This call was one of the ones I look back on as a perfect example of why a blanket C-Spine protocol is never a good idea. Paramedics need the training and authority to “clear” C-Spine in the field based on proven assessment techniques.
I’m assigned to an ALS ambulance dispatched to a PD eval late on a Saturday night to a nightclub famous for trouble. On scene PD advises that they responded to a call for a fight, but the defending party fled the scene 30 minutes ago, then suddenly returned.
Our patient is in his late 20′s, conscious and alert, no alcohol or elicit drug use admitted or evidenced on assessment. He states the bouncer came at him with a “baseball bat” which the bouncer denies. The patient has a small, non suturable laceration, approx 2 cm to his right parietal skull, bleeding controlled, and there is some blood in his long unkempt hair.
He is initially refusing treatment, but after talking him into the back of the ambulance where there is better light he decides to go with us simply to escape the situation.
He has no pain, no complaint and makes no indications that the laceration is bothering him. He also states he does not recall the bat hitting him and that he may have scraped his head on a wall as he ducked out of the way of the bat.
From my experience, and the fact I had to talk him into the ambulance, if I break out a cervical collar this guy will freak and fight, twisting his neck this way and that to avoid my cervical immobilization device.
My protocol states that full C-Spine precautions are to be taken on any person with trauma noted above the clavicles.
Do I C-spine this patient? Just collar? Based on your protocols…You make the call.
The Pre Hospital and ER/A&E Blog Carnival “The Handover” has gone live!
Our host, Medicblog999 a UK Medic and nurse mentioned more than a few times here at HM HQ, has chosen a great group of posts for the first category of “Your most memorable post.”
When did it become acceptable to wear pajamas out during daytime hours? There are a number of borderline adults as well as many teenage girls who are wandering the stores in pajama pants, slippers, sweatshirts and large sunglasses. When did this become the “in” thing to do? Their grandparents would have been scolded for not wearing a hat out of the house in their day and now these folks are in line at the Target dressed like they’re still in bed? I find it offensive and clearly lazy. Sure it’s a free country and they can wear whatever they want, but they’re idiots. Lazy idiots.
Ahhhhh, that feels better.
Speaking of being in line at the Target, why are there 28 checkout lines but only 3 of them are open? When they built this Target, and the 18 catrillion others, they apparently expected to have more high school kids working there because it seems every store I go to has at least a dozen registers, but only a handful open. What a waste!
And especially when I have to stand in line with the kid, behind the teenagers in the pajamas wondering why we don’t hire the folks in the PJs to open a few more registers.
Years ago, while the Angry Captain was visiting, a neighbor girl came screaming to our door that her house was on fire. We peaked around her and sure enough light smoke was beginning to show. We quickly searched the house, found a pot of oil burning on the stove and took it outside. By the time the first engine arrived the fire was out and the smoke gone. Mrs Happy Medic was at work for this excitement.
Today the excitement caught up with her.
THE EMERGENCY A young mother has rung our doorbell telling Mrs Happy Medic that her 3 month old is not responsive.
THE ACTION Oh, did I mention I’m at the store when this happened? Mrs HM called for a priority pediatric response, or help, and went back outside to help the mother with what seemed to be an alert, breathing child.
As she did that, I happened to be pulling into the garage. “Happy, I need you here please,” she said in a strict tone. The one usually reserved for emergencies in mixed company. I also noticed she did not use my BS call name “Steph.”
I grab the baby and start doing my assessment and asked Mrs HM to grab a stethoscope from inside. Everything seemed fine except baby wasn’t annoyed to be in my arms, wasn’t crying and was drooling. While gathering what history I could I heard the quick yelp of a police siren around the block. PD are the only ones to do that quick “Get the F$%& out of my way NOW” siren yelp.
The officer is half in the street and gets out of the car. I give a quick report and state I’m a Paramedic to which he replies, “so am I, just not here.” He reports to his dispatch that the baby is conscious and breathing and we hear a motor unit pull up as well. They indeed sent the cavalry. Baby is doing well as the engine company pulls up and I give another report and turn over care. They’ve got baby on O2, but he still isn’t perking up and getting annoyed, but the ambulance soon arrives and baby is taken into the back for a full assessment and later transport.
As one of my little ones was waving as the engine pulled away I took a quick look at the scene in front of my house. Police cruiser half in my driveway, half in the street, a motor unit in front of the house, an ambulance in front of the house near the cruiser and a fire engine pulling away.
I’m glad I didn’t come back 5 minutes later and see that on my street and panic knowing HM Jr was home at the time.
It should be obvious by now that I’m one of those rare Firefighter Paramedics that doesn’t mind working a transport unit. That’s how I started, so that was my norm.
When I finished college I went looking for a Department that still did their own transporting. I wanted to keep that aspect of what we do fresh in my mind since continuity of care is an important thing in my book. I found a Department in the midst of a change from 2 tier to single tier and it was exciting. I was brought in just near the end of a brutal confrontation between the “Box Jockeys” and the “Hose Monkeys.” Everything was settling down when the powers that be decided to shake things up.
