Thursday, November 22, 2012
Giving Thanks
"Thanks" is not a word often heard in the fire service. In fact, I can count on one hand, the number of times someone actually made an attempt to thank me or anyone else on my crew. Now, I'm in no way pitching a bitch about it, truth is, it's a thankless job. We see people on one of the worst days of their lives and with their world turned upside down, trying to figure out which way is up is difficult enough let alone remembering to thank someone for helping. So we understand, and quite frankly, we were just doing our job.
Sept. 11th kind of changed that, even if only for a little. But, most of us knew it would be short lived. For days, if not weeks after 9/11, residence and businesses dropped of cookies, sandwich rings, cases of pop, pizzas, what ever. People stopped to say thank you, brought their kids to meet the "heroes". All in all, it was a bit overwhelming. Granted, it was nice to be recognized for what we do, but we did nothing to deserve it.
But it was short lived, so we were able to get back to the comfortable thankless-ness we were used to. Today it's back to normal, and it really is OK, we kinda like it that way. We'll be here, outta sight, outta mind until we're needed.....it's what we do.
Then theres the other side of the stories, and as I look back on 18 years, I can say I have a lot to be thankful for during my career. Sure, there are those calls I would sooner forget if I could, but even in the darkest moments life has to offer, there is always something.
For me, it's my career itself. For a jolly volly in Southwest PA I have been blessed. From those who taught me in the beginning like My Asst Chief Bill & my one of my instructors, Jim. Both who taught me modern & old school techniques and skills to be an effective firefighter, and just as if not more important, why we do what we do and what it really means to be a firefighter.
There isn't a fire I haven't fought were something one of those two taught me hasn't helped me in some fashion or got my ass out of a bad spot, for their friendship, instruction and tutelage, I am thank full.
I am thankful for having the privilege to ride the rigs and fight, side by side with some of the best in the business, guys from places like Washington DC FD, Pittsburgh Bureau of Fire, Baltimore FD and even FDNY, to name a few.
Im thankful for the Guys from Engine Co 12 for busting through the door into the fully involved room in the basement, a split second after I fell through the floor and landed on the bed, in the fully involved room. Impeccable timing guys...thanks.
I'm thankful for seeing the warning signs and retreating from the second floor just in time to keep from getting cooked in a flashover in Engine 7s first due. I'll take a few small blisters over the burn unit any day.
I'm thankful there were no serious injuries when we sent 14 guys to the hospital after the roof collapsed during an apartment building fire.
I am thankful that, to date, my most serious injury from fighting fire was a very severely sprained ankle that almost ended my firefighting and construction careers.
I am thankful to have been able to fight many fires with my two best friends, Mike & Ryan.
I am thankful for the wood framed storage shed that stood between me an a 55 gallon drum of something at an industrial fire. The Drum experienced a bleve. (Boiling liquid expanding vapor explosion....BIG boom)...I don't know how much it actually helped since it was destroyed, but when I picked my ass off the ground and did a quick once over to make sure I was ok, I was convinced, had that Shed not been there..... neither would I. I'm also thankful my ears only rang for 3 days after the blast.
I am thankful for the nice warm diesel exhaust to warm your hands & feet on those long cold nights fighting fire in the snow. And since we're talking cold weather operations, lets not forget those that get up in the middle of the night to bring the Sally wagon and have ready for us, the best tasting coffee and hot chocolate flavored water you'll never want to drink again but do so just because its warm.
I am thankful that I've learned to appreciate life a little more.
I'm thankful to be in the right place at the right time on the right call to help someone else see tomorrow.
I am thankful not only for my time living at the firehouse, but for those I got to share that time with. Definitely 4 of my best years in the service.
I am thankful that I have been able to come home after an ugly call and kiss my kids and my wife.
I am thankful the engine I was driving had good enough breaks to keep from hitting a minivan with 4 kids in it when their mom blew a red light.....damn good breaks.
I am thankful for my Buddy Lurch, who in street cloths, at a working fire in a strip mall, grabbed and threw a 24 foot extension ladder to the roof so that myself and 2 others could get off the roof after the roof began to collapse, cutting off our two means of egress. Thanks brother.
I am thank full for having Chummy was a able to guid me to a vehicle fire as I drove through fog. He held his head out the officers window and watched the front tire of the engine and the white line on the road, shouting instructions "left a little, keep it straight, back to the right a little" to make sure we stayed on the road until we got to the fire because the Fog was so god damn thick we didn't see the burning car until we almost hit it. It was insane..
Good lookin out brother.
To the guy from Tower 112 who grabbed me by my air pack just before falling through a huge hole the arsonist cut in the floor at a fire in 94's first due. Never got your name, but thanks dude.
I am thankful to the State Trooper who, with the use of a flying fore arm, "subdued" the angry motorist that stopped and for some reason felt picking a fight a with a fireman at an accident was a good idea.
I am, for some odd reason, thankful for the engine company.....I know, I know, I know.... I can't explain it either.
I am thankful for my wife. She is a Firefighters wife, its hard to explain and there's more to it than you realize.
I am thankful that tomorrow, when the bell rings, I'll still be ready to go.
Be safe and Happy Thanksgiving.
Saturday, October 6, 2012
The Rivalry
In every high-school across the country, for every sport, there is a rival school somewhere. And its that rivalry that acts as a foundation for for the teams training & willingness to be the very best. Altho they train and prepare the same way for any given game on any given day against any given team, its the rivalry that squeezes ever ounce of commitment out of the teams members, and pushes them to be 110% at their very best. After all, we can't loose to the other team, especially our rivals, right?
Well, the fire service happens to be cut from the same fabric. Competition is in everything we do....being able to go from street cloths to full gear and SCBA breathing air in less than 2 minuets, first to get water on the fire, fastest at cutting a roof....or what ever. And, for every firehouse across the country, there is, just down the road a bit, or in the next town over,a rival fire house. They are the ones who, in the general opinion of your company, couldn't put out a burning bag of dog shit. When in all actuality they think the very same about you and your fire company. On the fire scene, it's (usually) not an issue. Your all there for the same reason, and you do your job, period end of story. That's not to say that some friendly ball bustin doesn't occur, but all in all, you work well with one another....except maybe when you beat them to a fire in their district AND put the fire out.....then it can get a little tense. (that ranks right below sleeping with their wives)
Then there is a more "traditional" rivalry. A rivalry thats as old as the fire bell, if not older. It's the rivalry between the (ladder) truck company and the engine company, or the "Truckies" and the "Hose Jockeys" as their commonly referred. It's a rivalry unlike any other...its lead some fire stations that house both an engine and a truck to "segregate" the firehouse with seperate bathrooms and sleeping quarters. (the kitchen is traditionally never divided, that's sacred turff, I'll get into that some other time) On top of that, the inside of the apparatus bays and sometimes even the entire firehouse, are decorated in different colors, evenly split right down the center.
For example, if you were to walk into one of these firehouses you would immediately notice that one half of the apparatus bay where the engine sits, is blue, and the side where the truck sits is red and its the same with the living quarters. From carpet to curtains, if it can be color coded and or split in half, it is.
Now, It's up to each individual to decide what side of the fence they'll stake claim. As for me, my fire service career got its start in an engine company. Not because I wanted to, but like the vast majority of those in the volunteer fire service, that's all my home town fire company had, an engine, 2 of them actually. (altho I would later come to my senses and hop the proverbial fence)
Engines are the most widely seen apparatus on the street and a vast majority of firehouses in America have at least one. In face, with a few exceptions, in any given city,engine company's out number truck companies. For example, the City of Pittsburgh Bureau of Fire has 28 engine company's and only 11 truck companies.
Both are usually staffed with 4 to 6 firefighters, but their responsibilities on the fire ground differ greatly and it's those differences in responsibility that are the foundation for the rivalry.
An engine company are those that respond on and operate/work from a fire engine, thats the fire truck that has the hose, the pump, hooks up to the fire hydrant & squirts the water. As defined, they have only 2 responsibilities at a fire, and those are to establish a water supply (the hydrant connection) and fire attack (the actual act of putting the fire out)
The basic routine of any engine company is the same, first, they need to establish a water supply, that's when they put the hose in the street with one end hooked to a hydrant and the other to their wagon (fire service slang for an engine). Next they pull a handling off and flake it out in the front yard. Now depending on they do things, they'll either charge the hose line at the front door, then make entry to find the fire, or (if they have a set) they take the line in dry to just outside the fire room, then call over the radio for water. Taking the line in wet can be difficult. When the line is charged, it becomes rigid, making it hard to bend without kinking it. The guys on the line have to really work to get the nozzle into position by forcefully moving the hose line around inside. It's a pain in the ass, especially when the fire is on the second floor in the back corner bedroom. But once they get into position, they put the fire out. Only thing after that is packing or rolling all that hose....other than that, the engine company's job is done.
Then there's the better half, um.......I mean, the other half of the rivalry. The Truck Company, or "Truckies". These are the big, built, well equipped, exceptionally trained, seasoned veteran bad asses that can put the fire out just by looking at it AND there ain't a damn we can't handle!!! Ok, maybe that's stretching the truth a little, sometimes we have to stomp the fire out with our boot.
Anyway, as the truck company,we arrive and work off of the apparatus that has the huge ladder on top. These rigs are usually packed full if tools, kind of like a rolling tool box. Some of them have a platform or "bucket" at the end if the ladder. In the fire service these are called "Towers" Then there are the ones that are just a big ladder or "straight stick" or more traditionally called a "truck". This too is a rivalry, only it just between truck companies. The argument being which is the better truck, a bucket or a straight stick? Both perform the job well but in my opinion, posers right in a bucket, real truckies climb the ladder.
Now, altho out rigs are a bit different, our responsibilities are the same. Those are forcible entry, search & rescue, ventilation, utility control (gas & electric), salvage, over haul and of course, ladders.
Forceable entry is just that, forcing entry into a building. This can be done a number of ways and how its done is usually determined by the situation at hand. It could be as simple as prying a door open, or removing security bars and taking out a window. What ever you need to get into, chances are, we have a tool for the job.
Search & rescue. This too is self explanatory. We go in (with no hose line) and search the building. The search is as methodical as it is chaotic and done in 2 stages. A primary and secondary search. The primary search is quick & dirty, sometimes crawling in pitch black feeling around with your hands, calling out in the event anyone trapped can hear you & respond. The secondary search is a more thorough search and is usually performed once the wagon fags...... sorry......once the engine company gets a knock on the fire. (knocked down but not completely out)
Now if you find a victim, you let command know to have the Bandaid Warriors (medics) ready, and now you and your partner remove the victim from the house via the fastest way. Sometimes your lucky and its the front door, other times, its a second or third story window.
The next one is one of my personal favorites, Ventilation. This is the process of removing smoke and heat from the structure to provided a safer environment for the interior firefighters and any possible victims. This too can be accomplished many different ways depending on the situation. It can be breaking windows, busting out sky lights and the always popular, cutting a hole in the roof. You can be a truckie, but your not "really" a truckie until you catch a job and put in some work on the roof...it's kind of a right of passage. Then there's the fans, ones that suck & ones that blow. The smoke ejectors "suck" the smoke out of the house, usually a window. The other type, Positive Pressure Ventilation, or PPV fans are positioned in front of an exterior door and "blow" fresh cool air into the house at a high pressure, forcing out smoke & heat.
Now the tricks to ventilation are type of ventilation, timing, and reading (understanding) the smoke & fire conditions. If you screw either one up, and the conditions are right, the result can be devastating. Increasing the rate of fire growth exponentially, or causing a flashover or even a back draft, all of them potentially lethal. So, as you can tell, ventilation is a lot more involved than just breaking stuff.
