More dangerous than drunk drivers (or at least more numerous)

It had been a hard year for my VFD. We’d had at least 4 fatal crashes and a number more where we’d had to use the Jaws of Life. We hadn’t had any big fires ourselves, but all of our neighboring cities had, and we’d been right in the middle of every one.

I was headed home from a 24 hour shift at my paramedic job, and running a bit late, when the tones went off for a possible rollover crash. The location was the scene of a particularly messy recent fatal crash. It was also directly on my way to the firehouse.

As I approached the scene, traffic started to back up. That was a bad sign, but the worse sign was that no traffic was coming the other way. I flipped on my red LEDs, honked my horn, and gingerly snuck around the blind curve on the wrong side of the road.

The vehicle was an old Saturn, on its roof across the road and missing its right front wheel. One of our police officers was on his knees talking to the driver, who was trapped in the front seat. There was no patrol unit in sight. I parked my pickup in the travel lanes to protect us, and went to talk to the officer.

“Phil, what do we have?” I asked.
“She’s OK, but she’s trapped in her seat belt.”
“OK. Do you have a radio?”
“Nope, I was on my way to a detail job,” he replied.

Me neither. It seems like that portable radio is never around when I need it. I used my cell instead, to call our dispatch center and advise them that we would need the Jaws when the engine arrived.

I crawled into the car through the missing rear window. If you turned my car upside down and shook it, all kinds of strange stuff would fall out. This woman was incredibly neat; all I found was a purse, a pack of cigarettes, a lighter, and her cell phone. As Phil had said, she seemed OK but was hanging upside down in her seatbelt. I reassured her that help was right around the corner, and then I crawled back out to meet the now-arriving engine.

I explained the situation to the Chief and the day crew on the engine. They looked surprised to see me in full uniform for my other job. The next thing I knew, I was back in the car with Mrs. Smith, and the crew was attacking the car with the hydraulic rescue tool.

In the middle of the large racket, Mrs. Smith (still hanging upside down) handed me her open cell phone. “Can you talk to my sister?” What?! No. I’m kind of busy here. . .

“Just tell her you’re fine, the car’s not, and you’ll be at Local Community Hospital,” I said.

We extricated her without incident, and I handed her over to the local paramedics. They took her to the hospital. Care to guess why she crashed on a smooth road on a nice morning? Her cell phone rang, of course.

Just keep squeezing. . .

The ambulance lurches as we leave the parking lot of Local Suburban Hospital. Partner du Jour looks at me with resignation in his eyes. “You know how this ends?” he asks.

“Yeah, I know.” I squeeze another bagful of oxygen into the patient’s lungs.

**SQUEEZE**

The patient fell last evening, tripping over a child’s toy. He’s apologetic for calling, but he’s done this before and knows his medications make him susceptible to internal bleeding. He doesn’t know that he has called at shift change and that my partner should be halfway home by now. We don’t tell him.

He’s very nice and wants to walk down the stairs to the ambulance.

**SQUEEZE**

Behind the wheel, Supervisor knows exactly what we need. She strives for the perfect balance between smoothness and speed. At this time of night, the quickest route to Big City Trauma Center is straight through the heart of the city, then up onto the highway. She does a good job, missing most of the potholes and making decent speed.

**SQUEEZE**

The patient identifies herself as pregnant, but doesn’t show it. She felt dizzy in the sun and almost lost consciousness. She leaned against the front wall of the supermarket and then slumped to the ground, scraping her face against the bricks.

She tells us that she doesn’t know who her doctor is, but her mother knows.

**SQUEEZE**

The patient’s blood pressure begins to drop. We infuse saline though his IV in hopes of raising it.

**SQUEEZE**

The patient sits on the floor of the gym, holding his knee and grimacing in pain. It was a simple foul shot gone horribly wrong. He’s been injured before, but never with this level of pain. He’s a tough guy, but today he’s near tears.