The details have been omitted to protect my sort of secret identity, but they went back to a 2 tier system but kept a few 24 hour cars simply to keep some Engines BLS. Seems retarded, I know, and it was.
Now the bean counters figured out those 4 dual Paramedic transport units were costing them way more than a 12 hour car staffed by a Paramedic and EMT.
So now the official word is that my second home in the Fire Department, Medic “99″ will be decommissioned by July. That means 100% of my days will be spent on a Fire Engine. Great, I guess.
Remember, I’m not all that bothered by an ambulance day here and there. The way dispatch is so screwy (The lawyers calling the shots anyway) we were running BS calls all night and it ruined my sleep schedule, but there was still that part of me that liked getting Erma all the way to the ER and making sure the staff knew what I wanted to emphasize about her.
Will I leave? Certainly not. I’m not going to chase my misery around, but I am a little bummed thinking about not having that extra chance to do right by my customers who need me. Those would be most of the people I meet yet you never hear about. That’s a whole different kind of blog.
So in the end I guess I’m OK with it.
More to follow.
the Happy Medic (Soon to be your Happ E. Medic, E for Engine.)
As you know your Happy Medic is now active over at Fire Fighter Nation as well as EMS United, what appears to be their sister site, but I’m now informed it is not.
Buried in all the photos of volunteers doing the standard two hoseline gas leak shutdown drill are various members of the site from around the world.
One that came to my attention was this Firefighter from St Petersburg…Russia.
He has quite the interesting photos in his slide show and instead of grabbing my favorites (the list kept growing) I chose to embed his slide show here. I am especially impressed with the large range of vehicle types he shows, from ladder trucks on snow tracks to large foam laying rigs and what appears to be a few riot trucks (Oh I wish I had those!) Take a look and to enjoy glorious trucks of fire.
We’re expected to run red light and siren to a cut finger? Seriously? Dispatch has additional information for us that reads “Not getting any information on callback. Caller keeps hanging up.” Great.
THE EMERGENCY
Some one at a local market has cut their finger.
THE ACTION
We arrived at the busy ethnic market and wander in asking people where the hurt person is. No one will talk to us and I’m getting frustrated. “Who here speaks English?!” I shout over the steady hum of shoppers.
No one even makes eye contact. My EMT has gone towards the meat area and signals she thinks she found someone. The fellow is standing back in 1/2 inch of questionable water and meat juice near the back of the market. He’s not in distress and is holding a band aid on his finger. Wondering who called us I see a middle aged woman with a clip board and a phone to her ear. “Hi there, are you in charge here?” My words go unnoticed and she pushed past on a mission somewhere else. Suddenly she turns, screaming at the finger guy and pointing at the meat counter. Apparently he needs to get back to work. I gently touch the paper on her clipboard and she jumps. “Do you speak English?” “No I don’t” she says to me and goes back to talking on the phone. “Hey Captain, block the door, no one in or out.” “Why would you do that?” She spins around. “Now that we have your attention, this man needs to go to a doctor and have his finger looked at. Ask him if he wants an Ambulance.” She just looks at me. My supervisor, nearing retirement, grabs the phone from her ear and says into it, “She’ll call you back.” and snapped it shut. She shouted a few words at band aid boy and they exchanged points towards the meat counter. “No, I’ll take him later.” And the phone is back open. “You’ll take him now.” The Captain has grabbed the guy by the arm and pushed him in front of the Manager. “He’s leaving, you’re leaving and we’re leaving.”
It just so happens that after 20 minutes of trying to find a solution for these dogs our dog tag phone call spree paid off. I was able to get in touch with a woman who was not at home, but had the information for the owner of the dog walking company.
I gathered that information and discovered the dog walking office/kennel was only a few blocks away. We elected to have the patient ride in the front seat, remembering he was stable and simply needed an eval for possible first time seizure, while my partner, the EMT, walked the dogs back.
It was less than 10 minutes and we drew stares from folks in the touristy area with a firefighter walking half a dozen dogs and an ambulance following closely, red lights flashing.
On arrival at the kennel we grabbed a few business cards and stuffed them into our patient’s pocket for next time. The owner was less than pleased that her walker was going into the hospital and made repeated attempts to get us to leave him behind to tend the dogs. “Sorry, not your call.” I said as we left. “Feeling OK buddy?” My friend was looking at me from under his worn baseball cap. “OK, OK” he said, and there were no complications.
If you said secure the dogs and transport, you made the right call.
If you said call a Police K9 unit, ask in at your local K9 officer and get that earful now, before you’re hot and tired. They handle their dog, and their dog only.
I’ve been hearing a lot about the perils of “socialized” healthcare not only with the election of the new President, but with private insurance so expensive and so clumsy.
But then I read stories about “socialized” systems missing people, ambulances getting lost and caretakers completely inept. Granted every crazy French medic has an American counterpart doing something just as stupid, but those stories aren’t covered with the same furvor. What is really going on over there?