Utility control is isolating the Gas & electric to the structure that's burning. A mix of natural gas and fire doesn't exactly help the cause, and with guys inside pulling down walls & ceilings, you don't want them to find a live wire and get zapped while standing in the puddle of water. (that shit hurts)
And niw, since you've turned off the electricity, Utility control also includes supplying lights & power to the home via small generators, long heavy duty extension cords and portable lighting inside & out.
Salvage is the process in which we try to save as many personal belongings as we safely can. It's generally not a favorite job, but, we understand that someone standing in the front yard is watching their life go up in smoke,literally, and the more we can save makes it that much easier for them to deal with. Basically it's Stacking the furniture in the rooms below the fire and covering them with huge sheets of plastic, carefully moving pictures and stuff lime that. Its amazing how handing something like a charged jewelry box to the home owner while its still warm, seems to make it all seem not quite as bad, if only a by a little.
Over haul is done generally in the fire room and is when we tear the walls open to the framing to check for hot spots and any hidden fire or extension. And removal of debris to a point as to not disturb any potential arson evidence.
And finally, there's the Ladders, more notably the big power ladder on top of the fire truck. But along with reaching high up in the air, it also provides an elevated master stream. It's a big nozzle attached to the top of the ladder capable of flowing upwards of 2000 gallons per minuet. (that's enough to fill your average above ground pool in about 4 1/2 minuets) Then there are the ground ladders, truck companies usually at least 6 or 8. These are used to gain access to the roof if the power ladder can't be used because if power lines (very common in SW PA) they're also placed at ever possible window for means if access and egress from the building. (you always try to have more than one way out of a room if the shit goes bad) the ladders can also be used as a platform to vent windows in upper floors or tear at the eves of the house to expose any fire. Basically, for a Truckie, working from a ladder must be second nature.
So in general, you now have an understand of what takes place and how every single task is important. However, to Truckies and Hose Jockeys the job can be done just as easily without their counterpart there. A million in one arguments have ensued over who is more important and I suspect it will continue that way well after I'm long gone.
Truth of it is, one cannot function efficiently without the other and all jobs are important to putting out the fire. And although putting water on a fire is kind of important, at least now we all know that the engine company cant do their job without the truck company, because after all.....Truckies are better.
Sunday, September 23, 2012
Your never really on vacation.
This is a picture of some "tool work" at an accident with entrapment I witnessed in the way home from vacation. The pictured vehicle, I would soon find out, was occupied by a late 30's female driver and her 22 month old little boy who was properly seated behind her. Her car was traveling southbound (I was northbound) and she was hit by someone who hydroplaned spinning her in front of a tractor trailer who blasted her, dead center in the "B" post on the drivers side (for you non first responder types, that is the post between the front & back doors on both sides of the vehicle) That impact spun her off the road, down into the grassy center divider then shot up and out the other side where her vehicle caught a good 6 or 7 feet of air before some how landing on all 4's then rolling to a stop in the slow lane, right in front of me.
I swerved & missed her, pulled to the burm and hopped out to do my thing & I have Laura-Lynn call 911 in the process.
A few others stop, one being a pick up with all kinds of shit in the back. I grabed about a 2 foot metal hunk of something and I busted out the front passenger window (yes, I tried before I pried) reached in & unlocked the door then climbed inside. I do a quick once over of the boy who wasn't crying at all..just lookin at me like "who the hell are you" and mom who was screaming and obviously in pretty good pain and concerned with her child. I assured her he was all right, and calmed her down as best I could. Even after just a quick once over I felt he would be just fine.....it's amazing how resilient kids are.
A few minuets pass and the medics show up, and then the fire dept. The fire dept. shows up in a early 90s commercial cab engine....a small one at that. From the size and type of apparatus, I assume they are there for fire suppression and expect at least something resembling a rescue would show up to perform the (rescue) tool work, after all this is a major interstate....but, unfortunately this would not be the case.
Theses back ass lookin country bumpkins fall out of what I would consider a poor excuse for an engine, onto the highway, stumble around like the Keystone Cops then eventualy manage to find and place into service portable power plant and a combi-tool. (short fir combination tool, it combines the abilities of the cutters and the spreaders) They fire it up & it sounds way different than it should, almost like a small Harley. So I looked at the power plant a little closer and notice the "after market" (obviously more like home made) muffler on the side and as it registers in my head what it is I'm looking at, I hear one of the toothless heroes say in his back hills accent "Damn! That some bitch sounds purdy good don't it?".....honestly, you can't make this shit up.
Now, as far as the damage to the vehicle, from a professional stand point, the front door needs to go, and there's about 18" of intrusion at the bottom of the "B" post, and it's buckled in such a way that you can't get at it without removing both drivers side doors. So it's a quick pop of the front and back doors, (both of which had picture perfect purchase points as if the Gods of vehicle rescue placed them there...that's the point in wich you set your tool to begin extrication), next remove the "B" post and while someone's making the cut, some one else can be untangling her feet from the pedals. Next, remove the patient......an operation that should take no more than 10 min, maybe 15 min tops.
These guys however, were in no hurry and as I would soon find out, had no clue. They attacked at the "B" post wich is now just a smashed pilar if wrinkled metal, and with out really looking at it, you couldn't see a separation between the front & rear doors. It took Larry, Darrel & Darrel about 10 minuets to pop the drivers door and it didn't matter because the car was so buckled that even if you bent the hinges back, the door wouldn't open far enough to get her out, not to mention the "B" post was right next to her head, and that hindered her extraction.....I was dumb founded,
Standing next to the medic I said "DUDE! There's no way in hell we're getting her out of there." The Medic, Matt was his name, a nice guy and obviously seasoned medic, he just shook his head and mumbled "un-fucking-believable"
I asked "Can't you say something?!"
He gave me a cliff-notes version of an interdepartmental scuffle where the responding fire company, Larry, Darrel & Darrel's company, was almost shut down but they managed to keep it open and feel everyone's out to get them, making it next to impossible to work with them on scene yada yada yada. (Yes folks, this petty shit actually takes place when lives are on the line...it's pathetic, I know)
"Uhh, oohkay....I replied...
So i do the logical thing and look for the officer in charge, their Chief.....and, well, he and I didn't say much.....in fact he didn't say a damn thing at all....ever, actually, he looked just as "amazed" as the fellow civilians who stopped with me & have never seen the "jaws of life" up close & personal.
Now, I am well aware of public Safety etiquette; "Thou shall not tell someone how to do their job while on scene in their district, (or in my case state) because everyone does it differently, BUT....in this case I had seen enough & it was OBVIOUS these fuckwads didn't have the slightest clue what they were doing, and chances were, someone's getting hurt. And judging from the medics comments and non verbals, I knew my assumption couldn't be far off.
So the only thing I could do next....start barkin orders. Now, it's not my place nor my demeanor to "butt in" on someone else's call, but it was bad, going to worse ....how ever, on a positive note.......they pulled the pre connected tool from their engine.....a step in the right direction, 10 min late, but still a step.
I told them to take the back door at the pin (latch) and they did....text book pop....even heard the guy on the tool say "well aint dat jus slicker en pig shee-it....that some bitch popped right off a dair Doo-wayne"
And "Doo-wayne" replied "what choo talkin bout" an obvious clue he wasn't paying attention. In fact, good ol "Doo-Wayne"had not been paying much attention since he arrived on scene. He had gotten him self pinned between the door & the tool on the first door pop attempt. (one of the cardinal rules of using rescue tools, NEVER place yourself between the tool & the vehicle)
The guy on the tool then switches to the cutters to take the "B" post and starts cutting into the car with the tips of the cutters (weakest part, they can break & send chunks of metal flying at great speed...not good, not to mention the back door is still attached to the post) I yelled "HEY! Hold up there Billy-Bob... (yes, I really did call him that, and honestly, he didn't seem to mind).....First, you need to totaly remove the back door." So Billy Bob takes the cutters and cuts the hinges. The door falls to the ground and Billy Bob steps onto the door and positions himself to cut the post.
"STOP!" I yelled, " Get that door the hell out of here, then make the cut, and when you go at the post, open the cutters as far as they'll go, then make your cut, and move up closer to her head (he was positioned mid-point to cut the post)
Billy-Bob asked "What bout Miss Lady's head? So I told him to have someone guid the cutter blade past her head with their hand. Clearly confused, Ol Billy Bob asks "But won't that cut the hand off instead?" Rather than explaining to process, it was easier for me to do it & show him... "Ooooh, I get it now....between the blade and the head..."
He finally gets through the in 3 cuts...not bad considering. Now it's time to cut the bottom of the post....this was another ordeal. 3 guys, who had obviously seen the benefits of understanding vehicle rescue, and now wanting to be the "hero" start fighting over who gets to cut & how.
The Medic chimes in...."Guys....it doesn't matter who, let's just get it done!"
Billy Bob stays on the tool...places the jaws on the post just above the rocker panel, then looks back at me and the medic, obviously looking for an "OK" so I give him a nod and he begins to make the cut. He finishes that, then looks back again for direction...so I tell him to do the same thing from the back side and he does. After this cut, he looks back and tells me it's no the whole way through. I explain how to reposition the tool and "connect" the two cuts. And in a few short minuets, the "B" post is removed.
Finally, we are to remove the Lady from the car and get her into the ambulance and on to better care. And the little boy was just fine.
Point if the story us this, it takes more than a shiny red fire truck and fancy tools to be a firefighter. There is training, lots of training. And more importantly, an understanding of the bigger picture. As it has traditionally been, there is a great sense of pride in our company and what we do. And every firehouse in America thinks they're the best in town....but never should that pride be prioritized over the well being of the patient.
I swerved & missed her, pulled to the burm and hopped out to do my thing & I have Laura-Lynn call 911 in the process.
A few others stop, one being a pick up with all kinds of shit in the back. I grabed about a 2 foot metal hunk of something and I busted out the front passenger window (yes, I tried before I pried) reached in & unlocked the door then climbed inside. I do a quick once over of the boy who wasn't crying at all..just lookin at me like "who the hell are you" and mom who was screaming and obviously in pretty good pain and concerned with her child. I assured her he was all right, and calmed her down as best I could. Even after just a quick once over I felt he would be just fine.....it's amazing how resilient kids are.
A few minuets pass and the medics show up, and then the fire dept. The fire dept. shows up in a early 90s commercial cab engine....a small one at that. From the size and type of apparatus, I assume they are there for fire suppression and expect at least something resembling a rescue would show up to perform the (rescue) tool work, after all this is a major interstate....but, unfortunately this would not be the case.
Theses back ass lookin country bumpkins fall out of what I would consider a poor excuse for an engine, onto the highway, stumble around like the Keystone Cops then eventualy manage to find and place into service portable power plant and a combi-tool. (short fir combination tool, it combines the abilities of the cutters and the spreaders) They fire it up & it sounds way different than it should, almost like a small Harley. So I looked at the power plant a little closer and notice the "after market" (obviously more like home made) muffler on the side and as it registers in my head what it is I'm looking at, I hear one of the toothless heroes say in his back hills accent "Damn! That some bitch sounds purdy good don't it?".....honestly, you can't make this shit up.
Now, as far as the damage to the vehicle, from a professional stand point, the front door needs to go, and there's about 18" of intrusion at the bottom of the "B" post, and it's buckled in such a way that you can't get at it without removing both drivers side doors. So it's a quick pop of the front and back doors, (both of which had picture perfect purchase points as if the Gods of vehicle rescue placed them there...that's the point in wich you set your tool to begin extrication), next remove the "B" post and while someone's making the cut, some one else can be untangling her feet from the pedals. Next, remove the patient......an operation that should take no more than 10 min, maybe 15 min tops.