We splint his knee as gently as possible. En route to Local Suburban Hospital, we give him his first dose of morphine, but it doesn’t even begin to touch the pain.

**SQUEEZE**

The patient’s blood pressure continues to drop. We have to stop the anesthesia to keep him alive. After a few minutes he begins to show spontaneous movement, but he doesn’t wake up.

**SQUEEZE**

We pound on the door of the house, with 4 firemen and a police officer behind us. The woman who answers looks completely surprised. The call came from a third party, whose friend left a message on his voicemail asking him to call 911 for her, two hours ago. When called back the friend isn’t sure about our patient’s address. It might be in the next block.

The house in question has multiple apartments, and no one answers any of the doors. After circling twice, the firemen hear a faint call for help from the second floor. We try the most likely door and find it locked. One of the firemen goes for the tools while we study the locks. As he returns, the door opens.

Our patient, too weak to dial 911, has walked downstairs to meet us.

**SQUEEZE**

We wheel into the critical care area of Big City Trauma Center and are met by the trauma team. “Is this the patient coming from Out of State Hospital by helicopter?”

Umm, does this look like a flight suit? “Nope, we’re from Local Suburban Hospital by ground.”

**SQUEEZE**

The patient is unresponsive in bed, with evidence of copious vomiting. He doesn’t fit into any of our easy diagnoses. We do everything we can in the bedroom, rule out anything easily fixed, and roll for the hospital.

**SQUEEZE**

We exchange one trauma team for another, just as the helicopter crew from OSH arrives. We give report to our team, transfer the patient to their care, and after one final

**SQUEEZE**

we melt away into the night.

The Show Must Go On

“We’ve got a fire on the stage!” I tore from the back of the Performing Arts office, sprinting for the Stage Right doors.

I grew up in a firehouse. I always knew someday I’d be not only a firefighter, but that special breed above all else, a ROWLEY firefighter. Episodes of ‘Emergency!’ piqued my interest and stealthily indoctrinated me with the value of EMS. Dad would leave at all hours of the day or night, answering box alarms sounded on the air horn in the center of town. He kept his turnout gear at the top of the back stairs, which he only used when going to fire calls. In later years we had an extension of the Red Base, a pre-911 fire department party-line emergency phone. I could listen in on the dispatchers as the emergencies happened! We could even sound the ‘fire whistle’ from our front hall, although I never succumbed to the temptation.

I used to attend drills on Sunday morning with Dad, learning all I could. I remember checking equipment; my specialty was the batteries in the flashlights. I have one vivid memory of sitting on top of the engine during a pump drill, guiding the deck gun and using it to blast the bark off dead trees.

I don’t exactly remember my first emergency call. I have one vague memory of sitting in the cab of Engine 7’s 1947 Howe on a flooding/service call. That truck was sold in 1980, so I was still pre-teen.

I remember my first call as a driver, and my first call as a Lieutenant.

On the medical side, I remember my first day on the ambulance as an EMT. We did dialysis runs all day long. First call as a newly-minted paramedic: an electrocution. I remember my first cardiac arrest, but that’s a subject for another post. I remember my first cardiac arrest SAVE, which should be yet another post. I remember my first fatal crash, and the first time I used the Jaws of Life.

First emergency, though, ummmmm. . .

First really big fire? Malden Mills, December 10, 1995. I doubt I’ll ever see another like that; it’s a story to tell the grandkids when I have some.

Very first emergency, uhhh. . .

As I rounded the corner, I could see my best friend approaching from Stage Left with a dry chemical extinguisher. He let loose on the small fire, barely missing me in his zeal. The charred remains of a smoke machine sat on the smoldering carpet on the stage riser.


While he unplugged the smoking hulk, I strode to center stage and waved for the sound man to turn up my microphone. I politely asked the milling crowd, waiting for intermission to end and the show to resume, to evacuate the auditorium. They didn’t hear a word, as our sound man had missed the cue.


