of the fire arrived at the Staging Area 2 just moments before the fire front, leaving little time to personally communicate the danger and to implement evacuations from the staging area.
• Many of the people were there (in Kings Canyon) in an unofficial capacity from their respective fire protection agencies, adding to the congestion on Kings Canyon Road.
• Operations recognized the potential for a bottleneck in Staging Area 2, but no
one took decisive action to remedy the situation.
• Evacuations of homes and private parties were accomplished using proper procedures and law enforcement personnel.
• Shortly after 1 p.m., two crew members from the Slide Mountain hand crew sustained potentially serious injuries from a rock slide. A medivac was discussed but never implemented... This rescue was based from Staging Area 2 adding more personnel, vehicles and confusion. The extractions took five to six hours with one victim being extracted immediately prior to the burnover at Staging Area 2. The other victim was moved into black above Staging Area 2 before the burnover and was extracted about 3 p.m.
• This medical situation diverted the attention of command away from the fire and the emerging situation. Bucket operations were also diverted to cooling the perimeter near the rescue operations limiting aerial support for other areas on the fire.
• There were some unassigned "freelancing" fire management supervisors that entered the fire area and started directing resources without the approval or even the knowledge of operations.
• Employees interviewed were all surprised by the volume of personnel coming off the fire using the same escape route. Coming down were the Hot Shot crew, the Slide Mountain Crew, engines and numerous overhead all trying to escape the same way. A Central Lyon County engine caught fire while stopping to let the Channel 4 news vehicle turn around and exit, this blocked the road for escape; the engine was abandoned and left without an operator or keys in the ignition. Numerous other vehicles were parked uphill and various fire personnel were not in required PPE. The road was wide enough for two vehicles but two separate vehicles were blocking the escape route. The burnover left three vehicles totally destroyed. Four other vehicles received moderate damage and numerous other vehicles received minor to moderate heat related damage.
• Media ceased to be managed after the notification of the medical emergency. Areas around the fire were not effectively closed to public prior to the entrapment.
• There were reports of five or six chiefs and battalion chiefs up King Canyon Road just having a look around adding to the confusion and congestion.
• Did the quality of the briefings improve as the incident went on? No!
Could Air Ops have made a difference in stopping the rate of spread on the south end of the fire had they not had to concentrate their efforts on the medical? Doubtful!