These guys however, were in no hurry and as I would soon find out, had no clue. They attacked at the "B" post wich is now just a smashed pilar if wrinkled metal, and with out really looking at it, you couldn't see a separation between the front & rear doors. It took Larry, Darrel & Darrel about 10 minuets to pop the drivers door and it didn't matter because the car was so buckled that even if you bent the hinges back, the door wouldn't open far enough to get her out, not to mention the "B" post was right next to her head, and that hindered her extraction.....I was dumb founded,
Standing next to the medic I said "DUDE! There's no way in hell we're getting her out of there." The Medic, Matt was his name, a nice guy and obviously seasoned medic, he just shook his head and mumbled "un-fucking-believable"
I asked "Can't you say something?!"
He gave me a cliff-notes version of an interdepartmental scuffle where the responding fire company, Larry, Darrel & Darrel's company, was almost shut down but they managed to keep it open and feel everyone's out to get them, making it next to impossible to work with them on scene yada yada yada. (Yes folks, this petty shit actually takes place when lives are on the line...it's pathetic, I know)
"Uhh, oohkay....I replied...
So i do the logical thing and look for the officer in charge, their Chief.....and, well, he and I didn't say much.....in fact he didn't say a damn thing at all....ever, actually, he looked just as "amazed" as the fellow civilians who stopped with me & have never seen the "jaws of life" up close & personal.
Now, I am well aware of public Safety etiquette; "Thou shall not tell someone how to do their job while on scene in their district, (or in my case state) because everyone does it differently, BUT....in this case I had seen enough & it was OBVIOUS these fuckwads didn't have the slightest clue what they were doing, and chances were, someone's getting hurt. And judging from the medics comments and non verbals, I knew my assumption couldn't be far off.
So the only thing I could do next....start barkin orders. Now, it's not my place nor my demeanor to "butt in" on someone else's call, but it was bad, going to worse ....how ever, on a positive note.......they pulled the pre connected tool from their engine.....a step in the right direction, 10 min late, but still a step.
I told them to take the back door at the pin (latch) and they did....text book pop....even heard the guy on the tool say "well aint dat jus slicker en pig shee-it....that some bitch popped right off a dair Doo-wayne"
And "Doo-wayne" replied "what choo talkin bout" an obvious clue he wasn't paying attention. In fact, good ol "Doo-Wayne"had not been paying much attention since he arrived on scene. He had gotten him self pinned between the door & the tool on the first door pop attempt. (one of the cardinal rules of using rescue tools, NEVER place yourself between the tool & the vehicle)
The guy on the tool then switches to the cutters to take the "B" post and starts cutting into the car with the tips of the cutters (weakest part, they can break & send chunks of metal flying at great speed...not good, not to mention the back door is still attached to the post) I yelled "HEY! Hold up there Billy-Bob... (yes, I really did call him that, and honestly, he didn't seem to mind).....First, you need to totaly remove the back door." So Billy Bob takes the cutters and cuts the hinges. The door falls to the ground and Billy Bob steps onto the door and positions himself to cut the post.
"STOP!" I yelled, " Get that door the hell out of here, then make the cut, and when you go at the post, open the cutters as far as they'll go, then make your cut, and move up closer to her head (he was positioned mid-point to cut the post)
Billy-Bob asked "What bout Miss Lady's head? So I told him to have someone guid the cutter blade past her head with their hand. Clearly confused, Ol Billy Bob asks "But won't that cut the hand off instead?" Rather than explaining to process, it was easier for me to do it & show him... "Ooooh, I get it now....between the blade and the head..."
He finally gets through the in 3 cuts...not bad considering. Now it's time to cut the bottom of the post....this was another ordeal. 3 guys, who had obviously seen the benefits of understanding vehicle rescue, and now wanting to be the "hero" start fighting over who gets to cut & how.
The Medic chimes in...."Guys....it doesn't matter who, let's just get it done!"
Billy Bob stays on the tool...places the jaws on the post just above the rocker panel, then looks back at me and the medic, obviously looking for an "OK" so I give him a nod and he begins to make the cut. He finishes that, then looks back again for direction...so I tell him to do the same thing from the back side and he does. After this cut, he looks back and tells me it's no the whole way through. I explain how to reposition the tool and "connect" the two cuts. And in a few short minuets, the "B" post is removed.
Finally, we are to remove the Lady from the car and get her into the ambulance and on to better care. And the little boy was just fine.
Point if the story us this, it takes more than a shiny red fire truck and fancy tools to be a firefighter. There is training, lots of training. And more importantly, an understanding of the bigger picture. As it has traditionally been, there is a great sense of pride in our company and what we do. And every firehouse in America thinks they're the best in town....but never should that pride be prioritized over the well being of the patient.
Saturday, August 11, 2012
Quite Shocking (literally)
As a firefighter/EMT, even with all the blood, guts & gore we see, there are the "routine" ambulance calls, false fire alarms and other less "exciting calls" But even those can change in a hurry and without warning.
It was Thanksgiving Day, about 7 years ago or so and after finishing my annual Thanksgiving running around, I decided to spend the night at the fire house to help with staffing. You see, at a fire house that has live in members, most of them are not from the area and go home to spend time with family and friends. These same guys run a vast majority of the calls because most of their free time away from work & college is spent at the firehouse, so on holidays, staffing gets light & us "home responders" pick up the slack.
I got there around 20:00 hrs (that's 8 pm in civilian time) and it had a fairly uneventful day so the few guys there were watching a movie. I settled in, watched the rest of it with them then decided to call it a night.
At just before 0700 (7 am) we get tapped (dispatched) for a Delta 2, a 70 some year old male, unresponsive & not breathing. We spring from our bunks, and head to work. I responded in the ambulance, only we were BLS (basic life support) and since it's an ALS (advanced life support) call, we requested a medic.
We receive confirmation that one of our Medics would be in rout but a bit delayed because he was just leaving work (at the dispatch center)
We arrive on scene & we run up to the house with a frantic women screaming "He's in the bed room, hurry, please save him"
So to the bed room we went. I walk in and there's our patient laying face down across the bed in his gutchies. I make my way around to his head & upper body and roll him over to check for an airway & as I'm rolling him he groans. "He's breathing" I yell to my partner/driver Chad as he comes through the door with the first in bag followed by the engine crew.
I give the guy a sternum rub (rub his sternum hard with my knuckles...it's definitely an attention getter) and he kinda swats at me & mumbles "stop it" and opens his eyes. I tell him I'm with the ambulance, then he shoots back, kinda confused "so, what in the hell are you doing in my bed room?" I explain that his wife found him all unconscious so she called 911. He denies anythings wrong, and swears he was just sleeping. He looks at me kinda funny and asks again who I am and why I'm there, only this time, a little more coherently. His wife then chimes in and explains how she found him, and pleads with him to let us check him out. It was obvious something had happened & he knew it, but it was obviously an awkward situation for the man, after all he came to on his bed, in his underwear, surrounded by a bunch of fireman.
I ask him what's wrong & how he's feeling but he still kinda denies anythings wrong, but you could tell he was now rethinking everything. So I politely ask him to let us check him real quick to make sure he's ok if for anything, to calm his wife down and he agrees. Chad starts taking vitals (pulse,blood pressure, O2 levels & lung sounds) Then Jim, the wagon driver, comes in with the heart monitor, we start hooking him up & Jim tells me the medic is about 2-3 minuets out. I nod and continue putting the stickers & wires on the patient. Once he's all hooked up Jim turns the monitor on and I start organizing the "retreat" of the guys in the bedroom & removal of some equipment we won't need. Then I start back with the patient, telling him he should let us take him to the hospital just to be safe when I here Jim say "Uuuh, Stan!...
I look over to Jim and he's holding the monitor so I can see the screen & I immediately notice what has him so concerned. On the screen his heart rhythm is showing what are called "Tomb Stones"
Now, most of you have some what of an idea of what a normal heart rhythm looks like. It's the line with the sharp high and low points followed by a short flat line, then repeat. Tomb stones look just like the name says, it's a flat line followed by a "hump" that looks like an old tomb stone or one from a cartoon, and also, as the name suggests, they are really REALLY bad! To put it in more convenient terms, we were basically watching this guy have a heart attack.
Now it's real, we need to go and we need to go right now. I call for the reeves stretcher (a long stretcher about the size ofva back board with carry handles) then sternly but polity tell our patient like it or not, he's going to the hospital. Now, by law, we cannot make anyone go to the hospital, you have the right to refuse, but I wanted to get across the seriousness of the situation with out frightening him or his wife anymore than he probably already was.
As one of the guys brings in the reeves stretcher, he's followed by our medic, Fred, who asks "What's up guys?"
Jim shows him the monitor, and Fred says "OK then, get him out to the bus (ambulance) I'm gonna go get a line ready (iv drip) and what ever you do, make sure you print that rhythm.
We get him onto the reeves then carry him out to the regular stretcher that's waiting in the living room. As simple as it sounds, 6 guys, in gear, carrying someone on a reeves stretcher, out of a bed room, around the corner and down the stairs, is anything but simple. (look at the hallway & stairs in your home and imagine it)
So after we carefully but expediently, carry sim down stairs, managing not to fall, or drop the poor guy, we place him onto the regular Ambulance Stretcher then make a B line out to the bus.
Fred starts a line (iv) and pushes a few drugs while I monitor vital signs. We give the nod to Chad who's our Chauffeur for the trip, tell him to run it "lights" (emergency) and off to Forbes we go.
We pull in, get the patient out of the back & wheel him in. It's kind of a slow morning so the Drs are waiting for us and lead us to a room. We switch him onto the ER bed, then start giving the report the Drs are looking at the monitor strip & one says to the unit clerk to start making arrangements for a helicopter to transfer the patient to West Penn hospital because he needs to be in a Cath Lab ASA (heart catheterization lab/procedure room).
I make exit from the room and head out to get new sheets for the stretcher & put the ambulance back together.
Chad and I step outside and notice that it had started snowing & it was coming down pretty good. I turn around and head back in to tell Fred do that we can get back to the station before the roads get bad. As I approach the patients room, Fred pops out from behind the curtain and with concern and a bit of confusion says, "They can't fly....they said the weathers to bad...?"
I tell him "Yea it is, it's snowing like crazy, we should probably get back soon."
Fred says, "Yea....That's probably not going to happen, their ground transport service can't be here for one to two hours, so they asked if we would transport."
"OK then, let's get it done, I'll go tell Chad & get the stretcher." I replied.
So i go inform Chad that our job here isn't finished and we get everything together & wheel it back into the ER and on the way I pass a Dr on the phone with West Penn so they can be ready when we get there.
Now I'm starting to get a feeling of urgency and out side the room Fred pops out again and I ask "This dude's pretty bad off, huh?"
He simply replies "Bad off would be an improvement."
Then I say, "Well, with the roads & the weather the way they are, I don't think this is going to be a quick trip."
He nervously replies "I know."
At this point the seriousness of the situation hits us. This guy doesn't need to be in a cath lab now, he needed to be in one yesterday.
We all kinda take a quick quiet deep breath & Fred asks "Ready"
"Yup....let's do this." I answered.
Chad nods & gives us a "Lets roll." then heads out to get the ambulance warmed up and ready while Fred and I wheel the stretcher into the room, to again, make the switch. This time, the patient has 2 more IV's that we have to maneuver as we lift him over to our stretcher, get him settled in for the ride then wheel him out to the ambulance.
Now by this time the patient has become more comfortable with us and is cracking jokes like "Oh great, you too again.....can I get a meal on the trip this time?" we nervously chuckle and load him into the stretcher with Drs in tow giving Fred instructions.
Fred acknowledges and tells them if needs be, we'll be back. And our journey begins.
Now as fast as weather would safely allow, we head towards the parkway, lights & siren, and as we approach the parkway the patient slips into unconsciousness. Fred starts to holler his name.
Chad questions from the front "Head back (to forbes)?"
Just then, the patient comes to.
"No Chad, we're good" Fred answers.
Then as we're on the parkway on ramp, the Pt slips out again & shows a goofy rhythm for a split second.