Returning to the seat of the fire, we peeled back the carpet and checked for extension. Fortunately there was none.


I returned to the office to look up the phone number for the local fire company. This was pre-911 in our area, and it wasn’t a real emergency anyway. Just a little smoke, now.


When the first engine arrived, the Captain was irate we hadn’t pulled the box. We saw no need – the fire was out. What’s a little smoke?


The engine company inspected our work, evacuated the smoke, condemned our smoke machine, and stomped out. Dress rehearsal was over.


The date was March 16, 1989; second Thursday of the month and the night I was appointed to the Rowley Fire Department.

Impressions

It’s been a weekend of firsts here at Notes from Mosquito Hill. My first submission to The Handover was published, and I’ve started to see my first readers and comments from outside my own personal circle. Today brings my first guest post.

I’d like you all to welcome my sister, Rescu82, to the Blogosphere. She says she’s not ready for her own blog, but she has a few stories for mine. 82 is a nurse in a major metropolitan trauma center. She lives out in the foothills and volunteers as a paramedic in Ancestral Hometown. She also works as a per-diem paramedic in Laketown, a neighboring tourist area. Recently she’s been dragged over to the Dark Side by the firefighters with whom she serves. Although her response areas are very rural, every summer we tourists bring the big city to them. What they lack in quantity, they surely make up in quality. I’d love to work there myself.

So without further ado:

Impressions: A Rookieʼs First Fire

I am doomed to wear sweaty, gross shorts.

I had just returned from a jog when one of the guys yelled across the station. “Neighboring Town was just toned for a fire in a garage!” I head for my gear anticipating the soon to drop Laketown tones. They drop before I reach my gear. “Respond mutual aid to Neighboring Town for a garage fire. Reported as person trapped in the building.” I barrel across the apparatus floor and jump up into Engine 9.

Looking around the truck I realize that I am with a young but good crew, all with more experience than me. As we cross the Causeway headed for Neighboring Town, we can see a cloud of thick black smoke roiling into the sky. When I see that, my stomach drops out from under me. “Oh my dear God….Iʼm about to be baptized!” Next, the adrenaline shakes hit…. followed by the paramedic instinct to take slow deep breaths and get the shakes under control. Fear is good, it makes you think. I remind myself panic is the enemy as I continue to gear up while we rumble down State Road toward the cloud of smoke.

As the truck pulls up to the scene all I can focus on are the flames shooting into the sky from the destroyed garage. It is gone, the cars are smoking hulks, and the flames are eating the house. Snapping out of it I try to get out of my seat and canʼt move. I try again and still canʼt move. “Great” I think, “what stupid thing have I done before I even got out of the truck?” I call one of my company members to help me. Grinning he reaches in and pulls the release for my SCBA. I had failed to pull it before I packed up. Determined not to make a bigger mistake, I hop out of the truck and grab my weapon of choice, a Halligan tool. My company and I report to Incident Command for our assignment.

“Attack line” is the answer we receive. Turning around and looking at the flaming house, the shakes threaten to return as I snap on my regulator. The mask sighs as I trigger the regulator with my breathing. I follow my company to the attack line. I focus on taking measured breaths. We take up our position and with a senior firefighter guiding our nozzle man off we go. “Wow look at the fire rolling out the front door,” is all I can think as we make entry into the house with a charged 2 1/2″ line. Doing my best to duck walk through the white hot ash at my feet, hang onto the Halligan, sound the floor, and drag the line, my next thoughts are “itʼs sort of pretty” and “Dang, I donʼt have enough hands for this!” Suddenly the hose goes limp in our hands and the fire which we have been successfully pushing back comes blasting at us like a blow torch, rolling over our heads. Rear over elbows the four of us bail out the front door.