From the front seat of the ambulance for profit healthcare is failing and expensively. Many folks are foregoing private insurance for the state endorsed program which requires the private firms to increase premiums to the remaining clients. Then those people can’t afford it, and so on and so on.
As I’ve said in the past, illegal immigrants are not a drain on my system, not as much as legal residents who find themselves “deserving” of immediate healthcare by ambulance and ER instead of prevention and a visit to the doctor.
The trouble is in the overlapping bureauocracy. There has to be a better way, right? Maybe yes, maybe no.
But when it comes to emergency care, no matter your income, race, gender, ethnicity or even level of sincerity, you are guaranteed by law, by the people, by the government, access to a medical professional. Be it EMT, Paramedic, Nurse, NP or MD, the law is if you are hurt, you get one regardless of your ability to pay. The insurance companies say you are covered in case of an emergency, but they reimburse at a rate quite lower than the actual cost of care.
Why does my insurance company have to raise my premiums and copays after buying naming rights to a professional sports stadium? Wouldn’t that money be better spent on preventative health screenings and public education or is there no profit there?
I’d ask anyone from a different system to chime in and let me know what kind of relationship their service has with federal/state agencies or regulation and any for profit healthcare models. Am I wrong about for profit healthcare?
That was the first line of an email I got over at thehappymedic at gmail.com. The writer was asking why it seems I keep making changes all the time.
So you’ve noticed some changes around here? So have I.
When I started my therapy (blog) I had no idea what I was doing. Now I have an idea what I want to be doing and am slowly learning how to make it happen.
Aside from the obvious banner change, I’ve added the Angry Captain as a blog team member to enlighten us all with the tales of his 30+ years in the fire service. He dropped a quick hello HERE and I for one am looking forward to hearing more about where we used to be as a profession.
In addition to content I’m trying to make your time here useful. I hate when sites I visit are poorly set up so I’m trying to accommodate you quick visitors. At the top of the right column is now a tabbed section to take you from recent posts to recent comments, to call type. This should make it easy to read the newest post, check for new comments, click an ad and be on your way.
The volume of posts may be deceasing as the Brass is toying with the idea of closing Medic 99. “Don’t do it!” you say, but we’re in a state of flux from 24 hour cars to 10 and 12 hour cars and the future is unclear. Rest assured we’ll still have the same ridiculous folks calling 911, just less contact with them throughout their EMS experience.
So hang in there, gentle visitors, I’m learning as I go and I do appreciate you stopping by to have a look around.
These may not be easy questions to answer, but why do folks think I have an answer for why I love my job?
I just do.
You have to want to do this job these days and millions of volunteers will tell you they’ll do it for free. But for me it comes down to a need to make a difference. Not in some glossy eyed vague sense, but take someone’s bad day and make it better. Not all better, but better.
Offering reassurance to the woman who lives in filth without food in her apartment that the people coming to help her really will and that it’s OK to ask for help.
Taking an emotional wife away from the dead body of her husband to explain to her why we aren’t trying to save him anymore. Her day is now burned into her memory, but I can help her start the recovery process immediately by consoling, understanding and helping her reach out to others be they family, clergy or neighbors.
Offering a fourth blanket to the frail old man suffering from dementia while I’m roasting alive with the heat turned all the way up.
Few of our patients will ever write a letter or call us thanking us for administering the epinepherine so quickly when they got stung, or for completing a secondary assessment of such thoroughness, but they do remember what we consider the little things.
If you enjoy fulfilling these little requests just as much as the chance to dart a chest, cut a trach or lead the first in line to the third floor, then you have the passion to have a successful career in this business.
There is no hope for me. I am hopelessly connected to the services I provide and can’t imagine doing anything else. I like to think I’m good at what I do, so I’m going to keep doing it for awhile.
It takes a lot out of you to care the same about every call you go on. Although there is a running theme on these pages of EMS abuse, those are the runs that make me strive to make the system better for those who might actually need the things in my bag of tricks. But, like I said before, it’s not about the magic medicines but being thorough and seeing to the little things while doing what is right for your citizens, clients or patients.
There are folks that drive me nuts but for each of them I know that sometime soon I’ll be able to make a bad day better and that makes it all worth it.
Call it a desire, call it love, call it Professionalism, but not until I read MAck505′s theme for the handover did I really consider it a passion.
I am passionate about what I do and you should be too.
For example,
There are addresses some EMTs know by heart. I still recall hearing the radio tone out for 2210 Sabana Grande and taking a deep breath. I knew it would mean fighting with nursing staff for a chart, if there was one, then someone not having a good day would want a 1 hour ride to a hospital that couldn’t help them. We had taken them there the day before.
But other addresses bring to mind something serious. The constant OD attempts of that girl on 5th avenue or the old man up in the hills off of Maple Drive that seems to always forget his insulin.
For me there was an address that always meant work. And the kind of work that makes you glad you listened in class.
“He’s not usually like this” the friends would say as we walk in.
