On July 6, 1994, Donald Mackey was helping oversee a team of 49 firefighters on Storm King Mountain in Colorado. It looked like a routine fire, but it is always a mistake to treat any back-country blaze as routine. Bad luck and a fatal confluence of environmental factors contributed to the flaming ambush of the firefighters, but individual decisions were critical. Fourteen firefighters, including Mackey, died on the mountain that afternoon as the fire blew out of control. Wildland fires are special. But the experience of those who fight fires in the outdoors has much to teach us about decision making indoors, especially when there’s little room for error or delay. And like so many critical business decisions, fire decisions brutally punish those who do not keep both the big picture and small detail in mind.
Acute Stress and Decision Making
Wildland fires can reach 2,500 degrees Fahrenheit, race at speeds up to 25 miles per hour and leap overhead without warning. At their most dangerous, such fires are said to “blow up,” acquiring a manic momentum of their own. A blowup is one of nature’s most terrifying spectacles—one reason tension is ever-present in a fire zone. For crew leaders and incident commanders, the tension can become acute. The more severe the stress, the less optimal decisions are likely to be just at a time when they are becoming most consequential.
The decision-making burden on fire leaders is made even greater by three organizational factors that are prevalent in combatting wildland blazes. First, crew leaders guide a workforce that is largely seasonal since fires are most common in the summer. Second, leaders are required to collaborate with agencies over which they have no control. And third, as fire crews meld into temporary amalgamations on larger blazes, crew leaders and incident commanders find themselves working with, reporting to, or instructing others whom they have never met or barely know.
The weak relations among the parties also tend to result in information hoarding as much as sharing. Add up the parts—a reduced flow of information to the fire leader, a weakened commitment by the leader to exercise authority and diminished team compliance with the leader’s instructions—and you have the makings of a decision crisis.
Authority Begins to Blur
As light dawned on July 5, Butch Blanco, 50, a veteran firefighter with the U.S. Bureau of Land Management, hiked up the mountain to evaluate the situation. Just a few months before, Blanco had qualified as an incident commander, the person who takes charge of a blaze. He and his team of seven began digging a line around the slow-moving fire. But this blaze was more tenacious than Blanco expected, and at 8:19 a.m. he radioed for help.
Since Blanco’s fire was not a priority (there were bigger ones in the region) it was not until 5:20 p.m. that an eight-person crew of smokejumpers, some of the best-trained wildland firefighters in the country, boarded a small plane. Among them was Don Mackey. Mackey, 34, had eight seasons of smokejumping under his belt and had also served as an instructor. Seated next to him was Sarah Doehring from upstate New York, whom Mackey had helped train.
At 5:45 p.m. the smokejumpers left the plane. Because Mackey happened to be sitting nearest the door, he leaped and landed first. That made him the “jumper in charge.” He would coordinate the landing and prepare the crew. The fire was still Blanco’s responsibility, but the lines of authority would begin to blur.
The Fire Spreads
Unequipped for a night on the mountain, Blanco and his crew descended to the town of Glenwood Springs not long before Mackey and his fellow smokejumpers arrived. Within hours, the flames had crossed the fire line Blanco’s crew had cut, growing from 30 acres to 50. Don Mackey went into action against the blaze.
“We all thought we were going to dig a line around it by midnight,” Doehring remembered. But it continued to spread. In Blanco’s absence, Mackey took the initiative, radioing a request for two more crews (Decision 1).
As dawn broke on July 6, Mackey again took the initiative, asking for a fixed-wing aircraft that would serve as a full-time “eye in the sky” (Decision 2). None was available; instead he got a helicopter that would have to do double duty ferrying gear. The effect was to leave him partially blind at a time when the blaze was threatening to morph into something larger.
The Critical Decision
Early that morning, Blanco reappeared on the ridge with a fire crew of 11. Now Mackey and Blanco huddled. Deciding they needed more information, they boarded the helicopter at 9:30 a.m. to get a better sense of the fire (Decision 3). What they saw was worrisome. The blaze had expanded to 125 acres and was creeping down the west flank of the ridge. Mackey proposed a bold plan (Decision 4). He wanted to cut a fire line below the flames since fire can climb up a slope faster than a person can.
Blanco agreed. This was a crucial moment in which two important things happened. First, Blanco effectively ceded some of his authority to Mackey, who became the point man on the downhill fire line. Second, both men committed themselves to a strategy at odds with established rules. “Downhill fire line construction is hazardous in steep terrain, fast-burning fuels or rapidly changing weather,” warns the wildland firefighters’ manual. All three conditions prevailed in the canyon. The manual also cautions against relying on a steep uphill escape route, but Mackey’s plan created just that. Some of Mackey’s team considered this a dangerous call. Mackey argued that the fire would run back uphill—above the proposed fire line—in the event it surged out of control. “Let me have a big crew and we’ll do this. We’ll do fine,” he said.
Mackey’s confidence got the crew moving. In the absence of an experienced decision-maker, a “can-do” attitude had triumphed.
Who’s in Charge?