Chad asks again "Do you want me to head back?....tell me now while I can still turn and go down the next on ramp (the wrong way)."
The patient again comes to and Fred says "Nah, i think we're ok"
"Are you sure, we're almost to the point of no return....." Chad shoots back.
"We're good, just keep going and watch the road (condition)"
Fred yells back.
"Don't worry," Chad says "the road (on the parkway) is just wet.
Which makes us fell just a tad bit at ease.
We make it a few more minuets down the road, and as soon as we get to what could be considered a "half way point" the Pt straight up crashes
Fred yells "Stan!, bag him" (use the bag valve mask to breath for the patient)
"Got it!" I say as we each switch seats.
I kinda stand over the patient and start bagging him with one hand while I'm doing chest compressions with the other.
Fred says "I know you gotta do it one handed but these compressions gotta count " as he starts pushing (administer via IV) certain cardiac drugs charging the monitor/defibrillator. Then we here the distinctive "snap crackle and pop" as a few of his ribs break from me doing compressions. (it's normal during good quality CPR)
"Never mind" he says, then "Ready?!" he asks
I give him a nod then he shouts "CLEAR!!"
I yell back "GOOD!" to let him know I'm safe and clear of the patient & stretcher then "Whack!" Fred delivers the shock...and the patient has a good heart beat again.
We continue on to West Penn, constantly check his vitals...he's kinda in and out and barely responding to his name.
Fred, tells me to move so he can intubate the patient to secure an airway (insert a tube in through the mouth down to/near the opening of the lungs) and hands me the mic & says I'm calling (medical) command, you just hold the mic.
So as he's intubating he's on the radio telling the Doc at Forbes what's going on & the doctor tells him to just follow protocol (preauthorized plan of care) and keep doing what we're doing and that he would update West Penn so they're ready.
I hang the mic back up as Fred gets the tube (successful intubation) and we hook the bag valve mask straight up to the tube and start helping him breath and bang, he crashes again. So again I go into the dual role of pumpin & blowin. (EMS slang for CPR)
Fred pushes more drugs and then "CLEAR" Fred hits him again, then looks at the monitor..."Nope!...CLEAR!"
he hits him again....looks....."We got it."
"Shit!....CLEAR!"
He drops out so Fred zaps him a third time.
This time the heart beat stays, but only for a minuet or two then down he goes again.
We would continue like this for what seemed like hours. A continuous hectic ballet of CPR, IV drugs and defibrillation. We started out following the general rule of 3 shocks followed by cardiac IV drugs and CPR but eventually it wasn't enough and we reached the end of Fred's paramedic protocol for a cardiac arrest, meaning we have performed every emergency medical intervention that we're authorized to do. So Fred says "let's just keep going" and the ballet continued, even managing to almost shock each other once or twice during the chaos and using up all of the cardiac drugs on the ambulance which only meant more CPR for us, and my arms were starting to feel like jello.
After what seemed like a few long hours, we pull into the ER at West Penn and we're still in the back pumpin, blowin & shockin.
Chad gets out and comes around back to help us get him out and as soon as he opens the door we tell him to tell security to get us help, then get in and help with CPR.
Chad screams over to the guard, climbs in & starts compressions to give Fred & I a break.
Caught up in our work, about 15 minuets goes by and we notice we still have no help from the ER. This guys feet from the door to the ER (and the rest of his life) and was in such condition that we couldn't stop even for a second to get him out of the bus. We were keeping him alive.
I switch with Chad and again start chest compressions stoping only to administer shocks, and send him to find our help.
He returns later with a nurse, she was a little thing, maybe 5'4" & 100 lbs soaking wet. She looks in the back and says "Oh My God" in utter disbelief of us administering more shocks and perform CPR amidst the absolute mess we've made in the back of the ambulance.
Fred calmly says, "Sorry hun, but I think your going to need more help" and the nurse takes off back into the ER for reinforcements.
The adequate help arrived, and we get the guy out & on the way into the ER. I'm standing on the side of the stretcher doing compressions, Fred's bagging explaining how we were originally supposed to go straight to the cath lab but he crashed & it's been chaos ever since.
We get him into an ER Room, then off the stretcher & onto the bed, and a nurse kindly relieves me of chest compressions so I switch up with Fred and started bagging again whole he continues with the report.
After about 5 minuets in the ER we get an acceptable rhythm and as soon as we go to move him to the cath lab, he crashes again.
We continued working him for another 40 minuets untill we got him stable enough to send him to the cath lab.
As they wheel him away, all that's left in the room is Fred and I. We just stand there, sort of collecting out thoughts as we begin to mentally process what had just just transpired. I notice the ER room is now trashed, with a small island of clean floor where the ER bed sat. I look at Fred, a seasoned medic, and he too kinda has the blank stare that I'm feeling. We look at each other and kinda nod, as If to say "Good job" He looks totally whooped and I'm sure I look no better. I'm sweating, my arms feel like rubber and I'm just plain exhausted. Then he breaks the silence and says "We should probably go clean up."
I quietly answer "yup...."
So we head out to the ambulance.
When we get there, to our surprise, we find the Chad had pretty much had it cleaned up. We helped him finish what little was left, then Fred suggested we head up to the cath lab to see if he in fact made it up for the procedure. so we had back in. We find our way and step into the control room to see them finishing preparations on our patient when the Dr walks in and asks "Can I help you."
"Fred tells him we brought him in how we had one hell of a fight to get him there. The Dr pats us on the shoulder and says "Good job guys, I got it from here." and then steps into the procedure room.
We stayed to watch for a little bit then decided it was time to go.
On the ride home, we light heartedly talk about the ordeal we had just went through, Fred, taking notes the whole time do that he can be sure to get everything documented on the state (ambulance) trip sheet (call report) And it wasn't until we "relived" it in conversation and looked at the printed strip (report) from the heart monitor that recoded to memory ever heart rhythm and every shock. As it turned out, we had defibrillated this guy 37 times (yes, thirty-seven) which is practically unheard of, we had done, re-done and done again every possible thing we could to get this guy where we needed to be.
Finally, at around 11:30 we arrive back at the station and we peel ourselves out of the ambulance so we can clean it and finish putting it back together to get it back in service. Then shower & head back to bed.
Later in the day we would receive a call from the Dr in the Cath Lab. As it turns out it was a curtsy call to let us know that our patient did intact make it through the procedure and would be just fine.
We had done it....We fought long and hard, faced practically ever challenge we possibly could and used every skill we had, and we came out on top, and had we not been so damn tired, probably went for a beer.
To this day, I don't think I have ever had to work that hard on any ambulance call......it was physically, mentally and emotionally exhausting, but it's the reason we do the job.
It was Thanksgiving Day, about 7 years ago or so and after finishing my annual Thanksgiving running around, I decided to spend the night at the fire house to help with staffing. You see, at a fire house that has live in members, most of them are not from the area and go home to spend time with family and friends. These same guys run a vast majority of the calls because most of their free time away from work & college is spent at the firehouse, so on holidays, staffing gets light & us "home responders" pick up the slack.
I got there around 20:00 hrs (that's 8 pm in civilian time) and it had a fairly uneventful day so the few guys there were watching a movie. I settled in, watched the rest of it with them then decided to call it a night.
At just before 0700 (7 am) we get tapped (dispatched) for a Delta 2, a 70 some year old male, unresponsive & not breathing. We spring from our bunks, and head to work. I responded in the ambulance, only we were BLS (basic life support) and since it's an ALS (advanced life support) call, we requested a medic.
We receive confirmation that one of our Medics would be in rout but a bit delayed because he was just leaving work (at the dispatch center)
We arrive on scene & we run up to the house with a frantic women screaming "He's in the bed room, hurry, please save him"
So to the bed room we went. I walk in and there's our patient laying face down across the bed in his gutchies. I make my way around to his head & upper body and roll him over to check for an airway & as I'm rolling him he groans. "He's breathing" I yell to my partner/driver Chad as he comes through the door with the first in bag followed by the engine crew.
I give the guy a sternum rub (rub his sternum hard with my knuckles...it's definitely an attention getter) and he kinda swats at me & mumbles "stop it" and opens his eyes. I tell him I'm with the ambulance, then he shoots back, kinda confused "so, what in the hell are you doing in my bed room?" I explain that his wife found him all unconscious so she called 911. He denies anythings wrong, and swears he was just sleeping. He looks at me kinda funny and asks again who I am and why I'm there, only this time, a little more coherently. His wife then chimes in and explains how she found him, and pleads with him to let us check him out. It was obvious something had happened & he knew it, but it was obviously an awkward situation for the man, after all he came to on his bed, in his underwear, surrounded by a bunch of fireman.
I ask him what's wrong & how he's feeling but he still kinda denies anythings wrong, but you could tell he was now rethinking everything. So I politely ask him to let us check him real quick to make sure he's ok if for anything, to calm his wife down and he agrees. Chad starts taking vitals (pulse,blood pressure, O2 levels & lung sounds) Then Jim, the wagon driver, comes in with the heart monitor, we start hooking him up & Jim tells me the medic is about 2-3 minuets out. I nod and continue putting the stickers & wires on the patient. Once he's all hooked up Jim turns the monitor on and I start organizing the "retreat" of the guys in the bedroom & removal of some equipment we won't need. Then I start back with the patient, telling him he should let us take him to the hospital just to be safe when I here Jim say "Uuuh, Stan!...
I look over to Jim and he's holding the monitor so I can see the screen & I immediately notice what has him so concerned. On the screen his heart rhythm is showing what are called "Tomb Stones"
Now, most of you have some what of an idea of what a normal heart rhythm looks like. It's the line with the sharp high and low points followed by a short flat line, then repeat. Tomb stones look just like the name says, it's a flat line followed by a "hump" that looks like an old tomb stone or one from a cartoon, and also, as the name suggests, they are really REALLY bad! To put it in more convenient terms, we were basically watching this guy have a heart attack.
Now it's real, we need to go and we need to go right now. I call for the reeves stretcher (a long stretcher about the size ofva back board with carry handles) then sternly but polity tell our patient like it or not, he's going to the hospital. Now, by law, we cannot make anyone go to the hospital, you have the right to refuse, but I wanted to get across the seriousness of the situation with out frightening him or his wife anymore than he probably already was.
As one of the guys brings in the reeves stretcher, he's followed by our medic, Fred, who asks "What's up guys?"
Jim shows him the monitor, and Fred says "OK then, get him out to the bus (ambulance) I'm gonna go get a line ready (iv drip) and what ever you do, make sure you print that rhythm.
We get him onto the reeves then carry him out to the regular stretcher that's waiting in the living room. As simple as it sounds, 6 guys, in gear, carrying someone on a reeves stretcher, out of a bed room, around the corner and down the stairs, is anything but simple. (look at the hallway & stairs in your home and imagine it)
So after we carefully but expediently, carry sim down stairs, managing not to fall, or drop the poor guy, we place him onto the regular Ambulance Stretcher then make a B line out to the bus.
Fred starts a line (iv) and pushes a few drugs while I monitor vital signs. We give the nod to Chad who's our Chauffeur for the trip, tell him to run it "lights" (emergency) and off to Forbes we go.
We pull in, get the patient out of the back & wheel him in. It's kind of a slow morning so the Drs are waiting for us and lead us to a room. We switch him onto the ER bed, then start giving the report the Drs are looking at the monitor strip & one says to the unit clerk to start making arrangements for a helicopter to transfer the patient to West Penn hospital because he needs to be in a Cath Lab ASA (heart catheterization lab/procedure room).
I make exit from the room and head out to get new sheets for the stretcher & put the ambulance back together.
Chad and I step outside and notice that it had started snowing & it was coming down pretty good. I turn around and head back in to tell Fred do that we can get back to the station before the roads get bad. As I approach the patients room, Fred pops out from behind the curtain and with concern and a bit of confusion says, "They can't fly....they said the weathers to bad...?"