In the middle of the tiny apartment, triple bunkbeds on one wall, tiny TV and microwave on another, is a 250 pound man seizing. And not the hollywood seizures that are thankfully so inaccurate that those trying to fool us can be spotted a mile away, but the not breathing, airway questionable, full tonic clonic seizures we are trained to treat.
Quickly to the head I’m working to get the BVM set up. It is important to remember that in full seizure even the diaphragm is not functioning meaning that whatever air might be moving through the trachea isn’t going far. The bag is set and I’ve sent the EMT out to the engine to retrieve my narcotics lock box.
It isn’t until the first dozen or so breaths that I take a chance to look around the room again.
I’ve been here before.
Flashes of deja vu fly through my mind and I feel like I’ve done this all before, because I have.
“He doesn’t respond to the first 5″ I hear escape my lips, I’m thinking out loud as I sometimes do.
“What?” asks the officer looking over to me.
“I need a line spiked,” I tell him shortly, focusing on bagging my patient as his overall muscle spasms continue.
When the EMT returns we switch and he begins to bag while I establish access and prep the first 5 of Valium to settle the seizures. My plan is to give 5mg, then almost immediately, the next 5mg, remembering the last time I was here.
The ambulance is arriving just as his seizing settles and he is breathing on his own, the bag only assisting his tired muscles perform the task of ventilation.
The eyes flutter open for a moment, then a curious arm feels over to it’s twin to find out what is causing the discomfort where I inserted the IV.
He’s groaning slightly as we prepare to transport, his hospital of choice being not far along and the meds working, the Paramedic from the ambulance decides to leave me back and keep our engine ready to serve.
It is now to the point that when I hear this address I bring the Valium with me, knowing exactly what awaits. It would be easy to walk in and curse the friends for not making our friend take his anti-seizure medicine, or take the easy road and just bag him and wait for the ambulance to treat him, but my desire to do what is right, my need to help, my passion for what I do makes me assess him and treat him to the best of my ability. Every time.
The idea of rotating general practitioner physicians through emergency rooms and neighborhood clinics seems like a neat concept but falls flat somewhere near where the patients need appropriate care.
I am not a physician. I do not claim to be a physician. I specialize in the acute, the emergent, the unknown. I took the same anatomy and physiology, biology and chemistry the physicians did before medical school so I like to think we have the same base education and they chose to specialize in medicine while I chose emergency care.
The old joke of a podiatrist trying to run a recuscitation without an IV is a classic example. The sad story of a Paramedic diagnosing toe fungus is even worse.
Point being some Doctors don’t belong on the front lines the same way I don’t belong upstairs at the hospital.
The clinic near the local firehouse I worked at recently is notorious for calling for code 3 transfers for runny noses, broken fingers and the like. The Doctors in for the day know that no ER physician will accept a transfer of these non emergent patients, so the Docs simply call 911. When we’re activated the MD knows we have to follow his treatment orders, within our protocols, regardless of our own impressions and assessments. The most aggravating is when we get called there just after 5 PM, closing time.
This day it was for the “chest pain code 3 transfer.” This is our 3rd time there since 8 AM.
The doctor’s hands are shaking as he’s describing the condition of the patient. His notes are scattered as well as his verbal report, jumping from lab results to muscle tone definition and everywhere in between. He describes the patient’s O2 as “TKO.” He’s left out the two things I want to know: Her name and her chief complaint.
When I ask those of our MD friend his face turns to the chart and he’s flipping pages, not realizing that the name will be on every page, near the top along with the records number. While he’s searching I walk around him to the patient who is sitting, smiling in the hospital exam chair. “Is anything the matter?” She asks me. “You tell me.” I responded a little confused.
She explains she’s been feeling a vague chest pressure for a few days but wanted to get her blood pressure checked here at the clinic just to be sure everything was OK.
That was just after lunchtime.
5 hours later, the pressure is the same, elevated, but here we are on a code 3 chest pain transfer. The MD has gathered his thoughts and tells us the patient is a rule out STEMI (the new pre-hospital catchphrase) and hands me a 12-lead EKG. I’m no expert but I see no ST changes in any leads, clean R wave progression anterior, heck not even a first degree block or hint of a-fib. The computer agreed when it wrote on the paper, in clean black ink,
***Normal EKG***.
I take a deep breath, assuming there must be something I’m missing that he learned in the extra 2 years of medical schooling he took when he let’s it out:
“I’m just not sure what to do with her, I was hoping you guys could keep an eye on her on the way to the ER. All my staff is leaving.”
“You don’t have to go home but you can’t stay here.” Is what he should have said. In the parking lot, loading the patient, I was eying the nice BMW and just hoping he would go running to the car to leave, but he waited ’till we were gone.
There are apparently many different definitions of “unresponsive.” To me it means a person does not respond. To our new friend it means, “Grandma won’t take her medicine.”
THE EMERGENCY
A man called 911 saying his grandmother is on oxygen and is unresponsive.
THE ACTION
Dispatch must, of course, stop asking questions there and get us on the road ASAP. It isn’t until we arrive at the scene with the ladder truck (It is assumed we will need additional man power) that we receive the additional information that the patient is alert. OK, change of gears then. Into the rundown apartment we go.