“Holy Cow! What just happened?” The answer comes back to me, “water supply issue”. Regrouping on the front lawn with my company, I watch the fire blast out the front door again. The line fills with water and command gives us the go ahead to again make entry. We resume our positions on the line. Iʼm directly behind the nozzle man and I have a linebacker behind me. Again, we enter the house and push the fire back into the kitchen. This time we make it a good 10 feet into the house before the hose goes limp. Again we bail out the door, this time blasting through a Loo who is blocking our escape while watching our progress. He is not impressed; neither are we.

This time the question as to what happened isn’t phrased as politely as it was the first time. The Pump Operator is fired and replaced with an old timer who can get water out of a stone. The line is charged for a third time. We make entry for the third time.

Weʼre doing great, pushing the fire back into the kitchen and following it toward the back corner of the house. The back-up line makes entry behind us.

The senior firefighter at the head of the line with the nozzle man turns to check our progress. He yells something, grabs the nozzle man, and slams him into the floor following him down. I canʼt hear what he yells over the crackle of the flames and the muffle of his mask. “What the?” I think followed a split second later by “better follow him!” I dive to the floor. I am face down in the white hot ash. All I can think is, “My knees are hot, my knees are hot.” I am waiting to be hit by the ceiling. I am waiting for the floor to drop away. I am waiting.

It happens fast. A scalding steam bath. The back-up line opened their nozzle over our heads on the fire in front of us. One molecule of water expands to 1700 molecules of steam. I am baking in my own skin. My knees are roasting. I am face to face with the inside of a giant wood stove. I am a log in that wood stove. I am thankful for my hood protecting my ears and neck. Just as quickly as it happened, it is over. I am back on my feet duck walking again.

Command pulls us out. The roof is getting soft and we are switching to an exterior attack. My company exits the building. I walk to the rehab area and pop myself off my air. I peel off my turnout. Underneath, I am sopping wringing wet. The 80 degree air feels as cool on my skin as opening a freezer door does on your face. It feels good. I sit down and drink water.

In a while we take up and go home. Ancestral Hometown is covering back at the station. As we back into the bays, the guys from Ancestral Hometown rowdily congratulate me on catching my first real fire. I get high fives all around. The senior firefighter who was on the hose with me pulls me aside. He tells me that he was impressed that I didn’t panic under pressure and he will take me with him into a burning building anytime. High praise from that person. I smile and laugh. I know how hard my heart was beating while I was waiting.

I stow my gear, stop to admire my pink knees, and hop into the Jeep to go home. I put down the windows and crank the CD player blasting Avril Levine’s “Girlfriend”. I sing at the top of my lungs. I am riding my adrenaline rush. I am dirty. I stink. I am still insweaty gross shorts and I donʼt care.


I swear I never told her about the topic for the upcoming August Handover.

Reciprocation, and perspective

This morning I’ve received my first official outside link. Kal over at TraumaQueen.net accepted my submission for this month’s edition of the Handover Blog Carnival. Read the post, and check out what some other great EMS bloggers are doing. From there you can follow the links to past monthly editions and see some of my inspiration.

It feels wonderful. I imagine this must be somewhat like getting your first magazine article published. Now people other than family members and those looking to install an iPod in their GMC will see my little blog. (You’d be amazed how many hits that one gets.)
In housekeeping notes, for my longer-term readers I hope you enjoy the new look. It was just installed last night.
And finally some notes on perspective for any new readers. I’ve been in EMS for 10 years and the fire service for 20. I’ve served on a fire company in a rural town which is transitioning to a suburban bedroom community. I’ve worked for two private ambulance companies in the neighboring metropolitan area, serving as both an EMT and Paramedic, doing 911/emergency work and routine transfers. What this all means is that stories from my career and life will be told from varied perspectives as a firefighter/lieutenant/EMT/Paramedic riding the Engine/Ladder/Ambulance in a rural/suburban/metro area. Got it? Good. Enjoy.

Olive Oyl

The patient lay emaciated in her own bed, propped up on pillows, with her head lolled to one side and her mouth wide open. I had to look twice to see if she was breathing. The firefighters said they couldn’t hear a blood pressure, and I wasn’t surprised.