I tell him "Yea it is, it's snowing like crazy, we should probably get back soon."
Fred says, "Yea....That's probably not going to happen, their ground transport service can't be here for one to two hours, so they asked if we would transport."
"OK then, let's get it done, I'll go tell Chad & get the stretcher." I replied.
So i go inform Chad that our job here isn't finished and we get everything together & wheel it back into the ER and on the way I pass a Dr on the phone with West Penn so they can be ready when we get there.
Now I'm starting to get a feeling of urgency and out side the room Fred pops out again and I ask "This dude's pretty bad off, huh?"
He simply replies "Bad off would be an improvement."
Then I say, "Well, with the roads & the weather the way they are, I don't think this is going to be a quick trip."
He nervously replies "I know."
At this point the seriousness of the situation hits us. This guy doesn't need to be in a cath lab now, he needed to be in one yesterday.
We all kinda take a quick quiet deep breath & Fred asks "Ready"
"Yup....let's do this." I answered.
Chad nods & gives us a "Lets roll." then heads out to get the ambulance warmed up and ready while Fred and I wheel the stretcher into the room, to again, make the switch. This time, the patient has 2 more IV's that we have to maneuver as we lift him over to our stretcher, get him settled in for the ride then wheel him out to the ambulance.
Now by this time the patient has become more comfortable with us and is cracking jokes like "Oh great, you too again.....can I get a meal on the trip this time?" we nervously chuckle and load him into the stretcher with Drs in tow giving Fred instructions.
Fred acknowledges and tells them if needs be, we'll be back. And our journey begins.
Now as fast as weather would safely allow, we head towards the parkway, lights & siren, and as we approach the parkway the patient slips into unconsciousness. Fred starts to holler his name.
Chad questions from the front "Head back (to forbes)?"
Just then, the patient comes to.
"No Chad, we're good" Fred answers.
Then as we're on the parkway on ramp, the Pt slips out again & shows a goofy rhythm for a split second.
Chad asks again "Do you want me to head back?....tell me now while I can still turn and go down the next on ramp (the wrong way)."
The patient again comes to and Fred says "Nah, i think we're ok"
"Are you sure, we're almost to the point of no return....." Chad shoots back.
"We're good, just keep going and watch the road (condition)"
Fred yells back.
"Don't worry," Chad says "the road (on the parkway) is just wet.
Which makes us fell just a tad bit at ease.
We make it a few more minuets down the road, and as soon as we get to what could be considered a "half way point" the Pt straight up crashes
Fred yells "Stan!, bag him" (use the bag valve mask to breath for the patient)
"Got it!" I say as we each switch seats.
I kinda stand over the patient and start bagging him with one hand while I'm doing chest compressions with the other.
Fred says "I know you gotta do it one handed but these compressions gotta count " as he starts pushing (administer via IV) certain cardiac drugs charging the monitor/defibrillator. Then we here the distinctive "snap crackle and pop" as a few of his ribs break from me doing compressions. (it's normal during good quality CPR)
"Never mind" he says, then "Ready?!" he asks
I give him a nod then he shouts "CLEAR!!"
I yell back "GOOD!" to let him know I'm safe and clear of the patient & stretcher then "Whack!" Fred delivers the shock...and the patient has a good heart beat again.
We continue on to West Penn, constantly check his vitals...he's kinda in and out and barely responding to his name.
Fred, tells me to move so he can intubate the patient to secure an airway (insert a tube in through the mouth down to/near the opening of the lungs) and hands me the mic & says I'm calling (medical) command, you just hold the mic.
So as he's intubating he's on the radio telling the Doc at Forbes what's going on & the doctor tells him to just follow protocol (preauthorized plan of care) and keep doing what we're doing and that he would update West Penn so they're ready.
I hang the mic back up as Fred gets the tube (successful intubation) and we hook the bag valve mask straight up to the tube and start helping him breath and bang, he crashes again. So again I go into the dual role of pumpin & blowin. (EMS slang for CPR)
Fred pushes more drugs and then "CLEAR" Fred hits him again, then looks at the monitor..."Nope!...CLEAR!"
he hits him again....looks....."We got it."
"Shit!....CLEAR!"
He drops out so Fred zaps him a third time.
This time the heart beat stays, but only for a minuet or two then down he goes again.
We would continue like this for what seemed like hours. A continuous hectic ballet of CPR, IV drugs and defibrillation. We started out following the general rule of 3 shocks followed by cardiac IV drugs and CPR but eventually it wasn't enough and we reached the end of Fred's paramedic protocol for a cardiac arrest, meaning we have performed every emergency medical intervention that we're authorized to do. So Fred says "let's just keep going" and the ballet continued, even managing to almost shock each other once or twice during the chaos and using up all of the cardiac drugs on the ambulance which only meant more CPR for us, and my arms were starting to feel like jello.
After what seemed like a few long hours, we pull into the ER at West Penn and we're still in the back pumpin, blowin & shockin.
Chad gets out and comes around back to help us get him out and as soon as he opens the door we tell him to tell security to get us help, then get in and help with CPR.
Chad screams over to the guard, climbs in & starts compressions to give Fred & I a break.
Caught up in our work, about 15 minuets goes by and we notice we still have no help from the ER. This guys feet from the door to the ER (and the rest of his life) and was in such condition that we couldn't stop even for a second to get him out of the bus. We were keeping him alive.
I switch with Chad and again start chest compressions stoping only to administer shocks, and send him to find our help.
He returns later with a nurse, she was a little thing, maybe 5'4" & 100 lbs soaking wet. She looks in the back and says "Oh My God" in utter disbelief of us administering more shocks and perform CPR amidst the absolute mess we've made in the back of the ambulance.
Fred calmly says, "Sorry hun, but I think your going to need more help" and the nurse takes off back into the ER for reinforcements.
The adequate help arrived, and we get the guy out & on the way into the ER. I'm standing on the side of the stretcher doing compressions, Fred's bagging explaining how we were originally supposed to go straight to the cath lab but he crashed & it's been chaos ever since.
We get him into an ER Room, then off the stretcher & onto the bed, and a nurse kindly relieves me of chest compressions so I switch up with Fred and started bagging again whole he continues with the report.
After about 5 minuets in the ER we get an acceptable rhythm and as soon as we go to move him to the cath lab, he crashes again.
We continued working him for another 40 minuets untill we got him stable enough to send him to the cath lab.
As they wheel him away, all that's left in the room is Fred and I. We just stand there, sort of collecting out thoughts as we begin to mentally process what had just just transpired. I notice the ER room is now trashed, with a small island of clean floor where the ER bed sat. I look at Fred, a seasoned medic, and he too kinda has the blank stare that I'm feeling. We look at each other and kinda nod, as If to say "Good job" He looks totally whooped and I'm sure I look no better. I'm sweating, my arms feel like rubber and I'm just plain exhausted. Then he breaks the silence and says "We should probably go clean up."
I quietly answer "yup...."
So we head out to the ambulance.
When we get there, to our surprise, we find the Chad had pretty much had it cleaned up. We helped him finish what little was left, then Fred suggested we head up to the cath lab to see if he in fact made it up for the procedure. so we had back in. We find our way and step into the control room to see them finishing preparations on our patient when the Dr walks in and asks "Can I help you."
"Fred tells him we brought him in how we had one hell of a fight to get him there. The Dr pats us on the shoulder and says "Good job guys, I got it from here." and then steps into the procedure room.
We stayed to watch for a little bit then decided it was time to go.
On the ride home, we light heartedly talk about the ordeal we had just went through, Fred, taking notes the whole time do that he can be sure to get everything documented on the state (ambulance) trip sheet (call report) And it wasn't until we "relived" it in conversation and looked at the printed strip (report) from the heart monitor that recoded to memory ever heart rhythm and every shock. As it turned out, we had defibrillated this guy 37 times (yes, thirty-seven) which is practically unheard of, we had done, re-done and done again every possible thing we could to get this guy where we needed to be.
Finally, at around 11:30 we arrive back at the station and we peel ourselves out of the ambulance so we can clean it and finish putting it back together to get it back in service. Then shower & head back to bed.
Later in the day we would receive a call from the Dr in the Cath Lab. As it turns out it was a curtsy call to let us know that our patient did intact make it through the procedure and would be just fine.
We had done it....We fought long and hard, faced practically ever challenge we possibly could and used every skill we had, and we came out on top, and had we not been so damn tired, probably went for a beer.
To this day, I don't think I have ever had to work that hard on any ambulance call......it was physically, mentally and emotionally exhausting, but it's the reason we do the job.
Monday, August 6, 2012
Thick Skinned
"For those who protect it, life has a meaning the sheltered will never know." - unknown
If you were to ask my wife what she thinks about me being a firefighter/EMT, one of the things she'd probably tell you, because theres no easy way to explain it, is "He's fucked up" or "cold hearted" Now some who know me may agree with that for different reasons, what she is referring to is my psyche, more specifically the "cavalier" additude I have towards the uglier parts of the job. More specifically, how after seeing blood, guts, death and dismemberment, I can come home and eat, or go back to sleep, or just carry on with my day like nothing happened.
You see, people always ask the same few questions..."Have you ever saved anybody?"....."Is it hot?"....and "What's it like?" All of them inquiring about the exciting and dangerous parts of the job, but never give two thoughts about the ugly side of the job. The dark and grim events in life for which we have a front row seat.
I honestly don't think I could even begin to tell you how many dead people I've seen, or even how many I've watched die, and by that I literally mean watching a persons life slip away and cease right in front of my eyes. As horrible as it may sound, it's all part of a any given day on the job. It could be weeks or months before your faced with a call where you can't make the save. Then there are the times when the grim reaper stows away on one of the rigs so he can ride around with you to get caught up on his quota.
Truth is, you never know what your going to find on scene. Sure, there's the more obvious patients. Usually it's something like a cardiac arrest call. Where you expect to run in & see the person lifeless & kinda pale laying on the floor. Or, if you get called for an MVA (motor vehicle accident) your going to find at least one wrecked vehicle, maybe more and you can almost always count on someone having at least some "lawyer pain" (the "agonizing" pain that changes in severity & location from the time you get on scene to the time you hand them off at the ER) Or say a traumatic injury call where you expect a lot of blood, or a bone sticking through the skin. You almost always have an idea of what you'll find, but your never 100% sure, and to really keep you on your toes, there are even times when you arrive on scene and find something totally different than what you were called for.
For example, a call for a "severe" nose bleed only to arrive on scene to find your patient had tripped and face planted onto a set of concrete stairs. So, yes his nose is in fact bleeding, what someone failed to mention was that it's also smashed. Along with his broken jaw, missing teeth, gash on the forehead and so on.
Then there are the calls that seem as if they'll be nothing more than an expensive taxi ride to the hospital but skips turning bad and goes straight to worse. I remember taking an call for a nose bleed, it was an Alpha response, meaning no lights or siren, the lowest priority call. I shoulda known nothing good was gonna come out of it either, I was driving & my tech (the person handling patient care) was a total idiot....but its a nose bleed so how bad can it be, right?
We arrived on scene to find an elderly female with an obvious nose bleed. She wanted to be transported, so we did, and wouldn't you know it, 5 min into the trip to the hospital, "SURPRISE" she go's into cardiac arrest. So just because a call seems like it will be routine doesn't mean it will be.
If you haven't figured it out yet, death is undoubtably part of the job, and it pretty safe to say that people in this field probably see more dead people and death in one year than most people do in a lifetime....literally. Sure it may sound a little harsh, but that's the truth of it. We are trained as firefighters, EMTs and Paramedics to save lives but we also understand that sometimes they're just too far gone and its just out of our hands.