The carpet isn’t urine soaked so much as simply hasn’t been cleaned or vacuumed in maybe 20 years and since then a good deal of urine has fallen on it. The walls have a smoke demarcation line upstairs from decades of cigarette smoke. The furniture and decorations are straight out of an episode of Madmen, except they are completely ignored on cleaning day, which looks like tomorrow. At the top of the stairs is our do-gooder, mid 20′s, stylish clothes, new shoes and a fancy cell phone in his hands.
“What’s the trouble?” asks my partner as we send the ladder truck back on their way. “It’s grandma, she won’t respond to me.” “THE HELL I WON’T!” I had to grab the hand rail mid stairway she screamed so loud. “She won’t take her medicine, I have to go.” And away he went. As I gave chase verbally, he turned sideways to pass me on the stairs. “Slow down there, Speed Racer,” he gives a blank look, “We need you to help us take care of your grandma. You can’t just call us and leave.” “No, it’s OK, my auntie lives a few blocks away, she’ll go to the hospital later today.” And away he went without a look back. In the movie version of my story I, played by Matt Damon, have a really great monologue about caring for our families in a time of moral decay which convinces the boy to come back and do the right thing.
Me? I just blinked and he just walked away.
Back upstairs we learn that grandma has been feeling poorly the last few days and just needs someone to come by and make her lunch every now and again and that her, “no good grandson” gives her a coca-cola and leaves. She refuses to take her medicine today because she’s simply had enough and wants to “get away from it all.”
Back out in the fresh air I don’t blame her. All she needs is someone to pay attention. And I get paid to pay attention.
I have a question about fate, karma, purpose, God or whatever it is that you believe makes people do things. Specifically, the reason each person is on the planet Earth and when can we tell we have achieved our purpose. I bring this up because I think a man was born, grew to adulthood, started smoking, had trouble sleeping, took a walk in the rain in the middle of the night…and saved a stranger’s life.
THE EMERGENCY
A man has called stating a man is down on the sidewalk and has a bruise on his arm.
THE ACTION
Driving through the rain we imagine the usual reason for this kind of call in this kind of weather, a homeless person sleeping in a doorway. The police won’t move them since it’s not a police issue, so who moves folks around? We do! Arriving on scene in the rain we see this is no doorstep call, this man is lying on the sidewalk in nothing but shorts and one shoe. We go into work mode and find his skin cold and muscles rigid, but he is mumbling and breathing quite well. “I couldn’t sleep so I went for a smoke. Then I went for a walk. Is he OK?” Blood pressure and blood sugar check out. We’re taking C-spine precautions since we’re not sure what’s causing his altered mental status. Rolled over and onto a waiting dry blanket between him and the board I note quite the odor of alcohol.
Into the ambulance with hot packs to the chest and pits, he’s wrapped and away they go.
I share this event not because of the oddness of who would be referred to at shift change as the “human popsicle,” but because of the odd circumstances that led to strangers meeting in such a way.
What was it that made this man wake in the early hours of the morning and go for a walk in the pouring rain only to find a man who would have been dead by morning?
I’m assigned to an ALS ambulance in the business district. We are sent code 2 to the eval and arrive on a warm summer day to a local tourist area. We find people who have witnessed what they describe as a seizure. The patient is a middle aged man who speaks little english and a language no one around seems to understand or even recognize. His vitals are a little elevated, but he certainly fits my model for an ER evaluation.
Here’s the trouble spot. He’s a professional dog walker and has with him, on an elaborate leash system, half a dozen dogs. He has no car keys, so there is no chance of finding a car for the dogs to hide in for a short while. He has no ID and no business cards for himself or an agency.
It’s not an emergency situation, but we can’t take six dogs in the ambulance let alone the ER. I tried checking the dog’s tags for owner phone numbers but each number goes to the home, not the cell phone and we’re only leaving messages to call my cell phone.
He needs to be evaluated, I need to get rid of these dogs. The ETA for animal control is 2-3 hours.
It’s a bit early for my annual rant about the misleading “Not for profit” MDA telethon and fund raising efforts, but the local hardware store just tried to guilt me into donating to the MDA Shamrock Fund. “Do you want to help cure sick children?” She asked. “I’m a Paramedic, I already do.”
I was sent a link by an old Probie about a local effort to help a local kid.
St Baldrick’s is a foundation that was established to aid in cancer research. Not unlike other charities they spend close to 20% of their income on management and fund raising. This particular fund drive is looking to raise $1000 for a local cause.
Don’t want to donate? Money a little tight? I understand not everyone can donate money.
Even better than a donation, organize a dinner for a family in need. Grab your tools and spend a day off helping your neighbors with home repairs. Volunteer at a local clinic or organization that helps a cause you believe in. Your time is more valuable than a $1 piece of paper on a wall in a store or 80 cents on the dollar to some researcher in some lab and 20 cents to the “Love Network.”
I’ll rant more about the MDA “Fill the Boot” debacle later in the year as Labor Day approaches.