Her husband was a wiry and determined looking little guy who only came up to my shoulder, a Popeye without the cartoon muscles. He told us the story. She had been diagnosed with an incurable degenerative condition almost a year ago. As we questioned him further, a picture began to emerge.

My initial feeling was that this poor woman belonged in a nursing home. She had had little or no outside medical care in the intervening months. The home was clean and orderly, but it bore none of the signs of a chronically ill patient. There was no hospital bed, no medical supplies, no chart or folder for the visiting nurse, no shoebox of pills, no commode by the bedside.

What she did have, however, was one incredibly dedicated caregiver. Her husband had seen to her every need, helping her to the bathroom and feeding her for as long as he could. Her degeneration had progressed to the point that he had to carry her upstairs to the toilet, yet he continued single-handedly. I began to realize that while I didn’t see much to the medical side of her care, he had been providing personal care at a level nursing homes can only dream about.

As we loaded her into the ambulance for the short ride to the local hospital, I wondered if she would survive the trip. We brought her husband along in the front seat, and I silently prayed we would not have to resuscitate her within his earshot.

He stayed right by her side as long as possible, all the way into the bay at the emergency room. He joined me in the hall as I made up my stretcher, standing in the doorway and staring back at his wife.

I was there when the doctor came out to discuss intubation, lifesaving measures, and Do Not Resuscitate orders. I will never forget his answer, “Doc, you do whatever is in her best interest.” And then I saw the spark in his eyes begin to fade.

Some necessary medical procedures are best not witnessed by family or friends; when the curtain was drawn across the doorway he suddenly looked like a lost, scared little boy. I led him to the special family waiting room, sat him down in a comfortable chair, and found a newspaper I knew he wouldn’t read.

I shook his hand, wished him all the best, and silently wished I could do more. When I left he was staring out the windows at the ambulances arriving and departing.

I made sure to give a small wave and nod as we drove out

A bear in the park

“Engine 3, Rescue 1, Medic 2: respond for the reported serious motor vehicle crash with entrapment.”


A chill ran through the room. We had just finished cleaning up from last night’s double-fatal crash. The equipment was all cleaned and back on the rigs, the coffee was fresh, and we had just sat down to begin the stress debriefing process.


This is a small town; one fatal crash per year is a lot. Two in eight hours, in the same location, was unthinkable. Cruel coincidence? Distraught friend of last night’s victims? Only one way to know.

We rolled out the door with the same three crews as before, unsure but expecting the worst.


There is an adage about the press: It’s like a bear in the park. If you feed it, it will stay where you want. If you don’t, it will be digging through your trash cans in no time.


The police arrived in the area first and found nothing. We all downgraded to a ‘non-emergency response,’ continuing to the scene without lights and sirens.


One of our local media outlets has a muckraking reputation. They are well known for their “If it bleeds, it leads” style, and they have no qualms about shoving their cameras in the faces of grieving widows/parents/children. I won’t identify them, but if you live in the USA the odds are very good that you have a similar local TV station.


This particular bear had gone straight for the dumpsters.


We arrived at the scene to find nothing but a camera crew awaiting us. We cruised slowly past, and returned to quarters without further incident.

The police investigated, but of course the press knew nothing. The 911 call had come from down the block; the old lady living there had never seen a thing. Someone had knocked on her door yelling for help and then run away.


We could never prove anything, but to this day I wouldn’t spit on a reporter from that particular TV station if he was on fire.

Steak Tips

Medic 9, you’d better take this one in, too. It sounds like they may need some help.”

 

Due to a quirk of geography we were actually closer, but the other crew had a head start. We both arrived on scene at the same time, from opposite directions.

 

“IF YOU’D BEEN HERE SOONER HE WOULDN’T BE DEAD NOW!” I see why the dispatcher thought we should assist. He’s been on the phone listening to the chaos. It’s no use explaining that we responded immediately, or that we were just around the corner. Ninety seconds can seem like an eternity when a loved one is not breathing.