There are the calls that always seemed to kinda piss me off. Those are the ones where you are able to keep the patient alive or even bring back to life, in the back of the ambulance, and usually your bustin your ass doing everything you can to save them. Then you get to the hospital and roll them in side with a heart beat, only to see the Dr. call it (pronounce them dead) not even 5 min after you get there. You want to grab him by his stethoscope and yell "Hey Doc!! What the Fuck!?"
You bust your ass and put in all that hard work to get some poor bastards heart beating again and then poof, its all for nothing. And you really do bust your ass. Ask any medic or EMT, after a good call where you have to seriously work the patient and time is of the essence, you are whooped. It's like this physically tiring emotional high, thinking that all your work will pay off this time only to find out it won't. It's a bit disheartening, but pisses you off more than anything, well at least me anyway.
Then there's the calls that stand out for different reasons. One example was an accident with rollover and ejection. (person thrown from vehicle) this poor guy, in his 30's lost control & rolled his pick up truck & was ejected. When he was thrown from the vehicle, he landed on top of the Jersey barrier, then plopped down onto the road. As we arrived on scene, we found two nurses performing CPR. Because patient care was started, we're obligated to continue. But we could tell it was a lost cause. By the way his head was positioned, it was fairly obvious his neck was broken. I happened to be in the fire side of things for this call, do we helped the ambulance crew load him up & get going, he was pronounced (dead) almost immediately upon arrival at the trauma center.
Back on scene, while cleaning up debris & looking for some patient identification, we came across A Military helmet. We then found his wallet in the cab of the truck, right next to a airline ticket stub that was paper clipped to some photos and discharge papers. Turns out he had just flown into the states after a tour of duty in Iraq. Here was an American soldier who had seen combat & couldn't have been back in the states for more than 12 hours, and now he was dead.
And somewhere, was his family, patiently waiting to hug him because he had made it home safe from War, only to find out they would never get the chance.
And then there are calls you get where you know it's just gonna be plain ugly, but you still aren't sure what to expect. Persons hit by a train fall into this category. I responded to a few of these over the years, and they're all different, gruesome as hell, but different.
One I went on turned into a lighting detail and a body (parts) recovery. According to the train engineer, he was tooling along at about 40 mph when he noticed something between the tracks but couldn't tell what it was, then, at the last second, "it"sat up.
We spent about 2 1/2 hours looking for pieces, parts & guts, chasing away the raccoons & other critters that were eating said pieces, and marking what we found with lite flags so the coroner could collect & identify (as best he could) what it was we found (you never realize how long the intestines are until they're laid out in the dirt) After everything was marked & documented, we placed everything into red biohazard bags, the placed those in a body bag. The largest "hunk" we found was a section of upper leg. It was still attached (sorta) to half the pelvis and lopped off just below the knee. We also spend a good 30 minuets explaining to the State Trooper why we couldn't find the head. Imagine taking a watermelon and throwing it in front of a speeding train. POOF! Instant disintegration. Except for the chunk of his scalp and a few teeth that we're stuck to the front of the train, the rest of the head had pretty much vaporized.
Over the years, I've seen just death from about every "common" way you can think of. I think the easiest way to explain the different ways I've seen death come would be to say the only "common" way I have NOT witnessed death is by stabbing. You also notice certain things, things you kinda wish you hadn't, for example, brains smell horrible, burt flesh is even worse, bone is actually off white tanish grayish kinda color and 98% of the time when they die, they shit themselves. I would guess its safe to say you really cant appreciate any of that unless you've seen or smelt it in person. And the smells are such that they practically stick with you all day and leave a taste in your mouth.
And with all of that and then some,we wake up the next day, strap our boots on and do it again. Not because we're sick in the head, but simply because someone has to do it, yea it's a bit cliché, but it's the truth. Your probably never truly going to understand why we do it, or what it's like unless you experience it, and even still you may not. It's just simply not for everyone.
As you can imagine based simply on what you've just read, we really do see truly horrible things. Dealing with what you come across as different for any given first responder. Some handle it pretty good & take it in stride, others, not so much. Each individual is different. Me, I deal with it by being thankful I can go home and hug my family, and, remembering that the dying die, the dead stay dead and I am not God. And even sometimes, once the stress of what I seen have built up inside me, a good hard cry is enough to reset the system.
So how does one continue to step into the horrors of life day after day? Simply put, once you've spent so much time around death, you simply just get used to it, but, in the process, you definitely learn to appreciate life a little more.
If you were to ask my wife what she thinks about me being a firefighter/EMT, one of the things she'd probably tell you, because theres no easy way to explain it, is "He's fucked up" or "cold hearted" Now some who know me may agree with that for different reasons, what she is referring to is my psyche, more specifically the "cavalier" additude I have towards the uglier parts of the job. More specifically, how after seeing blood, guts, death and dismemberment, I can come home and eat, or go back to sleep, or just carry on with my day like nothing happened.
You see, people always ask the same few questions..."Have you ever saved anybody?"....."Is it hot?"....and "What's it like?" All of them inquiring about the exciting and dangerous parts of the job, but never give two thoughts about the ugly side of the job. The dark and grim events in life for which we have a front row seat.
I honestly don't think I could even begin to tell you how many dead people I've seen, or even how many I've watched die, and by that I literally mean watching a persons life slip away and cease right in front of my eyes. As horrible as it may sound, it's all part of a any given day on the job. It could be weeks or months before your faced with a call where you can't make the save. Then there are the times when the grim reaper stows away on one of the rigs so he can ride around with you to get caught up on his quota.
Truth is, you never know what your going to find on scene. Sure, there's the more obvious patients. Usually it's something like a cardiac arrest call. Where you expect to run in & see the person lifeless & kinda pale laying on the floor. Or, if you get called for an MVA (motor vehicle accident) your going to find at least one wrecked vehicle, maybe more and you can almost always count on someone having at least some "lawyer pain" (the "agonizing" pain that changes in severity & location from the time you get on scene to the time you hand them off at the ER) Or say a traumatic injury call where you expect a lot of blood, or a bone sticking through the skin. You almost always have an idea of what you'll find, but your never 100% sure, and to really keep you on your toes, there are even times when you arrive on scene and find something totally different than what you were called for.
For example, a call for a "severe" nose bleed only to arrive on scene to find your patient had tripped and face planted onto a set of concrete stairs. So, yes his nose is in fact bleeding, what someone failed to mention was that it's also smashed. Along with his broken jaw, missing teeth, gash on the forehead and so on.
Then there are the calls that seem as if they'll be nothing more than an expensive taxi ride to the hospital but skips turning bad and goes straight to worse. I remember taking an call for a nose bleed, it was an Alpha response, meaning no lights or siren, the lowest priority call. I shoulda known nothing good was gonna come out of it either, I was driving & my tech (the person handling patient care) was a total idiot....but its a nose bleed so how bad can it be, right?
We arrived on scene to find an elderly female with an obvious nose bleed. She wanted to be transported, so we did, and wouldn't you know it, 5 min into the trip to the hospital, "SURPRISE" she go's into cardiac arrest. So just because a call seems like it will be routine doesn't mean it will be.
If you haven't figured it out yet, death is undoubtably part of the job, and it pretty safe to say that people in this field probably see more dead people and death in one year than most people do in a lifetime....literally. Sure it may sound a little harsh, but that's the truth of it. We are trained as firefighters, EMTs and Paramedics to save lives but we also understand that sometimes they're just too far gone and its just out of our hands.
There are the calls that always seemed to kinda piss me off. Those are the ones where you are able to keep the patient alive or even bring back to life, in the back of the ambulance, and usually your bustin your ass doing everything you can to save them. Then you get to the hospital and roll them in side with a heart beat, only to see the Dr. call it (pronounce them dead) not even 5 min after you get there. You want to grab him by his stethoscope and yell "Hey Doc!! What the Fuck!?"
You bust your ass and put in all that hard work to get some poor bastards heart beating again and then poof, its all for nothing. And you really do bust your ass. Ask any medic or EMT, after a good call where you have to seriously work the patient and time is of the essence, you are whooped. It's like this physically tiring emotional high, thinking that all your work will pay off this time only to find out it won't. It's a bit disheartening, but pisses you off more than anything, well at least me anyway.
Then there's the calls that stand out for different reasons. One example was an accident with rollover and ejection. (person thrown from vehicle) this poor guy, in his 30's lost control & rolled his pick up truck & was ejected. When he was thrown from the vehicle, he landed on top of the Jersey barrier, then plopped down onto the road. As we arrived on scene, we found two nurses performing CPR. Because patient care was started, we're obligated to continue. But we could tell it was a lost cause. By the way his head was positioned, it was fairly obvious his neck was broken. I happened to be in the fire side of things for this call, do we helped the ambulance crew load him up & get going, he was pronounced (dead) almost immediately upon arrival at the trauma center.
Back on scene, while cleaning up debris & looking for some patient identification, we came across A Military helmet. We then found his wallet in the cab of the truck, right next to a airline ticket stub that was paper clipped to some photos and discharge papers. Turns out he had just flown into the states after a tour of duty in Iraq. Here was an American soldier who had seen combat & couldn't have been back in the states for more than 12 hours, and now he was dead.
And somewhere, was his family, patiently waiting to hug him because he had made it home safe from War, only to find out they would never get the chance.
And then there are calls you get where you know it's just gonna be plain ugly, but you still aren't sure what to expect. Persons hit by a train fall into this category. I responded to a few of these over the years, and they're all different, gruesome as hell, but different.
One I went on turned into a lighting detail and a body (parts) recovery. According to the train engineer, he was tooling along at about 40 mph when he noticed something between the tracks but couldn't tell what it was, then, at the last second, "it"sat up.
We spent about 2 1/2 hours looking for pieces, parts & guts, chasing away the raccoons & other critters that were eating said pieces, and marking what we found with lite flags so the coroner could collect & identify (as best he could) what it was we found (you never realize how long the intestines are until they're laid out in the dirt) After everything was marked & documented, we placed everything into red biohazard bags, the placed those in a body bag. The largest "hunk" we found was a section of upper leg. It was still attached (sorta) to half the pelvis and lopped off just below the knee. We also spend a good 30 minuets explaining to the State Trooper why we couldn't find the head. Imagine taking a watermelon and throwing it in front of a speeding train. POOF! Instant disintegration. Except for the chunk of his scalp and a few teeth that we're stuck to the front of the train, the rest of the head had pretty much vaporized.
Over the years, I've seen just death from about every "common" way you can think of. I think the easiest way to explain the different ways I've seen death come would be to say the only "common" way I have NOT witnessed death is by stabbing. You also notice certain things, things you kinda wish you hadn't, for example, brains smell horrible, burt flesh is even worse, bone is actually off white tanish grayish kinda color and 98% of the time when they die, they shit themselves. I would guess its safe to say you really cant appreciate any of that unless you've seen or smelt it in person. And the smells are such that they practically stick with you all day and leave a taste in your mouth.
And with all of that and then some,we wake up the next day, strap our boots on and do it again. Not because we're sick in the head, but simply because someone has to do it, yea it's a bit cliché, but it's the truth. Your probably never truly going to understand why we do it, or what it's like unless you experience it, and even still you may not. It's just simply not for everyone.
As you can imagine based simply on what you've just read, we really do see truly horrible things. Dealing with what you come across as different for any given first responder. Some handle it pretty good & take it in stride, others, not so much. Each individual is different. Me, I deal with it by being thankful I can go home and hug my family, and, remembering that the dying die, the dead stay dead and I am not God. And even sometimes, once the stress of what I seen have built up inside me, a good hard cry is enough to reset the system.
So how does one continue to step into the horrors of life day after day? Simply put, once you've spent so much time around death, you simply just get used to it, but, in the process, you definitely learn to appreciate life a little more.