An hour later, eight additional smokejumpers floated onto the ridge. The melding of crews from diverse locales and agencies became further exacerbated at 1 p.m. when 20 hotshots from Prineville, Oregon, began arriving. Like smokejumpers, hotshots are among the most highly trained and esteemed wildland firefighters.
Mackey was now supervising 24 people over whom he had no authority. Did that mean the fire was his? At 2 p.m. he asked fellow smokejumper Kevin Erickson. “I don’t know,” Erickson responded. “Neither do I,” said Mackey. But he took no steps to clarify the issue (Decision 5).
The lingering ambiguity may also explain why Mackey ignored procedures that call for lookouts to ensure that no flames are burning below a fire line. Behind a vertical cleavage known as Lunchspot Ridge, the fire had already burned down below the level of the fire line. Had there been a lookout—or the surveillance plane Mackey never got—the radios would have been crackling with warnings.
The Forest and the Trees
Because Blanco concentrated on controlling the fire at the top of the ridge and Mackey on completing the fire line lower down, neither had an overall view of the situation. Nor did Mackey, Blanco or their crews know that nature was creating the catalyst for a catastrophe.
A meteorologist predicted that a cold front would surge through around 3 p.m. Bureaucratic bungling had bottled up the alert. Mackey never asked for a weather forecast (Decision 6). If Mackey had been certain that he was in charge, he might have felt compelled to seek the data. By 3:30 p.m., taking note of the rising winds, Mackey assigned Doehring to patrol the west-flank fire line for burning debris and hot spots.
“What should I do if the wind comes up?” she asked.
“Go down,” Mackey instructed.
As they stood, though, and Doehring began to resume her patrol, Mackey changed his mind and ordered her back to the top of the ridge (Decision 7). Tense about the worsening conditions, Doehring was relieved to turn around—an act that saved her life.
By 4 p.m., the fire came surging from both below and from the far end of the fire line. Mackey stopped fighting the fire and raced to survive it. He told eight firefighters to run up Lunchspot Ridge to an area where he knew there was sufficient cover (Decision 8). Mackey did not follow them. Instead he radioed ahead: “Okay, everybody out of the canyon!” Then he dashed back along the fire line, urging the remaining firefighters to flee (Decision 9).
Six firefighters crested the ridge top with seconds to spare. Mackey and the rest were not far behind, but the steepness of the hill meant that they were not moving fast enough. At 4:16 p.m., a 300-foot wall of flame overtook nine of the Oregon hotshots and three smokejumpers, including Mackey. They were less than 100 yards short of safety. It took five more days to bring the fire under control. The final death toll reached 14, making it one of the deadliest forest fires in U.S. history.
Five of Mackey’s nine decisions proved relatively optimal while the other four were less so, in some cases far less so. Those that improved the likelihood Mackey and his team would swiftly and safely suppress the South Canyon fire were:
Decision 1—to request two additional crews, which secured the firefighters necessary to combat a expanding fire.
Decision 3—to conduct aerial surveillance personally, which improved Mackey’s information on the environment.
Decision 7—to send Doehring to the top of the ridge, a decision that saved her life.
Decision 8—to dispatch eight smokejumpers up Lunchspot Ridge, moving them into a life-saving area.
Decision 9—to evacuate the West Flank fire line, helping to move six firefighters toward another life-saving area and placing team survival ahead of personal safety.
What Didn’t Work
Weighing against Mackey’s five successful decisions were four that lessened the likelihood that he and his team would halt the fire or even come out alive. In each case, the choice can be explained at least in part by the three factors identified as potentially undermining effective decision making: underpreparation, acute stress and ambiguous authority.
Decision 2—requesting continuous aerial surveillance. Mackey’s seeming reticence about pursuing the request further was probably derived from the fact that he was not the incident commander.
Decision 4—to construct the downhill fire line. A more thoroughly prepared decision-maker might have been less sanguine about transgressing standard operating procedures. A more experienced leader also might have been uncomfortable predicating this strategy on a resource not yet firmly in hand: the “big crew” that never materialized. Finally, a leader with unequivocal authority might have been more successful in deploying the big crew that was required.
Decision 5—not to clarify who was in command. With greater experience and training comes greater appreciation for the requirement of clarity in who carries ultimate responsibility on the line.
Decision 6—not to secure a weather forecast. The uncertainty of whether Mackey was incident commander was a likely factor in combination with his underpreparation and preoccupations.
Lessons in Decision Making
Fourteen people lost their lives in what most qualified observers have concluded was a preventable disaster, derived in large part from an underdeveloped capacity for making rapid decisions under demanding conditions. In 2001, the National Wildfire Coordinating Group, a consortium of federal and state wildland firefighting agencies, established the Wildland Fire Leadership Development Program. The odds are good that anyone who has been through this program will be better prepared to deal with two of the three root causes of the suboptimal decisions that plagued leaders on Storm King Mountain: inadequate preparation and high stress. Separately, the fire service has attacked the third cause—ambiguity of authority—by sharpening and better instilling the principles of unequivocal responsibility on a fire line.