Rarely is a call a twofer. I have only, in half a dozen cases, gone from thinking “I hate this crap” to “Wow, I’m glad I paid attention in class.” This one was indeed a twofer.
THE EMERGENCY
A caretaker has called stating that one of her Erma’s (See Glossary of Terms) is having trouble breathing.
THE ACTION
I’m new to this area of town and the crew is moving slowly to the engine. “Come on guys, someone could be dying!” I shout out sarcastically. En route they begin to share with me the stories of Bubba, who we’re apparently going to see. Bubba is in the neighborhood of 350 pounds, rarely wears pants and has not been sober in recorded history. He is able to accomplish these feats since he is a Bubba and lives with Erma, who does everything for him. Bubba has always called 911 saying his mom is sick but they’ve never even seen her sick. Not tired, nor upset, she often just stands there, arms crossed while Bubba begs for a ride to the hospital.
As we arrive, I see him on the front landing in all his pantsless glory. His belly sticks out from under a T-shirt that might have fit him 15 years ago and the tiny underpants are almost comically funny, but they were sad funny in real life.
As he spits unknown food particles from his mouth while yelling for us to hurry everyone is slowly gathering their things. Then it occurs to me. He’s yelling for us to follow him, not help him.
We tried to hurry upstairs to the source of the audible wheezing but Bubba is quite slow on the uphill and decides to stay in the room when we get there.
Erma is SIck. Capital S, Capital I. And she’s considering the capital C.
Tripoding position on the edge of the bed, pale skin, look on her face of impending doom and an expiratory wheeze that could have hailed a cab in another part of town. She’s unable to speak more than one word at a time and she doesn’t speak clear english so we have to treat what we see. Getting a blood pressure, even though I knew she would be hypertensive, proved difficult as Bubba decides to become a rescuer as well and is rifling through my kit looking for God knows what. She’s remarkably hypertensive for a frail 90 something year old woman and as the EMT places the oxygen mask the officer tries to convince Bubba to let us work. The monitor shows her in a narrow complex tach in the 160s and she is starting to have an extended inspiratory phase. Her level of compensation is dropping, her little heart can’t take much more of this stress. A bit of relief from some NTG and her pale look of death softens to more of an off white look of panic.
Suddenly, she lays back straight onto the bed, still.
Monitor shows no changes and I’m up at her side in a flash to intervene and she’s got a small smile on her face. “I breath” 2-3 deep breaths, the deepest yet. “better.”
We sit her up and then onto the floor so she can rest against the side of the bed. Her color continues to improve as I get an IV going and we hear ambulance sirens. The crew chooses to have the CPAP ready in case her difficulty worsens, but carrying her out there was no regression to what we had seen earlier.
Bubba was in hysterics. Usually he’s the one getting taken away. He’s asking us who will cook for him and wash his clothes. “Your mother is very sick, she needs rest. Have you ever lived alone?” He has not. In his 50 something years, he has never left his mother’s house. Maybe because he has no pants.
One of the drawbacks of Twitter is it makes me follow things I might never have found. But I did find Crusty and as a result, I’m paying more attention when all of you alert on a good blog.
Crusty follows along all the wacky junk we see in the streets and gives it like a log book of runs for the day. Quick, easy to read and not bogged down over analyzing medical cases, just telling it like it is. I often groan like Crusty does in the Simpson’s show when I’m frustrated. Those in the know give a smile and those who are not miss it completely.
Wander on over a give Crusty a read, you’ll be glad you did.
Unfortunately for me on this day, this officer is one who refuses to listen to those below them. Or above them, I learned.
As we went to make entry, me on air and the officer losing air quickly, I made every effort to point out what I perceived as a safety issue, but was pushed ahead by both the officer and the instructors. With no fire and no inhalation hazard, I chose to continue the drill, hoping the situation will be remedied immediately following the drill.
Just as we got the line to the back of the drill prop, the officer’s low air alarm went off. Thinking I had lost track of time I checked my gauge: 3000psi. The air leak is worse than I thought. As I turned to assist the officer out, since we were alone, they were gone. I followed the line back and out and wasn’t far behind.
“My airpack is malfunctioning” the officer said. I raised my issues and explained I was trying to stop the evolution based on what I had seen and was told I didn’t see what I said I saw. It was explained to me that the airpack was clearly faulty and that the officer was obviously properly dressed or they wouldn’t be an officer. When I asked the instructors if they had also seen the safety issues, they answered in the affirmative and simply told me there was nothing they could do. The officer was untouchable and never listened to anyone.
Great. Now I have to hold my supervisor’s hand if we get a fire.
If you said do everything you can to keep your crew safe, you make the right call.