 

All four of us grab our gear and weave through the furniture into the ground-floor apartment. My partner makes an offhand comment that it may be interesting getting the patient back out. Sprawled at the rear of the apartment we find the patient, a tatoo’d off-season Santa Claus in biker garb. I’m instantly sure there must be a Harley-Davidson parked around here somewhere, as the man wouldn’t look right riding or driving anything else.

 

A fireman kneels at his head, attempting to force air into his lungs using a bag-valve-mask without effect. Another checks a pulse and nods; we aren’t too late.

 

A crash occurs behind us as the patient’s adrenaline-high son tosses the kitchen table across the room. He continues throwing furniture across the room and out the front door until the police restrain him. I think he might have started in on the appliances next. Although unorthodox, we appreciate his efforts to assist us.

 

Yoda snaps an extra large blade onto the laryngoscope. He looks into the patient’s airway, muttering something about steak tips. He reaches in with forceps, fumbling briefly, then begins to remove the obstruction. It’s like watching a perverse sort of reverse childbirth, as we marvel that the patient could ever have gotten his lips around such a chunk of meat.

 

With his airway now clear, the patient should begin breathing on his own. After a few assisted breaths, he does. But he doesn’t wake up. Has his brain been deprived of oxygen too long?

 

We all head for the ambulances through the tornado-like path of destruction. We won’t know for a while, if ever, if we have been quick enough to make a difference.

Sunrise and CISD

The Martin boys were home from college, enjoying a night out on the town. Some time around midnight, the twin brothers decided they were too drunk to drive home. They did the right thing, like their parents taught them, and called their friend and neighbor ‘Joe’ for a ride. Unfortunately, Joe was also too drunk to drive and too drunk to know it.

The intersection had a stop sign. The street approaching it was a 25 MPH zone. The intersection sloped upward, creating a ski jump shape. Joe was a local boy and knew all of this. The accident investigation would reveal Joe’s car was going almost 60 MPH when it left the ground.Continue reading “Sunrise and CISD”

Emergency Medical Weather

We have a term to describe certain EMTs and Paramedics at work: White Cloud. A White Cloud is a crew member who never has anything critical happen around him. This is not to say big things don’t happen when a White Cloud is on duty, but he/she will be busy helping Mrs. Smith off the floor and back into bed when they do. It’s nothing deliberate, but through some strange quirk of probability nothing bad happens when a White Cloud is responsible.

 

Conversely, we also have Black Clouds. Death, destruction, and general mayhem seem to follow our Black Clouds whether on duty in the Big City or the Quiet Suburbs.

 

I know it’s all probability and not real, but we can be a superstitious bunch. It’s not that we want bad things to happen, but we train hard to be ready when they do. We need to use our skills now and then so that we stay sharp.

 

Regular Partner and I had developed a reputation as White Clouds. We had been working together exclusively for almost 8 months, so we weren’t sure which one of us was the good luck charm. We’d started off with a bang, having two major notable incidents during our first month together. Then six months of nothing.

 

We’d been doing minor chest pain calls, old ladies fallen out of bed, drunks, car crashes with no injuries; we had awakened a couple diabetics. I think we went almost 4 months before we had to put anyone on a backboard. We were beginning to get jumpy, feeling that God or karma or probability or whatever was saving up a Really Big One for us. The proverbial ‘bus full of hemophiliac nuns crashes into a plate glass truck’ kind of call.

 

Then it happened. RP got married and left on his honeymoon.

 

In the first 4 hours of my first shift without RP, Partner du Jour and I ran a cardiac arrest and an unresponsive with almost no blood pressure. We capped the evening with a pedestrian struck by a car.

 

So RP, enjoy your honeymoon. You should have plenty of good weather with you.


Edit: Before RP got back, we added an MVC with ejection, a STEMI, an aortic dissection, a CHF patient, and a few more which I don’t remember right now.