Friday, July 27, 2012
The Pin Stripe
I remember one specific call for an vehicle accident about 12 years ago. It was early in the morning and we were out on a fire alarm call across town when we get hit out for a wreck & they report one patient still in the vehicle, unconscious & breathing not verified, a Delta 2 response. (a delta 2 is the highest priority call indicating an immediate life threat)
Now it was still early in the morning and it had snowed about 4 or 5 inches of heavy wet snow, and most of the roads were still covered. We're released from the fire alarm and high tail it back across town in the engine, stoping at the end of the road the firehouse is on so one of the new guys can hope out and literally run to the station and get the ambulance. We had a medical "jump kit" on the engine and the guy driving was a medic so we had enough training & equipment to get us started on Pt care until the ambulance got there. So one of the guys, Mike, hops out and begins his 40 yard dash for the station to grab the ambulance and we continue about a quarter mile down the road to the scene.
As we pull up, I notice a gold 4 door Toyota that has wrecked into a garage where the side of garage door meets the wall. The driver is a 23 year old female, kind of slumped forward a little. (i distinctively remember her age & birthdate, turns out I was exactly 3 days older than her) There is some damage to the corner of the building, not to bad but still bad enough to consider the building unstable making the patient extraction a little more challenging, because now one wrong move of the vehicle, and part of the building can come down. So we add a rescue truck to the assignment and get to work. As "luck" would have it, aside from the medic, the rest of the crew was fairly new to the station, none of them having their EMT training. I had the training,but was just waiting to hear if I had passed the state exams. Bill, our Medic on the call, and also an Asst. Chief looks at me and says, "Your the closest thing i have to an actual EMT so glove up, hop in the back seat & hold C-spine (stabilization)." the rest of the guys started prepping for the extrication. So I glove up, take out the rear passenger door window and crawl in the back seat as the guys begin stabilizing the car to take off the doors. I make my way over behind the driver, looking around the car at the windshield & steering wheel trying to see if there's any evidence that the drive impacted any parts of the vehicles interior. Imidiately I notice some blood and hair on both the "A" post and the "B" post. (the part of the car body that supports the roof of the vehicle, from front to back they go in alphabetical order) I also notice some on the block wall that's directly outside of the drivers window. I relay the info to Bill and get situated inside to grab C-spine. (I'm 6'6" in full gear, in the back seat of a Toyota, needless to say its a bit cramped) I reach over the back seat and gently place my hands on the sides of her head so i can lift it into the normal upright position and as I begin to apply slight pressure to lift her head and I feel this "squish" with my left hand. Wondering WTF it was I pull my hand away and look to see my hand covered in blood and a piece of skull bone about the size of a silver dollar stuck to my palm with long bloody brown hair hanging from it.
I yell "ahhh, Bill.....we've got a serious problem!...."
Bill replies "what's that?" then looks in through the back window. I calmly show him my hand with the her pieces and parts still stuck to it.
"OH SHIT.....ok, we need to get her the fuck outta hear now.....rapid extract......and don't loose that!"
He lets the guys know there will be no car cutting, we're doing this quick & dirty. (to "properly" perform the extrication would have eaten up time this girl didn't have)
Luckily, they managed to get the front passenger door open just before my gruesome discovery, making the rapid extrication a little easier, and, the ambulance had just pulled up, it was time to go.
I grab C-spine, we quickly get a collar on her, wrap her head wond with gauze and bandages & begin the extrication. We get her out into the stretcher & into the back of the ambulance to start working on her. At some point a medic from another station, Rich, shows up & hops in the ambulance to help. We give him a quick run down then start cutting her cloths off to look for other injuries, start IVs and hook her up to the heart monitor. Rich, tries intubation, but there's teeth & blood in the way...he tries a few times then turns & says "here, you try"
I said "Dude!....I'm not a medic..."
He replied, "Don't worry about it, you can't do any worse than me" "Are you fuckin serious?!" I shot back.
"Yea god damn it, now come on!" basicaly this poor girl was in such bad shape that there weren't enough Medics to do everything that needed done, and "trying" was better than "not doing" at all. So we switch places and he starts talking me through it while beginning another task.
"Look for the (vocal) cords, do this, do that, ok try and place the tube" all of this while he's using suction to remove blood and help guid the Tube.
"Did you get it?" he asks
"I don't know!? I think it's in but I don't know!" I replied
Rich then says "Hook up the bag valve and give some breaths, I'll listen"
So I do, and sure as shit he looks at me and says "You Got It!!"
Bill looks up at me with a smirk and says "Beginners luck." (and it was) But before I can even catch a breath and take a second to soak in what i had just accomplished, the driver of the ambulance yells back "Give me some towels, I need a dam!" I turn and look at the floor and all this blood was running across the floor towards the front of the ambulance and into the step well for the side door. We throw a bunch of towels down, then Bill tells the kid driving "Lets Go!.....Presby,now!" and off we go.
I'm baggin her, and I cant help but notice the blank stare in her eyes, Rich & Bill are starting a central IV (into the jugular vein just below the neck) and pushing drugs to keep her alive. As we reach the tunnels the heart monitor goes into alarm.....she's starting to "crash."
Rich grabs the paddles, charges them up, places them on her and yells "CLEAR" Bill and I get clear and reply "CLEAR" to let Rich know we are in fact clear of the stretcher, then he whacks her. Her body kinda twitches a little bit (it's not the big lunge you see on tv) and her heart rhythm returns to something not quite normal, but acceptable considering the condition, but it lasts only for about 30 seconds, then she crashes again. We ended up shocking her about 3 or 4 more times and that's when I notice the blood gushing from the now solid red bandage, is starting to look clear,the damn of towels on the floor is also soaked, holding back a puddle of blood and the step well also has about an inch deep puddle of blood, and every time I squeeze the bag to give her a breath, a clear/redfish blood bubble inflates from the location of the head wound then pops. Basically what has happened is most of her blood, which is all over the floor of the ambulance, has been "replaced" with saline from the IV.
"ummm, Guys!?....her blood is turning clear..."
Bill & Rich look at each other as if to say "oh shit" then Bill asks the driver where we're at.
Mike the driver tells back "Bates St. About 2 minuets out"
Bill turns to me and says "you just keep bagging" then starts chest compressions. Then no sooner do we make our last turn towards Presbys ER, she flat lines. And as the monitor starts to make the infamous long "beep" tone to indicate flat line (no heart beat) I look down at her & I rember watch both pupils in her pretty blue eyes slowly dilate to about the size of a dime.
We pull into the ER & the trauma team is waiting. We get her out & right into a trauma room. I'm still bagging as the trauma team gathers around to start there job.
They push a few drugs then shock her a few times to no avail....then the Dr calls it, "OK people, Time of death 8:41" and then that's it. All the work we had done during the longest 10 min ride ever, is now null & void. We did what we could, but it was out of our hands.
Before leaving, we go over the ordeal with the trauma team again & they compliment us on the work we did, assuring us that we did everything we could and we did it right but today it just simply wasn't enough.
we head back to the ambulance. In side, it looks like a massacre & is totally trashed with gauze wrappers & empty IV bags & heart monitor cable just thrown about in a blood covered ambulance.
I walk around to the side door and open it to see coagulated blood kinda slide out onto the ground & go splat. Then I noticed blood down the side of the ambulance in a perfectly straight 3" wide pin stripe. The blood in the side step well was leaking out through a bad door seal and as we drove to the hospital, and worked its way down the side of the ambulance perfectly parallel to the red reflective strip thats supposed to be there.
It took about an hour just to clean up the ambulance enough to drive back and would take another 2 hours of scrubbing at the station to get it in service. But on the way back we swing by the scene to let the police know she didn't make it and just to take a look at what happened & how she wrecked. As it turns out she was on her way home from work driving on the snow covered roads when she lost control & hit the garage. When she hit the garage and the car stopped, she kept moving forward striking her head off off the "A" post then coming back and striking the "B" post and finally hitting the block wall just outside the drivers window. Hence the severe head trauma.
The car itself wasn't that bad, needed a bumper, fender and hood, that's all. The police also told us to look at the speedometer, it was stuck at 23 mph, the speed at wich she was traveling on impact.
As it would turn out, relatively low speed crash and no seat belt equaled out to a dead 23 year old girl.
It's a shame, but in this business you see a lot of death that could have been prevented. You just learn to accept it.
Now it was still early in the morning and it had snowed about 4 or 5 inches of heavy wet snow, and most of the roads were still covered. We're released from the fire alarm and high tail it back across town in the engine, stoping at the end of the road the firehouse is on so one of the new guys can hope out and literally run to the station and get the ambulance. We had a medical "jump kit" on the engine and the guy driving was a medic so we had enough training & equipment to get us started on Pt care until the ambulance got there. So one of the guys, Mike, hops out and begins his 40 yard dash for the station to grab the ambulance and we continue about a quarter mile down the road to the scene.
As we pull up, I notice a gold 4 door Toyota that has wrecked into a garage where the side of garage door meets the wall. The driver is a 23 year old female, kind of slumped forward a little. (i distinctively remember her age & birthdate, turns out I was exactly 3 days older than her) There is some damage to the corner of the building, not to bad but still bad enough to consider the building unstable making the patient extraction a little more challenging, because now one wrong move of the vehicle, and part of the building can come down. So we add a rescue truck to the assignment and get to work. As "luck" would have it, aside from the medic, the rest of the crew was fairly new to the station, none of them having their EMT training. I had the training,but was just waiting to hear if I had passed the state exams. Bill, our Medic on the call, and also an Asst. Chief looks at me and says, "Your the closest thing i have to an actual EMT so glove up, hop in the back seat & hold C-spine (stabilization)." the rest of the guys started prepping for the extrication. So I glove up, take out the rear passenger door window and crawl in the back seat as the guys begin stabilizing the car to take off the doors. I make my way over behind the driver, looking around the car at the windshield & steering wheel trying to see if there's any evidence that the drive impacted any parts of the vehicles interior. Imidiately I notice some blood and hair on both the "A" post and the "B" post. (the part of the car body that supports the roof of the vehicle, from front to back they go in alphabetical order) I also notice some on the block wall that's directly outside of the drivers window. I relay the info to Bill and get situated inside to grab C-spine. (I'm 6'6" in full gear, in the back seat of a Toyota, needless to say its a bit cramped) I reach over the back seat and gently place my hands on the sides of her head so i can lift it into the normal upright position and as I begin to apply slight pressure to lift her head and I feel this "squish" with my left hand. Wondering WTF it was I pull my hand away and look to see my hand covered in blood and a piece of skull bone about the size of a silver dollar stuck to my palm with long bloody brown hair hanging from it.
I yell "ahhh, Bill.....we've got a serious problem!...."
Bill replies "what's that?" then looks in through the back window. I calmly show him my hand with the her pieces and parts still stuck to it.
"OH SHIT.....ok, we need to get her the fuck outta hear now.....rapid extract......and don't loose that!"
He lets the guys know there will be no car cutting, we're doing this quick & dirty. (to "properly" perform the extrication would have eaten up time this girl didn't have)
Luckily, they managed to get the front passenger door open just before my gruesome discovery, making the rapid extrication a little easier, and, the ambulance had just pulled up, it was time to go.
I grab C-spine, we quickly get a collar on her, wrap her head wond with gauze and bandages & begin the extrication. We get her out into the stretcher & into the back of the ambulance to start working on her. At some point a medic from another station, Rich, shows up & hops in the ambulance to help. We give him a quick run down then start cutting her cloths off to look for other injuries, start IVs and hook her up to the heart monitor. Rich, tries intubation, but there's teeth & blood in the way...he tries a few times then turns & says "here, you try"
I said "Dude!....I'm not a medic..."
He replied, "Don't worry about it, you can't do any worse than me" "Are you fuckin serious?!" I shot back.
"Yea god damn it, now come on!" basicaly this poor girl was in such bad shape that there weren't enough Medics to do everything that needed done, and "trying" was better than "not doing" at all. So we switch places and he starts talking me through it while beginning another task.
