The state coroner has confirmed that a bushfire that destroyed homes in the outer reaches of the Blue Mountains in December 2019 was caused after a planned RFS backburn jumped Mt Wilson Road, sparking spot fires which quickly spread.
But the coroner declined to make recommendations sought by a number of affected residents, including about the appropriateness of advice and warnings. She said those issues were outside the scope of her inquiry.
Teresa O'Sullivan last month handed down her findings into the Black Summer bushfires, including into the deaths of 25 people across the state, seven of them fire-fighters.
She made 28 recommendations, including that bushfires started as an unintended result of a backburn should be considered for referral to the coroner as they may relate to a safety issue that is in the public interest.
Ms O'Sullivan found that the Grose Valley fire, which burnt homes and out-buildings at Mt Wilson, Mt Tomah, Blackheath, Berambing and Bilpin, was started by the strategic backburn at Mt Wilson.
The backburn was meant to halt the progress of the massive Gospers Mountains fire, the so-called "mega blaze" which burnt 512,600 hectares over 15 weeks and was the largest single forest fire in Australian recorded history.
Ms O'Sullivan said the Mt Wilson backburn was lit on a day when winds and humidity were predicted to be as good as conditions could get during that extremely dry and dangerous summer.
But the humidity levels dropped and the wind direction changed at lunchtime, the easterly turning south-westerly which pushed the embers across Mt Wilson Rd and eventually into the Grose Valley.
Residents whose properties burnt the next day had told the inquiry the emergency warnings they were given were not timely or appropriate and gave them little indication of the level of threat they faced.
Ms O'Sullivan noted that some communities affected, including Mt Wilson, had only one road in and out, "leaving them with little option but to shelter where they could and brace for impact. Even those who were on notice of the oncoming fire were not prepared for its relentless ferocity and speed."
But she recommended that the RFS develop training addressing the "significance of early warning to communities with limited access to reliable communication systems".
She also found that the backburn was "appropriate in the circumstances".
The residents had also asked that the NSW Government formally apologise to residents, fire-fighters and communities impacted by escaped backburns and that it set up a compensation scheme for those affected by the Mt Wilson backburn and others.
But Ms O'Sullivan said it wasn't appropriate for her to make such recommendations as the NSW government had not been represented at the inquiry by a capable department and had not been asked to comment on the appropriateness or practicality of any such recommendations.
The residents expressed their disappointment that the coroner made no recommendations around the practice of lighting backburns.
In a statement, they said: "Hearings around the implementation of backburns went for over 10 days. People would find it incomprehensible that the coroner made no recommendations relating to the implementation of backburns."
They added: "It is concerning to hear the NSW RFS mention several times during the hearings that they would essentially do the same thing again. This type of mentality should make anyone living in bushfire-prone regions like the Blue Mountains very worried.
"We need emergency response agencies like the RFS to be continuously looking at ways to improve public safety, not insisting that they would just do the same thing again."
They called for an independent oversight body to promote continuous learning and best practice, and were joined by the Independent Bushfire Group, an organisation of fire experts, ecologists and land managers formed after Black Summer.
"NSW needs an ongoing and independent capability for reviewing and improving disaster operations, like the inspectors general of emergency management that Victoria and Queensland created a decade ago," the group said.
While welcoming the report, they said the coroner could not "do the heavy lifting".
"We are shocked that after more than four years, there is still no comprehensive and expert review of the worst fires ever in NSW. We respect the good work done by the coroner but there are acknowledged limits to what the coronial process can do.
"There's so much to learn from the Black Summer fires, about what worked well and what needs to change. Here we are four fire seasons down the track into our worsening fire climate, and there still is no comprehensive independent and expert analysis of the fires and how they were managed."
While some fires were slowed by backburning, others were accelerated. "Has there been any comprehensive analysis to understand what made the difference?"