A tip of the helmet to the folks over at Walgreen’s corner Drug Stores. I’m not usually one to applaud corporate actions, but some folks just do the right thing sometimes. While driving around on errands yesterday I passed a Walgreen’s with one of those giant red signs out front. Usually the sign shows me I can get 2 gallons of milk for $3.95 or that Vioxx is on special. But imagine my surprise when I glanced over and saw, “AMBER ALERT!” followed by vehicle, child and suspect information. After returning home I learned that this has been Walgreen’s policy for most stores since the late 1990s. Recently, in September of 2008, they added severe weather notifications to their policy of helping to find abducted children. For the rest of my errands, as the banks reminded me of their high yield savings accounts, I wondered why every screen in the abduction area wasn’t automatically used to help find missing children. A huge undertaking, I’m sure, but if it can save 1 life, it’s worth it in my mind.
So a tip of the helmet to Walgreen’s and their Amber Alert sign policy.
This is not a cartoon. This is an actual photo of the Angry Captain.
The Angry Captain got his nickname from his fellow workers when he was in charge of reconciling FEMA grants for his department’s Urban Search and Rescue responses to nationwide emergencies. The paper trail required to receive reimbursement was finite in FEMA’s eyes as well as requiring receipts for all purchases. These are foreign to the rescuers trying to get the job done in stormy weather and lack of any initial support at the scene. Simple things that we use every day get lost when power is out as well as cell sites, land lines, and stores and banks are closed; credit cards mean nothing. Sorting out these items later creates great stress on the person trying to get the money back. Hence the “Angry Captain” moniker.
The call 1 a.m. Saturday…cell phone call from passerby of smoke in the area of an industrial complex, no specific address. This is a single engine response to investigate. We get many calls in the same area due to the nature of the businesses in this area and the proximity to a major road. As usual, we cruise by the buildings that have night shifts finding nothing. We continue, as my eye catches something from the corner of a building that appears to be smoke but dissipates immediately at the roofline.
We walk around the building not seeing anything except in the one corner above a rollup door that is closed. I remember this business from an inspection I did in the last year. It specialized in drying and preserving plants for use in household decorations. They had a special room inside (not unlike an auto spray booth) for drying the plants with a foul smelling preservative. I suspected that this might be something that was a normal part of the operation. However, to have something coming from the rollup door instead of the roof where the booth would normally vent was odd.
We called dispatch to contact a responsible party. They responded “no response” from the number on file. Now, with no means of visualizing the warehouse area from the outside and continued wisps coming from the top of the door, I elect to force entry to a man-door next to the roll up. No heat on the doors, but I just was not comfortable leaving (unlike the responsible party who choose not to answer the phone). We opened the door and found a haze from the top 6-8 feet of the warehouse. I called for a full structure response as we continued in (better to have them on the road and turn them around if not needed).
No heat, just the haze; as we inspected the drying unit, it was shut down and closed up. It was clear inside. We continued into the office areas, which were clear. Other units started arriving and the truck was sent to check the roof. We opened the other doors to ventilate and clear the haze. The rest of the units were released except for the Truck and the BC who hung out just to see what the deal was. Finally, dispatch received a call from the owner who said he would be there in 30 minutes.
About an hour passed until he arrived. He stated that a fumigation company had been there Friday to fumigate the warehouse. No signs were posted on the doors to warn us of any hazards. We placed all the units exposed out of service until their turnouts could be bagged and replaced. Luckily, everyone wore SCBA until the building was clear, but the unknowns of the fumigation process created mountains of paperwork and exposure reports, as well as activating our service center to replace 18 sets of turnouts for all companies at 3 a.m. The paperwork and documentation took me well past my normal relief time of 8 a.m. It took 2 weeks to find out what the fumigation company used due to “trade secrets.” The chemicals were then listed on all the exposure reports.
Lesson Learned – Expect the unexpected, always, no matter what you think you know about the situation.
Some of you know, and many of you may have read in an earlier post, that I am a second generation Firefighter. I’ve asked my father, who retired just a few years ago, to think of some of the better tales from his 30+ years of service and share them with us new kids in the business. No way to know where you’re going unless you know where you’ve been, right?
Funny thing about my dad is that he had a silly nickname when he worked too. Any guesses?
The Angry Captain.
I’m not kidding. Your Happy Medic’s dad was the Angry Captain. I think that’s why he laughs more at my name here at work than most others.
But hidden somewhere in our history of silly names and lame jokes is where a spark in me said, “I want to be like him. I want to do what he does.”
There are a few memories I wanted to share, maybe sparking the memories of other second generation folks and what it was like to more or less grow up in a fire house.
The Crown Climbing the Hill
For a number of my formative years, dad worked at a Ladder Truck Company in the area we lived. His was the first due truck in our neighborhood which meant he was able to come by the house if needed, and if his Captain approved of course. Yup, I was the coolest kid in town when my dad pulled into the small cul de sac driving that 100′ Crown Tiller. We could also hear him responding from quite a distance. Not just because of the sirens, but because when that Crown started up a nearby hill there was no mistaking her.