"Look for the (vocal) cords, do this, do that, ok try and place the tube" all of this while he's using suction to remove blood and help guid the Tube.
"Did you get it?" he asks
"I don't know!? I think it's in but I don't know!" I replied
Rich then says "Hook up the bag valve and give some breaths, I'll listen"
So I do, and sure as shit he looks at me and says "You Got It!!"
Bill looks up at me with a smirk and says "Beginners luck." (and it was) But before I can even catch a breath and take a second to soak in what i had just accomplished, the driver of the ambulance yells back "Give me some towels, I need a dam!" I turn and look at the floor and all this blood was running across the floor towards the front of the ambulance and into the step well for the side door. We throw a bunch of towels down, then Bill tells the kid driving "Lets Go!.....Presby,now!" and off we go.
I'm baggin her, and I cant help but notice the blank stare in her eyes, Rich & Bill are starting a central IV (into the jugular vein just below the neck) and pushing drugs to keep her alive. As we reach the tunnels the heart monitor goes into alarm.....she's starting to "crash."
Rich grabs the paddles, charges them up, places them on her and yells "CLEAR" Bill and I get clear and reply "CLEAR" to let Rich know we are in fact clear of the stretcher, then he whacks her. Her body kinda twitches a little bit (it's not the big lunge you see on tv) and her heart rhythm returns to something not quite normal, but acceptable considering the condition, but it lasts only for about 30 seconds, then she crashes again. We ended up shocking her about 3 or 4 more times and that's when I notice the blood gushing from the now solid red bandage, is starting to look clear,the damn of towels on the floor is also soaked, holding back a puddle of blood and the step well also has about an inch deep puddle of blood, and every time I squeeze the bag to give her a breath, a clear/redfish blood bubble inflates from the location of the head wound then pops. Basically what has happened is most of her blood, which is all over the floor of the ambulance, has been "replaced" with saline from the IV.
"ummm, Guys!?....her blood is turning clear..."
Bill & Rich look at each other as if to say "oh shit" then Bill asks the driver where we're at.
Mike the driver tells back "Bates St. About 2 minuets out"
Bill turns to me and says "you just keep bagging" then starts chest compressions. Then no sooner do we make our last turn towards Presbys ER, she flat lines. And as the monitor starts to make the infamous long "beep" tone to indicate flat line (no heart beat) I look down at her & I rember watch both pupils in her pretty blue eyes slowly dilate to about the size of a dime.
We pull into the ER & the trauma team is waiting. We get her out & right into a trauma room. I'm still bagging as the trauma team gathers around to start there job.
They push a few drugs then shock her a few times to no avail....then the Dr calls it, "OK people, Time of death 8:41" and then that's it. All the work we had done during the longest 10 min ride ever, is now null & void. We did what we could, but it was out of our hands.
Before leaving, we go over the ordeal with the trauma team again & they compliment us on the work we did, assuring us that we did everything we could and we did it right but today it just simply wasn't enough.
we head back to the ambulance. In side, it looks like a massacre & is totally trashed with gauze wrappers & empty IV bags & heart monitor cable just thrown about in a blood covered ambulance.
I walk around to the side door and open it to see coagulated blood kinda slide out onto the ground & go splat. Then I noticed blood down the side of the ambulance in a perfectly straight 3" wide pin stripe. The blood in the side step well was leaking out through a bad door seal and as we drove to the hospital, and worked its way down the side of the ambulance perfectly parallel to the red reflective strip thats supposed to be there.
It took about an hour just to clean up the ambulance enough to drive back and would take another 2 hours of scrubbing at the station to get it in service. But on the way back we swing by the scene to let the police know she didn't make it and just to take a look at what happened & how she wrecked. As it turns out she was on her way home from work driving on the snow covered roads when she lost control & hit the garage. When she hit the garage and the car stopped, she kept moving forward striking her head off off the "A" post then coming back and striking the "B" post and finally hitting the block wall just outside the drivers window. Hence the severe head trauma.
The car itself wasn't that bad, needed a bumper, fender and hood, that's all. The police also told us to look at the speedometer, it was stuck at 23 mph, the speed at wich she was traveling on impact.
As it would turn out, relatively low speed crash and no seat belt equaled out to a dead 23 year old girl.
It's a shame, but in this business you see a lot of death that could have been prevented. You just learn to accept it.
Monday, March 26, 2012
Big fire, cold night
At just about every firehouse there is one night a week or month set aside for training. Usually it's nothing more than training on techniques, tools & equipment we use on a fairly regular basis, or, on a rarer occasion, for the guys to familiarize theirselves with something new. One night while at drill as a member of 13 Engine Co, we were doing search training. This is the task of entering a burning building and methodically searching every room for victims. It more or less boils down to two firefighters working as a team, crawling around and sweeping the floor with their arms and legs in hopes of feeling any victim laying on the floor, only in a real fire, you usually can't see anything & it's hard to hear anything over the Darth Vader like sound as you breath into your air mask mixed with the sounds of fire trucks, chain saws, breaking glass and of course, the roar and crackle of the fire. So, as "simple" as it may seem, in the real world, it's a little more challenging than you think. . Now as you can imagine, it's a bit difficult to mimic those conditions for training, after all, lighting off the firehouse isnt exactly good for business or PR, so you crank up some tunes for background noise and pull your nomex hood over your mask so you can't see. Then, you search the firehouse for victims. In our case, he was a dummy made out of fire hose & stuffed into a set of bunker gear. We were about 30 minuets into drill and i was patiently waiting ny turn when we hear a first alarm assignment go out in station 21's first due (their fire district) for a working structure fire at an old glass manufacturing plant. Shortly after dispatch, chief 21 calls for a second alarm. You can tell by the tone of his voice this was a good fire, so we turn up the radio a little and listen a little more carefully as the call unfold. As we continue to listen we notice the anxiety in the voices of those on scene....and practically everyone with a radio reporting heavy fire conditions...and in almost no time at all, the attempt at an interior fire attack is nixed and the decision is made to go defensive....or as its know in the service, a "Surround and Drowned." By this time, drill has come to a standstill as everyone at the fire house huddles around the radio & listens. Debating exactly where the building is located & what the best place to set up elevated master streams (ladder trucks with the big nozzles at the tip of the ladder) Its not too long into the call that we begin hearing pump operators starting to get a little frantic as they do everything they can to get as much water out of the hydrant as they can. We begin to realize, as I'm sure they already had, they're running out of water. The small water main that feeds the area in which the fire is located simply isn't big enough to supply the needed amount of water to fight a fire of this size. Compile that with multiple engines in a 2 block radius sitting on hydrants that are all on the same water line, and you've got water issues, and that in itself is a huge problem. You see, water supply is key in the firefighting operation. Obviously you need water to actually put the fire out, but it's more than that. Water supply is the building block of the entire operation. Any fireman with some experience will tell you, if you have problems with the water supply, the rest of the call turns to shit in a hurry. By now a third alarm has been transmitted plus a few "special calls" for ladder trucks and first and second alarm companies are putting in for standbys. These are engines and trucks that are dispatched to fill in at fire stations who are on scene. It was obvious that this was turning into a block party ("invite" a bunch of fire companies to squirt water and watch the block burn) so we were wondering not so much if but when and where we would end up on stand-by. Then we here the familiar "clunk!" and the fire whistle behinds to wind up and scream. At first we're all sorta confused, after all we never heard the alert tones over the radio, so we're not quite sure where we're going. "911, station 13 respond, assist station 21 with a working commercial fire" Well, I guess No stand-by for this house, we're going to the scene of my first "big fire." Already half dressed from drill, me and 7 others grab the rest of our stuff, hope on the wagon and away we go. We pull out, make the left out of they bays and Scott, our chauffeur puts the hammer down. 13 has a pretty good wagon with some real get up and go, and Scott, one of if not the best driver we have and one of the best I've ever seen, knows how to squeeze every last bit of power out of the motor. The 5 mile or so drive seems to take for ever, even at what seemed like Mach 2. The whole way, the radios going not stop with alert tones, stand- by companies marking up (acknowledging the call) firefighters and pump operators all over the air (talking on the radio) and poor chief 21 who for the most part can't get a word in edge wise, is trying to run a large scene and give orders,. I know, you have to wonder how the guy in charge is unable to talk on the radio. At the time, the county radio system wasn't exactly the best thing goin and the fire service in general had the radio etiquette of a toddler. Basically it boiled down to one simple phrase "Have radio, will talk"
We continue through the neighboring towns on the way, and at about 3 miles away you can see the large orange glow in the sky. As we wind through some of the tight streets we start haveing to weave in and out of traffic that has either gathered to watch or has been turned away from the scene by police. As we get a few blocks away, we somehow, amongst all the radio chatter, manage to call approaching and get instructions to reverse lay (lay hose from the fire to the hydrant.) from an engine positioned about 100 yards from the fire building to a hydrant a couple blocks away that we're told should have sufficient water because it's on a different water grid. We pull up to an engine at in intersection, and stop. The officer yells back "Let's Go!" and we peal off the rig. As I step out and look up the street toward the scene, trying to make sense of the many fire trucks just beached all over what looked like miles of hose....and this orange glow that practically lit up the entire neighbor hood, and that smell..... As one of the guys bumps me & breaks my thoughts...."Got your face piece?" he asks. I check and give him a nod. "Well then lets go" And up the street we went, up hill, a steep ass hill I might add. Up past the still parade of fire trucks all the while stepping over and around the miles of hose. As we crest the hill, the excitement of seeing my first big fire up close were dashed with disbelief as I see that the building is still about 200 yards down the street. So we continue the long hike. After what seemed like forever, we make it to the front of the building. The entire scene is lit with a bright orange glow, a glow so bright it was next to impossible to even look at the building. And the heat was intense. You couldn't get within 40 ft of the building itself without risking minor burns to yourself. I imagine it would be like standing next to the sun.
We're instructed to stretch a few hand lines and a portable deck gun, (that's the big "water cannon" on top of a fire engine) and officially set up for surround and drowned, for this was definitely well beyond an interior attack and had been for some time. We sat on our hand lines, aiming water at the inferno in what seemed like a pointless effort, occasionally knocking down the fire in a nearby tree that had lit off from the heat, wich added a little flavor to the monotony of sitting in one place babysitting hose lines. After a while we decided to just strap the hose lines to nearby trees & fences so we could go get warm. We walked down a small driveway that led to the building and about 150' down was what looked like a small building burning with a bunch of firemen huddled around. As it would turn out, it was an old guard shack that command elected to let free burn so that it could be used as a source of heat for the guys as the night went on. It was a damn good idea too. You see, when the call came in, the temperature outside was in the upper 50's but had been forecast to drop drastically....and boy did it. We warmed up and drank some luke warm brown water (we were told it was hot chocolate) and after about 45 min stepped away from the "Bon fire" and went back to our hose lines. Immediately we notice a thin layer of ice starting to build up on a chain link fence, that by morning would be a solid 3 inch thick wall of ice. It got bitterly cold and fast and we did everything to keep warm, but in soaking wet gear, it was next to impossible. At one point we did 15 minuet shifts taking turn huddled around the exhaust of a nearby ladder truck. It was horrible.
Eventually we were relieved but asked to remain on scene to relieve another crew in about an hour or so. We headed to our squad truck, climbed out of our we gear and wrapped ourselves in blankets. We tried to get some sleep but you just couldn't get warm, and just about the time I fell asleep, it was our turn back on the lines. It continued that way the rest of the night & by the time we returned to station the following morning we had been on scene for 18 very long, cold hours. The first due company would remain on scene for another 2 days and even felt kind enough to call us back the next evening to relieve some of the crews on scene and help pick up some of the miles and miles of hose. As it would turn out my first major (abandoned) commercial structure would become and still stands as the single biggest fire I have ever gone to battle with.
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