The hill in question stood maybe a half mile, not more, from my bedroom window and on a summer night you could hear the sirens die down and that Crown go into low gear. That low rumbling was unmistakable. It was Dad. And just to let us know he was thinking about us, just as they crested that hill he would carefully give 2 half pulls on the air horn before that Crown would take a break and head down the other side of the hill, sirens blaring again. As a kid, I was relieved to know that dad was OK. I know now that he was on his way to work and that the siren sound should have made me nervous, kept me up, not put me back into a gentle sleep like it did. I’m sure mom was in the next room getting the opposite effect from those honks. As if Dad was saying, “I love you,” in case he never got another chance.
I’m at a training exercise with a number of other companies. As part of the evolution we are to lead a line into a single residence for simulated initial fire attack. As I flake the line and prepare for entry, donning my mask, then hood, I re-affix my helmet and look to the officer doing the same.
The officer has placed the SCBA mask on their face over eyeglasses causing the mask to not seal properly and the air is escaping rapidly. It is then that I notice the officer has placed their mask OVER their flash hood, causing even more complications. Trying to point out these issues brings only shouts from the instructors to advance the line. With the mask on my issues are not heard. Touching the problem areas leads only to swats from the officer’s arm and a push towards the door. There is no live fire and no real inhalation hazard.
Should I continue with the drill and address the issue before leaving training? Is it more appropriate to bring such glaring issues to light immediately? Do I keep my mouth shut and talk with the officer later? What should I do? You make the call.
The following tale is told not because we are reminded to always leave the engine with a tool; Not because we were the only ones to bring water to the fire; Not because you need to be careful when extinguishing burning wax, but because of how determined the owner was to “let us in.”
THE EMERGENCY
A caller states, “Smoke alarm downstairs is beeping and the unit feels like smoke.” Not smells, but “feels.”
THE ACTION
We are second due in the first alarm compliment. It is early evening on a calm winter night, no wind. First engine reports smoke showing from a garage, no fire noted. We kick it up a gear. Our assignment as second in is to supply the first in engine so we pull past them and to the hydrant, it’s a short pull.
The first in engine is at the garage door, peering in, we see no smoke. I grab my airpack, buckle the hip belt (like so many forget) and BAM! axe holster. Noting a heavy fuel load and no pre-connected line stretched yet, I reach for the pump can and away we go. Since our job is to back up the first line, and there is no first line, we’re searching for the seat of the fire.
In this shotgun style house, the garage and attached area reaches back maybe 60 feet, on average, and can be dotted with small closets and in most cases small illegal apartments. As we pass the halfway point the smoke has forced us to our knees and we have yet to find the fire. Smoke is mostly light, grey, but no heat.
We have good communications, no one is panicing, a plan has been made and is clear. As I’m reaching past some debris to see how deep the closet is I feel a touch on my shoulder from behind.
It’s a civilian. “I need to get to my unit and let you in” he mumbles as he begins to push past me into the closet. This guy is clearly altered and where on earth did he come from? He’s got keys in his leading hand and before I can react he suddenly disappears into the closet, gone. My officer and I decide to give chase in the most unusual search and rescue I’ve been involved in in some time. Turns out what we thought was a closet was simply a jog in the hallway with heavy painter’s canvas leaning in all directions. As I pass through, axe and pump can in tow, I see the occupant near another door near what must now be the back of the garage. Smoke is thicker and warmer here.
The man is trying to unlock the door when the officer reaches him first and pushes him forcefully out the back door, immediately ventilating the small, cramped hallway.
It also introduced fresh air to the fire area because the heat intensified behind the slightly open basement apartment door.
We found the fire.
The team now behind me started calling back for a line to be charged.
“We got it! Hand in a nozzle! We need a line in here.”
My officer sticks his head in from outside and screams, “Did no one think to bring water to the fire?”
“I got this Cap’n” already footing the door open and peaking in I see what used to be a candle on what is still mostly a dresser, all standing beneath what might have been a curtain.
Not 30 seconds of quick bursts and the fire was out. Well before the line made it in.
When I hit the dresser the first time, I knew the wax would scatter, but I had no idea how neat it would look. It was similar to throwing water on a grease fire, only the wax cooled as it flew.
I tried to help overhaul but the man in the back yard needed my particular attentions at that time.
Turns out he ws fine, mentally sound, simply wanted to make sure we opened the door instead of breaking down the door. Not sure why, exactly, since the landlord now will have to explain why this guy was paying rent on a tiny little illegal bedroom in the back of a garage.
At the end of it all I didn’t have a single drop of candle wax or water on my gear. The folks cleaning up were covered in it as it was still dripping from everywhere I had spread it.
Before you all start commenting about “You weren’t on air?” and “No charged line?” We were on our knees to maintain clear visibility due to all the junk in this garage. On a similar note, dragging a charged attack line around a crowded area can prove dangerous. There should have been someone assigned to bring it in, and there may have been, but I never heard if there was.
I mention this incident here because it was hilarious to hear the Captain the next night tell the story of a man just wandering into a closet and disappearing, “And me and my medic say, let’s see where it goes! Sure as hell it goes to the fire!”
The following tale is told not because we are reminded to always leave the engine with a tool; Not because we were the only ones to bring water to the fire; Not because you need to be careful when extinguishing burning wax, but because of how determined the owner was to “let us in.”
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